The urgent need to implement new measures to reduce overdose deaths among its patients — and all people experiencing homelessness — prompted Inner City Health Associates (ICHA) to add its voice to deliberations by Toronto’s Board of Public Health this week.

Responding to the 2021 Report Update, ICHA urged the City to exercise its municipal discretion and to advocate for provincial and federal changes to:

• Decriminalize drug possession for personal use and make people who use drugs key stakeholders in all changes;
• Provide widely accessible harm reduction supports and mandatory OD response training for staff in shelters, respites and physical distancing hotels;
• Bring in rigorous accountability measures for OD preparedness across city-funded shelters, respites, and physical distancing sites;
• Provide equitable harm reduction support and OD prevention interventions for people in shelters, encampments, respites and physical distancing hotels; and
• Produce a comprehensive assessment by Toronto Public Health on the impacts of forced encampment clearing on fatal and non-fatal overdose risk and vulnerability and a public-health-based formal opinion on the forced displacement of people from encampments.

ICHA Medical Director Dr. Andrew Bond says ICHA’s patients have been doubly devastated by two crises: the COVID-19 pandemic and the opioid overdose crisis.

Over the last year, a toxic supply of many drugs produced unprecedented rates of fatal and non-fatal overdoses. In 2020, fatal overdose rates in Ontario increased over 60%, the loss of 2,500 lives causing pain and sorrow for families and communities across the province. For people experiencing homelessness – ICHA’s patients — rates were more than double that. A significant portion of the 133% increase in OD deaths occurred in shelters, respites and physical distancing hotels. 

Those avoidable losses stem from two underlying sources: incoherent and conflicting policy approaches to drug use and badly underfunded mental health care and promotion and underdeveloped models of treatment.

First, two distinct counter-indicated policies prompt vastly different practices and approaches. One views drug use as a health issue best addressed by public health and clinical intervention while the other considers it a matter of criminal activity to be policed and punished. The latter approach has been highly unsuccessful and the former underused and underfunded.

Second, mental healthcare continues to garner second-tier attention and assistance in society and within Ontario’s healthcare system.  Dr. Bond says substance use programs remain profoundly and inadequately funded, lacking the range, diversity and sophistication of models to meet the well-established needs of people with substance use disorders.

The answer lies not in addressing drug use through the ineffective anachronism of criminal justice or in starving mental health policy and practice of what it needs to do its job. Supporting a comprehensive, evidence-based public health approach is the most effective and cost efficient way to treat individuals with substance use disorders and the only way to help vulnerable individuals heal with dignity while improving population health. 

“While we deliberate on the remedies, people continue to die, and die unnecessarily,” . says Dr. Bond. “ICHA’s recommendations are evidence-based, widely supported by health professionals and their professional bodies and essential to maintaining accountable health governance for people who use drugs.”   He adds that the Medical Officer of Health has long advocated for a public health approach to substance use. The Toronto Overdose Action Plan and the Board of Health echo that, noting that meaningful and sustained progress on the opioid crisis demands it.