Two motions were recently passed in Hamilton City Hall that address the ongoing drug crisis and lack of safer-use spaces in the community
On Feb. 13, 2023, two motions regarding harm reduction were moved at Hamilton City Hall by Ward 13 councillor Alex Wilson and seconded by Ward 3 councillor Nrinder Nann.
The first motion called to allocate funding towards a substance abuse and addictions program and the second called for the development of an evidence-based harm reduction plan for safer use spaces in Hamilton. Both motions were passed with a unanimous vote.
Alongside the recent opioid crisis in 2020, Hamilton has seen a significant rise in opioid-related death this year, spiking conversation surrounding the potential of a drug poisoning crisis.
Kim Ritchie is a social worker with lived experience of opioid usage in Hamilton, and extensive knowledge and experience advocating for the implementation of harm reduction practices.
In an interview with the Silhouette, Ritchie explained that the climbing number of opioid-related deaths is alarming and abnormal, with Hamilton seeing 814 incidents related to opioid overdoses in 2022. For this reason, Ritchie explained that it is urgent that Hamilton address drug-poisoning and opioid related emergencies now.
“The body count is ever rising because half our clients out there and half the workers out there have complex grief and trauma for navigating direct medical crises that they're ill-prepared for or from constantly saving each other,” said Ritchie.
“The body count is ever rising because half our clients out there and half the workers out there have complex grief and trauma for navigating direct medical crises that they're ill-prepared for or from constantly saving each other,”
Kim Ritchie, social worker
In a separate interview with the Silhouette, Wilson explained that the harm reduction motions aim to respond to this significant rise in opioid cases and opioid related deaths in Hamilton. Wilson explained that current challenges within the city such as high rent costs and soaring food prices may contribute to high rates of opioid usage.
The plan to advance a whole-community harm reduction framework entails consulting experts in health and drug policy while also convening with individuals with lived or living experience with addiction and opioid usage.
“We need a new approach, and we need an approach that's based in evidence and based in saving lives, informed by those with lived and living experience,” said Wilson.
“We need a new approach, and we need an approach that's based in evidence and based in saving lives, informed by those with lived and living experience,”
Alex Wilson, Ward 13 councillor
Consulting individuals with lived and living experience is an important principle also shared by the Student Overdose Prevention and Education Network, a prevalent student organization works towards overdose prevention and harm reduction awareness.
SOPEN co-founder Olivia Mancini explained that the harm reduction and prevention work they do is rooted in listening to and uplifting individuals with lived experience with drug use to foster a stigma-free environment for learning safer-use practices and discussing the drug poisoning crisis.
Mancini, who has worked alongside Ritchie to enact harm reduction awareness and practices within Hamilton, explained that many of SOPEN’s initiatives aim to educate and de-stigmatize harm reduction and drug education among youth, such as community engagement initiatives at Hamilton’s Art Crawl. However, the mission to normalize and educate about harm reduction is not always widely accepted.
“Yeah, our focus is youth. We would like to have [harm reduction] education included in high school curriculum. It’s proven to be difficult to just do, much how sex education is controversial, it’s been hard to get into high schools,” said Mancini.
Alongside SOPEN, Wilson explained how organizations such as the YWCA are already demonstrating the feasibility of effective harm reduction plans. The YWCA has been operating a safer use space that has seen over 200 unique guests and have successfully reversed 34 drug poisonings.
Wilson explained that while community organizations are able to provide successful safer-use spaces, outside of these spaces individuals continue to overdose and lose their lives while faced with hospital delays and lack of available ambulances on the roads.
These motions are just the beginning of a longer process of acknowledging and acting upon prevalent drug-related emergencies in Hamilton. Mancini explained that with policy in place for safer-use spaces and broader-spanning harm reduction services, a tremendous weight will be taken off many frontline workers.
“If we have those funded services, it will also create cost savings to the community. It would relieve that pressure off of frontline workers, police, paramedics, the emergency department if people had access to harm reduction services,” said Mancini.
“If we have those funded services, it will also create cost savings to the community. It would relieve that pressure off of frontline workers, police, paramedics, the emergency department if people had access to harm reduction services,”
Olivia Mancini, SOPEN co-founder
Ritchie shared the same sentiment, explaining the complex grief and trauma that accompanies frontline workers, shelter workers and opioid users from navigating an influx of medical crises.
Ritchie explained that implementing harm reduction policy and work surrounding safer-use and de-stigmatization will ripple into other areas of intersectionality.
“I don't want to look one more worker in the eye and watch them sob because they just saved somebody's life, I don't want to talk to another client who just buried another friend in a poppers grave, I don't want to stand in one more meeting having to yell for the rights of people who use drugs who are somehow villainized as though it's their fault, instead of acknowledging intergenerational trauma, structural racism,” said Ritchie.
Following this motion, Hamilton residents should expect a follow-up report detailing an updated opioid response plan and recommendations to be presented at the next Board of Health meeting in June 2023.
Ritchie explained that this work is a step in the right direction, and she has hope for positive outcomes from effective and informed harm reduction.
“And that's why I love harm reduction, it demands that we hang up our capes and we sit down in humility with other people's pain, and we start asking what they need instead of pushing change. There's no gaslighting in it. There's no heroism. It's humility and empowerment and education and understanding, and I really do feel that this is a foundation for momentum moving forward,” said Ritchie.
More information on City of Hamilton harm reduction policy plans can be found in the recent Board of Health reports.
As the funding period for Hamilton’s only overdose prevention site draws nearer to a close, community organizations and stakeholders have come together to push for the continued existence of opioid support services.
In 2017, 87 people in Hamilton died as a result of opioid overdose. This represented a death rate 72 per cent higher than the average in Ontario. According to the Office of the Chief Coroner of Ontario, the number of opioid-related deaths in Hamilton has almost doubled over the past 10 years.
Additionally, sharing needles can make people more vulnerable to blood borne infections. In 2016, there were 230 newly diagnosed cases of Hepatitis C in Hamilton, 32 per cent higher than the provincial rate.
Supervised Injection Sites
One method of harm reduction that the city has pursued is supervised injection sites, which aim to minimize the risks associated with the injection of drugs.
An SIS is a place where people bring pre-obtained illegal drugs to be injected in a clean and supervised environment. SIS staff members are trained to respond to overdoses and can connect clients to other support services.
In December 2017, the city of Hamilton funded a study to assess the feasibility and need for an SIS in Hamilton. The study analyzed health and crime information as well as qualitative data from community stakeholders.
In a survey conducted as part of the feasibility study, 80 per cent of people who inject drugs stated that they would use an SIS if it were available.
The study found that an SIS would be likely to have community benefits, such as lowering needle litter and reducing stigma towards people who inject drugs.
Multiple case studies have found that the presence of an SIS has safety benefits for individuals who inject drugs and can lead to fewer opioid-related deaths and illnesses.
A 2011 retrospective study of a Vancouver SIS found that fatal overdoses in the surrounding area decreased by 35 per cent after it opened. To contrast, overdose-related deaths in parts of the city with no nearby SIS decreased by only 9.3 per cent.
Furthermore, the presence of clean needles reduces the risk of blood borne illnesses such as Hepatitis and Human Immunodeficiency Virus.
However, SIS are not without their risks, perceived or otherwise.
The 2017 Hamilton feasibility study found that perceived risks included police monitoring of SIS and the potential to be identified as patients at the SIS. There were also perceived community risks of increased crime, and that the perception of an SIS may create a negative image of Hamilton.
Overdose Prevention Sites in Hamilton
In June, the Shelter Health Network and partners opened a temporary overdose prevention site at Hamilton Urban Core Community Health Centre. Unlike SIS, which are permanent facilities that require federal approval, overdose prevention sites are temporary facilities approved by the province that address an immediate need.
OPS facilities can be set up in a matter of weeks. As a result, many cities use them as building blocks to eventually transition to a permanent SIS.
In June, there were 112 clients using the overdose prevention site at HUCCHC. By August, this number had risen to 332.
So far there have been a total of 11 overdoses, all of which have been treated on site.
Currently, the temporary overdose prevention site at HUCCHC is relying on $116,300 of provincial funding. However, this money will run out on Nov. 30.
Provincial Funding
The Ford government has put on hold the opening of any new OPS or SIS and withhold the extension of funding for current sites.
The Hon. Christine Elliott, Ontario Minister of Health and Long-Term Care, has stated that it is necessary to review the merits of OPS and SIS before opening new ones or extending the funding periods of current sites.
One of the Ford government’s main concerns is the issue of rehabilitation. According to Elliott, further study is needed to determine whether SIS and OPS help with rehabilitation.
“What is happening that is saving lives? What else can we do to save more lives? Are there other examples that we should be looking at besides supervised injection clinics,” Elliott asked during question period on Aug. 13.
The decision to withhold funding has sparked backlash. According to official Opposition leader Andrea Horwath of the New Democratic Party, the immediate needs of people who rely on SIS and OPS are of utmost importance.
“People can’t get treatment if they are dead,” she stated during question period on Aug. 13.
Other stakeholders have also expressed concern about the decision to put funding on hold. In an open letter to Elliott, the Registered Nurses’ Association noted that SIS and OPS have already been proven to save lives, and therefore should not be subject to a review period.
“Preventing deaths from overdoses must be treated with the same rigour and commitment as other avoidable deaths that are not stigmatized. We all share the responsibility and consequences of further marginalizing extremely vulnerable groups,” the letter states.
What Is Being Done in Hamilton?
Currently, Shelter Health Network is pushing to extend the funding period for the OPS.
Additionally, De dwa da dehs nye>s Aboriginal Health Centre and Wesley Urban Ministries have put in applications to Health Canada to house permanent supervised injection sites. However, the approval process for a permanent supervised injection site can be complex and can take years.
Hamilton city council has expressed support for the continued existence of SIS. On Sept. 17, the Hamilton board of health, a standing committee of the city of Hamilton, voted unanimously in favour of a motion to write to the provincial health minister in support of SIS.
Approximately 20 McMaster medical students lobbied city hall to bring the motion forward. According to second-year medical student Debbie Brace on behalf of the group, the data clearly demonstrates the benefits of SIS.
“People will die without these sites. It’s pretty clear cut,” Brace said.
Ward 3 city councillor Matthew Green echoed these sentiments, noting that without the maintenance of safe injection sites, people will be forced to inject unsafely in public spaces.
“If we know that this is happening, the question is: ‘do you want to have it to happen in a safe space or an unsafe space?” Green asked. “And do we want to save lives or not?’”
What Now?
While Hamilton city hall has expressed support for the sites, decision-making power rests on the provincial and federal governments.
Elliott has said that a decision will be made by the end of September.
Hamilton relies heavily upon opioid support services. The decisions that will be made in the weeks to come will have major impacts on the Hamilton community. Until these decisions are made, the safety and well-being of OPS clients across the province remains unclear.
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