EDITOR’S NOTE: This article originally appeared on The Trillium, a new Village Media website devoted to covering provincial politics at Queen’s Park.
The 10 supervised drug consumption sites being forced to shut down this spring prevented nearly 1,600 fatal opioid overdoses in one year, Ontario’s auditor general has found.
In her annual report tabled Tuesday, Auditor General Shelley Spence was highly critical of the province’s opioid strategy. She calculated the number of fatal overdoses prevented at each supervised consumption site (SCS) in the 2022-23 fiscal year.
The statistics call into question assurances from Health Minister Sylvia Jones that "people are not going to die" after the closure of the facilities.
The auditor general also found that the government has made no attempt to determine if anyone will die or not as a result of the site closures. Nor did the Progressive Conservatives talk to anyone who might be affected by the closures, such as the SCS operators, the people who use them, or the Northern Ontario communities who will be left without any access to an SCS despite having the worst opioid statistics in the province.
The PCs passed the legislation closing the facilities, Bill 223, on Monday, one day before Spence's report.
"The ministry did not develop a comprehensive plan to assess and quantify the impacts on public health and Ontario’s health system — for example, a potential increase in overdoses and emergency department visits — prior to finalizing the decision to introduce (Bill 223)," the report concludes.
The government also "has not developed plans to mitigate the risks" that the Ministry of Health's internal documents acknowledge are the likely result of closing the SCSs, including "an increased risk of deaths," financial and operational "burden" on emergency rooms, more public drug use and discarded needles, and leaving "Northern Ontarians with no access to supervised consumption services going forward."
Two SCSs closed in Timmins and Sudbury earlier this year after the province refused to approve their applications for provincial funding, despite Timmins seeing a 227 per cent increase in opioid-related deaths between 2018 and 2023, and Sudbury experiencing a 184 per cent increase.
Minister Jones denied responsibility for the closures since they were municipally funded when they had opened, but the AG report states that allowing them to close will still hurt residents in Northern Ontario.
Bill 223's passage will also force the closure of the SCS in Thunder Bay, a community which experienced 55 opioid-related deaths per 100,000 residents in 2023, the highest per capita rate in the province. The rate for all of Ontario is 37 deaths per 100,000, compared to the rate for all of Ontario at 17 per 100,000.
The death rate for Indigenous people in Ontario is 11.4 per 100,000, compared to 1.6 deaths per 100,000 for non-Indigenous people, the report states.
“The ministry’s actions to address the needs of these communities have been insufficient,” concluded the report, while noting that the province had not consulted with northern Ontario municipalities before shuttering their SCS, or anyone else outside the government.
Nor did it consult with Public Health Ontario, finding it only included internal stakeholders, including other ministries and Ontario Health.
The province has dismissed concerns about the closure of SCSs by arguing that they will be replaced with new Homelessness and Addiction Recovery Treatment (HART) hubs, which will focus on getting drug users into treatment while not providing supervised consumption services.
In her report, Spence finds that the decision to adopt the HART hub model was made "without proper planning."
"The Ministry’s investment of $378 million for the HART Hubs was decided upon without a needs-based assessment," the report points out.
The report recommends to the Ministry of Health that it "complete all necessary planning work before transitioning to the new HART Hubs," including impact, risk and financial analysis, to "engage with all relevant stakeholders, and come up with a framework for measuring the HART Hubs' performance — something the province also doesn't have.
The ministry said it agrees with the recommendations and will perform "outreach to public health units to update their harm reduction strategies. It also notes that HART hubs will be subjected to a "third-party evaluation to determine outcomes, lessons learned and areas for improvement."
"Results of the evaluation will inform future decisions on mental health and addictions services, including HART hubs in Ontario," the ministry said while promising to make sure the new hubs also "collect the necessary data to support the evaluation."
Data collection, however, has not been the government's strong suit when it comes to the opioid crisis.
The AG report also blasts the province for not "adequately" collecting the data or measuring performance when it comes to combating the opioid crisis. The report found that only 10 of the 24 performance indicators the province promised to track five years ago " were consistently tracked."
"Examples of these indicators include the number and rate of hospitalizations for opioid overdoses, the percentage of people who are prescribed opioids and subsequently develop an opioid addiction, the number and proportion of patients who are referred from Rapid Access Addiction Medicine Clinics to primary care, and the number of CTS site client visits," the report explains.
When asked why they were not all being tracked, the ministry explained that it had fallen along the wayside when the province introduced its health care system reform strategy, Roadmap to Wellness, in 2020, which included a new opioid strategy with new provincial standards for data collection.
"That foundational work is yet to be completed," the report notes.
The 2020 strategy also created the Mental Health and Addictions Centre of Excellence to oversee the implementation of the new strategy. However, the new agency admitted to the AG that "it does not have reliable, validated and standardized data on mental health and addictions services" and that this "limits (its) ability to perform meaningful analysis to identify service gaps."
