The historic center of Cobourg, Ont., is brimming with small town charm. There are stately buildings, quaint shops and old-fashioned wrought-iron lampposts adorned with hanging baskets of flowers. The local business authority even coined the hashtag #8BlocksofAwesome.
But on Friday nights, just steps away from postcard Main Street, another side of life emerges. Volunteers set up camp chairs and folding tables in an alleyway and prepare supplies, including alcohol swabs, plastic tubes and naloxone kits for use in case of overdoses. All for a safe, unauthorized pop-up site for local drug users, geared specifically to people who snort rather than inject.
“There seems to be more and more need, more and more people dying,” said Ashley Smoak, one of the organizers. “There are a lot of people who are struggling and there is no one to help them.”
Coburg, home to 20,000 people on the shore of Lake Ontario east of Toronto, has had dozens of fatal overdoses over the past 18 months. The nearest official safe consumption site is in Peterborough, approximately 60 kilometers away. And like all government-funded harm reduction facilities in Ontario — and most of the country — it does not allow smoking drugs, only injecting, oral and nasal use.
The cost of not having supervised spaces for those who sniff the drug can be seen in Canada’s near-record overdose numbers, Smoak said.
“The consequences were death. Many people lost their lives. There is so much loss and grief,” they said.
in 2022, More than 7,300 Canadians have died from an apparent opioid overdose87 percent of those deaths occurred in British Columbia, Alberta and Ontario.
Overdose prevention has become a pillar of government efforts to combat the opioid epidemic, with a growing national network of safe consumption sites approved by the federal government and funded by provinces and territories.
However, even as this system expands, it fails to meet the needs of drug users because it largely excludes inhalation—the most common method of consumption, advocates and experts say.
“What the country really lacks are indoor inhalation sites,” said Patrick McDougal, a Vancouver-based harm reduction specialist who helps community groups across the country set up consumption sites.
“There aren’t some safe and secure places for people to use it right now, unlike what we have with injectables.”
In British Columbia, there have been 3.87 million visits to safe sites since 2017, according to the Department of Mental Health and Addiction, with 25,000 overdoses and just one death. That compares to 2,342 fatal overdoses in homes and streets in 2022.
studies suggest Adding breathing spaces would save additional lives.
Only British Columbia and Ontario keep statistics on the consumption pattern associated with drug deaths, but the trend towards smoking is clear and long-standing.
In British Columbia, inhaling overtook injection in 2017, causing 56 percent of drug deaths in 2021. Ontario’s numbers were reversed five years earlier, with smoking accounting for 68 percent of deaths by late 2022.
But there are still only five approved indoor inhalation sites across the country, As opposed to nearly 50 focused on injections .
The reasons why it looks mostly bureaucratic.
“In my opinion, it’s routine,” McDougal said. “And I think the result is what we’re seeing now: six deaths a day in British Columbia, 20 deaths a day in Canada … many times what you would get from auto accidents and suicides and other forms of death combined.”
Health Canada will exempt inhalation sites from federal drug laws, and require the same safeguards for injections or other uses, a process that usually takes only a few weeks with community support. But things seem to get stuck at the provincial level.
$10,000 to build, 18 months to approve
Ontario has only one permitted smoking location, a small room that caters exclusively to clients of Casey House, a specialist HIV hospital in Toronto. It was easy to build, said Joan Simmons, the hospital’s CEO.
“What we needed to pin down was just a really big fan that could blow smoke as fast as we could,” she said. Construction cost about $10,000 and was covered by the hospital’s benefactors, as well as the ongoing operating costs of the room.
However, even without taxpayer money on the line, the approval process took 18 months.
“The piece that initially seemed like the barrier was about Ontario’s smoke-free law because you obviously can’t smoke inside a public facility, especially a hospital,” Simmons said. “And it took some time to understand from the government’s perspective whether they were going to allow us to get people to take illegal drugs in that area.”
Now that such questions have been answered, Simons is hopeful that future approvals will be faster.
But other significant bureaucratic hurdles remain, especially for secure sites that receive provincial funding.
Kerry Kightley is the director of consumption processing services for a facility in Peterborough, Ontley, a city of 135,000 people that saw 59 overdose deaths in 2022 and more than 38 deaths. The first six months of this year. Its secure site caters to up to 70 users per day, a number that it estimates would at least triple if smoking was allowed.
“There’s been a radical shift away from injection use and toward inhalation use, and the county government just didn’t realize it,” Kightley said.
Under the current funding agreement with the province, Ontario Safe Sites must use their government funds to subsidize injections and oral and nasal drug use and nothing else. Even using the same supplies, space, or staff to facilitate smoking may be a breach.
“The requirements prevent us from using county funds for anything other than what is approved,” Kightley said. “It’s a bit complicated.”
CBC News made repeated requests for an interview with Ontario Health Minister Sylvia Jones, but has not received a response from her office or the ministry.
We also asked the Alberta government about its plans for supervised sniffing sites. The county’s only smoking area, part of a facility in Lethbridge, closed in 2020, thereafter County review Find evidence of financial mismanagement.
Dan Williams, Alberta’s Minister of Mental Health and Addiction, provided a statement saying his focus is on treatment and holding offenders accountable.
“Our vision for Alberta is for families to have the opportunity to live in healthy communities free from illegal drug use and trafficking. Our vision is for those struggling with addiction to have immediate access to treatment,” he wrote, noting plans for 11 new “recovery communities.”
British Columbia, which began a three-year trial last winter decriminalizing possession of small amounts of opioids, cocaine and methamphetamine, has expanded rapid access to safe smoking, with one indoor facility and 16 hybrid indoor-outdoor tented sites and other shelters now in operation.
In April, sniffing sites had more than 35,000 visits, according to the latest update from the Department of Mental Health and Addiction.
But it is not clear how such hybrid sites could prove practicable in parts of the country with harsher winters or whether the political climate is conducive to such innovations, with Conservative leader Pierre Poiliver and his Federalist party about attacking harm-reduction strategies such as safer drug supplies.
Users report that smoking is safer
All of this worries experts like Tara Gomez, a Toronto epidemiologist and principal investigator for the Ontario Drug Policy Research Network.
Gomez and colleagues The switch to inhalation was traced A trend fueled by multiple factors: epidemic isolation, wear and tear in veins from injections of powerful opioids such as fentanyl and public health advice that reduces smoking reduces the risk of an increasingly toxic supply.
It compares the government’s response to the COVID-19 pandemic to the opioid crisis.
“A constant concern for many of us who work in this field is just being able to mobilize money to be able to make changes to legislation if needed to respond to this emergency. We’ve seen how quickly this pandemic can happen,” Gomez said.
“Unfortunately, because of the stigma around drug use, this often doesn’t have the same level of urgency even though we lose thousands of people across our country and thousands of people in Ontario every year from this.”
Back in Coburg, reaction to the pop-up sniffing site was mixed.
When volunteers set up a tent to provide users with privacy, the city council responded by sending out law enforcement officers and threatening fines of up to $50,000 for zoning violations.
However, Coburg Police have made it clear that they support sanctionable harm reduction approaches and will not arrest individuals solely for illegal drug possession. So far, the table and chair fixtures have been left alone.
John, a Friday night smoker not fully identified by CBC News, said he hoped to find a compromise.
“People here need something,” he said. “They need a safe place to go.” Suggest, perhaps just a trailer down the beach, a place for the users to hunt for one another.
“Being here with the kids on the street and the police and everything is just too much,” he said. “These people are not safe here. They don’t have the help they need.”
Jonathon Gatehouse can be contacted via email at firstname.lastname@example.org or reached via CBC’s digitally encrypted Securedrop system at https://www.cbc.ca/securedrop/