KFL&A Board of Health addresses new provincial strategy for opioid crisis

The Kingston, Frontenac, Lennox and Addington (KFL&A) Board of Health recently made it clear that, while it appreciates the Ontario government's vow to support the treatment and recovery of people with complex service needs, much more needs to be done and that includes more funding.

At its recent meeting on Wednesday, Sept. 25, 2024, the board heard a presentation from Daphne Mayer, manager of the KFL&A Public Health's Substance Use Health and Mental Well-Being Team, addressing the Local Harm Reduction Program and the efforts of the Community Drug Strategy Advisory Committee toward decriminalization of illegal drugs.

Essentially, Mayer’s report notes that in the midst of a drug poisoning crisis (which has been officially acknowledged by Kingston City Council), the provincial government plans to introduce legislation in the fall of 2024 that would "prevent communities from responding to local needs" with “evidence-based” harm reduction interventions, such as safe consumption. Meanwhile, the government has also announced a $378 million investment in 19 Homelessness and Addiction Recovery Treatment Hubs (or "HART Hubs") to support the treatment and recovery of people with complex service needs. Therefore, the Community Drug Strategy Advisory Committee will need to change its current approach and is looking to the board for direction.

Mayer called the $378 million investment in the HART Hubs demonstration project “a welcome announcement” in the government's plan.

“Through these HART Hubs, the province is introducing an integrated system of locally tailored health and human services that will support the treatment and recovery of people with complex service needs,” she noted. “Also… the government will add up to 375 highly supportive housing units, in addition to addiction recovery and treatment beds… helping people transition to more stable long-term housing.”

However, she was less enthusiastic about changes to Ontario's consumption and treatment services (CTS, commonly referred to as safe or supervised consumption, or safe injection/needle exchange services) --- changes that mean the committee will need to refocus its mission on decriminalization. She explained that under the new plan, “Nine CTSs and one self-funded consumption site will close by March 31, 2025.” The remaining publicly funded CTSs, including the one located at the Integrated Care Hub (ICH) in Kingston, will have to enforce new measures that prevent municipalities or organizations from participating in federal safer supply initiatives and requesting a federal exemption to decriminalize illegal drugs, Mayer explained.

“So with this last point,” she said, “you might be wondering about how the proposed legislation will impact the direction of the decriminalization work of the KFL&A Community Drug Strategy.”

In May 2024, she recalled, the provincial government made a very clear stand on the issue when Premier Doug Ford called drug decriminalization an “absolute nightmare” that would “never” happen under Ontario’s Progressive Conservative government: “They were firmly against it and [against] safer supply, and their focus was going to be on treatment."

“So, rather than focusing on decriminalization, the Community Drug Strategy Advisory Committee will broaden the scope of discussion to alternatives to criminalization, allowing for the group to be poised to respond to policy windows that may or may not include decriminalization,” Mayer said. She noted the committee would “focus on and assess the impact of the drug poisoning crisis on program and service delivery in KFL&A.” 

Mayer then invited the board to consider and discuss the impacts of these measures. Harm reduction programs and services are evidence-based interventions that have demonstrated a reduction in deaths, unsafe drug use behaviours, infectious diseases, public disorder, and emergency service impacts and emergency department visits, she stated. On the other hand, they create an increased connection with help and access to other services for people who use drugs. 

Mayer acknowledged that “drug policy reform can be a very polarizing topic of conversation. When people talk about the harms of a policy option like decriminalization, we also need to remember that there are harms associated with the current prohibition policies.”

She further noted that there are health, social, and economic harms associated with the criminalization of drugs: things like high levels of incarceration and associated costs, heightened spikes of infectious diseases, high morbidity and mortality from the unregulated and very toxic supply, and the violence inherent in the drug market. She pointed out that people with criminal records experience limited housing and employment opportunities and decreased access to health, harm reduction, and social services “because of stigma and discrimination.”

Board member David Pattenden admitted he was embarrassed that he didn't fully understand the concept of harm reduction and asked the team to explain it more succinctly. “How do you reduce harm?”

The question was welcomed, and Mayer explained that the philosophical approach to harm reduction focuses on meeting people where they are, addressing stigma, and addressing the social determinants of their health. 

Medical Officer of Health for KFL&A Public Health Dr. Piotr Oglaza gave some specific examples. The spread of blood-borne infections like HIV, he said, is reduced by providing safe injection supplies. Recognizing that people who suffer from addictions will continue to use drugs even if they do not have a clean needle or other supplies, providing a clean supply reduces the likelihood that infectious diseases will spread in the community.

Similarly, providing naloxone will not stop someone from using drugs, but it does prevent death in the case of drug poisoning. The hope is that the person lives another day and, with continued support, will overcome their addiction.

Board member and Kingston City Councillor Brandon Tozzo commented that he was at the Association of Municipalities of Ontario (AMO) meeting when the provincial government made its announcement, and "It went over like a lead balloon.”

“I don't think I have ever seen a government [whose] politics are so different from where the evidence is," Tozzo went on. "I've talked to walls that were more receptive to evidence than this government.” 

So, Tozzo said, while he might support the evidence-based approach of Public Health, there is a need to be “cognizant of the political reality.” He gave the example of how Public Health lobbied the government not to put alcohol in corner stores, “and a week later, they put it in corner stores.” 

"The political winds are blowing in one direction, and we're blowing in another. So I would keep that in mind as we go ahead and maybe put our resources lobbying toward something where they're more receptive,” Tozzo concluded.

Board member and Frontenac Islands Mayor Judy Greenwood-Spears pointed out that she, too, was at the AMO meeting and was encouraged to learn money would be going toward residential treatment beds, because “until you invest in the residential treatment beds, which we have virtually none [of] in this entire three board area except for one private one that [costs $26,000 a month], then we're treating cancer with a band-aid. And that's reality. So going after them from the Canada Health Act aspect of [universal] access to care might be an avenue in the near future for a lot of people that need intensive care and not just harm reduction.”

Kingston City Councillor Conny Glenn also pointed out that, while she agreed with Mayer’s recommendations, “I think the conversation has to change a little bit." She described the 375 care beds as "too few even for our own community, and they are meant to be across the province.”

Glenn urged for more public education on what harm reduction is, saying, “It seems to me there's a good analogy to be made --- like with any skill acquisition, whether it's sport or whatever, it takes more than one try to be able to accomplish something. It doesn't just happen overnight.”

She also cited the recent information session on the Queen Mary Road Project as an example of good public education about a controversial topic. She thought the project should serve as a model for any similar projects moving forward.

Kingston City Councillor Jeff McLaren said he was also at the AMO meeting when the announcement was made, "and I don't think it 'went over like a lead balloon.' I think it was a very polarized response… This is a polarizing issue, and this government is not stupid. They are a populist government. I think they understand where most homeowner voters are, which is very much against how we are going. Which is good for them politically.” 

“On the philosophical side,” McLaren the spoke to "the philosophical side," saying that the harm reduction data can be interpreted differently depending on one's values. One might interpret harm reduction through a lens that says, "human dignity suggests that the individual is the best person to decide on their course of action and treatment," he said.

However, McLaren countered to that, “there is another tradition that suggests that some people who are not in their right mind do not have that privilege. For example, in our society, we do not let little children decide on their health needs; the parents do. For those who have become [incapacitated] with dementia, we have ways of taking [medical decisions] away from them, through powers of attorney and things like that.” 

“It is not too hard to see that from a harm reduction perspective, if somebody has a severe mental health issue or a severe addiction problem, they are not in their right mind and need somebody else to make that decision for the sake of harm reduction," he continued. "In such cases, that data will point to forced rehabilitation, [which] is I think where this particular government is going… and that's something that we should be aware of. Because I think this government is going to stick around throughout the next election.”

Board Chair Wes Garrod summarized these very different viewpoints, saying, “Whatever way it goes, to do it well, it requires money. There have to be support services." He emphasized that doing one thing in isolation will not work: "I think it's the overall approach we must take. "

In the end, after much discussion, the board passed a motion to commend the government of Ontario for its investment in the HART Hubs demonstration project “that will support access to treatment and meet people where they are at in their recovery journey.”

However, the board also strongly urged the government to “reconsider legislation that would prevent communities from implementing evidence-based harm reduction interventions, as part of a comprehensive and community-driven approach to addressing the drug poisoning crisis.” Board members also reiterated the “urgent need to adopt a comprehensive strategy designed to reduce opioid-related harms as outlined by the Chief Medical Officer of Health for Ontario in his 2023 Annual Report.” 

The correspondence from the KFL&A Board of Health will be sent to Sylvia Jones, Deputy Premier and Minister of Health, and copied to Dr. Kieran Moore, Chief Medical Officer of Health; Michael Tibollo, Associate Minister of Mental Health and Addictions; Ric Bresee, MPP for Hastings-Lennox and Addington; Ted Hsu, MPP for Kingston and the Islands; John Jordan, MPP for Lanark-Frontenac-Kingston; Loretta Ryan, Executive Director of Association of Local Public Health Agencies; and all boards of health in Ontario.

For more information on the KFL&A Board of Health, visit the board's page on the KFL&A Public Health website.

Those experiencing substance abuse and addictions issues can find more information and direction to resources on the KFL&A Public Health Substance Use Health page. Those seeking support in dealing with addictions issues --- for themselves or others --- can find further information and connect with Addictions and Mental Health Services of Kingston, Frontenac, Lennox and Addington (AMHS-KFLA) through the AMHS-KFLA website, which also includes a toll-free phone number for their 24-hour crisis line.