To Ontario’s credit, the government is facing this serious public health challenge head on. The need for safer inhalation methods among drug users continues to grow. The province took a historic step last fall by switching from injection to inhalation. It presently only provides one supervised inhalation space at Casey House in Toronto. The opioid crisis is worsening at an alarming rate. Health professionals and advocates have been sounding the alarm for months, calling on authorities to dedicate additional resources to address this pressing disaster.
Ahmed Bayoumi, senior researcher at the MAP Centre for Urban Health Solutions of St. Michael’s Hospital He’s been doing the deep research into the health impacts of this big change. In addition, his findings support the conclusion that inhalation is increasing. Only 20 percent of people arriving at Casey House still inject drugs – the other 80 percent inhale. This trend creates new challenges for public health, particularly with the overall total of opioid-related deaths still climbing.
By 2024, researchers estimate that over 40 percent of fatal opioid overdoses in Ontario will be attributed to inhalation only. This is a huge increase from only 18 percent in 2018. In 2024, the percentage of deaths attributable to injection is expected to decrease to only four percent. This is a drastic drop from 20 percent just six years prior. With over 2,200 deaths already in 2024, Ontario is facing the worst of the ongoing opioid crisis. While this is a small decrease from past years, it highlights the ongoing crisis of this alarming public health crisis.
The Cost of Innovation
Joanne Simons, CEO of Casey House, recognized an increasing need for supervised inhalation spaces. She led the creation of Ontario’s first and only inhalation booth in 2021. She brought on a team of engineers to figure out how to create a safe, welcoming space for people to use drugs under medical supervision.
Funding is still the biggest challenge to scaling up these services. As Simons added, “I think the barrier to entry actually is the funds. The provincial government’s previous funding plan did not include provisions for inhalation booths despite increasing calls for such services dating back to Kathleen Wynne’s premiership in the mid-2010s.
When talking to stakeholders, Simons found signs of optimism about the growing interest in and expansion of supervised inhalation services. He continued, “We’re already planning our second one, just because the need is so extensive. This collective statement from NPSP partners highlights the urgency that health advocates across the country are experiencing towards expanding additional safe consumption options.
The Evidence of Need
Infusing opioids, as per Dr. Bayoumi’s research, provides users greater control over their drug use. By comparison, injecting opioids does not provide the same degree of self-regulation. He illustratively challenged the audience to come to Seattle and ride transit there with some provocative evidence. Heroin smoking allows drugs to build up in the blood relatively slowly compared to injecting, providing people a much finer degree of control over how much they take. This finding speaks to the growing need to tailor public health efforts to address changing patterns of drug use.
As long-time harm reduction advocate Gillian Kolla noted, the deliberately concealed move was catastrophic for Ontario. The province is lagging in providing appropriate support for people who want to smoke drugs instead of inject them. We already know how to help people who smoke their drugs. We’ve gotten very far behind on delivering those solutions,” she continued. Deaths from opioid toxicity via inhalation almost doubled from 2017-2021. Kolla’s worries resonate with the emerging chorus of public health experts who have called for more comprehensive and systemic solutions to this crisis.
Her story, along with that of Zoë Dodd, co-organizer of the Toronto Overdose Prevention Society, and her experiences with supervised inhalation came through loud and clear. We tracked thousands of visits through that service. And we saved so, so many overdoses within that tent as well,” she reflected, emphasizing the lifesaving power of harm reduction strategies.
Calls for Action
Even with increased awareness and advocacy efforts, many feel that Ontario’s response to the opioid crisis is still lacking. In 2019, the provincial consumption and treatment services expansion plan authorized 15 supervised consumption sites. It failed to provide any funding for inhalation booths. This major blind spot has been heavily criticized by public health experts. They say that it does not begin to recognize the changing realities of drug consumption.
Advocates are currently pushing the administration to include funding for safe inhalation spaces. As such, they feel this is a critically important step towards a comprehensive harm reduction strategy. Ema Popovic, a spokesperson for public health campaigns, reiterated the message of getting people who suffer from addiction to treatment and recovery. As she explained, “We don’t have a toolbox that includes using toxic, illegal drugs.”
That’s why health officials need to move quickly. There is even more mounting evidence highlighting the risks of inhalation usage, and we need safer consumption methods NOW more than ever.
