On the Friday afternoon of July 7, a gunfight took place at the intersection of Queen and Carlaw in Leslieville. Tragically, 44-year-old Karolina Huebner-Makurat was fatally struck by a stray bullet while waiting at the bus stop on Queen Street. The community grieved; however, the conversation quickly moved to a vilification of the consumption and treatment service that is located in South Riverdale Community Health Centre driven in large part due to an article published by the conservative publication the Toronto Sun shortly after the tragedy.
The consumption and treatment service has been targeted due to a number of factors, but mainly due to the proximity of the health centre to the gunfight and a community grasping to place blame. Unfortunately, many in the community of Leslieville and beyond are leaning on harmful and discriminatory stereotypes of people who use drugs and people who are unhoused.
About the South Riverdale Community Health Centre
The South Riverdale Community Health Centre has been in operation since 1976, and moved to its current location at Queen and Carlaw in 1998. This health centre serves a wide population, with 150 staff and over 12000 clients. The majority of clients who access the centre are low-income, many with complex mental health challenges. Centre clients are from over 135 different countries.
In 2017, centre opened an overdose prevention site to meet the demand of people using opioids and other illicit substances who needed a safe place to manage their use amidst the ever-growing opioid crisis. Now under the consumption and treatment service model, KeepSix, the centre continues to serve this population by providing a safe place to use substances, preventing overdose deaths and other associated health risks of intravenusdrug use. KeepSix is one of 9 supervised consumption sites across Toronto.
Consumption and treatment services essential in opioid crisis
Consumption and treatment services and overdose prevention sites are vital healthcare resources for people who use substances and those struggling with substance use. They opened as a response to the rising deaths from a toxic street supply of opioids such as fentanyl.
According to the City of Toronto, June 2023 saw 455 non-fatal and 26 fatal calls to EMS for suspected opioid overdoses. In 2022, there were 2,521 confirmed and possible opioid-related deaths in Ontario. Across Canada and North America, the opioid crisis has become an epidemic, largely due to policy failures from both Conservative and Liberal governments’ refusal to address the root causes of substance use, poverty, and the opioid crisis.
Services like consumption and treatment services and overdose prevention sites are essential components to address the needs of those who use opioids but will not fix the problem alone. Safe supply programs need to be prioritized, which requires an increase in funding and a wider range of pharmaceutical-grade opioids for the prevention of associated diseases and ultimately death.
Not only are these services essential to the well-being of those who use substances, but they also provide a space for those who have been discriminated against in the medical system for their drug use. They provide a place to feel safe from judgment and to access primary care in places such as South Riverdale Community Health Centre. These are often the first point of care for many seeking medical attention.
The opioid crisis is not going to disappear without addressing its root causes. This means addressing how the medical system treats the unhoused and those who use illicit drugs. The criminalization of those using substances continues to incarcerate people who need access to healthcare and forces people to hide out of shame and fear of criminalization. This ultimately can lead to declining health and often death.
Closing consumption and treatment services, or even moving them out of “certain neighborhoods” (as some in Leslieville are calling for), not only makes it harder for people to access their basic healthcare needs, it can be a death sentence.
Town hall fails to talk about causes of gun violence
On Wednesday, July 26, a small group of Leslieville residents held a town hall at Jimmy Simpson Recreation Centre with a group of stakeholders for the community to ask questions about the gun violence and the consumption and treatment service at South Riverdale Community Health Centre.
The gymnasium was packed with hundreds of community members with polarizing views. The panel included Liberal MP for Toronto-Danforth Julie Dabrusin, Ontario’s deputy minister of health Dr. Catherine Zahn, local councilor Paula Fletcher, South Riverdale Community Health Centre CEO Jason Altenburg, and Superintendent Kim O’Toole of the Toronto Police.
The panel made it clear that the consumption and treatment service is a vital healthcare service that people in the community had a right to access, and closing such services would exacerbate the problem. Unfortunately, after clear statements that these health services and those who use the services were not to blame, many questions still focused on the service, rather than the gun violence itself.
Notably, many voices of those working on the front lines of the opioid crisis were missing. As a resident of Leslieville and a former consumption and treatment service worker, I couldn’t help but note that there was no front-line staff from the health centre or any harm reduction service workers on the panel. The panel as it stood wasn’t able to answer most of the questions asked by the community, mostly due to their lack of proximity to the problem and to the organization itself. Questions of “Who organized this [the townhall]?” in the crowd were also dismissed and ignored.
Let healthcare professionals do their job
The organizers of the town hall claimed to have surveyed the community about this issue. As a resident of Leslieville myself, I was not consulted. I only found out about the town hall through my work contacts. This continues to show me that only a tiny part of the Leslieville community was spoken to or considered, and judging by the turnout of the town hall, this mainly included middle-upper-class residents.
I am a trained social worker that has worked in multiple consumption and treatment and overdose prevention services for close to four years, including KeepSix. The staff of these services are made up of nurses, community health workers, and harm reduction/overdose response workers. These workers are dedicated and hardworking healthcare professionals that support an incredibly vulnerable population that has largely been neglected by our government. I have personally responded to and reversed well over a thousand overdoses both in the sites and out. As such, I can attest to the life-saving services that supervised consumption services and their highly-skilled staff provide.
Many of the questions during the town hall focused on the continued regulation of these services. Both increasing the number of inspections required and placing more restrictive rules were asked of the panel, who often couldn’t comment on existing policies.
Someone at the townhall asked, “How do we keep these sites accountable?” to which another community member muttered beside me, “Let healthcare professionals do their job.”
Consumption and treatment services are run by trained individuals who have the knowledge and experience to work with the population they serve. It is demeaning that these healthcare settings and their staff are viewed as less professional than other services and thus are required to be inspected more often and thoroughly. Other healthcare services are not held under as much scrutiny, and it is an extension of how the larger community views the people who use these services.
Understanding gun violence and violent crime
Notably, Angela Robertson, CEO of the Parkdale Queen West Community Health Centre, made a statement at the townhall about gun violence and its correlation with consumption and treatment services. She asked for evidence and city statistics that showed a direct link between the two. Throughout the meeting, many also echoed this same call. Superintendent. Kim O’Toole responded with the confirmation that there was no notable increase in violent crime in that area since KeepSix opened. According to Toronto Police data, there has actually been a significant decrease in gun violence in the city.
The community’s grief and concern about the death of Karolina Huebner-Makurat is warranted. At the same time, not all victims of gun violence are mourned equally.
There has been little uproar about the tragic death of a young Muslim man in the Regent Park area in July. Or a shooting in Moss Park last fall that left a young black man rushed to hospital. Where is the outrage for them? Or does violence only warrant outreage when the victim is a white woman who happened to be in proximity to those in the community who residents from a certain class background deem unsafe?
Some residents at the town hall shouted, “What about the children?” This, despite the police confirming that there was no correlation between violent crimes and the consumption and treatment services. Many other consumption and treatment and overdose prevention services are located in proximity to schools and daycares without incident. Clients of these services are not inherently violent, and this assumption is discriminatory.
To address violent crimes in Toronto we need to take a look at the social determinants of health. Many studies have shown the links to crime and poverty, signaling a need to address the issue of class inequality. Poverty and under/unemployment leads to mental health stress and a desperation for people trying to provide for themselves. There are also correlations between incarcerated individuals and homelessness and poverty, so incarceration does not solve violence but merely hides it from public view.
Toronto has residents living in tents in parks and on the street. With the rising cost of rent and stagnant wages, it is no wonder more and more people are becoming precariously housed. There is absolutely no available social housing in the city, while over 9000 people are left unhoused.
As long as people are neglected by the city and left to live in extreme poverty, Toronto will continue to experience violence. Addressing social determinants of health takes away the necessity of crime, which at its core is a problem of class-based society. As long as corporations continue to make money from the housing and food crises, people will suffer. Whether that is being the victim of direct physical violence or of capitalism, our communities will not improve.
Instead of scapegoating the most vulnerable in the city and the workers that support them, we need to work together to address these issues. The new mayor has made promises for social housing, now let’s focus our righteous anger towards fighting for these basic needs.
While the death of a bystander anywhere is certainly tragic and horrible, the response and criticism of the consumption and treatment services begs the question of whose lives we value more in our communities? The closure and even relocation of these services to a new community would lead to far more deaths related to opioid poisoning.
In the almost four years I have worked in harm reduction, I have personally known well over 50 people who have passed away from an overdose. That is truthfully an incomprehensible number. So I ask, where is the outrage for these people? These are preventable deaths, and just as tragic as a random act of gun violence.
Overdose awareness day is August 31. Read more about safe supply here.
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