“It’s life or death”: Harm reduction workers on Doug Ford’s decision to close safe consumption sites

In August, Doug Ford’s government announced its plan to close supervised consumption sites located within 200 metres of schools and daycares. The decision will shut down 10 of the 17 supervised consumption sites across Ontario. Site operators, mostly community health centres, must comply by March of 2025.

Health advocates have criticized the move, warning that the closures will lead to an increase in preventable overdose deaths. Meanwhile, some concerned neighbours and politicians have praised the decision, claiming that the sites have made their neighbourhoods unsafe. Last year, tensions reached a fever pitch following the tragic death of Karolina Huebner-Makurat, a 44-year-old mother of two who was killed by a stray bullet near the South Riverdale Community Health Centre’s supervised consumption site.

Here, Tina Estwick, supervisor of Kensington Market Overdose Prevention Services (KMOPS)—one of five Toronto sites affected by the announcement—and Bill Sinclair, CEO of The Neighbourhood Group Community Services (TNG), the charity that operates KMOPS, explain the potential fallout.

What drew you to this line of work?

Bill Sinclair: I grew up in Parkdale, where my mother ran the local Meals on Wheels. From a very young age, I helped out with deliveries, and I saw first-hand the positive effect it had on my community. That motivated me to pursue a career in social work, and I’ve now been in the field for 35 years.

Tina Estwick: I also had the strong urge to help those in need, and after getting a social service worker diploma from George Brown, I joined TNG in 2015. I started off supporting people with alcohol dependency, and then I became a case manager for TNG’s mobile community action team that assists people with complex substance use issues. Since 2022, I’ve been the supervisor of KMOPS.

Doug Ford has said that supervised consumption sites are “the worst thing that could ever happen to a community,” calling them “a haven for drug dealers.” KMOPS has been operating since 2018. What has your actual experience of a supervised consumption site been?

Estwick: That is a false characterization of what we do here. We’re not a drug den. People cannot buy drugs from us, nor are they given free drugs. Our service reverses overdoses and saves lives by creating a judgment-free space for people to use safely in a sterile environment. We also provide safer drug use education, naloxone training and referrals to detox treatment centres, if clients request them. We even offer a skills-training peer program, which many former KMOPS clients have taken, eventually becoming employees who help us in our work. One of our former clients has helped save more than 200 lives.

Sinclair: We house KMOPS in our community centre right in the middle of Kensington Market, and most people in the neighbourhood don’t even know we’re running a supervised consumption site here. We have what we call a “chill zone” in place, where we ask about people’s needs and monitor them to make sure they’re not at risk of overdosing. Afterward, they’re welcome to get something to eat and drink in our community centre or access our other services. We have doctors, nurses and counsellors available to all community members, and we even provide a drop-in for unhoused people as well as supportive housing for people in need. For the past 24 years, the community centre has been a friendly and vibrant place that supports people of all ages, genders and backgrounds, and the consumption site’s presence within our centre hasn’t changed that.

City councillor Dianne Saxe, who represents Kensington Market within her ward of University-Rosedale, has said that she’s received many complaints about open drug use near KMOPS as well as condoms and drug paraphernalia being left in a nearby schoolyard. Ontario health minister Sylvia Jones has referenced “numerous stories of altercations, stabbings and even a homicide” near several supervised consumption sites. How would you respond to those claims?

Estwick: The death of Karolina Huebner-Makurat was incredibly tragic, but I don’t agree with people who say supervised consumption sites are at fault for these very real problems. Taking away those sites is not going to prevent crime in any neighbourhood. If we don’t provide people with a safe space to use drugs, they’re going to use in other public spaces in the community. There are going to be more needles in parks and playgrounds. Every morning from Sunday to Friday, my team does a community clean-up, sweeping our neighbourhood—we cover Kensington Market south of Oxford Street and east of Bellevue Avenue as well as nearby parks and schools—and picking up any paraphernalia we see on the ground. Often, our clients will help us with the clean-up.

Sinclair: Torontonians are distressed and upset when they see homelessness, hunger, the lack of sufficient mental health supports and the resulting effects of those issues. But I think they’re wrongly placing blame on supervised consumption sites like ours. There’s a lot of violence and crime happening in the city, but our experience has been that community health centres and supervised consumption sites are actually positive influences on the safety of a community. There’s even data that shows that crime rates usually go down in neighbourhoods with supervised consumption sites.

We have to remember that there are several crises happening in Toronto right now. There is a homelessness crisis, where our shelter beds are full and people are forced to sleep in tents in parks. We also have a hunger crisis. There’s a food bank just up the street from our community centre. Every day they’re open, the lineup stretches down the block. And then there’s the affordability crisis. Many working families are struggling to cover rent and pay their bills. But none of these crises are caused by supervised consumption sites.

Some people are opposed to having shelters or supervised consumption sites in their neighbourhoods, but they also don’t want encampments or open drug use. Shelters and supervised consumption sites are solutions, not problems. I don’t think closing KMOPS and other sites is going to make anyone safer. To make an analogy: if there were long waits for treatment at a local hospital, and neighbours were complaining about sick people spilling out onto the sidewalk, would it make sense to close that hospital?

When someone using the centre’s services is distressed or poses a potential safety risk to other clients, staff or neighbours, how do you address those incidents?

Sinclair: We have specialized staff inside and out during our operating hours to protect our clients. But we don’t call them security. We call them door persons, because their role is to welcome people in and provide them with assistance as they leave. They’re our eyes and ears in the community, frequently liaising with our neighbours, who keep us informed about people in distress and other issues. If they notice that someone needs assistance down the street, they’ll go there and help out.

Estwick: Our close ties with our neighbours actually help us prevent incidents from occurring because they bring to our attention people who need our support before things get worse for them. As part of these mitigation efforts, I run an outreach team that goes out six days a week to nearby encampments to hand out harm reduction supplies, hygiene kits, sandwiches and water. It’s all focused on building relationships with community members, so they know they can come to us. They’ll come in and do their laundry, have a shower or seek treatment for injuries. Often, they’ll also ask for a referral to a detox treatment centre. Through word of mouth, we’ve even had visitors from encampments elsewhere in the city.

Were you surprised when you found out that the government would be closing sites near schools and daycares and preventing new ones from opening?

Sinclair: We’d always known there was some community opposition across the city to programs like ours, but we also knew that the province had commissioned two reviews of the supervised consumption site at South Riverdale. Word on the street was that the reviews had concluded that sites like ours and South Riverdale were doing a lot of good and that the province needed to boost its support. Because of this, we were expecting an announcement along those lines, so we were completely shocked when we heard instead that the province was going to shutter a bunch of centres instead—especially when, the same day it announced that it was forcing us to close, the province released the reviews’ conclusions, which did indeed support our work.

Estwick: My entire staff and I were stunned. Because of critical news headlines—particularly after Huebner-Makurat’s tragic death—we thought that something like this might happen one day, but we weren’t expecting it to happen quite this quickly. At the same time, we’re feeling hopeful because our understanding is that laws may have to be changed and voted on in the legislature before anything is formally put into place. Until that happens, we’re just going to keep doing the work we do every day to save people’s lives.

Are you going to fight the closure?

Sinclair: Right now, we’re just waiting to see what happens. But, if this ends up going to the legislature, we plan to send a deputation to explain why we should be allowed to continue and to share data that proves our work saves lives. Our best hope is that the government will reconsider and listen to the many people who are saying that this isn’t a solution and that there are other measures we should be taking: more affordable housing, more addiction recovery treatment centres and more family doctors. Another long-term solution could be safer supply services, where doctors and nurse practitioners prescribe medications as safer alternatives to black market drugs for people who are at very high risk of overdosing.

If the sites shutter, what will happen to the people who rely on them?

Estwick: We have 729 registered clients who rely on this service. If this spot is taken away from them, it will hurt the community immeasurably. If we close, where will our clients go to use? How high will the overdose numbers spike? How many lives are going to be lost? When our clients are in our chill zone, I ask them to share their thoughts on our service, and many tell us that our programming saved their life, that they found a family and a place they could call home with us. Over the past eight years, we’ve saved thousands of lives. It’s a matter of life and death.

After the predicted closures, Toronto will still have five functioning sites. Can clients of the closed sites go to the ones that remain?

Sinclair: Since the two closest sites to us will also be closing, people would have to trek quite a distance to get to the nearest ones that will remain open, on Dufferin or Parliament. If people don’t have the ability to travel there, they may just use drugs in an unsafe way or in an unsafe place, because those are the only choices that they have.

How would you feel about an alternative plan that prioritized relocating sites?

Sinclair: We didn’t pick this spot in Kensington Market at random. This is exactly where Toronto Paramedic Services said there was a consistent cluster of 911 calls related to overdoses. There’s no part of this neighbourhood that isn’t within 200 metres of a school or a daycare, so it’s a concern that we won’t be able to provide this service where the data is telling us that people need it. The same applies to other sites located in densely populated neighbourhoods that will likely have schools or daycares nearby. That’s why relocation can’t be the only solution we put on the table.

Queen’s Park says it will spend $378 million on 19 new Homelessness and Addiction Recovery Treatment (HART) hubs, with 375 supportive housing units as well as addiction recovery and treatment beds. Although these hubs will not offer supervised drug consumption, will they help fix the problem?

Sinclair: I think it’s a great down payment, but the government can easily spend three or four times as much and have three or four times as many sites as that, because we’re talking about the needs of the whole province. We need much more affordable housing built, and we need way more treatment beds. When someone comes to a place like KMOPS ready to receive detox treatment, they should get a treatment bed that day instead of having to wait upward of a year, as some do currently. It’s just not acceptable. So this is all good investment from the government, but there’s no need to close supervised consumption sites while we build more supportive housing and treatment centres and hire more doctors and nurses. It’s not an either/or situation. We need to do all these things. What would you like to tell Doug Ford and other opponents of supervised consumption sites?

Estwick: Come visit our site and see exactly how we support clients—and perhaps talk to some of them. I also think a lot of people don’t realize that KMOPS and other sites like it are typically a small part of bigger community organizations. We’re the starting point for people to access all sorts of resources: food, laundry, showers, counselling, housing, training in harm reduction and more.

Sinclair: Because we help clients who are using drugs, people sometimes assume that we don’t want our clients to seek treatment. But nothing could be further from the truth. Between August 2023 and August 2024, we made 1,800 referrals for beds in detox treatment shelters. We are so happy when clients choose treatment, and we’re frustrated that they can’t get it at the provincial or municipal level when they want it.

What people sometimes forget about the overdose crisis is that there’s hardly a single family that hasn’t been affected. It is universal across the province. It affects big cities and small towns, rich families and poor families. We’re not going to help guide people to seek treatment and make different life choices by treating them like monsters or criminals. You need to treat them like your friends, your neighbours, your family. That’s really how you make a difference in people’s lives. And my hope is that people see supervised consumption sites as something that brings people together instead of something that drives them apart.

These interviews have been edited for length and clarity.