The Safer Opioid Supply (SOS) Program

Safer Opioid Supply programs are now an established, evidence-based approach, part of a continuum of options for people who use opiates and opioids. Through these programs, people using contaminated opioid supply have access to pharmaceutical-grade opioids, as well as increased access to and engagement with healthcare and social services.

At South Riverdale Community Health Centre, an interdisciplinary team of health and social service workers offers comprehensive community-based care and programming. Part of a Downtown East collaboration with Regent Park CHC and Street Health, the SRCHC team consists of two nurse practitioners, a registered nurse, a community health worker and a manager.

Recent evaluation findings add to growing support for an increase in community-based, harm reduction approaches to safer opioid supply programming. People who use such programs report improvement in their wellbeing, including improved quality of life, increased stability, decreased criminalization and stigmatization, better health, fewer overdose events, reduced emergency hospital visits and greater social inclusion. The program also offers other social support such as referrals for housing, counselling and crisis assistance. As well, people using safer supply decrease their reliance on a contaminated street drug supply, increase their use of safer-use practices, and engage in health care and social services.

Nationwide advocacy for greater access, decriminalization and legalization is part of the teams’ focus. As well, building capacity, benefitting from the expertise of our DEC team, ensures that other health and social service providers have a greater opportunity to learn about SOS programming.

A Health Impact Assessment of the Ontario Line

Save Jimmie Simpson, in conjunction with the South Riverdale Community Health Centre, commissioned a health impact assessment (HIA) to better understand the health impacts that the proposed Ontario Line could have on the residents of Riverside and Leslieville and to compare them to the impacts of an underground option.


Community Collaboration: COVID-19 Pandemic

At SRCHC, we work to maximize positive community action through collective impact. During the last year, this has meant being nimble, thoughtful and collaborative in order to reduce the transmission of COVID through testing, support for outbreak management in congregate settings, help for individuals and their families who test positive for COVID, and vaccinations for community members.

In March, 2020, our team came together with staff from community health centres and Michael Garron Hospital (MGH) to host regular meetings for staff working in shelters and other congregate living programs. In a pandemic, knowledge is power; we helped organizations develop plans to reduce the spread of covid through infection, prevention and control measures. We also visited sites with suspected COVID cases to test residents and provide outbreak management support. When vaccine became available, the SRCHC team worked with our partners at MGH to provide mobile, low-barrier vaccine clinics in some of the highest risk settings in east Toronto.   Kate Mason, Research Coordinator, organized the outreach and Bernadette Lettner, RN, rode her bike, motorcycle or camper van to bring COVID-19 vaccine to shelters, group homes, supervised injection sites and other congregate settings.

Coordination support, teamwork and partnership development have allowed SRCHC to build programs quickly with support that is easy for community members to access. In November, to help reduce the spread of COVID, we starting working with a team at MGH to run pop up COVID assessment sites. We hosted 25 drop-in clinics and tested over 860 people. During this time, we received a grant from MGH to develop a program to provide case management support to those individuals testing positive for COVID. The case management team members came from four organizations: East End Community Health Centre, The Neighbourhood Organization, SRCHC and MGH. Many of the members have never met in person but, over the last five months, they have worked over Zoom to plan the program. We have a sense of shared purpose that, as COVID recedes, we will get back to better.   As one partner noted, “We have been able to leverage different funding pools and resources to extend the care network and reach more people in need of support. The work we have done around the COVID Response Team has laid the foundation for other work.”

As well, the team provided regular phone check-ins, connecting clients to contactless food and grocery delivery such as those available at The Neighbourhood Organization and the Scarborough Centre for Healthy Communities. It helped assess clients’ financial needs to assist them with government supports like the Canada Recovery Sickness Benefit. 98% clients who completed an evaluation said that the supports they received helped them to better cope with their COVID diagnosis and 97% said the project helped them to self-isolate. One client noted, “It was … absolutely fantastic! I was very impressed and I cannot speak highly enough. My friend lives in a different neighbourhood and did not receive any followup. Groceries being dropped off was a life saver. No reason to have to leave the house – absolutely brilliant! Life was a little more pleasant and reassuring, being able to ask questions no matter how ridiculous they might be.  Also, very educational as well. I learned a lot that I did not know about! Thanks a million!”

To learn more about the program, see:

Substance Use and Mental Health

On Wednesday, March 11, 2020, the World Health Organization announced a global pandemic. On the following Monday, March 16, 2020, one day before the Ford government declared a state of emergency, the world as we knew it shifted and the way in which clients were able to access services at South Riverdale changed dramatically. For those most affected by health inequities, social injustices and systemic oppression, such as community members/service users connected to the Substance Use and Mental Health (SUMH) programs, the added impact of COVID has been complicated.

In the face of adversity, our commitment to innovative care, cutting-edge approaches and health equity only deepened with the alignment and expansion of our services. Committed to offering dignified, meaningful and relevant care, the newly-formed SUMH team offers a continuum of service and support for individuals impacted by substance use. Many are also impacted by other challenges including mental health concerns, poverty, discrimination, criminalization and homelessness. Programs under this team’s umbrella include: consumption and treatment services (keepSIX and Moss Park), the Hepatitis C program, COUNTERfit harm reduction programming (mobile delivery, satellite sites, east Toronto outreach project, Common Ground group programming, and women’s harm reduction) and, most recently, the safer supply program.

With the emergence of COVID, services disappeared that had previously provided a modicum of dignity, safety, respite and refuge for people who are street-involved or unhoused. Community drop-ins, food programs, shower and laundry programs, washroom facilities and libraries across the city closed their doors. Deemed “essential services” by the organization and adept at staying responsive, we suited up in gowns, masks and face shields, and quickly adapted to provide safe and supportive care in a rapidly changing environment that demanded physical distancing and social isolation.

Over the course of this year, our two sites for consumption and treatment services (CTS), keepSIX and Moss Park, have worked tirelessly to try to save lives by reversing an unprecedented number of overdoses and by offering client-centred care, reducing the burden of stigma and promoting dignity for individuals who use drugs. The CTS teams, including service users, have been unrelenting and fearless advocates for local and systemic change: providing deputations to decision-makers, showing up at encampment sites to offer support, providing onsite drug checking to identify tainted supplies, mobilizing teams to respond to community overdoses, and participating in a range of community partnerships and research initiatives.

For people in the shelter system, the burden of COVID has also been disproportionately high. Many people who are unhoused choose to avoid the cramped and unsafe shelter system, and homeless encampments have popped up all over the city. We are opposed to the dismantling of the encampments and will continue to advocate for people’s right to live in tents as long as permanent housing is not available. We lobbied for the use of hotel rooms, sitting empty, as a safer alternative to shelters and homelessness and will continue to advocate for permanent housing – not warehousing – that prioritizes people’s health and safety. Through the shelter hotel program, service users have access to an interim housing option with a range of services, including harm reduction supports and overdose response services offered by members of our harm reduction team who continue to advocate for the expansion of these services throughout the city-wide program.

While in-person group programming for Hepatitis C ground to a halt with COVID, the program moved to a virtual platform to maintain connections between community members and continued to offer individual support. Despite the barriers, this year saw 55 treatment starts. And the safer supply program, the newest addition to the SUMH team, launched in 2020 in response to the national overdose epidemic. The program connects people who use opiates to prescribing clinicians, case management support and nursing services with the goal of improving health outcomes and reducing risks associated with a toxic drug supply.

Prior to COVID, service users were facing a host of challenges and barriers including devastating losses and harm from an opioid epidemic that has caused skyrocketing increases in preventable death. Our service users and staff have been dealing with unending trauma and grief, and COVID added another layer of complexity to an already difficult situation. The pandemic has made social inequities much more apparent. Yet, community continues to come together to share space, to make noise, to demand change, to show solidarity, and to grieve the tremendous toll that the dual pandemics have taken on us. Despite it all, we are still hopeful for positive change and are committed to working towards that.

Chronic Disease & Community Health

This year, the pandemic has amplified and widened health inequality gaps, especially among racialized communities and seniors. It has highlighted important issues such as social isolation, lack of access to healthcare, low digital literacy, precarious housing, food insecurity and mental health challenges. Newcomers, immigrant seniors, ethno-racial communities with language barriers and people living with multiple chronic conditions were among those at higher risk of the consequences of these inequalities.

The Community Health and Chronic Disease programs at SRCHC quickly changed gears to phone-based contact, virtual support and groups. Personal protective equipment, public health protocols and enhanced cleaning and infection control allowed us to provide acute care to clients and community members as well as Allied Health and Health Promotion programs. In order to maximize client and staff safety during the year, a hybrid model of both in-person and virtual care was provided. Phone or video assessment and followup were available; additionally, in-person services were offered based upon the complexity of the condition, barriers to access and risk of adverse effects from COVID-19 exposure. The demand for service remained consistent with most people preferring in-person followups along with virtual supports.

The Diabetes Education Community Network of East Toronto (DECNET) remained active in order to maintain the well-being of those impacted by Type 2 diabetes. DECNET provided appointments for urgent foot assessments, foot care and counselling appointments. Via phone or video, education, support and care were provided.

By establishing friendly calls with clients, weekly online support groups, exercise classes, and information sessions throughout the year, Harmony Hall Centre for Seniors and Harmony Community Food Centre checked in on isolated seniors at home. Food security needs were supported by grocery gift cards, delivery and meals. Harmony Community Food Centre, also established a seasonal affordable food market, open to all. Addressing food insecurity, a weekly, freshly-made take-out meal was available. The Community Food Centre offered live, online community kitchens for all ages in which participants received ingredient kits. The seniors’ transportation program continued to provide seniors with rides for medical appointments and expanded to assist with drop-offs and pick-ups of essential items. Enhanced support and more frequent programming for Chinese seniors was provided by our Grand Cafe program, moving from a monthly to weekly schedule.

Community-based programming and environmental health promotion work continued, virtually in most cases, to help those who are socially isolated gather in a safe (virtual) space. Programs included client parenting support, a Muslim womens’ social, a “dental bus” supporting staff and clients, monthly meetings across southern Ontario on climate action, the bike repair clinic, mindfulness tours to the Art Gallery of Toronto and the Royal Ontario Museum, and movie screenings. We recognized that there are many people who are not comfortable or adept with digital usage, or cannot afford its associated costs (computer, cell phone, reliable internet). Through our “Phone Drive” campaign, we have provided some with cell phones, allowing access to services and contact.

One of the lessons provided by the pandemic is that, even if our teams do very different tasks, we are all in this together. It became clear over the year that unity was needed more than ever to support clients facing social, economic, mental, emotional and physical barriers, especially those living in poverty and/or with chronic health conditions. The Community Health and Chronic Disease programs have shone during difficult times; we have learned that support from family, friends and our networks is essential to our well-being. We look forward to identifying even better ways to facilitate access to healthcare by continuing to address the social determinants of health and by utilizing a new, “hybrid normal” of both virtual and in-person care.