What is a Consumption and Treatment Services (CTS)? How is it different than an Overdose Prevention Site (OPS) or Supervised Consumption/Injection Site (SIS/SCS)?
Overall, these services are all quite similar. The main differences between CTS, OPS, and SIS/SCS are the expected duration of the sites, the different services they are each able to offer and which level of government (federal or provincial) approves the site to operate.
From January to June 2018, Ontario had an Overdose Prevention Site (OPS) program. This program was established to allow the rapid establishment of servicesto help address the overdose crisis. Agencies wishing to open an OPS only had to apply to the Ministry of Health and Long-Term Care for both exemption approval and funding. Exhaustive community consultation was not a requirement, nor were renovations. Supervised Injection/Consumption Services are more permanent and require a more onerous application to the federal government for an exemption under the Controlled Drugs and Substances Act (CDSA), in addition to applying to the province for funding.
In terms of service delivery, only OPS allow peer-to-peer assisted injection for people who use drugs but who cannot self-inject. OPS are also lower barrier because they had fewer reporting requirements which meant fewer intake questions for service users. Both OPS & SIS/SCS provide people with a safe and hygienic place to inject or consume pre-obtained drugs in the presence of trained staff who provide sterile equipment and safe disposal, overdose intervention and/or reversal, and safer drug use education. On-site primary care, mental health supports and referrals to health and social services (including treatment) have been part of both models in Toronto. Toronto currently has 5 OPS and 4 Supervised Injection/Consumption Services. South Riverdale CHC operates both a SIS/SCS (“keepSIX”) and OPS (Moss Park).
Consumption and Treatment Services (CTS) are the new terminology/model developed by the provincial government in November 2018. The CTS model encompasses and combines both OPS and SCS/SIS. The CTS model includes all of the services of an OPS/SCS/SIS with the exception of peer-to-peer assisted injection (which is not currently –permitted by sites with federal exemptions). The CTS model requires that each agency go through the federal exemption process, for each service site. All existing OPS and SIS/SCS must reapply under the new model and there will be a cap of 21 sites across the province. The CTS model has an emphasis on treatment (substance use counselling, referrals to methadone/suboxone providers, detox, and residential treatment programs); however, these services and/or pathways to treatment have always been available to SCS and OPS service users and are part of the harm reduction continuum of care. With CTS, more rigorous data collection and compliance measures are required, including more comprehensive enforcement and audit protocols. In addition, CTS have restrictions about how close these services can be located from one-another (not less than 600m) and require letters of support from nearby schools and child care centres.
What is the Moss Park Overdose Prevention Site (OPS)?
In August 2017, in response to a dramatic spike in overdose deaths in the area, a group of harm reduction volunteers set up a tent in Moss Park to support and care for people who use drugs. The volunteer OPS received an outpouring of public support from people who congregate in the park, local social service agencies and the general public. When the Overdose Prevention Site program was formally established by the Ministry of Health & Long-Term Care in January 2018, the Moss Park group transitioned to this new model. The Moss Park OPS now operates indoors near Queen & Sherbourne as a satellite service of South Riverdale Community Health Centre. The Moss Park OPS has a harm reduction supply distribution area, an intake/waiting area, six injection tables and a post-injection observation space. The service has operated 6 days per week since July 3/18 from 12 to 6 pm and has been staffed by nurses, overdose prevention workers (people with lived expertise of drug use) and community health workers. The Moss Park site has a daily average of 60 visits for consumption and 48 additional visits for supplies, support and referrals. 56 overdoses were reversed in its first 5 months of operation.
What is keepSIX Supervised Consumption Service?
keepSIX opened on November 27/17 at SRCHC’s Queen St East location after a very long consultation and program planning process. keepSIX is open at the same time as the rest of the Health Centre from Monday to Friday. keepSIX is a small-scale service with a daily average of 14 visits. In nearly one year of operation it saw over 400 unique visitors, supervised over 2,800 drug consumptions and reversed 8 overdoses. keepSIX is also staffed by nurses, health promoters and harm reduction workers (who have lived expertise). keepSIX means “got your back” and is an homage to Raffi Balian, founder of SRCHC’s COUNTERfit harm reduction program (established 20 years ago) and lifelong advocate for people who use drugs.
Will SRCHC apply to have Moss Park OPS and keepSIX SCS be established as CTS?
Yes. Applications were submitted for both sites to the Ministry of Health and Long-Term Care in December 2018. There will be no change to the number of service users that each site can accommodate at any one time but there may be an expansion of hours (if funding is approved). A federal exemption request was submitted for Moss Park OPS to the federal government in August and is still pending. The federal exemption for keepSIX was recently renewed for a period of 3-years.
Why do we need these services?
Unfortunately, the overdose crisis continues to get worse and we need services like these more than ever. Recently released data estimates that 11 to 12 people die per day from overdose across Canada. In 2017, 308 people died from overdose in Toronto (the most recent time period for which we have data). This represents a 66% increase in deaths compared to 2016 and a 125% increase in deaths compared to 2015. The Moss Park neighbourhood has been described as the epicentre of the overdose crisis in Toronto by Toronto’s Medical Officer of Health. The proposed CTS at our Queen St location is the only service of this kind east of the Don Valley.
Is there ongoing opportunity for community input?
Engaging with the local community and providing opportunities to raise any issues or concerns has always been important to South Riverdale CHC. If you would like more information or have questions, please contact us. The contact person for Moss Park site is Jen Ko who can be reached at 416.303.4453 or firstname.lastname@example.org. For information about the keepSIX supervised consumption site, please contact Julia Barnett at 416-461-1925 x 356 or email@example.com. keepSIX has a monthly open house from 8:30 to 9:30 am on the first Wednesday of each month. Moss Park also has bi-monthly Open House events, with the next one scheduled for January 23, 2019 from 9 am-11 am. Contact us for more information.