Why London's supervised drug-use site can't serve clients who smoke illegal drugs

As London police move to crack down on illegal drug use in public spaces, the operator of the city's supervised drug consumption facility is frustrated Ontario rules don't allow them to supervise the smoking of illegal and often deadly drugs, including fentanyl.

Speaking on CBC's London Morning on Friday, London police Chief Thai Truong explained the force's new approach to dealing with public drug use. Instead of arrests and enforcement, Truong said officers will first engage drug users in conversation to let them know what they're doing is illegal, and where they can get addiction treatment.

"[Officers] are going to ask them to stop using those drugs, and they're going to direct them to a safe consumption site," Truong said. 

However, under the funding framework for Ontario's supervised consumption sites, only injecting, snorting or swallowing drugs are permitted at the sites.

Although smoking is now cited in many studies as the most frequent way people consume illegal drugs, London's supervised consumption site can't provide supervision for people who inhale substances such as methamphetamine, cocaine and fentanyl. 

It's a situation that frustrates Martin MacIntosh, executive director of Regional HIV/AIDS Connection, which operates London's Carepoint and Counterpoint Harm Reduction Program at 446 York St. 

"Inhalation remains one of the most common modes of drug use," said MacIntosh. "Yet people who inhale substances are often left without options to use indoors. As a result, people are using outdoors in public spaces, alleyways and doorways, and ultimately this increases the risk for overdose and growing public safety concerns." 

Smoking room would be 'absolutely vital'

Carepoint would like to have a ventilated smoking room so they could prevent overdoses in clients who smoke substances, MacIntosh said. 

"Having that service available within our community would be absolutely vital," said MacIntosh. "I think that if we're serious about addressing public drug use, we have to consider safe spaces for all modes of consumption, not just injection." 

CBC News reached out to Ontario's Health Ministry for comment about the rules but did not receive a reply on Friday.

Across Ontario only Casey's House —  a specialized HIV hospital in Toronto — has a sanctioned supervised consumption site for clients who smoke illegal drugs. 

Casey's House built an enclosed room with windows for observation and a high-powered ventilation system so staff aren't exposed to the smoke.

Dr. Edward Kucharski, chief medical officer of Casey's House, said the smoking room came in response to a rise in smoking as the preferred way to consume street drugs. It's a trend that began prior to the COVID-19 pandemic. Now about two thirds of the drugs consumed at Casey's House are smoked instead of snorted, injected or swallowed. 

"For many of our clients it's their preferred approach to substance use," he said. "By allowing them to use their drugs in a safe area, where they can be observed to make sure they don't overdose, is fundamental." 

Kucharski said clients have shifted away from injecting drugs, in part to avoid transmission of HIV and other diseases. Also, intravenous users often develop vein health problems, which can complicate HIV treatment.

Casey's House is able to avoid provincial rules against offering inhalation because they're donor-funded and don't rely on provincial funding. They also operate differently than a supervised consumption site in that clients have to be registered to access the service. 

The centre does have an exemption from Health Canada from federal drug use laws. But they are one of only two sites with that exemption in Canada which also have approval to supervise drug inhalation. The other is Prairie Harm Reduction in Saskatoon. 

"I really just look at it as having as many options available as possible," said Kucharski.