As drugs overwhelm this downtown block, is safer supply the problem or the solution?
Critics say prescribing Dilaudid to fentanyl users is hurting their neighbourhood
Day after day, Dan Sauvé watches the same chaotic routine play out by his shop.
Mornings bring a rush into the clinic and pharmacy next door to Steve's Music on Rideau Street. People come out with pills. According to Sauvé, the front stoop of the store he manages is often their next stop.
"They go to the clinic and then come right next door to my front door to sell whatever they got," he said.
"I'm seeing exchange of pills. I'm seeing exchange of money, right out in the open."
The patients aren't really the problem, Sauvé said. It's the dealers.
He's watched what he calls a criminal "ecosystem" take shape, bringing along a wave of thefts and violence he links to the drug trade.
He said it's become so aggressive that his staff are afraid to come to work.
"We've had to take some pretty extraordinary measures just to make people working here and people shopping here feel safe," he said. "We just keep the door locked now."
WATCH | What Sauvé says has been happening at his shop:
Ottawa's safer supply program has been running for about four years. It provides legally prescribed hydromorphone pills — better known by the trade name Dilaudid — to people who are at risk of dying from the fentanyl-dominated street drug supply.
Its proponents say the program has drastically reduced overdoses among its roughly 500 patients.
"Without safer supply, things would actually be much worse than they are now," said Rob Boyd, CEO of Ottawa Inner City Health, one of the six organizations that run the program under the umbrella of a non-profit organization called Pathways to Recovery.
The program has already received $7.7 million from the federal Substance Use and Addictions Program and proponents have submitted a new application to Health Canada seeking more federal money to better support their patients.
Neighbouring residents, businesses and police say the program has to change to stem the flow of cheap, addictive pills they believe are reaching the streets and fuelling social disorder and crime.
"Harm reduction is a great idea. So is safer supply," said Calla Barnett, vice-president of neighbourhood association Action Sandy Hill.
"These could save lives, it's true. And they do. But the implementation is hurting us. The way they are implemented disregards their impact 50 feet beyond the door."
Diversion 'rampant,' police say
Ottawa had 93 opioid overdose deaths during the first half of 2023, according to the latest confirmed data from Ottawa Public Health.
According to Boyd, the culprit is fentanyl. It's so potent that a few grains can kill.
The logic behind safer supply is simple: help drug users replace fentanyl with prescribed pharmaceutical opioids that are much less likely to kill them.
The evidence is just beginning to roll in, but it's encouraging, according to Thomas Kerr, head of the division of social medicine at the University of British Columbia and director of research with the British Columbia Centre on Substance Use.
He said the first major quantitative studies are showing reduced overdose mortality and lower use of health-care services.
The Safer Supply Ottawa program's own evidence, based on self reporting from a group of patients, suggests 70 per cent of them reduced their fentanyl use. Four out of five didn't report any overdoses while on the program.
Patients also say they're committing fewer crimes.
"This is part of the solution to the problem. It's not what's causing the problem," said Boyd.
"The impact happening in the neighborhood is the impact of the unregulated toxic drug supply, the extreme poverty that people are living under and the affordable housing crisis."
In Kerr's view, concerns about drug diversion to the illicit market are a secondary issue next to "the worst public health crisis in Canada in the modern era, the overdose crisis."
He said there isn't yet any "rigorous evidence" to suggest diversion is a major issue.
We have a hydromorphone solution for a fentanyl problem, and this is sort of the equivalent of giving a baby Aspirin for a migraine.- Donna Sarrazin, CEO of Recovery Care
Ottawa police Const. Paul Stam said officers have a wealth of anecdotal evidence, collected with their own eyes as they patrol what he called one of the city's top three high-priority hotspots for crime.
It's the block of Rideau Street between King Edward Avenue and Nelson Street, the site of Steve's Music and locations of two Safer Supply partners: Recovery Care and Respect RX.
Virtually any time officers pull up, he said, "they would observe people openly trafficking in diverted hydromorphone."
In Stam's view, that hydromorphone is coming from safer supply providers. He said there are also reports of street gangs edging into the trade near the clinics and extorting their patients.
Stam said the street price of Dilaudid has fallen through the floor provincewide from about $8 to $9 per pill to just $1 or $2 today.
"The street is flooded with this pharmaceutical grade hydromorphone," he said.
Robberies, beatings 'demoralizing' for residents
Residents have found what they consider their own evidence of diversion: little plastic vials strewn around the neighbourhood.
Chris Greenshields of the Vanier Community Association said residents are finding them, with labels torn off, scattered around the Montreal Road location of Respect RX and Recovery Care.
Louise Lapointe, president of Action Sandy Hill, said the same thing about the Rideau Street location. Increasingly, she avoids that block.
"You can see drug deals totally in the open, with impunity," she said.
In her view, though, the victims are more likely to be vulnerable patients than residents.
"The violence against people who are intoxicated. It's really demoralizing, because you can see them getting robbed and beaten," she said.
The intersection of Rideau and Nelson streets was the site of at least 933 reported crimes last year, according to the Ottawa Police Service crime map, which excludes crimes such as sexual assault for privacy reasons.
The large majority were thefts, though there were also robberies, threats, assaults and break and enters.
That total was higher than any block adjacent to the city's three major homeless men's shelters, for example, and well above the 529 reported crimes in the same spot in 2019.
That was the last year before the pandemic, of course, but also just before the start of the Safer Supply Ottawa program. Stam is hesitant to draw any connection, but neighbours and businesses are not.
"There was very much a noticeable before and after, so to say there's no correlation would just be naive," said Sauvé. "It's been progressively getting more violent."
That block has had its problems. The clinic and pharmacy are steps away from both a supervised injection site and in the ward with the highest concentration of social services in the city.
But Sauvé is hardly the only one who sees the launch of safer supply as a turning point.
"This opening in 2020 ended up throwing fuel on the fire," said Lapointe.
Dilaudid like 'giving a baby Aspirin for a migraine'
Donna Sarrazin, CEO of Recovery Care, said the clinics will continue to prescribe safer supply medications regardless of what happens with the new Health Canada application, which is meant to fund support such as counselling and an improved housing program.
She admits that safer supply as it currently exists is "not perfect."
"It needs to change and we don't have the right resources in place for safer supply right now. It needs to grow. It needs to continue to progress," she said.
"The tools that we've been given to engage safer supply are not adequate for what we need. You know, we have a hydromorphone solution for a fentanyl problem, and this is sort of the equivalent of giving a baby Aspirin for a migraine."
She said the clinic investigates suspected cases of diversion and tries to find a way to resolve the problem. Sometimes, the clients are "being bullied for their medications," or sharing them with a partner.
Still, Sarrazin said there are limits.
"Being on safer supply doesn't give you permission to have bad behaviour," she said. "In the end, if diversion continues, then they can't stay on the program."
In Boyd's view, diversion isn't stemming from too much safer supply, but the reverse. He said safer supply programs simply aren't big enough to reach all the people who need them.
"Diversion is created by scarcity, so whenever we have limited access to a life-saving medication you get diversion happening," he said.
"We don't have the scale that we need for safer supply programs, not enough people get access to it. People are naturally going to share that when somebody close to them is dope sick."
While that debate continues, Sauvé is waiting for his lease to run out. He said business is impossible without a change.
"We're very dependent on families," he said. "For people who don't necessarily come to the neighbourhood day in day out, it's pretty shocking.
"We'll have to find another spot to operate, because this is not tenable."
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