Safer supply clinic's move to Chinatown worries community

A controversial 'safer supply' clinic that prescribes opioids to fentanyl users through virtual consultations has moved from Hintonburg to Chinatown, and the local city councillor says it isn't welcome unless it makes changes.

Neighbouring residents and businesses say the arrival of Northwood Recovery on Somerset Street W. has brought an upsurge in open drug use to their doorsteps. They fear drug diversion, street dealing and violence will follow.

James Taylor, who owns the Hangout board game and bubble tea café directly across from the new clinic, said it was once relatively rare to see someone shooting up near his business, but it's now become a daily or even hourly occurrence. He said he routinely sees people heating up their drugs in front of his doors or loading up their needles in his back alley.

He called it "a constant battle."

"I've seen, personally, groups of individuals over here pulling out pipes and smoking pipes right on the sidewalk when groups of children are trying to walk," he said.

Nick LePine, a member of the local Dalhousie Community Association, said he's heard the warnings coming from Hintonburg residents who've been through this before.

"There were stabbings and robberies that were happening, and it seems inevitable that that stuff's going to come here as well," he said.

What is safer supply?

Safer supply is a harm reduction approach that aims to reduce the risk of overdose by helping users replace street drugs like fentanyl with prescription opioids, which are generally less dangerous because their potency is known.

Dr. Suman Koka is the prescribing physician at Northwood Recovery, and he confirmed that the clinic does prescribe hydromorphone, also known by the trade name Dilaudid. The medication is dispensed on site, not in a pharmacy.

Koka said hydromorphone is just one form of treatment the clinic provides, in addition to medications like methadone and suboxone.

"We're here to treat opiate use disorder. We've been doing this for 10 years, my practice and our physicians' practice," he said in a phone interview with CBC. "We have university affiliations. We work in inpatient addiction medicine. We work in correctional facilities. We're pretty comfortable with our medicine that we deliver to patients."

Koka declined to provide further details about which institutions he was referring to. 

He said his clinic aims to reduce fentanyl use and the illegal drug supply. In his view, that will help resolve the very issues that are troubling the community.

But that's not what Kitchissippi Coun. Jeff Leiper noticed during the clinic's time in Hintonburg. After it opened last September, he said an "open-air drug market" took shape as patients sold or traded their pills onto the black market to get stronger drugs like fentanyl, a practice known as diversion. Leiper said it attracted dealers and crime to the area.

Now, Somerset Coun. Ariel Troster is afraid the same thing will happen in Chinatown. She said she has "serious concerns" about the way Northwood operates.

"People are walking away and they're carrying large quantities of these medications, which leaves them vulnerable to being robbed and vulnerable to diversion, and so there are problems both with this private operator and with the way the safe supply program is structured," she said.

Koka said Northwood takes diversion very seriously and has protocols in place to prevent it. He said the clinic does regular urine screens and has hired a security company. A guard could be seen doing rounds this week.

"If we find somebody that is diverting and we have clear evidence that they're diverting, then we will discharge them from our program," Koka said.

Even the suspicion that patients are diverting can prompt the clinic to require them to take their doses on site, according to Koka.

City councillor calls telemedicine for narcotics 'unacceptable'

Patients who spoke to CBC generally supported the clinic, saying it has helped them stay off street drugs. They said it does enforce rules and some people get kicked off the program for diverting drugs. Few wanted to provide their real name, citing the stigma of using hard drugs.

One, Joseph Ladouceur, spoke to CBC shortly before the clinic moved from Hintonburg.

"It's helped me quite a bit," he said. "It's cut my drug use down to a bare minimum. The program they run here, it's by far one of the best things I've had."

He confirmed that Dr. Koka sees patients remotely, but does show up "from time to time."

Northwood Recovery has several clinics across the province, and Koka is not based in Ottawa. He said he sometimes comes for on-site visits, but acknowledged that the majority of consultations at the Ottawa clinic occur remotely.

Troster said that's not acceptable. She called it "an abuse of the system."

In 2019, Koka was "cautioned in person" by the College of Physicians and Surgeons of Ontario following a complaint that he had issued a prescription during a virtual appointment, and had also delegated his assistant to issue a prescription.

"I support safe supply in principle. It is extremely important. It helps people with serious addiction stabilize their lives, but it needs to be done in a way with proper case management, proper support, not with an absentee doctor who's just prescribing narcotics from an iPad," she said.

In her view, it's unfortunate that a for-profit clinic has stepped in to fill the gap left by the closure of the supervised consumption site at the Somerset West Community Health Centre.

"They were forced to stop by the Ford government and literally within a few days this new operator is setting up shop in Chinatown," she said. "It's not a coincidence."

Doctor and councillor plan to meet next week

In Troster's view, part of the problem is the use of Dilaudid, instead of a stronger, longer-lasting opioid that fentanyl users actually want to take.

"They're prescribing Dilaudid for a fentanyl problem, which means that in order to stave off addiction, people need to take the drugs six or eight times a day, which means consuming on site is impossible," she said. "You'd have to be sitting in the clinic all day."

Troster said she has a meeting arranged with Koka next week. Along with incoming MPP Catherine McKenney, she plans to push the clinic to change its protocols to follow the guidance of the community health centre and Ottawa Inner City Health. She said the main issue, for her, is providing in-person supports instead of virtual care.

"If they're not able to follow the very same protocols that every other safe supply provider in the city provides, then we don't want them in the community," she said. "We don't want them taking advantage of vulnerable people, and we don't want them causing potential security problems in the neighborhood."

If Northwood won't agree to make changes, Troster said she and McKenney will write to the provincial minister of health and ask her to shut the clinic down.

But Koka defended the use of remote medicine, saying it allows more patients to access treatment they need. He added that Northwood has brought on an on-site nurse since moving to Chinatown, and their clerical staff is a trained phlebotomist.

"Remote addiction medicine or remote medicine in general has increased the number of people that you can treat as a whole," he said.

"Whether it's through video conference or through in person, the interaction is the same."

He would not provide the size of his caseload.

"I don't know if I need to comment on that," he said.

For the time being, Koka said he has no plans to open more clinics in Ottawa, though he said that could change if the need is there.