Source: Office of the Chief Coroner of Ontario, extracted from the Public Health Ontario Interactive Opioid Tool, December 13, 2019.
Drug and substance use is an important community health issue that has significant impact on people who use drugs, their families, and the broader community. These impacts include death and disability from overdose, the spread of infectious diseases, injection drug litter and injection in public spaces. City of Hamilton Public Health Services is planning to expand its services for people who use drugs to include Consumption and Treatment Services (CTS).
Substance use in Hamilton
Substance use remains a top cause of avoidable deaths in Hamilton. The rate of opioid-related deaths in Hamilton has been consistently higher than the provincial rate, and Hamilton continues to see increasing opioid overdose deaths, 9-1-1 calls for opioid overdose, and emergency department visits for suspected overdose. For example, in 2018, 123 people died due to opioid-related overdose in Hamilton (109% higher – more than double – the provincial rate). Among health units in Ontario, Hamilton has the third highest opioid-related mortality rate (2018) in the province, behind Thunder Bay District Health Unit and Algoma Public Health. Hamilton has the highest opioid-related mortality rate among southern Ontario health units (2018). Learn more about Hamilton’s Opioid Information System.
Consumption and Treatment Services (CTS)
Consumption and Treatment Services (CTS) are locations where people consume pre-obtained drugs in a safe, hygienic environment under the supervision of trained and authorized harm reduction staff. These services reduce the harm caused from substance use (e.g. overdose, infection), while offering additional services such as counselling, primary care, addiction treatment, and connection to critical social supports such as housing. Currently there are 17 approved CTS sites in Ontario, including Toronto, Guelph, Kitchener, London, St. Catharines and Hamilton.
In 2017, Hamilton’s Supervised Injection Site Needs Assessment and Feasibility Study found that Hamilton would benefit from one or more of these services due to annual increases in opioid-related overdose deaths, high rates of infectious disease, and community support demonstrated during community and stakeholder consultation.
Photo Credit: Insite, PHS Community Services Society, Vancouver
Supervised consumption services have been studied in Canada and worldwide. Research has demonstrated benefits of supervised consumption services for both people who use drugs and for their communities. The addition of permanent, comprehensive Consumption and Treatment Services in the community has the potential to:
- Save lives by reducing the number of fatal and non-fatal drug overdoses
- Reduce the spread of infectious diseases like HIV and hepatitis C amongst people who inject drugs by promoting safe injection practices
- Connect people who use drugs with primary health care, addictions treatment, and social services like housing
- Create a safer community by reducing drug use in public spaces and publicly discarded needles and debris
There is no evidence that consumption services result in increased drug use, shifting drug use to different neighbourhoods, or increased drug trafficking or crime in the surrounding area.
Proposed service model
Pending approval from the provincial and federal government, the service will operate from 9 am to 9 pm seven days a week, year-round with at least four staff on site at all times, two of which will be health care professionals.
The proposed location for the CTS Program has not been announced. For any proposed site not owned by the City, arrangements must first be put in place that will allow the site to be made public and to initiate community consultations. The selected site will be located near the area with highest concentration of opioid-related emergency department visits and suspected opioid overdose paramedics calls.
In addition to the City of Hamilton’s proposed site, Hamilton Urban Core Community Health Centre operates Consumption and Treatment Services at 71 Rebecca St.
Consumption and Treatment Services are funded by the Ministry of Health as part of a provincial response to the opioid crisis, in a model that provides harm reduction services and connects people with addiction treatment and other health and social services.
As an extension of the City of Hamilton’s harm reduction services, the proposed CTS program is part of a comprehensive strategy to reduce death and disability from drug-related overdose. Public Health Services continues to:
- Partner with service providers and community members through the Hamilton Drug Strategy
- Provide education to prevent drug use
- Provide support to people who use drugs, including treatment and harm reduction services, such as naloxone training and kits
- Promote safer drug practices
There are many steps to complete prior to opening a Consumption and Treatment Services (CTS) program. Major milestones are listed below, and Public Health Services will update our progress as steps are completed.
Identify potential sites for Consumption and Treatment Services (CTS) program and initiate site assessment and finalize location details.
Announce proposed site location of CTS program
Work with local partners and community to assemble a committee for planning and implementing a CTS program and liaising with the local community
Conduct community information and consultation sessions
Submit a complete application, including results of community consultation, to provincial Ministry of Health for funding and approval to operate a CTS program
Submit a complete application to Health Canada for an exemption to the Controlled Drugs and Substances Act to permit the operation of a CTS program
Obtain all required permissions and approvals to proceed
Sign lease with landlord of proposed CTS site
Complete building renovations
Launch Consumption and Treatment Services
Timeline from 2017 to 2019
- December 2019 Public health identifies possible CTS site.
- April to November 2019 Public health staff reviews 29 different sites as possible CTS locations, but none meet the requirements.
- March 27, 2019 Hamilton City Council supports proposal for Public Health to seek government approvals and funding for a Consumption and Treatment Service in Hamilton.
- January 11, 2019 Hamilton Urban Core Community Health Centre submits an application to Health Canada proposing a Consumption and Treatment Site at the interim site of 71 Rebecca Street.
- December 19, 2018 Board of Health supports the Hamilton Urban Core Community Health Centre to submit an application moving from a temporary overdose prevention site to the provincially approved Consumption and Treatment Service model.
- December 12, 2018 Public Health Services convened the first Consumption and Treatment Site Working Group to consult on application process and potential CTS site locations within the City of Hamilton.
- October 22, 2018 The MOHLTC announces a new, enhanced approach to services provided under the new Consumption and Treatment Services model.
- June 5, 2018 Urban Core Community Health Centre and Shelter Health Network open a temporary Overdose Prevention Site at 71 Rebecca St, Hamilton.
- May 2018 Ministry of Health and Long-Term Care announces funding for OPS in Hamilton awarded to applicants Urban Core Community Health Centre and Shelter Health Network.
- December 2017 Health Canada issued an exemption to Ontario to establish temporary overdose prevention sites across the province.
- December 2017 Public Health Services SIS needs assessment and feasibility study recommendations are endorsed by City Council (BOH 17004(b)).
- May 2017 Health Canada simplifies application process for Supervised Consumption Sites (Bill C-37).
- December 2016 City Council approves funds for 2017 Supervised Injection Site (SIS) Needs Assessment and Feasibility Study.
Community Information and Consultation Opportunities
Public Health Services will be conducting community consultations with people who may use these services, neighbouring residents and businesses of the proposed CTS site, and the broader Hamilton community. Stay tuned for upcoming public information and consultation opportunities! Feedback, comments and questions are always welcome.
Consumption and Treatment Services
Email [email protected]
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