Ontario Is Closing Safe Consumption Sites—And Overdoses Are Rising

At the AMHO conference in Toronto, the room was full of intelligent, experienced professionals who knew exactly what was happening across Ontario. They had the data. They had the timelines. They had the firsthand experience.

There was an elephant in the room which, for most of the conference, no one addressed plainly.

Slides moved. Language softened. Phrases like “complex challenges” and “evolving systems” did a lot of work that more direct language could have done better.

It wasn’t that people didn’t understand. It was that they wouldn’t quite say it.

A Policy Decision Everyone Can See (But Few Will Name)

Ontario’s approach is not subtle. Under the Community Care and Recovery Act, the province has been systematically shutting down its supervised consumption sites: first nine, now the remaining eight are set to lose funding entirely.

The framing is familiar: a shift toward “treatment,” “recovery,” toward something more structured and accountable.

And at the conference, in room after room, this framing was acknowledged, analyzed, gently questioned—but rarely confronted.

This is a dismantling. And it is happening in the middle of an ongoing crisis.

What Courage Would Have Sounded Like

There were moments—small ones—where the truth almost broke through.

A presenter paused on a slide showing a nearly 70 percent increase in EMS calls following site closures.

“Those are significant increases,” she said.

Which is one way to describe it.

This is exactly what we warned would happen.

Of course, that version never quite made it to the microphone. Instead, it lived in the spaces between sessions.

Where the Real Conversation Happened

In the hallway, the tone changed.

The people I knew from Ottawa—people working closely with my new friends at Ottawa Inner City Health—weren’t hedging.

Neither were a few people I met from Toronto.

They were worried. Directly worried.

They talked about people they knew who were now more likely to use alone. About relationships that had taken years to build and were now being fractured. And about systems that were being removed faster than anything meaningful could replace them.

But what stood out just as much was that they weren’t just venting.

If this is happening, what do we do now?

The Numbers Everyone Knows (But No One Owns)

Because the numbers are not unclear.

Following the first round of site closures, opioid-related emergency calls have surged—nearly 70 percent across Ontario. In Toronto, over 80 percent. Emergency departments have reversed prior declines. Deaths are rising again.

Everyone at that conference knew this.

Which made the disconnect harder to ignore.

When evidence becomes this obvious, the issue is no longer whether people understand—but whether they are willing to say what that understanding implies.

The System That Actually Existed

There is a tendency, especially in policy conversations, to reduce supervised consumption sites to their most controversial function:

Places where people use drugs.

Of course, that framing collapses quickly when you talk to anyone who has spent time inside one.

“They’re where people are known,” someone told me.

Not simply processed or managed. Known.

The distinction matters because what is being removed is not just a service—but a relationship infrastructure.

One that does not reassemble itself simply because a new model is announced.

The Assumption That Won’t Hold

The province’s answer is “treatment.” And again, no one at the conference argued that treatment shouldn’t exist. But in smaller conversations, there was a certain blunt honesty that never made it onto the stage:

Most people aren’t ready. Nor do they want to feel coerced into a program that doesn’t match their life experience. People aren’t all ready for structured programs or abstinence requirements.

And they’re not ready for the kind of system now being positioned as the solution.

What happens to the people who don’t fit the new model?

The People Who Will Still Be There

The answer, in practice, is simple: they stay exactly where they are. And the people who will continue to meet them there are peer and outreach staff.

They are the ones still showing up. Still building relationships and navigating the gap between what the system offers and what people are actually able to engage with.

But they are also the ones being asked to absorb the consequences of decisions they didn’t make.

The Missing Middle—Still Ignored

What became clear to me in Toronto is that the real gap in Ontario is not between harm reduction and treatment. It is the absence of anything that meaningfully connects the two.

The conversations that help someone move—not dramatically or all at once—but incrementally, realistically, in a direction they can actually sustain.

That space exists.

It’s just not being built.

What It Would Look Like to Take This Seriously

This is where something like the Life Process Program—developed by Stanton Peele—starts to feel less like an alternative and more like an obvious missing piece.

It does not replace either harm reduction or treatment. It operates in the space between them.

It gives outreach workers a way to do more than respond to crisis—and to help people think about their lives in a way that leads somewhere.

Which is aligned with how people change.

What Happens When No One Names the Problem

By the end of the conference, the discomfort hadn’t gone away. If anything, it had settled in. Because the truth was present in the room, and still mostly away from any microphone that might project the wise sentiment.

And when something this consequential is happening, silence—especially informed silence—has a cost.

Ontario is dismantling a system that, while imperfect, was real. What replaces it, so far, is largely conceptual. And the people who will bear the weight of that gap are not policymakers or presenters.

They’re the ones who were being talked about all weekend.

And the ones who will still be there long after the conference ends.