Kitchissippi, like every part of Ottawa, is not immune from the effects of the opioid crisis. Public drug use and the effects of that – overdose deaths, homelessness, poverty, social disorder, discarded needles and diminished feelings of safety on residents’ part – are being experienced in every part of the city, and require an all-stakeholders approach to address. But the opening of Northwood Recovery in Hintonburg in September has disproportionately exacerbated the negative consequences of the drug crisis in a way that must be addressed. Rather than being part of a solution, Northwood’s presence in the community is creating harm: for people who use drugs, for residents and for businesses.
Northwood provides “addiction recovery” services that includes – and community members would suggest are almost entirely – the daily prescription (after a videoconference consultation with a doctor) of hydromorphone that is dispensed in batches of dozens of pills at a time. Patients fill the prescription at the adjacent pharmacy, in theory to take them throughout the day. Hydromorphone is an opioid used as an alternative to less safe street alternatives of unknown quality or toxicity. It is the basic tenet of safer supply that people who use drugs have a right to drugs that are clean. This is something I fully endorse.
Each day, though, there has been a wholesale diversion of those drugs in an open-air drug market around Northwood Recovery. Hydromorphone is valuable in the private market to people who use drugs recreationally rather than for prescribed alternatives (safer supply), and selling the pills once those are acquired to buy harder and more dangerous street drugs – consumed quickly at the point of sale – is being seen every day. Some of those patients have been verbally abusive to passers-by while they’re congregated near the pharmacy and feelings of safety in the community have been rapidly diminished.
In addition, there have been several robberies of the drugs from patients including with the use of weapons and even including in one instance by assailants with a firearm. In a period of six weeks there have been three violent attempts by drug dealers to buy, steal or extort prescription opiates from the clients of Northwood Recovery. After the first attempted robbery police arrested three men and recovered a loaded gun and fentanyl; in the second event a client was beaten up and had his drugs stolen; and the third event was a robbery with a knife. These are the violent instances that have been reported.
The non-observance of good prescribed alternatives protocols is fueling a drug trade, social disorder and violence that is qualitatively different from the normal issues in a busy downtown(ish) neighbourhood. It doesn’t have to be this way, and it can’t stay this way.
I want to be clear that prescribed alternatives is a critical life-saving part of addressing the opioid crisis. Unregulated street drugs are killing people and we have a responsibility to ensure a cleaner alternative. When I first heard about Northwood this summer, I heard that it would be a methadone clinic, something we already have in Hintonburg and that I support despite the objections of some. Prescribed alternatives, though, is different. The fundamental precondition of treatment is that the patient is alive to be treated: prescribed alternatives fulfills that requirement. But there are harms associated with the unregulated practices of prescribed alternatives that need to be addressed.
Safer Supply Ottawa is an initiative of multiple health care stakeholders engaged in the provision of prescribed alternatives to people who use drugs. Central to their model is the adoption of wraparound supports and collaboration with each other and with the patient. Its operation is a model for best practices in providing prescribed alternatives that helps mitigate community harm while still centering the patient. It’s not perfect, but the commitment to reducing community harm is at least there.
A few weeks ago the BIA, the community association, police and I met with the adjacent pharmacist who is also landlord to Northwood to set out our expectation of reduced community impact. I am not satisfied that there has been any change.
It is important to note that the provision of these services at Northwood is unregulated. There is no permission from any level of government to operate or funding that can be withdrawn. Police enforcement is not a sustainable solution. Senior management at the Ottawa Police Service have agreed to the community’s request for greater presence around Northwood, but the resources will likely not be available for that to continue on any consistent basis. The community association undertook to engage the Premier’s office to discuss regulation of prescribed alternatives operations and I and community members continue that conversation; I recognize that advocates for prescribed alternatives may not be comfortable with the involvement of this government in the issue, but Queen’s Park is not going to ignore the issues being raised by residents. I have maintained a dialog with staff in the Premier’s office.
In the meantime, we expect both Northwood and Victoria Pharmacy to adopt practices that reduce community harm, and to adopt those as quickly as possible. If hydromorphone is being sold into a secondary market – or being violently stolen in brazen daytime incidents as has happened on at least a couple of occasions – then the expected public benefit of prescribed alternatives won’t be fully achieved. Northwood is a private enterprise, but it absolutely has a responsibility to its neighbours and the public that I urge it to accept immediately.
At a higher level, advocates have long advocated to be allowed to provide more powerful drugs that people who use drugs such as fentanyl are seeking. The failure to mount a prescribed alternatives initiative that provides the drugs people actually want to use has had the predictable result: diversion. There are also arguments for the supervised injection of prescribed drugs that could mitigate some of the neighbourhood harm. These measures, however, will be slow to achieve. It has to be said that city councillors across the country facing these issues are staring down policy failures that advocates have long cautioned against. Prescribed alternatives saves lives, but it is worth re-visiting the basis upon which it is offered. Other models are needed.