Over the past two years, the elephant in the room has been revealed for everyone to see.
As residents, we have for years been aware of the lack of affordable housing, addiction and drug use in Ward 3. The pandemic brought these issues out into the open, and our city has been scrambling to address them. In a reactive move, they landed on short-term, quick fix solutions: give the unhoused free tents and an open space or multi-room shelters to live in. But what about long-term, supportive housing? No clear and definitive answers. People are dying from drug overdoses and addiction. Let’s open safe injection sites (SIS) that provide a safe place to screen the drugs but not look more deeply into root causes that would actually help heal and cure the addictions!
Often, these short-term solutions were done without asking the residents and communities how they affected their quality of life or their families or their neighbourhood, and that raised questions. These questions brought accusations: you want to see people die, you are a NIMBY (not in my backyard), you have no compassion, you are heartless and uncaring.
The truth is that long before this, we included this vulnerable population in our community: we opened places like 541 Eatery and St. Pat’s Church that provided meals; we opened our closets to give out clothing and warm winter wear for the Mitten Fence at the General Hospital, Eva Rothwell Centre and other facilities; we referred those on the street to places like Helping Hands and Mission Services and called for supports to help them and improve their situation.
The September article “The Transformation of our Neighbourhoods” The Transformation Of Our Neighborhood | The GALA Herald spoke specifically of the over-concentration of high acuity facilities in our Ward 3 neighbourhoods that have been branded as “Code Red” and explored these questions: how do we really help; are there other solutions like treatment centres; do we need more proactive housing such as Indwell and Kiwanis provide; can we look at long-term solutions instead of trying to heal the wound with a kiss and a bandaid; and, do we need to look at spreading out these facilities?
We reached out to Tim McClemont, Executive Director of The Aids Network to respond to these questions. Our goal was to address the viability of treatment centres and their long-term benefits: to get the facts, not put one option over the other or create a debate. Tim graciously agreed to answer our interview questions and offer his perspective. Tim in turn he reached out to Dr. Robin Lennox, a family medicine specialist with McMaster Family Practice, to provide additional information.
Information from Dr. Robin Lennox
Q: How many treatment centres are there in Hamilton? Are they inpatient or outpatient facilities?
· The Rapid Access Addiction Medicine (RAAM) program is at St. Joseph’s Hospital (SJH) with physician and addiction counsellor support for people using any substance. SJH also has a youth-focused substance use program (Y-SUP) and the Concurrent Disorders Outpatient Program for people with complex mental health needs and substance use disorder.
· For people who use opioids, there are more than 15 outpatient clinics in Hamilton providing low-barrier access to opioid agonist therapy (OAT), such as methadone, suboxone, and Kadian (the standard of care for treatment of opioid use disorder).
· People who use substances are also often cared for within primary care and receive treatment for their substance use (medication, counselling, etc.) from their family doctor or nurse practitioner. We do not have data on how many individuals access substance use care specifically from their family doctor in Hamilton, but this is often reported as a preferred option for many individuals.
· There are two non-medical detox facilities in Hamilton: Men’s Addiction Services Hamilton (MASH) and Womankind where individuals can go for acute withdrawal management, and also to be connected to longer-term care.
· Womankind also has a residential treatment program (8-12 weeks) for women who use substances. Wayside House of Hamilton offers a residential treatment program for men.
Q: What resources are in place to support those who successfully complete a treatment program?
A: After individuals complete residential treatment, they are usually offered an aftercare program where they can continue to connect to support. This is the case for both Womankind and MASH.
While in outpatient care, as long as individuals are receiving opioid agonist therapy, they will have regular visits with their physician or team of care providers where they can receive ongoing support, even after they have reduced or eliminated their substance use.
Patients at any stage of change (including when in remission from substance use) may also access supportive counselling or relapse prevention counselling via the RAAM clinic, Alcohol Drug and Gambling Services (ADGS), Concurrent Disorders outpatient program, or family health team-associated counselling.
Q: What percentage of people who successfully complete a treatment program are still drug free 1 year later, 5 years later and 10 years later?
A: This is difficult to answer because there isn’t one standard “treatment program” for people who use substances. Different substances require different forms of treatment, some requiring medication that is long-term (more than one year) and some requiring psychosocial interventions like counselling, contingency management programs, etc. Some individuals access substance use treatment through their primary care provider or dedicated addiction medicine physician while others enter specific time-limited programs. We do not have data or studies that capture rates of sustained remission from all substances and all different treatment modalities.
Q: What are some of the reasons that people decide to enter a treatment program?
A: Decisions to seek care in a residential treatment program are very individual and based on each person’s unique needs and values. Some people express a desire to have dedicated time to focus on their substance use and mental health and feel that residential treatment affords them that opportunity.
For many people who are working or who cannot be dedicated to a treatment program full-time, outpatient care is a preferred option as they are able to continue their day-to-day activities while also managing their substance use disorder.
Q: How long is the typical inpatient treatment program?
A: Locally, most residential treatment programs are 8-12 weeks. Longer programs do exist in other regions and can be accessed by Hamilton residents.
Q: Is there government funding available for treatment centres and how does it compare to what is provided for a safe injection site (SIS)?
A: Yes, some residential treatment centres receive government funding and others are private pay. Outpatient care is funded by agencies (many of whom may receive grant or government funding) and by OHIP (for physician care). As there are very few safe injection sites in Ontario to date, typically the funding for SISs has been much less than those dedicated to other treatment programs.
Interview with Tim McClemont, Executive Director, The AIDS Network
Q: What percentage of people who enter treatment programs do so because of the influence of the staff and information received at a safe injection site?
A: The proposed Consumption Treatment Services (CTS) site at 647 Barton Street will have the following pathways to services:
· OAT treatment – existing partnership with the Hamilton Social Medicine Response Team (HAMSMaRT), Dr. O’Shea, Shelter Health Network (SHN)
· Detox, treatment – existing referral pathways, as well as HAMSMaRT, SHN
· Mental Health Services – existing partnership with Mental Health and Street Outreach, reach out to Canadian Mental Health Association (CMHA), peer support through Keeping Six
· Primary Care Services – existing partnership with Shelter Health Network.
I understand the Consumption Treatment Services (CTS) in Ontario are expected to report any referrals to treatment programs. Reporting is extensive and it goes to the Ministry of Health monthly. As of yet this information is not tabulated and distributed to all the programs. Doing a referral is one thing, tracking whether a person could actually get in or their needs were met, is not something the programs are asked to track unless this has changed. This will be something we can pursue and then we will be part of this reporting for the proposed site at 746 Barton.
Q: Should facilities like safe injection sites be more widespread so that those who want to use them have easier access?
A: We and many people believe that Consumption Treatment Services should be offered as part of the support programs for people who use substances. These can be integrated into existing facilities and care centres that offer complementary services such as treatment referrals and holistic supports in a safe environment.
Q: How do you determine or decide on the location of a safe injection site other than statistics? Do you consider the proximity to schools, hospitals, or community services?
A: A proposed Consumption Treatment Services must consider proximity to school, day care and other community services according to the Ontario Ministry of Health funding guidelines. In the case of The AIDS Network’s proposal to locate the CTS at 746 Barton Street East, we reached out to the closest school (St. Ann’s Elementary) to engage with them. There have been communications with the St. Ann’s parent teacher group and that is ongoing.
As well, the Ward 3 Hamilton Wentworth District School Board (HWDSB) trustee Maria Felix Miller contacted me in 2021 to find out more information about our proposal. I offered to engage in community consultations with both Bernie Custis and Prince of Wales schools which are even further away. At that time, she declined, but we remain open to continue consultations with them moving forward.
We also engaged in community consultations with Luso and the Afro Canadian Caribbean Association (ACCA) Hamilton in 2021, two organizations located nearby the proposed site. We met with participants and residents, heard their concerns, and provided an overview of our proposal and our commitment to continue dialogue with them.
While the answers provided to our questions were not what we expected in some cases, the openness and willingness of Tim McClemont and Dr. Lennox to provide us with fact-based answers was a step in the right direction toward open communication with the community. Concerns about the location of the two safe injection sites remain but with more community consultations that provide honest and open answers to our concerns, a solution is still achievable.
Perhaps the questions we propose will inspire someone to do further research into the success rates of the different approaches to addictions in our community.