The care we lose with Carepoint

On March 13, the Ford government announced it would be ending all provincial funding for supervised consumption sites in the province. Sites were given until June 13 to scale down services for closure. Today, with two days left before these services fully shut down, Londoners should brace for the impacts on our neighbours, loved ones, emergency services, and first responders.

The only supervised consumption site in London, Carepoint, is operated by Regional HIV/AIDS Connection (RHAC). The site shares its doors with Counterpoint, another RHAC program focusing on harm reduction by providing sterile materials and education on safer practices.  The mission of Counterpoint is to limit the risks associated with substance use, particularly blood-borne infections. 

Riskier, more public usage

For Lily Bialas, the closure of Carepoint poses another shock not only to the harm reduction system, but addiction recovery as a whole.

Bialas serves as the interim director of Harm Reduction at RHAC. She described the province’s approach as having a ripple effect in communities surrounding these sites, one that will negatively impact London.

“Substance use often shifts to more unsupervised settings. So public spaces, but also people trying to keep themselves relatively hidden in public spaces — it creates a lot of risk in terms of overdose,” says Bialas. “Who’s going to be there to be able to respond?”

The province’s closure of these sites follows similar actions a year prior, when the province passed, the Community Care and Recovery Act, a law restricting sites from operating within 200 meters of schools or daycares, a decision that saw the closure of nine sites in March of last year — two-thirds of the existing consumption sites in Ontario.

People with substance dependency issues typically stay within 500 meters from where they have acquired or used substances, according Dr. Andrea Sereda, a physician at London InterCommunity Health Centre. “Every single injection that happened within Carepoint — up to 15,000 in 2025 — is now going to happen outside,” says Sereda. “There’s no other facility where people can go to use [substances].” Londoners can expect visible consumption in public spaces to only increase.

All of the organizations around closed consumption sites in Toronto and Ottawa — of which London has starkly fewer — are responding to increased rates of overdose.

Sereda believes that these cuts to services amounts to the Ford government forcing substance users into riskier usage behaviours, including usage in isolation, or rushed usage, a concern echoed by the Registered Nurses’ Association of Ontario. A rise in toxic drug supply, coupled with a decrease in availability of substance testing and other harm reduction programs, is all but certain to lead to increased substance-related harms. Bialis says a lack of supervised consumption means that every injection that takes place is an unsafe injection, which can lead to increased fatalities, particularly when the use happens in isolation where nobody might be able to support in case of any emergencies.

With Carepoint, “[participants] can do what they need to do in a relatively private setting where there’s people who are going to care for them, people who are going to provide new harm reduction gear for them to be able to do what they need to do and keep them a little bit safer,” says Bialas. 

Hospitals, emergency services further overwhelmed

In the 2024-2025 fiscal year, the London Health Sciences Centre saw the worst deficit of the province’s 136 hospitals. Cuts to harm reduction means that unreduced harms will increasingly make their way to our emergency departments and ICUs.

While Carepoint’s sister program Counterpoint will continue its current work of distributing harm reduction equipment, it is detrimental to have one without the other. The lack of a supervised space to utilize for consumption also may mean lack of immediate access to harm reduction gear, potentially leading to increased risk of transmission of blood-borne illness via non-sterile or reused supplies. The impact of non-sterile or reused supplies is the potential for systemic infections, including complex skin infections, cardiovascular infections, and sepsis. These conditions require medical intervention and hospitalization for affected individuals for hours, if not days or weeks, on end. 

“Each one of these infections is costing [the healthcare system] hundreds of thousands of dollars when it could have been prevented with pennies of harm reduction equipment distributed from Carepoint,” says Sereda.

“If these new infections are going into our emergency room, your wait is going to get longer because those things come in triaged fairly high because people are either sick or are being resuscitated,” she added. “Infective conditions that can keep people in hospital for four to six weeks, often needing an operating room.”

Surgery wait times, ICU beds, and crucial hospital services, already facing their brink given the lack of provincial funding, will be left to take on cases that were diverted and likely even prevented by supervised consumption sites. “I need other Londoners to know that this doesn’t just affect the drug-using population. This will affect all of your access to service as well,” says Sereda.

The province’s closure of sites is also likely to add additional pressure to first responders. Whereas Carepoint had in-building services in case of an overdose, limiting the necessity for EMS calls, non-supervised suspected overdoses are typically met by calls to 9-1-1, resulting in any combination of ambulance, firefighter and police services responding.  The reduction in harm reduction services is yet another guaranteed addition to London’s first responder case load.

Emergency room physician Dr. Sarah Griffiths, based in downtown Toronto, has seen the effect of site closures on emergency room waittimes. “These overdoses take hours to respond to. They do not respond to Naloxone,” says Griffiths. “I will now see multiple people, sometimes per shift, who have toxic drug poisoning from this, who require hours and hours of emergency department care to manage.”

Lost connections

“Connection creates a pathway for people. When they are in crisis or when they’re looking to make a change, they’re going to go to people that they have a connection with,” says Bialas.

According to Bialas, Carepoint was a space where people could build the connections necessary to pull them out of harmful substance use habits.

Gillian Kolla, a public health researcher who specializes in substance use and harm reduction research, says that last year’s closure of nine supervised consumption sites saw people across the province disconnected from the larger health systems they were able to access. But the loss of this connection also impacts the workers who grew relationships and played active roles in recovery journeys, most of whom are having to find other careers.

“As much as there is uncertainty for myself right now and running a program, there’s also so much uncertainty in terms of keeping jobs. There’s uncertainty around, ‘how am I gonna be looked after and taken care of? What’s my healthcare gonna look like?’” says Bialas.

“I think that the other thing that’s really, really hard to quantify is the moral and emotional distress that staff and workers go through,” says Kolla. “People who they had strong connections with… [the fear] that they’re going to die from overdoses because of the services being shut down and the lack of access to a supervised consumption site that’s going to come about.”

Political motivated targetings

Sereda believes that the decision to pull funding amounts to a populist political ideology. “[Politicians] are the loudest in spreading misinformation and disinformation about the consumption site and about harm reduction generally,” shares Sereda. 

Harm reduction researchers in Canada, including Sereda, have been targets of a variety of right-wing campaigns against supervised consumption sites. Columnists have published numerous pieces criticizing her in outlets like the National Post. Toronto Sun columnist Brian Lilley accused Sereda and other researchers of “hiding behind the shield of science” to claim expertise, calling them “activists pushing a harmful agenda.”

After Sereda testified at a House of Commons committee meeting on the opioid epidemic and toxic drug crisis, the federal Conservative Party put out a news release accusing her of lying and calling for her medical license to be revoked. On X (formerly Twitter), Leader of the Conservative Party, Pierre Polievre, called Sereda a “radical hard drug advocate.”

At the meeting, Sereda was one of four invited experts attending, and though she spoke for only 34 minutes, she was grilled and frequently interrupted by Conservative MPs. According to Dustin Godfrey, an independent journalist in British Columbia, Sereda was interrupted by committee members far more than any other speaker, going an average of 82 seconds before being interrupted by a committee member for reasons other than time constraints. The only other interrupted speaker, Dr. Rob Tanguay, was interrupted for non-time-constraint reasons once every 403 seconds. 

This characterization of Sereda by political figures and in the media has fueled thousands of voices against her on social media. Often branded as the face of harm reduction nationwide, she bore a large brunt of the directed disdain towards the practice. 

Sereda described name-calling, being targeted with insults, among other actions she described as hurtful. Although she has adapted to take such comments in stride, she shared concern for how it affects her daughter: “She reads the news. So we have talks about what people are saying about [Sereda].” Despite this, she takes no issue with being called an “activist doctor” or a “radical advocate”, acknowledging that patient advocacy is a cherished part of her medical training. 

“It’s really hard to get out accurate scientific information, especially in opposition to voices that are full of rage and moral panic and building fury against these services,” shared Sereda. “The conservative right-wing voices in our country, province, and city have been very successful in their branding campaign to brand us as radical harm reductionists or the radical left voices in the city — ignoring the fact that we actually believe harm reduction is just one component.”

“You will not find a harm reduction clinician anywhere who doesn’t say that we need more treatment beds. We need hundreds more — but we don’t have that.”

Pathways to treatment

In addition to directing people to other services to continue their treatment journey, Carepoint staff also act as a referral pathway for basic needs, including food, shelter, provisions, and a variety of other supports.

“We are a pathway to treatment services — these services were never intended to solve substance use on their own. [They are] part of a continuum of care for people who use substances, and part of that continuum of care also includes things like treatment,” says Bialas.

“Recovery isn’t a straight line, it’s a wavy up and down [journey], and that is usually over the course of a person’s life,” says Sereda. “Every single individual’s personal definition of recovery is going to be different, so we need supports the whole way along.”

Bialas hopes to see treatment services bolstered as harm reduction services are forced to wind down, but simultaneously believes that harm reduction services are necessary for people who might not be ready for treatment, saying, “we need to have services available for people regardless of where they’re at in their journey.”

For as large and complex of an issue as substance use is, Bialas believes that a comprehensive healthcare response is needed. Preventative care, enforcement, harm reduction and treatment services all combine to make up a comprehensive four pillar response. “When one pillar is particularly [targeted], then the others don’t match up and can’t support in the same way,” says Bialas. “It’s so important to be able to have investment in multiple different areas for people because not everybody is in the spot where they’re looking to go to treatment.”

For many who are ready for that next step, going to treatment often isn’t as easy as it sounds. There are only four live-in treatment facilities in London, and as with treatment centres across the province, they are dealing with lengthy waitlists. 

With treatment wait times extending and harm reduction services reducing, people hoping to begin their recovery journey will be losing another service, says Bialas.

Carepoint specifically has been met with numerous misconceptions about their services, namely individuals suggesting that they provide illicit substances for usage. On the contrary, to use the service individuals come to the site with pre-obtained injectable substances, as per the site’s federal exemption. Meaning, the site is not and has not supported any individuals that consume substances via inhalation. “[Inhalation]’s a big driving factor in some of the use in public as well, right? [That’s] because we don’t have a facility in London where people are able to go in order to smoke substances.”

“We see over 15,000 visits in a year, and we respond to 218 overdoses,” says Bialas. “That’s over 15,000 times where somebody is not going to have a place to go to in order to use — 15,000 times that somebody might not be able to get connection to other people, to other services.”

War on drugs

Of the four pillars involved in substance use response, the only one that rarely seems to be at a loss for funding is enforcement. The vast majority of funding to address substance use primarily goes towards the policing and enforcement of policy. In fact, as substance use has become more visible, policing budgets have skyrocketed across the province.

“The war on drugs is this idea that if you criminalize substance use, then you’re going to make drugs harder to obtain, and you’re going to make them more expensive — we’re not seeing that,” says Kolla. “Drugs have become more potent. They’re killing more people, despite the huge amounts of money we put into policing and enforcement efforts.”

Sereda echoes this finding, with reference to the impacts that prohibition, an older war on drugs, had on alcohol consumption.

Prior to alcohol prohibition, the drink of choice for most Americans was beer. However, once prohibition came into effect, alcohol smugglers sought to change that. Given the space needed to smuggle in large quantities of low alcohol beer, smugglers opted to bring in smaller quantities of spirits containing far higher alcohol concentration. Just like our present drug crisis, Americans witnessed a shift in consumption to higher concentration substances, and especially those that were unevenly mixed or possibly laced, due to the lack of regulation.

“You didn’t know if you’re going to get moonshine that was 11 per cent or 88 per cent — that’s what fentanyl is right now, right? People don’t know if they’re going to get a little. People don’t know if they’re going to get a lot. They don’t know if they’re having an overdose,” says Sereda.

The double standards of “deadly” substances and the war on WHICH drugs?

The province’s crackdown on supervised consumption sites, and broader trends against harm reduction for “hard” substances, come at a time in Ontario when it’s never been easier to access the Group 1 carcinogen responsible for the deaths of 1 in 4 Canadians a year: alcohol. 

“If you go downtown and you see people smoking drugs, injecting drugs downtown, that’s very in your face. It’s very icky to most people — we talk a lot about opioid overdoses, but alcohol kills 10 or 20 times more Ontarians and Canadians every single year than opioids do. Tobacco does too,” says Sereda.

As of January 1 of this year, Ontarians can buy beer, cider, and wine at convenience stores, big box outlets, and gas stations — including ONRoutes, in the middle of the 400 and 401 highways.

“I wish [Premier Ford] would see the irony in that he’s expanding access to this substance that causes widely more morbidity and mortality than opioids do,” says Sereda.

“We’re not actually learning the lessons of the regulated substances we have available,” adds Kolla. “We don’t talk about jailing people who are struggling with their alcohol use, we talk about providing them with support and treatment. We don’t talk about making alcohol more difficult to access because people do struggle with their alcohol use”

In the same vein of enforcement, aside from being one of the most costly ways to respond to substance use, research has consistently found that incarcerating substance users has profoundly negative effects on their addiction recovery journeys. 

“I don’t know that people actually realize the way in which our governments spend money on substance use. I don’t know that people actually realize the huge amounts of money we spend on criminalizing and putting people who use drugs into prison, especially vis-a-vis how ineffective it is,” says Kolla. “The most dangerous time for overdose is when people are released from prison.”

“We’ve moralized the debate around drug policy and made it very, very resistant to evidence-based interventions because moral opinions around drug use tend to hold sway much more than the evidence does,” says Kolla.

Visible crisis, cyclical crisis

Kolla argues that the province’s closure of nine sites last year led to an increase in public visibility of substance use across the province, which itself led to outrage felt by community members who are opposed to public consumption.

“The initial closure of the ones that were close to schools, is part of that kind of narrating an argument that’s focused on, well, this isn’t safe to be seen, but causing it to be seen more and more,” says Kolla.

“[People] think that closing these programs is going to magically solve substance use problems within the community — it doesn’t. People used drugs long before we had supervised consumption sites, and they will continue to use drugs once they’re closed,” says Kolla. “I’m just interested in seeing what they’re going to blame next once these sites are closed.”