Opioid Crisis Compels New York to Look North for Answers
Posted May 21, 2018 4:21 p.m. EDT
TORONTO — An aging construction worker arrived quietly in the building’s basement, took his seat alongside three other men and struck his lighter below a cooker of synthetic heroin.
A woman, trained to intervene in case of an overdose, placed a mask over her face as his drug cooked and diluted beneath a jumping flame. He injected himself, grew still and then told of the loss of his wife who died alone in her room upstairs — an overdose that came just a few months before this social service nonprofit opened its doors for supervised injections.
“I don’t want to say, ‘What if, what if,'” said the 52-year-old man, known as Gordie. He said his wife, Carol, had talked about kicking her habit before her death in September. “It never happened,” he said.
He repeated a kind of mantra, born of personal grief, that is quickly becoming a guiding principle for many heroin users and advocates across Canada, Europe and, now, a handful of United States cities like New York: “Don’t do it alone.”
As New York City Mayor Bill de Blasio has come out in support of supervised injection centers in New York, his stance has been shaped by Canada’s lead.
The country has been a pioneer; its first supervised injection facility, where heroin can be used under supervision, opened in Vancouver in 2003. A decade of political and legal wrangling followed, culminating with the Canadian Supreme Court ruling in favor of the approach in 2011.
No such federal approval exists in the United States, and none is likely to come from the Trump administration. But cities from Philadelphia to San Francisco — which could open the nation’s first sites this summer — are discussing going forward anyway, risking a potential showdown with federal authorities.
In New York, where as many as four sites are being envisioned as part of a one-year pilot study, officials suggest that the Justice Department may be reluctant to interfere with a city-backed effort to combat the seemingly unstoppable surge of deaths from prescription opioids, heroin and the powerful opioid, fentanyl.
In Toronto, the largest city in Canada, opening sites became a recent imperative: In 2013, there were 104 fatal opioid overdoses; in the first 10 months of 2017, there were 263, according to the latest data available from the city’s health department.
Two official sites opened here last year; four more have opened so far this year. In some, users can only inject drugs; in others, they can snort or swallow them. At the moment, none allow drugs to be smoked.
Days before de Blasio announced his decision this month, he and John Tory, the conservative mayor of Toronto, spoke by phone for about 30 minutes, mostly about doing the “preparatory work” to ensure public support.
“I think that many people in the public would feel as I did — a bit uneasy at first,” Tory said in an interview. But as he familiarized himself with studies of the benefits of supervised injection facilities, he said he was “persuaded of the view that it really is about saving lives.”
The New York Police Department sent a small camera-toting contingent to Toronto and Vancouver to see how officers there handle the sort of drug-related disorder that for years has been anathema to New York’s policing culture.
They did not like everything they saw.
“We did see quality-of-life issues; we did see drug dealing,” Commissioner James P. O’Neill said at a news conference this month. “It wasn’t a 24/7 operation, so at one point we actually saw someone shooting up in the doorway of the center.” “It was good for us to see that to make sure that it doesn’t happen here,” he added.
The Toronto police are currently studying crime trends to figure out whether the quality-of-life issues have worsened because of the new facilities or from other factors like the general rise in drug overdoses in the city over the same period.
In Toronto, calls to 911 have risen near the biggest sites. “Public urination, public defecation, prostitution, sexual assault, robberies, noise, you name it, we’re hearing about it,” said Staff Superintendent Mario Di Tommaso of the Toronto Police Service. “And that’s all coming from the public.”
Indeed, groups of users, drugs in hand, are a common sight outside the biggest of these centers; many arrive before the doors open, some unable to wait to use inside.
For health officials, users and advocates, that underscores the need to have a place safe from overdose, or from worries about robbery while the drugs are taking effect. Several times in recent weeks, staff members had to revive people overdosing outside a center.
“It’s like the AIDS crisis; we’ve had people dying for a decade and nobody cared,” said Councilor Joe Cressy, 33, among Toronto’s most assiduous advocates for the sites. “The question we’re asked today is: Why can’t you open more sooner?”
Other cities in Canada are moving forward as well. Montreal has opened several supervised injection sites in the last year. Ottawa got its first site in April. Vancouver now has more than a half-dozen places where users can inject. (Police in Vancouver said their sites have not caused crime to increase.) Toronto’s path was not exactly smooth. Last August, activists fed up with waiting for Canadian federal approval took over a section of a downtown park, pitched a tent and began a volunteer site. They did so after a particularly bad week in which a half-dozen people fatally overdosed in the city, said Sarah Ovens, 28, a social worker and volunteer who helps run the site in Moss Park.
Soon Tory came down. Then Ontario’s premier, Kathleen Wynne, visited.
The tents have since been replaced by a trailer. Since August, about 7,500 injections have been supervised by a rotating cast of hundreds of volunteers; 214 overdoses have been reversed, usually with oxygen rather than naloxone, an overdose reversal medication, Ovens said.
Crowds now gather in the muddy grass outside before its doors open at 4 p.m. Soon the renegade site will get an officially sanctioned location in a nearby storefront.
Across the street, in an officially sanctioned site at the nonprofit Fred Victor, Gordie, the construction worker, said he comes daily when it opens in the evening.
Nick, a 28-year-old Ojibwe man who took fentanyl at the injection site, said he had been through treatment but could not make it stick. “It’s the devil,” he said of opioids, adding that he and his girlfriend come to Fred Victor because it is safe to use there. The site will eventually be open around the clock, every day.
Not everyone is sold.
“If your son, daughter, loved one ever had an addiction, would you want them to go in a little area and do more drugs?” Doug Ford, a conservative populist running for Ontario premier and the brother of the former Toronto mayor Rob Ford, told reporters in April. “I am dead against that.”
Ford, who hosts big rallies and campaigns on a bus with a huge image of himself giving a thumbs-up, is the front-runner in next month’s election, and has invited comparisons here to President Donald Trump. In a statement to The Times, Ford said he had his own personal views, but would consult with experts on the issue. “Helping people is my top priority,” he said.
His big lead in polls has worried some city officials that provincial funding for supervised injection sites could be at risk should he win.
“I am concerned,” said Kristyn Wong-Tam, a city councilor whose downtown ward contains a city-run site called The Works. “We don’t push people out. We draw them in. To me, that’s the Toronto way.”
The Works, a harm reduction center and methadone clinic, has already overseen nearly 9,000 injections. The site, open 12 hours, six days a week, sits a few steps from a university campus and just off the corner of Yonge-Dundas Square, the equivalent of New York’s Times Square.
Intake is still done by paper — the computer system could not be developed fast enough — and visitors are asked to provide some information, such as gender, age, the drug they will be using and whether they have overdosed; they can remain anonymous. About three-quarters of those who come are men, many are homeless and less than 10 percent are first-time visitors, according to Toronto Public Health, which operates the site.
Each person gets a kit that includes saline solution for mixing with heroin or other drugs, a choice of different gauge needles, a cooker — thinner than a spoon and single-use — and a spot at one of the five booths. (Other sites may also have straws for snorting.) Because it can get crowded, there is a 30-minute time limit in the injection area and in the nearby “chill out” room. Each month, about half of those who come receive referrals to other health or city services.
There have been 123 overdoses through April, and most are brought back with oxygen. The goal is to treat the overdose without reversing the high — a result when naloxone is used — so that the user is not thrust into immediate withdrawal and a new search for drugs. Staff administered naloxone in fewer than a third of overdoses.
The city-run site gets heavy traffic and its presence can be felt on the streets outside.
Discarded needles can be found in streets and alleys. At a Tim Horton’s across the street, an “out of service” sign hangs on the bathroom door as a decoy to dissuade people who would deal or use drugs inside. (Customers are buzzed in.)
Business owners want the disorder contained. “I think we’re at a time when the Giuliani mentality needs to come to Toronto,” Mark Garner, the head of the local business improvement area, said, referring to the former mayor of New York. “The perception of safety” is diminished by the facility, he said, but added that he wanted more outreach workers and better data, not more police.
As it is, officers keep a low profile. They do not enter the site, though undercover officers do conduct buy-and-bust operations targeting dealers in the area.
Tory did not dispute the idea that some upheaval can be found at the sites. But he said O’Neill’s team may have misinterpreted what they saw in Canada.
“Far be it for me to substitute my judgment for that of your police commissioner,” Tory said. “But the same people had the same issues before, and maybe they were a little bit out of view in alleyways, taking drugs.
“I think if we’re bringing them to a place now where professionals are helping them to deal with their drug issues, maybe that’s why they’re more in plain view.”