Drug treatment experts in London not surprised auditor general says Ontario's opioid plan lacking

Experts in harm-reduction and opioid addictions in London, Ont. say the auditor general's report that found the province's opioid crisis strategy lacking in key areas tells them what they already know, but say they hope its findings lead to change.

The report, released by Auditor General Shelley Spence on Tuesday, said the province needs to develop a new comprehensive strategy to deal with the opioid crisis, as the current one has not been updated since 2016. It concluded the government's current plan is not enough to handle the "challenging and changing nature of the opioid crisis in Ontario."

"It's always great to have a critical lens on something that's as important as the opioid crisis," said Megan Van Boheemen, the Regional HIV/AIDS Connection's director of harm reduction services, who oversees Carepoint, London's supervised drug consumption site.

Most in line with Van Boheemen's area of concern is Spence's finding that the province didn't do enough planning and analysis before changing the rules for supervised consumption services.

Premier Doug Ford's Progressive Conservative government has taken a hard line on drug-consumption sites, fast-tracking legislation that prohibits and closes any sites within 200 metres of schools or daycares, and effectively stops new sites from opening.

In their place, the government is launching 19 new homelessness and addiction recovery treatment (HART) hubs, plus 375 highly supportive housing units at a planned cost of $378 million.

Spence's report says that process was rushed, and not based on evidence — a point Van Boheemen understands.

"Evidence-based is the key word there, right? We know we do harm reduction work really well here. Harm reduction is evidence-based. We also have abstinence-based pathways that we can support people on getting as well," said Van Boheemen.

While she likes to see the government approach the issue with its mind on getting people housed and connected to supports, she said it doesn't have to be one or the other.

"What we want to do is continue to build. We don't want to take away from one to build another, right? Any sort of comprehensive strategy that is going to be evidence-based is always the goal," Van Boheemen said.

Abe Oudshoorn is a Western University professor who studies poverty, homelessness and health. The report, he said, echoes what people researching the issue already know.

"I am frustrated that the opioid crisis continues. On the other hand, I do feel validated because a lot of the knowledge represented in the report is reflective of what folks know on the ground," Oudshoorn said.

As for Spence's finding that the changes to consumption site rules were under-researched, Oudshoorn agrees.

"That's a decision that's going to cost lives. Folks across the province have been saying that," Oudshoorn said. "I would hope that the government would take this as a a chance to reconsider the change and maybe think about how the new HART clinics might offer a more comprehensive suite of services that would help save those lives."

Oudshoorn also expressed concerns with the language the government used in its responses to the report's recommendations.

The government formally agreed to each of the seven recommendations laid out in the report. Each response opens with the statement, "The ministry agrees with this recommendation," but Oudshoorn says what comes after gives him pause.

"The responses are sort of inconclusive, or not even in line with the recommendations. They agree with the concern about closing the [consumption sites] without adequate consultation and planning, then they just say things like, 'We're going to start this HART program and the HART programs don't replicate what was being done at those sites.'"

Other concerns outlined in the report include a lack of centralization in the province's administration of its opioid crisis response and a lack of data collection on things like addiction rates and overdose-related hospitalizations.

Van Boheemen said there's certainly a level of disorganization present in the system, especially when it comes to connecting people with provincially-run services. 

Patients in need often spend weeks, or months waiting to get into treatment beds for services like withdrawal management, she said.

"I can't speak highly enough about the community in London, how well we work together, but provincially, it does make it challenging sometimes when there aren't those connections from A to B to C. I could see that being a challenge, yet," Van Boheemen said.