
It’s 6:00 a.m., and I’ve almost finished a busy overnight shift in the emergency department. The hallway is lined with stretchers. Monitors are beeping, and the air feels thick with resigned exhaustion. I’m called to the resuscitation room. A young woman was found pulseless in a public washroom, alone, with a needle nearby. Another fentanyl overdose.
Except this isn’t just another anonymous statistic. It’s the same woman I saw earlier that night—alive, scared, and in the throes of precipitated withdrawal after receiving naloxone for using fentanyl from a new, untested supply. She had been offered treatment, but she was too sick and uncomfortable to wait in our overcrowded emergency department. She left before we could start her on opioid agonist therapy.
We did everything we could—chest compressions, naloxone, epinephrine. But after 20 minutes, we pronounced her dead.
Later, I sat with her partner. Through tears, he told me that she had been doing better. She had started methadone, was connected to Peer Support, and had gotten her ID and been connected to services. A big part of her progress, he said, was thanks to the supervised consumption site she had relied on—a place where she felt safe, seen, and supported. But it had recently reduced hours and staff, and she’d stopped going. She stopped her prescribed medication. Her opioid use had escalated and she started using alone again.
As an emergency physician, I am sounding the alarm—again. The political trend of closing supervised consumption sites is a catastrophic mistake. These are not fringe services. They are an essential part of the healthcare system. They prevent overdose deaths, reduce the spread of infectious disease, connect people to care, and lessen the immense burden on emergency departments like mine.
In 2022, more than 1,800 overdoses were reversed at Toronto’s SCSs. That’s 1,800 people who might otherwise have ended up pronounced dead on the streets or in my trauma bay. 1,800 families spared from the heartbreak of a preventable loss. Research is clear: SCSs reduce overdose deaths, improve community safety, and are a bridge to treatment for many people who use substances. They save lives—full stop.
Without them, overdoses don’t go away. They just happen in alleys, parks, bathrooms—places where no one is watching, no one is trained, no one is there with oxygen or naloxone. When those patients do arrive at our EDs, they come in sicker, later, sometimes with permanent brain damage. Others never make it at all.
Every overdose that’s reversed at a supervised consumption site is one less 911 call, one less ambulance tied up, one less critical patient in a hallway waiting for an ICU bed. When these sites are shut down, our already overwhelmed system is pushed further to the brink—for everyone, not just those who use drugs.
The government’s suggestion that treatment hubs can replace SCSs misunderstands the nature of this crisis. Harm reduction and treatment are not mutually exclusive. We need both. SCSs often serve as the first point of contact for people seeking help. Take them away, and we remove one of the few safe entry points to care.
Please understand—this isn’t about politics. It’s about people. It’s about the young woman we couldn’t save last week. It’s about the thousands more we can save – and connect to housing and services —if we choose evidence over ideology, compassion over stigma, and life over loss. I urge all levels of government to reverse course on these closures.
– Dr. Jennifer Hulme, Emergency Physician at the University Health Network in Toronto