What Brantford can learn from Calgary’s harm reduction methods


By Jessica King

Alberta’s Ophelia Black didn’t think there was a way out of her addiction. It seemed hopeless. But then she found Calgary’s Safeworks, a safe consumption site that opened in 2017. She was welcomed with open arms from the staff and other users to start her journey of recovery. “The safe site is the reason that I learned about the middle ground, the reason I tried it. So, without them, I likely wouldn’t be where I am today.”

Black is an example of how someone can come out of darkness with the help of a safe consumption site. Calgary is not the only Canadian city that has people who are struggling with addiction that could use a helping hand.

Brant/Brantford’s community has been struggling with an opioid problem for years. In September 2022, there were 22 opioid overdoses and six deaths in Brantford. Since 2016, there have been more than 9,000 apparent opioid-related deaths in Canada. Within this number, 94 per cent of these overdoses happen by accident. 

Brantford is experiencing rates almost double Ontario’s when it comes to opioid-related issues. According to Brant/Brantford Opioid Information System, in 2022, the rate of emergency department visits for opioid overdoses in Brant was 136.8 per 100,000 people compared to Ontario’s rate which was 56.4 per 100,000 people. In 2021 the rate was 33.3 per 100,000 people for opioid-related deaths in Brant compared to the 18.5 per 100,000 people in Ontario.

Brantford and Brant have a joint plan to make a supervised consumption site for people struggling with addiction. But the plan, which came out in 2017, has stagnated because of the lengthy application process, difficulty in finding a site location and community pushback. 

But Calgary has seen the benefit of such a site. Since a supervised consumption site opened in Calgary in 2017, more people are getting the help they need. The site has had a total of 248,880 visits and have responded to 4,918 overdoses.

Hogge says the site helps clients re-develop relationships with themselves to help them in their recovery process. “You’re not a bad person for where you are in life, and we can help you get out,” he says.

Supervised consumption sites don’t claim to be a guaranteed way for someone to get clean. They provide resources for people and prevent overdose deaths. According to WHY SCS, a Canadian research initiative, there hasn’t been a recorded fatal overdose inside any SCS in Canada. Rather, the sites help people on their journey to recovery, like Calgary’s did for Black. 

Black has struggled with mental illness her whole life and after being sexually assaulted and abused, she felt like opioids where the only solution to her problem. “I wanted to die. I knew that a lot of people died from using opioids, so I started injecting opioids in the hopes that I would die,” said Black. But then her addiction became her reason to live. “The only thing I was living for was that next high.” 

What Safeworks is all about

Calgary’s program was made to act as a response to their overdose problem. The goal is to create fewer risks for people who use drugs and other people who have HIV and hepatitis C by providing care, treatment and support. The consumption site is an important part of the program. 

Since opening in 2017, the daily average of visits has grown from 59 per day to 108. The site provides services that support prevention, harm reduction and treatment for users. The SCS is a place where people can use drugs in a monitored, hygienic environment to reduce the risk of overdose deaths, disease/infection transmission, public substance use and discarded needles. The site, open 24 hours a day, seven days a week, is staffed by registered nurses, licensed practical nurses, paramedics, social workers, peer supporters, outreach workers and dieticians. 

Staff members at Calgary’s SCS have to share their stories of substance use before getting the job, which is how Gene Hogge landed his role as a peer-support worker. Hogge was working as a hospital security guard when he met the Safeworks’ program managers and staff. When the peer-support job opened, Hogge knew he wanted to help others and share his story of substance use. “If it wasn’t for the consumption site opening, I wouldn’t have found my real purpose in life,” said Hogge. In his role as a peer-support worker, Hogge builds relationships to find out what clients need and want.

According to WHY SCS, many people who use safe consumption sites find it hard to access primary healthcare and social services due to the stigma behind drug use. Black worked with a therapist through the site and a doctor to get a prescription of hydromorphone, a short acting opioid that provides quick but short relief. Black takes a pill twice a day and can now sleep properly, is repairing relationships with close ones and has quit drugs. She’s also quit smoking and her prescription dose of hydromorphone has also dropped. 

Her mother, Marianne Balogh, found out about the SCS through her own personal research. That changed Black’s life. At first, she wasn’t ready to get sober. She didn’t want to go back to the state of mind she was in before using drugs. “The safe site is what really planted that seed that maybe there’s a middle ground,” said Black.

Black wishes she knew about the site sooner. “I was using illicit substances for almost a year before I found out about the safe site,” said Black, who believes more people could benefit from the site if there was better advertising. “There are a lot of people who are struggling with addiction who don’t know that that’s an option.”

Brantford’s substance use

The opioid crisis in Brantford is not a new problem, but it is one that is getting worse. According to the Brant/Brantford Opioid Information System, there was an increase in suspected opioid overdose related deaths in September 2022, when the area reported 22 overdoses and six deaths. Before that, the area had an average of three overdose related deaths per month all year. Brant/Brantford’s Opioid Information System says the higher number of overdoses and deaths is due to a higher potency of drugs, fentanyl and other unknown opiates appearing in the drugs throughout the community. 

Even without a safe consumption site, Brant has taken steps to address opioid overdoses. The county has opened an addictions and mental health care clinic. The Rapid Access Addictions Media clinic (RAAM) in Brantford provides treatment for people who have substance use disorder and addiction. People don’t need an appointment to use the service. As part of Brantford-Brant’s Community Drugs Strategy plan, Brantford created a pilot project in 2019 where a downtown outreach team that reaches out to people who need help but who might not seek it on their own. The team is made of a nurse practitioner, an outreach worker and a peer-support worker. The goal is to connect people to primary care services with a long-term goal to provide more permanent housing, counselling and medical services. 

Addiction is not a cookie-cutter problem. Not everyone can be helped in the same way. Hogge grew up with people telling him that he could simply just stop his addiction without help. After working at the clinic and learning about how addiction is different for everyone, he realized that his mindset about sobriety was wrong. “I was going through my own process of sobriety and there were a lot of questions I had. I was so focused on recovery that I just did whatever anybody told me,” said Hogge.

Having staff who understand the world of substance use is an important factor in what makes safe consumption sites a good harm reduction tool, said Bill O’Leary, an assistant professor in social work at Wilfrid Laurier University, who’s also an expert in harm reduction. “You’ll likely have a better approach to how you manage all the other life pieces because using drugs is just one thing. But how do you understand the other life pieces that happen in this person’s world?” 

This is true to Hogge’s experience, who said when he worked in security, he couldn’t share his problems with addiction. “It’s kind of like an alpha-male thing where you have to be a superhero almost. You can’t really share those kinds of things because they are looked upon as weaknesses,” he said.

Since September 2021, the Calgary site has made 1,573 referrals. From September 2021 to September 2022, referrals to social workers, opioid dependency programs, treatment programs, shelter or housing programs and urgent care have grown by 548 per cent.

Hogge said Black’s story is an example of how consumption sites bridge the gap between the medical system and the clients who use safe consumption sites. 

“We can help people and give them hope that we can do it as long as you walk with us,” said Hogge.

Black said because of the relationships she’s formed and the support and compassion provided from the site staff, she now considers herself recovered. “I know that I am not sober, so a lot of people are hesitant to call that recovery. However, I am living a higher quality of life now than I would be able to live sober,” said Black.

Just like addiction, recovery does not look the same for everyone. For Black, recovery is about getting her life back. “I don’t take any stupid risks anymore. I wake up excited to live my life. I value my health and my safety. I eat. All those things scream recovery,” said Black.

For Hogge, recovery means getting a job that gives him purpose while still bettering himself in the process. Hogge is now partway through an undergraduate degree, studying human services with a specialization in addiction studies.

Recovery is one of the positive outcomes that can come from a safe consumption site, but it’s not the only way to measure its success. The sites can also benefit the communities around them.

Since Calgary’s site responds to any medical emergency or care needed on site, the cost of emergency services has dropped. At Safeworks, paramedics don’t respond to overdoses. In a 2022 study published in the journal Harm Reduction, researchers, including the University of Calgary’s Shahreen Khair, studied how much Calgary taxpayers saved in emergency healthcare costs because of Safeworks. The researchers found the city saved about $1,600 for every overdose Safeworks managed on site. During the two-year study, the site saved Calgary taxpayers $2.3 million. 

Although emergency wait times weren’t studied, the researchers suggested wait times for ambulances and emergency department visits could drop as well since paramedics are responding to fewer overdose related calls.

Where Safeworks could improve

One thing Hogge thinks could improve at Calgary’s safe consumption site are the wait times for booths. There are six booths which has led to long wait times due to the number of people who want to use them. The Safework’s site is the only one in the area. There are plans to close the current site and open two smaller sites to replace it in locations Alberta deems more appropriate. The new locations haven’t been made public.

Nearby Calgary residents aren’t always keen on having a consumption site in their neighbourhood.

A 2020 Government of Alberta review of the impacts of supervised consupmption sites in the province, found that people who live near safe consumption sites in Alberta complain about finding needles, broken crack pipes and other drug-related tools. Residents have also complained about the potential effects on property values and the increase in disruptive behaviour that makes them feel uncomfortable and/or unsafe. 

Residents in Brantford have similar concerns with bringing a consumption site to the city. But Brant County health unit already has a strategy for how it would deal with the problem of needle debris should the health unit open a consumption site. “We have 11 needle bins in our community right now. We would put one right at the SCS to make sure people use them,” said Gerry Moniz, the health unit’s chronic disease and injury prevention manager.

Calgary’s site has needle disposal bins both inside and outside of the building. But they don’t always get used. Hogge compares the needle debris issue to garbage left behind at different chain restaurants and bars. He said it’ll happen no matter what. But if people find needle debris, they can contact the Safeworks Connect team to clean it up, he added.

Stigma behind drugs and drug users has created challenges in running consumption sites in Calgary. Brantford could see the same challenges if a consumption site is opened. WHY SCS said residents in communities considering a consumption site often raise concerns about increasing crime rates and people behaving in a disruptive way. But WHY SCS said the sites don’t increase crime and may actually improve disruptive behaviour in neighbourhoods. O’Leary said the numbers aren’t going up because more people are using drugs but because people were previously using drugs out of the public eye. 

There’s also contradicting research on whether consumption sites increase crime rates. The Government of Alberta review found that calls for police services increased 18.6 per cent around the Calgary site from 2017 to 2018. But the same study also found that calls decreased by 1.3 per cent around Edmonton’s safe consumption site. 

 The outcomes of consumption sites vary from region to region, just like substance user’s stories vary from one person to another.

People start using drugs for many different reasons. Some, like Black, face mental health issues. Others face poverty and homelessness. But the list of reasons doesn’t end there. Consumption sites aren’t a solution for all these factors, but rather an emergency response, said Rachel Goodland, a health promoter at Grand River Community Health in Brantford. Calgary’s site offers services like counselling and referrals to other programs, but there’s no guarantee that anyone will use them. “I think with SCS we also need other types of services that deal with the drug poisoning crisis [overdoses]. Until there are large scale policy changes around drug criminalization and the criminalization of people who use drugs, we are not going to be able to address some of those larger issues,” said Goodland.

Calgary’s consumption site doesn’t address the stigma and stereotyping that happens outside of the site. While the site directs clients to healthcare services that are designed for users, it doesn’t address the outside healthcare services that might not be so understanding. So substance users continue to experience negative treatment, like judgement from the healthcare system, said Brice Balmer, an assistant professor in spiritual care and psychotherapy at Wilfrid Laurier University, who’s also an expert in harm reduction. 

Black said stigma causes some people to dehumanize and treat substance users differently than they would treat others. “I just wish people knew that I’m not just an addict, I’m also a person,” she said.

In Brantford, existing stigma and community complaints make it hard to gain support for opening a consumption site, said Moniz. “There’s a lot of moving pieces. One of those pieces is getting a location and that has been challenging. We’ve had two or three locations fall through because there’s still that negative connotation around a consumption site,” said Moniz.

Brant County has tried to flip the narrative on consumption sites. The health unit has tried to educate the community on the benefits of such a site. “That’s a key component because if people are aware and educated and know why it’s coming, you usually have less resistance,” said Moniz.