Despite 'massive shift' towards smoking over injection, Ontario has only 1 supervised drug inhalation space

Advocates and researchers say Ontario is far behind when it comes to protecting the growing number of drug users in the province who are choosing to inhale opioids rather than inject them.

"We know what we need to help support people who smoke their drugs — and we've been really, really behind the curve on it," said Gillian Kolla, an assistant professor of medicine at Memorial University, who studies drug use across Canada.

Data shared with CBC Toronto last week from the Ontario Office of the Chief Coroner shows that in 2024, just four per cent of deadly opioid overdoses are thought to have been caused by injection alone — down from 20 per cent in 2018.

That's the opposite trajectory of the statistics for inhalation alone, which are thought to be responsible for 40 per cent of last year's fatal overdoses — up from 18 per cent in 2018.

Though Kolla cautioned that the coroner's data has some uncertainty baked in, since about half of overdose fatalities are listed as having no evidence at all as to what consumption method was used, she said the growing move toward inhalation has been a clear trend in Canada for years.

Opioid toxicity deaths in Ontario where inhalation was the only mode of use nearly doubled between 2017 and 2021, according to a study carried out by Kolla and academic colleagues.

"We have multiple sources of data that are telling us about this," she told CBC Toronto.

"We can see it when we talk to harm reduction programs which distribute equipment to people who use drugs," Kolla said.

"And when we talk to people who use drugs about how their use is changing, they are also talking about how they have been moving more towards smoking."

The growing need for safer ways to inhale drugs has long been obvious to Joanne Simons, Casey House CEO.

Her specialty Toronto hospital, which serves people who have HIV or are at risk of it, runs the province's only supervised inhalation booth, installed in 2021.

"It's a very simple setup," Simons said of the small room. "There isn't anything super technical about it other than a very powerful fan that is venting any of the smoke outside of the building."

She said the hospital decided to open the booth in the first place because clientele were requesting it, and that since then, about 80 per cent of the people who arrive to use supervised consumption services at Casey House are choosing to inhale over inject.

"We're thinking about doing a second one because the need is so great," said Simons, describing the move toward smoking as a "massive shift."

Ontario's 2019 consumption and treatment services plan, which approved 15 supervised consumption sites in the province, did not include funding for inhalation booths.

At a price tag that Simons estimates around $50,000, that means only supervised consumption services that can solicit private funding and donations — like Casey House — can foot the bill to build one.

"Since we've installed it, we have had consistent interest from [other health centres] across the country, in terms of what it does," said Simons.

"I think the barrier to entry actually is the funds."

The government "does not and will never support the use of illicit drugs in public spaces," said a spokesperson for Ontario Health Minister Sylvia Jones in a statement.

"Our focus is on connecting people struggling with addictions challenges to treatment and recovery, not giving them the tools to use toxic, illegal drugs," Ema Popovic said via email.

A couple of kilometres south of Casey House, at the MAP Centre for Urban Health Solutions in St. Michael's Hospital in downtown Toronto, Dr. Ahmed Bayoumi has been examining the health implications of the shift towards inhalation.

The researchers and advocates that spoke to CBC Toronto for this story all said that part of what's been driving changing habits is the belief among people who use drugs that it's safer. So, is it?

When it comes to the risks posed by needles specifically, Bayoumi says inhalation would "clearly be safer" since it dodges the possibility of infection via dirty equipment.

The risk of overdose may also be lower, he said.

"There is some evidence that … the rate at which the drugs accumulate in the blood is slower with smoking than it is with injecting, which allows people to control the amount of drug that they're taking in more precisely," said Bayoumi.

Calls to fund safe inhalation sites have been ongoing since Liberal Kathleen Wynne was premier in the mid 2010s, said Zoë Dodd, co-organizer of the Toronto Overdose Prevention Society.

Dodd said her organization set up a supervised inhalation tent in Moss Park in 2017, where they operated unsanctioned for a year. Eventually, they moved indoors and had to give up the tent.

"We saw thousands of people through that service. And we reversed many, many overdoses within that tent itself," she said, adding that now, she and other harm reduction workers have to run outside when they're alerted to an inhalation overdose.

This spring, Doug Ford's government closed nine supervised drug consumption sites and transitioned them into HART Hubs, their new concept for treating addiction and homelessness.

The province invested over $500 million to build 28 HART Hubs across the province, according to the health minister's spokesperson.

"HART Hubs will reflect regional priorities, providing community-based, life-saving services including mental health and addiction care, primary care, social and employment services," Popovic said.

Data from the coroner shows more than 2,200 Ontarians died from opioids in 2024 – a slight dip from the last few years – and more than triple the deaths from a decade ago.