Juanita Lawson fidgeted with two scraps of paper as she wound down a meeting with Thunder Bay media on Monday. The interviews marked the official end of her consumption and treatment program, as well as the closure of the only safe supply site in northern Ontario.

The NorWest Community Health Centres CEO didn’t refer to her notes, which consisted only of two anonymous client testimonies. One read, “Safe supply + Path 525 have harmoniously saved my life in so many ways. When they inevitably will no longer be available to us, it’s going to be a very short matter of time until the clients (past clients at that point) will start dying. I will quite likely be one of them.”

Thunder Bay had the highest death rate from opioid overdose in Ontario last year at 69.5 per 100,000 people, four times higher than the provincial rate of 17.5. That rate has increased 663 per cent since record-keeping began in 2016. The local health unit consistently issues warnings over the toxic drug supply and the city has been under an active HIV outbreak since 2019 that disproportionately impacts unhoused people.

Frontline workers are now bracing for what they say will likely be a tide of overdose deaths.

On Tuesday, NorWest was among nine harm reduction sites the province converted to “Homelessness and Addiction Recovery Treatment” Hubs. All nine were located within 200 metres of a school or daycare centre, which is a violation of the Community Care and Recovery Act that Doug Ford’s majority government passed in August.

NorWest is not included among 10 consumption sites that were also slated to close on April 1 until a Superior Court judge granted a temporary injunction on Friday. That came in response to a Charter challenge that the Act violates the right to life, liberty, and security of the person. Justice John Callaghan wrote in his decision that the proposed closures would cause “significant harm,” including the loss of life.

But while Minister of Health Sylvia Jones attributed her government’s service direction change to “communities and families” who have decided these sites “make communities unsafe” in a release on Tuesday, the closures run counter to the advice of Ontario’s own experts, whose safety review calls the sites a “necessary public health service.”

There have been no overdose deaths at the NorWest site since Path 525 opened in 2018, while staff has reversed more than 500 overdoses. And according to Thunder Bay’s safer supply pilot project’s final report, “the majority of the clients interviewed believed they would have been dead due to the toxic drug supply if not for the Safer Supply Program.”

The results of that 2022 to 2024 pilot, in which Indigenous people made up two-thirds of clients, showed improvements in every category it measured. Eighty-six per cent experienced material improvements on the housing continuum. 

Self-reported drug poisoning incidents fell 92 per cent. More than half of clients reported reducing their unregulated fentanyl intake, while a quarter no longer used fentanyl at all. Over half of those who were supporting their substance use through criminal activity at the time they enrolled were no longer engaging in crime by the end. And four-fifths of those living with Hepatitis C cleared the virus over the pilot’s duration.

As NorWest transitions to a HART Hub and the focus shifts to treatment, Lawson said the change for those directly affected will be significant.

“One of the things I’m certain of is that a lot of people will have unmet needs that we were connecting people with medical care, medical intervention, also low-barrier access to medical treatment, services and harm-reduction supplies,” Lawson said.

“Our community will support them with the distribution of harm reduction supplies but I do think it’s a gap and there’s only so many things, as an organization, that we can do to mitigate risk. At the end of the day, I think there’s going to be some impacts in terms of more overdoses where people are using alone and not in places where there’s interventions.”

The move also shutters the site’s sanctioned illicit drug testing, as Ontario prohibits HART Hub sites from employing any harm reduction programs. In its stead, Health Canada has committed to funding a local two-person mobile drug analyzing unit, which will be set up in local parks.

Across town, Elevate NWO executive director Holly Gauvin stood before the “Memory Wall,” shelves full of photos of those who have lost their lives to overdose. She was grieving a man who had overdosed last weekend; a friend who she said knew how to use safely; a volunteer who cooked grilled cheese sandwiches for those living in the encampments nearby.

She pointed out that Ontario is funding NorWest to deliver abstinence programs at a rate three times higher what it was willing to fund harm reduction, positing that if harm reduction was funded at those levels, organizations like hers dedicated to serving people living with HIV and Hepatitis C wouldn’t even have to exist.

“Why on Earth would you cancel something that is working and that costs you pennies on the dollar? It’s classist. It’s racist. They’re eliminating a health care option for people that was working.”

Gauvin believes “there will be more deaths” but she foresees the pain of addiction becoming more visible, discarded and used equipment becoming more prevalent, and deaths occurring in whatever private spaces are easily accessible, including alleyways, backyards, or unlocked sheds.

One Elevate staff member has lost 30 personal relationships to overdose deaths, this year alone. Gauvin says the impact of so many losses is already straining the mental health of the entire community for those who use and those who support them. 

The bleak pivot she’s planning in the wake of NorWest moving out of harm reduction is to rally around those remaining and strengthen resolve. She’s planning bereavement training for staff and clients, including recruiting Elders to lead “letting go” ceremonies for those with few connections and who may not otherwise have funerals when they pass.

“Watching the fallout within our group, it has been a lot. And that’s just one loss. Imagine that happening in larger and larger numbers,” Gauvin said. “What happens when we have nowhere to go with that grief and loss? What systems are going to be most impacted by that? You’re going to see increased hospital visits, impacts on the mental health systems, increased drug use. People will be coping the best they can with the lack of resources we already have and the lack of equitable access. Everything needs to be on the table.”

Frontline service providers say they rely on those genuine relationships at the core of the trust that’s needed to make treatment options available.

Kandace Belanger manages a five-member street outreach team at the Thunder Bay Health Unit. The health unit and downtown businesses have been increasing naloxone training to manage the anticipated increase in public consumption and overdoses.

But she says the deepest impact of losing harm reduction work might be to the human bridges that allow her staff to do the street-level medic and service access work.

“The really important part of harm reduction is the connection that people have to those service locations and the people who work there,” she said. “I think when we talk about harm reduction, public perception is that perhaps it’s an enabling facet of substance use but truly, it’s a very important part of the whole continuum of substance use health… By meeting people wherever they’re at in their use, where they’re at physically, meeting those needs is really important to forge connections with people. They say the opposite of addiction is connection. That’s something we’ll potentially lose.”

Public health has been holding strategy meetings with the local hospital, emergency services, and police.

While Thunder Bay police chief Darcy Fleury calls the city’s high opioid overdose death rate “troubling,” he won’t speculate on whether overdose numbers will change over the coming weeks and he’s not planning any adjustments to officer resources or deployment.

“I’m not sure if it’s really going to have a huge impact on what we’re seeing,” Fleury said, pointing to recent provincial investments in local treatment and detox beds, as well as the HART Hub’s treatment model.

“The intent is that there will be opportunities for treatments, which I think is going to be a good thing. I think that’s always something that needs to be done, not just safe injections but the actual aftercare and helping people to get off of the things they’re on. I don’t know if there’s going to be a huge impact for us because we do work with other agencies already that are very involved in helping these people, so probably not a lot of impact to us.”

Sol Mamakwa is the MPP for Kiiwetinoong, the majority-First Nations riding in Ontario’s far north. Many of his constituents are in Thunder Bay because Canada and Ontario don’t fund services in their communities.

“He doesn’t live in our communities. He’s not the one losing his people,” Mamakwa said of Fleury’s comments. “I don’t believe that one bit. You cannot just brush it away as if our people are not people. That’s what it sounds like to me.”

Mamakwa pointed out that despite Indigenous people officially making up only 14 per cent of Thunder Bay’s population, they represented half of Path 525’s clients. Indigenous people experienced opioid fatalities at a rate of 40.8 per cent in Thunder Bay versus the Ontario average of 4.4 per cent.  

Not only does Mamakwa expect the move will result in a higher rate of overdose deaths, but he foresees the community mental health strain will result in more state interventions like child services and correctional institutions. Ultimately, he said many fly-in First Nations, whose members are in Thunder Bay, are working toward land-based programming to treat addictions, but in the meantime, Ontario moving away from harm reduction is putting those people in harm’s way.

“These people that die by overdoses in Thunder Bay, they’re not numbers. They’re often people from the North that are our friends, our relatives, and they deserve to have a culturally-safe, Indigenous-led, medical care available to them, and into the future. This closure is totally the opposite.”

Jon Thompson is a Local Journalism Initiative Reporter based in Thunder Bay. Contact him with tips and story ideas at editor@ricochet.media.