Death on Hamilton streets an enduring concern ahead of city election

Jason Detlor offers some advice.

Just to be safe. Don't do it alone."

Detlor's talking about fentanyl, a powerful opioid fuelling a deadly overdose crisis in Hamilton and across the country.

Because if you're alone, you don't know what's going to happen," says the 35-year-old who's struggling with homelessness.

Supply on the street is also increasingly volatile, with drug mixtures that can make dosing an unpredictable deadly gamble.

It's hard to come by stuff that's not going to kill you. You take one and you pass right out," Detlor says.

An ongoing data-collecting effort by local health-care providers underscores that morbid observation.

Between Dec. 1, 2021, and May 31, 2022, 10 people died prematurely while experiencing homelessness in Hamilton.

Overdose was the cause in eight cases, making it the leading factor by a wide margin. The average age at time of death was 43.

The starkly grim information should serve as a call to action for government decision-makers to prevent more carnage on the street, the project team says.

I would hope they come to the same conclusion as us: that policy-makers are the ones who have the power to do something about this," said Dr. Inna Berditchevskaia.

The initiative relies on community partners, such as agencies in the homeless-serving sector, but organizers say it may not be a complete picture, with other deaths flying under the radar.

Of the 10 fatalities, one person died of a heart attack and another of cancer. Seven people died in emergency shelters, while two lives ended in hospital and another on the street.

The data build on an earlier set that counted 19 deaths between June and November last year. Then, the average age was 36. Likewise, overdose was the leading cause (eight), and shelters (seven) were the most common setting.

The information points to a need for more supervised consumption sites, including in shelters, to help people use drugs more safely, said Berditchevskaia, a McMaster University internal medicine resident.

And more housing, said project partner Dr. Claire Bodkin, a family physician with the Hamilton Social Medicine Response Team (HamSMaRT) and a McMaster assistant clinical professor.

People need access to safe, secure, permanent, stable housing," Bodkin said. And that's really the important thing."

Both doctors hope the second report's release in the run-up to the Oct. 24 municipal election will also inspire scrutiny among Hamilton's electorate.

I would hope that people are looking at the candidates before them and seeing who cares about these issues," Berditchevskaia said.

The candidates

Homelessness and the initiative's mortality data have garnered the attention of candidates hoping to form Hamilton's next city council.

Adequate mental health services are key to helping people overcome trauma that can fuel addiction, mayoral candidate Andrea Horwath said.

If we don't have those services, then at the very least we have to make sure that we are providing a space where they can consume their drugs safely and not isolated."

Consumption and treatment services (CTS) prevent death by overdose and poison drug supply," the former Ontario NDP leader said.

Keanin Loomis, another mayoral candidate, also supports CTS sites and safer-supply programs that see doctors prescribe opioids, such as hydromorphone, as alternatives to the street's toxic supply.

Basically, what I'm listening to (are) the experts. HamSMaRT (are) the premier experts in this community, so let's work together," said the former chamber of commerce boss.

Asked about the mortality data, mayoral candidate Bob Bratina said police liaison officers must be put back in public schools to help prevent drug use among young people.

Where does this all start? Where do drug addictions begin? They begin in school," the former Liberal MP and ex-mayor said.

So, on the one hand, we have the tragedy on the street of addiction, but on the other hand, we have the entry-level situation, which is going on in our schools."

All three, meanwhile, have emphasized the need for more affordable and supportive housing in Hamilton.

Tents in parks

People living outside in Hamilton is nothing new.

But during the COVID-19 pandemic, the homelessness crisis deepened, resulting in tents pitched in parks across the city.

Encampments became a flashpoint of public debate during this past council term.

Some city politicians pushed for stepped-up enforcement of a bylaw that bars tents in parks amid a variety of complaints from constituents, ranging from garbage to late-night noise and violence.

Sorry folks, if you were a councillor that constantly sees an increase in these concerns, you'd be bringing this amendment, too," Coun. Jason Farr, who represents downtown, said in March.

Advocates, including HamSMaRT doctors and legal clinic lawyers, meanwhile, have argued uprooting people from tents without acceptable alternatives only disperses them elsewhere and erodes their health.

Throughout the pandemic, shelters have run at or near capacity, despite the city's efforts to increase spaces through temporary sites and hotel rooms.

As of September, Hamilton's 563 shelter beds were running at an occupancy rate of 97 per cent, according to the latest city data. Inflow and outflow that month were even at 230 people each.

Another indicator, the city's byname list, which includes people who have used services such as shelters and drop-in centres, sat at 1,543 last month.

Depending on the time of year, roughly 100 people can be found living outside. But this past summer, the numbers thinned to around 30, according to the city, a dip attributed, in part, to the beefed-up bylaw enforcement.

This fall, however, the numbers have crept up to 44, the city says.

Even if there is space, some avoid shelters for a variety of reasons, including fear of theft, mental illness, addiction challenges or not wanting to separate from spouses or pets. Service restrictions also bar people from shelters due to behavioural issues.

Ashley Macdonald-Greene describes an odyssey of bouncing between parks and wooded areas since the city broke up a large encampment on Ferguson Avenue North in the fall of 2020.

For a female, especially for me, it's dangerous. I don't know where the hell to go."

With winter around the corner, it's already cold, said the 36-year-old, who was hunkered down without a tent across the street from the YWCA, in an alley behind Whitehern Historic House and Garden.

I'm telling you, I freeze to death at nighttime."

Bratina is adamant that the city must enforce a policy of a tent goes up, a tent has to come down," arguing allowing encampments to linger sets a dangerous precedent.

Horwath, however, said she'd encourage council to make sure that we're not pushing people into the alleyways and hidden places and pushing them into places where they don't have any support or access to support."

Loomis has called breaking up encampments cruel" and said he'd try scrapping expedited bylaw enforcement with a mind to redirect funding to housing with support services.

The mortality data that the health-care experts collected also focused on comorbidities, or conditions that accompanied the main cause of death - for instance, mental illness, cirrhosis, lung disease, hepatitis C and anemia.

When a person is housed and stable and knows where their next paycheque is coming from, they can worry about things like cholesterol or their heart disease," Berditchevskaia said.

But those health concerns tend to take a back seat to the demands of a cycle of transience, she said.

If a person's priority is thinking, Where am I going to be tonight? Where am I going to be safe?' ... then everything (else becomes) a second priority."

Between 2019 and 2022, roughly $605 million was spent on Hamilton's housing and homelessness sectors, nearly half of which was municipal funding at $264 million.

In that period, funding for homelessness programs alone was $283.3 million, which included pandemic-response dollars from senior levels of government. The city's contribution was 19.5 per cent.

The total for social housing, housing allowances and rent supplements was $212.5 million, with the city picking up 69 per cent (or $146.5 million) of the tab.

In January, the city and major partners, including police and hospitals, pitched to the province a $5-million project that would pair health services with subsidized units to house roughly 100 people with complex needs.

The city has not yet received commitments" from the Ontario government but continues to press for continued pandemic-relief funding, housing director Michelle Baird said.

The city's ongoing pressures have been articulated, including at the (Association of Municipalities of Ontario) conference in August, and we will continue to advocate for further relief."

Saving lives

Bob Watters prefers to have a positive outlook.

A tattoo on his forearm spells out his name. A waterfall cascades through the letters.

I look at the glass always half full - I mean overflowing full because my last name is Watters."

But the 44-year-old doesn't see powerful street drugs through rose-coloured glasses.

When you shoot up, you know in the first three, four or five minutes if you're going down," said Watters, who's staying at the Salvation Army.

In such a scenario, programs that allow people to use drugs under supervision could save lives, including in shelters, where overdoses can be rampant, he said. If there's an emergency, help is right there.

If you can't walk out the door of that place, then you know there's something wrong," Watters said.

The opioid crisis has notched a relentless death toll in Hamilton. In 2020, there were 127 probable or confirmed opioid-related deaths, the city notes. In 2021, there were 166, and as of March this year, the count was 55.

For a short time last year, health-care providers teamed up on a temporary arrangement that allowed men at the Salvation Army to use drugs under supervision during a COVID-19 outbreak.

There were no fatal overdoses during the period of time when that was being operated, and there was a very significant reduction in the number of overdoses on-site during the time that was operating," Bodkin of HamSMaRT said.

Another example is an overnight drop-in at the YWCA on MacNab Street South, where agency partners HamSMaRT and Keeping Six have teamed up on a safer drug-use space.

We had people literally overdosing right across the street," recalled Medora Uppal, the local YWCA's director of operations.

Since the program started in late April, 120 women and gender-diverse people have visited; 16 lives were saved during drug overdoses or poisoning, and there were more than 1,200 supervised injections.

We don't require EMS. We're able to revive everybody safely," Uppal said.

The safer-use initiative is made possible through a federal exemption and is reliant on funding from community sources.

We definitely have to look to government funding for sustainability," Uppal said, noting annual operations are roughly $250,000 to $300,000.

Elizabeth Spencer - who stays at the YWCA's overnight drop-in, which is called Carole Anne's Place - keeps naloxone kits in her shopping buggy in case she has to help someone.

That happened last summer, she said, when she gave CPR to a man who'd just overdosed on fentanyl near Beasley Park before staff at the nearby Good Shepherd men's shelter intervened.

Around here, you do have to be prepared," said Spencer, 38, after picking up a Thanksgiving meal from the Mary Street shelter.

Good Shepherd is looking at supervised consumption options, says executive director Brother Richard MacPhee.

Because we know that we have to deal with it in our shelters every day."

But staffing could be a challenge, said MacPhee, noting shelters - not unlike the health-care sector - are already grappling with a personnel crunch.

Near the YWCA, Hamilton Urban Core Community Health Centre operates CTS at St. Paul's Presbyterian Church on James Street South.

The plan is to move the service to Urban Core's future purpose-built health centre in late 2023 or early 2024, when construction is expected to wrap up.

In the meantime, the service is saving lives, says executive director Nhlaloenhle (Nala) Ndawana.

The CTS just gives them that additional day to live ... to figure out what's next."

Urban Core's future home is at 430 Cannon St. E., near Wentworth Street North in Ward 3, which is also where the AIDS Network and HamSMaRT hope to open a CTS on Barton Street East near Barnesdale Avenue North.

Both plans have been met by neighbourhood resistance, however, including from Ward 3 candidate Walter Furlan.

The Barton Street East business operator and resident argues another CTS will only further saturate the ward with services like shelters and lodging homes.

We don't want them all concentrated into one area. It has a detrimental effect to the rest of the community, including children, including seniors," Furlan said.

They're telling me that they're afraid for their safety," he said, pointing to the erratic" behaviour of people with addictions.

Coun. Nrinder Nann, who's seeking re-election in Ward 3, has voiced support for the life-saving health supports and services" that CTS sites provide amid a worsening opioid crisis.

Dr. Claire Bodkin, meanwhile, disputes that CTS sites drive up crime rates.

That's not what the data and the evidence bears out," she says, citing studies to the contrary. It's a life-saving service, and I think people who use drugs deserve to live. That's what it comes down to."

Teviah Moro is a reporter at The Spectator. tmoro@thespec.com