The Agenda with Steve Paikin (Audio) - Can Mobile Clinics Fix Ontario's Care Gap?

Episode Date: June 16, 2026

What do recent shifts in public health policy reveal about how care is delivered, and who can access it? After a woman was killed outside a Toronto community health centre in 2023, the province reviewed supervised consumption sites, introduced a new model, and this month cut public funding, raising questions about safety and access. At the same time, mobile health clinics are appearing outside Toronto libraries, aiming to connect more people with primary care. Journalist Adam Zivo, joining from Odessa, Ukraine, Montreal-based writer Emma Paling, and Martin McIntosh of the Regional HIV/AIDS Connection examine what these changes signal. Then, Dr. Andrew Boozary and Aly Velji consider whether mobile care can fill gaps or create new ones.See omnystudio.com/listener for privacy information.

Hi, I'm Nam Kiwanuka, host and producer of mistreated, a podcast on women's health. There just hasn't been a lot of money put into researching women's health issues. If women are in pain, it's hysteria, it's an emotional issue. And this is what you see consistently. Women's health is not taken seriously. How did we get here? Find us wherever you get your podcasts, and be sure to check out the video version of the show on the TVO Today YouTube channel. Hope to see you then. Ontario has art for every learner and TVO wants to bring it to you. No velvet ropes, no glass cases.

There's a rich artistic history you won't find in museums and traditional archives waiting to be discovered. From film, visual art and music to beadwork, textiles and street art. These moments, movements and makers have shaped who we are. With your support, a new TVO video series will uncover Ontario's remarkable art stories and preserve them in a living public archive. Visit TVO.com slash TVO Arts to make your donation today. Your gift is matched up to $100,000. I don't want to hurt these people.

I want to help them. I want to be productive. That was Premier Doug Ford back in March talking about people with substance use disorders and defending his government's decision to stop supporting Ontario's last publicly funded supervised consumption sites. There were eight of them left, and the funding ran out on June 13th,

and sites in London and Ottawa shut down for good last week. The Premier has made his feelings clear. What I don't believe in sticking these injection sites in the middle of the community, down the street from a school, needles are all over the place. So the government will be going in a different direction. It's investing in homelessness and addiction recovery treatment, also known as heart tubes.

But many experts and frontline workers say that closing the sites will cost lives and that heart hubs aren't the answer. So we're going to look at how these closures and the safety concerns that drove them are affecting communities across the province. Then we'll look at a new initiative that will connect vulnerable Torontoans with primary care right outside their local library. This is the rundown. After a woman was killed outside a community health center in Toronto in 2023, the province conducted a review of supervised consumption sites. It since introduced a new model, and as of this month, cutoff support for publicly funded sites. From Odessa, Ukraine, Adam Zivo is a journalist and a columnist for the National Post.

From Montreal, journalist and writer Emma Paling. And here in studio, Martin McIntosh is the executive director of the regional HIV-AIDS Connection. Thank you so much for joining us. Thank you so much for joining us in studio. Really appreciate it. Martin, I want to come to you first. Please. What are the thoughts on the closure of provincially funded safe consumption sites across Ontario?

You obviously essentially ran one up until this past weekend in London, Ontario. But what are your thoughts just overall? Well, I think one of the first thoughts is one of grief. Yeah? And I'm talking about the real human grief related to loss of life and an ongoing crisis that isn't going away with the closure. There will still be the toxic drug supply. There will still be the need to connect people who are using substances to care and to support.

Definitely one of grief and a big challenge for our community. Adam? I will say this is long overdue because the evidence clearly shows that supervised consumption sites do not save lives and that they dramatically increase crime in their immediate vicinity. And Emma. I would echo what Martin said, which is right away. there's a feeling of grief, especially when you're inside the sites, spending time with people who use them. Safe consumption sites have reversed 68,000 overdoses in Canada, and each one of those in a different setting could have been fatal, could have caused permanent brain injury,

paralysis, and a whole host of other permanent health issues to the people experiencing the overdose. All right. I want to get a better sense of sort of the inside of what, you know, what one of these sites looked at. So Martin, help me understand. The CTV news report says that CarePoint, the site that's now closed in London, recorded 15,000 visits and responded to 218 overdoses last year. What did the day-to-day look like in that clinic? Well, the day-to-day, and in that clinic, we actually took a lot of time in consulting community and looking at best practices to eliminate some of those harms to broader community. It's a standalone site, and people could come there to use pre-obtained drugs in a safe and supervised way.

We do not sell drugs. We do not encourage that. But what we do is make sure that if there is a overdose response needed, we are there to deliver that for those individuals. But it goes beyond that. We actually connect people to care, to treatment, to other social supports. One of the criticisms I think a lot of that some people share with these sites when they were existed, that people weren't necessarily using them physically in the space,

that they would come in, grab sort of the tools in things that they needed, and then they would go out into the neighborhood. Was that what was being seen in your clinics? No, we build a trust relationship so that people understand and can use those services fully. With the closure of that, we no longer have spaces where people are actually using under supervision. we can get rid of the discarded gear that we see out in community. Without, we're losing that. And we're also losing that important connection to additional supports,

up to treatment, medical supports, as well as social supports. Emma, you've come to know and report on the people that we're using in Moss Park at the site there and the staff who work there. Help me understand, how have they been feeling? sort of up to the run-up of the closure of these sites? There's a range of emotions, for sure. The day that the closure was announced, there was a lot of grief. You know, when somebody came through the door, they said, who died?

Because everybody was sitting on the floor. It was very quiet. It was very somber. A lot of tears. People are scared. They're mostly scared for their friends. You know, these are people who experience the rise of fentanyl in the mid-2010s, and they've seen a lot of their friends die.

A lot of people have had their spouses die of overdoses. So there's like this very extreme fear of what will happen. And then since the runway was three months, the site kind of returned to day to day. But there's been, I would say, more mental health crises since the closure was announced. People are feeling afraid for their friends. Some people are trying to make plans for the closure,

but a lot of the way too precarious to really, plan. They're just worried about finding somewhere to sleep tonight. Adam, there's a couple of points that, you know, have been made that I'm sure you want to get in on there. Well, I would argue that this fear for their safety is unfounded because the data clearly shows that these sites do not save lives. So last year in Toronto, we shut down five sites. Well, nine in total, five in March, and then four additional months throughout the year. And fatal opioid rates did not increase at all. In fact, they were at their lowest level last spring and summer than they were since 2019, and they've remained low. So we've heard all of this fear-mongering

about there being an explosion of deaths that these sites close. We closed the sites in Toronto. We didn't see that explosion in death. Furthermore, in Alberta, they closed a supervised consumption site in red deer and then did a study where they compared it with a similar city, and which still had a supervised consumption site. And they saw that there was no increase in mortality, no increase in hospitalizations, no increase in opiate-related ER visits. The evidence-based for supervised consumption sites have always been really shoddy and low, and this evidence base was politicized from the very beginning. Back in 2003, when Insight was opened, the evaluation contract for that pilot program was given to an organization

that employed two doctors who lobbied for Insights creation. And they were tasked with producing the evaluations for Insight, that was clearly a conflict of interest. They subsequently produced over 30 evaluations, all of which were glowing, which then became the foundation for the evidence-based for supervised consumption sites. The RCMP, then around 2006 and 2007, hired their own external evaluator to assess these evaluations, and he found that the studies actually misrepresented the underlying data. We also have another study that was published a pre-version of it, which was published in late 2024,

which looked at supervised consumption sites in Toronto and found that crime dramatically increased within 100 meters, but then when you looked at 200 and 500 meters, that that increase was diluted and was no longer statistically significant because, of course, when you add in a larger area, that dilutes the crime in the immediate vicinity of the site. Then the car reduction researcher.

Sorry, Adam, I want to get Martin in here, obviously. You're not based in Toronto. You're learning London, but help me understand a couple points that Adam made there. I think that when we look at all the evidence that is being gathered, and I think we will continue to look at this very closely as we move forward. I think that when you mentioned the lack of overdose deaths in relation to the closures that have happened, I think we need to also look at other parts of the system that have been picking up those strains.

So when we look at the number of EMS calls, the number of hospitalization, picking up that gap that supervised consumption sites have been delivering, is really important to look at the holistic picture. And I think sometimes we just zero in on one piece and don't look at the whole picture. These will have insignificant impacts, and we've seen it in other studies, in relation to those closures for EMS and emergency services, as well as for many other parts of the system. I'll get you in on there as well.

Yeah, I just think to say that somebody is fearmongering when three years ago they woke up next to their dead spouse to say that they're fearmongering when they say they don't want that to happen again and they're scared. Really unfair comment to make. I've been inside one for 18 months. And I think it's just a really unfair character. characterization to say that those overdoses that are happening in a site like Moss Park where I've been to say they would have no effect elsewhere is just false. Moss Park reversed 62 overdoses just in March and each one of those overdoses it could have been fatal. It could have had a life-changing physical disability as a result of those.

The evidence is just really clear actually that these sites reduce deaths. They reduce other health harms, and they do connect people with services. There's their main that's reduced his drug use from 17 points of fentanyl, which is 1.7 grams a day down to one point because Moss Park connected him to a methadone doctor who actually comes on site and has those appointments with people at a safe consumption site. So those are just a few examples of the ways that the site has improved, not just people's lives, but the whole community. in addition to saving 62 lives just last large. Now we can gather from our conversation here. Many people argue that harm reduction provides important public health benefits, but as Adam mentioned, you know,

neighborhood opposition remains strong in many communities. We can just look at, you know, the one that's been in headlines in 2023, a stray bullet killed Carolina Hugner Macorette near the Keep Six Consumption Treatment Service at Toronto's South Riverdale Community Center. And I want to read a little snippet. This is from a 2024 Toronto Life article that described sort of the community fallout that followed. And it goes, in the weeks after the shooting, two factions had emerged and become entrenched. One side believed that the center had proven it couldn't handle the assignment and that this failure had dire consequences.

How many deaths would be enough? They didn't want to find out. The other side believed that the site's clients had just as much right to the neighborhood as anyone. That, in fact, they had been there long before the new wave of residence and wanted keep six. to stay put. Moving the consumption site away from the health center would cut its clients off from other forms of treatment. With that, Adam, what has been the biggest point of contention for people concerned about safe consumption sites in their neighborhood and communities? Well, people like to feel safe and they don't feel safe when they have violent addicts around

them who are often threatening them and their children. And Derek Finkel, my colleague at the National Post, has reported extensively on this. Stories of, for example, people who are high off of their minds, threatening to burn down houses and emphasizing that they would do so even if there were children inside. People are being threatened by drug dealers. Keep in mind that police are often dissuaded from enforcing the law around consumption sites because they are told this would provide a barrier. Now, we can talk about anecdotes, but once again, I do think that addiction policy should be driven by data. And there was a Montreal consumption site that was opened back in 2024. And what's interesting here is that within 50 meters of the site, emergency calls went up by

1,967%. Within 250 meters of the site, crimes against people increased by 800%, sorry, 93%, and mischief calls increased by 800%. So we have the data that consistently shows, you know, going back to the other study that I cited earlier, that these sites are engines of public disorder. And keep in mind that this is only just reported crime. With that, Martin, can the two sides find consensus in sort of what works, what's currently in place with heart hubs, does that answer sort of some of the questions here, or do you think we're going backwards with the closures here? I think that we certainly are going backwards. And when I say that, it's recognizing that substance use and addiction is really complex. We're talking about two different ends of the spectrum. Heart hubs, definitely,

I welcome them. I welcome recovery. For myself, in my own personal journey, they're a wonderful thing. But at the site where someone is actually in addiction, we need to support them. As one of a close friend of mine who has gone through recovery has said,

where there's a heartbeat, there is hope. I do believe that from the two sides, instead of pitting against each other, what we need to look at is, okay, it's not perfect. So then how do we address some of them, those issues in a really concrete and good way, where community actually speaks and we listen, and I think that's really important around safety concerns and other concerns,

and then mitigate those risks through action. And we've done that in London. I've seen that being worked out in other sites over the time from last year when those sites were closed to today. Emma, with the closure of Moss Park, what comes next? some of the people that you had talked to, obviously, in terms of the timeline when these closures were announced, a short period of window for people who are dealing with addiction, but what did they tell you as to what they're doing next? So the site staff are preparing to continue reversing overdoses, but without any of the tools that they previously had.

So instead of reversing overdoses in a controlled environment with access to oxygen in a setting where they know how much the person used and what substances the person use, these staff are going to be carrying backpacks with naloxone and bag valve masks. And they're going to be just responding to people screaming or banging on the door. They're going to be running at full speed around the neighborhood and reversing overdoses in alleyways, in important. and bathrooms in port-a-potty in those types of environments. And what Sarah Gregg, the director of the site, told me, was that this community has taken care of themselves and each other for many decades. People were reversing their friends overdoses before safe consumption sites existed, and they're going to have to continue.

Unfortunately, there was a real opportunity here to do something long-term, very innovative with addiction to actually continue these long-term relationships and let people build on the progress that they've made over the past eight years. And that opportunity is going to be lost. So really a group of people who are pretty alienated and living very precarious, unpredictable lives are about to become more alienated, more angry at the government, and living more chaotic lives. Adam, what would those opposed to safe consumption sites like to see?

in harm reduction going forward. I think more of a focus on recovery and more of an understanding of the tradeoffs that come with treating people to struggling with addiction. Obviously, we all want people who are struggling with addiction to seek treatment and to survive. No one likes the idea of people overdosing on the streets. However, many people who were formally supportive of harm reduction strategies, who were open to the concept in the late 2010s, found that their empathy was exploited and that they were vilified because they were speaking out about the fact that they felt unsafe. So I think understanding

that there are competing interest here that need to be balanced is important. And I think that there also needs to be more of a focus on evidence. Martin, I'm going to be the last word here in terms of leaving us sort of next steps forward what you would like to see, but also, as you know, there are two sides to this conversation and has been quite contentious from the start of it. But what do you want to leave people with in terms of the conversation that we're having today, but also moving forward. For me, I think that it's not just a two-sided piece. There are other elements for the response that are needed. When we talk about mental health and addiction, we need to look at prevention as well. How are we responding to the increasing mental health and addiction issues that are

presenting themselves? We need more prevention. We need more. recovery. We also need to meet people where they're at in addiction to make sure that they have the opportunity to move forward with their lives. This is a story that we will continue to follow, of course, as we know, this only happened last weekend. I want to thank you, Emma, Martin, Adam for your time and for your insights on this very important topic. Thank you so much. Thank you. Thank you. If you're in Toronto, you may start seeing something new outside your local library branch. a mobile health clinic aimed at connecting more people with primary care. Dr. Andrew Bizarre is the executive director of the Gatsuo Center for Social Medicine.

Ali Velgi, senior manager, adult services at Toronto Public Library, and they both join us in our studios. Great to have you both. How are you doing? Thank you. Thanks for having us. Andrew, let's talk about how did the idea of a mobile health unit come about? So I think there's been terrific work for many decades from community health centers and various community organizations that have been able to try to advance mobile health options to get health care to where people are. So Shareborn Health, Parkdale, Queen West Community Health Center, Anishinaabe Health have had mobile vans or mobile clinics for some time.

And we've been able earlier to partner with some of the organizations to evaluate. Is this something that can work? What we found in the last few years is that the mobile health clinics are incredibly effective at providing the sort of care that can keep people out of resorting to the emergency department. For 37% of the folks who were able to be seen, they said that actually averted an emergency department visit. So there's a longstanding history and evidence base for mobile options, which is really pushing back against the mantra we've had in healthcare is that if you build it, people will come. The reality is for folks who've been marginalized from the system,

who have obstacles and barriers to reach the system, you have to go out to where people are. And so to me, what's really unique about this work and this initiative is the partnership with Toronto Public Library, who I'm the longest standing fan and public fan of public libraries, and I believe they've been the original social medicine hubs. And so to me, it's a really long-overdue marriage

to try to ensure that we are continuing to build a relationship and a connective tissue between hospital and community that will prevent more people from falling through the cracks. All right, we do have some photos of the van that I want to pull up. So this is the exterior of it. You wouldn't know what's inside of it. And we do have a photo inside, just a little bit, a little sneak peek. You can see a bit of a chair set up, sort of what you would see in a regular clinic.

But there's a little bit more in there. Tell me, what are the services that are provided? Tell me what it looks like inside. So it's rather comprehensive. From the outside, you look at it sort of as a usual sort of van. But there was a lot of work in designing the service. space. So as you can see at the front, there's a sitting area. Again, we're trying to rebuild trust with people who can sit, have conversations that are private, again, whether that's around

access to various mental health and addiction supports, or really being able to have a reassessment of where they are in terms of their health care journey. And then in the back of the van, there's a full clinical space, just like where I was working this morning. You've got bed, the blood pressure cuffs, all of the screening tools that you would need to ensure that, you can provide high-quality primary care. And so I think that was a lot of the co-design with people with lived experience of what kind of experience what they want, what kind of setting can be as dignified,

given that you've got some limitations with a mobile clinic, but the importance of it having the ability to provide high-quality primary care. And that's basically all the things that you can access in a clinic office. All right, Allie, the first one, this mobile clinic here is outside the Sanderson Library branch near Bathurst in Dundas and the city's downtown core. Why this location? Yeah, so I think, you know, as libraries overall are open and accessible spaces, and we serve a lot of individuals,

especially those that are looking for social supports and other health supports as well. And this library specifically serves a wide range of individuals, including newcomers, including individuals who are under housed and who are looking for those kind of support. So the Sanderson Library made perfect sense because it was also right next to UHN suggest across. And you know, Andrew and his team did a lot of research as well to identify spaces that needed that extra support. Now talk to me a little bit about sort of the wrap-around services as well, that the library provides that people, once they've, you know, gotten in the van,

done their check-up, what else are we provided? Yeah, for sure. So as soon as they visit the clinic, they're able to come by to the library, they're able to meet our staff where we can find out a little bit more about what they need. Of course, we're going to want to make sure that they get a library card. After that, we'll have a conference. with them to find out what else they need support in. So you might have a newcomer family that is looking for some support, so we'll link them up with the library's settlement partnerships that we have or a settlement agency in the area.

They might be an individual who's looking for work, so we can help them build their resume, we can also help them with the necessary digital literacy skills that they need, or you might get an individual who is lonely and isolated, really need some support, so we might be able to allow them sorry, we might be able to help them find out ways to get online so they can get connected or even join one of our many programs that we have. In terms of the staffing of the van and sort of the role of the library but also the health

workers there, what's the crossover, how many people are actually in the van, and then what's the crossover with staff? So I'll let Angie speak about who's in the van. Yeah, I think you've nailed it. It's about trying to build one team with the library workers that are. I think Ali's mentioned have done incredible work to try to stitch together different options, whether it's from loneliness to accessing income supports. But they also have a good idea of what some of those needs are, of the clients and folks who are in the library.

And so the Sanderson Branch is less than a block away from Toronto Western Hospital. So you could literally throw a football from the door of Sanderson Branch to the emergency department. And so the reality is that there has not. not been that kind of connection and relationship between these two institutions that serve many shared patient populations. And so with the mobile health clinic, it's about having a community health worker, an RN, and nurse practitioner from a primary care piece, but also from the mental health and addiction support that can be there.

And so that's how the teams are starting to integrate. And beyond whoever's on the mobile health clinic service, it's also about being able to call a community health worker as part of the Center for Social Medicine and say, you know, I'm a little bit worried of so-and-so. They've seemed to deteriorate over the last few weeks. It may be worth for a check-in. And then also vice versa. There might be clinical staff or folks who are working at the hospital or at the center. Say, well, what kind of supports could be there from tax support to housing support to, again, loneliness and isolation, which can't be effectively or fully addressed in the clinical setting or inside the hospital walls. Why is this needed now? I know. This is

not something that just you guys put together in a couple months. It was a couple of years in terms of the process here. But just knowing that, you know, what Andrew talked about, the libraries being this hub, I'm sure you guys noticed that this is a great idea. This is something that we need now. But why now? Yeah, for sure. I mean, I think we are always facing, you know, individuals who are looking for those kind of supports, and we're always doing our best to be able to refer them to other agencies. So I think the timing was perfect where we were finally able to bring those services into our spaces, allow them to meet supports in a safe and welcoming environment, and then being able to support them in whatever else other way we can.

As I was going to say, Andrew, I think a lot of people will see this clinic and also see the timing of funding being pulled from safe injection sites, safe consumption sites, and I think a lot of people will make those connections. But as you mentioned, this has been in the works for a couple of years, but why now? Or is that timing kind of a good thing? Look, I think that the timing is urgent wherever you look across the system. We know that there are millions of people who can't access primary care in Ontario and again across the country.

That's been a real challenge. And fundamentally, I would say if we believe in a universal health system, you need strong primary care as the bedrock of a high performing system. And we believe in universal health care. I think that's what we continue to hear from people across the country, from people in the city. And there have not been enough options that have been. able to go out and again really partner with community and be able to ensure that there's access. So one, I think that is fundamentally important in delivering on our promise of universal

healthcare. Two, I think the other realities are that we are facing a toxic drug overdose crisis, that there have been far too many lives lost. And we look at some of the most recent data from Toronto Paramedic Services, there's been a doubling in the amount of non-fatal overdoses, the amount of calls to EMS. And as Ali mentioned earlier, I mean, this is an intersection at Bathurst and DHS. that has seen increasing poverty. We've seen a doubling in homelessness in the last four years in our city, probably a tripling just around the Toronto Western. And so we need a real

concerted approach. We need different responses. Mobile health clinics by themselves alone are not going to solve the primary care crisis or the toxic drug overdose crisis. But I think it's finally starting to learn both from community, from our partners, from the needs of patients about trying to mobilize options that have been denied for far too many people. I think it's a fantastic idea. I wish we did it sooner. I think you gentlemen. I would agree.

Yeah, gentlemen, I want to thank you so much. Keep doing the great work. I really appreciate your time. Thank you. We appreciate it. I'm Jan. Thanks for watching The Rundown. We'd love to know what you think of the show.

So send your suggestions and feedback along to rundown at tbO.org. Or as always, you can leave us a comment on our YouTube page. Until then, I will see you tomorrow. If you're enjoying this series, please consider supporting TVO with a donation to make more insightful and thought-provoking podcast possible. TVO is a registered charity, and you will receive a tax receipt for your gift. Visit TVO.org slash give TVO to make your donation today.