TORONTO – People were dying on the streets here. The city was losing its citizens to heroin overdoses at a rate like never before. Fentanyl, a lethal synthetic painkiller, had made its way into the drug supply and was killing with grim efficiency.
But almost as quickly as the death toll spiked earlier this year, advocates and city leaders who had successfully pressed for the opening of three safe-injection sites realized they could not wait the months it would take to open them.
So they led. And this Canadian city followed.
A pop-up safe-injection site in a city park has since saved the lives of 100 people. And an interim injection site at a downtown needle exchange quickly saved five more lives – and supplied hundreds more with overdose training or treatment referrals.
In short, they treated an emergency like an emergency.
The death toll that had so alarmed Toronto? 179.
This year, in Philadelphia, the dead are expected to number more than 1,200.
Any death is a catastrophe, but Toronto treated it as such.
I traveled there this week to see firsthand the kind of safe-injection sites that Philly activists have long been fighting for.
I walked to Moss Park on Monday night, where the pop-up site sits – three tents in a downtown park next to a hockey arena, in a few-block stretch that's long suffered from poverty and drugs.
Inside the injection tent, a father and son sat together, shooting heroin. The son, Dylan Alward, 19, looked like death. That's because Dylan had nearly died the night before. He had found a needle – a "rig," they call it here – in his father's jacket loaded with Carfentanil, the ultra-deadly synthetic, 100 times more powerful than fentanyl. He shot up in the bathroom of the hostel where they were staying.
That's where paramedics restarted his heart. Now, his father, Leon "Poppy" Alward, had brought him to the safe-injection site. He had been shaken by his son's overdose – and so had Dylan, enough to finally agree to seek treatment. Suboxone. But first, he wanted one last hit. His father wanted the teenager to shoot up somewhere he could walk out of alive.
"This is security," Poppy said of the site. "This is a mother's arms."
Volunteers of the Toronto Overdose Prevention Society opened the camp without official permission in August, amid the rising deaths – and what activists saw as the provincial government's foot-dragging.
"We kept telling them we're burying more people," said Zoë Dodd, 42, an impassioned woman who wears her long black hair in a bow as she works the tent. Dodd cries when listing the names of friends and colleagues and clients lost in the last year to overdoses –and also when thinking of all the lives saved at the camp.
"We just did it," Dodd said of the pop-up. " 'This is a spot where people are dying. Let's just pick this spot – let's just go to the park and open up tents.' "
They had a point. Vancouver, which has long battled the addiction crisis, opened a safe-injection site nearly 15 years ago. And there have been other pop-ups in other Canadian cities. The evidence is clear: These save lives (no one has died in a safe-injection site, anywhere in the world, ever) and usher more into treatment, while not increasing crime or drug use. Montreal opened three in June. Toronto had long ago embraced other harm-reduction methods, such as expanded access to Naloxone. And the city has 47 needle exchanges, where Philly has one.
Still, opening a safe-injection site in Toronto took some doing — a citywide education campaign, outreach efforts in prospective neighborhoods, town-hall meetings.
But the city got on board. So did the police, and city council members.
"People said, 'Yes, in my backyard,' " Councilor Joe Cressy told me. Cressy, who represents downtown Toronto and chairs the city's drug strategy, led the push for the sites. Why did business and neighborhood associations come out in overwhelming support?
"Because there was already drug use in neighborhoods – needles in the parks, and in the restaurant and library restrooms," he said.
Mayor John Tory told me he was troubled by the idea at first. But his mind changed after talking with frontline workers and people in addiction who would be kept alive by the sites.
"We will come down as a city on the side of preventing deaths," the mayor said.
Council approved the experiment almost unanimously. "Hardly a ripple," Tory said.
Even then, funding was slow to come.
So Dodd and the other advocates acted on their own.
There's a tent with food and water, and a "chill tent" for people to sit in after they inject. Outreach workers don't push. They are there to build trust and help anyone wanting help.
Photos of friends gone from overdoses line the walls, hung from tourniquets people use to expose a vein. A nurse observes.
At the injection table sat a rail-thin 27-year-old man, who asked to be referred to by his middle names: Robert Johnson. Hard hat from his construction job at his feet, he prepared a shot of heroin. He has overdosed in the tent twice.
"This place," he said, "is literally life for me."
Since August, volunteers have used naloxone to revive 36 people. Add those needing oxygen to reverse an overdose, and the number climbs to nearly 100.
"It shows how little it takes to offer a tiny bit of safety," said Bernadette Lettner, 36, a registered nurse volunteering Monday night. "We have a folding table and a light in a park and nobody dies here."
Some neighbors aren't happy, like Vincent Gray, who owns the antique shop across the street. He said he gets that they are trying to save lives, "but do it somewhere else."
Zoë Dodd isn't too concerned. "What's more important – backlash or human life?" she asked. And that's a very Zoë thing to say. At a town hall, she lit into Prime Minister Justin Trudeau – and berated a health minister to tears. She's holding up a crisis – and it's working. The mayor visited, talking to a 42-year-old woman named Angie Austin as she injected fentanyl into her jugular.
And this week, in what the advocates marked as a historic occasion, Ontario's premier visited the site, sitting on the floor of an injection tent for almost two hours, listening and watching.
It took only seven days after the pop-up opened for city officials to follow in the activists' steps.
They opened an interim site at the city's main downtown needle exchange, The Works.
For now, they are operating out of a makeshift space in the needle exchange, while the new injection site is being constructed in a storefront next door – a homier, more-welcoming space, with hardwood floors, flowers, and muted light from the windows, and a large lounge where people can talk with outreach workers about services or treatment or just a plan to get through the night safely. It will be a dignified place, said Shaun Hopkins, who runs the needle exchange. One that will draw people in, keep them alive.
The plan is simple: All three sites will be located in health centers already providing harm-reduction services. Before, they were sending people off to use poison in the shadows, where no one could save them. Now they can do everything they can to save those same people.
It would be naïve to say the politics surrounding safe-injection sites in Philadelphia are the same as they are in Toronto. It would be the first in our county. But we must go from talking about saving lives to actually saving lives — and now. It is far past time for elected leaders to get the city at large on board. In our growing crisis, we praise individual life-savers – like outreach workers and Kensington librarians who rescue with naloxone. But we look at safe-injection sites, essential life-saving factories, and say, "It would cause too much trouble."
Toronto stepped up. Meanwhile, 1,200 people go to their deaths in Philadelphia, and we're still talking.
Safe-injection sites are no magic cure, but they have to be part of our strategy when we are saving, shamefully, so few. When we still fail to treat an emergency like an emergency.
In Toronto, I sat outside the interim safe-injection site with a man named Danny Wilson. He had been coming to the place since it opened. He likes using with a nurse around – he likes the company and support of the staff. He was so happy to have turned 50 a few days, he said. He never thought he'd live that long.