Over the past two years, there has been a heated debate about the closure of overdose prevention sites, not just in Alberta cities such as Red Deer, but also in Toronto and Ottawa. Such supervised injection sites — increasingly seen as hubs of crime or disorder and often dropped into neighbourhoods with high concentrations of social services — have become so unpopular that relentless campaigns opposing new sites have made headlines in Winnipeg and Montreal as well.

On Tuesday, a striking new study about injection sites was published online in the scientific journal Addiction, which is likely to raise further questions about the evidence Health Canada and others have relied on to justify drug policy decisions that often override community safety concerns.

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There are two unique elements to this study. First, the study focuses on an overdose prevention site (OPS) in Red Deer that was closed at the same time as four sites in Toronto, on March 31, 2025. It studies several outcomes between June 30, 2024, and September 27, 2025, and compares six months of data after the closure to what happened in the months prior.

Second, this study relies on data linked to the provincial health-card numbers of the clients using the Red Deer OPS. In 2024, Alberta became the first province to link injection site clients to their provincial health numbers. As a result, the study’s 11 authors believe this is “the first Canadian study to assess the effects” of an injection site closure “using individual-level, linkable administrative health data.”

While some of the authors are affiliated with various departments at the University of Calgary, all but one have an association with the Canadian Centre of Recovery Excellence (CoRE), a Calgary-based research organization that receives funding from the Government of Alberta, albeit not specifically for this study, which the authors say it was not involved in.

The analysis includes 381 clients at the Red Deer site and 300 clients at an OPS in Lethbridge, which remained open during the months of the study and is comparable to Red Deer “in terms of population size, median income and Indigenous population proportions.”

The findings are fascinating. For starters, there was no increase in deaths among Red Deer clients after the site closed, a finding that pokes holes in the claim that these sites save lives over time. What’s even more remarkable is that, unlike Lethbridge, the highly potent drug carfentanil caused more than half of Red Deer’s overdose fatalities, which could easily lead one to hypothesize deaths would increase post-closure — but they didn’t.

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While there was a slight increase in inpatient hospitalizations for the Red Deer clients after the OPS closed, the number of emergency department visits and “opioid-related EMS events” remained stable, countering oft-used arguments that injection sites provide relief for emergency departments.

Health Canada and other injection site proponents are also fond of citing the number of referrals such sites make for addiction treatment, detox and other services. But another revelation from the CoRE study has to do with the relationship between overdose prevention sites and demand for treatment.

Before the Red Deer site’s closure announcement in September 2024, the amount of Opiate Agonist Therapy (OAT) medications dispensed in Red Deer was lower than in Lethbridge. After the closure announcement, however, weekly OAT dispensing increased markedly until the site closed.

By then, the number of Red Deer clients seeking OAT treatment “exceeded those in Lethbridge.” The study is reluctant to ascribe causation — that closing an injection site created an increase in demand for treatment — but the authors do assert that the finding “underscores the importance of examining how changes in harm-reduction service availability may influence treatment-seeking behaviour.”

Harm reduction proponents might be tempted to minimize or dismiss this study’s findings based solely on the fact that it only analyzes a 15-month period. That would be an interesting gambit, given the fact that a much-publicized study claimed that injection sites in Toronto caused significant decreases in overdose deaths by comparing just three months in 2017 with the same three months in 2019.

That study was heavily criticized by several expert witnesses in litigation initiated by a Toronto injection site in late 2024 for cherry picking months in 2019 that coincided with the lowest number of overdose deaths in Toronto for years.

Last week, CTV News published an article with a headline that harm reduction activists across the country pounced on: “Drug overdoses in Toronto up nearly 50 per cent since last January, city data shows.”

The party to blame, in their view, of course, is the Ontario government for closing injection sites a year ago. But if you look at the data the story was based on, the activists’ I-told-you-so’s are wildly off the mark.

While there was a rise in emergency service calls for non-fatal overdoses in December and January in Toronto, responses to fatal overdoses between January of last year and this year remained consistent. The number of fatal overdoses this January, 12, was in line with the monthly average for 2025 (11).

Overdoses did not spike when four injection sites in Toronto closed on March 31, 2025, as harm reduction proponents had repeatedly warned they would. In fact, according to the Toronto Overdose Information System, monthly fatal overdoses have been lower every month since the last month those now-closed sites were open (May being the only exception; it had the same number as March 2025).

As for calls for non-fatal overdoses, those remained below or (briefly) on par with 2024 data for eight months after the closures. When predictions that fatal overdoses would skyrocket as soon as some sites in the city were closed didn’t materialize, harm reduction activists were quick to chalk this up to a less toxic drug supply.

Which raises a question: If some are going to argue that a drop in overdoses for almost a year has no bearing on the effectiveness of now-closed injection sites, is it not a tad problematic and hypocritical to now blame Toronto’s jump in non-fatal overdoses on the closure of the sites eight months after the fact?

To some extent, these misguided efforts to selectively declare causation between overdose data and injection sites are born from the fissures in the foundational research underlying supervised injection sites. If there was one irrefutable fact to emerge from the 2024 Charter litigation in Toronto, it’s that the science on injection sites is far from settled.

Recent disclosure from a freedom of information request to Health Canada reveals that, in November 2024, when the government body decided to renew the federal drug law exemption required for the injection site operated by Toronto’s South Riverdale Community Health Centre, it did so even though more than 200 of the local residents and businesses surveyed were overwhelmingly opposed to the site’s continued operation.

What reasons did Health Canada offer for overriding such comprehensive community feedback? In a talking-point memo it prepared for the minister of mental health and addictions at the time, Health Canada considered injection sites an “evidence-based” service that “reduced drug-related harms” and improved “the health of drug users” by referring them to treatment and other services.

Health Canada may not have examined the evidence that carefully. A 2021 review of studies on injection-site outcomes found only 22 such studies (not a deep evidence base). Nineteen of these studies were about one site in Vancouver (16) and another in Australia (3); most were considered only fair in terms of quality.

Neither of the two sites was located near schools or daycares; both were in areas of overwhelming need with minimal services, and the studies were largely based on self-reporting by clients who used the sites.

The Addiction study’s findings also have relevance to an injection site in Ottawa that Health Canada renewed the drug law exemption for last year, despite community complaints about crime and disorder from a wide array of stakeholders.

The director of the site, in Ottawa’s Sandy Hill neighbourhood, sent out a letter to stakeholders last week, advising that Health Canada had renewed its drug law exemption again — this time for one year. Interestingly, the director, Dean Dewar, writes that this renewal “provides needed stability as we continue our work with the Ontario Ministry of Health on exploring an alternative model of service.”

An “alternative model of service” means something other than an injection site. If successful, hopefully this site will be cognizant of the positive “shifts in engagement with evidence-based treatment” the Addiction study found with pending closure and the “low-barrier treatment pathways” it recommends are “widely available” during the transition.

Derek Finkle is a Toronto-based investigative journalist.

© Calgary Herald