SIMCOE — First there was one. Then, three years ago, another appeared. And when rumours started circulating earlier this year that a third methadone clinic was going to open in downtown Simcoe, local councillor Peter Black decided it was time to do something to keep it out of his downtown.
Black had heard an earful of complaints from downtown merchants in the community of 14,000 about the clinics that prescribe and dispense methadone and Suboxone to help people break addictions to opioids such as heroin. (The drugs are opioids that relieve withdrawal symptoms and reduce drug cravings but don’t produce a high.) The merchants complained that large groups of people were loitering and deterred customers from visiting their businesses. Needles and other drug paraphernalia littered the ground. One business, a paint store, moved to another location.
“Socially, it’s the right thing to do to help these people get to get off of their drug addiction,” Black says. “The problem is, the business people are frustrated because the community is already [struggling]. There is little traffic in the downtown and now you’re driving people away because they don’t want to shop in the downtown with people of this nature.”
Across the province, municipalities have been debating what to do with the methadone clinics clustering in their downtowns as Canada’s opioid addiction crisis deepens. Federal experts estimate that opioid deaths across the country will exceed 4,000 this year, an increase of 40 per cent over the 2,861 deaths that occurred in 2016.
Opioid addiction rates are especially acute in the region. According to Haldimand-Norfolk HealthUnit, in 2016, the two counties that make up its coverage area ranked second out of the 36 public health unit areas in the province for opioid-related deaths and together they ranked first out of 49 regions in terms of the number of people who were being prescribed high-strength opioids.
Meanwhile, despite the prevalence of opioid addiction locally, Simcoe’s two clinics are the only facilities in Norfolk’s 1,600 square kilometres where people can obtain prescriptions for methadone and Suboxone.
Both facilities are privately owned — as are the majority of methadone clinics in the province. Provincial financial incentives introduced in 2011 encouraged doctors and pharmacies to deliver opioid replacement therapies, and created a boom in the number of OHIP-funded facilities.
At the two Simcoe clinics, most patients receive daily doses of methadone. The facilities provide other supports, too, including referrals to social services and counselling. Most clients already live in Simcoe, the county’s most populated community, but the clinics’ ability to prescribe methadone makes them a destination for people from across the county.
Black had hoped to convince council to impose a temporary ban on new clinics, to give the municipality the breathing room to establish zoning bylaws. (The discussions involved locating any new clinics on the outskirts of Simcoe rather than downtown.) Controlling clinic locations through zoning was the route London, Woodstock, and Tillsonburg had taken.
As Norfolk county council learned this month, however, wielding municipal legislation to control the location of clinics might be illegal. In a 2015 report, a former Human Rights Commissioner wrote that bylaws targeting methadone clinics would contravene the Ontario Human Rights Code.
Despite the dubious legality, Ontario municipalities are using zoning laws to regulate opioid clinic locations.
Medical clinics and pharmacies, regardless of their specialization, are typically lumped together under the same designation for the purposes of municipal zoning, so a methadone clinic typically doesn’t face any special challenges from a zoning perspective. To obtain tighter controls over the clinics, however, many municipalities have established a separate zoning class for them. The approach opens the development to greater public scrutiny and allows municipalities to establish specific rules developers of the clinics must follow to obtain rezoning approval.
Carol Strike, a public health professor at the University of Toronto and one of the authors of a recent study probing the practice, says this has become a “common tactic by some governments to try and push methadone out of their centre core either because of revitalization or because of public nuisance problems.”
For example, from 2012 to 2015, London added new zoning bylaws, changed definitions in its official plan, and added licensing for methadone clinics and pharmacies that dealt with more than 40 people a day. The city required the clinics and pharmacies to be located at least 300 metres away from schools, libraries, public pools, arenas, and the city’s Western Fair. London also mandated that space be allocated to a waiting room, that the facilities provide adequate parking, and that owners supply a planning impact analysis.
John Fleming, London’s planner, justified the approach in a 2011 report by noting the facilities “have the potential to generate land-use impacts,” such as parking congestion, lineups on the street, and loitering, all of which create problems for pedestrians, have the potential to attract criminal activity, and encourage excessive littering (littering from a clinic can include cups, needles, and gel packs).
Gregg Barrett, manager of long-range planning and research for the city of London, says one of the two applications made since the changes were introduced was refused because it didn’t meet the criteria. He describes the strategy as successful; he notes that the bylaws provide an exemption for clinics and pharmacies that deal with up to 40 patients, which has encouraged services to be dispersed throughout the city “to where there’s a need and it’s at a lower level of intensity so there weren’t the same issues or the same concerns.”
In the University of Toronto study, however, Strike and her colleague, Miroslav Miskovic, found that clinic location bylaws meant addicts trying to kick their habits have to travel farther to get help. When Quinte West in eastern Ontario imposed a year’s ban on the establishment of new clinics and dispensaries in Trenton, for instance, it meant people living there had to drive half an hour to Belleville or more than an hour to Peterborough.
More worrisome, the study says, is the provincial government’s silence on the municipalities’ rule making. The failure to pursue the issue “may constitute discrimination against people with addictions, who are protected by the Canadian Human Rights Code,” assert the study’s authors.
- Cottage country’s secret drug problem
- Harm reduction in a region the size of Sweden
Back in Norfolk County, councillors decided in early December not to take any action for now. Mat Vaughan, the county’s senior planner, says council was reluctant to tread on the toes of the code. “At the end of the day, they have to follow provincial policy,” he says.
For his part, Vaughan disputes the perception that clinics impede downtown revitalization. “There’s no indication [from Norfolk County OPP] that crime rates have gone up as a result” of the clinics, he says. “There may be more people hanging around outside, but that’s not always necessarily a bad thing. It’s downtown; you want people downtown.” And removing a necessary assistance program won’t revitalize downtowns. “There are a number of reasons why downtowns in rural Ontario are struggling right now, and it doesn’t have anything to do with opioid replacement therapy clinics.”
Vaughan says there has been criticism locally of council’s decision not to proceed with a bylaw. Some people are confused about what can be achieved through land-use policy. Others are confused about what a methadone clinic actually does. Some people mistakenly believe it’s where people go to take the drug crystal meth, he explains.
Black acknowledges Simcoe’s downtown problem is not methadone clinics. The downtowns of both Simcoe and Delhi — the county’s next-largest community, with a population of nearly 4,200 — are economically challenged and need some sort of incentive system and overall plan for redevelopment, he says.
Downtown Simcoe’s two clinics — located a mere 90 metres apart and within view of each other — prompt different responses from nearby merchants. Cam Carter, owner of a clothing store, says he understands people need help but “absolutely” would like to see the municipality take greater control over clinics’ location. The existing clinics are too close together, and one is on the main street, he says. He’s shortened his evening hours because customers don’t want to shop at night and staffers are nervous about staying later.
Tiffany Niece, who recently opened a gift store next to one of the clinics, is less inclined toward municipal regulation. No one loiters, she says, and the clinic tends to be busiest in the morning when her store isn’t open.
William Brown, who owns the Water Street Clinic, didn’t offer a perspective on whether municipalities should be able to control a clinic’s location, but did say there may be some benefits to municipalities controlling the number of clinics within their borders. At any rate, he says, “The number of clinics is not necessarily consistent with the need.” Brown notes that Brantford is home to five clinics while Milton, a slightly larger city, has just one.
Simcoe could also get by with a single clinic, Brown adds. After he acquired Water Street from its previous owners in 2014, former employees established the town’s other clinic, Water Street Medical Clinic and Hope Pharmacy.
Strike, the public health researcher, insists the opioid crisis is too broad an issue to be solved through municipal regulation: “Communities, politicians or sometimes residents seem to think that if you push methadone out of the centre core or out of other busy areas that the problem will go away. But it doesn’t.”
This is one in a series of stories about issues affecting southwestern Ontario. It's brought to you with the assistance of faculty and students from Western University’s Faculty of Information and Media Studies.
Ontario Hubs are made possible by the Barry and Laurie Green Family Charitable Trust & Goldie Feldman.
May we have a moment of your time?
Our public funding only covers some of the cost of producing high-quality, balanced content. We depend on the generosity of people who believe we all should have access to accurate, fair journalism. Caring people just like you!
Get Current Affairs & Documentaries email updates in your inbox every morning.