It’s been a tough road for downtown merchants located on Sault Ste. Marie’s Queen Street. The Station Mall, entry of corporate retail outlets, online purchasing habits and an exodus of businesses and services to Great Northern Road have contributed to declining patronage in the downtown. The gristliest of business owners have hung in and a few newcomer businesses have joined the crusade to restore Queen Street to the once vibrant and bustling main street it once was –and still can be.
Seeking an increase in private sector investment to invigorate the downtown core, the Sault Ste. Marie Downtown Development initiative obtained grants that provided funding for interior renovations, structural upgrades, façade improvements and professional design service as well as providing for tax rebates for large-scale investments.
However, some Queen Street merchants have expressed that revitalization efforts are cramped by an unwelcome neighbour –the Ontario Addiction Treatment Centres (OATC) Sault Clinic located on the corner of Queen Street and Spring Street. The clinic provides a methadone treatment program for people who have voluntarily sought out the resource to break free of opioid and opiate dependency.
Marnie Stone, owner of Stone’s Office, expressed concern that the presence of the clinic is counter-intuitive to the undertaking to bring the downtown back to life. “We’d love to have a conversation and know more about what is going on and perhaps work together so it’s a benefit for both the client of the clinic and downtown merchants because it’s certainly not sending the right message as to what the downtown and your main street is all about. You would never, ever see a clinic like that on the main street in Traverse City or Petoskey. And I think it sends the wrong message and the wrong vibe to what we are trying to create downtown.”
Stone is not the only business owner that feels this way.
Terri Williams is the owner of Body First, located in the Paul Mall on Queen Street. “I’m down here every day,” shared Williams. “I have clients that are afraid to walk down Queen St. There’s so many that are messed up- they’re out there smoking their faces up, they’re in their pajamas, their dogs are pooping. They’re on Queen St. And it’s not just them. We have a lot of street people that beg on Queen St.”
Jill Zago, owner of Stonehouse Wines, also remarked, “My thoughts are is it possible to start a dialogue with the downtown merchants who are concerned with what is happening in front of the methadone clinic with the loitering and the needles, that sort of thing. And how it appears to people working downtown or a tourist. It’s a matter of what we can do to work together to make people more comfortable especially for those walking through the area at the time those appointments are happening in the clinic. The patrons do stand out front and there is language and cigarette butts, there’s needles and it’s just uncomfortable. It’s not fair to the businesses on that block.”
May works at the OATC clinic and was mystified that needles had been discovered in front of the clinic. “We do have to sweep up cigarette butts but I’ve never heard of needles being found in front of the clinic. I’d investigate if we had.”
Duane Moleni, executive director of the Downtown Association has received one or two complaints about the clinic from downtown merchants. “It’s not really the priority concern among the merchants,” commented Moleni.
As far as concerns regarding the outward presentation of the clinic Moleni has suggested practical fixes by the municipality such as the placement of garbage cans, containers for cigarette butts and bike racks. Otherwise, Moleni is encouraging everyone to try and get along. “I’d like to open up discussion around this public space and look at how we might accommodate everyone without making anyone feel singled out or not welcome. The downtown is meant to be an inclusive place. Not a place where others are excluded.”
So what’s the big deal with opioids, opiates, methadone and methadone treatment clinics (MTC)?
Opioids are a family of drugs that have morphine-like effects. Opioids are synthetic or partly-synthetic drugs that are manufactured to work in a similar way to opiates. Their active ingredients are made via chemical synthesis. Opioids may act like opiates when taken for pain because they have similar molecules. Opioids can also produce euphoria, making them prone to abuse.
Opiates are alkaloids derived from the opium poppy. Opium is a strong pain relieving medication, and a number of drugs are also made from this source.
Experts have noted that dependency on legal, prescribed opiate/opioids is even harder to kick than a heroin addiction. And of course opiate/opioid dependency is non-discriminatory – it’s the kid on welfare, the business man on Main Street, the stay at home mom next door, your grandma and it’s every colour of the rainbow.
Dr. David Marsh is the Chief Medical Director with the OATC and oversees the methadone clinic on Queen Street.
“The increase in opioid dependency has been a problem throughout Canada for the past 15 years and is to the point where opioid related overdose deaths in Ontario, Alberta, B.C. and some other provinces now out numbers motor vehicle accident deaths,” remarked Dr. Marsh.
“Opiates have become much more available as physicians are prescribing them for treating pain,” continued Dr. Marsh. “Depending on what measures you go by, Canada ranks first or second in the world for the consumption of prescription opioids. Physician prescribing has gone up 10 fold in the last 20 years. There are much more opiates available and that’s led to more people being dependent on opioids and more people having a problem with them.”
A report by the Globe and Mail shows a 23% increase in the prescribing of opioids in Canada over a four year period. In 2010, 17,542,822 opioid prescriptions were dispensed compared to 21,716,832 prescriptions in 2014. The same report indicates that 200,000 Canadians are addicted to pain killers.
Experts have noted a resurgence in the use of heroin when acquiring prescription drugs becomes too expensive or too difficult to find. Heroin is readily available, cheaper and more potent than ever before.
Methadone, a long acting synthetic opioid agonist, has been identified as a successful treatment for many people dependent to opioids. But methadone treatment is not a new practice. “It’s been available in Canada since 1959. In 1972 the Federal Parliamentary Commission recommended that methadone be expanded across,” remarked Dr. Marsh. “This is a treatment that has been around a very long time. It’s been well studied scientifically.”
Methadone is delivered orally -not via injection, typically mixed with a sweet drink and curbs withdrawal symptoms including anxiety, restlessness, runny nose, tearing, nausea and vomiting. Methadone also diminishes the euphoric effects of other opioids making it less likely that people will either use illicit opioids or overdose. At the onset of treatment use of methadone must be supervised. Depending on the methadone program supervision could be provided by a physician or another healthcare professional such as a pharmacist.
Methadone treatment can be delivered in a range of settings but in Sault Ste. Marie people seeking release from opioid dependency can access one of two MTC’s –the methadone program at Algoma Public Health (APH) or the methadone program at the OATC Sault Clinic on Queen Street.
Sandra Byrne is the program manager of APH’s Community Alcohol and Drug Program. Of their methadone maintenance program Byrne spoke about the isolation experienced by many people who have a dependency on opiates and opioids. Developing support and social networks during their treatment is an important factor contributing to the individual’s recovery and maintenance success.
Remarked Byrne, “Methadone requires you to have a contract with a doctor so now you’re seeing a physician once a week. They are engaging with other health professionals throughout the week and receiving their methadone treatment at a pharmacy. So now we’ve added at least three healthcare professionals to their life that want to help them.”
The methadone program at APH also provides individuals with an opportunity to access counselling and supportive groups as well as ‘one-stop’ options. “Often we can just walk someone down the hall to speak with someone who can address other needs like dental, sexual health or housing.”
Byrne adds, “I think it’s important to mention that the methadone program is voluntary- not mandatory. This is a person who is willing to come in and look at using a medication to help make some kind of change in their life.”
The College of Physicians and Surgeons of Ontario reports that, as of July 2015, there are 474 providers who care for 42,000 methadone treatment patients. In Sault Ste. Marie, APH serves 30-40 patients in their methadone treatment program and at the OATC Sault Clinic the number of people receiving support fluctuates between 300 -400 patients.
According to Dr. Marsh, “It’s a significant number but it’s also significant in the sense that it doesn’t fully meet the need of people in the community. We’re trying constantly to improve our service so that we can provide access to people who need help. But the need in Sault Ste. Marie and around the province has been steadily increasing. The counselling aspect of opiate dependence treatment has not increased in line with the increased need in the province and the country. That’s one of the components of care that is more difficult to access.”
Health Canada reports myriad benefits associated with methadone maintenance treatment that include: reduced criminal activity; improved family stability and employment potential; reduced or stopped use of other opioids and other illicit substances; reduced risk of overdose; reduced risk of acquiring or transmitting HIV, hepatitis B or C; and reduced mortality rate.
So MTC’s sound like a great thing right? As Moleni remarked, “People are trying to come off drug use so is that clinic not serving a fantastic service in this community to help people come off drugs so they can be healthy and contribute to the community in a way that is positive?”
Well, not everyone would agree with Moleni. Williams doesn’t agree and didn’t have a problem expressing her thoughts about the methadone clinic on Queen Street and those that access services there.
“Who the heck wants a methadone clinic in their backyard? I don’t,” stated Williams. “I think if there is anything worth doing for the downtown core the clinic should move. Just relocate it. I don’t know where- even if it was Albert St. There’s a building there that’s empty but it’s near a church. But the church will have something to say about it. They won’t want them next door. Nobody wants them next door. They need to be in the middle of a field somewhere. They need to be somewhere semi-secluded- somewhere where they aren’t going to put the fear factor into people. Maybe they can put it next to the Soup Kitchen? Then they could go and eat after they get their fix. They’re fine if they’re medicated when they come out. But what are they like when they’re going in?”
The Downtown Dialogue in Action initiative was a massive undertaking led by NORDIK Research Institute and the Sault Ste. Marie Police Department. Upwards of 300 participants took part in the research process. “Participants represented a wide cross-section of ages, genders, institutional affiliations, ethnicity, and abilities among other demographics, and included residents, businesses, social service providers, and equity seeking groups.”
Among the many findings produced by the research it was found that participants expressed an urgency that mental health and addiction services “be accessible and remain in the downtown to better address the needs of those accessing these supports”.
Researchers also noted that participants who utilize the services at the methadone clinic on Queen Street have experienced stigma and discrimination. Researchers noted in the final report that, “Those accessing services can be less inclined to do so when they experience discrimination and shame for doing so. Working to reduce stigma and discrimination through education and advocacy can help create a safer environment for those coping with mental health and addictions issues, thus increasing chances for success and fostering positive, supportive relationships.”
Negative perceptions about MTC’s and their users are not uncommon universally or at home. Business owners have indicated that they are worried that potential customers might stop coming downtown or to the Queenstown block that hosts the clinic.
“I want to stress that I’m not criticizing the people that are going to the methadone clinic. I have a lot of respect that there is help out there and that they are getting help. I’m certainly not accusing anyone patronizing the clinic of being criminals. That’s not a fair assumption to make,” remarked Zago. “It’s just a matter of balancing that and where they are located. And being respectful of surrounding businesses. It’s more about the culture and creating a downtown atmosphere that is inviting and not asking the methadone clinic to move.”
Of the reaction by pedestrians to the methadone clinic and clinic patients, Stone remarked, “It is scaring people. People are afraid of them. People don’t walk on that side of the street. They are fearful. People are afraid. And then we are also having to deal with the thefts. I chased a gal out of here that took a printing machine right off the shelf and chased her to the methadone clinic. So were having to deal with those things- the thefts that are taking place from it.”
Participants who access services downtown identified in the Downtown Dialogue study that they were aware of the beliefs people held about who they were. The researchers noted, “Other participants also identified the issues that people experiencing poverty, addictions, and mental health issues are being associated with crime whether that is the case or not. This was consistent with our survey and media review findings where several people said that they felt unsafe when someone had asked them for spare change in the downtown, while others attributed crimes in the downtown to youth and methadone clinic users.”
Emotional responses to MTC’s and their patients have spurred much research on the matter.
A study of MTC’s in Baltimore, Maryland looked at the incidents of crime that occurred within a geographical proximity to the clinic. Researchers evaluated crime around 13 MTC’s and 3 types of control locations- 13 convenience stores, 13 residential points and 10 general medical hospitals. Findings demonstrated that “there was no significant geographic relationship between crime counts and MTC’s or hospitals”. Findings also showed that the crime counts were higher closer to the location of convenience stores leading researchers to conclude, “Methadone treatment centres, in contrast to convenience stores, are not associated geographically with crime.”
Likewise research conducted in Sydney Australia with 304 patients attending methadone clinics shows that criminal activity among patients with a previous history of crime decreased. “Crime during methadone treatment is substantially lower than during street addiction, although the extent of reduction depends on the quality of treatment being delivered.”
A study conducted in 1981 looked at measurable consequences among MTC patients from three clinics. For patients with a history of crime it was found that 1 year prior to treatment patients spent 31.3% of their time (days) involved in criminal activity and after 1 year of treatment that percentage dipped down to 12%. Similarly, those who sold drugs prior to 1 year in treatment invested 57.7% of their time into the activity and 1 year after treatment – 27.3%. For those patients who were incarcerated, 1 year prior to treatment 31.7% of their time was spent locked up, after treatment- 6.7%.
Dr. Marsh commented of the common concern that society holds of MTC’s and service users, “I don’t think a lot of people in these communities are aware of how these drug problems have expanded so dramatically in Ontario and Canada. If there are more and more public disorder problems related to drug use then methadone is the answer and not the cause of that. This is a treatment that helps save lives, saves money for the healthcare system and it helps improve the lives of patients who were previously struggling with drug problems.”
Stone and Zago emphasized that they are not seeking to banish the methadone clinic from Queen Street but they are looking for a dialogue among other merchants and service providers at the clinic. They have also offered some suggestions that they believe could contribute to a harmonious compromise.
Posed Zago, “Can the service patrons have a waiting area out back? Or inside -instead of being outside in front on Queen dropping their paraphernalia and banter that goes on, so that people don’t have to walk around or walk through it? I have spoken with two other people that will avoid that corner. Those are the types of things that I thought could be discussed in a mutually respectful way.”
Stone echoed Zago’s sentiment stating, “If they could move the entrance to the rear of the building it might give the client more privacy because I feel badly for them too. They are getting help or support but when people drive by it’s as plain as day- they’re standing out front. They know if it’s full inside. The line goes out the door to the rear. It’s got to be degrading for them. And all different types of people go in too- professional people. It’s unfortunate that it’s not more private.”
Moleni has a different angle on the matter. “Are there ways in which we can work to clear up perception? There are other downtowns that have clinics and I don’t think this is a problem unique to Sault Ste. Marie. There are solutions. That’s what I’m getting at. We don’t have to jump to the end point of ‘get out’ or ‘hide them away’.
Byrne approaches the issue from an educational position. As a health professional in the community Byrne is familiar with the challenges associated with perception.
“I think there is stigma generally around addictions. I think that’s real, I think that happens and I think there is work that needs to be done around that- and not just in our community but in general around addiction issues,” shared Byrne. “There’s another side to stigma –there are the people experiencing it. How do we deal with it? Do we make a move? Do we educate? At Algoma Public Health our focus is prevention, education and information to help raise awareness about certain issues. I think this fits in. And maybe it’s time to start doing some work on that.”