Supervised injection site CACTUS Montréal to cut hours despite rise in fentanyl overdoses

The head of Montreal's largest supervised drug consumption site says the service is preparing to cut hours as of Saturday due to a funding shortfall, prompting fears of more deadly fentanyl overdoses in the midst of a worsening opioid crisis.

Jean-François Mary, executive director of CACTUS Montréal, says his organization is facing a 27 per cent drop in public health funding earmarked for its needle exchange program compared to last year, which he says will also affect the centre's supervised consumption site.

He says the centre's staff only realized the extent of the shortfall when it received a letter from public health dated March 20, less than two weeks before the end of the fiscal year.

"It's totally irresponsible from public health," said Mary.

"We've been holding the fort during the pandemic. We have never closed our services … and that's the way we are being thanked," he said.

Montreal public health meanwhile disputes that CACTUS is facing a drop in funding, adding that overall, the organization will see a 20 per cent increase to its budget.

But Mary says that new funds are largely tied to specific projects and won't be able to make up the shortfall for the needle exchange program, leading to breaks in service.

The news comes as officials and harm reduction advocates have been sounding the alarm about a sharp increase in overdoses following the spread of fentanyl through the city's street drug supply.

CACTUS, located on Berger Street in the downtown Ville-Marie borough, serves the largest clientele of the four supervised injection sites in Montreal, according to Mary. 

The centre, which is normally open from 2 p.m. to 2 a.m., was already anticipating reducing service by an hour a day due to budgetary constraints, but Mary says this week's news will likely force deeper cuts to service.

"Probably we'll need to cut a massive amount of hours," said Mary. "Every hour that we cut, people won't be able to access the services and they will die."

He said the organization is convening an emergency meeting of its board to try to find a way to maintain its current service levels.

Public health disputes funding shortfall

Jean Nicolas Aubé, spokesperson for Montreal public health, says the budget for all of the CACTUS services has actually increased by roughly $385,000 compared to last year, for a total of more than $2.2 million.

Aubé says CACTUS received three different sources of public health funding, adding that the funds allocated directly for the operation of the supervised injection site alone increased by nearly $320,000 to just over $1.2 million this year.

This increase was intended in part to offset administrative costs taken on by CACTUS when it took over direct administration of the supervised injection site from public health, Aubé said.

But Mary said CACTUS had requested just over $1.3 million for the operation of the site, in part to hire more staff to handle a 300 per cent increase in clients overdosing since 2019.

While no one has died at the site, he said there were 45 overdoses in February alone, caused by increasingly potent and unpredictable drugs containing fentanyl.

"Before [2019] overdoses were a bi-weekly, a monthly occurrence … But now it's a daily occurrence," said Mary.

As well, a decision by Montreal public health to restructure how it funds services for prevention of HIV and other sexually transmitted infections (STIs) and other harm reduction measures, has left CACTUS with a shortfall of more than $260,000 — or 27 per cent — for its needle exchange program, Mary says. 

In its March 20 letter, Montreal public health underlined that funding from Quebec's provincewide overdose prevention strategy will no longer be used to supplement programs for STI prevention, such as the needle exchange. 

Aubé said this change had already been communicated to organizations last year. He said public health made the decision to split the two funding sources — STI prevention and overdose prevention — because they "don't respond to the same needs or the same population." 

While CACTUS did also receive just under $330,000 from the overdose prevention strategy, Mary says those funds are tied to two specific drug testing projects and cannot be used for the needle exchange.

Aubé said organizations can request to reallocate their funds toward a different use. 

He said public health officials plan to meet with community organizations "in the coming days" to address their concerns and will work with organizations to find solutions.

'Lives in our hands'

Among other things, Mary says the shortfall for the needle exchange will make it more difficult for drug users to get access to supplies such as clean needles and naloxone to prevent overdoses.

He says it will also have a knock-on effect on staffing for the CACTUS supervised injection site, he says. 

As the two services are housed in the same location, staff from the needle exchange are normally on hand to help out at the supervised consumption site, particularly if multiple people overdose at the same time.

"It's a safety issue. We have people's lives in our hands when we are running this service," said Mary.

"If we don't have enough staff, we won't take the risk of having our people die in our hands."