Peterborough plans opioid crisis summit amid 'drastic restructuring' of regional health units

The city of Peterborough is hoping to keep a local focus on its worsening opioid crisis, even as the province prepares to merge its public health unit with several others. 

This week, city council voted in favour of hosting a summit on the opioid crisis later this year.

It comes after 12 people in Peterborough died of opioid overdoses in the first quarter of 2019 — nearly half of the total number of opioid-related deaths in the previous year.

It also comes as municipalities around Ontario digest the province's plan to merge 35 regional health units into 10.

Dr. Rosana Salvaterra, Peterborough's chief medical officer of health, spoke with Ontario Morning host Wei Chen about both issues.

The interview has been edited and condensed for length.

Wei Chen: Twelve deaths in three months, even more suspected deaths... what do you think is behind the numbers?

Rosana Salvaterra: We have a crisis with opioid use in Canada and what we're experiencing in Peterborough is being experienced across the country. Statistics show it's the smaller urban centres and communities like ours that are really bearing the brunt of this crisis. 

WC: What do you think a summit would be able to accomplish?

RS: I think [council] is remaining vigilant, they're helping to draw attention to this serious issue, and I know that our municipal councillors want to ensure that our community remains focused on this issue despite the drastic restructuring of public health and the health-care system that's underway. I think a summit would also offer an opportunity for our councillors to be leaders in our community, to help address the stigma that people who use drugs face, and this remains an enormous barrier for many in our community who are seeking treatment.

WC: How do you think the merger of public health units could affect the opioid crisis?

RS: We're very concerned that the download to municipalities is actually going to mean that public health programs and services receive less funding over the next many years. We're also concerned that diluting the representation into large regional boards that you'll lose the kind of focus and attention that we're currently getting from our boards of health that are very connected to municipal councils and, here in Peterborough, also connected to our First Nations communities.

WC: It is an issue that almost every community is dealing with. Could it mean better co-ordination of resources?

RS: Every community is different. What we have found in Peterborough, for example, is that even though the community has been eager to see a safe, supervised injection site, we've been unable to have one funded and operated here in Peterborough. Our community at the city centre of 80,000 people is a very small centre — much of the research on these sites comes from larger urban centres. We're keen to pilot something here, there just isn't the appetite or the funding from the province right now to do that. There are things that we would like to do in Peterborough that would work in our community or solutions that are specific to our community that we would like to be able to take on.

WC: What do you think having a supervised injection site would do?

RS: We're experiencing many poisonings here in agency sites where volunteers or staff are just not prepared. A supervised safe injection site would provide greater safety, we know they work, they save lives. Here in Peterborough, as well, our board of health in April, we passed a motion for a managed opioid treatment. What they would like to be able to do is offer pharmaceutical-grade opioids so that physicians could prescribe drugs to users who have responded poorly to conventional treatments like methadone or suboxone. We would love to be able to pilot such a site here in Peterborough.

WC: Are you worried that that sort of local response might be lost with these mergers?

RS: It's hard to tell right now, as far as specific to opioids, because each community looks a little different. Each community, the partners may be different. Depending on patterns of use, or on size, the strategies might be different. 

WC: What have you heard about the future of your public health unit?

RS: We're very concerned. We've heard that the proposed region would stretch from Pickering on the west to Picton on the east. We're very concerned that the size would jeopardize that strong representation that we've enjoyed in Peterborough to date, and about the cost of delivering services over such a large area. Certainly concerned that any economies of scale would be lost once you're trying to service such a large geographic size.

WC: Would you be out of job?

RS: Yes. What would happen would be the 35 existing boards would be closed down by regulation and 10 new regional entities would be begun, and each of the 10 would be begun, and each of the 10 would hire their own local medical officer of health. Potentially there would be associates who would work as well, so there would be a team, but there's no doubt in my mind that such a merger would mean the end of Peterborough Public Health and an end to my position.