McGill University researchers from the Department of Epidemiology, Biostatistics, and Occupational Health recently found that overdose prevention and supervised consumption sites in Toronto were not associated with long-term increases in local crime, with rates remaining stable or even declining over a decade. Yet fear about public safety continues to shape opposition to these initiatives, often projecting discrimination and stigma onto individuals who use drugs. However, people’s perceptions of safety and comfort should not take precedence over protecting human lives, especially when harm reduction has been proven effective to save them.
Fear drives much of the resistance to supervised consumption sites. In neighbourhoods such as Milton-Parc in downtown Montreal, many residents recount uncomfortable or distressing encounters with unhoused individuals—but the discomfort these interactions may bring does not justify eliminating initiatives that have positive impacts on the people they serve.
When access to regulated substances is restricted without adequate investments in harm reduction, drug use does not simply disappear. Instead, it finds another way to survive. This often results in the creation and expansion of unregulated drug markets that offer cheaper, more potent, unpredictable, and consequently toxic substances. This push-pull dynamic reflects what is often described as the iron law of prohibition: When governments and authorities intensify efforts to eliminate drug supply or circulation, markets respond by producing increasingly dangerous substances. Additionally, the criminalization of substance use corners people who use drugs into hidden and unsafe conditions, where they face higher risks of infection, disease, and, above all else, overdose. Ultimately, deprioritizing harm reduction to accommodate public perceptions of safety only creates the very risk it claims to prevent.
Harm reduction is necessary for saving lives. However, framing it as a cure-all solution—or as enabling substance use—is as damaging as rejecting it altogether, as it suggests that lives are only worth saving if individuals are working toward a single, prescribed goal: sobriety. Instead, the objective should be unconditional care that promotes well-being and, most importantly, the autonomy, dignity, and safety of people who use drugs.
Society often frames individuals who use drugs as socially disengaged or incapable of care, but this perspective overlooks the reality of their lived experiences. Many of them actively participate in informal systems of mutual aid as caregivers, advocates, and sources of support for those around them. For instance, at Kensington Market Overdose Prevention Services, a community-led, supervised consumption site (SCS) in Ontario, individuals not only access life-saving care but also contribute to their communities’ well-being. Some go on to become peer educators and staff. Through these roles, they teach safer drug use practices and overdose reversal, and ultimately save lives.
Addressing this situation requires not only a shift in perspective but also a great deal of honesty. It means abandoning standardized and linear visions of recovery while also recognizing that fear surrounding SCSs should not dictate decisions that determine who lives and who dies. Effective harm reduction embraces the complexities of human experience and prioritizes care. Listening to people who use drugs, including those who are unhoused, is essential. Their expertise, grounded in lived experience, should guide decisions about which interventions work best for them. In the end, safety cannot be defined solely by the absence of discomfort for the public; it must also include the security, health, and autonomy of those most affected by systemic failures.
Rejecting harm reduction is not a neutral act; it produces measurable harm and deepens inequality. People who use drugs should not forfeit their right to healthcare, housing, or dignity because of public discomfort or moral judgment. This fight is no longer about drug use. It is about human rights.
