With five safe consumption sites in Toronto poised to be shuttered in the new year, drug users seeking harm reduction services may have to turn to more impersonal outlets.
Outside Toronto’s Casey House, a hospital serving those with HIV, a pair of vending machines have been distributing harm reduction supplies since July.
The vending machines, produced by SMRT1 Technologies, operate 24-7. With the touch of a button, they supply products like syringes, condoms and naloxone, a fast-acting medication used to temporarily reverse the effects of opioid overdoses. No payment is required.
Using the vending machines is simple. Patrons tap the large screen, select from various harm reduction products such as a “Snorting & Foils Kit” and then discretely gather their supplies.
While these machines could fill gaps left behind by safe consumption site closures, similar machines have faced backlash across the country.
What the vending machines are for
The aim is to reach those in need, provide support and save lives, said Steve Ramage, SMRT1’s chief technology officer.
“Opioid addiction ends in death,” said Ramage, who had a family member die as a result of drug addiction.
Lisa McDonald, Casey House’s communications and public policy director, said the machines “make it easier for the vulnerable members of our community to access supplies and resources that they need to live more safely.”
Between 2023 and 2024, McDonald said Casey House supplied almost 125,000 harm reduction kits to Torontonians. The vending machines now allow the specialty hospital to distribute a larger variety of supplies than it previously could, she added.
Each SMRT1 vending machine costs roughly $15,000. Ramage said his company’s tech is worth it because it allows health-care workers to focus their time on providing medical assistance, rather than handing out supplies.
McDonald, however, detailed frustrating technical difficulties with the machines, such as faulty screens that have impacted their reliability. Data about their level of use since July was not available.
Noting the costs of drug addiction and HIV treatment, Hannah Stahl, a street nurse whose brother died of an overdose, said harm reduction efforts — like the vending machines — keep people healthier, lowering the overall burden on the health-care system.
She added machines can help organizations like Casey House build relationships with drug users who distrust the health-care system.
The hospital’s website advises using the vending machines “in conjunction with the services provided by Casey House’s interdisciplinary health team.”
The vending machines also share directions to local food banks and homeless shelters, while preserving users’ anonymity. McDonald said Casey House switched off the cameras and microphones they came equipped with.
Similar vending machines are used across Canada, sometimes garnering pushback
Clinical neuropsychologist Dr. Sean Rourke works with the Our Healthbox program, which oversees 11 SMRT1 vending machines across Canada. Despite serving mostly small communities, these machines have distributed nearly 20,000 harm reduction supplies.
Rourke recently appeared before a Hamilton city council committee following concerns from some councillors that vending machines in that city could perpetuate addiction. Hamilton city council ultimately approved their use.
In September, the use of SMRT1 vending machines that dispensed supplies like pipes and naloxone in three municipalities on Vancouver Island was suspended following scrutiny from a local Conservative Party of BC candidate who argued providing the gear and medication would keep people addicted to drugs.
B.C.’s NDP Premier David Eby announced the suspension in the lead up to an election campaign where concerns about drug use were front and centre.
Eby’s government is currently undertaking a review of the machines.
Asked if there are any political threats facing the vending machines at Casey House, Ramage said “100 per cent, anytime there's an election.”
Stahl agreed there is a “huge risk” to the future of harm reduction, particularly in the wake of Ontario Premier Doug Ford’s decision to close safe consumption sites near schools and childcare centres.
“There's lots of correlations that can be drawn,” she said. “These services aren't made in a vacuum.”
According to McDonald, Casey House has been permitted by Toronto Public Health to supply harm reduction supplies since 2014. Currently, there are no efforts to remove the machines in Toronto.
Asked about the community’s response to Casey House’s machines, McDonald said there was “certainly a lot of curiosity and questions” when the tech first appeared. She said locals in the neighbourhood likely still have “a lot of assumptions” about the vending machines and the product offerings.
One assumption came as a complaint that the vending machines distribute opioids, which McDonald said is untrue.
The public perception needs to shift more in line with actual data and evidence, rather than “what we’re afraid of might happen,” Stahl added.
A recent University of Cincinnati study found the roll out of harm reduction vending machines in Hamilton County, Ohio led to a 10 per cent decrease in local overdoses, “despite overdose rates increasing dramatically across the nation.”
McDonald and her colleagues at Casey House hope the Toronto machines will have a similar impact.
