What are the impacts of removing harm reduction services that have been scaled up to address overdose and other drug-related harms?
That’s what Dr. Gillian Kolla is investigating with $1.4 million in funding from the Canadian Institutes of Health Research (CIHR).
An assistant professor of population health and applied health sciences in Memorial’s Faculty of Medicine, Dr. Kolla researches the impacts of policy changes on prescribed safer supply programs and supervised consumption sites in Ontario.
Prior to joining Memorial University, Dr. Kolla spent years as a counsellor and social worker, including working with young people who were homeless or street-involved.
Over time, she became frustrated because she says she could do a lot of work with the person in front of her and help them, but then end up with another person in a similar situation.
“I realized that a big part of the problem was the system, services and government policies themselves,” she said. “They are often not designed to meet the needs of people and ignore the wider circumstances that contribute to issues like substance use.”
That frustration was the driving factor that led her back to graduate school and into public health.
Crisis intervention
Her master’s and then PhD work took her from Montreal to Toronto, where she began working with harm reduction programs providing services to people who use drugs.
She says she was interested in how communities came together to support and help each other outside of the public health and formal health-care system.
“Many of our health care and social services are often quite inaccessible to people facing multiple forms of disadvantage and marginalization,” she said.
She quickly focused on interventions to address the overdose crisis. Every day, 20 Canadians die from the drug toxicity crisis, a continuing public health emergency across the country.
“We’re in a moment here in Newfoundland and Labrador where it still feels possible to have an impact.”
Her move to Memorial in 2024 was shaped by the desire to expand her research beyond Canada’s largest cities.
She says what works well in a large city might work differently in a smaller city, or rural or remote areas.
“We’re in a moment here in Newfoundland and Labrador where it still feels possible to have an impact on the social issues our communities are facing, but it can go one of two ways,” she said. “We can either come together to support our community members who need help, or it can tip in the other direction, where people who are vulnerable and experiencing difficult circumstances are framed as the problem, and we villainize them and the few services designed to meet their needs.”
Policy turnaround
Her new five-year CIHR funding project was inspired by Ontario’s rapid scale-up of harm reduction programs in response to that province’s overdose crisis, “one of the most devastating public health crises we’ve seen in Canadian history,” and the same government’s quick policy turnaround, leading to the closure of more than half of its sites in 2025.
“What’s going to be the impact of scaling back these services so rapidly in the middle of a continuing drug toxicity crisis?”
Dr. Kolla says that in a crisis, we sometimes have to act very quickly and that it can be difficult to pause, re-evaluate what went well and what the challenges were, and then continue building and moving forward, even in the face of increasing need.
“We have strong evidence that supervised consumption sites and safer supply programs reduce overdose deaths and connect people to the broader health-care system. The key question is, what’s going to be the impact of scaling back these services so rapidly in the middle of a continuing drug toxicity crisis?”
Continuum of care
To answer that question, Dr. Kolla will work with project partners and collaborators from across Ontario.
They will look at large, medium- and small-sized cities that had to close their supervised consumption sites and those that stayed open.
Dr. Kolla will lead the qualitative components of the study while her collaborators specialize in health administrative data and mathematical modeling.
She says the second phase of their study will work with community members to determine the actual continuum of care and the mix of services needed to support health, wellness and social well-being.
“I’m hopeful that we’ll be able to pull out some learnings that will be helpful across the country,” she said. “Not all places have scaled up supervised consumption sites, Newfoundland and Labrador is one example. What are the learnings for places that are looking to address the issues they’re facing in their communities?”
