Thank you, Mr. Chair. As a point of correction, I'm not a doctor yet. I'm still a mister. I apologize for the error on that form, but I am a Ph.D. student.

Thank you for this opportunity to speak.

My name is Steven Rolfe. I am the director of health partnerships at Indwell. We are a supportive housing charity in southwest Ontario specializing in creating deeply affordable housing, combined with access to mental health and addiction services. We currently provide services to over 1,200 people.

Our tenants all come to Indwell programs with two core needs. These are the need for stable and deeply affordable housing, and the desire to access supports that foster health, wellness and belonging. While everyone's journey toward health is varied in the complexity and time to achieve goals, there is a commonality: Our tenants have experienced lives of precarity and instability, they seek space to heal and they have no interest in returning to lives of instability.

Our tenants come to us from hospitals, shelters and states of homelessness with a range of complex needs. In some of our programs, the rates of concurrent or primary substance use disorder challenges are eight out of every 10 tenants. Each comes to us with the hope for change that comes with finding a place of safety to live.

My professional background is in nursing. I have spent 37 years focusing my practice on the care of people experiencing profound health and social challenges arising from mental health and addiction. I am confident that I cannot recall a period where the availability and lethality of chemicals has had such an impact on the people I am privileged to serve. Vulnerable people beset with a multitude of challenges arising out of chronic disease, disadvantage and poverty are subject to the offer of inexpensive drugs amid hopelessness.

Today I want to share two key thoughts in relation to opioids and the toxic drug supply. The first is to state that the proliferation of opioids and toxic drugs, including methamphetamine, fentanyl and derivatives, has exacted a terrible toll of death and disease in our communities over the last six years.

The second is to highlight the value of meaningful responses to loneliness, illness and houselessness through safe housing, care and connection that restore hope and build health and wellness. Tangible responses of supportive housing that people choose to live in are the foundation of recovery and can mitigate the impact of toxic drugs.

Few Indwell communities have been spared the loss of a neighbour to overdose or drug poisoning within the last six years. In 2022, from my recollection, we had an average of one memorial service a week. This is across eight or nine different sites.

The years of the COVID-19 pandemic and associated public health measures seemed to accelerate the proliferation of drugs in our communities, with an increase in the number of overdose occurrences and, sadly, deaths related to drug use. Evaluation of this period provides us with some insights into correlates of toxic drugs and community impact. One is the loss of physical connection and contact with positive community events, the loss of communal meals and social events, and the reduction of human contact to virtual or distant and short contacts, which creates loneliness. Another is limited access to mental health and addiction programming in hospitals and community mental health agencies. Another is the loss of community cohesion, which allows for an increased presence of people taking advantage of vulnerable tenants by offering drugs.

Indwell's response to this built on the strengths of the supportive housing model to restore housing as a place of safety and healing. This response included tenant-led development of guest management policies that included the implementation of overnight security. The lifting of public health measures led to the swift reimplementation of social gatherings, understanding that healthy community connection is the building block of resilience. Finally, there was the implementation of a blend of life-saving measures—which would include the issuance of harm reduction supplies and the presence of naloxone, both staff- and tenant-led—with a sharp focus on accessing addiction treatment.

As an example, in 2022, we opened a new, 15-unit supportive housing program in St. Thomas, Ontario, where we offered people who were living in encampments the choice to live in housing with access to supports. Every person who accepted the offer had significant challenges with substance use, including opioids and other toxic drugs. For these individuals, supportive housing became a catalyst for their respective journeys toward wellness.

Some common touchstones of their experiences included a desire for personal security and freedom from people offering drugs, interest in developing mutually beneficial guest management policies that facilitate a reduction in the availability of substances, engagement with staff and a reduction in the necessity for emergency overdose intervention. This was a program where daily overdose occurrences were happening. As we began introducing addiction medicine into the facility and bringing in primary care doctors and addiction medicine doctors, we watched the number of overdose occurrences go from daily to zero in six months.

In general, it's about a shift in attitude from survival to a focus on health and wellness. When you provide basic necessities, people are better able to focus on the things that are going to keep them well.