City to push ahead with plans for ‘multiple’ supervised injection sites
Ten years after the Toronto Drug Strategy was first tabled, the city is facing a public health crisis in drug overdoses. The city’s medical officer of health says supervised injection services are needed where drug use is concentrated.

TheStar.com
Jennifer Pagliaro
March 12, 2016

Toronto is moving ahead with plans to become the second Canadian city to open controversial supervised injection sites for drug users, the Star has learned.

A report from the city’s medical officer of health, to be released Monday, will outline the need for “multiple” locations where drug use is concentrated and will be embedded in existing health services. The proposed locations are also expected to be announced Monday.

The move follows an escalating number of overdose deaths in Toronto, which climbed to an all-time high of 206 in 2013, and the growing trend of heroin and fentanyl use — what medical officer of health Dr. David McKeown has declared a “significant public health issue.”

As the new Liberal government in Ottawa signals they are willing to support these sites — an about-face from the Conservative government’s attempts to block their existence — Toronto advocates are now laying the groundwork for approval.

“The need is more significant now than it’s ever been in our city’s history — that people are dying on our streets and we can save those lives,” said Councillor Joe Cressy (Ward 20 Trinity-Spadina), who chairs the Toronto Drug Strategy Implementation Panel.

“We have a responsibility and a capacity to act and we should . . . We needed these programs yesterday and I hope we’ll be able to have them open and saving lives as quickly as possible.”

Supervised injection sites allow drug users, who bring in their own substances, a safe place to inject while supervised by health professionals in case of overdose. Those who use these sites are also provided with new, sterilized equipment to prevent infection and have ready access to treatment and community supports.

“One of the benefits of supervised injection, which has been repeatedly shown in studies, is its ability to reduce overdose and particularly fatal overdoses,” McKeown said in an interview. “That is the kind of model that I think makes the most sense in this city.”

Talk of supervised injection sites in Toronto has previously sparked concern from local communities and hesitation at council. The issue was given prominence by the Toronto Drug Strategy’s release in 2005, which called for an assessment of the need for such sites and a feasibility study.

That study, by St. Michael’s Hospital and the University of Toronto, completed in 2012, found Toronto would benefit from the cost-effective, harm reduction achieved by opening at least three sites in Toronto, integrated into existing services. The study raised the possibility of up to five locations.

In 2013, city’s board of health backed integrated supervised injection services on the recommendation of McKeown.

With plans now underway, Cressy said there will be a “robust” public consultation on the sites before it is sent to council and then submitted for approval by the federal health minister.

“It’s also about public safety,” Cressy said. “We don’t want people injecting in our streets, in our coffee shops, in our parks and in our stairwells.”

Any organization looking to open a supervised site must apply to the federal government for an exemption “necessary for a medical or scientific purpose” under the Controlled Drugs and Substances Act.

Last year, the changes to the law initiated by the Conservative government created what critics have called an onerous number of requirements to apply for exemption status.

That change followed a 2011 Supreme Court decision unanimously in favour of Canada’s first supervised injection site in Vancouver, InSite, which the government had tried to prevent from renewing its exemption status.

That Supreme Court decision ruled InSite, which is a standalone service, should be allowed to continue operating, saying it has “saved lives and improved health without increasing the incidence of drug use and crime in the surrounding area.” It also outlined that the federal health minister must weigh those public health needs in generally granting exemptions.

Though the requirements put forward by the previous government are still in place, Liberal Health Minister Jane Philpott has recently opened the door to more applications.

“I suspect now that municipalities are aware of the fact that the government is supportive of harm reduction facilities like this . . . we will see other locations that will make applications,” she told iPolitics last month.

Those comments followed Ottawa’s approval of the country’s second supervised injection site inside an existing facility in Vancouver this January.

Cressy said the change in leadership helped spark Toronto’s plans to move forward now.

“We have a new Government of Canada that recognizes the urgent need to tackle overdose and has expressed not just a willingness, but a keenness to support the introduction of supervised injection services,” he said.

Several international and Canadian studies have outlined the benefits of supervised injection sites, citing life-saving measures, positive community impacts, and cost savings for the public health system.

Since it opened in 2003, InSite in Vancouver says no overdose deaths have occurred there and the number of overdoses in the surrounding area have decreased by 35 per cent — nearly four times the rate of decline in the city overall, according to their website.

The Toronto-based feasibility study found 54 per cent of drug users surveyed were injecting in public spaces, such as washrooms. Among those who participated in the study, there was a 70 per cent prevalence of hepatitis C and a three per cent prevalence of HIV.

Nearly 30 per cent of those who were surveyed reported having an overdose in the six months leading up to the study.

Researchers found there was support to open integrated sites in Toronto where drug use is concentrated, especially where drug use is publicly visible.

In Toronto, the report said, drug use is concentrated in more than one area, highlighting the need for multiple sites. Half of the drug users surveyed said they would travel up to 10 blocks to use a supervised injection site.

Donna May, whose daughter, Jac, died in 2012 from disease contracted through intravenous drug use, said she wasn’t always supportive of supervised injection sites.

Once a proponent of “tough love,” May said her daughter’s death at age 35 was an education, one that spurred her to start the advocacy group Moms United and Mandated to Saving the Lives of Drug Users (mumsDU).

“I’ve walked both sides of the street. I’ve seen it from both points of view. I understand when a community says, ‘I don’t want it in my backyard,’ the NIMBYism,” May said. “But the truth of the matter is it’s already in a person’s backyard.”

She said breaking the social stigmas around addiction and opening supervised injection sites in Toronto and elsewhere is crucial for other families and to prevent more deaths.

“It could happen to anyone’s child,” she said, remembering her own daughter. “She was a mother of three. She was a wife. She had a home. She was educated. Funny. Contributing member to society until everything got away from her.”

“We need to start treating addiction as a public health concern.”