Toronto’s plan for 3 safe injection sites has supporters, detractors

[An injection kit is shown at Insite, a safe injection facility in Vancouver, on May 6, 2008. THE CANADIAN PRESS/Jonathan Hayward]

Toronto Public Health’s new report calls for the creation of three supervised injection sites in the city, but reaction in the Ontario capital is mixed.

The report, released Monday, says that three agencies are planning to add supervised injection sites to existing clinics: Toronto Public Health through The Works program, Queen West-Central Toronto Community Health Centre and South Riverdale Community Health Centre. All three clinics already provide harm-reduction services like needle exchange.

The report will be considered next week at a Board of Health meeting. If the board gives its approval, the next steps are public consultation, a vote by city council and federal approval for the sites.

Safe or supervised injection sites provide injection drug users with a safe location to take illegally obtained drugs under the supervision of nurses and/or other public health and harm-reduction staffers. There are currently only two legal safe injection sites in Canada, both in Vancouver, but Montreal has applied for one.

When the country’s first site, Insite in Vancouver, opened in 2003 in the city’s Downtown Eastside neighbourhood it was met with criticism from parties including the Canadian Police Association and the Bush administration in the United States. Under then-prime minister Stephen Harper, the government cut funding to Insite and appealed a court decision granting the facility an exemption to federal drug rules. The Harper government lost. A 2008 Health Canada report found that 78 per cent of Vancouver residents supported the facility, and today the site has the support of the city and the Vancouver police department.

Here is a look at how various groups feel about safe injection sites like those recommended for Toronto.

Law enforcement

Chief Mark Saunders’ position is that he needs detailed information before he is able to comment on Monday’s announcement, Toronto Police Service spokesman Mark Pugash tells Yahoo Canada News.

But Toronto Police Association president Mike McCormack told News 1130 on Monday that supervised injection sites will increase work for front-line officers and aren’t the best way to fight drug abuse.

Canadian Police Association president Tom Stamatakis tells Yahoo Canada News that if communities want to open safe injection sites, they must do so while considering the wider safety of the area around the sites.

“In addition to having a conversation about having a safe injection site, I hope they’re also having a conversation about making sure they have the right amount of police resources in the neighbourhood wherever these facilities will be created,” Stamatakis says of Toronto’s plans. “Along with this focus on harm reduction initiatives like safe injections sites, you also have to manage the public order issues and safety issues that will come along with that.”

Health officials

Toronto Public Health and the city’s medical officer of health have previously spoken in support of safe injection sites. Back in 2013, Dr. David McKeown urged the provincial government in a report to fund pilots for safe injection sites.

At Monday’s announcement of the recommendation to open three Toronto sites, Toronto public health said that overdose deaths in the city had increased by 41 per cent over 10 years. Research published in The Lancet in 2011 found that overdose deaths dropped after the opening of the Insite supervised injection clinic in Vancouver. And Vancouver is considering expanding safe injection services due to a rise in fentanyl-related overdose deaths.

Considerable research has found that there are benefits to safe-injection sites. One study published in the journal Addiction in November found that safe injection sites in Ontario would be cost effective in treating hepatitis C even beyond the savings predicted in a 2012 report. The annual cost of a free-standing safe injection clinic is an estimated $1.5 million for building costs and $130 per patient for equipment and staff, the Addiction study found. However, the three proposed Toronto sites would be located in existing facilities.

The 2012 study found that opening safe injection sites in Toronto and Ottawa would reduce harms to both injection drug users and the wider community.

Politicians

At an unrelated news conference on Monday, Toronto Mayor John Tory called for a rational, not emotional, debate about supervised injection sites in the city.

“Obviously this is a public safety and a public health issue, and I look forward to seeing the report,” Tory said at the news conference. “This is a consultation that I’m going to be looking at with very keen interest to see that what are very substantial public health and public safety issues are properly addressed in coming to whatever decision we come to.”

Though Tory didn’t outright support the creation of the three sites, his tone differed considerably from that of his predecessor, Rob Ford, who once said that safe injection sites were “the worst thing that could happen to this city right now.”

Coun. Joe Cressy, chair of the Toronto Drug Strategy Implementation Panel, told the Toronto Star that supervised injection sites are needed in Toronto and will have positive impacts on public health.

The supervised injection sites will require the approval of Ottawa, due to a law passed under the previous Conservative government. While the Harper government was strongly against safe injection sites, there are indications that the Trudeau government doesn’t feel the same.

In March 2015, Justin Trudeau told students at the University of British Columbia that he hoped to see safe injection sites across the country. And his government approved the second Vancouver site, at an HIV/AIDS clinic, in January.

Health Canada says it will assess applications for safe injection sites “without undue delay.”

“Supervised consumption sites have shown positive results in Canada as well as in other countries,” Health Canada spokeswoman Sylwia Krzyszton told Yahoo Canada News in an emailed statement. “Disease transmission and overdose deaths decrease, and infections, emergency room use and hospital admissions in relation to injection drug use are reduced.”

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