It’s an idea that’s always proved too radioactive for council to touch, but Toronto Public Health believes it could save lives.
In a report released Tuesday, July 2, the city health agency recommends seeking provincial funding to set up Toronto’s first supervised drug consumption site. The report, authored by medical officer of health Dr. David McKeown, calls for a pilot project of the controversial practice. The proposal goes before the board next week.
“I think this is a big step forward,” says board member Gord Perks, chair of the Drug Strategy Implementation Panel. “This is the senior medical person in the Toronto community taking a principled stand in favour of a service that will be controversial but will save lives and money, and reduce harm in our community.”
The pilot project would last at least two years and likely be integrated into three existing facilities. TPH has not yet identified potential locations, but Perks admits that wherever it goes, a shooting gallery, albeit a supervised one, is bound to meet with opposition. “It’s going to be a very difficult conversation,” he says.
Already Mayor Rob Ford has come out against the proposal. A day after the report was published, he told reporters safe injection sites are “the worst thing that could happen to this city right now.”
There are at least 90 supervised sites in operation around the world. These facilities allow addicts to consume intravenous drugs in a sanitary environment under the care of health professionals. Clients bring their own drugs and are provided with clean needles, tourniquets and other paraphernalia, and are also offered connections to treatment and detox programs.
According to TPH, research shows supervised consumption reduces the incidence of overdose and needle-sharing, helps get more people into treatment and does not result in increased crime in the area.
Data on Toronto’s drug problem is imperfect, but according to associate medical officer of health Dr. Rita Shahin, between 2002 and 2010 there were 538 deaths linked to opiate use and 319 to cocaine. (She couldn’t provide data on how many of the victims injected the drugs, however.)
The most recent research also indicates that 61 per cent of intravenous drug users could be infected with hepatitis C and 6 per cent with HIV. One in five report spiking up with used needles. In light of these stats, Shahin says it’s illogical for critics to accuse safe injection sites of encouraging dangerous drug use. “It is a way of recognizing that it is happening, and [saying] let’s reduce the harms associated with it,” she says.
But although the board appears set to take a strong stand, the other levels of government on which the project depends are hardly onside. “Supervised injection sites aren’t something we’re moving forward with right now,” says Minister of Health Deb Matthews in an emailed statement.
“Our government supports a wide range of strategies including needle exchange, injection drug user outreach and methadone treatment. Since 2003, our investment in addictions programs has increased by nearly 50 per cent,” she says.
Meanwhile, Ottawa’s attitude is effectively hostile. Anyone wishing to open a supervised consumption program must first obtain an exemption under the Controlled Drugs And Substances Act, which can only be granted by the federal health minister herself. In 2008, the minister refused to renew the exemption for Vancouver’s InSite, which led to a legal challenge and eventually a Supreme Court ruling that found the government’s decision violated the Charter Of Rights And Freedoms.
The court ordered the minister to approve future applications unless there was evidence that doing so would compromise public safety.
In response, the Conservatives tabled Bill C-65, which lays out a long list of conditions that any proposed site must meet. These include providing hard-to-measure data on local drug use, and police checks going back 10 years for all employees.
The TPH report calls these conditions “extremely onerous and disproportionate to what is required for other health services.” It recommends the health board formally register its opposition to Bill C-65, which is still pending.
The Conservatives say the provisions, some of which focus on seeking approval from local governments, residents and the police, are intended to ensure injection sites don’t go where they’re not wanted.
“The introduction of [Bill C-65] will make certain local voices are heard,” writes Health Minister Leona Aglukkaq in a statement. “We don’t think a supervised drug consumption site should be created in a neighbourhood without consultation.”
bens@nowtoronto.com | @benspurr
