No room to shoot

After a decade of dithering, politicians don't seem to be moving any closer to safe injection sites

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It’s an unusual event that can draw city cops and councillors, licensed marijuana users, the Woman’s Christian Temperance Union, drug court advocates and the Church of Scientology. All were present at two recent forums the city held to develop a comprehensive drug strategy.

And while seeking citizen input is always dandy, one has to wonder if after a decade of dithering, pols are moving any closer to the real guts of harm reduction: safe injection sites.

Certainly, they have a new report to give them some spine – Substance Use In Toronto: Issues, Impacts & Interventions, a survey of what other cities have done, prepared by public health staff in consultation with everyone from the RCMP to the Safer Crack Use Coalition. Couched in neutral, careful language, the document makes a strong case for harm reduction and details the success of supervised shoot-up facilities and prescription heroin.

Downtown councillor Kyle Rae (Toronto Centre-Rosedale), chair of a city council advisory committee on drug strategy, points out, “The city of Toronto has a long history of supporting harm reduction models. In 1988, we started distributing needles so people would reduce transmission of HIV and hep C. Harm reduction is a model we’ve tried, and it works.”

The question is, however, whether public opinion can make the leap from clean needle handouts to injection sites – and what neighbourhood would be willing to lay down the welcome mat?

In Vancouver, where there were 2,500 drug-related deaths between 1988 and 98, a sense of emergency fed the political will. An estimated one-quarter of Vancouver’s needle drug users are HIV-positive. Earlier this year that city launched a heroin prescription trial – another Canadian first.

Toronto’s stats, however, are less staggering. The report tells us the city recorded 19 deaths from cocaine in 2001 (down from 38 in 1999) and 25 deaths from heroin (down from 67 in 1994). About 5 per cent of injection drug users in Toronto have contracted HIV, largely by sharing dirty needles.

As well, Vancouver’s drug scene is out in the open and confined largely to one downtrodden neighbourhood – a visual reminder of the need for radical reforms. Toronto’s hardcore milieu is considerably more hidden and diffuse, making it easier to ignore.

“We have mini drug scenes all over the place,” said Richard Coleman, coordinator of Toronto’s Drug Treatment Court, at a May 5 forum in Etobicoke. “There are a couple of parts of town where a [drug] consumption room might be appropriate, but it would require a lot of consultation with the neighbourhoods.”

How will it be possible to garner public backing and avoid NIMBY freakouts? Perhaps by packaging the proposal in a broad, multi-layered approach to harm reduction. At one of the forums at the Y, the chair didn’t mention supervised injection sites or heroin prescriptions at all. Instead, he led the audience through a meandering discourse on “strategic approaches” to handling substance abuse.

If the dialogue was vague, handouts at the meeting were more explicit. Toronto’s proposed drug strategy, stated one, is based “on four components, or pillars: prevention, harm reduction, treatment and enforcement” – the umbrella formulation Vancouver used during the battle to open its facility.

Mayor David Miller has made no public declarations for or against supervised injection sites, though Andrea Addario, his communications director, says he has privately expressed support for “the four-pillars approach” and “harm reduction measures in Frankfurt and Vancouver.”

Police, for their part, are tight-lipped. Constable Kristine Bacharach, a Toronto police services media rep, says the cops won’t comment about safe injection sites until one is actually up and running.

But as Rae points out, the lack of a geographically concentrated drug area could sink the whole idea in political complacency and inertia. “Frankfurt was ready to test a safe injection room because the police and the business and residential communities all threw up their hands and said, ‘We cannot continue to have this open drug scene in the streets,'” says Rae. “My sense is that Toronto has not reached that perfect storm.”

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