Shannon Hazlett

According to a 2013 Toronto report, 206 people died from drug overdoses in that year, the highest annual number to date. Toronto is following the lead of its West Coast counterpart, Vancouver, in establishing supervised injection sites. The City is planning to introduce at least three supervised injection services to provide drug users with a safe place to inject, where they will have access to clean needles and supervision from nurses.

A recent report published by the City of Toronto presents supervised injection services as a health service working to reduce the number of overdoses and transmission of blood borne diseases such as HIV or hepatitis. According to the report, there was a 41 per cent increase in the number of deaths by overdose between 2004 and 2013.

Toronto chose to implement safe injection services to address the health risks associated with higher levels of drug use following the successful implementation of this model in the jurisdiction of Vancouver. The Toronto Drug Strategy was approved in 2005 by the Board of Health and City Council. It includes a list of preventative, harm reduction, and enforcement measures for injection drug users, with safe injection services being a preliminary step to a long term solution. Since 2005, measures were undergone by the City of Toronto to introduce safe injection services, these processes include a needs assessment, a feasibility study, as well as an independent research study from a team of experts. In addition, the City of Toronto has been collaborating with different stakeholders to gain approval for safe injection services. Interest groups include following criteria set out by Health Canada, approval from the Board of Health as well from the Medical Officer of Health. These measures help to explain why it took the City of Toronto several years to start the implementation process of safe injection services.

The City plans to introduce three safe injection services to already existing clinical health service agencies in Toronto, which include the Toronto Public Health facilitated through The Works program, the Queen West – Central Toronto Community Health Centre, and the South Riverdale Community Health Centre. Agencies are planning to collaborate to ensure consistency of health services.

Drug users who go to Insite, one of Vancouver’s two safe injection service locations, are less likely to share needles because they receive access to clean ones.

A study by the BC Centre for Excellence in HIV/AIDS suggests that the enormous benefits of introducing safe injection services among injection drug users include reducing HIV risk behaviour, promoting access to addiction treatment, and reducing the risk of overdose. Sharing needles is one of the primary ways HIV is contracted among injection drug users. Drug users who go to Insite, one of Vancouver’s two safe injection service locations, are less likely to share needles because they receive access to clean ones. In addition, those who use the safe injection service were more likely to enter into a detox program. Vancouver’s Downtown Eastside saw the fatal overdose rate decrease by 35 per cent after opening the supervised injection facility in 2005.

Harm reduction policies for injection drug users in Canada have largely changed since the introduction of safe injection services. Developing Canada’s Research Base for Harm Reduction and Health Equity Approaches to HIV Prevention and Treatment report found that since the establishment of Insite, all health authorities in British Columbia are required to inform injection drug users about HIV therapy. The attention given to harm reduction policies and practices for injection drug users across Canada has increased as a result of Insite. Changing the policy process is necessary to significantly reduce the number of deaths by injection drug overdoses.

Although injection sites have been proven to be beneficial for reducing harm to injection drug users, they can be a cause of concern for those living near the facilities. Through City of Toronto consultations, the City recognized that local communities were worried about an increase in crime, a decrease in personal safety, heightened drug use and a negative impact on neighbourhood cleanliness due to discarded needles. To address these challenges, the City proposed to increase police presence in the neighbourhoods, as well as create patient waiting areas to reduce loitering among drug users. The City also plans to implement a community advisory committee to address ongoing concerns regarding the operation of supervised injection services.

International research has concluded that safe injection sites have the potential to reduce overdose deaths and reduce unsafe injection practices and drug use, all the while being cost effective.

To ensure the success of the new supervised injection services locally, the City of Toronto has put evaluation methods in place. This will include the collection of pre- and post-service initiation data to identify trends, address concerns and inform strategies on an ongoing basis. International research has concluded that safe injection sites have the potential to reduce overdose deaths and reduce unsafe injection practices and drug use, all the while being cost effective, with successful adoption of the service in Sydney, Australia and New York City and in more than 90 sites worldwide. CBC Canada reports $12 million to be invested over three years to create safe drug injection sites in Montreal, reiterating the high need and demand across Canada. Along the way there may be some challenges with stakeholder concerns or skepticism of success, but the implementation of supervised injection sites has the ability to help save lives.

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Shannon is a first year Master of Public Policy Candidate at the University of Toronto. She grew up in the Greater Toronto Area, and has lived on both the east and west coasts. She recently completed her undergraduate degree in Health Promotion, specializing in Research & Policy from Dalhousie University. Shannon has a passion for the Social Determinants of Health, environmental policy and if she could, she would spend all her time on the mountains.