This scenario is a reality for many users, and it’s one of many reasons Toronto is working toward opening the three supervised drug injection services that were approved by Toronto city council in July 2016.
Supervised injection services are legally sanctioned spaces where people can inject illegal drugs, typically opiates or cocaine, under the supervision of trained health staff and without fear of arrest. These services allow for safer injection and scientific evidence shows they lead to a reduced number of overdoses, increased referrals to drug treatment, and benefit public order. More than 90 of these operate globally, most within nine European countries, as well as one in Australia, and two in Vancouver.
Across Canada and the United States, rates of overdose to opioid drugs, including Fentanyl, have skyrocketed in recent years. The situation in British Columbia led the province to declare a public health emergency after 200 overdose deaths in the first four months of 2016. And this past summer, Toronto’s former medical officer of health, Dr. David McKeown, spoke to city council in favour of creating supervised injection services to help address overdose-related deaths, which climbed to an all-time high of 252 in 2014 in Toronto.
Five former Toronto mayors and McKeown endorsed the plan to integrate supervised injection services into three existing community health facilities and public support has been strong. These facilities are located at Queen and Bathurst Sts., near Yonge and Dundas Sts., and in Leslieville.
You’ll probably never notice them.
More than 50 places across the city — community health centres, public health, social service organizations etc. — already offer harm reduction services, where people access needle and syringe distribution programs every day. For over 30 years, these facilities have integrated so well into their neighbourhoods that they have gone largely unnoticed — operating quietly but efficiently helps to address the stigma associated with drug use.
Because supervised injection is an extension of these services and will be opened in facilities with a wealth of experience in harm reduction, we expect they will not significantly change surrounding communities — except by decreasing public drug use, which benefits everyone.
People will use them.
When Vancouver’s first supervised injection site, Insite, opened, there were wait lines immediately. There is similar high demand for a recent pop-up site opened by community activists in Vancouver. In Toronto, people inject in places that are not always clean or safe and where they may not be able to get help if they need it.
People who inject drugs in Toronto attended the consultations held over the past year to vocally offer their support of these life-saving programs. Over 75 per cent of people in Toronto who inject drugs said that they would use one.
Ignoring the problem will make it worse.
Toronto carefully selected the locations of these services to be in communities where rates of injected drug use are high. This is an excellent example of fitting the service to the real, unmet needs of people who use drugs. If we do not provide a safe space, we are ignoring a problem that will only getting worse — more people will overdose and we will fail to prevent infections such as hepatitis C and HIV.
Supervised injection services are one part of the drug reduction strategy.
Supervised injection services are just one part of a multi-pronged approach to reducing drug use. Through a combination of law enforcement, prevention, harm reduction and public health programming, the Toronto Drug Strategy aims to minimize the harm caused by drug use.
Supervised injection services work.
Research has shown that supervised injection services reduce public drug use and drug-related littering, and decrease the number of overdoses and risky injection practices. They also provide an important way to refer people to drug treatment and health and social services. They are a cost-effective way to improve the health of people who use drugs.
Dr. Carol Strike is a professor in the Dalla Lana School of Public Health and Dr. Ahmed Bayoumi is a professor in the Institute of Health Policy, Management and Evaluation and a clinician-scientist at St. Michael’s Hospital. Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine. Email email@example.com .