Montreal Isn’t All That Close To Having Supervised Injection Sites

A shot of InSite, a safe injection site in Vancouver. Photo via.

If you have a Google Alert set up for "supervised injection site," you probably already know that Montreal's Public Health Department is lobbying to get four new supervised injection sites for drug addicts. Except, chances are, the department won't be successful. There’s plenty of red tape to follow, no anticipated date of opening, and no guarantee that any sites will actually open. Particularly not anytime soon.

Here’s what happened: on December 11, Montreal’s Director of Public Health filed a funding request to Quebec’s provincial health ministry, asking for $3.2 million in start-up money and $2.7 million annually to run four safe injection sites. That request hasn’t been approved yet; and Quebec’s health ministry did not return any of my calls asking for an anticipated date for a decision.

“We have great hopes that it’s going to work out,” says Amélie Panneton, communications director for Cactus, a local support centre for addicts, which would house one of the supervised injection sites. “Things could also go really fast and get approved quickly and open in the summer. But at this point it’s all speculation.”

Presuming the provincial government agrees to fund the project, there’s another major hurdle to cross. It would then need to file an application to the federal government for the sites to be exempt from Canada’s drug laws. But the Conservative government has been hostile to Canada’s only operating supervised injection site (SIS), InSite, in Vancouver, refusing to renew the centre’s exemption in 2008, which had originally been granted by the Liberal government in 2003. It was only after a lengthy court battle that in September 2011 the Supreme Court ruled against the Conservatives, ruling that InSite’s benefit to society trumped Canada’s drug laws.

Since then, the government introduced Bill 65, later renamed Bill C-2, which they’ve dubbed the “Respect for Communities Act.” The Bill places 27 conditions on any exemption application. It hasn’t passed yet, and is currently in its second reading stage.

Even the office of Montreal’s public health authorities, who prepared the exemption request, admit the bill could cause problems. “We won’t hide our concern about some aspects of Bill C-2, particularly with regard to the power granted to the Minister of Health Canada, who will have the last word on applications and how the government will take into account the views of the community,” they said in an e-mail.

Most of the requirements have to do with providing detailed scientific studies of drug and crime usage of the areas in which the SISs operate. The Bill’s language doesn’t state how these studies would be assessed, and also puts in other requirements, such as a 10-year criminal background check for anyone who works there.

“It was anticipated that when the Supreme Court supported Insite, it was considered likely they would come up with some sort of new criteria. But instead of following what the Supreme Court said, they made it harder,” said Mark Tyndall, an Ottawa doctor specializing in infectious diseases, who helped set up InSite and subsequently researched the effects it had on its local environment. He noted he wasn’t against providing information in order to convince local community members it was a good thing, but that the potential new regulations would go beyond that.

“All the issues people continue to bring up have been basically been dealt with. To me it seems should be pretty straightforward. Now it’s the same old tired arguments.”

Another potential roadblock is the condition that the head of the police has to provide a letter along with any future exemption requests giving his or her opinion on the site, and outlining any security issues. A Montreal police spokesperson told me that the department had no official stance on safe injection sites. I asked whether the police chief provided a letter, but they haven’t gotten back to me.

The required opinion of police chiefs, as well as the other municipal and provincial authorities could cause even bigger problems for other cities. Tyndall said he is working on an exemption request for potential site in Ottawa, but in that case the police have come out against the idea, and public political support has been nonexistent.

“We’ve been in contact with many politicians and they’ve given us a variety of opinions. But no one's going to come out publicly and support it for political reasons. And in Ottawa the police have publicly come out against it,” he says.

People dreaming of a speedy decision should probably take pause. The effort to create safe injection sites in Montreal dates back to the formation of a provincial committee on cocaine addiction in 2000, which recommended the creation of designated injection and care sites for addicts in downtown Montreal. In 2003 the provincial government asked Montreal’s health authorities to conduct a feasibility study to create supervised safe injection sites, but the resulting project, P.L.A.I.S.I.I.R.S, was an addict support network that did not provide supervised injection.

It was only after being pressured by a coalition of 30 community groups in 2010 that the feasibility study was taken up again, finally being published in 2011. The funding request was supposed to be submitted in 2012, but only came at the end of 2013 in order to be better prepared. In other words, it’s taken 13 years to get to this point in Montreal alone, and there’s no telling how long the next steps will take.

For people like Tyndall, the delay is absurd. As part of Montreal’s funding request, it had to provide a cost analysis arguing that the centres would provide a net profit to the Quebec healthcare system within four years, which he says should be obvious.

“Just think of the costs of the reducing the rates of infection of HIV and hepatitis alone. But people don’t factor other costs into this. There's nobody asking the police how much they're spending throwing people in jail. Nobody is asking hospitals how much they're spending on drug treatments. I think it would pay for itself within a month,” he said.

“This should be a very boutique issue. If you had a breast cancer clinic opening up, would you ever have the mayor involved? It should be a health care issue.”

Panneton says that one hope is that the government follows the lead of Australia’s centre-right governments, which she says embraced the sites as a tool for social control. “That’s obviously not the way we see things, but maybe our government could see it that way. We could be surprised by the outcome.” With files from Stephanie Mercier Voyer.