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Toronto Eyes Safe Injection Sites to Combat Rising Overdoses

There are over 90 supervised injection services around the world, mostly in Europe, and Australia. In North America, however, Vancouver is still the only city to officially provide spaces for users to consume their drugs.
Photo by Jonathan Hayward/The Canadian Press

A rise in overdose deaths from opioids like heroin and fentanyl has renewed calls in Canada's largest city for government-sanctioned facilities where addicts can shoot up under the supervision of a nurse.

At a press conference attended by politicians, harm reduction workers, and injection drug users themselves, Toronto's Medical Officer of Health David McKeown touted the potential benefits of introducing three safe injection sites within its borders.

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McKeown wants Toronto's board of health to launch community consultations on the possibility of integrating the locations into existing harm reduction facilities. The public push comes just two months after Vancouver received the green light for Canada's second safe injection site, and as the federal government signals it is softening to the concept overall.

"These programs will save lives," Councillor Joe Cressy, whose ward would include one of the proposed sites, told reporters at the press conference. "These programs will also make our communities safer. They will move drug use and needles from streets, our parks, our backyards, and our coffee shops, and into a supportive and safe environment."

There are over 90 supervised injection services around the world, mostly in Europe, and Australia, according to McKeown. In North America, however, Vancouver is still the only city to officially provide spaces for users to consume their drugs, despite the fact that the facilities are legal in Canada.

Several sites are planned in Montreal, and city officials in the smaller Ontario cities of Thunder Bay and London are looking into the possibility. But the process is a long and complex one that requires a city to get an exemption from federal drug laws from the minister of health.

In June of last year, the Conservative government passed the widely-panned Respect for Communities Act, which sets out a laundry list of criteria to obtain an exemption, including quantitative evidence of the need for such a site in a particular area (crime statistics, overdose rates, drug-related litter, etc), letters of opinions from stakeholders like members of local government and the chief of police, as well as measures to address any concerns raised.

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For now, the Liberals have no plans of repealing the legislation, according to the office of Health Minister Jane Philpott, who visited Vancouver's Insite, in the drug-ridden Downtown Eastside, in January and called the experience "incredibly moving."

Research says Toronto is different from Vancouver in that drug use is spread out throughout the city rather than being concentrated in one area — this is why McKeown recommends three small-scale sites be integrated into existing harm reduction programs, citing studies that say people will only use the facilities if they are close by.

"Conditions currently in Toronto support the need for these health services," McKeown told reporters.

Between 2004 and 2013, Toronto saw a 41-percent increase in the reported number of overdose deaths — from 146 in 2004 to the highest annual total to date of 206 in 2013, the report notes. Additionally, according to a recent study, 36 percent of people injecting drugs in Toronto are doing so in public places, like washrooms and alleyways.

Montreal Plans to Open Safe Injection Sites With or Without Federal Approval

There were 100,000 client visits to harm reduction services in 2015 and 1.9 million needles were distributed, according to the report.

But the proposal would also need the support of city council, where the issue continues to be divisive.

In an interview with VICE News, Councillor Giorgio Mammoliti characterized today's move by Toronto Public Health as "people making a couple of hundred thousands of dollars a year […] trying to preach to people and tell them what's best for their communities."

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While the councillor supports safe injection sites as a service for users, he is opposed to the idea of them operating outside of hospitals, and argues that "you cannot mix heroin and residential communities in any way."

"You can't do it in strip plazas, and you can't do it with commerce," he said, adding that "there's no way that a community economically will ever bounce back from the devastation that drugs bring."

Mammoliti also expressed concern over how the city would fund the extra police officers he believes will be needed in the neighborhoods surrounding the sites.

"Heroin addicts can be one of the most violent people around," he said. "They'll do anything for a shot of heroin, and so do we really want them lingering the streets in between their hits?"

But McKeown argues that safe injection facilities don't contribute to any more crime.

"They'll located in neighborhoods where there is a demonstrated need, usually when drug use is already having an impact," he wrote in his report, adding that there's been no increase in crime at all around Insite. To the contrary, there's been decreases in vehicle break-ins and theft.

But the head of Toronto Police Association Mike McCormack has attributed the decrease to "an influx" of police officers in the area surrounding Insite. He told the Toronto Sun that more police officers in neighbourhoods with safe injection sites may be necessary to keep crime down.

The proposal needs to cross various political hurdles before it becomes a reality. Toronto Mayor John Tory acknowledged on Monday the issue was a "difficult" one, but maintained that his priority is "the safety of the public and that means working to prevent drug-related deaths and keeping needles and drug paraphernalia out of schoolyards and other public places in Toronto."

Follow Tamara Khandaker on Twitter: @anima_tk