Supervised Injection Sites Are on the Way. Here’s What They Look Like Now

"I can't remember if it was me who was sick first, or if it was him," Amy Wright tells me, describing how she and Robert Quenville—the "one person" who she could rely on while homeless—had both caught a cold one winter. Depending on who was weaker on a given day, the two traded roles in nursing each other back to health.

For Quenville, however, it was not the common cold that would rob him of his health and eventually his life.

"I'm certain—90 percent sure, actually—if supervised injection sites were around when he was, he would not be dead."

The place Wright and I spoke at, an alleyway just a few hundred feet from the entrance of Toronto's St. Michael's Hospital, used to be where Quenneville would sleep and sometimes inject drugs. That day, the passageway was largely empty, kept in company by only the light patter of rain and a handful of restaurant employees on their smoke break.

At one point, both Wright and Quenville were heavily-addicted to opiate drugs. The two had met while on the streets of Vancouver's Downtown Eastside in the summer of 2009, and, due to proximity, were both regular users of Insite (the city's first and and at one point only supervised injection site). After Wright's brother took his own life in 2011, Wright moved back to Toronto to help get herself clean. By the end of the year, Quenville had—like the drugs—disappeared from her life.

Yet Wright would run into him again, this time as an outreach worker. In Toronto, Quenville was still using, but he wasn't coping as well as he had in Vancouver. He spent most nights on the street, stuffed into that same alleyway. Due to the city's affordable housing crises and lack of access to shelter beds, Wright says this is a common problem for Toronto's homeless.

On top of being unable to find a bed to sleep in, Quenville had zero access to supervised injection services like he had in Vancouver. Instead, like many of the city's opiate-using individuals, Quenville would inject drugs inside coffee shop bathrooms or in public, oftentimes being kicked out or harassed by people who felt uncomfortable with the sight.

On August 1st, 2015, Quenville collapsed from an overdose on the northwest corner of Queen St. E. and Jarvis St.—a five-second walk across the road from Fred Victor House. Aside from Wright's memory of him, the only public trace of Quenville's existence in Toronto is his name, which can be found on the unofficial memorial list for Toronto's homeless. In June, Toronto's health officials and city councillors came together on a formal agreement to greenlight the proposal for three separate supervised injection sites in the downtown core. Without federal approval, however, the sites have sat in limbo.

On Monday, after months of deliberation and a report from medical experts on how to combat the opiate crisis, federal Minister of Health Jane Philpott announced Bill C-37: legislation slated to amend the Controlled Drugs and Substances Act so supervised injection sites can be opened with much greater ease.

Currently, under Bill C-2, the federal government—in conjunction with local and regional police, and numerous political agencies—must give a case-by-case exemption to any location trying to give drug-using individuals the ability to inject illegal drugs under the care of medical professionals.

"I've made it very clear to my department that there should be no unnecessary barriers for communities who want to open supervised consumption sites," Philpott said in a September question period in the House of Commons.

"Clearly, it's important that this is done right."

Still, some say that by having it "done right," the process has been slow—too slow. In fact, debate over how to "properly" go forward with supervised injections sites stems back into the early 2000s, with Insite being a catalyst for much of the dialogue found in discussions about harm reduction today.

Even with the new law, safe injection sites will still need to obtain funding from their respective provincial health agencies—a process that could prove difficult in provinces that have, unlike BC, not yet tested a successful model that could be used as precedent.

As of December 2016, the only two supervised injection sites that are both federally and municipally-approved to operate are Vancouver's Insite and Dr. Peter Centre. The next proposed sites within striking range of federal approval are located in Montreal and Ottawa, but both have yet to get the final thumbs up.

In September, VICE reported on a back alley supervised injection site in Vancouver that was operating without the city's approval. Along with the few who defy federal law by working there, the site operates on a bare bones setup—a tent, some tables, clean injectable tools, and the overdose antidote naloxone.More recently,

By October, the City of Vancouver had formally acknowledged the site's presence and agreed to, with the guidance of police, "assess the risk of the unsanctioned overdose management site." Regardless of what that may mean for the future of the site, co-founder of the site Sarah Blyth told VICE that this is just the beginning of DIY sites in North America.

"Someone from Boston just contacted me," Blyth said. "They want to get a tent set up as soon as possible—they're having five to six people dying a day in Boston."

Back in Toronto, Shaun Hopkins is the manager of The Works: the city's official needle exchange program and harm reduction agency. The Works' headquarters, located at the Toronto Public Health offices, which sit on the edge of the Ryerson University campus, is one of the three proposed spots that the city's board of health has designated as a space suitable for being a supervised injection site—the other two being in the Queen West-Central Toronto Community Health Centre, and South Riverdale Community Health Centre.

Hopkins, who's been working at the facility for 25 years, said she's happy there has been a shift in the attitude toward safe injection centres—especially now that Toronto's city council, which voted almost unanimously in favour of the sites.

Still, Hopkins notes that there has and continues to be a big price to pay in having to wait on Ottawa's blessing, and told me that whatever comes of that wait should be bigger in scope than just a series of one-off exemptions.

"I hope that these three initial places are just that—three initial places," Hopkins told me behind the curtains of a makeshift interview room at the Works. "There has to be a comprehensive strategy. I mean, that's why we're doing this—to save lives, and to have people inside where we are. That way, if they do overdose, there's help."

Across the country, there has been a steady and alarming rise in overdose deaths. In Alberta and British Columbia, the increasing presence of fentanyl has ravaged the opiate-using population, contributing to hundreds of deaths per year in each province. In Ontario, over 5,000 people died from opiate overdose between 2000 and 2013. Since then, fentanyl has now become the number one cause of opiate-related overdose death in Ontario—killing 162 in 2015, up from just 86 in 2010.

Yet, beyond federal limitations, there's even opposition to supervised injection sites being set up at a local level. During the debate to have Toronto's own locations greenlit, three city councilors opposed the recommendation to set up the sites put forward by the board of health.

"Using drugs is illegal and I don't know why we set up a facility where we allow that to happen under our supervision," said Coun. Stephen Holyday at the final council vote for the supervise injection plan, according to the Toronto Star. "[I]n some ways, it's an enabler."

Coun. Giorgio Mammoliti, a local politician who is notorious for going on absurd tirades and pushing polarized issues city hall, took issue with the plan for Toronto's safe injection sites. He argued it would be inappropriate to have locations, like the Works, so close to businesses and schools, and told VICE that he would fight the establishment of supervised injection sites "tooth and nail."

In 2011, Wright's took his own life Brad while battling addiction to non-opiate drugs. At the time, Wright was a regular opiate user and had been since she was prescribed percocets for a sports injury while in university. That habit eventually developed into heroin use, and she found herself homeless not long after. Unlike Wright, who overdosed on a number of occasions and managed to survive each time, Brad had trouble coping with his addiction.

Brad's death "shook [her], more than anything had before." Within a week, she hopped on a Greyhound charted from Vancouver to Toronto, detoxed herself of drugs, and found a place to live in the city. 2016 marked her fifth year of sobriety, and now, Wright sits on Toronto's planning committee for the formulation of its supervised injection strategy. She says that her job is a reminder to what could have been.

"It's a definitely a reminder of where my life could be, where it could go again. I see the struggle that people who use heroin go through and I can feel it," she said. "I know my brother in a sense gave me a gift, and I know it could have taken me down a another road."

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CORRECTION: A previous version of this article stated that Wright's brother had died from an overdose. This is incorrect. Wright's brother was battling addiction to non-opiate drugs and took his own life in 2011. We apologize for this error.