Pubdate: Thu, 04 Jul 2013
Source: NOW Magazine (CN ON)
Copyright: 2013 NOW Communications Inc.
Contact:  http://www.nowtoronto.com/
Details: http://www.mapinc.org/media/282
Author: Ben Spurr

SHOOTING FOR A SOLUTION

Medical Officer of Health Hypes Plan for Safe Injection Site

It's an idea that's always proved too radioactive for council to 
touch, but Toronto Public Health believes it could save lives.

In a report released Tuesday, July 2, the city health agency 
recommends seeking provincial funding to set up Toronto's first 
supervised drug consumption site. The report, authored by medical 
officer of health Dr. David McKeown, calls for a pilot project of the 
controversial practice. The proposal goes before the board next week.

"I think this is a big step forward," says board member Gord Perks, 
chair of the Drug Strategy Implementation Panel. "This is the senior 
medical person in the Toronto community taking a principled stand in 
favour of a service that will be controversial but will save lives 
and money, and reduce harm in our community."

The pilot project would last at least two years and likely be 
integrated into three existing facilities. TPH has not yet identified 
potential locations, but Perks admits that wherever it goes, a 
shooting gallery, albeit a supervised one, is bound to meet with 
opposition. "It's going to be a very difficult conversation," he says.

Already Mayor Rob Ford has come out against the proposal. A day after 
the report was published, he told reporters safe injection sites are 
"the worst thing that could happen to this city right now."

There are at least 90 supervised sites in operation around the world. 
These facilities allow addicts to consume intravenous drugs in a 
sanitary environment under the care of health professionals. Clients 
bring their own drugs and are provided with clean needles, 
tourniquets and other paraphernalia, and are also offered connections 
to treatment and detox programs.

According to TPH, research shows supervised consumption reduces the 
incidence of overdose and needle-sharing, helps get more people into 
treatment and does not result in increased crime in the area.

Data on Toronto's drug problem is imperfect, but according to 
associate medical officer of health Dr. Rita Shahin, between 2002 and 
2010 there were 538 deaths linked to opiate use and 319 to cocaine. 
(She couldn't provide data on how many of the victims injected the 
drugs, however.)

The most recent research also indicates that 61 per cent of 
intravenous drug users could be infected with hepatitis C and 6 per 
cent with HIV. One in five report spiking up with used needles. In 
light of these stats, Shahin says it's illogical for critics to 
accuse safe injection sites of encouraging dangerous drug use. "It is 
a way of recognizing that it is happening, and [saying] let's reduce 
the harms associated with it," she says.

But although the board appears set to take a strong stand, the other 
levels of government on which the project depends are hardly onside. 
"Supervised injection sites aren't something we're moving forward 
with right now," says Minister of Health Deb Matthews in an emailed statement.

"Our government supports a wide range of strategies including needle 
exchange, injection drug user outreach and methadone treatment. Since 
2003, our investment in addictions programs has increased by nearly 
50 per cent," she says.

Meanwhile, Ottawa's attitude is effectively hostile. Anyone wishing 
to open a supervised consumption program must first obtain an 
exemption under the Controlled Drugs And Substances Act, which can 
only be granted by the federal health minister herself. In 2008, the 
minister refused to renew the exemption for Vancouver's InSite, which 
led to a legal challenge and eventually a Supreme Court ruling that 
found the government's decision violated the Charter Of Rights And Freedoms.

The court ordered the minister to approve future applications unless 
there was evidence that doing so would compromise public safety.

In response, the Conservatives tabled Bill C-65, which lays out a 
long list of conditions that any proposed site must meet. These 
include providing hard-to-measure data on local drug use, and police 
checks going back 10 years for all employees.

The TPH report calls these conditions "extremely onerous and 
disproportionate to what is required for other health services." It 
recommends the health board formally register its opposition to Bill 
C-65, which is still pending.

The Conservatives say the provisions, some of which focus on seeking 
approval from local governments, residents and the police, are 
intended to ensure injection sites don't go where they're not wanted.

"The introduction of [Bill C-65] will make certain local voices are 
heard," writes Health Minister Leona Aglukkaq in a statement. "We 
don't think a supervised drug consumption site should be created in a 
neighbourhood without consultation." 
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MAP posted-by: Jay Bergstrom