Pubdate: Sat, 12 Mar 2016
Source: Toronto Sun (CN ON)
Copyright: 2016 Canoe Limited Partnership
Author: Jennifer Pagliaro
Page: A1


With overdose deaths at record levels, Toronto to offer service for 
users in multiple locations

Toronto is moving ahead with plans to become the second Canadian city 
to open controversial supervised injection sites for drug users, the 
Star has learned.

A report from the city's medical officer of health, to be released 
Monday, will outline the need for multiple locations where drug use 
is concentrated and will be embedded in existing health services. The 
proposed locations are also expected to be announced Monday.

The move follows an escalating number of overdose deaths in Toronto - 
they climbed to an all-time high of 206 last year - and the growing 
trend of heroin and fentanyl use, which medical officer of health Dr. 
David McKeown has declared a "significant public health issue."

As the federal Liberals signal their willingness to support these 
sites - an about-face from the Conservative government's attempts to 
block them - Toronto advocates are laying the groundwork for approval.

"The need is more significant now than it's ever been in our city's 
history - that people are dying on our streets and we can save those 
lives," said Councillor Joe Cressy (Ward 20 Trinity-Spadina), who 
chairs the Toronto Drug Strategy Implementation Panel. "We have a 
responsibility and a capacity to act and we should.

"We needed these programs yesterday and I hope we'll be able to have 
them open and saving lives as quickly as possible." Supervised 
injection sites allow drug users, who bring in their own substances, 
a safe place to inject while supervised by health professionals in 
case of overdose.

Those who use these sites are also provided with new, sterilized 
equipment to prevent infection and have ready access to treatment and 
community supports.

"One of the benefits of supervised injection, which has been 
repeatedly shown in studies, is its ability to reduce overdose and 
particularly fatal overdoses," McKeown said in an interview. "That is 
the kind of model that I think makes the most sense in this city."

Talk of supervised injection sites in Toronto has previously sparked 
concern from local communities and hesitation at council. The issue 
was given prominence by the Toronto Drug Strategy's release in 2005, 
which called for an assessment of the need for such sites and a 
feasibility study.

That study, by St. Michael's Hospital and the University of Toronto, 
completed in 2012, found Toronto would benefit from the 
cost-effective, harm reduction achieved by opening at least three 
sites in Toronto, integrated into existing services. The study raised 
the possibility of up to five locations.

In 2013, city's board of health backed integrated supervised 
injection services on the recommendation of McKeown.

With plans now underway, Cressy said there will be a "robust" public 
consultation on the sites before it is sent to council and then 
submitted for approval by the federal health minister.

"It's also about public safety," Cressy said. "We don't want people 
injecting in our streets, in our coffee shops, in our parks and in 
our stairwells."

Any organization looking to open a supervised site must apply to the 
federal government for an exemption "necessary for a medical or 
scientific purpose" under the Controlled Drugs and Substances Act.

Last year, the changes to the law initiated by the Conservative 
government created what critics have called an onerous number of 
requirements to apply for exemption status.

That change followed a 2011 Supreme Court decision unanimously in 
favour of Canada's first supervised injection site in Vancouver, 
InSite, which the government had tried to prevent from renewing its 
exemption status.

That Supreme Court decision ruled InSite, which is a stand-alone 
service, should be allowed to continue operating, saying it has 
"saved lives and improved health without increasing the incidence of 
drug use and crime in the surrounding area." It also outlined that 
the federal health minister must weigh those public health needs in 
generally granting exemptions.

Though the requirements put forward by the previous government are 
still in place, Liberal Health Minister Jane Philpott has recently 
opened the door to more applications.

"I suspect now that municipalities are aware of the fact that the 
government is supportive of harm-reduction facilities like this . . . 
We will see other locations that will make applications," she told 
iPolitics last month.

Those comments followed Ottawa's approval of the country's second 
supervised injection site inside an existing facility in Vancouver 
this January.

Cressy said the change in leadership helped spark Toronto's plans to 
move forward now. "We have a new Government of Canada that recognizes 
the urgent need to tackle overdose and has expressed not just a 
willingness, but a keenness to support the introduction of supervised 
injection services," he said.

Several international and Canadian studies have outlined the benefits 
of supervised injection sites, citing lifesaving measures, positive 
community impacts, and cost savings for the public health system.

Since it opened in 2003, InSite in Vancouver says no overdose deaths 
have occurred there and the number of overdoses in the surrounding 
area have decreased by 35 per cent - nearly four times the rate of 
decline in the city overall, according to their website.

The Toronto-based feasibility study found 54 per cent of drug users 
surveyed were injecting in public spaces, such as washrooms. Among 
those who participated in the study, there was a 70-per-cent 
prevalence of hepatitis C and a 3-per-cent prevalence of HIV.

Nearly 30 per cent of those who were surveyed reported having an 
overdose in the six months leading up to the study.

Researchers found there was support to open integrated sites in 
Toronto where drug use is concentrated, especially where drug use is 
publicly visible.

In Toronto, the report said, drug use is concentrated in more than 
one area, highlighting the need for multiple sites. Half of the drug 
users surveyed said they would travel up to 10 blocks to use a 
supervised injection site.

Donna May, whose daughter, Jac, died in 2012 from disease contracted 
through intravenous drug use, said she wasn't always supportive of 
supervised injection sites.

Once a proponent of "tough love," May said her daughter's death at 
age 35 was an education, one that spurred her to start the advocacy 
group Moms United and Mandated to Saving the Lives of Drug Users (mumsDU).

"I've walked both sides of the street. I've seen it from both points 
of view. I understand when a community says, 'I don't want it in my 
backyard,' the NIMBYism," May said. "But the truth of the matter is 
it's already in a person's backyard."

She said breaking the social stigmas around addiction and opening 
supervised injection sites in Toronto and elsewhere is crucial for 
other families and to prevent more deaths.

"It could happen to anyone's child," she said, remembering her own daughter.

"She was a mother of three. She was a wife. She had a home. She was 
educated. Funny. Contributing member to society until everything got 
away from her."

"We need to start treating addiction as a public health concern."
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