Pubdate: Mon, 19 Dec 2016
Source: Toronto Star (CN ON)
Copyright: 2016 The Toronto Star
Authors: Carol Strike and Ahmed Bayoumi
Page: B12


These life-saving places that promote public health will mostly be in
existing centres

A woman uses the public bathroom of a Toronto community centre to
inject heroin.

She figures it's safer than injecting on the street - it's clean and
she won't be robbed. And if she overdoses, she hopes someone will find
her soon enough to help her.

This scenario is a reality for many users, and it's just one of many
reasons Toronto is working toward opening the three supervised drug
injection services that were approved by Toronto city council in July

Supervised injection services are legally sanctioned spaces where
people can inject illegal drugs, typically opiates or cocaine, under
the supervision of trained health staff and without fear of arrest.

These services allow for safer injection and scientific evidence shows
they lead to a reduced number of overdoses, increased referrals to
drug treatment, and benefit public order.

More than 90 of these operate globally, most within nine European
countries, as well as one in Australia, and two in Vancouver.

The evidence shows that drug use can lead to many health and social
problems, but access to supervised injection services can keep people
alive and healthy.

Across Canada and the United States, rates of overdose to opioid
drugs, including Fentanyl, have skyrocketed in recent years.

The situation in British Columbia led the province to declare a public
health emergency after 200 overdose deaths in the first four months of

And this past summer, Toronto's former medical officer of health, Dr.
David McKeown, spoke to city council in favour of creating supervised
injection services to help address overdose-related deaths, which
climbed to an all-time high of 252 in 2014 in Toronto.

Five former Toronto mayors and McKeown endorsed the plan to integrate
supervised injection services into three existing community health
facilities and public support has been strong. These facilities are at
Queen and Bathurst Sts., near Yonge and Dundas Sts., and in
Leslieville. Here's what you need to know about supervised injection

You'll probably never notice them More than 50 places across the city
- - community health centres, public health, social service
organizations etc. - already offer harm reduction services, where
people access needle and syringe distribution programs every day.

For over 30 years, these facilities have integrated so well into their
neighbourhoods that they have gone largely unnoticed - operating
quietly but efficiently to address the stigma associated with drug

Because supervised injection is an extension of these services and
will be opened in facilities with a wealth of experience in harm
reduction, we expect they will not significantly change surrounding
communities - except by decreasing public drug use, which benefits

People will use them When Vancouver's first supervised injection site,
Insite, opened, there were wait lines immediately.

There is similar high demand for a recent pop-up site opened by
community activists in Vancouver. In Toronto, people inject in places
that are not always clean or safe and where they may not be able to
get help if they need it.

People who inject drugs in Toronto attended the consultations held
over the past year to vocally offer their support of these life-saving
programs. Over 75 per cent of people in Toronto who inject drugs said
that they would use one.

Ignoring the problem will make it worse Toronto carefully selected the
locations of these services to be in communities where rates of
injected drug use are high. This is an excellent example of fitting
the service to the real, unmet needs of people who use drugs. If we do
not provide a safe space, we are ignoring a problem that will only
getting worse - more people will overdose and we will fail to prevent
infections such as hepatitis C and HIV.

Supervised injection services are one part of the drug reduction
strategy Supervised injection services are just one part of a
multi-pronged approach to reducing drug use.

Through a combination of law enforcement, prevention, harm reduction
and public health programming, the Toronto Drug Strategy aims to
minimize the harm caused by drug use.

Supervised injection services work Research has shown that supervised
injection services reduce public drug use and drug-related littering,
and decrease the number of overdoses and risky injection practices.

They also provide an important way to refer people to drug treatment
and health and social services. They are a cost-effective way to
improve the health of people who use drugs.

Dr. Carol Strike is a professor in the Dalla Lana School of Public 
Health and Dr. Ahmed Bayoumi is a professor in the Institute of Health 
Policy, Management and Evaluation and a clinician-scientist at St. 
Michael's Hospital. Doctors' Notes is a weekly column by members of the 
U of T Faculty of Medicine. Email  ---
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