By Peter Chow
The first supervised injection service opened 30 years ago in Switzerland. Today there are more than 90 supervised injection services worldwide, including in Europe, Australia and Canada.
They save thousands of lives — people were revived from overdoses 2,275 times in Ontario’s 19 federally approved injection sites in 2018.
In the first three months of 2019, the Toronto Sherbourne St. site was visited 6,484 times by drug users. Workers reversed 257 overdoses, usually by pumping oxygen into the victim, sometimes by injecting opioid-blocking naloxone.
By the numbers:
137,711 – visits to 24 officially designated supervised drug consumption sites in Ontario in 2018
2,275 – overdoses reversed at designated consumption sites in 2018
59,257 – visits to designated consumption sites in first 3 months of 2019
1,017 – overdoses reversed at consumption sites in first 3 months of 2019
1,471 – deaths apparently due to opioid overdoses in 2018
0 – deaths at consumption sites in 2018, and first three months of 2019
With the pandemic, there is a more lethal drug supply due to border closures, more drugs containing Fentanyl and, recently, Benzodiazepines. This has sent addictions services scrambling to help users across the country as opioid overdoses and the resultant death toll continue to mount.
In Ottawa, the injection facility halved the number of booths to ensure distancing when the COVID-19 pandemic broke out in March, resulting in a “huge increase” in overdoses in the surrounding community.
Toronto Public Health opened the city’s first permanent supervised injection service on November 8, 2017. Located inside The Works at 277 Victoria Street, this life-saving health service provides a safe and hygienic environment for people to inject pre-obtained “clean” drugs under the supervision of qualified staff.
The Works is staffed by eight full-time and unionized city employees who have benefits and higher salaries.
Clients arrive at the program with pre-obtained drugs. Each person is assessed to ensure they are eligible for the program.
They are given sterile injecting equipment and instruction on safer injecting practices. A nurse then supervises their injection in a room dedicated for this purpose and intervenes in the case of any medical emergencies.
Once the individual has injected their drugs, they are directed to a waiting room where they continue to be observed for any negative drug reactions. They also receive information and referrals about other health and social supports and services at the agency or elsewhere in the community.
International and Canadian research shows that supervised injections services have benefits both for individuals using the services and for the community, including:
1) Reducing the number of drug overdoses and deaths
2) Reducing risk factors leading to infectious diseases such as HIV and hepatitis
3) Connecting people with other health and social services
4) Reducing the amount of publicly discarded needles
6) Not contributing to crime or increased drug use in the local community
In addition to supervised injection, individuals using these health services will be provided with sterile injection supplies, education on overdose prevention and intervention, health counselling services and referrals to drug treatment, housing, income support and other services.
Supervised injection services do not contribute to more crime.
There is considerable research on this subject. For example, in the neighbourhood around InSite in Vancouver, there has been actual decreases in vehicle break-ins and thefts. Australian studies have found decreases in drug-related crime, public drug use and loitering.
The government says it plans to invest $3.8 billion over the next decade to implement a “comprehensive and connected mental health and addictions treatment strategy, including a “Centre of Excellence” to help people access “integrated and standardized” services across the province.
Provincial funding also includes $31.3 million for up to more sites called Consumption and Treatment Services (CTS). It’s a new harm reduction model that continues supervised injections while adding a focus on connecting drug users to treatment and rehab. Budgets for these new sites “can include funding for benefits and training for frontline staff,” the ministry states.
In Canada, legal operation of a supervised injection service requires an exemption under Section 56 of the Controlled Drugs and Substances Act (CDSA). Exemptions are granted by the federal Minister of Health. In 2015, the federal government passed the Respect for Communities Act, which outlines the process and criteria for applicants seeking a Section 56 exemption.
There are currently 37 supervised drug injection sites in Canada, including 24 in Ontario, 9 in Toronto and 4 in Ottawa. Other cities in Ontario include Thunder Bay, London, St. Catherines, Guelph, Hamilton and Kitchener.
Isn’t it time for Sault Ste Marie to apply?
On Nov. 25, 2020, Vancouver became the first city in Canada to decriminalize all drugs.
Mayor Kennedy Stewart put forward the motion saying it was time to develop a “health-focused” approach to substance use and end the stigma against drug users.
Vancouver’s city council unanimously voted on the measure to decriminalize the possession of small amounts of illegal substances, from marijuana to LSD to heroin, following in the footsteps of Oregon, which became the first state in the U.S. to pass a similar measure at the ballot box this month.
Dr. Patricia Daly, chief medical health officer for Vancouver Coastal Health, has said decriminalization alone won’t solve the drug crisis, but will complement expanded harm reduction and treatment services, including the province’s safe supply program.
The elimination of criminal consequences for possessing drugs for personal use also has the support of Premier John Horgan, provincial health officer Dr. Bonnie Henry and the Vancouver Police Department.
Before the measure is official, it’ll need to be approved by Canada’s federal government. Vancouver Mayor Kennedy Stewart will submit a request to the federal ministers of health and justice for an exemption to the Controlled Drugs and Substances Act.
This is not the same as legalization. What we are talking about is alternative pathways for people that are caught with substances for their own use, where there are alternatives to criminal charges and incarceration.
Under decriminalization, drug dealers still go to prison. But anyone caught with less than a 10-day supply of any drug -including cocaine and heroin – is typically sent to a local commission, consisting of a doctor, lawyer and social worker, where they learn about treatment and available medical services.
No distinction is made between “hard” or “soft” drugs, or whether consumption happens in private or public. What matters is whether the relationship to drugs is healthy or not.
The decriminalization of people who are in possession of drugs for personal use is the next logical and responsible step we must take to keep people alive and connect them to the health and social supports they need.”
Stigma leads drug users to hide their usage and creates barriers to accessing harm reduction and treatment services.
It is a new philosophy concerning drugs and drug based on the following assumptions:
1) drugs and drug use are not inherently evil; addiction is a disease, not a moral failure.
2) a drug-free society is unattainable.
3) people use drugs for a number of reasons.
4) punitive policies are unethical and totally ineffectual.
Vancouver’s approach to solving the problem, instead of compounding it, is the humane, logical approach to helping its citizens. Understanding it, and then looking at what we do here, should make one think of our approach and policies as almost Neanderthal.
What’s the point of arresting drug users and confiscating their drugs? It just drives them to committing break-ins to be able to buy more drugs, which are even more likely to be laced with Fentanyl.
Earlier this past year, the Canadian Association of Chiefs of Police also called for the decriminalization of simple possession of illicit drugs.
The science behind safe drug consumption sites, harm reduction and decriminalization is settled.
The issue now, is that progressive governments across Canada, including municipal, provincial and federal governments, are jockeying to avoid being the one to take the first step, fearing political backlash from conservatives for doing so.
But that fear is misplaced. They think it’s still 20 years ago. But look what just happened in Oregon.
Even if you’re the most craven politician around and you want to win the next election, guess what? Campaign on drugs, and you’re going to win.