Supervised drug injection sites are on their way to Toronto if local councillor Joe Cressy (Ward 20, Trinity-Spadina) gets his way. The rookie member of city council finds himself on many civic bodies, but at the Toronto Board of Health, he is the elected chair. Cressy announced the initiative in late March after the board directed the Medical Officer of Health to conduct community consultations for several supervised injection sites. This could lead to the federal government’s endorsement of the proposal; that is, making it legal for injection drug users to come into a controlled site with their own privately procured drug, get some guidance and a clean needle, and under the watchful supervision of a nurse, inject themselves.
“Cressy’s announcement exhibits courage, compassion, and an understanding of the merits of good public health policy.”
This plan has been brewing at the board of health for some time, but Cressy’s announcement, as well as the unequivocal manner in which he delivered it, exhibits courage, compassion, and an understanding of the merits of good public health policy.
In Toronto, there was a 41 per cent increase in deaths related to drug overdose from 2004 to 2013, with 206 in 2013 alone. The existing statistics identify a rise in opioid-related deaths caused by overdoses of heroin, morphine, oxycodone, and fentanyl.
A rash of lethal overdoses from China White (heroin laced with fentanyl — one hundred times more potent than morphine and fifty times more potent than heroin on its own) is occurring in British Columbia and Alberta, and it’s a trend that is slowly migrating eastward. This past Easter weekend saw four fentanyl overdose deaths alone. Naxalone is an antidote to a fentanyl overdose, but the victim must be treated immediately, which is why nurses at injection sites are so important.
Unlike in Vancouver, which built sites specifically for safe injection, the City of Toronto proposes to locate safe injection sites within pre-existing harm reduction health facilities. The first facility of this nature opened in Sweden approximately 30 years ago, and there are now 90 such places operating globally. If approved, three Toronto agencies would join their ranks: the Toronto Public Health facility known as The Works on Victoria Street, the South Riverdale Community Centre, and the Queen West-Central Community Health Centre, which is just south of Queen Street West on Bathurst Street.
Supervised injection sites can not only prevent overdose deaths, but they also reduce the spread of infectious diseases relating to using dirty needles, reduce the number of discarded needles littered in public spaces, and give public health workers an opportunity to connect users with much needed health and social services.
It’s a sea change from the approach of the former federal government.
Under the leadership of Stephen Harper and then health minister Tony Clement, the government had tried to shut down the supervised injection site in Vancouver, but was stymied by the Supreme Court of Canada ruling stating that the federal government was in breach of provisions of the Charter of Rights and Freedoms. Undeterred, the government responded with the Respect for Communities Act, which mandated that cities meet a high standard — including broad local community support — before approving any future safe injection sites.
It was a signature passive-aggressive workaround. It effectively prevented the establishment of any additional safe injection sites, and downloaded the burden of compliance onto the municipalities.
What they didn’t expect was for municipalities to pursue the matter anyway.
Toronto will have to apply for a federal exemption from the Controlled Drugs and Substances Act before seeking approval from the new federal Minister of Health, but in doing so, it has shown that leadership on pressing health issues is possible, even at the municipal level.
The Conservative scheme has backfired.