June 21, 2016
Ottawa’s board of health voted 9-2 to encourage Supervised Injection Sites to open in the city
“Listen to, more than anything, the people who live this,” Capital Coun. David Chernushenko told skeptics. He’d come into the health-board meeting not knowing how much he didn’t know about addiction, and treatment, and what it’s like to be a drug addict, he said.
The board heard from several, all begging the board to say it supports the notion of opening supervised facilities where addicts can inject drugs in the presence of nurses who can rescue them from overdoses. People like Darren Noftall, twitchy, tense, out of place at the formal table in city hall’s committee room, who said his life had been saved twice at Vancouver’s Insite. He overdosed at Canada’s first safe-injection site and the nurses saved him.
He left Vancouver, thinking he’d be better at home in Ontario. It hasn’t worked out that way yet.
“I live alone. I use alone. That puts me at high risk to die alone,” he said. “When I go home, I’m going to do that hit tonight, I don’t know if I’m going to be alive in the morning.”
Ray Harrison, 18 months clean from multiple drugs, said he believes his life was saved by the Somerset West Community Health Centre.
“I feel very strongly on this,” he told the board. “The more doors you have open for people to come in to get help, the greater the chance we have to save decades of their lives.”
That, ultimately, was what convinced the board: The idea that chronic users of injection drugs on the streets, some of the most troubled, needy people Ottawa has, could die — are dying — because they don’t have safe places to use the drugs to which they’re addicted. So they use in stairwells, in bathrooms, in parks, even on buses in the winter because they’re warm and have some light. They don’t know the purity of what’s in their needles, they don’t know whether there’ll be anybody to help them if something goes wrong.
People have died within sight of needle exchanges because although they can get clean paraphernalia in them, they can’t use drugs in them, the board heard.
“It’s a matter of public health … This is not a matter of criminality any more than when our paramedic services show up at the scene of an accident, they don’t wonder what that driver was doing before. They treat the patient first,” Somerset Coun. Catherine McKenney said, her voice thick.
One dissenter was the chair of the board, Stittsville Coun. Shad Qadri, who said his skepticism of safe-injection sites was hardened during a visit to Vancouver, where he was going to visit Insite and a cabbie wouldn’t take him closer than a couple of blocks away.
Perhaps he could still be convinced, Qadri said. But he wants a summer of wide consultations to have the issues aired fully. Gloucester-South Nepean Coun. Michael Qaqish also registered a dissent on similar grounds.
Coun. Mark Taylor said six years ago he’d have voted against the idea of a supervised injection site. He thought sites like Vancouver’s were just “enabling bad behaviour,” he said.
But he’s read the studies of Vancouver’s experience. He’s listened to the Ottawa public-health unit’s experts. He’s looked at the evidence, projected on an overhead screen, that more Ottawans are using opiate drugs like heroin and morphine and especially fentanyl, and dying from overdoses.
“That line that keeps moving on that graph? It doesn’t give any weight to what our philosophical objection is. It just keeps moving,” Taylor said.
Injection sites are a point of contact with the health system for severe addicts who might have literally nowhere else to go. Treatment for drugs almost never means quitting cold turkey, said addictions doctor Lisa Bromley, urging the board to back injection sites. For the deeply addicted, it can mean making one better choice one day — to use a clean needle, to simply be around people — and hope to build on that.
“I think (an injection site) would capture those people who are scared, who are apprehensive, who are intimidated,” Bromley said.
There is, the board heard, no scientific evidence that injection sites promote drug use; addicts won’t go far to reach them. There’s no scientific evidence they promote crime, according to the health unit’s experts, who spent the spring studying them.
Neither the city nor the health unit would run any injection sites directly, at least according to everyone’s current plan. The Sandy Hill Community Health Centre is well into planning to add a “micro-site” to its existing needle exchange and methadone clinic in its building at Rideau and Nelson streets; three other health centres, serving Centretown, Somerset West and Carlington, are in earlier stages. They cobble together funding from multiple sources, but mainly the provincial government.
Meanwhile, it’s the federal government that has to approve each place’s separate injection-site plan, granting exemptions to national anti-drug laws. That’s an involved process that will go much more smoothly if each place can demonstrate it has co-operation from local authorities.
The city’s support will have to come site by site; the board’s vote just encourages the possible operators to pursue their plans.
Injection drug use in Toronto, By the numbers
- 77%: Increase in drug overdose deaths in Toronto between 2004 and 2014.
- 258: Drug overdose deaths in 2014.
- 61%: Injection drug users who tested positive for hepatitis C in 2012 study.
- 5%: Those who tested positive for HIV.
- 100,000: Client visits to harm reduction services in 2015.
- 1.9 million: Clean needles distributed in 2015.
- 84% to 96%: Respondents to online survey who identified benefits to safe-injection sites.
- 4% to 36%: Respondents who identified concerns over safe-injection sites.
- 3: Safe-injection sites proposed for Toronto.
- 2: Safe-injection sites operating in Vancouver.
- 90: Safe-injection sites operating worldwide.