Injection site for Toronto under study
Vancouver's Insite, Canada's only safe injection site, has been embroiled in controversy since it opened in the city's Downtown Eastside in 2003.
Researchers are quietly studying whether a facility would curb disease and reduce substance abuse
Even as the future of Vancouver's controversial supervised drug injection site remains in doubt, a group of researchers are quietly studying whether Toronto and Ottawa would benefit from similar facilities.
The study, launched more than a year ago, will evaluate whether there is a need in the two cities for clean, staffed medical clinics where drug addicts can inject or use illegal drugs, including heroin and crack cocaine.
"This is not a study to see how to establish a site. This is a study to look at whether it makes sense to have a site or not, whether there should be one site or multiple sites or no sites, and whether the sites, if there should be any, should be fixed or mobile. We will be answering those types of questions," said Dr. Ahmed Bayoumi, a co-principal investigator of the study and scientist at the Centre for Research on Inner City Health at St. Michael's Hospital.
The feasibility study, dubbed the Toronto and Ottawa Supervised Consumption Assessment (TOSCA), was requested by the city. It stems from a recommendation in the Toronto Drug Strategy, which was approved by Toronto council in December 2005.
Vancouver's Insite program, the first supervised injection site in North America, has been embroiled in controversy since it opened in the city's Downtown Eastside in 2003.
Advocates of supervised injection sites say the facilities offer a safe place for people to inject drugs, where trained staff can provide sterile equipment, offer addiction counselling and treat disease and infection. A growing body of research suggests Vancouver's program helps curb the spread of infectious disease and reduces substance abuse and drug overdoses.
But critics say the facility encourages drug use, eats up money better spent on drug prevention programs and has not proven to have long-term cost or health benefits.
The federal government has questioned Insite's usefulness and is trying to shut it down. In May 2008, the B.C. Supreme Court extended Insite's protection from drug laws. Ottawa is appealing that decision.
For the Toronto and Ottawa feasibility study, Bayoumi and his team are seeking a range of opinions on supervised consumption sites, including those of health-care workers, public health officials and emergency workers, including police officers, paramedics and firefighters as well as drug users themselves.
The team is also contacting city residents and business owners in specific communities – including a focus group in the Parkdale and Bloor/Landsdowne areas – to gauge their views on the drug use that occurs in their neighbourhoods and the potential need for supervised consumption sites.
Bayoumi said the study will also use simulation models to determine how much the sites might cost, estimate how they might affect infectious disease rates and gauge whether costs outweigh projected health benefits.
"We're really using a whole lot of health services research methods to look at different nuances to this question," he said.
The results of the study, funded by the Ontario HIV Treatment Network, will be published in a public report in the spring of 2010.
Last year, Bayoumi published a study in the Canadian Medical Association Journal that found Insite will save B.C. $14 million and prevent 1,000 HIV infections over a 10-year period. His team will use the same modelling system for the Toronto and Ottawa assessment.
"We showed Insite saved money and extended lives," Bayoumi said. "But that was very specific for ... Vancouver. The Vancouver situation is unique in North America, and perhaps in the world, in that it has many drug users in a concentrated area. I think everybody would be hesitant to translate the findings from that study to other cities."
Toronto has the largest number of injection drug users in Ontario, but unlike Vancouver, drug users are not concentrated in one area, Bayoumi said.
"One thing we know for sure is there is a high level of crack cocaine use in Toronto," said assessment investigator Peggy Millson, an associate professor at the University of Toronto's Dalla Lana school of public health. "That raises another whole set of issues, including providing services for people whose risks are more associated with smoking rather than injecting."
There is also a high number of people who inject crack cocaine and other forms of cocaine in Toronto, Millson said, and high rates of people who inject opiates, including heroin and pharmaceutical opiates, such as OxyContin and morphine.
Sam Galati, a member of the Toronto Lansdowne Residents' Association, said residents will want to know as much as they can about the possibility of a supervised consumption site in their neighbourhood, especially since there is a general feeling that the community is not consulted about major decisions.
"It's not NIMBYism for people to want to preserve or enhance the health of their community," he said. "If this (supervised consumption site) enhances the health of the community it would be a positive."
Aug 12, 2009 04:30 AM