Injection site for Toronto under study

By Euphoric · Aug 13, 2009 · Updated Apr 18, 2011 · ·
  1. Euphoric
    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
    Megan Ogilvie
    Health Reporter

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  1. einar
    This is a good idea for any place that has a hi number of hard drug using residence. I remember reading Toronto has 14000 heroin addicts alone. But as the article states these numbers are sped out all around the City so maybe multiple sites or mobile sites would make more sense?.
  2. Piglet
    A friend of mine working in Canada told me that if you are a street junkie, the local council gives you a)jail or b)one way ticket to Toronto. Dunno if it's true, but similar things happen in the UK.
  3. catseye
    Excellent story! Thanks for pointing it out Euphoric.
    Let's hope that Toronto does more with the report than the UK Gov did with the one issued in 2002 by the Home Affairs Select Committee recommending they be trialled here.
  4. Oxymorphone
    How bizarre, I wouldn't imagine many junkies would really give a crap about wasting their time going to a safe injection site to shoot up unless those supervised sites supplied the drugs as well. I can't fathom why they would think having such a place available would help curb substance abuse... if someone is going to shoot some heroin, they're going to be less likely to avoid it's use knowing it's more or less condoned by the place they live.

    It also doesn't seem like it has the possibility of being an asset to the city(ies) because it's not like medical marijuana here or a hash bar or whatever you want to call it, people aren't paying to have a good time, they're being provided for and catered to while they feed their drug addictions.

    The entire idea is baffling.. at least to me. I didn't think not having a "safe place" to shoot up was as big of a problem as having a crippling drug addiction in the first place... what do these places aim to accomplish...?

    I'm far from anti-drug and I think everyone has a right to put whatever they want into their body, but something like this seems like a huge step in the wrong direction in enabling people and providing a service to them for it that regardless of whether it is used or not, is still going to be a huge drain on funds, paying doctors and whatnot to supervise the activities.
  5. catseye
    I think the biggest asset of drug consumption rooms lies in the research outlining the harm reduction aspects of them (see the likes of Hunt et al, 2007; Gantry et al, 2009, the Joseph Rowntree Foundation Independent Working Group Report etc for more details). Basically, some of the most difficult to reach or 'chaotic' IV drug users will frequent DCRs - often this is their first point of contact with services of any kind. DCRs don't only offer a safe and clean environment to inject (thereby reducing exposure to infection and also drastically lowering incidences of OD fatalities), but depending on which centre - they also offer a spectrum of services such as treatment referral, housing, and basic medical care/blood born virus testing.
    It has also been shown that DCRs reduce incidences of street level crime in the area and lower public injecting which poses concerns for the whole neighbourhood. DCRs employ medically trained staff that can advise on safer injection practice, and generally help the user be safer in their practices...the staff cannot actually inject the user though.
    Vancouvers Insite DCR is an excellent example of what can be done to help keep IV drug users safe - there is a link on the forum somewhere I believe if you are interested in watching the documentary...if not, PM me and I'll send it to you if you like :thumbsup: They see over 600 IV drug users per DAY come through the doors and have supervised literally millions of injections without one fatal overdose - good stuff!

    Hope that helps explain, swiOxymorphone :vibes:
  6. kailey_elise
    Especially for "street level" junkies (homeless, borderline homeless, whatever), this DOES decrease the harm associated with IV drug use. It helps with getting them access to clean equipment, treatment in the case of an overdose, detox & rehab treatment, overdose prevention, etc.

    It helps the harms associated with IV drug use to the city, by junkies not shooting up in "public" places, some place to dispose of works after use (many people don't want to carry around dirty works, even to a garbage can, for fear of being stopped by the police while it's still in their possession) & giving the addict a place to chill for a bit & get medical attention if needed (so no junkies nodding out on a park bench or blue & dead alone in a hallway).

    These are just some of the reasons for DCR (Drug Consumption Rooms)/SIS (Safe Injection Sites). I'm sure there are others; whether you think the reasons are valid or not, however, isn't something I can decide. *grin*

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