Toronto should consider opening safe-injection sites for drug users inside existing health-care institutions to help reduce the number of drug-related deaths, the city's public health agency suggested Tuesday.
Toronto Public Health said research from Vancouver, where a safe-injection site was first opened 10 years ago, and other countries shows the sites are effective in preventing drug overdoses and reducing the risk of disease transmission.
About 900 people have died of accidental overdose in Toronto between 2002 and 2010, according the office of Ontario's chief coroner. Of those deaths, 538 were due to opioids.
Dr. Rita Shahin, a spokeswoman for Toronto Public Health, said the city doesn't have one single concentrated site of drug users, as is the case in Vancouver, and would benefit from several small safe-injection sites.
Shahin said she expects some community opposition to the idea even though there haven't been any discussions on possible locations.
"None of these sites would be opened up in places where there is no existing drug use," she said.
Fewer discarded needles, fewer deaths
Shahin said research shows communities with supervised safe-injection sites have seen a reduction in overdose deaths and public drug use. They also see fewer discarded needles on the streets, she said.
About 75,000 drug users in Toronto had access to needle exchange services in 2010, but Shahin said that program does not prevent overdoses. Supervised injection sites have trained nurses on hand who can monitor addicts in addition to giving them clean needles, she said.
The pilot project for safe-injection sites was one of two major recommendations touted by the public health agency in its report released Tuesday.
The agency also asked for recent draft legislation — Bill C-65 — to be withdrawn. The Respect for Communities Act — introduced in June — outlines how health providers could seek exemption from federal drug regulations to open a safe-injection site.
The legislation requires applicants to consult with the community, provincial and municipal authorities and law enforcement officials.
"It's a lot of barriers being put up," Shahin said, adding that the "onerous" piece of legislation isn't health-focused.
The Canadian Medical Association opposed the legislation and stated that it creates "unnecessary obstacles."
Dr. Perry Kendall, B.C.'s health officer, said drug users who go to Vancouver's safe-injection site, Insite, are more likely to seek out treatment for their addiction.
By using existing health-care infrastructure, the Toronto Public Health proposal is advantageous, he said.
"Rather than a big stand-alone site, incorporate the ability to supervise injections into primary care places that are already serving the needs of these clients," he said. "It means you don't have to go to city council and look for rezoning."
Bill C-65 would be a step backwards for places like Insite, he said.
"It sets out quite deliberately to put a number of insufferable objections in the way of anybody coming forward with a new site or continuing an existing site," he said.
Dr. David McKeown, Toronto's medical officer of health, said safe-injection sites address public health issues.
"The reality is that injection drug use is already happening in neighbourhoods across Toronto, in apartments, in alleyways, in washrooms," he said in a statement.
"Society has made significant advances in the past decade in addressing the denial that surrounds mental health. We need the same honesty and openness regarding injection drug use."