London·In Depth

What you need to know about London's bid for supervised injection sites

Several agencies in London have called for supervised injection services in London. Canada's health ministry has very specific documents that must be part of the application.

A primer on what needs to happen before Londoners will see supervised injection services in the city

Dundas St. at Richmond St. (Dave Chidley/CBC)

Getting a supervised injection site doesn't come quickly.

While London has checked off some of the requirements to apply for supervised injection services, it's not touched on some of the basics, including who would be applying to Health Canada for approval. 

It comes as the city's HIV rates are growing faster than anywhere else in Ontario — as are the rates of Hepatitis C and two other types of injection-related infections. The Middlesex-London Health Unit even declared injection drug use a public health emergency last summer. 

The city hands out 2.5 million needles to drug users every year, second only to Vancouver when it comes to publicly-funded needle use. 

But unlike Vancouver, health officials say Londoners are not dying quickly of overdose. They're dying slowly due to infections that cripple their heart valves. 

Users inject drugs in alleys and parks, along the Thames River and in their own homes. 

Advocates say they need a supervised place to get clean needles, be watched as they inject by nurses, and have access to treatment if they need it. 

No lead agency for supervised injection site

In London, health officials and addictions advocates have hinted they'd like to see a broad range of supervised injection services, not just one site. Those services would be integrated into existing health services, such as the Middlesex-London Health Unit, the London Intercommunity Health Centre or Regional/HIV Aids Connection. 

Those three agencies have formed a partnership to focus on getting supervised injection services into the city, but none have stepped up to be a lead agency on the matter. 

Earlier this week, city councillors voted to form a working group about the opioid crisis in London, though they didn't define who would be on it or what, exactly, it would do that isn't already being done. 

By August 11, applications to the health unit are due from organizations that want to lead public consultations into setting up injection services. Those will take place in September and October, with a report due back to the health unit by the end of November. 

In light of all that -- and the growing number of people dying from injection drug-related infections and overdoses -- CBC News has looked at what the government needs to approve a supervised injection site here. 
This is an example of the type of drug injection kit that would be used by drug users at a supervised injection site. (Darryl Dyck/Canadian Press)

First, you should know: 

  • Officials don't like calling it a "safe" injection site. Rather, they call it "supervised" injection services, because they don't want to leave the impression that any injection drug use is safe. 
  • An agency doesn't apply to have supervised injection services. Instead, it applies to Health Canada for an exemption to the Controlled Drugs and Substance Act. That act allows the health minister to issue exemptions to drug laws for medical or scientific purposes. 
  • In federal lingo, the exemption is for a "supervised consumption site" because some drugs consumed there could be smoked, not just injected. 

To apply for an exemption, agencies must provide specific details, part of the application process. Here's what's needed, and where London stands. 

What's needed?

To start an application for an exemption, Health Canada needs to know: Who is applying; the main contact person; the operating procedures that will be in place at the site, and what it might look like (a specific address isn't required); a community consultation report; a financial plan. Other details, such as where a site would be located, can be filed after the initial application. 

Who is applying?

  • Health Canada wants information about the organization (or organizations) applying, and the services it already provides.
  • London officials from the city, the health unit, Regional HIV/AIDS Connection and London Intercommunity Health Centre have said they are partnering right now, but whether that will continue or if one agency will eventually take the lead is unknown. 

Where will it be?

  • The application requires a detailed list of where drugs will be stored, how people -- staff and clients -- will access the site, a physical site plan, conflict management protocols, the responsibilities of staff members, and, if the site is part of a larger structure such as a community health centre, a description of other services provided there. An exact address isn't required. 
  • In London, officials have said they'd like to see a mobile site, or services integrated into existing health clinics, to be able to serve drug users where they already are. 
  • A survey of 200 injection drug users in London concluded services should be established in downtown and/or somewhere in the Old East Village. 

Who will it serve? 

  • This doesn't have to be part of the initial application, but eventually Health Canada want to know who will be served at the site and the number of people who will use the service. They also want to know the rates of infectious diseases in London that might be related to the use of illicit drugs, the number of drug-related overdoses, and the intended health and safety impact of the site on the target population and local area. 
  • London knows a lot about its drug users, thanks to a supervised injection site feasibility study which surveyed 199 injection drug users. The findings were released in February. 53 per cent said they injected drugs in the Dundas and Adelaide area, while a quarter said they injected downtown. 86 per cent said they'd use a supervised injection site if one were available in London. 
  • London has a higher than average rate of Hepatitis C, HIV, infectious group A strep and endocarditis, all fatal illnesses associated with injection drug use. 

What do Londoners think?

  • A broad range of consultations must be held in the community, including in the immediate vicinity of the site. The public consultations must speak to potential users, as well as governments, police, businesses and community groups. A summary of their views and all of their written statements must be submitted, as well as steps that will be taken to address any concerns that were raised during community consultations. 
  • Public consultations will begin in September and run through October. They will include an online survey, at least four town hall-type meetings in different parts of the city, including downtown and east London, and up to 10 focus groups with businesses, residents, local agencies and people who use drugs. Findings will be released at the end of November. 

Who will we pay for it? 

  • Health Canada wants to see a financial plan that "demonstrates the feasibility and sustainability of operating the site," according to its website. Financial statements, documentation confirming sources of funds, funding commitments and budget proposals must be submitted. 
  • Considering there's no lead agency in London yet, the financial details have yet to be considered -- or released.