The introduction of safe injection services and overdose prevention sites in Toronto has divided public opinion about the city’s drug strategy and how it is dealing with the ongoing opioid crisis.
There are more than 90 supervised injection services around the world, with the first one being opened in Switzerland over 30 years ago.
In 2017, there were 303 opioid overdose deaths in Toronto and the city’s Board of Health adopted supervised injections services as part of the city’s Overdose Action Plan, adopted in March that year.
With the concept being fairly new to Toronto and deeply polarizing, how these services operate and what goes on inside is a mystery to most.
Broadly, supervised injection services and overdose prevention sites both offer supervised injection and medical care in case of an overdose.
The following is a compilation of the most frequently asked questions about harm reduction services and how they work:
What is a supervised injection service (SIS)?
The City of Toronto describes supervised injection services as “health services that provide a hygienic environment” for people to inject drugs under the supervision of trained staff.
Shaun Hopkins, Manager, Needle Exchange says they are longer term services that offer a wide range of health/harm reduction services including:
- Referrals to drug treatment
- Housing and income support
- Education on overdose prevention and intervention
- Medical and counselling services
People who use the service are also provided with sterile injection supplies, education on safer injecting as well as overdose intervention and prevention services.
Legal approval to operate these services is granted by Health Canada. In Ontario operational funding is provided by the Ministry of Health and Long-Term Care.
What is an overdose prevention site (OPS)?
Hopkins says overdose prevention sites are “temporary, low-barrier services focused on overdose prevention and response.”
They have been broadly implemented in British Columbia and Alberta in response to the opioid overdose crisis. For similar reasons, the Ministry of Health and Long-Term Care launched an overdose prevention site program for Ontario in January.
They provide many of the same services as safe injection sites including supervised injection and the provision of sterile supplies.
The province grants overdose prevention sites approvals to operate for three or six month periods with the potential for extension.
Does an SIS or OPS provide drugs?
No. Supervised injection sites and overdose prevention sites do not supply users with drugs. Anyone availing of the services brings pre-obtained drugs to the site acquired elsewhere or accesses life-saving services when needed.
Are these services legal in Canada?
Yes. Supervised injection services and overdose prevention sites are legal in Canada and require an exemption under Section 56 of the Controlled Drugs and Substances Act (CDSA). Exemptions are granted by the federal Minister of Health. The Respect for Communities Act passed in 2015 outlines how to apply and the criteria that need to be fulfilled to attain a Section 56 exemption.
What happens inside an SIS?
When a person visits a supervised injection site, they are assessed by staff to make sure they are eligible for the program.
They are then given sterile needles and other equipment along with instructions on safe injecting practices. The person then injects drugs under the supervision of a nurse in a room designated specifically for safe injecting. The nurse intervenes in case of any medical emergencies.
Once the person has injected their drugs, they are taken to a waiting room where they are watched for any negative drug reactions. They are also given information and referrals to other health and social supports at the site or elsewhere in the community.
Won’t a service like this enable or encourage more drug use?
According to the City of Toronto, there is no evidence that harm reduction services like supervised injection sites encourage or promote drug use. The availability of supervised injection services does not cause people to start injecting drugs.
The services are used mainly by people who have a long history of drug use and research has found that SIS do not lead to relapse or stop people from quitting.
How many supervised injection sites does Toronto have?
Toronto currently has four supervised injection sites:
- Toronto Public Health, 277 Victoria St.
- South Riverdale Community Health Centre, 955 Queen St. E.
- Fred Victor, 145 Queen St. E.
- Parkdale Queen West Community Health Centre, 168 Bathurst St.
There are also several overdose prevention sites which provide life-saving services that help to reduce the number of overdose deaths across the city. A full list of overdose prevention sites can be found here: Overdose prevention sites in Toronto.
Are safe injection services available 24/7?
No. The locations offering safe injection and overdose prevention services in Toronto have specific hours and some are open all week while others are closed on the weekend.
A full list of locations and the hours they are open can be found here: List of locations and hours of operation.
Does crime noticably increase in neighbourhoods where SISs are located?
Safe injection sites are commonly opened in areas that clearly need them, usually where drug use is already affecting the neighbourhood. The City of Toronto says research shows they do not contribute to more crime in communities where they operate.
Are the police allowed to arrest people using safe injection services?
No. Supervised injection services have an exemption to Section 56 of the Controlled Drugs and Substances Act. The exemption means people who use the services are protected from being prosecuted for drug use within the site.
What are the benefits of safe injection services?
Both international and Canadian research shows that safe injection services not only save lives, but also benefit the community in a number of ways:
- With supervised injecting, the number of drug overdoses and deaths are reduced.
- Provision of clean needles and other supplies helps reduce risk factors that lead to infectious diseases like hepatitis and HIV.
- By reducing the spread of disease, safe injection services help reduce the burden on healthcare services and are therefore cost-effective.
- Safe injection services connect people with other health and social services.
- Safe injection services lead to an increase in the use of of detox and drug treatment services.
Are SIS and OPS programs effective?
“The goal of these services is to prevent overdose deaths, reduce public injection and publicly discarded drug use equipment” says Hopkins. “The evidence shows that they are effective in meeting these goals.”