Toronto's top public health official is urging the creation of three to five supervised drug-injection sites, making the country's largest city the latest to push for the controversial harm-reduction services.
In a report to be released on Monday, the city's medical officer of health is urging city council to support efforts to open safe-injection sites to help combat the rising number of drug overdose deaths – which hit 206 in 2013, a more than 40-per-cent increase in the span of a decade.
"If we're seeing 200 people a year die from overdose, I think that measures which can help reduce that toll have some urgency to them," David McKeown told The Globe and Mail on Friday.
The report recommends that safe-injection sites be housed in existing health clinics or centres that already provide services to drug addicts, such as clean-needle exchanges, a key recommendation of past studies. Dr. McKeown declined to reveal the potential locations.
Dr. McKeown is also calling for the supervised injection sites to be geographically spread out. Research has found that Toronto's injection drug users are scattered throughout the city rather than largely concentrated in one neighbourhood, such as in Vancouver.
"It's important to have them where the users are because they won't travel far," he said.
According to the Toronto Public Health website, there are 41 sites currently offering other harm-reduction services, including needle exchanges, across the entire city, located in hospitals and community health centres.
Proponents argue that safe-injection sites, which are typically staffed by nurses, reduce overdose deaths and the transmission of HIV or other diseases via dirty needles, while also allowing some addicts access to treatment. They also contend that neighbourhoods are cleaned up because addicts are more likely to use the facilities rather than discarding their needles in parks, laneways and stairwells.
"Having supervised injection services in the neighbourhoods where we have high drug use occurring allows us to not only save the lives and improve the health of those who are using, but ensures that there's safety in those communities for the public, as well," said city Councillor Joe Cressy, chair of the Toronto Drug Strategy and a member of the board of health.
City Councillor Joe Mihevc, chairman of the board of health, said the need for safe-injection sites in Toronto is underscored by what he called the "startling" rise in drug-overdose deaths in the city over the past decade: "This will save lives, in a very clear manner," said city councillor and chairman of the board of health Joe Mihevc, who said proposed locations would be revealed on Monday.
Federal law governing safe-injection sites, which was passed by the previous Conservative government, requires facilities to apply for exemptions from Health Canada under the Controlled Drugs and Substances Act. They must meet a lengthy list of requirements, including obtaining letters from the city's mayor and police chief, as well as public consultations.
Mr. Mihevc cautioned that the federal rules are a "high bar." He said Monday's report, to be debated at a March 21 board of health meeting and eventually by city council, was only the beginning of a lengthy process that would include public consultations. The province would also need to launch its own approval process, he said.
However, critics argue that safe-injection sites condone drug use, and bring drug users and crime to areas where they are established.
Toronto Police Chief Mark Saunders warned through a spokesman last year that such sites can "cause enormous damage to neighbourhoods." But on Friday, spokesman Mark Pugash said the chief could not comment until he had reviewed the Toronto Public Health report: "The chief's position is he's got to see the detail."
Sources say Chief Saunders has met with proponents of the injection-site plan, in meetings set up to try to address his concerns.
A spokeswoman for Mayor John Tory declined to comment on the report before it was made public.
There are now more than 90 similar injection sites worldwide. The well-known InSite facility on Vancouver's Downtown Eastside was the first in Canada. Montreal Mayor Denis Coderre has committed to establishing safe-injection sites in his city, and is awaiting approval from the federal Liberal government of Prime Minister Justin Trudeau, who supported injection sites in last year's election campaign.