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Supervised injection sites: A brave, important service for Toronto

David Crombie, Art Eggleton, Barbara Hall, and John Sewell have all served as Mayor of Toronto.

Health issues are rarely a matter of much concern at city council, but when they do come to the fore, they are treated with considerable respect and lead to very useful change. We suspect that will be the case with supervised injection services.

Think of the first steps to restrict smoking. In the early 1980s, Toronto city council represented one of the first municipalities in Canada to debate the issue and declare that smoking in elevators would not be permitted. Opponents said that any restrictions on smoking would scare away tourists, but that proved not to be the case, and within a decade, the move to restrict smoking had spread to many enclosed public places, including restaurants. Today it is common wisdom across the country that restrictions on smoking have been a good thing.

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That happened at the same time council decided to tackle HIV and AIDS, a move that some thought risky since it was only seen as a disease among gay men and not really mainstream enough for council to concern itself with. It was a bold and important initiative.

Or think of the move a decade earlier, in the reform era of the 1970s at city hall, when council decided to do something about lead pollution. Studies in the South Riverdale area in the east end showed that soil was heavily polluted, a result of industries in the area which had spewed lead into the air for almost a century. Lead pollution in the air was also a problem, because of both industrial emission and emissions from vehicles. City hall devoted the funds to clean up the area, something we all now take for granted.

Here's another health issue to which council should respond: intravenous drug use. In 2013, more than 200 people died in Toronto from drug overdoses. The number has risen relentlessly in the last decade. The policies that make these fatal drugs illegal have not helped – the situation is growing worse. And there is too much public fallout from this drug use – used needles in parks and in alleyways; people shooting up in coffee shop washrooms and in laneways, behind buildings. And deaths, many of them our young.

In recent years the city has responded by providing free needle-exchange programs, which try to cut down on the number of shared needles, since shared needles quickly spread HIV and hepatitis C. That program has been successful. But the extent of intravenous drug use is seen in the numbers: Last year the city distributed nearly 2 million needles.

A new initiative is now under way in Toronto, and that is to make an application to the federal government to operate supervised injection services. The city's medical officer of health is recommending that council support these applications so that drug users will have a safe place to inject.

The proposal is based on the Insite facility in Vancouver. For more than a decade, it has been providing a place where users can shoot up in a clean and controlled place, and where nursing staff can do everything possible to reduce disease and are available to intervene in cases of overdoses. As well, users can be informed of treatment and prevention options.

Studies of Insite have shown that crime has not increased in the area; drug deaths are down; public safety has improved, as fewer people are shooting up in public places, and the number of needles discarded on the street has decreased. The Insite strategy of acting to reduce harm has been successful on all counts. Insite is not condoning drug use, but instead it is trying to lessen its harm and make a social link to the users.

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We agree that establishing supervised injections services in Toronto is a good step that residents and city council should agree to support. It will help benefit very vulnerable people. It will reach out to them and try to work them back into the fabric of a successful city.

We applaud the initiative to ask for approval of safe injections sites in Toronto. If we were on city council today, we would be voting in favour of these applications.

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