Harm Reduction Services for People Who Inject Drugs in Toronto

Introduction to issue:
People who inject drugs are more vulnerable of acquiring hepatitis C and HIV. In Toronto, people who inject drugs have also been dying from overdoses at an increasing rate. Distributing unused injection drug gear and establishing integrated supervised injection services are effective public health tools for reducing the spread of HIV and hepatitis C, and preventing unnecessary deaths from overdoses. For these reasons, ACT fully supports Toronto establishing comprehensive harm reduction services that protect people who inject drugs and affirms their right to healthcare services.

Background + context:
In 1989, and in the face of ardent opposition from the police, Toronto Public Health began offering unused injection drug gear as part of a new needle distribution program called the Works. The program was initially set up in direct response to high rates of HIV and AIDS among people who inject drugs.

Toronto Public Health’s needle exchange program has since expanded to cover many areas of the city and has been highly effective at preventing HIV from spreading. It has been found that the prevalence of HIV among people who inject drugs is approximately 3%, one of the lowest among major North American cities. However, upwards of 70% of people who inject drugs in Toronto were living with hepatitis C.1

In 2012, St. Michael’s Hospital and the University of Toronto published the results of a feasibility study into supervised consumption sites in Toronto. The authors recommended that Toronto “would benefit from implementation of supervised injection facilities” and that “the optimal model” for such sites are a “fixed facility that is integrated within an existing organization.”2

Between 2004 and 2013 (the most recent figures available), deaths resulting from overdoses increased by 41%, 146 to 206. When looking specifically at deaths from accidental overdose, the numbers have jumped by more than 80%, going from 82 in 2004 to 149 fatalities in 2013. The reasons for such a rise are understood to be an increase in the prevalence of narcotics such as fentanyl and heroine. This increase has not been met with an increased awareness regarding the risks of using specifically fentanyl.

In response to an explosion in the reported number of overdose deaths over the past several years, in March, 2016, the City of Toronto indicated that it was moving forward with the process by which three supervised injection sites would open. Located at the Works building, South Riverdale and Queen West Community Health Centres, the three sites would provide a much needed, overdue, and crucial intervention into protecting the health of people who inject drugs.

The applications are backed by Toronto’s chief medical officer of health, Dr. David McKeown, but first require approval by city council before going through an onerous application process to qualify for a federal exemption. Although the current federal government has indicated it will not reject applications for anything outside of merit, there exists a clear need for the federal government of Canada to pass legislation that protects the rights of people who use drugs to safety and healthcare. Rather than rely on ad hoc decisions, leadership in this area is needed to fully legalize and protect comprehensive harm reduction measures in Canada.

ACT supports equitable access to life-saving health services for all people living with and affected by HIV and AIDS, including people who inject drugs. We acknowledge that some people who inject may not be ready, willing or able to begin treatment to reduce their use. For this, we encourage all proposed and future supervised injection sites to offer a range of supports to help care for people who use drugs who struggle with addiction, HIV and AIDS, hepatitis C, mental health challenges, and other physical sickness.

ACT believes in the benefit of comprehensive harm reduction strategies for all groups living at increased risk for HIV and hepatitis C, including safer sex tools, safer injection drug gear distribution and safe injection sites.

1: http://www.stmichaelshospital.com/pdf/research/SMH-TOSCA-report.pdf page 11.
2: http://www.stmichaelshospital.com/pdf/research/SMH-TOSCA-report.pdf page 14.