Toronto Public Health has produced an excellent report that will be considered at the Board of Health on July 10. Its analysis should be endorsed and its recommendations adopted.
Policy development is always about competing priorities, assessing evidence and impact, and weighing costs and benefits. Here is the equation on this issue:
- There is an enormous need. The report notes that Public Health and 35 community-based agencies provide a range of harm reduction services, including needles and safe drug use supplies, in some 75,000 client visits a year, 1.1 million needles and other supplies are distributed. Rates of avoidable infectious diseases such as Hepatitis C and HIV are high among drug users. Sharing needles and other unsafe practices are a significant risk.
- Comprehensive research supported safe injection sites integrated into health services for people who inject drugs in Toronto and Ottawa. It highlighted significant potential population health and system savings.
- Over 90 safe injection sites, including the pioneering and much-researched InSite in Vancouver, have been operating effectively in many jurisdictions for years.
- There is an enormous body of peer-reviewed scientific evidence on the population health benefits of safe injection sites: reducing avoidable overdoses, providing an effective place to deliver primary care and other essential support services to high-needs populations, contributing to people seeking and staying in treatment, reducing public needle use and other unsafe practices, and reducing the numbers of dangerous needles left about on the street.
- There is a clear expert consensus that these sites should best be seen as part of comprehensive harm reduction strategies. Toronto has developed such a Drug Strategy and a toolkit to assist effective implementation of safe injection sites.
- In addition, there is a solid local base of innovative and committed public health, harm reduction, health promoters, and community-based health providers that can be built upon to implement successful harm reduction strategies.
The report recommends that the Board of Health urge the province to fund the implementation and evaluation of a pilot project integrating safe injection into provincially funded health services for people who use drugs. The Board should endorse this recommendation.
And then the province should stop being so timid on this issue. Through its Excellent Care for All Act and the Ministry of Health and Long-Term Care’s Action Plan, Ontario quite properly emphasizes health promotion policies and services that will prevent avoidable illness and ensuring that public resources are allocated to the most effective and evidence-based clinical practices. The weight of evidence and proven population health benefits of harm reduction show that the modest costs of a safe injection pilot project is a highly effective healthcare investment. The Act also enshrines equity as one of the fundamental principles of a high performing healthcare system. Yet the people who are harmed when proven harm reduction directions such as safe injection are not followed are precisely the most vulnerable and marginalized populations. The Province should act on the Toronto Public Health recommendation to get a pilot safe injection sites in place quickly.
At the federal level. despite all this evidence and a clear Supreme Court ruling, the government continues to try to find back-door ways to sabotage harm reduction. Its Bill C-65, disingenuously titled the Respect for Communities Act, would impose unworkable consultation processes and excessive documentation requirements that would essentially make obtaining the required federal exemption for sites impossible. This title is doubly ironic because public health professionals and harm reduction proponents know full well the importance of community engagement and widespread consultation, and are solidly connected to the communities they serve and support. This latest response from the federal government demonstrates again the public health danger of ideologically driven policy. The Toronto Public Health report calls on the Board to develop a submission to the federal government calling for a more effective exception process and consultation with relevant provincial, public health and community stakeholders. This recommendation should be endorsed and acted upon by the Board.