Item - 2016.HL13.2

The Board of Health recommends that:  

1.  City Council request the City Manager to provide the letter required by clause 56.1(3)(c) of the Controlled Drugs and Substances Act indicating that Council supports the implementation of small scale supervised injection services at Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre and South Riverdale Community Health Centre.

The Board of Health:  

1.  Supported the implementation of small-scale supervised injection services at Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre and South Riverdale Community Health Centre;

2.  Directed that the Board of Health and the Medical Officer of Health submit and complete Health Canada's application form for "a Section 56.1 exemption for medical purposes under the Controlled Drugs and Substances Act regarding activities at a supervised consumption site";

3.  Forwarded the report (June 16, 2016) from the Medical Officer Health to the provincial Minister of Health and Long-Term Care and requested that he provide the letter required by clause 56.1(3)(b) of the Controlled Drugs and Substances Act in respect of small scale supervised injection services at Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre and South Riverdale Community Health Centre;

4.  Forwarded the report (June 16, 2016) from the Medical Officer Health to the Chief Medical Officer of Health for the Province of Ontario and requested that he provide the letter that is required by clause 56.1(3)(g) in respect of small scale supervised injection services at Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre and South Riverdale Community Health Centre;

5.  Forwarded the report (June 16, 2016) from the Medical Officer Health to the provincial Minister of Community Safety and Correctional Services and requested that he provide the letter required by clause 56.1(3)(h) of the Controlled Drugs and Substances Act in respect of small scale supervised injection services at Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre and South Riverdale Community Health Centre;

6.  Requested the Ministry of Health and Long-Term Care, to fund 100 percent of the capital and operational costs for implementation of small-scale supervised injection services at Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre, and South Riverdale Community Health Centre;

7.  Directed the Medical Officer of Health to submit a comprehensive program proposal to the Ministry of Health and Long-Term Care, requesting capital and operating funding for Toronto Public Health (The Works) to implement supervised injection services; and

8.  Urged the Ministry of Health and Long-Term Care to increase capacity (spaces and diversity of program options) in the drug treatment system in Toronto to enable on-demand access for people seeking help, including clients of supervised injection services.

The Medical Officer of Health gave a presentation on Implementing Supervised Injection Services in Toronto.

A supervised injection service (SIS) is a health service that provides a safe and hygienic environment where people can inject pre-obtained drugs under the supervision of a nurse. More than 90 SISs are operating worldwide. The Toronto and Ottawa Supervised Consumption Assessment (TOSCA) study concluded that Toronto would benefit from multiple supervised injection services that are integrated into existing health services already serving people who inject drugs.

The TOSCA report concluded that conditions in Toronto warranted implementation of SIS. Between 2004 and 2014 there was a 77 percent increase in the reported number of people dying from overdose in Toronto – from 146 in 2004 to 258 in 2014, the highest annual number to date. Of particular concern is the role of opioids such as heroin and fentanyl in these deaths. There is a high demand for harm reduction services in Toronto with over 100,000 client visits and almost 1.9 million needles distributed in 2015.

In March 2016, the Medical Officer of Health (MOH) reported to the Board of Health (BOH) that Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre (Queen West), and South Riverdale Community Health Centre (South Riverdale) are proposing to add small-scale SIS to their existing clinical health services. The BOH supported initiation of a coordinated community consultation, with a request to report back on the results to the BOH in July. This report responds to that request.

The three health care organizations worked together to align consultation efforts. Plans were developed with input from the ward councillor that included common and organization-specific activities. An external vendor was retained to facilitate and report on certain activities, including public meetings, focus groups and an online survey. Input was gathered about SIS in general and for each of the three locations regarding perceived benefits and concerns about SIS, and suggestions of how to address concerns. A large majority of respondents identified benefits associated with SIS (between 84 and 96 percent depending on location), including reducing overdoses and the risk of infectious diseases such as HIV, reducing public injection and increasing the use of other health and social services. Concerns were identified by between 14 and 36 percent of respondents (depending on location). Respondents could identify both benefits and concerns. Concerns included a potential increase in crime and community safety issues, negative behaviours of service users, and a negative impact on community reputation. Strategies to address concerns raised included establishing community advisory committees, ensuring sufficient waiting room space and service delivery hours, developing police protocols, and active monitoring and evaluation. A summary of program proposals for each of the organizations seeking to implement SIS were developed, and are included in the appendix of this report.

Legal operation of an SIS in Canada requires an exemption under section 56.1 (2) of the Controlled Drugs and Substances Act (CDSA), which is granted by the federal Minister of Health. The exemption application includes an extensive list of documentation and letters of opinion from various stakeholders, including the municipal government. This staff report seeks support from the BOH and City Council to implement integrated SIS at the three health organizations named in this report, authority for the BOH and MOH to submit an exemption application to the federal Minister of Health and for the BOH to advocate for capital and operational funding from the provincial government.