Toronto Public Health opened the city’s first permanent supervised injection service on November 8, 2017. Located inside The Works at 277 Victoria Street, this life-saving health service provides a safe and hygienic environment for people to inject pre-obtained drugs under the supervision of qualified staff.
International research shows that supervised injection services reduce drug overdoses, save lives and limit the spread of HIV and hepatitis C related to unsafe injection practices. In addition to supervised injection, individuals using these health services will be provided with sterile injection supplies, education on overdose prevention and intervention, health counselling services and referrals to drug treatment, housing, income support and other services.
These important health services are part of Toronto’s Overdose Action Plan, which was adopted by the Board of Health in March 2017. See frequently asked questions below for more information on supervised injection services.
Toronto Public Health is also collaborating with the Toronto Overdose Early Warning and Alert Partnership to provide timely information on overdose activity, with a current focus on opioids. Visit our statistics page to find out more on our work in this area.
As of August 30, 2017, there were:
- 78 visits to the supervised injection site at 277 Victoria Street
- 2,500 naloxone kits distributed by Toronto Public Health
- over 1,200 people trained by Toronto Public Health in administering naloxone
Toronto Public Health, Queen West-Central Community Health Centre and South Riverdale Community Health Centre are planning to add small-scale supervised injection services to their existing clinical health services for people who inject drugs. This is a different model than Vancouver’s InSite. Supervised injection services are health services that provide a hygienic environment for people to inject pre-obtained drugs under the supervision of a nurse. In addition to supervised injection, individuals are provided with sterile injection supplies, education on safer injection, overdose prevention and intervention, medical and counselling services, and referrals to drug treatment, housing, income support and other services.
Three agencies are adding supervised injection to their existing health services for people who inject drugs. The agencies are:
- Toronto Public Health (The Works)
- Queen West-Central Toronto Community Health Centre
- South Riverdale Community Health Centre.
The three agencies planning to provide supervised injection services already deliver harm reduction services to a significant number of people who inject drugs, including people who are engaging in high-risk behaviours such as injecting alone, frequently, and in public. Each agency has delivered harm reduction services in their community for over 20 years. They have multi-disciplinary health teams providing health care and support to people who use drugs.
These agencies are three of the busiest needle distribution programs in Toronto. Together they distribute almost 75% of all sterile needles in the city:
- The Works at Toronto Public Health had almost 14,000 client visits with over 800,000 needles distributed in 2015.
- Queen West- Central Toronto Community Health Centre had over 15,000 client visits with almost 300,000 needles distributed in 2015.
- South Riverdale Community Health Centre had over 22,000 client visits with over 320,000 needles distributed.
Research has concluded that Toronto would benefit from multiple supervised injection services that are integrated into health services already working with people who inject drugs.
Conditions in Toronto support the need for supervised injection services. There is a high demand for harm reduction services. In 2015, there were over 100,000 client visits to harm reduction services, and almost 1.9 million needles were distributed along with other sterile injection supplies through community agencies across the city. Overdoses in Toronto are on the rise. In 2013, there were 206 people died from drug overdoses in Toronto, the highest annual number to date. This represents a 41% increase from 2004. Of particular concern is the increasing role of opioids, such as heroin and fentanyl, in these deaths. Rates of HIV (5%) and hepatitis C (61%) infection among people who inject drugs are much higher than for the general population. In addition, a Toronto study found 36% of people who use drugs reported injecting in public places such as washrooms and alleyways.
The majority of people using these services will be existing clients. Clients will arrive at the program with pre-obtained drugs. Each person will be assessed to ensure they are eligible for the program. They will be given sterile injecting equipment and instruction on safer injecting practices. A nurse will then supervise their injection in a room dedicated for this purpose, and intervene in the case of any medical emergencies. Once the individual has injected their drugs they will be directed to a waiting room where they will continue to be observed for any negative drug reactions. They will also receive information and referrals about other health and social supports and services at the agency or elsewhere in the community.
International and Canadian research shows that supervised injections services have benefits both for individuals using the services and for the community, including:
- Reducing the number of drug overdoses and deaths
- Reducing risk factors leading to infectious diseases such as HIV and hepatitis
- Increasing the use of detox and drug treatment services
- Connecting people with other health and social services
- Reducing the amount of publicly discarded needles
- Not contributing to crime or increased drug use in the local community
Yes. In Canada, legal operation of a supervised injection service requires an exemption under Section 56 of the Controlled Drugs and Substances Act (CDSA). Exemptions are granted by the federal Minister of Health. In 2015, the federal government passed the Respect for Communities Act, which outlines the process and criteria for applicants seeking a Section 56 exemption.
Toronto Public Health began providing supervised injection services in August of 2017, opening the permanent site in November of 2017 at 277 Victoria Street inside The Works. The site provides health services for people who inject drugs, including supervised injection. Further supervised injection services are being constructed and considered in different locations in Toronto. Drug use happens in communities across Toronto, rather than in a single concentrated area as in other jurisdictions. Research has shown that people who use drugs will only travel a short distance to use a supervised injection service, the planning and implementation of supervised injection services reflects this.
Supervised injection services do not contribute to more crime. They are located in neighbourhoods where there is a demonstrated need, usually where drug use is already having an impact on the community. There is considerable research on this subject. For example, in the neighbourhood around InSite in Vancouver, there has been no increase in crime, and actual decreases in vehicle break-ins and thefts. Australian studies have found decreases in drug-related crime, public drug use and loitering.
People do not start injecting drugs because of the availability of supervised injection services. There is no evidence that harm reduction services promote drug use. Supervised injection services are used mainly by people with a long history of injection drug use. Research has also found that supervised injection services do not cause people to relapse (e.g., start using drugs after a period of abstinence) or prevent people from stopping drug use altogether.
Many organizations across the city deliver a broad range of services to reduce the harms of substance use. This includes prevention programs as well as withdrawal management and treatment programs. Toronto also has a City Council-approved strategy that provides a comprehensive approach to alcohol and other drugs based on the four integrated components of prevention, harm reduction, treatment, and enforcement. Action is being taken across each of these areas. Implementation of supervised injection services will not eliminate harmful drug use, but they are part of the range of strategies to reduce harm. Details about the implementation of the Toronto Drug Strategy are provided every two years in a status report.
The first supervised injection service opened 30 years ago in Switzerland. Today there are more than 90 supervised injection services worldwide, including in Europe, Australia and Canada. A complete list of the status of the sites in Canada can be found on Health Canada’s website.