Supervised Injection Services

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.

For statistics related to use of Toronto Public Health’s supervised injection site, visit our statistics page.

What Is a Supervised Injection Service?

Supervised injection services are health services that provide a hygienic environment for people to inject pre-obtained drugs under the supervision of trained staff. 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.

Where Are These Services?

Four organizations are operating supervised injection services in Toronto:

Toronto Public Health, 277 Victoria St.
South Riverdale Community Health Centre, 955 Queen St. E.
Fred Victor, 145 Queen St. E.
Parkdale Queen West Community Health Centre, 168 Bathurst St.

In addition, there are a number of overdose prevention sites that provide low barrier, life-saving, time-limited services to help reduce the number of overdose deaths across the city.

How Do These Services Work?

Clients arrive at the program with pre-obtained drugs. Each person is assessed to ensure they are eligible for the program.

They are given sterile injecting equipment and instruction on safer injecting practices. A nurse then supervises their injection in a room dedicated for this purpose, and intervenes in the case of any medical emergencies.

Once the individual has injected their drugs they are directed to a waiting room where they continue to be observed for any negative drug reactions. They also receive information and referrals about other health and social supports and services at the agency or elsewhere in the community.

What Are the Benefits of These Services?

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
Cost-effectiveness
Not contributing to crime or increased drug use in the local community

Are Supervised Injection Services Legal?

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.

Will the Supervised Injection Services Increase Crime in Our Neighbourhood?

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.

Won't These Services Just Encourage More Drug Use?

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.

What Else Is Being Done to Address Drug Issues in Toronto?

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.

Are There Supervised Injection Services in Other Cities?

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.