Toronto doesn't look likely to get a supervised injection facility anytime soon, even though numerous studies have shown such facilities to save lives as well as healthcare dollars.
Nearly a decade's worth of research on Vancouver's supervised injection facility InSite has shown it to lower the spread of HIV and decrease the incidence of overdose fatalities in the city's Downtown Eastside. Furthermore, drug injection in public spaces has become less common in the area and locals are now less likely to tread on discarded syringes while walking the streets.
"The evidence is in, not only from Vancouver but also from elsewhere," says Dr. Philip Berger, chief of the Department of Family and Community Medicine at St. Michael's Hospital. "Supervised injection facilities are beneficial not only to drug users, but also to communities and neighbourhoods."
However, InSite's success hasn't moved the federal government, which has twice appealed against the exemptions the facility enjoys from federal drug laws. The government favors old-fashioned law-and-order approaches towards combatting drug abuse, as indicated by the fact that 70 per cent of its National Anti-Drug Strategy funds are directed towards law enforcement, with a meager 17 per cent set aside for prevention and two per cent for harm reduction.
Dr. Berger says law enforcement has never been successful in curbing drug-related illness and death. "Law enforcement approaches have been around for a very long time," says Dr. Berger, one of Canada's most prominent AIDS doctors.
"But every analysis of the so-called 'war on drugs' -- policing, prosecution, imprisonment, etc. -- has shown that it has failed miserably to reduce drug use or the illnesses and death associated with it."
Both government appeals against InSite were struck down by the courts, raising hopes that a similar facility could be introduced to Toronto.
However, the prospects of this happening in the near future appear dim. Mayor Rob Ford has stated his opposition to the idea in the past, while Premier Dalton McGuinty's provincial government has consistently maintained a non-committal stance on the issue.
Dr. Berger notes that the political mood at the federal level is also far from conducive.
"The current federal government ranks moral position and view of the world much higher than scientific evidence," he says. "This government is prepared to see people die in order to preserve and implement its ideological viewpoint, while completely ignoring scientific evidence."
Others share Dr. Berger's view that while supervised injection facilities would be beneficial to the city, political obstacles prevent them from taking shape.
"Toronto does have a drug problem, and I absolutely think it could benefit from a supervised injection facility at some point in time," says Leah Boelhouwer, supervisor of The Works, a needle exchange program in the Yonge and Dundas area. "But they really thought things through in Vancouver before opening their facility and I don't think Toronto is close to having that kind of dialogue yet. The political climate isn't right."
Political obstacles aside, any move to set up a supervised injection facility in Toronto can also be expected to attract considerable opposition from the general public, particularly residents' associations. In October, fierce pressure from the Corktown South Residents' Association helped prevent a methadone clinic from opening in that neighbourhood.
The Works' mobile vans -- which distribute clean needles and other harm reduction supplies around the city -- have also occasionally run into trouble with what Boelhouwer describes as "residents' associations rallying against the perceived encouragement of illegal activities in their communities."
Writer and activist Dr. Peter Ferentzy says that while harm reduction programs are effective, they are difficult to implement as they challenge long-held beliefs.
"Harm reduction programs have saved the lives of many people that I know," says Dr. Ferentzy, a recovering crack addict. "But [supervised injection sites] are a step in a direction that people fear, as they undermine the logic of prohibition."
Holly Kramer, coordinator of the Toronto Harm Reduction Task Force, agrees that the distrust of supervised injection facilities stems from a fear of change.
"Most people are leery, suspicious and scared silly of the unknown," she says. "Some people opposed racial integration and later, sex education in schools. Now, people oppose needle exchange programs, methadone clinics, homeless shelters and any change in general in ‘their' neighbourhoods."
Kramer says she is looking forward to the release of the Toronto and Ottawa Supervised Consumption Assessment, a report looking into the need for supervised drug consumption facilities in the two cities. It is expected to be released in the coming months. "If the study shows that supervised injection sites are needed in Toronto, we will help work toward the actualization of such," Kramer says.
The study's co-principal investigator, Dr. Ahmed Bayoumi of the Centre for Inner City Research at St. Michael's Hospital, declined to be interviewed. According to a Toronto Star report in November, preliminary findings suggest that supervised injection facilities would at the very least represent good value for money.
But with the government and many regular Torontonians still wary and reluctant to accept such facilities as a reality, it is still too early to inject hope into Toronto's embattled drug user community.
Rahul Kalvapalle is a graduate student of journalism at Ryerson University. He hopes to pursue a career in science and health journalism. He can be reached by email.