Russ Ford's Blog

Getting a Safe Space

John (not his real name) and I were friends in high school. Like many others we lost touch. John went to one university and I went to another. He was smart, very outgoing and there was little question he was someone who would be successful in life.
A couple of years ago we held a reunion and John was one who did not come.  Reunions are   a time to renew friendships, find out what people are doing and, of course, inquire as to what happened to those who are not there.
No one really seemed to know or have recent information on John.  But there were rumours.  If you believe them, John did not finish university but got involved in some shady businesses which went bankrupt and left him broke.  There were stories that he was living on the streets. There were reports of alcohol and drug abuse as well.  Bottom line is no one knew if John was still alive, or had succumbed to the brutality of living on the streets.
I did make an attempt to find him but according to Google, he does not seem to exist. So I do not know what happened. If you buy into the rumours and if he did succumb, he has become just another public health statistic.  On average between 300 and 400 people die on the streets of Toronto as a result of unsafe injection drug use.  From 2004 to 2013 the number of deaths grew by 41 per cent.
Although it is not an epidemic, street drug use has become a significant problem in this city. It has resulted in deaths by over dose, Hepatitis and HIV/AIDS.  We can only wonder how many of these deaths were entirely preventable.
It also has public costs.  Treating a person with hepatitis, for example, costs the health care system about $60,000 and there is always the danger associated with discarded needles.
There is one safe injection site in North America. Located in Vancouver, Insite serves a population of users that are either homeless or living in shelters.  They have reduced deaths through injection by 35 percent and see just over a thousand persons a day.
I could not find any data on how many people went off injection use because of Insite.  My guess would be very few.  The precarious life of living on the street is not an environment that is conducive to eliminating drug dependence.  The research clearly shows that a strong system of social supports is essential to rehabilitation.  Insite is keeping people alive, saving the health care system millions of dollars and reducing the risk to non-users by reducing the number of discarded needles on the street.  Perhaps that’s good enough.
It goes without saying that many of their clients have mental health issues. These people face real stress on a daily basis.  Living on the street is not “executive stress”.  Their stress is real and is often about figuring out where your next meal with come from. 
But John did not live in Vancouver so there was no access to the supports he required.  Toronto does not have such a service although the City’s Board of Health is making another attempt to bring such a service here.
There will be an outcry; there is no doubt about that.  Safe injection sites do not increase the number of IV drug users.  No one would choose to take up heroin simply because they know they can now get a clean needle.
Injection sites currently exist they are just not safe.  You will likely find them in a back alley, discarded building or the back of a car.
No, safe injection sites are about reducing the harm from a behaviour that already exists.  Being an addict should not be a death sentence.  John was my friend.  He was also someone’s child, brother and possibly father. 
Whatever happened to him that found him on the streets we will never know.  We do have it within our power to keep people like John alive.
We need to support the creation of a safe injection site in Toronto. It is within our power to save lives.


Totally agree, Russ. Thanks

Totally agree, Russ. Thanks for this message and encouraging us all to see past fear and information. Supervised injection sites save lives and make our communities healthier, safer and more inclusive.

Safe Injection Sites

Excellent post. As a woman who works in the mental health and addiction field as well as a person who lives with a significant mental illness I cannot agree more with the points you have made here.

I was very lucky in my past to not have gone to drug or alcohol use for relief of my symptoms when I was not well. I cannot imagine how people with co-occurring disorders manage to survive. I suppose what I have learned through my work, from my peers and my manic travels through North America is that many don't survive. I am thrilled to see that Toronto is finally looking at safe injection sites as an option for folks in need. This is way overdue and I cringe at the thought of the push-back by our communities.

I believe that the smartest part of this latest proposal is that the programs are meant to be placed in health care facilities that already cater to people who use drugs. It is because of this that I truly don't understand why there will be opposition to the implementation of what is a common sense response to people in need.
I've been listening to CBC radio programming on this issue over the past couple of weeks. I was truly disappointed by the TPS response to the possibility of the safe injection site implementation. The officer who was interviewed was absolutely fixated on what he said were evidence based statistics from the Insite program in Vancouvers lower east side. Apparently the need for increase policing in the neighbourhood proved to be costly and the police are blaming Insite. I lived in Vancouver for 7 years. I managed one of the Boys and Girls Clubs located in that neighbourhood. I don't know how you could increase police presence without causing a "police parade" 24/7.

I really hope he listens to his interview as he was so busy trying to convince the listener that costs would rise he could not hear or respond to the fact that the program proposed for Toronto is nothing like insite. They have create an option for our community that is sensible and will work. Insite is a stand alone program - as I said previously, Toronto's programs will be placed in Health Centres that already exist and serve the clientele who will use the safe injection site in addition to the services they are already accessing.

Mental health and addictions issues are Public Health issues, they are community issues, they do not exist in isolation and we all need to be part of the solution.

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