What is Queen West – Central Toronto Community Health Centre (Queen West)?
The Queen West Health Centre has been operating in the community for over 45 years and at 168 Bathurst (Bathurst and Richmond) since 1997.

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Queen West is an accredited community-based health and wellness service governed by a Board of Directors. They are one of 73 Community Health Centres across Ontario with inter-professional teams of service providers including physicians, nurse practitioners, social workers/counsellors, health promoters, and community workers. They work to improve the health and well-being of individuals and communities who are at risk and/or face barriers to accessing high quality health care services and supports. Priority is given to low-income people, adults and youth who are homeless and street-involved, people living with substance use issues, people living with mental health issues, immigrants, and refugees. Visit their website www.ctchc.org for more information and to contact them directly.

What services are provided at the Queen West Health Centre?
Queen West offers a broad range of services including medical and dental care, health promotion, counselling and mental health supports, HIV and Hepatitis C supports and education, anonymous HIV testing, wellness groups, practical supports (legal and housing), harm reduction including needle distribution and illness prevention, advocacy, and community engagement and development.

What is a nurse supervised injection service?
Nurse supervised injection services are health services that provide a clean environment for people to inject pre-obtained drugs under the supervision of a nurse. In addition to nurse 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.

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Over 90 nurse supervised injection services exist in Europe, Australia, and Canada, but each city offers them differently. The model proposed for Toronto is unique to meet the needs of our city. Very small-scale, nurse supervised injection services, of only three booths, are being proposed at a few different existing medical facilities throughout the city. This model has been recommended based on years of studies conducted by St Michael’s Hospital and the School of Public Health at the University of Toronto, culminating in the 2012 Toronto and Ottawa Supervised Consumption Assessment study (TOSCA, 2012).

What is the new service being proposed at Queen West?
Queen West is asking the Federal Government for an exemption so that they can add a very small-scale, nurse supervised injection service – three small booths (see photo) – to their existing health services for people who inject drugs. This is a different model than Vancouver’s InSite. The service will be located within the agency’s existing program space with no addition or change to the exterior of the building.

The service will include an assessment and treatment room, an injection room with three small supervised injection booths and an adjoining post-injection room. This will occupy 46m2 or 495 sq. ft. of space on the ground floor of the existing centre at Richmond and Bathurst.

They are looking to add three small booths within their building where a nurse can supervise people injecting pre-obtained drugs, to provide sterilized supplies, provide education and counselling support including referrals to drug treatment, and to help prevent overdose as well as the spread of HIV and Hepatitis C.

The service will operate during the day, aligned with the Centre’s current hours of operation for health care services and will serve roughly 6-8 people per hour. Most people using this service will be existing clients of Queen West Health Centre – people who already visit for harm reduction supplies and the use of other support services.

Why is a supervised injection service needed at Bathurst and Richmond?
Queen West has been delivering harm reduction and health services at Bathurst and Richmond for decades. They serve a significant number of people who inject substances, including people engaged in high-risk behaviours such as injecting alone and sometimes in public. The Queen West Health Centre at Bathurst and Richmond is one of the busiest needle distribution programs in Toronto. In 2015, they had over 15,000 client visits and distributed almost 300,000 needles. They also collected over 300,000 used needles.

The Public Health Agency of Canada conducted a study of Queen West Health Centre clients and found that 11% had experienced an overdose (in the last 6 months), over a third reported publicly injecting, 15% said that they inject in public most often, almost a third reported injecting every day, 42.5% had evidence of a current/past infection with Hepatitis C and 51% did not have stable housing. Queen West Health Centre clients also told researchers that they wanted and would use an integrated supervised injection service.

Rather than picking up needles, potentially injecting in public, and then returning the needles, people will now be able to inject under the supervision of a nurse and then use a post-injection room within the health centre. This will provide Queen West with the opportunity to offer other services including referral for treatment. The wrap around services that the health centre can provide are key in helping Toronto tackle our growing overdose crisis.

Will this help keep needles out of our parks and public spaces?
Yes. More than a third of Queen West’s clients report injecting in public spaces such as alleyways, parks, and public bathrooms. This service will also make our communities safer by reducing issues such as public injecting and needles being left behind. We hear stories from our neighbours and our parks ambassadors of used needles in public parks, playgrounds, and coffee shop washrooms. Nurse supervised injection services will reduce this significantly, as those who use drugs are brought indoors and provided with clean and safe places to dispose of needles and other materials, as well as counselling and medical support.

Where else are nurse supervised injection sites being proposed in Toronto?
There are three agencies planning to add small-scale, nurse supervised injection to their existing health services for people who inject drugs. The other two agencies are The Works (277 Victoria St, Yonge and Dundas) run by City of Toronto’s Public Health Agency and the South Riverdale Community Health Centre (955 Queen Street East).

Multiple nurse supervised injection services are needed because drug use is spread out in Toronto and research finds that people will not travel to use a supervised injection service. These services are being offered in areas where people are already using.

How will the nurse supervised injection service at Queen West work?
Most of the people using the service will be existing clients. Clients will arrive at the program with pre-obtained drugs. They will enter the large lobby in the existing facility at Bathurst and Richmond so no one will have to wait outside. Each person will be assessed in the assessment and treatment room 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 small room with three booths (see photo on earlier page) 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 post-injection room, for users of the service only, 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. Hours of operation will be aligned with need and other programs and services offered at the Health Centre.

Will this be like Vancouver?
No. The services at Queen West and the two other Health Centres in Toronto will be a different model than Vancouver’s InSite. The service will be located within the agency’s existing program space with no addition or change to the exterior of the building. The service hours will be aligned with need and other programs and services offered at the Centre, and will be staffed at all times by a nurse, a coordinator/health promoter and harm reduction workers. Most of the people who will use this service will be existing clients of the Health Centre.

Will the nurse supervised injection service increase crime in our neighbourhood?
No. Supervised injection services do not contribute to crime and there is considerable research on this subject. We need to address use and overdose through a number of approaches including prevention, harm reduction, treatment and enforcement. The Health Centre at 168 Bathurst works closely with Toronto Police and local enforcement is a part of addressing the harms associated with drug use. Nurse supervised injection services are one part of this comprehensive approach.

In Toronto, what is being proposed are very small-scale supervised injection services in existing health centres that people are already visiting to pick up clean supplies and access health services. This service would move people out of public spaces and into a supervised health centre.

“Supervised Injection Services address both public safety and public health. Public injection drug use is both a crime and a source of public disorder. Supervised injection services reduce disorder and keep needles out of public places. Conventional prevention, treatment and enforcement don’t work for everyone. Some will stop using drugs on their own, and others will move in and out of treatment many times. While they fight to overcome addiction, an SIS helps them stay alive and makes our streets and public places safer.”
– Norman Inkster, Former Commissioner, Royal Canadian Mounted Police (RCMP) and Former President, INTERPOL

Why do we need supervised injection services in Toronto?
Research has concluded that Toronto would benefit from multiple small-scale supervised injection services that are integrated into health services already working with people who inject drugs. This way people can be supervised by a nurse, provided with clean supplies, and offered supports including treatment.

It might not always be apparent, but there is a high demand for harm reduction services in Toronto. In 2015, there were over 100,000 client visits to harm reduction services, and almost 1.9 million needles distributed. Hundreds of people die from overdose each year and the number is unfortunately rising. 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 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. This means used needles are found in our parks and other public places. Supervised injection services will help to prevent deaths due to overdose, prevent the spread of HIV and Hepatitis C, offer much needed treatment referrals, help to stop people from injecting in public places, and ensure used needles are disposed of properly.

Will the supervised injection service encourage drug use?
No. There is no evidence that the provision of supervised injection services encourages increased drug use or initiates new users. There is little evidence that by providing better conditions for drug consumption they perpetuate drug use in clients who would otherwise discontinue consuming drugs such as heroin or cocaine, nor that they undermine treatment goals. Research in Europe and Vancouver identifies that when managed in consultation and cooperation with local authorities and police, they do not increase public order problems by increasing local drug scenes or attracting drug users and dealers from other areas.

Are there any benefits to these services? Do they help people to stop using drugs?
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.

On Tuesday March 15, The Globe and Mail published an editorial titled: Supervised injection sites are imperfect – and better than the alternative. The editorial argued that this public health initiative deserves public support because it will save lives, reduce the number of needles in washrooms and public spaces, and help prevent the spread of HIV and Hepatitis C. See the full editorial here.

On March 17 a statement of support was released by former Mayors of the City, RCMP offers, faith leaders, former Government Ministers, non-profit and community leaders, and even the former president of the Toronto Blue Jays. Over 50 leaders – including Dr. Howard Ovens, Chief of Emergency Medicine at Mount Sinai Hospital, former Mayors Barbara Hall, David Crombie, John Sewell, Art Eggleton and David Miller, Norman Inkster, former Commissioner of the RCMP, Paul Beeston, former President of the Toronto Blue Jays, Rev. Colin Johnson, Anglican Archbishop of Toronto, Roy McMurty, former Attorney General and Chief Justice of Ontario, Lorna Marsden, former President of York University, Greg Corbara, former Minister of Finance – Government of Ontario, Dr. Paul Garfinkel, founding CEO, Centre for Addiction and Mental Health (CAMH) and Dr. Doris Grinspun, CEO of the Registered Nurses Association of Toronto – signed the statement, urging that Toronto implement these services to help save lives and improve public safety. You can see that statement and full list of signatories here.

Will there be an opportunity for more community input?
Safe injection services are being recommended by the Toronto Medical Officer of Health as a way to prevent deaths in our city. Each local agency has a right to apply to the Federal Government for an exemption to offer these services at their existing health centres.

We want to provide you with as much information as possible and an opportunity to raise any issues or concerns you might have so that we can work to address them. That is why we delivered over 5,500 newsletters to the local community the week of March 14, sent out information to over 12,000 residents through our e-newsletters, held our first public meeting on April 14, held open houses at the health centre throughout April and May, met at length with local stakeholders and are now holding our second public meeting on Monday June 20, 7pm-9pm at the Trinity Community Recreation Centre (155 Crawford Street).

If the Federal Government approves Queen West’s application, we will work with them to create a Community Liaison Committee where we can all work together to resolve any concerns that may arise, while continuing to save lives with this vital health service.

Community Liaison Committee
Should the Federal Government approve a small-scale, nurse supervised safe injection service at the Health Centre at Bathurst and Richmond, a Community Liaison Committee will be created. This Committee will include members of the local community and the Health Centre, will hold publicly accessible meetings, and will be a place for concerns to be heard and dealt with on an ongoing basis.

Community Liaison Committees are a great place for community members and the service provider to express any concerns they may have and provide updates locally. They allow for conversations to take place so that medically essential services can be provided and we can all work together to continue to build our community.