The courage to offer hope and new opportunity

Comments on the Supervised Injection Services in Toronto Report
Submission to members of the Toronto Board of Health
by David B. Gibson, Executive Director, on behalf of the Sandy Hill Community Health Centre.

I have travelled from Ottawa to be here before you because I have finally heard publically for the first time in this Province, the courage of a Public Health Organization to challenge what I call - the Politics of Harm – the silence of indifference, moral indignation, fear, ignorance, misinformation and outright discrimination of a small minority of people who live in our communities.

For much too long in this country, I have witnessed political ideology and expediency dismissing the available scientific evidence that over 90 sites around the world have been sharing for decades - that supervised injection services work as part of a continuum of health and well-being services.Time and time again we hear public officials who oppose supervised injection services on public health or safety grounds, make assertions that supervised injection services have a negative impact on the communities in which they operate.

They have been doing so it seems with impunity and yet they make these public statements without any evidence to support their assertions. Just saying no is not good enough anymore – not when people’s lives are at stake.

Instead of the Politics of Harm why can’t we reframe the discussions to the politics of hope and opportunity – where saving lives is more important than fixating on just one service intervention, namely, supervised injection services.

In reality today we only have two choices – either supervised injection services or unsupervised – nothing more nothing less – On the streets, in the public parks, alleyways, and in local businesses’ washrooms – or under the supervision of a health care provider behind closed doors – out of sight out of mind and not a public nuisance – this is what matters to most people, not the spread of HIV and HEP C.

As members of the City of Toronto Council I am not naive to your political challenges when the topic of SIS comes up – but would it not be more politically palatable and astute for you to speak to how you will support any proven evidence-based intervention that will save people’s lives – this is the new political reframe.

I consider the two recommendations before you this afternoon as an important reminder of the lessons of the 2011 Supreme Court's ruling: that governments, and all health and public health organizations, have a duty to act in ways that enhance the health of individuals and their communities.

Collectively, you as members of the Board of Health have the responsibility to protect the health of all Toronto citizens, no matter what their situation.

Addiction-related drug use is a health issue and not a criminal justice issue.

The 2011 Supreme Court of Canada decision stated that just because you use drugs does not mean that you give up your fundamental human right to health and security of the person.Supervised injection targets a small minority, those who experience the greatest struggles with their addiction, those who are homeless, those with severe and persistent mental illness, and those with an extensive history of childhood trauma. The threat of prosecution is meaningless in this group and, sadly, treatment options are few. When it comes to complex addictions, we have no cure, but we can ease suffering. And we can minimize the impact their substance use has on their local neighbourhoods.

“The effect of denying the services of SIS to the population it serves and the correlative increase in the risk of death and disease to injection drug users is grossly disproportionate to any benefit that Canada might derive from presenting a uniform stance on the possession of narcotics,” Chief Justice Beverley McLachlin wrote in a key section of the 2011 ruling.

“These sites are evidence that health authorities are increasingly recognizing that health care for injection drug users cannot amount to a stark choice between abstinence and forgoing health services,” she said.

Successful treatment requires acknowledgment of the difficulties of reaching a marginalized population with complex mental, physical, and emotional health issues.

I would now like to present to you a real-life example highlighting the importance of the recommendations before you.

The image I am about to show you is disturbing to view and I want you to be aware of this ahead of time. This individual could be your son, grandson, brother, partner, or best friend and there are thousands of ‘just like him’ in this City, Province and Country.

In August 2012 at the age of 19, (let’s call him Michael) - Michael visited our downtown Ottawa CHC to exchange his used needles with clean needles. Having declined further support that day, Michael left our CHC. Consider this picture my son Colin is now showing you. This is not a supervised injection site. But for Michael this was the safest place this 19 year old could find to inject his drugs. And he was correct; it is one of the safest places because so many people inject drugs that the workers of this business regularly check the washrooms.

When he woke up in the hospital emergency department he was told that he was clinically dead when the Paramedics arrived. The most disturbing part of this picture is what you cannot see…that this photo was taken only 25 metres from our Community Health Centre where we have medical staff who are trained to intervene in the event of an overdose and to engage people who use drugs into the health and social service system.

A week later one of his closest friends was not so lucky, she died of an overdose.

This is preventable. We can do better. We must do better.

I urge you to support the two recommendations before you – For Michael and the 1000s like him who need your help.

Source: Sandy Hill Community Health Centre (PDF)