WATERLOO REGION - Waterloo Region will explore the possibility of supervised injection sites with the aim of reducing overdose deaths and disease transmission, along with public drug use and unsafe needle disposal.

"The main goal of supervised injection services is to save lives," said Grace Bermingham, manager of information and planning with the region.

The feasibility of supervised injection sites was one of four recommendations on enhanced harm reduction services made to a regional council committee on Tuesday.

Currently, there are more than 90 supervised injection sites operating worldwide, including in Canada. Toronto, Ottawa, Vancouver, which is adding additional sites, and Surrey, B.C., are waiting for a federal exemption to open sites, and 12 other cities are in the planning stages.

"Supervised injection services are not new," Bermingham said.

Research shows benefits, including decreasing overdoses and high-risk behaviours that lead to HIV and hepatitis C infections, decreased public drug use and improved disposal of used equipment, increased access to health and social services including addiction treatment, reduced opioid-related visits to emergency departments and engaging high-risk marginalized drug users who do not access the health-care system.

There was support among councillors for supervised injection sites, although some expressed concern that not everyone will be on board.

"I don't think our community is necessarily there yet," said Coun. Elizabeth Clarke. "I think there will be pushback."

Coun. Sean Strickland agreed: "I support it in principal, but I'm not 100 per cent sure the community is there yet."

Strickland asked medical officer of health Dr. Liana Nolan what the process will look like. She said there will be "broad discussion" to ensure people in the community are aware the sites are being considered.

"There's more work to be done," Strickland said. "And we need to bring the community along with us on this journey."

The committee carried the motion, but the plan will still need final approval from council.

Recommendations also included: working with health-care providers to improve their knowledge of harm reduction and ability to support people who use substances; identifying and working with new community partners to provide harm reduction services; and exploring opportunities and funding to expand outreach/mobile initiatives in the community.

Five delegations spoke, endorsing the plan to boost harm reduction efforts. Stigma about substance use, several said, was a big barrier stopping people from staying safe and getting help.

"They deserve dignity and they deserve respect. A supervised injection site is a step in the right direction," said Jenn Boyd, harm reduction co-ordinator for the AIDS Committee of Cambridge, Kitchener, Waterloo and Area (ACCKWA).

She said the sites are "an effective way to keep people healthier and engage them more meaningfully."

Adding more services can reduce vulnerability and, as a result, harm, Boyd said.

"It says that we see you, we hear you and we care. Change comes from support."

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Violet Umanetz, outreach manager for Sanguen Health Centre, said after getting calls from business owners about drug use in public bathrooms, she asked clients why they used those spots.

"What they told me flat out was that they didn't want to die," Umanetz said.

They told her they knew if something went wrong and they overdosed, there would be someone there to call 911. With a "staggering number" of fatal overdoses over the past year, more work is essential to avoid preventable illness and death.

"We have lost so many good people. People who never had the chance to recover," Umanetz said.

Region of Waterloo Paramedic Services averaged just under 43 suspected opioid overdose calls per month ending in March - a 92 per cent increase since January 2016 or an extra 21 calls per month.

"Harm reduction keeps our entire community safe and healthy," Umanetz said. "We need to expand the work we are doing."

Marion Best, addictions programming director at Simcoe House in Cambridge, said misconceptions linger about addiction.

"People still think it's a choice," Best said. "No one feels more guilt or shame than the person with the addiction."

A new local substance abuse study was also presented to council on Tuesday.

It found the top substances used in the region, in order, are alcohol, cannabis, "club drugs" such as ecstasy, cocaine, prescription opioids, methamphetamine (crystal meth), benzodiazepines, amphetamines, crack and heroin. Crystal meth use was emerging when the first study was done in 2008, while opioid use continues to be prevalent. Emergency department visits for opioid use increased by 17 per cent between 2005 and 2015.

The spike in fatal and non-fatal overdoses are linked to fentanyl, which people are using intentionally and unintentionally when it's added to another drug - that's caused a lot of fear among drug users about overdosing, Bermingham said.

A safe place to use was mentioned during interviews for the study, which included substance users, service providers and police. The sites could also offer clean supplies and proper disposal.