A startling dissection of drug use in London — with the personal illnesses and public ills exposed — has laid on the table a compelling case for a supervised injection site in the city.

But the sticky questions of exactly where the site or sites should go, whether the city can take the other steps necessary to make a site worthwhile, and how crystal meth and fentanyl will play a role remain unanswered.

The lead researcher of a study on providing supervised injection in London did have one answer for residents still questioning the sanity of giving people a place to inject their illicit drugs.

“Typically, there’s a lot of concern that all hell is going to break loose, that there is going to be all this crime,” Dr. Thomas Kerr said Wednesday in London. “It just doesn’t happen. All hell is not going to break loose.”

In fact, the opposite has occurred in cities with supervised injection services, he said.

“Communities are a little cleaner, a little safer, and people who use drugs are getting the health-care services they need. And it’s cost effective.”

People don’t use more drugs and more people don’t start using drugs because of injection sites, Kerr added.

The study released Wednesday by the Ontario HIV Treatment Network concluded supervised injection services should be established in London, preferably in downtown and/or Old East London.

Researchers surveyed 199 Londoners who inject drugs, and found 86 per cent said they would use a supervised injection site.

Previous experience and research shows people usually follow through on that willingness, said Kerr, a B.C. addiction researcher and professor of medicine at the University of British Columbia.

The London study also assessed the support of city organizations for supervised injection service.

“Basically all the stakeholders we talked to expressed support, but some people had very firm conditions and preferences,” Kerr said.

There was no consensus among community groups on where the service should go, with some preferring decentralized services and others a site near the core, but almost all supported 24/7 help and many supported additional “wraparound” health care and social aid.

The study built its case for the need of a supervised injection site with alarming statistics about drug use in London and the harm it’s causing.

Rates of injecting opioids are higher than the national average, and there are high rates of injecting crystal methamphetamine, cocaine and crack, as well as borrowing of syringes and sharing of needles, the study said.

The damage is clear: high rates of hepatitis C, a record number of new HIV cases in 2016, and a rate of opioid-related deaths higher than the nation’s.

The study indicated as well the impact on the public. Of the 199 people surveyed, 72 per cent said they’d injected in public in the last six months, including public washrooms, parks, parking lots, alleys, stairways, doorways and hotels.

The study noted that London experiences higher than Ontario rates of opioid-related visits to emergency departments and higher than Ontario averages for treatment of crystal meth.

It costs about $1.3 million to treat one HIV patient over their lifetime, Middlesex-London’s associate medical officer of health, Dr. Gayane Hovhannisyan, said at the presentation of the study to an audience of several dozen community leaders.

“It is pouring money down the drain,” Kerr said of allowing the situation to continue. “Here is an opportunity for very simple prevention.”

A supervised injection site offers a rare opportunity for treatment workers to connect with the hardest to reach group of drug users, Kerr noted.

“For a lot of people, active addiction is a full-time job. You wake up, you hustle the money to try and get drugs. You use, you recover from that use and you start again,” he said. “These services provide a unique opportunity because they accommodate the cycle of active drug use . . . and a unique opportunity to connect with that segment that mainstream health care often misses.”

But Kerr warned London needs to ensure other addiction services are in place before establishing an injection site.

“Supervised injection services are by no means a panacea. They are one small part of a larger response to the problems of substance use and injection drug use.”

The next step in considering an injection site will be consulting a wider range of people, said Brian Lester, executive director of Regional HIV/AIDS Connection and a co-ordinator of the drug strategy.

Establishing a site would have to follow federal guidelines that have shifted as the Canadian public seems more willing to accept the service.

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THE STUDY

199study participants

62%male

57% homeless, or in unstable housing

19%involved in sex work

57% never accessed addiction treatment

DRUG USE, TYPE

83%: crystal methamphetamine

79%: hydromorphone

64%: morphine

54%: ritalin or biphentin

WHERE THEY USED

53%: in Old East (Dundas and Adelaide area)

26%: downtown

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WHAT THEY SAID

"The message of a supervised injection site that London would be giving is that we care, you’re important, your life is important and you’re valuable. That message helps get people into recovery.”

Dr. Sharon Koivu, site chief, London Health Sciences Centre (University Hospital)

"I think what we have to acknowledge right off the bat is we have an issue in our community. The data shows that if done correctly, it can help decrease a number of the issues our community is facing.”

Mayor Matt Brown

"We’re supportive of a continuing dialogue to look at harm reduction. Will we be part of the ongoing discussion? Absolutely, cautiously given that we have a broader mandate. Our responsibility is to the security and safety of the broader public.”

Insp. Lynn Sutherland, London police

"I don’t think we’re at this discussion point yet as to where it should be located. We’re happy to be part of the discussion and be at the table to decide where it is going.”

Janette MacDonald, chief executive, Downtown London

"It is not necessarily one site. It is services. Why wouldn’t they be available everywhere? Why don’t we have a doctor’s officer where you can have supervised injection service? It doesn’t all have to be one place. Perhaps a mobile approach might work very well in London.”

Ward 4 Coun. Jesse Helmer, who represents Old East London

"You will have people who will be very against it and very for this type of service. What makes citizens most upset is if they don’t have that opportunity to have input into services that are being put into their particular neighbourhood.”

Peter Strack, president, Old East Village Community Association