Intravenous drug users run the risk of higher rates of HIV and hepatitis infections, as well as the ever-present danger of overdose. A straightforward policy that could save lives and money across Canada, and has already been cleared by Canadian courts: supervised injection facilities. In a 2011 ruling on their legality, the Supreme Court of Canada declared that there is little or no evidence that they will have a negative impact on public safety.

But in 2016, no legal supervised injection sites exist anywhere but British Columbia. People who’ve been advocating for an expansion of safe injection beyond the two legal sites in Canada — Insite and the Dr. Peter Centre, both in Vancouver — say it's urgently needed.

“For me, it means less of my friends are going to die,” says Sean Leblanc, chair of Ottawa’s Drug Users Advocacy League. “We lose 40 people a year in Ottawa to overdose deaths, and a lot of those could be prevented with supervised injection.”

Safe injection sites allow intravenous drug users to inject drugs with medical supervision, to prevent them from overdosing, or intervening if they do.

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In 2011 the Canadian government lost a court battle that would have effectively ended Insite’s safe injection practice. It subsequently introduced a law to regulate supervised injection and exempt it from criminal prosecution.

The problem, according to critics, is that this 2014 legislation contains so many conditions and approvals that the technically legal is simply a step away from forbidden. Applicants must provide dozens of pieces of information before the federal health department will even consider at proposal. These include detailed information about staff and directors of any proposed facility—something that some facilities may find impossible to provide in advance. The law also requires letters of approval from five different bodies at both the municipal and provincial levels. Critics say these letters effectively put peoples’ opinion in the place of scientific expertise.

“[The Conservative government’s] motivation was to make it as difficult as possible to have a safe injection site established. I think that was their goal, and you can see it by the result,” says Toronto Councillor Joe Mihevc, chair of the city’s board of health.

It’s another example of the longstanding argument over harm reduction methods: using services like needle exchange or managed alcohol clinics to treat the consequences of addiction until drug users are ready for more comprehensive treatment.

Dr. Ahmed Bayoumi, a researcher at the University of Toronto and St. Michael’s Hospital, says supervised injection saves money and lives, and can lessen the impact of drug addiction on the surrounding community.

“We improve the health of people who inject drugs by reducing the risk of blood-borne viruses and overdoses. From a community perspective we remove injection that will happen on the street into a cleaner space, reducing litter and perhaps even crime,” Bayoumi says.

Bayoumi’s research has shown that Ontario would save lives and money with supervised injection sites in Ottawa and Toronto. Patients with Hepatitis C or HIV end up being treated at provincial expense regardless, so minimizing the spread of those diseases with supervised injection would bring a substantial saving.

Given how many forms of harm reduction Toronto already offers — including mobile teams that provide clean needles to users — supervised injection is a reasonable next step, Mihevc says.

“The feds put a lot of roadblocks in the way, but the only step that’s missing is safe injection sites. We need to have that conversation here in Ontario. Sooner or later someone will apply,” he says.

Indeed, Thunder Bay has started the planning process to determine the feasibility of a safe injection site, and a group in London is studying the issue. Groups in Ottawa and Toronto are expected to bring formal proposals forward in the near future.

The Ontario government ruled out supervised injection sites in 2013 when Toronto’s board of health initially supported the idea of one. Today, the Liberals say they will give any formal proposals for supervised injection a full and fair hearing.

“If a municipality were to come forward with a proposal, we would of course consider it. More than anything, though, I think this is an opportunity to bring together all jurisdictions and look at this in a uniform way,” says Health Minister Eric Hoskins. “We now have a [federal] government that understands the science and is willing to make decisions based on science and evidence. This provides us with an opportunity to do just that.”

While the provincial government is letting the feds and municipalities take the driver’s seat on this file, it isn’t the most likely obstruction for future supervised injection sites in Ontario. The Harper-era law on supervised injection requires not just municipal support, but specifically support from the city’s chief of police in any area where a site might open.

In Toronto, Police Chief Mark Saunders said last year he was opposed to supervised injection sites saying they “cause enormous damage to neighbourhoods where they are located.” Toronto Police spokesperson Meaghan Gray says Saunders’ position is unchanged but added the force will adapt if any level of government changes the laws it must enforce.

Saunders’ predecessor, Bill Blair (now the federal Liberal MP heading the government’s efforts on marijuana decriminalization), also opposed supervised injection in 2012 when the Insite decision first came out, as did other police chiefs across Ontario. As long as law enforcement’s consent is enshrined in Canada’s supervised injection laws, the sites are unlikely to spread very far or very quickly.

Leblanc says it’s inappropriate for police support to be a condition for supervised injection at all.

“It’s like saying you need a letter from a doctor to open a new police precinct. Police aren’t experts on treating addiction, they’re not experts in public health,” he says.

Mihevc suggests some of the provisions of current Canadian law should be changed to require “consultation” instead of “approval” from local bodies, including city councils and police services.

“I don’t think it’s a bad thing for a proposal to go to council. Let’s use it as an opportunity for education. Let’s demystify some of the prejudices,” he says. “I wouldn’t be opposed to [the federal government] overruling recalcitrant councils.”

For now, only one clinic has opened under the new legislation — in Vancouver, complementing the services already provided at Insite. But Leblanc says demand for the service is so great that governments will have to relent.

“There’s just such a desperate need for this … It’s very personal to me. There’s so much evidence proving how much it helps.”