“You’ll get bad policy if you don’t actually develop policy based on lived experience. The whole approach—and there’s been a sea change, I think we’re starting to see people looking at drug use as a health issue as opposed to a criminal justice issue is what’s critical.”

Cressy also mentioned that users of the sites will not be forced to undergo treatment, rather those resources will be available if they’re ready.

“The alignment here is that by having increased points of contact between the person who’s using drugs and the health professional, you increase the likelihood that they’ll be interested and willing to access those [treatment] services,” he said.

Kristyn Wong-Tam (Ward 27, Toronto Centre-Rosedale) said residents are very happy to know that drug users will be getting more assistance with safe injection services. But even without the safe injection services, she says the community has been saying for some time that they really want to have a holistic approach to health services that will not just treat their drug consumption habits.

“We want to make sure that people have the tools to be successful and that would include mental health support, addiction counselling, stable housing, access to emergency shelter beds if they need it, employment counselling, and overall the right type of medical care assistance,” Wong-Tam said.

Wright is on a committee that is helping to design the new safe-injection sites. She is also on the Registered Nurses’ Association of Ontario panel for best practices in safe injection sites and sits on the University of Toronto’s overdose prevention study panel.

For a 15-week contract as a peer assistant worker at the Works, she packed clean supplies for shipment to the different centres in Toronto that provided safe supplies for drug users.

During that time, she was asked to sit on the panel as a peer assistant to design the safe injection site that will be going into the Works. This was where she was able to bring her life experience to the table and offer a perspective on what she saw when she visited Vancouver’s Insite.

“I had the opportunity to experience a safe injection site and the benefits as a client and witness how much more helpful that has been to my recovery than anything I ever did that was abstinence based,” she said.

One thing Wright recommended was the use of wheeled garbage pails for people who have a bad reaction and vomit in the safe-injection site.

“I just come from a harm-reduction approach, where I don’t see the person as something to be changed or sort of problematic. [Drugs are] the way that they’re coping right now.”

She also mentioned there is a need for backup power in case there’s a power loss.

“Not so much so that people could continue to use the safe injection site but for those already in the middle of their injections,” she said.

Vancouver’s Insite

Wright spent two years on Hastings Street, on Vancouver’s Downtown Eastside, from February 2010 to October 2011, where she and her girlfriend, Marie, were both regular users of Insite, which is where she learnt how to cook the drug properly.

For Wright, it started as a once-a-month shot on weekends from opiates. But in Vancouver, it became an everyday habit, as she also became addicted to heroin for two years. During cheque week, her use would triple until the money ran out, then back to once a day.

She didn’t know the safety procedures, and six months into her heroin use, Wright saw her girlfriend overdose seven times at Insite, where the staff saved her life—something she wouldn’t have been able to do if they were on the streets alone. Each and every time, a group of them pounced on her with Narcan, oxygen, and a supportive hand.

A typical day for Wright in Vancouver when she was a frequent drug user would be focussed on getting $10 to buy a hit.

“I tried to panhandle once and felt so much shame,” Wright said, whose girlfriend was in the sex trade. “I worked the bars, got the boys drinks and kept the tips.”

Wright would also hunt the streets of Vancouver for roaches, something she did a bit of in Toronto, to then sell joints at five bucks a joint.

“I could usually survive off of that,” she said.

“I rarely had to go a day without and thankfully, I would get pure dope. So I rarely needed more than a hit.”

Occasionally, she found jobs that would give her a weekly or biweekly cheque, or the once a month assistance cheque, and when she had money her use increased. Sometimes uncontrollably, she said.

Wright would then go to Insite, which would open at 10 a.m. and use her street name, “Amz,” to get a booth. She would then get supplies, go to her booth, put some powder into a spoon with some water, and start cooking.

“Just pulling it up and injecting, looking for that vein, and pushing through,” she said.

Between the hours of 6 a.m. and 10 a.m., dope wouldn’t be impossible to find on Hastings Street, but hard, she said.

“Depending on the time of day and how close to cheque day it was, my wait was always different,” she said. “Most of the time it was bearable. The times it wasn’t, I would grab supplies at the front desk and find a bathroom. I tried not to as my girlfriend had overdosed a lot.”

Wright said there would be about 20 drug dealers on the street, and if one got arrested, there were always people there to handle it. She said she did her best to stay away from police seizures.

She said dealers never work alone, and have other people hold the money and the drugs, keeping an eye out for police. It’s a big business on the east side of Vancouver’s downtown area, she said.

The most trouble she got into was for trespassing.

She recalls sleeping in a stairwell and someone calling the police on her girlfriend because they were screaming and fighting at 4 a.m. on the streets.

“I knew that if my support circle was a group of those people, I was never going to get out of that. But in times of need, when I was in that bad place, they were somewhat of a good support system. However, it depends because there are dealers who don’t care.”

Wright says she may have spent about $50,000 on drugs, and adds that it’s really scary out there right now. She doesn’t know if she would have survived the current fentanyl crisis on the streets today.

“As long there are people wanting it, there’s a need for it,” she said. “My experience with some of the dealers in Toronto is that they were looking out for you, they sort of do warn you. Those were the kind of dealers I was kind of mixing around with.”

Opponents

Councillor Giorgio Mammoliti (Ward 7, York West), who was one of three councillors along with Christin Carmichael Greb (Ward 16, Eglinton-Lawrence) and Stephen Holyday (Ward 3, Etobicoke Centre) to vote against the sites, said the use of the sites will have a negative impact on any community on which it is imposed.

“I guarantee that even if all the residents—other than the usual professional activists—come out overwhelmingly in opposition to safe injection sites, their voices will have zero impact on the decision to impose a site on their neighbourhoods,” he told Torontoist.

When asked about whether or not safe injection sites should be operating out of hospitals, Dr. Klaiman said the more places that can provide people with lifesaving resuscitation and, if they need it, access to naloxone, addiction services, and clean supplies, the better.

“Whether that’s in the community or in the hospital, it doesn’t matter,” she said. “Both would be ideal.”

According to Mammoliti, advocates describe the facilities as providing a safe and hygienic environment where people can inject pre-obtained drugs. What advocates refuse to acknowledge, he says, is that the drugs are illegal and purchased by “desperate people” in “desperate circumstances.”

While he supports the concept of safe injection sites, Mammoliti doesn’t believe it’s the right way to approach the use of illegal drugs, adding that “commercial and residential areas are not the right places. Safe injections should and must be situated inside hospitals,” he said.

Wright said supervised drug-injection sites will be extremely helpful during the winter because they are dealing with needles, veins, and arteries.

“When you do find that vein, it’s helpful if your not shaking from freezing,” Wright said. “When you’re shaking, things tend to spill and depending on how bad you are hurting, you will find a way to soak up that spill and use it, possibly causing cotton fever, chalked lung, or other health complications.”

Access to clean water can be a challenge when using on the streets during the winter, Wright said.

In part three of the series, Torontoist will look at Wright’s experience with the shelter system in Toronto, and examine how supervised-injection sites are not accessible to those living in the suburbs.

Correction: An earlier version of this article identified Amy Wright as having worked at Vancouver Insite. She was a client at the safe injection site her entire time in Vancouver. Torontoist regrets the error.