Did Science get lost for a second at Toronto City Council vote on Supervised Injection Sites?

2016-KohutRachelBy Rachel Kohut

During the final weeks of my internship at the Legal Network, I got the chance to witness Toronto City Council pass three supervised injection sites. It was an enlightening experience to say the least, and definitely not what I was expecting. What was supposed to be an hour at City Council watching the motion pass, quickly turned into a whole morning.

Research, community consultations and careful planning had been thoroughly undertaken before these three proposed sites were brought before city council, with these recommendations ultimately brought forward to City Council by the Board of Health. Day of, the Medical Officer of Health for City of Toronto was present for any lingering questions. Turned out, there were many. I was admittedly a bit shocked that so many people had so many lingering questions, and that many of them were seemingly entirely off point. It was as if they only skimmed a few documents the night prior. All of a sudden, the conversation became about methadone treatment, instead of about safe injection sites.

Toronto City Council Chambers

Toronto City Council Chambers

Three Councillors voted against the proposed supervised injection sites: Giorgio Mammoliti, Christin Carmichael Greb and Stephen Holyday, as they were not swayed by the arguments presented to the Council Chamber. They questioned the efficacy of the sites, further arguing that the sites would be ‘enabling’ and ‘dangerous’. Mammoliti made a motion to change the location of the sites to hospitals, pharmacies and medical clinics to make them more safe. This was rejected by Council.

This last minute hail mary pass that caught me off guard. There were many other opportunities to raise these concerns beforehand, whether at community centres where consultations were held, or at discussions with the Board of Health. Why weren’t these concerns raised them, particularly given the technical nature of the subject matter?

Interestingly, once Mammoliti’s motion was tabled, he didn’t stay in his seat for long. He immediately shimmied to the top of the chamber, where the press was eagerly waiting to question him. But the discussions in the lower part of the Council Chamber didn’t stop. In other words, Mammoliti wa voicing his plight about the safety and efficacy of supervised injection sites to various news outlets at the top of the Chamber, while those in the lower part of the Council Chamber who were elected to represent the voice of Torontonians were continuing the discussion.

It quickly became apparent that this was a last minute media ploy more than anything, which got me thinking about the role of the press. Everyone has the right to know what is happening at City Council and media plays a big part in communicating discussions to the public. But did it really have to be that second?

Medical Officer of Health for City of Toronto, Dr. David McKeown, answering questions from councillors.

Medical Officer of Health for City of Toronto, Dr. David McKeown, answering questions from councillors.

What further struck me about this process was the role of the Medical Officer of Health in the discussions. Having previously worked at the Chief Public Health Office at the Public Health Agency of Canada, I am aware that the role of medical officers in decision- and policy-making is often murky at best, but it is hard to disagree with the fact that they are brought in for their technical medical knowledge and opinion.

As I watched David McKeown thoughtfully and patiently fielded questions from councillors who obviously didn’t read up on supervised injection sites, and what it meant for the city, I could only imagine what was running through his head. Maybe he was just as frustrated as me to witness councillors not seizing the opportunities to become better informed when they are presented, and instead turning around to create opportunities for public confusion and personal gratification. This moment for clarification rapidly spiralled into a moment of public health education 101, with science struggling to hold its own for a moment in the mix.

Thankfully the motion passed and if all goes well in Toronto’s application for a federal exemption, the city will soon have three supervised injection sites. But wow, what a whirlwind to get there.

Let’s Talk About Drugs

2016-KohutRachelBy Rachel Kohut

Last Friday, the Canadian HIV/AIDS Legal Network co-hosted the conference Chartering the Future of Drug Policy in Canada. The conference had a strong start. Federal Minister of Health Jane Philpott opened the conference by calling Canada’s opioid problem “nothing short of a public-health crisis”.

One-Day Post-Canadian Public Health Association Conference Session

In response to this crisis, the Minister announced that she has ordered an expedited review of naloxone nasal spray. Known by its trade name, Narcan, this nasal spray can be used as an antidote to opioid overdoses. It is currently used in primarily western Canada to combat the ever-increasing number of fatal fentanyl drug overdoses.

[read more about her announcement here in The Globe and Mail]

Minister of Health during her speech at the conference.

Minister of Health during her speech at the conference.

This announcement came at the same time as the B.C. Centre for Disease Control admitted that steep prices are hindering access to naloxone, and authorities across the country are calling for the crisis of the number of opioid overdoses to be declared as a public health emergency. To note, the B.C. Centre for Disease Control has now distributed over 9 700 free “Narcan kits”, of which 1 400 have been used to help people from overdosing, and about 8 900 people have been trained to administer the antidote through a provincial harm reduction program, Toward the Heart.

A drug considered to be 30 to 50 times stronger than heroin, an investigation by the chief coroner of British Columbia found that fentanyl was detected in the blood of 148 people who died of a drug overdose in the first four months of 2016 alone. This is more than three times the number in the same period of last year.

In Vancouver, this translates to one death every five days.

[see more about the use of Narcan in the response to fentanyl overdoses in this article]

Following the Minister of Health’s speech, she gracefully took questions from the audience, including from people who use drugs, many of whom flagged the need to do something about the increase of opioid drug overdoses, particularly in western Canada.

João Goulão—the National Drug Coordinator of Portugal, who is often heralded as the architect of the country’s national drug policy—was also in attendance at the one-day conference to present on Portugal’s experience decriminalizing drugs. That’s right. The country decriminalized every drug, from marijuana to cocaine to heroin.

If you are caught with less than a 10-day supply of any narcotic today in Portugal, the penalty is almost the equivalent of a speeding ticket.

Before decriminalizing drugs, the former physician said that “it was impossible to find a Portuguese family that did not have (drug-related) problems”. But in treating drug-use as a public health problem, and not a criminal one, the theory goes that more people are likely to seek treatment and support.

Instead of heading to jail, it is more likely that the person caught with less than a 10-day supply will be referred a committee consisting of a health professional, lawyer and social worker that determines the best step forward. This multifactorial approach attempts to get to the bottom of the issue. So the national strategy was not just to decriminalize: it was to create a complete package of policies that focus on treatment, prevention, harm reduction, reintegration and methadone treatment, among other avenues.

And even though there has been hesitations and critiques about this strategy, the numbers have illustrated very positive public health outcomes.

Although drug use did appear to climb in the first few years after decriminalization, it has since decreased, with the number of cocaine and heroin addicts steadily decreasing. And with the decrease of intravenous drug use, the number of new HIV and HCV infections due to intravenous drug use has also plunged, falling from 1 000 in 2001 to less than 100 in 2013. And drug-caused deaths? They dropped from 80 to 20 per year, far below the European Union average.

[read more in this National Post article, and in this Toronto Star article]

But what the Canadian federal government is currently proposing is not as broad sweeping. They aren’t going to decriminalize all drugs, instead seeking to legalize one: marijuana. But in ignoring other drugs from this strategy, are they glancing over a more pressing public health emergency? Could Canada learn a thing or two from a country of 10 million people right across the Atlantic on how to create a more complete package of policies? So Canada, let’s start talking about not just one drug, but all drugs.

Fellow UofT intern, Chelsey, and I at the end of the conference.

Captions generated from the #SupportDontPunish photo campaign held during the conference.

Captions generated from the #SupportDontPunish photo campaign held during the conference.

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