The State of Supervised Injection Sites in Hamilton

Illustration by Sukaina Imam

As the funding period for Hamilton’s only overdose prevention site draws nearer to a close, community organizations and stakeholders have come together to push for the continued existence of opioid support services.

In 2017, 87 people in Hamilton died as a result of opioid overdose. This represented a death rate 72 per cent higher than the average in Ontario. According to the Office of the Chief Coroner of Ontario, the number of opioid-related deaths in Hamilton has almost doubled over the past 10 years.

Additionally, sharing needles can make people more vulnerable to blood borne infections. In 2016, there were 230 newly diagnosed cases of Hepatitis C in Hamilton, 32 per cent higher than the provincial rate.

Supervised Injection Sites

One method of harm reduction that the city has pursued is supervised injection sites, which aim to minimize the risks associated with the injection of drugs.

An SIS is a place where people bring pre-obtained illegal drugs to be injected in a clean and supervised environment. SIS staff members are trained to respond to overdoses and can connect clients to other support services.

In December 2017, the city of Hamilton funded a study to assess the feasibility and need for an SIS in Hamilton. The study analyzed health and crime information as well as qualitative data from community stakeholders.

In a survey conducted as part of the feasibility study, 80 per cent of people who inject drugs stated that they would use an SIS if it were available.

The study found that an SIS would be likely to have community benefits, such as lowering needle litter and reducing stigma towards people who inject drugs.

Multiple case studies have found that the presence of an SIS has safety benefits for individuals who inject drugs and can lead to fewer opioid-related deaths and illnesses.

A 2011 retrospective study of a Vancouver SIS found that fatal overdoses in the surrounding area decreased by 35 per cent after it opened. To contrast, overdose-related deaths in parts of the city with no nearby SIS decreased by only 9.3 per cent.

Furthermore, the presence of clean needles reduces the risk of blood borne illnesses such as Hepatitis and Human Immunodeficiency Virus.

However, SIS are not without their risks, perceived or otherwise.

The 2017 Hamilton feasibility study found that perceived risks included police monitoring of SIS and the potential to be identified as patients at the SIS. There were also perceived community risks of increased crime, and that the perception of an SIS may create a negative image of Hamilton.

Overdose Prevention Sites in Hamilton

In June, the Shelter Health Network and partners opened a temporary overdose prevention site at Hamilton Urban Core Community Health Centre. Unlike SIS, which are permanent facilities that require federal approval, overdose prevention sites are temporary facilities approved by the province that address an immediate need.

OPS facilities can be set up in a matter of weeks. As a result, many cities use them as building blocks to eventually transition to a permanent SIS.

In June, there were 112 clients using the overdose prevention site at HUCCHC. By August, this number had risen to 332.

So far there have been a total of 11 overdoses, all of which have been treated on site.

Currently, the temporary overdose prevention site at HUCCHC is relying on $116,300 of provincial funding. However, this money will run out on Nov. 30.

Provincial Funding

The Ford government has put on hold the opening of any new OPS or SIS and withhold the extension of funding for current sites.

The Hon. Christine Elliott, Ontario Minister of Health and Long-Term Care, has stated that it is necessary to review the merits of OPS and SIS before opening new ones or extending the funding periods of current sites.

One of the Ford government’s main concerns is the issue of rehabilitation. According to Elliott, further study is needed to determine whether SIS and OPS help with rehabilitation.

“What is happening that is saving lives? What else can we do to save more lives? Are there other examples that we should be looking at besides supervised injection clinics,” Elliott asked during question period on Aug. 13.

The decision to withhold funding has sparked backlash. According to official Opposition leader Andrea Horwath of the New Democratic Party, the immediate needs of people who rely on SIS and OPS are of utmost importance.

“People can’t get treatment if they are dead,” she stated during question period on Aug. 13.

Other stakeholders have also expressed concern about the decision to put funding on hold. In an open letter to Elliott, the Registered Nurses’ Association noted that SIS and OPS have already been proven to save lives, and therefore should not be subject to a review period.

“Preventing deaths from overdoses must be treated with the same rigour and commitment as other avoidable deaths that are not stigmatized. We all share the responsibility and consequences of further marginalizing extremely vulnerable groups,” the letter states.

What Is Being Done in Hamilton?

Currently, Shelter Health Network is pushing to extend the funding period for the OPS.

Additionally, De dwa da dehs nye>s Aboriginal Health Centre and Wesley Urban Ministries have put in applications to Health Canada to house permanent supervised injection sites. However, the approval process for a permanent supervised injection site can be complex and can take years.

Hamilton city council has expressed support for the continued existence of SIS. On Sept. 17, the Hamilton board of health, a standing committee of the city of Hamilton, voted unanimously in favour of a motion to write to the provincial health minister in support of SIS.

Approximately 20 McMaster medical students lobbied city hall to bring the motion forward. According to second-year medical student Debbie Brace on behalf of the group, the data clearly demonstrates the benefits of SIS.

“People will die without these sites. It’s pretty clear cut,” Brace said.

Ward 3 city councillor Matthew Green echoed these sentiments, noting that without the maintenance of safe injection sites, people will be forced to inject unsafely in public spaces.

“If we know that this is happening, the question is: ‘do you want to have it to happen in a safe space or an unsafe space?” Green asked. “And do we want to save lives or not?’”

What Now?

While Hamilton city hall has expressed support for the sites, decision-making power rests on the provincial and federal governments.

Elliott has said that a decision will be made by the end of September.

Hamilton relies heavily upon opioid support services. The decisions that will be made in the weeks to come will have major impacts on the Hamilton community. Until these decisions are made, the safety and well-being of OPS clients across the province remains unclear.

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