St. Michael’s chief medical officer has written the Toronto Board of Health to recommend the city should go ahead with some form of supervised injection services. The board voted July 10 to recommend asking the province to fund pilot program for a safe injection site in the city, as recommended by Toronto’s Medical Officer of Health, Dr. David McKeown.
McKeown’s recommendation is based largely on a University of Toronto-St. Michael’s Hospital study completed last year, which concluded Toronto needed a safe injection site.
St. Michael’s executive vice president and chief medical officer Dr. Doug Sinclair knows pushing for safe injection is bound to be controversial, but it’s the kind of thing Toronto’s urban angel has always done, he said.
“Our mission really is to advocate for the disadvantaged. That’s been part of our role since the sisters founded the institution in 1892,” Sinclair said. “We certainly believe advocacy, treatment and care of the disadvantaged is part of our job. That’s why we wrote the letter.”
It’s going to be an uphill battle, with agreement needed from three levels of government, Sinclair said.
Ethically, safe injection sites are a culture-of-life issue, said Bridget Campion.
“From a Catholic perspective, maybe the question we want to ask is how do we care for this very vulnerable and very marginalized patient population?” said the Canadian Catholic Bioethics Institute researcher and bioethicist. “Looking at it from a pro-life, culture-of-life standpoint — the standpoint of promoting a culture of life — is absolutely key here.”
The debate over safe injection strategies gets out of balance when people fail to look at it as part of a continuum of care. A well-run safe injection site represents an opportunity to reach and care for an otherwise unreachable portion of the addict population, she said.
“And then they will be exposed to counselling, to primary care, to help for other issues that they are likely facing, including poverty, homelessness, mental health issues,” Campion said.
The idea that safe injection sites encourage drug use is not borne out by scientific evidence, said Sinclair.
“Having a safe injection site doesn’t mean people are going to say, ‘Well, now I can pick up and start using drugs.’ That just doesn’t happen,” he said.
Many of the people who come to safe injection sites are those who have tried and failed to end their addictions, or are convinced they cannot stop, Sinclair said. At Caritas School of Life, a Catholic ministry to addicts founded by Fr. Gianni Carparelli, its therapeutic community model depends on addicts being ready to deal with their addictions and issues behind their addictions, said executive director Tulio Orlando.
“Unless they’re ready to buy in, success will be limited,” he said. “They have to be at that stage in their lives where they’ve tried other programs, 30-day and 60-day, and it just hasn’t worked for them because it’s not long-term enough.”
Orlando is cautious about venturing an opinion on safe injection sites for those who wouldn’t qualify for the Caritas program.
“It’s not our form of therapy. The program we run here is abstinence based,” he said. “Over the 30-plus years this organization has been around, it’s never been something we’ve advocated for. We completely believe our philosophy that abstinence-based therapy is the best therapy.”
At the Good Shepherd on Queen Street East, the Little Brothers of the Good Shepherd send an average of 100 people a year on to treatment, and 97 per cent of those who complete the program go on to sustained sobriety. But for every three people who come to The Good Shepherd, only one will stay with the program long enough to be admitted to treatment. Executive director Br. David Lynch has mixed feelings about a safe injection site, which would be a service to only a small portion of Toronto addicts.
“I’m a big believer in recovery rather than encouragement,” Lynch said.
There’s a serious debate that must be had about different forms of harm reduction, but Lynch fears we’re headed for a debate dominated by alarmism and simplistic formulas.
“We need a debate, but a debate among professionals working in the field rather than a not-in-my-backyard debate,” he said.
Campion wants a debate about the addicts themselves rather than property values or knee-jerk judgments.
“If you truly believe in promoting the dignity of all human persons we must weigh in and make sure that drug users are seen as persons who have an essential dignity. They are children of God,” she said.
“A safe injection site is not necessarily going to cure an addiction, but it is a way of caring for the person in their disease.”