It was announced in December 2013 that Montreal will soon be home to four supervised injection sites. The sites will include three permanent locations in already existing clinics across the city, as well as one mobile clinic to serve the Montreal area.
The news comes after a decade-long struggle between the Canadian federal government and the Quebec-based organizations that have been advocating for supervised injection sites (SIS) in Montreal ever since the first site, Insite Vancouver, was established in 2003.
SISs are places where injection-drug users can go to obtain clean needles and dispose of used ones. Additionally, social workers and on-site emergency medical attention are available to users if needed. These sites are part of an approach known as harm reduction, which involves programs that provide safe spaces and medical services for drug users in a non-judgemental and non-coercive manner.
Since its inception, Insite has operated under an exemption to the Controlled Drug and Substances Act, allowing it to legally provide help to drug users.
Inspired by Insite, Montreal-based organizations, such as Association pour la Défense des Droits et l’Inclusion des personnes qui Consomment des drogues du Québec (ADDICQ) and CACTUS Montreal, began campaigning for SISs in 2003. However, they were unable to obtain the same exemption that Insite was given, and thus had little hope of creating the sites. In 2011, the Supreme Court ruled that Insite was a necessary service, according to Sylvain Côté of ADDICQ, a community-based organization that provides support for injection drug users.
“It was a decision that said that Insite should be not only implemented but continued as an essential service for drug addicts that saves lives and that could prevent overdoses and HIV,” said Carole Morissette, public health doctor for Montreal Public Health. “For us, in Montreal, that judgement was a real boost in this situation and then gave us an opening.” This decision fueled a huge campaign for SISs in Montreal.
“We campaign,” said Côté, “we did some protest[s], we wrote letters…we demand to be included on the committee that was working on SISs, such as the public health committee of Montreal.”
Côté noted that such sites are important as they create services for drug users that allow them to perform injections in a safe space, dispose of their used needles properly, and obtain medical services if needed. Both they and the surrounding community benefit, with lower instances of both common diseases in users and drug usage in public.
“What we see is that [...] people who would use the safer injection sites are people who have no place to go to inject themselves safely,” said Amélie Panneton, community organizer with CACTUS Montreal. “[This] means that usually they consume the drugs in the street, in the public domain, which is dangerous for them because we know there are lots and lots of overdoses in public spaces.”
One important aspect of SISs is that they provide on-site access to medical care and give users access to a social worker if they decide that they want to stop using, or need support.
“We have lots of evaluations and research projects that can demonstrate the efficacy of safer injection sites to prevent death to prevent overdoses, and to prevent HIV [...] and that help drug users to be related to the rest of the health network and have access to other services they need,” said Morissette.
“The main obstacle is from the Conservative government,” said Côté, “but public health departments from major cities […] are really supporting the idea.” The federal government’s policy on drug prevention does not favour supervised injection sites, Côté noted. They have instead chosen to focus more on increasing funding for law enforcement and preventative education, while decreasing spending on harm reduction. “They simply consider drugs as evil – people who use drugs as criminals,” Côté added.
Some opposed to SISs argue that sites like these promote illicit behaviour and can lead to increases in crime and drug use in the area, a major reason behind the Conservative tabling of Bill C-65 (also known as the “Respect for Communities Act”) this summer that sought to make it harder to have such sites.
Panneton noted that the sites are awaiting the go-ahead for funding from the Ministère de la Santé et des Services sociaux (MSSS), a process whose length CACTUS cannot fully predict. Additionally, the sites would have to receive an exception from the federal Controlled Drugs and Substances Act, such as Insite did in Vancouver.
For organizations like CACTUS, the creation of these sites is a step towards reducing the harm caused by illicit drug use in Montreal. “We’ve been giving out material,” said Panneton. “We’ve been doing intervention with these people, trying the best we can. But we see that we would really need a safe injection site to help even more, that’s why we find it really really important to have multiple sites in Montreal.”