Item - 2016.HL13.2

Tracking Status

  • City Council adopted this item on July 12, 2016 without amendments.
  • This item was considered by the Board of Health on July 4, 2016 and adopted without amendment. It will be considered by City Council on July 12, 2016.

HL13.2 - Implementing Supervised Injection Services in Toronto

Decision Type:
ACTION
Status:
Adopted
Wards:
All

City Council Decision

City Council on July 12, 13, 14 and 15, 2016, adopted the following:  

 

1.  City Council request the City Manager to provide the letter required by clause 56.1(3)(c) of the Controlled Drugs and Substances Act indicating that Council supports the implementation of small scale supervised injection services at Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre and South Riverdale Community Health Centre.

Background Information (Board)

(June 16, 2016) Report and Appendices A-G from the Medical Officer of Health on Implementing Supervised Injection Services in Toronto
https://www.toronto.ca/legdocs/mmis/2016/hl/bgrd/backgroundfile-94548.pdf
(July 4, 2016) Presentation from the Medical Officer of Health on Implementation of Supervised Injection Services in Toronto
https://www.toronto.ca/legdocs/mmis/2016/hl/bgrd/backgroundfile-94790.pdf

Communications (Board)

(June 23, 2016) Letter from Mohamed Lachemi, President and Vice-Chancellor, Ryerson University (HL.Main.HL13.2.1)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61709.pdf
(June 26, 2016) E-mail from Roxana Ciobanu (HL.New.HL13.2.2)
(March 21, 2016) Letter from Donna May, Founding member and Facilitator, mumsDU-moms united and mandated to saving the lives of Drug Users (HL.New.HL13.2.3)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61811.pdf
(June 27, 2016) Letter from Paul Seaman, Chair, Board of Directors, Downtown Yonge Business Improvement Area (DYBIA) (HL.New.HL13.2.4)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61814.pdf
(June 15, 2016) Letter from Dr. Jeff Powis, Medical Director of Research and Infectious Diseases Consultant, Toronto Community Hepatitis C Program and Director, Antimicrobial Stewardship Program, Michael Garron Hospital, Toronto East Health Network (HL.New.HL13.2.5)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61820.pdf
(May 27, 2016) Letter from Sarah Downey, President and Chief Executive Officer, Michael Garron Hospital (HL.New.HL13.2.6)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61841.pdf
(June 29, 2016) Letter from Kapri Rabin, Executive Director, Street Health (HL.New.HL13.2.7)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61862.pdf
(June 30, 2016) Letter from Sheila Braidek, Executive Director, Regent Park Community Health Centre (HL.New.HL13.2.8)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61863.pdf
(June 30, 2016) Letter from Axelle Janczur, Executive Director, Access Alliance Multicultural Health and Community Services (HL.New.HL13.2.9)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61868.pdf
(June 29, 2016) Letter from Dr. Samantha Green, Chair, Health Providers Against Poverty, Family Physician, St. Michael's Hospital, Lecturer, University of Toronto (HL.New.HL13.2.10)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61844.pdf
(July 3, 2016) Letter from Lanadee Lampman, Parish Nurse, The Cathedral Church of St. James, Diocese of Toronto - Anglican Church of Canada (HL.New.HL13.2.11)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61845.pdf
(June 30, 2016) Letter from Shamez Amlani, Chair, and Spencer Sutherland, Executive Director, Queen Street West Business Improvement Area (HL.New.HL13.2.12)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61846.pdf
(July 4, 2016) Letter from Maureen Fair, Executive Director, West Neighbourhood House (HL.New.HL13.2.13)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61847.pdf
(July 4, 2016) Letter from Queen West Residents for Safe & Caring Communities (HL.New.HL13.2.14)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61849.pdf

Communications (City Council)

(June 30, 2016) Letter from Michael Demian, Metro Drugs (CC.Main.HL13.2.15)
https://www.toronto.ca/legdocs/mmis/2016/cc/comm/communicationfile-61888.pdf
(July 5, 2016) E-mail from Eileen Bagley (CC.Supp.HL13.2.16)
(July 11, 2016) Submission from Lily Lina Lin (CC.New.HL13.2.17)
(July 11, 2016) E-mail from Lily Lina Lin (CC.New.HL13.2.18)
(July 10, 2016) Submission from Queen West Residents for Safe and Caring Communities (CC.New.HL13.2.19)
https://www.toronto.ca/legdocs/mmis/2016/cc/comm/communicationfile-62072.pdf
(June 24, 2016) Letter from Mark Saunders, Chief of Police, Toronto Police Service submitted by Toronto Public Health (CC.New.HL13.2.20)
https://www.toronto.ca/legdocs/mmis/2016/cc/comm/communicationfile-62083.pdf
(July 12, 2016) Petition from Lily Lin, on a supervised injection site at Queen West Central Toronto Community Health Centre (CC.New.HL13.2.21)
(July 13, 2016) Letter from Chantel Marshall, Program Director, Urban Health Programs/Nursing Practice Lead, Sherbourne Health Centre (CC.New.HL13.2.22)
https://www.toronto.ca/legdocs/mmis/2016/cc/comm/communicationfile-62102.pdf
(July 12, 2016) Petition from Councillor Joe Cressy, Ward 20, Trinity-Spadina, regarding supervised injection services, containing the names of approximately 3,154 persons filed during the Routine Matters portion of the meeting (CC.New)

Motions (City Council)

1 - Motion to Amend Item moved by Councillor Giorgio Mammoliti (Lost)

That City Council amend the Board of Health Recommendation by deleting the words "Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre and South Riverdale Community Health Centre" and inserting the words "hospitals, pharmacies and/or medical clinics", so that it now reads as follows:

 

1.  City Council request the City Manager to provide the letter required by clause 56.1(3)(c) of the Controlled Drugs and Substances Act indicating that Council supports the implementation of small scale supervised injection services at hospitals, pharmacies and/or medical clinics .

Vote (Amend Item) Jul-14-2016 11:59 AM

Result: Lost Majority Required - HL13.2 - Mammoliti - motion 1
Total members that voted Yes: 4 Members that voted Yes are John Campbell, Janet Davis, Michelle Holland, Giorgio Mammoliti
Total members that voted No: 34 Members that voted No are Paul Ainslie, Maria Augimeri, Ana Bail„o, Jon Burnside, Christin Carmichael Greb, Shelley Carroll, Raymond Cho, Josh Colle, Gary Crawford, Joe Cressy, Vincent Crisanti, Glenn De Baeremaeker, Justin J. Di Ciano, Frank Di Giorgio, Sarah Doucette, John Filion, Paula Fletcher, Mary Fragedakis, Mark Grimes, Stephen Holyday, Jim Karygiannis, Norman Kelly, Mike Layton, Chin Lee, Josh Matlow, Pam McConnell, Mary-Margaret McMahon, Joe Mihevc, Frances Nunziata (Chair), James Pasternak, Gord Perks, Anthony Perruzza, John Tory, Kristyn Wong-Tam
Total members that were Absent: 6 Members that were absent are Denzil Minnan-Wong, Ron Moeser, Cesar Palacio, Jaye Robinson, David Shiner, Michael Thompson

Vote (Amend Item) Jul-14-2016 12:00 PM

Result: Lost Majority Required - HL13.2 Mammoliti - motion 1 - REVOTE
Total members that voted Yes: 2 Members that voted Yes are Michelle Holland, Giorgio Mammoliti
Total members that voted No: 36 Members that voted No are Paul Ainslie, Maria Augimeri, Ana Bail„o, Jon Burnside, John Campbell, Christin Carmichael Greb, Shelley Carroll, Raymond Cho, Josh Colle, Gary Crawford, Joe Cressy, Vincent Crisanti, Janet Davis, Glenn De Baeremaeker, Justin J. Di Ciano, Frank Di Giorgio, Sarah Doucette, John Filion, Paula Fletcher, Mary Fragedakis, Mark Grimes, Stephen Holyday, Jim Karygiannis, Norman Kelly, Mike Layton, Chin Lee, Josh Matlow, Pam McConnell, Mary-Margaret McMahon, Joe Mihevc, Frances Nunziata (Chair), James Pasternak, Gord Perks, Anthony Perruzza, John Tory, Kristyn Wong-Tam
Total members that were Absent: 6 Members that were absent are Denzil Minnan-Wong, Ron Moeser, Cesar Palacio, Jaye Robinson, David Shiner, Michael Thompson

Motion to Reconsider Vote moved by Councillor Shelley Carroll (Carried)

That in accordance with the provisions of Chapter 27, Council Procedures, City Council reconsider the vote on motion 1 by Councillor Mammoliti.


Motion to Adopt Item (Carried)

Vote (Adopt Item) Jul-14-2016 12:01 PM

Result: Carried Majority Required - HL13.2- Adopt the item
Total members that voted Yes: 36 Members that voted Yes are Paul Ainslie, Maria Augimeri, Ana Bail„o, Jon Burnside, John Campbell, Shelley Carroll, Raymond Cho, Josh Colle, Gary Crawford, Joe Cressy, Vincent Crisanti, Janet Davis, Glenn De Baeremaeker, Justin J. Di Ciano, Frank Di Giorgio, Sarah Doucette, John Filion, Paula Fletcher, Mary Fragedakis, Mark Grimes, Michelle Holland, Jim Karygiannis, Norman Kelly, Mike Layton, Chin Lee, Josh Matlow, Pam McConnell, Mary-Margaret McMahon, Joe Mihevc, Frances Nunziata (Chair), Cesar Palacio, James Pasternak, Gord Perks, Anthony Perruzza, John Tory, Kristyn Wong-Tam
Total members that voted No: 3 Members that voted No are Christin Carmichael Greb, Stephen Holyday, Giorgio Mammoliti
Total members that were Absent: 5 Members that were absent are Denzil Minnan-Wong, Ron Moeser, Jaye Robinson, David Shiner, Michael Thompson

Point of Order by Councillor Giorgio Mammoliti

Councillor Mammoliti, rising on a Point of Order, stated that he would like to ask questions of staff and asked why Members went directly to speaking to the Item.

Ruling by Speaker Frances Nunziata
Speaker Nunziata, accepted the Point of Order and ruled that she had asked Members three times if they had questions of staff and not one Member had indicated they had questions.


Point of Order by Councillor Giorgio Mammoliti

Councillor Mammoliti, rising on a Point of Order, stated that he would like to ask questions of staff.

Rulings (City Council)

Ruling by Speaker Frances Nunziata
Speaker Nunziata, accepted the Point of Order and ruled that Council would have to consent to questions of staff on this Item and put the proposal to a vote.

Vote Jul-14-2016 10:15 AM

Result: Carried Majority Required - HL13.2 - Mammoliti - Ask questions of staff
Total members that voted Yes: 22 Members that voted Yes are Jon Burnside, John Campbell, Christin Carmichael Greb, Josh Colle, Gary Crawford, Glenn De Baeremaeker, Justin J. Di Ciano, Frank Di Giorgio, Mark Grimes, Michelle Holland, Stephen Holyday, Jim Karygiannis, Chin Lee, Giorgio Mammoliti, Josh Matlow, Frances Nunziata (Chair), Cesar Palacio, James Pasternak, Gord Perks, David Shiner, Michael Thompson, John Tory
Total members that voted No: 13 Members that voted No are Paul Ainslie, Ana Bail„o, Shelley Carroll, Joe Cressy, Janet Davis, Sarah Doucette, John Filion, Paula Fletcher, Mary Fragedakis, Norman Kelly, Mike Layton, Pam McConnell, Mary-Margaret McMahon
Total members that were Absent: 9 Members that were absent are Maria Augimeri, Raymond Cho, Vincent Crisanti, Joe Mihevc, Denzil Minnan-Wong, Ron Moeser, Anthony Perruzza, Jaye Robinson, Kristyn Wong-Tam

HL13.2 - Implementing Supervised Injection Services in Toronto

Decision Type:
ACTION
Status:
Adopted
Wards:
All

Board Recommendations

The Board of Health recommends that:  

 

1.  City Council request the City Manager to provide the letter required by clause 56.1(3)(c) of the Controlled Drugs and Substances Act indicating that Council supports the implementation of small scale supervised injection services at Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre and South Riverdale Community Health Centre.

Decision Advice and Other Information

The Board of Health:  

 

1.  Supported the implementation of small-scale supervised injection services at Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre and South Riverdale Community Health Centre;

 

2.  Directed that the Board of Health and the Medical Officer of Health submit and complete Health Canada's application form for "a Section 56.1 exemption for medical purposes under the Controlled Drugs and Substances Act regarding activities at a supervised consumption site";

 

3.  Forwarded the report (June 16, 2016) from the Medical Officer Health to the provincial Minister of Health and Long-Term Care and requested that he provide the letter required by clause 56.1(3)(b) of the Controlled Drugs and Substances Act in respect of small scale supervised injection services at Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre and South Riverdale Community Health Centre;

 

4.  Forwarded the report (June 16, 2016) from the Medical Officer Health to the Chief Medical Officer of Health for the Province of Ontario and requested that he provide the letter that is required by clause 56.1(3)(g) in respect of small scale supervised injection services at Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre and South Riverdale Community Health Centre;

 

5.  Forwarded the report (June 16, 2016) from the Medical Officer Health to the provincial Minister of Community Safety and Correctional Services and requested that he provide the letter required by clause 56.1(3)(h) of the Controlled Drugs and Substances Act in respect of small scale supervised injection services at Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre and South Riverdale Community Health Centre;

 

6.  Requested the Ministry of Health and Long-Term Care, to fund 100 percent of the capital and operational costs for implementation of small-scale supervised injection services at Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre, and South Riverdale Community Health Centre;

 

7.  Directed the Medical Officer of Health to submit a comprehensive program proposal to the Ministry of Health and Long-Term Care, requesting capital and operating funding for Toronto Public Health (The Works) to implement supervised injection services; and

 

8.  Urged the Ministry of Health and Long-Term Care to increase capacity (spaces and diversity of program options) in the drug treatment system in Toronto to enable on-demand access for people seeking help, including clients of supervised injection services.

 

The Medical Officer of Health gave a presentation on Implementing Supervised Injection Services in Toronto.

Origin

(June 16, 2016) Report from the Medical Officer of Health

Summary

A supervised injection service (SIS) is a health service that provides a safe and hygienic environment where people can inject pre-obtained drugs under the supervision of a nurse. More than 90 SISs are operating worldwide. The Toronto and Ottawa Supervised Consumption Assessment (TOSCA) study concluded that Toronto would benefit from multiple supervised injection services that are integrated into existing health services already serving people who inject drugs.

 

The TOSCA report concluded that conditions in Toronto warranted implementation of SIS. Between 2004 and 2014 there was a 77 percent increase in the reported number of people dying from overdose in Toronto – from 146 in 2004 to 258 in 2014, the highest annual number to date. Of particular concern is the role of opioids such as heroin and fentanyl in these deaths. There is a high demand for harm reduction services in Toronto with over 100,000 client visits and almost 1.9 million needles distributed in 2015.

 

In March 2016, the Medical Officer of Health (MOH) reported to the Board of Health (BOH) that Toronto Public Health (The Works), Queen West-Central Toronto Community Health Centre (Queen West), and South Riverdale Community Health Centre (South Riverdale) are proposing to add small-scale SIS to their existing clinical health services. The BOH supported initiation of a coordinated community consultation, with a request to report back on the results to the BOH in July. This report responds to that request.

 

The three health care organizations worked together to align consultation efforts. Plans were developed with input from the ward councillor that included common and organization-specific activities. An external vendor was retained to facilitate and report on certain activities, including public meetings, focus groups and an online survey. Input was gathered about SIS in general and for each of the three locations regarding perceived benefits and concerns about SIS, and suggestions of how to address concerns. A large majority of respondents identified benefits associated with SIS (between 84 and 96 percent depending on location), including reducing overdoses and the risk of infectious diseases such as HIV, reducing public injection and increasing the use of other health and social services. Concerns were identified by between 14 and 36 percent of respondents (depending on location). Respondents could identify both benefits and concerns. Concerns included a potential increase in crime and community safety issues, negative behaviours of service users, and a negative impact on community reputation. Strategies to address concerns raised included establishing community advisory committees, ensuring sufficient waiting room space and service delivery hours, developing police protocols, and active monitoring and evaluation. A summary of program proposals for each of the organizations seeking to implement SIS were developed, and are included in the appendix of this report.

 

Legal operation of an SIS in Canada requires an exemption under section 56.1 (2) of the Controlled Drugs and Substances Act (CDSA), which is granted by the federal Minister of Health. The exemption application includes an extensive list of documentation and letters of opinion from various stakeholders, including the municipal government. This staff report seeks support from the BOH and City Council to implement integrated SIS at the three health organizations named in this report, authority for the BOH and MOH to submit an exemption application to the federal Minister of Health and for the BOH to advocate for capital and operational funding from the provincial government.

Background Information

(June 16, 2016) Report and Appendices A-G from the Medical Officer of Health on Implementing Supervised Injection Services in Toronto
https://www.toronto.ca/legdocs/mmis/2016/hl/bgrd/backgroundfile-94548.pdf
(July 4, 2016) Presentation from the Medical Officer of Health on Implementation of Supervised Injection Services in Toronto
https://www.toronto.ca/legdocs/mmis/2016/hl/bgrd/backgroundfile-94790.pdf

Communications

(June 23, 2016) Letter from Mohamed Lachemi, President and Vice-Chancellor, Ryerson University (HL.Main.HL13.2.1)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61709.pdf
(June 26, 2016) E-mail from Roxana Ciobanu (HL.New.HL13.2.2)
(March 21, 2016) Letter from Donna May, Founding member and Facilitator, mumsDU-moms united and mandated to saving the lives of Drug Users (HL.New.HL13.2.3)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61811.pdf
(June 27, 2016) Letter from Paul Seaman, Chair, Board of Directors, Downtown Yonge Business Improvement Area (DYBIA) (HL.New.HL13.2.4)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61814.pdf
(June 15, 2016) Letter from Dr. Jeff Powis, Medical Director of Research and Infectious Diseases Consultant, Toronto Community Hepatitis C Program and Director, Antimicrobial Stewardship Program, Michael Garron Hospital, Toronto East Health Network (HL.New.HL13.2.5)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61820.pdf
(May 27, 2016) Letter from Sarah Downey, President and Chief Executive Officer, Michael Garron Hospital (HL.New.HL13.2.6)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61841.pdf
(June 29, 2016) Letter from Kapri Rabin, Executive Director, Street Health (HL.New.HL13.2.7)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61862.pdf
(June 30, 2016) Letter from Sheila Braidek, Executive Director, Regent Park Community Health Centre (HL.New.HL13.2.8)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61863.pdf
(June 30, 2016) Letter from Axelle Janczur, Executive Director, Access Alliance Multicultural Health and Community Services (HL.New.HL13.2.9)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61868.pdf
(June 29, 2016) Letter from Dr. Samantha Green, Chair, Health Providers Against Poverty, Family Physician, St. Michael's Hospital, Lecturer, University of Toronto (HL.New.HL13.2.10)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61844.pdf
(July 3, 2016) Letter from Lanadee Lampman, Parish Nurse, The Cathedral Church of St. James, Diocese of Toronto - Anglican Church of Canada (HL.New.HL13.2.11)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61845.pdf
(June 30, 2016) Letter from Shamez Amlani, Chair, and Spencer Sutherland, Executive Director, Queen Street West Business Improvement Area (HL.New.HL13.2.12)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61846.pdf
(July 4, 2016) Letter from Maureen Fair, Executive Director, West Neighbourhood House (HL.New.HL13.2.13)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61847.pdf
(July 4, 2016) Letter from Queen West Residents for Safe & Caring Communities (HL.New.HL13.2.14)
https://www.toronto.ca/legdocs/mmis/2016/hl/comm/communicationfile-61849.pdf

Speakers

Andrew Sherbin, Chair, Leslieville Business Improvement Area
Leigh Chapman, Registered Nurse
Lorna Morin, South Riverdale Community Health Centre
Cori Chapman
Joyce Rankin, Clinical Manager, Street Health
John MacDonald, Evaís Satellite
David Willis, Chair, South Riverdale Community Health Centre Board
Enza Trentadue, Manager, Open House Drop-In and Support Services, Fred Victor Centre
Zoe Dodd, Toronto Drug Usersí Union
Cindy Reardon
Margaret Harvey
Denise Baldwin, IDU Outreach Coordinator, Ontario Aboriginal HIV/AIDS Strategy (Oahas)
Donna May, Founding Member and Facilitator, mumsDU-moms united and mandated to saving the lives of Drug Users
Kevin Lee, Executive Director, Scadding Court Community Centre
Lori Ross
Ali Lienaux, Associate Executive Director, Centre Francophone de Toronto
Geoff Demel, Community Advisory Committee, The Works
Meagan Masse
Lanadee Lampman, Parish Nurse, The Cathedral Church of St James
Marc Andre Hermanstyne, Board Director, Central Toronto Community Health Centres
Angela Robertson, Executive Director, Queen West Central Toronto Community Health Centre
Dennis Long, Breakaway Addiction Services
Roxanne Danielson, Street Nurses Network
Shamez Amlani, Queen Street West BIA
Peter Leslie
Dan Shimski
Julia Barnett, Director of Population Health and Community Engagement, Parkdale Community Health Centre
Amy Wright, Peer Worker, Parkdale Community Health Centre
Doris Grinspun, President, Registered Nurses' Association of Ontario
Councillor Paula Fletcher
Councillor Gord Perks
Councillor Kristyn Wong-Tam
Councillor Mike Layton

Motions

Motion to Adopt Item moved by Councillor Joe Cressy (Carried)

Vote (Adopt Item) Jul-04-2016

Result: Carried Majority Required
Total members that voted Yes: 10 Members that voted Yes are Ashna Bowry, Joe Cressy, Sarah Doucette, Chris Glover, Angela Jonsson, Elisa Levi, Joe Mihevc (Chair), Paul Nagpal, Frances Nunziata, Peter Wong
Total members that voted No: 0 Members that voted No are
Total members that were Absent: 3 Members that were absent are Stacey Berry, Jon Burnside, Christin Carmichael Greb
Source: Toronto City Clerk at www.toronto.ca/council