Transcript: Coming Soon: Safe Injection Sites | Jan 13, 2017

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a gray suit, white shirt, and spotted blue tie.

A caption on screen reads "Coming soon: safe injection sites. @spaikin, @theagenda."

Steve says AS MANY SMALLER
COMMUNITIES IN THIS PROVINCE
ALREADY KNOW ALL TOO WELL,
ONTARIO IS FACING AN OPIOID
CRISIS.
PUBLIC HEALTH OFFICIALS AND
ELECTED LEADERS ARE SCRAMBLING
TO DEAL WITH IT, AND THIS WEEK
THAT HELPED TORONTO AND OTTAWA
SECURE BACKING FROM THE PROVINCE
FOR SOMETHING THAT SO FAR ONLY
VANCOUVER HAS DEPLOYED IN
CANADA: SO-CALLED SAFE INJECTION
SITES.
WHAT ARE THEY, HOW WILL THEY
WORK, AND WHERE WILL THEY GO?
LET'S ASK TWO TORONTO
PROPONENTS:
JOE CRESSY, TORONTO CITY
COUNCILLOR FOR WARD 20,
TRINITY-SPADINA...

Joe is in his late forties, clean-shaven, with short, side-parted blond hair. He's wearing a gray suit, white shirt, and spotted blue tie.

Steve continues AND AHMED M. BAYOUMI, PROFESSOR
IN THE DEPARTMENT OF MEDICINE AT
THE UNIVERSITY OF TORONTO AND
ONE OF THE AUTHORS OF A STUDY
THAT RECOMMENDED SAFE INJECTION
SITES FOR TORONTO AND OTTAWA.

Ahmed is in his forties, with a trimmed salt and pepper beard and receding gray hair. He's wearing glasses, a brown suit, white shirt and spotted brown tie.

Steve continues gentlemen, we welcome you to TVO.
IT'S NICE TO SEE YOU BOTH.
LET'S SET UP OUR DISCUSSION WITH
THIS, WHICH CANADIAN PRESS
REPORTED ON A FEW DAYS AGO.

A quote appears on screen, under the title "Ontario opioid stats." The quote reads "ONE IN EIGHT DEATHS OF ONTARIANS between the ages of 25 and 34 is related to opioid use and Toronto has seen a 77 percent increase in overdose deaths in the past decade, rising to 258 in 2014. 'These numbers show the need for urgent action and commitment,' Hoskins wrote to Philpott. 'As minister and as a physician, I support evidence-based policy-making and any initiative around making our communities safer."
Quoted from The Canadian Press. January 9, 2017.

Steve says JOE CRESSY, LET'S
GET STARTED ON THIS.
HOW IMPORTANT DO YOU THINK IT IS
FOR THE PROVINCIAL GOVERNMENT TO
WEIGH IN ON THIS?

The caption changes to "Joe Cressy. Toronto City Councillor."
Then, it changes again to "Changes ahead."

Joe says IT'S A SEA CHANGE AT THE
PROVINCIAL LEVEL, CERTAINLY IN
TORONTO WHERE WE'RE BRINGING
THEM FORWARD, AND IN THE COUNTRY
OF CANADA WHERE THE MINISTER OF
HEALTH SAYS WE ALSO NEED SAFE
INJECTION SITES.
FOR YEARS WE TALKED ABOUT DRUG
USE AS SOMETHING THAT YOU COULD
HIDE, AS SOMETHING YOU COULD
ARREST YOUR WAY TO A SOLUTION,
BUT IT'S A PUBLIC HEALTH ISSUE.
PEOPLE ARE DYING.
THEY'RE DYING IN INCREASING
NUMBERS.
AND UNLESS WE START TO TREAT
DRUG USE FROM A PUBLIC HEALTH
APPROACH, WHICH IS TO SAY YOU
LOOK AT HARM REDUCTION, YOU LOOK
AT TREATMENT, YOU LOOK AT
PREVENTION.
UNLESS WE SHIFT OUR FOCUS, WE'RE
GOING TO CONTINUE TO LOSE LIVES,
SO IT'S A SEA CHANGE BECAUSE
IT'S CHANGED IN THIS PROVINCE.

Steve says WHEN DID YOUR
COUNCIL VOTE ON AGREEING TO
CREATE THESE SITES?

Joe says SIX MONTHS AGO.

Steve says WHY DID IT TAKE THE
PROVINCE SIX MONTHS TO FINALLY
GIVE YOU THE GREEN LIGHT TO GO
AHEAD?

Joe says OFTEN WHEN IT COMES TO
SUPERVISED INJECTION SERVICES,
IT'S POLITICS BUT IT'S GOOD
POLICY.
WHAT'S CHANGED IS WE HAD IN
TORONTO 146 PEOPLE DIE DUE TO
OVERDOSE IN 2004, IT WAS 285
PEOPLE, 285 PEOPLE DIED DUE TO
OVERDOSE IN 2015.
SO WHAT'S CHANGED IS THAT THE
LANDSCAPE IN TORONTO, THE PUBLIC
KNOWS THERE'S A PROBLEM.
SO WHEN YOU SEE THE PROBLEM,
YOU'RE ASKING WHAT THE SOLUTION
IS.
SUPERVISED INJECTION SERVICES IS
PART OF THE SOLUTION.
AND IN THE PROVINCE OF ONTARIO,
THAT'S WHY I THINK THIS HAS
TAKEN SIX MONTHS.
IN THE PAST IT WAS TOUGH
POLITICS TO TALK ABOUT HARM
REDUCTION, LIKE SAFE INJECTION.
BUT THE PROBLEM IS SO VISIBLE,
THE OVERDOSE CRISIS IS BECOMING
SO PREVALENT IN COMMUNITIES,
THAT PEOPLE ARE SAYING, WHAT'S
THE SOLUTION, AND THE PROVINCE
RESPONDED.

Steve says IN SOME RESPECTS
IT'S TAKEN LONGER THAN 6 MONTHS
BECAUSE I KNOW, PROFESSOR, IT
WAS 14 YEARS AGO VANCOUVER GOT
ITS FIRST SITE AND FOUR YEARS
AGO YOU ROTE YOUR REPORT
RECOMMENDING TORONTO AND OTTAWA
GET SAFE INJECTION SITES.
LET ME GET YOUR VIEW ON THAT.
WHY DID IT TAKE SO LONG FOR
ONTARIO TO FOLLOW SUIT?

The caption changes to "Ahmed Bayoumi. University of Toronto."

Ahmed says WELL, THERE IS A NEW
NARRATIVE, AND THAT'S THE
NARRATIVE OF OVERDOSE, AND THERE
ARE NEW DRUGS WITH THE
APPEARANCE OF FENTANYL AND
CARFENTANIL, SO WHEN PEOPLE DO
OVERDOSE ON THOSE DRUGS, THEY
CAN BE MUCH MORE LETHAL AN THE
PREVIOUS DRUGS PEOPLE WERE USING
GENERALLY.
ALSO AS JOE WAS SAYING, THERE'S
BEEN A CHANGE AT THE POLITICAL
LEVEL.
WE HAVE NEW LEADERSHIP.
WE HAVE PUBLIC HEALTH
LEADERSHIP, THE FORMER MEDICAL
OFFICER OF HEALTH FOR TORONTO,
DR. McEWAN, CAME OUT AS A VERY
STRONG PROPONENT AND WE NEEDED
THAT LEADERSHIP AT THAT LEVEL.
WE ALSO NOW HAVE LEADERS AT THE
FEDERAL, PROVINCIAL, AND
MUNICIPAL LEVEL WHO ARE ALL
SUPPORTIVE OF SUPERVISED
INJECTION, WHICH IS ALSO A
CHANGE.

Steve says I WONDER IF THESE
SITES WILL DISAPPEAR... FOR
EXAMPLE, KELLIE LEITCH IS
RUNNING FOR THE CONSERVATIVE
PARTY LEADERSHIP.
SHE IS AGAINST IT.
TONY CLEMENT, WHO WAS A
LEADERSHIP CANDIDATE, ALSO
DROPPED OUT, HAS SAID HE WAS
AGAINST IT.
IF IT TOOK A CHANGE POLITICALLY
FOR THIS TO HAPPEN, IS IT JUST
AS LIKELY THAT A CHANGE
POLITICALLY IN THE FUTURE COULD
MAKE THESE THINGS DISAPPEAR?

The caption changes to "Ahmed Bayoumi, @AMBayoumi."

Ahmed says I THINK ONE OF THE OTHER
THINGS WE'VE SEEN IS THIS IS NOT
REALLY A PARTISAN ISSUE, AT
LEAST IN TORONTO.
WE HAVE PEOPLE FROM ACROSS THE
POLITICAL SPECTRUM WHO ARE
SUPPORTIVE OF SUPERVISED
INJECTION, PEOPLE ON THE LEFT,
PEOPLE ON THE RIGHT.
THAT'S INCREDIBLY IMPORTANT AT
THE LOCAL LEVEL.
WE ALSO KNOW THAT ONCE... WE
HAVE PUBLIC OPINION POLLING DATA
THAT SUGGESTS MOST PEOPLE ARE
SUPPORTIVE OF SUPERVISED
INJECTION IF IT CAN BE SHOWN IT
WORKS.

The caption changes to "Connect with us: @theagenda, TVO.org, Facebook, YouTube, Instagram, Podcasts."

Steve says CAN I GET YOU
THAT... THE POLITICS CHANGED TO
ENABLE IT TO HAPPEN.
WHAT IF THE POLITICS CHANGED
AGAIN AGAINST IT?

The caption changes to "Joe Cressy, @joe_cressy."

Joe says I WOULD SAY THAT POLITICIANS
WERE FOLLOWING PUBLIC OPINION AS
OPPOSED TO POLITICIANS LEADING
PUBLIC OPINION, AND THAT'S WHY
THE FUTURE IS SAFE FOR HARM
REDUCTION AND SAFE INJECTION.
LISTEN, IN THE 1970s, WE
STARTED HANDING OUT CONDOMS IN
SCHOOL.
AT THE TIME THERE WERE PEOPLE
THAT SAID TERRIBLE IDEA.
YOU'RE GOING TO CONDONE PEOPLE
HAVING SEX.
GUESS WHAT?
WE REDUCED THE TRANSMISSION OF
SOME DISEASES.
IN THE 1980s AND '90s, WE
STARTED HANDING OUT NEEDLES.
AT THE TIME THERE WAS HUGE
OPPOSITION.
THIS IS GOING TO ENCOURAGE
PEOPLE TO USE NEEDLES IN DRUG
USE.
IT REDUCED H.I.V. AND HEPATITIS
C.
IN THE 2000s, WE'VE SAID SAFE
INJECTION SITES WILL REDUCE THE
HARMS OF DRUG USE.
AND THEY WILL.
IT JUST TAKES A TIPPING POINT.
IN THIS CASE POLITICIANS WERE
FOLLOWING THE PUBLIC, NOT THE
OTHER WAY AROUND.

Steve says PROFESSOR, HAVING
SAID THAT, THERE IS THIS IN
INSIGHT.
THERE WERE ACCORDING TO THE
COUNT I HAVE HERE, 374 ILLICIT
DRUG OVERDOSE DEATHS LINKED TO
FENTANYL IN VANCOUVER BETWEEN
JANUARY AND THE END OF
OCTOBER 2016.
DOES THIS REALLY WORK?

The caption changes to "How safe is safe?"

Ahmed says THE IMPORTANT POINT IS THAT
THERE WERE NO DEATHS WITHIN
INSIGHT ITSELF.
WHEN PEOPLE USE DRUGGED IN A
SUPERVISED FACILITY, PEOPLE CAN
IMMEDIATELY ATTEND TO THOSE
PEOPLE IF THEY HAVE A MEDICAL
ISSUE, INCLUDING OVERDOSE.
DOES IT WORK?
YES, THERE IS GOOD SCIENTIFIC
EVIDENCE FOR A WHOLE LOT OF
HEALTH BENEFITS, INCLUDING
REDUCTION IN OVERDOSE AND PEOPLE
WHO ARE ABLE TO ACCESS
SUPERVISED INJECTION SERVICES.
THERE HAS BEEN A CHANGE.
THE CHANGE IS THE APPEARANCE OF
NEW DRUGS THAT ARE MORE POTENT,
MORE TOXIC, LIKE FENTANYL AND
CARFENTANIL, BUT THAT ACTUALLY
ARGUES FOR THE NEED FOR MORE
HARM REDUCTION.
IT DOESN'T INDICATE THE
FACILITIES AREN'T HAVING AN
EFFECT.

Steve says THE KEY IS TO GET
THEM TO THE SITE.
IT'S NOT GOING TO STOP IT IN THE
CITY TOTAL, BUT GET THEM TO THE
SITE, AND YOU THINK YOU CAN
REDUCE THE HARM SIGNIFICANTLY.

Ahmed says THAT'S RIGHT.
WE PROPOSED A DIFFERENT MODEL
FOR TORONTO AND OTTAWA THAN A
SINGLE CENTRAL SITE LIKE THEY
HAD IN VANCOUVER, BUT RATHER
SITES THAT ARE THROUGHOUT THE
CITY SO THAT PEOPLE CAN ACTUALLY
GET TO THEM.

Steve says THAT DOES RAISE THE
ISSUE OF WHETHER TORONTO IS
SETTING ITSELF UP FOR A BIGGER
POLITICAL PROBLEM THAN
VANCOUVER.
BECAUSE THERE IS NOT ONE SITE,
YOU'VE GOT THREE PROPOSED FOR
TORONTO, RIGHT?

Joe says THAT'S RIGHT.

Steve says THAT'S THREE
NEIGHBOURHOODS POTENTIALLY THAT
ARE GOING TO BE UP IN ARMS ABOUT
THIS.
WHAT DO YOU DO ABOUT THAT?

Joe says ONE OF THE NEIGHBOURHOODS IS
IN MY COMMUNITY, IN DOWNTOWN
TORONTO AND TRINITY-SPADINA, AND
I HAVE TO TELL YOU, WE SPENT A
YEAR AND A HALF CONSULTING WITH
NOT JUST THE LOCAL RESIDENTS BUT
ALSO THE LOCAL BUSINESSES
LEADING UP TO OUR APPROVAL...

A satellite view of Toronto pops up with the title "Toronto safe injection sites." Three places appear highlighted on the map: the Queen West Central Toronto Community Health Centre, the Toronto Public Health – The Works, and the South Riverdale Community Centre.

Steve says JUST INTERRUPT.
THERE'S THE MAP OF THE CITY
INDICATING WHERE THE THREE SITES ARE.
WHICH IS YOUR RIDING?
THE ONE ON THE WEST?

Joe says THE ONE ON THE WEST.
THE QUEEN WEST HEALTH CENTRE.
WHAT'S INTERESTING IS IN THE
CASES OF THESE THREE
NEIGHBOURHOODS, IT WAS ACTUALLY
THE LOCAL COMMUNITIES WHO SAID,
YES, IN MY BACK YARD.
AND THEY SAID YES BECAUSE DRUG
USE IS ALREADY TAKING PLACE IN
THESE COMMUNITIES.
WE'RE FINDING NEEDLES IN THE
LOCAL PLAYGROUND, IN THE LOCAL
TIM HORTON'S WASHROOM, IN
ALLEYWAYS.
WHAT SUPERVISED INJECTION
SERVICES DO IS NOT ONLY DO THEY
IMPROVE THE PUBLIC HEALTH OF
PEOPLE WHO USE DRUGS BY BRINGING
THE DRUG USE INTO A SAFE AND
SUPPORTIVE ENVIRONMENT, BUT THEY
ALSO IMPROVE PUBLIC SAFETY.
WE DON'T HAVE DISCARDED NEEDLES
OUT IN THE PUBLIC REALM, INSTEAD
MOVE THOSE IN.
IN TORONTO THE POLITICAL ISSUE
HERE IS HOW QUICKLY CAN WE GET
THESE OPENED BECAUSE SUPERVISED
INJECTION IS A SOLUTION TO THE
PROBLEM, NOT A PROBLEM ITSELF.

Steve says YOU HAVE NOT HAD
LOCAL BUSINESSES OR HOME OWNERS
UP IN ARMS ABOUT THIS?

Joe says WE'VE HAD SOME OPPONENTS.
LISTEN, I TRY TO PUT IN A SPEED
BUMP AND I HAVE PEOPLE OPPOSED
TO IT.
THERE'S NEVER CONSENSUS ON
ANYTHING.
WE HELD PUBLIC MEETINGS AND WE
HAD PEOPLE COMING OUT EN MASSE
IN SUPPORT.
THAT'S WHY I SAY WE'VE SEEN A
CHANGE.
IN THESE COMMUNITIES PEOPLE SAY
SUPERVISED INJECTION IS PART OF
THE SOLUTION TO PUBLIC SAFETY
AND PUBLIC HEALTH AS OPPOSED TO
SOMETHING THAT'S GOING TO CAUSE
A PROBLEM.

Steve says YOUR REPORT, IF I
UNDERSTAND IT, DID SAY IF YOU'RE
GOING TO SET THESE THINGS UP,
YOU NEED VERY CLEAR RULES ABOUT
SUPERVISION, ET CETERA, THAT
EVERYBODY NEEDS TO UNDERSTAND.
CAN YOU JUST... FOR EXAMPLE,
WHAT ARE THE RULES THAT PEOPLE
ARE GOING TO NEED TO UNDERSTAND
AND FOLLOW?

Ahmed says SOME OF THE RULES... SO THERE
HAVE BEEN MORE THAN 90 SUCH
FACILITIES THROUGHOUT THE WORLD.
EACH ONE HAS ITS OWN SET OF
RULES.
WHAT WE ARGUED WAS THAT WE NEED
RULES THAT ARE APPROPRIATE FOR
THE LOCAL CONTEXT.
BUT SOME OF THE RULES, FOR
EXAMPLE, RELATE TO MINORS.
SO IF SOMEBODY IS UNDER AGE 16
AND THEY WANT TO INJECT IN
SUPERVISED INJECTION, IS THAT
ALLOWED OR NOT?
IF SOMEONE WANTS ASSISTANCE IN
INJECTION, IS THAT ALLOWED OR
NOT?

Steve says WHAT ARE THE ANSWERS
TO THOSE QUESTIONS?

Ahmed says THE ANSWERS TO THE QUESTIONS
ARE GOING TO HAVE TO COME IN THE
REPORTS THAT THE SITES HAVE
SUBMITTED AND THROUGH
DISCUSSION. I'M NOT HERE TO
GIVE THOSE ANSWERS.
I'M HERE TO SAY THESE ARE THE
QUESTIONS THAT THE FACILITIES
THEMSELVES HAVE TO ESTABLISH THE
ANSWERS FOR.

Steve says DO THE FACILITIES
THEMSELVES SUPPLY THE DRUGS?

Ahmed says NO.
THESE ARE... UNDER CURRENT
RULES, PEOPLE BRING THEIR OWN
DRUGS THAT THEY HAVE ACQUIRED IN
WHATEVER WAY THEY USUALLY
ACQUIRE THE DRUGS AND THEY
INJECT THOSE WITHIN THE
FACILITIES.

Steve says HOW DO WE KNOW, JOE,
THAT THE DRUGS THAT THEY WILL
USE ON THOSE SITES, WHICH
PRESUMABLY THEY WILL BRING
THEMSELVES, ARE SAFE?

Joe says WELL, WE DON'T.
AND SO WHAT'S HAPPENING RIGHT
NOW IS PEOPLE ARE USING,
INCREASINGLY, SO SAY YOU'RE
USING HEROIN, IT MIGHT BE CUT OR
LACED WITH FENTANYL, WHICH IS AN
EXTREMELY FATAL AND POTENT
SUBSTANCE.
SO RATHER THAN RISKING A FATAL
OVERDOSE IN AN ALLEYWAY, WHEN
YOU HAVE IT CONSUMED IN SITE
UNDER A NURSE'S SUPERVISION, IF
THIS DRUG IS LACED OR IF YOU
TAKE A STRONGER DOSAGE THAN YOU
INTENDED, YOU HAVE A NURSE THERE
TO HELP BRING YOU BACK TO LIFE.
BUT I THINK THE PRINCIPLE HERE
WHICH IS KEY IS THAT WITH
SUPERVISED INJECTION, IT'S NOT
THE SOLUTION TO THE OVER DOSE
CRISIS.
WHAT IT DOES IS ENABLES YOU TO
REDUCE THE HARMS ASSOCIATED WITH
DRUG USE BUT THE SOLUTION IS
COMPREHENSIVE, IT'S TREATMENT
AND PREVENTION.
SO THE MODEL IN TORONTO IS YOU
COME INTO A SITE WHERE YOU CAN
USE DRUGS YOU'VE PREOBTAINED.
BUT THEN WE ALSO HAVE TREATMENT
ON SITE.
AND SO IF AND WHEN YOU'RE READY,
NOT ONLY DO WE ENSURE YOU DON'T
DIE IF YOU'RE USING, BUT WE CAN
HELP TRANSITION YOU TO
TREATMENT.
I LIKE TO USE THE ANALOGY THAT
IF I HAD A SIBLING THAT USED
DRUGS, I'D WANT THEM TO STOP.
I'D ALSO WANT TO KEEP THEM ALIVE
LONG ENOUGH THAT THEY HAD A
CHANCE FOR STOPPING.
THAT'S WHAT THESE SITES WILL DO.

Steve says CAN I ASK A HORRIBLY
AWFUL QUESTION HERE THAT SOME
PEOPLE WATCHING ARE GOING TO BE
ASKING THIS AND I THEREFORE DO
NOT WANT TO IGNORE THIS, AS
UNPLEASANT AS THIS QUESTION WILL
BE. WHO CARES IF THEY DIE?

Joe says WELL, YOU KNOW, HERE'S THE
THING.
IS WE ALL CARE.
IT'S A MORAL QUESTION...

Steve says WE DON'T ALL CARE,
JOE.
NOT EVERYBODY CARES.
SO WE CAN'T SAY THAT.
THERE ARE GOING TO BE SOME
PEOPLE WHO SAY THESE ARE DRUG
ABUSERS, THESE ARE PEOPLE WHOSE
LIVES ARE OUT OF CONTROL, WHY
SPEND MY TAX DOLLARS TO HELP
SAVE THEIR LIVES WHEN THEY'RE
DETERMINED TO KILL THEMSELVES?

Joe says TO WHICH I WOULD SAY IT'S A
PUBLIC HEALTH ISSUE.
JUST LIKE WHEN SOMEBODY HAS
CANCER, WE ALL HAVE A
RESPONSIBILITY TO ENSURE THEY
HAVE TREATMENT, JUST AS IF
SOMEBODY HAS A MENTAL HEALTH
ISSUE, IF YOU'RE USING DRUGS, WE
ALL HAVE A RESPONSIBILITY.
PEOPLE USING DRUGS ARE NOT
HIDDEN IN THE SHADOWS AND
ALLEYWAYS.
THEY ARE IN EVERY COMMUNITY.
THEY WORK ON MAIN STREET BUT
THEY ALSO WORK ON BAY STREET IN
TORONTO.
WE'RE ALSO WORSE OFF IF WE DON'T
CARE FOR EACH OTHER.

Steve says AHMED?

Ahmed says JUST TO ADD TO THAT.
THERE ARE STUDIES THAT SHOW THAT
THE MOST STIGMATIZED CONDITION
IN HEALTH CARE IS ADDICTION.
MORE STIGMATIZING THAN H.I.V.
THERE IS TREMENDOUS
DISCRIMINATION AGAINST PEOPLE
WHO USE DRUGS.
AND PART OF THE RESPONSE, THE
COMPREHENSIVE RESPONSE THAT JOE
WAS TALKING ABOUT IS DEALING
WITH THAT STIGMA AND
DISCRIMINATION.
SO I'M GLAD YOU ASKED THAT
QUESTION BECAUSE IT'S A REAL
PROBLEM.
WE NEED TO HAVE A PUBLIC
DISCUSSION ABOUT DRUG USE.
IT'S NOT JUST ABOUT SUPERVISED
INJECTION, IT'S ABOUT DRUG USE
AND ADDICTION IN GENERAL.
AS JOE SAID, THERE ARE PROMINENT
POLITICIANS WHO USE DRUGS.
THERE ARE PROMINENT CELEBRITIES
WHO USE DRUGS.
BUT EVERYBODY HAS PEOPLE IN
THEIR FAMILIES WHO HAS BEEN
TOUCHED BY ADDICTION.
ADDICTION IS SO PREVALENT THAT
WE NEED TO ACTUALLY CONFRONT
THIS AND DISCUSS IT IN A REALLY
OPEN, HONEST WAY THAT WE HAVEN'T
DONE YET.
I'M HOPING THIS WILL BE PART OF
THAT RESPONSE.

Steve says WE SHOULD LOOK WITH
A MORE SYMPATHETIC EYE TO THE
PLIGHT THESE PEOPLE ARE IN, IN
YOUR VIEW?

Ahmed says WE SHOULD RECOGNIZE EVERYONE
IS TOUCHED BY ADDICTION.
THIS IS NOT A MORAL FAILING,
THIS IS A HEALTH ISSUE AND THAT
PEOPLE NEED HELP AND IF WE CAN
ACTUALLY OFFER HELP TO PEOPLE TO
DEAL WITH THEIR ADDICTIONS.

Joe says I WOULD JUST... YOU KNOW, IN
2004, WE HAD 146 PEOPLE IN
TORONTO DIE DUE TO OVERDOSE.
IT WAS A CRISIS THEN BUT WE
DIDN'T TREAT IT AS SUCH.
NOW THAT NUMBER HAS INCREASED TO
258 PEOPLE AND IT'S SEEN AS A
BIGGER CRISIS, BUT IT'S ALWAYS
BEEN THERE.
THE DIFFERENCE IS THAT IN THE
PAST, TOO MANY OF THE PEOPLE
DYING DUE TO OVERDOSE WERE DYING
IN HIDDEN SPACES, IN ALLEYWAYS,
THEY WERE DYING ALONE.
AND WHAT'S CHANGED NOW IS THAT
WITH THE ARRIVAL OF FENTANYL,
THE PEOPLE AT RISK OF AN
OVERDOSE, IT'S MOVED FROM MORE
THE HABITUAL DRUG USERS TO
OCCASIONAL AND RECREATIONAL
USERS.
SUDDENLY YOU MIGHT BE DOING A
LINE OF COKE, AND GUESS WHAT?
IT'S LACED WITH FENTANYL AND
THAT'S IT.
GAME OVER.
IF IT TAKES A CRISIS OF THIS
PROPORTION, IF IT TAKES THE
ARRIVAL OF THE RISK OF A FATAL
OVERDOSE, IF THAT IS WHAT MAKES
US WAKE UP AND DEAL WITH THE
ISSUE, SO BE IT.
WE ALL HAVE A RESPONSIBILITY.

Steve says LET ME FOLLOW UP
WITH THIS.
YOU'VE MADE THE CASE, THERE ARE
GOING TO BE PEOPLE OUT THERE,
THOUGH, WHO WILL SAY, THIS JUST
RUBS ME THE WRONG WAY.
THIS JUST FEELS LIKE THE
OFFICIAL SEAL OF APPROVAL OF
CITY HALL IS GOING ON PEOPLE
ABUSING DRUGS.
WHAT'S THE ARGUMENT AGAINST
THAT?

The caption changes to "tvo.org/theagenda."

Joe says WELL, IT STARTS WITH THE
FOLLOWING.
ONE OF THE REASONS WE NOW TALK
ABOUT SUPERVISED INJECTION SITES
AND NOT SAFE INJECTION SITES IS
THAT DRUG USE IS NEVER SAFE.
BUT IT'S GOING ON.
AND IT WILL CONTINUE TO GO ON.
PEOPLE USE DRUGS FOR ALL SORTS
OF REASONS.
AND WE HAVE A RESPONSIBILITY TO
RESPOND TO IT WITH A PUBLIC
HEALTH APPROACH THAT'S BASED ON
EVIDENCE ABOUT WHAT WORKS.
IF WE WANT PEOPLE TO STAY ALIVE
LONGER, HARM REDUCTION WORKS.
IF WE WANT TO HELP PEOPLE MOVE
INTO TREATMENT TO GET OFF DRUGS,
HARM REDUCTION IS A NECESSARY
COMPONENT OF THAT.
THIS IS ABOUT EVIDENCE-BASED
HEALTH POLICY THAT WORKS AS
OPPOSED TO IDEOLOGICAL BASED
DRUG POLICY THAT CRIMINALIZES IT.

Steve says SPEAKING OF
EVIDENCE, LET'S PUT SOME ON THE
TABLE HERE.
WE LOVE CHARTS HERE.
IF YOU WOULD, LOOK AT THE
MONITORS HERE IN THE STUDIO, AND
WE WANT TO LOOK AT THE COST PER
INFECTION AVERTED, BECAUSE I
THINK, AHMED, YOU LOOKED AT THIS
IN YOUR REPORT, AND HERE WE ARE...

A slate appears on screen, with the title "Cost per infection averted."

Steve reads data from the slate and says
TO AVERT H.I.V., IN OTTAWA
VERSUS TORONTO, YOU SEE THE
TORONTO NUMBER IS SO MUCH
BIGGER, AND THEN AGAIN TO AVERT
HEP C, THE COST IN OTTAWA AND
AGAIN COMPARING THAT TO THE COST
IN TORONTO, AND ONCE AGAIN,
THREE TIMES HIGHER BY THE LOOKS
OF THINGS.
HOW COME?

The caption changes to "Ahmed Bayoumi. Saint Michael's Hospital."
Then, it changes again to "Checking the price tag."

Ahmed says SO THERE'S A LOT THAT'S GOING
INTO THOSE NUMBERS, BUT THERE
ARE TWO OR THREE POINTS THAT ARE
REALLY IMPORTANT TO RECOGNIZE
THERE.
THE FIRST IS THAT THE PREVALENCE
OF H.I.V. AND HEPATITIS C
AMONGST PEOPLE WHO INJECT DRUGS
IS ACTUALLY CONSIDERABLY HIGHER
IN OTTAWA THAN IT IS IN TORONTO.
AND THE SECOND POINT IS THAT THE
CONCENTRATION OF PEOPLE WITHIN
NEIGHBOURHOODS IS ALSO HIGHER,
PEOPLE WHO USE DRUGS IS ALSO
HIGHER IN OTTAWA THAN IN
TORONTO.
ACTUALLY, YOU GET MORE EFFICIENT
REDUCTION IN BLOOD BORNE
INFECTIONS LIKE H.I.V. AND
HEPATITIS C THROUGH SUPERVISED
INJECTION WHEN YOU HAVE A LOT OF
PEOPLE WHO ARE INFECTED AND THEY
LIVE CLOSE TO EACH OTHER, LIKE
IN OTTAWA, RATHER THAN IN
TORONTO.
BUT THE MORE IMPORTANT POINT I
THINK IS THAT ALL OF THOSE
ISSUES, YOU KNOW, WITH THE
PREVALENCE OF H.I.V. AND
HEPATITIS C, WHERE PEOPLE LIVE,
WHAT DRUGS THEY USE, HOW CLOSE
THEY LIVE TO EACH OTHER, REALLY
MEAN THERE ISN'T A SINGLE MODEL
OF SUPERVISED INJECTION THAT'S
GOING TO BE APPROPRIATE FOR
EVERY CITY OR EVERY COMMUNITY
ACROSS THE COUNTRY.
RATHER, EACH COMMUNITY IS GOING
TO HAVE TO LOOK AND DECIDE FOR
ITSELF WHAT MODEL WORKS BEST.

Steve says AS YOU CONSIDER IT
FOR TORONTO VERSUS OTHER CITIES,
DOES THAT MAKE IT A TOUGHER
SELL, SEEING AS IT'S SO MUCH
MORE EXPENSIVE TO AVERT THESE
PROBLEMS IN TORONTO THAN ELSEWHERE?

Ahmed says WE'RE ONLY LOOKING AT THE
COSTS THERE.
WE AREN'T REALLY LOOKING AT THE
BENEFIT.
SO WE DID SOME MORE ANALYSES,
COST EFFECTIVENESS ANALYSES, AND
THESE ARE HIGHLY COST EFFECTIVE
INTERVENTIONS.
IN TERMS OF HOW MUCH YOU GET FOR
THE DOLLARS YOU SPEND, THEY ARE
COMPARABLE TO ANYTHING WE DO IN
HEALTH CARE.

Steve says JUST HELP US
UNDERSTAND THAT.
BY SPENDING THIS MONEY UP FRONT,
WHAT HIGHER COSTS PRESUMABLY
DOWN THE ROAD ARE YOU AVOIDING?

Joe says THIS IS WHERE EMERGENCY ROOM
VISITS, HOSPITALIZATION, ADDED
INCREASED HEALTH CARE COSTS OF
DEALING WITH AN OVERDOSE AFTER
IT OCCURS AS OPPOSED TO
PREVENTING IT OR SUPERVISING IT
IN REAL TIME.
THE COST SAVINGS... WE'RE NOT
DOING THIS WORK BECAUSE IT'S
GOING TO SAVE US MONEY.
WE'RE DOING THIS WORK BECAUSE
IT'S GOING TO SAVE LIVES.
BUT THERE ARE HUGE COST SAVINGS
TO BEING MORE PROACTIVE ON A
HARM REDUCTION BASIS WITH
SUPERVISED INJECTION AS OPPOSED
TO STRADDLING ALL OUR EMERGENCY
ROOMS AND HOSPITAL ROOMS WITH
THE AFTER-EFFECTS OF AN
OVERDOSE.
AND I THINK, DOCTOR, YOU WENT
THROUGH IN DETAIL IN SOME OF
THESE NUMBERS LOOKING AT TORONTO
AND OTTAWA, IF IT I'M NOT MISTAKEN.

Ahmed says THAT'S RIGHT.
YOU KNOW, WE HAVE HIGHLY
EFFECTIVE TREATMENTS NOW FOR
BOTH H.I.V. AND HEPATITIS C BUT
THEY'RE ALSO REALLY EXPENSIVE.
IF WE CAN PREVENT EVEN A FEW
H.I.V. AND HEPATITIS C
INFECTIONS, THERE ARE REAL COST
SAVINGS TO BE HAD DOWN THE LINE
FROM THAT.

Steve says GOTCHA.

Joe says THAT SPECIFICALLY IS
SUPERVISED INJECTION, YES, IT
HELPS PREVENT A FATAL OVERDOSE,
BUT REDUCES THE TRANSITION OF
HEPATITIS C AND H.I.V.
SO THE LONG-TERM COST SAVINGS OF
REDUCING THE NUMBER OF PEOPLE
LIVING WITH H.I.V. ARE A...

Steve says YOU DO KNOW GIORGIO
MAMMOLITI, DON'T YOU?

Joe says I DO.
WELL.
COLOURFUL CHARACTER.

Steve says I REMEMBER HIM WHEN
HE WAS GEORGE MAMMOLITI 25 YEARS AGO.
HE HAD THIS TO SAY:

A quote appears on screen, under the title "No such thing as safe." The quote reads "In my opinion, there's no such thing as a safe injection site... I think that the word 'safe' is misleading. If anything you're creating chaos and unsafe neighbourhoods in those safe injection sites... and you're localizing the illicit drug dealer. The dealer isn't going to be touched anymore because he's going to be selling outside the safe injection sites... because whate we're doing, in fact, is saying 'it's alright. Give it to the addict and they're going to come inside and take it safely.' That, to me, doesn't work."
Giorgio Mammoliti, as quoted in the Toronto Sun. July 10, 2016.

Steve says WANT TO TAKE HIM ON?

The caption changes to "Neighbourhood concerns."

Joe says SURE.
I MEAN, LISTEN, THERE'S
FACT-BASED DECISION MAKING WHICH
IS WHAT WE'RE DOING HERE IN THE
CITY OF TORONTO AND THERE'S
DECISION-BASED FACT-MAKING,
WHICH IS WHAT GIORGIO MAMMOLITI
SPECIALIZES IN.
THERE ARE MORE THAN 90
SUPERVISED INJECTION SITES
AROUND THE WORLD, INCLUDING TWO
IN CANADA RIGHT NOW, IN
VANCOUVER.
AND IN EVERY CASE, THE RESEARCH
AND EVIDENCE HAS SHOWN THAT NOT
ONLY DOES IT IMPROVE PUBLIC
HEALTH, IT ALSO IMPROVES PUBLIC
SAFETY.
THAT IN FACT IN VANCOUVER, IT
WAS SHOWN THAT WHAT HAPPENED
WITH THE INTRODUCTION OF INSIGHT
WAS A DECREASE IN A LOT OF THE
PETTY CRIME OFTEN ASSOCIATED
WITH DRUG USE.
SO WHAT WE SEE HERE IS A MODEL
THAT ACTUALLY DOES THE EXACT
OPPOSITE BASED ON FACT THAN WHAT
GIORGIO MAMMOLITI THINKS.
THIS IS GOOD PUBLIC POLICY.
I THINK WITH ALL DUE RESPECT TO
MY COLLEAGUES WHO DIDN'T AGREE,
CITY COUNCIL VOTED 36-3 IN
SUPPORT OF THESE SITES.
YOU'VE BEEN COVERING CITY HALL
IN TORONTO FOR A WHILE.
WE NEVER VOTE 36-3 ON ANYTHING.
WE DEBATE EVERY ISSUE, WHETHER
IT'S A TREE REMOVAL OR A SPEED
BUMP.
BUT WE CAME TOGETHER AS A CITY,
WITH JOHN TORY, OUR MAYOR, AND
THE CHIEF OF POLICE SUPPORTING
THESE SITES, BECAUSE THEY WORK.
THAT'S WHAT WE'RE GOING TO MAKE
SURE.

Ahmed says ONE OTHER POINT I WOULD ADD,
YOU KNOW, COUNCILLOR MAMMOLITI
WAS TALKING ABOUT PEOPLE SELLING
DRUGS.
THE EXEMPTION FROM THE FEDERAL
ACT IS REALLY FOR POSSESSION OF
DRUGS.
IT SAYS NOTHING ABOUT SELLING
DRUGS.
SELLING DRUGS REMAINS ILLEGAL.
IT REMAINS UNDER THE AUSPICES OF
THE POLICE TO CONTROL WHO SELL
DRUGS.
SUPERVISED DRUG SITES ARE USED
IN AN ENVIRONMENT TO KEEP PEOPLE
HEALTHY.

Steve says DOES IT NOT MAKE
COMMON SENSE IF YOU WANT TO SELL
THIS STUFF, THE BEST PLACE WILL
BE RIGHT CLOSE TO THOSE CLINICS?

Joe says ONE THING ON THAT IS ALL THE
RESEARCH HAS SHOWN WITH
SUPERVISED INJECTION IS THAT
PEOPLE DO NOT TRAVEL TO USE
DRUGS.
THEY USE DRUGS IN THE
NEIGHBOURHOODS WHERE THEY ARE
ALREADY, WHICH IS WHY WE SET UP
IN TORONTO THESE THREE SITES IN
THE NEIGHBOURHOODS WHERE DRUG
USE ALREADY TAKES PLACE.
WHERE DRUG DEALERS ARE ALREADY
DEALING.
AND THE PARTNERSHIP MODEL OF
DRUG POLICY SAYS, YES, YOU NEED
HARM REDUCTION, YOU NEED
TREATMENT, YOU NEED PREVENTION,
AND YOU ALSO NEED ENFORCEMENT.
AND THE MODEL WE'VE CREATED IN
TORONTO, JUST LIKE IN VANCOUVER,
IS ONE WHERE WE WORK
COLLABORATIVELY WITH POLICE TO
DEVELOP A PROTOCOL AND A MODEL
FOR THAT AREA.
AND SO THAT'S ONE OF THE KEY
PILLARS HERE, IS THAT WHEN IT
COMES TO DRUG USE, JUST BECAUSE
YOU'RE TALKING ABOUT PUBLIC
HEALTH DOESN'T MEAN YOU'RE NOT
TALKING ABOUT ENFORCEMENT, BUT
YOU ENSURE THAT THE ENFORCEMENT
STRATEGY, THE POLICING MODEL, IS
GOING TO HELP KEEP PEOPLE ALIVE
WHILE FOCUSING ON SOME OF THE
DEALERS.

Steve says I PRESUME YOU WORKED
WITH POLICE IN SETTING UP THIS
NEW POLICY?

Joe says THAT'S CORRECT.

Steve says ARE THEY ON SIDE?

Joe says CHIEF SAUNDERS HERE IN
TORONTO IS SUPPORTIVE OF THESE
SITES.
I HAVE TO SAY I SPENT A LOT OF
TIME WITH THE CHIEF IN THE
LEADUP TO CITY COUNCIL, AND WE
SPOKE AT LENGTH.
IT'S NOT ALWAYS EASY WHEN YOU'RE
TALKING ABOUT A CHANGE IN
POLICY.
BUT OUR POLICE HERE IN TORONTO
UNDERSTAND THAT GOOD PUBLIC
HEALTH POLICY WORKS ALONGSIDE
GOOD ENFORCEMENT WHEN YOU DO IT
COLLABORATIVELY.

Steve says A COUPLE OF MINUTES
TO GO HERE.
LET'S COVER A COUPLE MORE
THINGS.
HOW LONG BEFORE THESE SITES ARE
UP AND ROLLING?

Joe says WELL, I'LL TELL YOU, THEY
SHOULD HAVE BEEN UP AND ROLLING
YESTERDAY.
AND WE NEED THEM TODAY.
NOW THAT THE PROVINCE HAS SAID
THAT THEY WILL BE FUNDING THEM,
WE'RE BEGINNING CONSTRUCTION.
IN TORONTO WE'RE DOING THE
NECESSARY WORK.
AS SOON AS THE SITES ARE UP AND
CONSTRUCTED, THE FEDERAL
GOVERNMENT HAS SAID THEY WILL
GIVE US THE NECESSARY EXEMPTION
THAT WE NEED TO LEGALLY OPERATE
THEM.
SO WE'RE LOOKING AT A MATTER OF
MONTHS.
IF WE COULD DO IT IN DAYS, WE
WOULD.
UNFORTUNATELY CONSTRUCTION TAKES
A LITTLE BIT LONGER.

Steve says AND, AHMED, THE
QUESTION FOR YOU IS, WE'VE DONE
NUMEROUS STORIES ON THIS PROGRAM
OUTSIDE THE CITY OF TORONTO.
IN FACT, IN LOTS OF PLACES IN
RURAL ONTARIO WHERE THIS IS AN
ISSUE.
DO WE NEED THESE SAFE INJECTION
SITES IN RURAL ONTARIO AS WELL?

Ahmed says SO DRUG USE IN RURAL
COMMUNITIES IS A REAL PROBLEM.
WE NEED SOMETHING IN RURAL
COMMUNITIES, YOU KNOW.
AS I WAS SAYING EARLIER, WE NEED
MODELS THAT ARE SPECIFIC TO EACH
COMMUNITY, THAT WORK IN EACH
COMMUNITY, THAT TAKE INTO
ACCOUNT HOW TO STRUCTURE HARM
REDUCTION SERVICES.
BUT IT IS AN ISSUE IN RURAL
COMMUNITIES BECAUSE GETTING
PEOPLE TO TRAVEL TO A SUPERVISED
INJECTION FACILITY IS NOT EASY.
SO WE NEED TO THINK ABOUT
DIFFERENT MODELS.
WHERE CAN WE DO SUPERVISED
INJECTION IN SETTINGS THAT ARE
ACCESSIBLE TO PEOPLE?
MAYBE IN PHARMACIES.
MAYBE IN HOSPITALS.
WE NEED TO BE BROAD IN OUR
THINKING.
BUT THAT'S A RESEARCH AGENDA.

Steve says I DON'T MAKE YOU TO
SEEM YOUNGER THAN YOU ARE OR
OLDER THAN I AM, WHEN YOU SAY I
COVERED COUNCIL FOR A WHILE, I
COVERED YOUR MOTHER, AND IT WAS
A LITTLE WHILE AGO.

Joe says I THINK FOR SURE SHE WAS A
BETTER COUNCILLOR THAN I'LL EVER
BE. THAT WE'LL AGREE ON TWO.

The caption changes to "Producer: Gregg Thurlbeck, @GreggThurlbeck."

Steve says THAT'S JOE CRESSY,
CITY COUNCILLOR, AND AHMED
BAYOUMI, U OF T.
THANKS TO YOU BOTH.

BOTH guests say THANK YOU, STEVE.

Watch: Coming Soon: Safe Injection Sites