In the alley behind Dave Osborne's hair salon, there's a filthy alcove with a locked gate that does little to stop drug addicts from grabbing a bit of privacy.
Mr. Osborne worries about what goes on in there – not about whether people do drugs, because it's clear they do. His fear is that someone will overdose.
"If something happens in there and then nobody sees or knows or hears about it, somebody's going to die," he said, standing in his garage off the graffiti-covered laneway near Queen Street West and Bathurst Street in downtown Toronto.
The closet-sized nook, with its scalable chain-link fencing, is a popular spot among drug users drawn to the free supply of clean needles at the community health centre across the alley. On a recent visit, a used syringe was visible among trash strewn on the ground.
Under a plan proposed by Medical Officer of Health David McKeown, the nearby Queen West-Central Toronto Community Health Centre could soon become one of three downtown clinics in the city to allow addicts to inject illegal drugs under the supervision of nurses. The others are inside a clinic known as The Works opposite Yonge-Dundas Square and the South Riverdale Community Health Centre in Leslieville, in the east end.
Since it was announced earlier this week, the controversial idea – there are currently only two supervised injection sites in Canada, both in Vancouver – has been largely been met with resigned acceptance in the Queen West neighbourhood. The proposal goes before the city's Board of Health on Monday, the first of several approval processes.
Many residents and business owners, including Mr. Osborne, see a supervised injection site as a pragmatic response to the area's long-standing drug problem, a facility that would help reduce the risk to everyone – from curbing the number of dirty needles in public spaces to increasing safety for addicts.
The board of the West Queen West Business Improvement Area is even considering endorsing the plan, executive director Rob Sysak said. "The needles are there and my members have to sweep them up, clean them up from the laneways and in the bathrooms, so a lot of them are hoping that this will stop that," he said.
Unlike in Vancouver, where the city's main supervised injection site is in the downtrodden Downtown Eastside, the area near the Queen West-Central Toronto Community Health Centre is a vibrant urban neighbourhood proclaimed by Vogue magazine as one of the world's coolest. Trendy home-furnishing stores and ethnic restaurants co-exist with a drop-in centre for homeless people, and the area's artists, professionals and drug users generally tolerate one another. On a rainy day this week, a man clearly under the influence stumbled down the sidewalk past a mother pushing her baby in a stroller and professionals absorbed in their phones.
But living or working in this area means encountering ever-present reminders of illegal drug use – discarded needles, tiny baggies, addicts passed out on the sidewalk.
Mr. Osborne, who co-owns The Loft-Toronto hair salon, regularly scans the pavement behind his business for dirty syringes, fearful that his two dogs will step on them, and usually finds a couple each week. Workers at a nearby Starbucks and Tim Hortons say they are on guard when emptying the garbage cans in the washrooms, where people sometimes shoot up and leave their needles behind.
A few blocks away, staff members at the Scadding Court Community Centre make a point of searching the playground for syringes before they take their young charges outside to play. Every couple of weeks, they find one.
"That's just one of the realities that we have downtown," said Kevin Lee, executive director at Scadding Court, who says that "it's about time" that a supervised injection site is created.
Some local business owners have asked whether an injection site would attract an influx of drug users from other parts of the city and increase crime, Mr. Sysak said.
Advocates, including the area's city councillors, point to a 2012 feasibility study that found about half of addicts said they would not travel more than 10 blocks to use such a program. They also argue that a safe haven wouldn't cause crime to spike or encourage drug use among non-users, citing the experiences of more than 90 similar programs around the world.
"There is an existing need," said Angela Robertson, executive director of the Queen West-Central Toronto Community Health Centre. "People will not be busing in to line up to use the site. So we're looking at a service that is going to be responsive to folks who are already in the community, who are already using but who are sometimes using in spaces where there isn't safety, there isn't supervision and support."
There are an estimated 350 to 700 injection-drug users in the Queen West health centre's catchment area, Ms. Robertson said. As a group, they take significant risks. According to the feasibility study, 27 per cent of adult and 41 per cent of youth injection-drug users in Toronto said they injected at least once a day. And 18 per cent of those who injected drugs – typically cocaine or opiates, including heroin – said they had shared needles. About half said they injected in public places, including washrooms, stairwells or alleys.
For Ms. Robertson and other harm-reduction advocates, establishing a supervised injection site is personal. In 2014, 10 of the centre's clients died from drug overdoses. There is often a photo display memorializing a familiar face in the building's lobby and staff members talk about how they have "become proficient as kind of funeral planners," she said.
Citywide, overdose deaths hit 206 in 2013, an increase of more than 40 per cent in the span of a decade.
"We see this as a crisis," Ms. Robertson said. "For us, it brings a certain urgency for action to halt that and to give people a chance for this thing that folks call recovery that can only be made possible if folks are alive to have access to that opportunity."
The three proposed supervised injection sites – which must still go through public consultations and approvals from the city, province and federal government – would feature a room with three booths for drug users to inject pre-obtained drugs while being watched by a nurse. Afterward, users would go to a "chill-out room" to be watched for adverse reactions. Staff members would assess clients and make referrals to support services.
Together, the centres proposed for the sites already account for about 75 per cent of the 1.9 million needles given to drug users every year.
For Diana VanderMeulen, a freelance artist who was painting props for a fashion show in a garage off the alleyway beside the Queen West health centre, there is little question about the benefits of providing local drug users with a supervised place.
"This neighbourhood is pretty crazy anyways. There's a lot happening and I think as neighbourhoods become gentrified … it's really important to respect the people who already exist in that neighbourhood. So I don't really think it would cause further disruption at all," she said. "They're already here, is what I'm saying. It's their neighbourhood."