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Health Promotion Specialist Samira Walji demonstrates how opiate users would prepare opiates for injection. Toronto’s Medical Officer of Health is recommending three current harm reduction centres establish small-scale supervised injection sites.Fred Lum/The Globe and Mail

To deal with a rising rate of overdose deaths, three Toronto health clinics that already distribute hundreds of thousands of clean needles to drug users should be allowed to open "small-scale" supervised injection sites, the city's medical officer of health says.

While the idea remains controversial, reaction to the proposal from business associations near the clinics and local politicians was muted on Monday. If Toronto's Board of Health approves the concept at a meeting next month, consultations with the public must be held before city council and the provincial government approve the plan. The federal Health Minister then has the final say on whether the sites can operate.

The three proposed sites include the clinic known as The Works, located on the first floor of Toronto Public Health's headquarters opposite Yonge-Dundas Square, where clean needles have been handed out to drug users since 1989.

In the west end, the service would be offered at the Queen West Central Toronto Community Health Centre, near Queen Street West and Bathurst Street, while in the east, it would be available at the South Riverdale Community Health Centre, on Queen Street East near Carlaw Avenue in Leslieville. Together, these three centres now account for about 75 per cent of the 1.9 million needles the city already hands out to drug users every year.

Unveiling the proposed locations on Monday, David McKeown, the city's medical officer of health, said the sites would consist of small rooms set up inside the three clinics, and would serve mostly existing users.

Users would first obtain their own drugs, such as heroin and other opioids. A nurse would provide a sterile syringe, give safety instructions and stand watch, and drug users would be observed afterward in a "chillout room" for any signs of an overdose. Drug users will also be given access to health and other social services.

With 90 such sites operating around the world, including Vancouver's well-known Insite in the Downtown Eastside, Dr. McKeown said research shows they reduce overdose deaths and prevent the transmission of HIV and other diseases. They also reduce the number of needles found in the neighbourhoods around them, as drug users instead discard their needles inside the safe injection sites, he said. Studies show the sites have not been associated with any increase in crime, Dr. McKeown said.

Nurses at Vancouver's Insite have supervised roughly two million injections since 2003. At another smaller Vancouver site, the Dr. Peter Centre, nurses have supervised more than 15,000. There has not been a single fatal dose at either facility. And a 2011 study by the B.C. Centre for Excellence in HIV/AIDS found that the fatal overdose rate within 500 metres of Insite decreased by 35 per cent after the facility opened.

Police in Vancouver have been very supportive of Insite. Sergeant Randy Fincham said while it's difficult to draw conclusions from crime rates in the city's Downtown Eastside, the opening of Insite did cause a reduction in public drug use and the facility has saved lives.

"The harm-reduction strategy is acknowledging that people are going to use drugs, and how can we best equip people to save lives and not have them ingesting somewhere where it will impact other people?"

Toronto health officials stress that Vancouver's large Insite model is not the plan they are importing to the city. Instead, Toronto is proposing small facilities in three different neighbourhoods in clinics that already offer harm-reduction services.

Mayor John Tory remains non-committal, but he said something needs to be done to counter the city's rise in overdose deaths, with 206 people dying this way in the city in 2013. On Monday, he said he needed to speak to police Chief Mark Saunders and hear the concerns raised during public consultations.

A spokesman said Chief Saunders will need to know more about exactly what's being proposed before sharing his views.

Business owners near the sites, which are all part of vibrant mixed neighbourhoods, say they have questions about how the facilities will operate, the security arrangements and what happens to drug users after they inject. But spokespeople for business improvement areas near both the western and eastern sites said they did not want to stand in the way of access to important health services.

Rob Sysak, executive director of the West Queen West Business Improvement Area, said he hoped concerns could be addressed in the public consultation process. "We're comfortable in a sense, but we do want some more details."

An elementary school is just a two-minute walk away from the South Riverdale Community Health Centre, located in the trendy Leslieville neighbourhood. The Works clinic is on the edge of Ryerson University, steps away from the Eaton Centre, with a daycare nearby.

In an opinion piece published online on Tuesday by The Globe and Mail, four former Toronto mayors – David Crombie, John Sewell, Art Eggleton and Barbara Hall – all urge city council to support the injection site plan.

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