A guide by and for people who use drugs on how to get involved

June 2015

Canadian AIDS Society / Société canadienne du sida

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PROUD presents Experts-by-experience: A community colloquium

June 6, 2016 event poster - final

PROUD is hosting an event on June 6, from 1:00 pm – 3:30, at the St. Brigid’s Centre for the Arts, located at 310 St. Patrick St (entrance on Cumberland St). Some refreshments and snacks will be provided. The event will be held in English.

Here are some details regarding the event:

  • Peer researchers will share recent findings stemming from the Life Story Board study, which was conducted at the SHCHC, CTCHC and SWCHC in the summer of 2015;
  • Youth from the community will give a presentation on their experiences of drug use and HIV and Hepatitis C prevention needs;
  • Rob Boyd, from Oasis at the SHCHC, will give a summary of the recent round of public consultations and update the community regarding SIS in Ottawa;
  • There will be a community consultation in order to identify current community research priorities.
    Please circulate this message widely in your networks. We hope to see you there!

For more information, please send an email to

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Rob Boyd of the PROUD Community Advisory Committee on CBC Radio this morning!

Rob Boyd, Director of the OASIS program at the Sandy Hill Community Health Centre and ex-officio member of the PROUD CAC, spoke on CBC Radio One this morning on why the Sandy Hill Community Centre would be well equipped to receive Supervised Injection Services (SIS) in Ottawa! Ottawans, including the Mayor and the Chief of Police, need to get behind SIS in our City! Tune in and spread the word!

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Canada urged to create national system to track opioid-related deaths


Medical experts are calling for the creation of a national system to track Canada’s epidemic of opioid-related deaths, as fatalities from popular painkillers continue to mount.

A new study released Monday in the Canadian Medical Association Journal highlights the lack of timely and accurate information on fatal opioid overdoses. Unlike countries such as the United States and Australia, the study says, Canada has no mechanism for collecting and monitoring the number of people who die each year from opioids.

Opioids such as morphine and oxycodone are prescribed as painkillers, but a spike in the illegal use of the drugs, especially fentanyl, is raising alarms with public-health officials across the country.

Against this backdrop, the group of researchers looked for ways to solve what they say is an incomplete picture of the harm done by prescription opioids in Canada.

Tara Gomes, an epidemiologist at Toronto’s St. Michael’s Hospital and one of the researchers on the study, said such information is vital to track and respond to patterns in drug use, which often change quickly.

“As new drugs enter the market, it’s a constantly shifting target, so having up-to-date information on overdose death is a really important surveillance tactic that has been historically quite difficult,” she said in an interview.

In Alberta, the government is under pressure to take immediate steps to respond to a growing problem of fentanyl abuse. Over the first nine months of this year, fentanyl has resulted in 213 deaths in the province, up from 120 in 2014. The powerful opioid is available by prescription, and is also manufactured in clandestine labs and sold on the street.

Donald MacPherson, executive director of the Canadian Drug Policy Coalition at Simon Fraser University, said the number of deaths from fentanyl alone should galvanize policy makers. He called on the federal government to play a leadership role in setting up a national database.

“I would be interested to know if there are other causes of accidental deaths that double annually and are subject to the same level of continuing complacency,” Mr. MacPherson said in an interview.

Dr. John Younes, Manitoba’s acting chief medical examiner, said there should be a national database tracking all classes of drugs that result in fatal intoxications. However, he said, it would take a fair bit of effort to figure out how to create such a database because each province has its own system for conducting death investigations.

The solution proposed by the researchers is to extract numbers from existing Statistics Canada data. Statscan records the cause of death in its vital statistics death database, they note, based on information from a physician, coroner or medical examiner. While the numbers do not exactly match the results that researchers were able to gather through the detailed study of coroners’ records in Ontario, they believe they can provide a reliable indication of trends.

Up until now, Ms. Gomes said, researchers have relied on detailed examinations of coroners’ records – the “gold standard” for this data. She said national numbers are sometimes estimated based on what is happening in Ontario and British Columbia, which publish annual statistics on deaths associated with several classes of opioids.

Neither province, however, has up-to-date statistics available on deaths. In Ontario, the most recent numbers show that opioid-related deaths rose to 652 in 2013 from 344 in 2008.

Dr. Roger Skinner, regional supervising coroner in Ontario’s Office of the Chief Coroner, said it can sometimes take more than a year to complete an investigation, including toxicology testing.

He said he understands that researchers would like more timely information, but he thinks more of the focus should be on drug safety and measures aimed at curbing opioid addiction. To that end, he would like to see the creation of a system to monitor which doctors are prescribing the painkillers.

“By the time folks are dead, the damage is done,” he said in an interview.

Story by:

Karen Howlett and Elizabeth Church
Follow us them Twitter: Karen Howlett @kahowlett, Elizabeth Church @lizchurchto

Globe and Mail, November 30, 2015
Click here for the story.

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Safe-injection sites make financial sense for Ontario, study says

Health-care system could be spared high cost of new hepatitis C treatments.

A drug user injects at Insite in Vancouver. The facility, where addicts shoot up their own drugs under the watchful eyes of a nurse to prevent overdoses, is the only legal safe injection site in North America. Studies and advocates have pushed for similar sites in other major cities.

A drug user injects at Insite in Vancouver. The facility, where addicts shoot up their own drugs under the watchful eyes of a nurse to prevent overdoses, is the only legal safe injection site in North America. Studies and advocates have pushed for similar sites in other major cities.


Opening five safe-injection sites in Ontario makes financial sense, says a medical researcher who based his study on a Vancouver clinic where drug users shoot up under supervision.

Dr. Ahmed Bayoumi of St. Michael’s Hospital in Toronto said establishing facilities such as Insite in that city and in Ottawa would save money and reduce the incidence of diseases such as HIV and hepatitis C.

“Three facilities for Toronto and two for Ottawa represent a good investment compared to other things that we ordinarily invest in in health care,” he said in an interview Monday.

The study follows up on earlier research that said safe injection sites in Toronto and Ottawa would improve the health of intravenous drug users. The latest information takes into account new treatments for hepatitis C which, though effective, are also much more expensive.

A typical six-month course of hepatitis C treatment costs about $60,000, Bayoumi said.

“So preventing hepatitis C becomes particularly important because it helps avert those costs that would otherwise be incurred by the health-care system,” he said.

Insite is North America’s only supervised-injection site, where addicts shoot up their own drugs under the watchful eyes of a nurse to prevent overdoses.

The site provided a baseline for estimating the approximate cost of operating a safe-injection site as well its effectiveness at improving users’ health, Bayoumi said.

Victoria and other cities across Canada have considered establishing similar facilities.

Montreal announced its intention to open a safe-injection site after a 2011 Supreme Court of Canada decision ruled against the former Conservative government’s attempts to shut down Insite for violating federal drug laws.

Ahmed Bayoumi
Dr. Ahmed Bayoumi of St. Michael’s Hospital in Toronto says safe injection sites would save money and reduce the incidence of diseases such as HIV and hepatitis C. (CBC)

Multiple facilities

Unlike in Vancouver’s Downtown Eastside, Bayoumi said multiple facilities would be more appropriate in Ontario, where populations of drug users are more spread out.

He said the study’s economic estimates are conservative because they’re based on Insite being a freestanding clinic, compared to an approach that would incorporate safe-injection facilities into existing health centres.

While the study focused on needs in Toronto and Ottawa, Bayoumi said other Ontario cities could also benefit from such facilities.

“The next step is mostly a political decision rather than a research decision, as in, ‘Is there an interest and a will to actually establish some facilities?”‘

Ontario’s health minister said a national strategy to deal with intravenous drug users, rather than a piecemeal approach, would be most beneficial.

“I think that more than anything, this is an opportunity to bring together all jurisdictions and look at this in a uniform way,” Eric Hoskins said.

“We, up until recently, had a federal government that made it clear they didn’t support such sites. We now have a government that understands the science and is willing and prepared and wants to make decisions based on evidence.”

The minister said any request for a safe-injection site would have to come from municipal governments.

Researchers say multiple safe injection sites would be more appropriate in Ontario cities, where populations of drug users are more spread out, in contrast to the more concentrated population in Vancouver’s Downtown Eastside.

Reducing deaths, disease

Insite opened in 2003 as part of a harm-reduction plan to tackle an epidemic of HIV-AIDS and drug overdose deaths in the Downtown Eastside.

The facility provides clean needles to addicts to stop the spread of infectious diseases before they inject drugs at one of 12 booths.

Studies in major medical journals have hailed the success of Insite, suggesting it has helped reduce overdose deaths, infectious diseases and crime in the 10-block area that draws addicts.

The former federal government was criticized for wanting Insite to be shut down over concerns it promotes drug use, but lost a series of legal battles that kept the clinic open.

The Canadian Press (with files from CBC News), November 30, 2015

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Safe-injection sites are cost-effective to health system: study



A new Canadian study about safe-injection sites for intravenous drug users concludes that they are cost-effective to the health-care system — an argument that is likely to be advanced as Montreal takes steps to open four such facilities in the city.

Researchers at St. Michael’s Hospital in Toronto carried out an analysis that compared the projected costs of maintaining supervised injection sites over a period of 20 years with the potential savings to the health system in averted HIV and hepatitis C infections. The researchers’ estimates were conservative, as they did not include other infections associated with intravenous drug use and the costs involved in treating and hospitalizing patients suffering from overdoses.

Still, despite their conservative approach, the researchers found that one facility in Toronto would incur $33.1 million in direct operating expenses over 20 years, but save $42.7 million in health-care costs because of an anticipated reduction in HIV and hepatitis C infections. This represented a net savings of $9.6 million.

The researchers predicted that a single site Toronto would spare 164 people from contracting HIV (because they wouldn’t be using dirty needles) and prevent 459 hepatitis C infections.

“I would say that having supervised injection sites in Ottawa and Toronto are a good investment in health dollars because we get considerable health benefits at a reasonable cost,” Ahmed Bayoumi, the study’s senior author, said in an interview.

The study, published on Monday in the journal Addiction, focused exclusively on Toronto and Ottawa. But Bayoumi suggested that setting up safe-injection sites in Montreal might also be beneficial.

“I think it’s a reasonable hypothesis that it would be cost-effective to do this in Montreal, but I really hesitate to say anything definitive without further study,” he added.

In June, Mayor Denis Coderre vowed to establish three safe-injection sites and one mobile unit in the fall despite former prime minister Stephen Harper’s resistance to the plan.

“This is urgent in Montreal,” Coderre said after Montreal applied formally to Health Canada for an exemption that would permit the sites to open in the city.

However, the mayor has since been mum on the subject as he focused on the city’s sewage problems and then the municipal budget.

In 2011, the Supreme Court ruled that Ottawa’s refusal to renew the exemption for Canada’s sole safe-injection site — Insite in Vancouver — was unconstitutional because it deprived people of access to potentially life-saving medical care. Montreal plans to open its sites downtown, in the Plateau and Hochelaga districts and run a mobile unit in the city’s northern and southwest neighbourhoods.

The St. Michael’s study found that running as many as three sites in Toronto and two in Ottawa would be cost-effective.

Although former Conservative Health Minister Rona Ambrose has described the sites as “drug-injection houses,” Prime Minister Justin Trudeau has supported the principle behind the facilities. In June, Trudeau praised Coderre’s plans to open the sites in Montreal as helping to “make people’s lives better, to keep them safe, and I applaud him for moving forward on this.”

Story by Aaron Derfel.

Montreal Gazette, November 30, 2015.

Click here for the article:


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Study bolsters case for safe injection sites

A new study says that the opening of three supervised injection sites in Toronto would be good value for money.


Dr. Ahmed Bayoumi, Scientist, St. Michael’s Hospital and Associate Professor, University of Toronto


A new study bolsters the case for opening five safe injection sites in Ontario, including three in Toronto, by showing they would be more cost effective than previous research has projected.

Because of a recent surge in the cost of treating hepatitis C, there is now a better economic case to be made for preventing the spread of the potentially deadly virus through the sharing of needles in the first place, according to a paper published Monday in the journal Addiction.

Advocates of safe injection sites hope the findings put the issue back on the front burner and nudge the federal Liberals into making good on a commitment to expanding supervised injection services across the country.

The study points out that new drugs on the market are highly effective in treating hep C, but come at a steep price.

“Because hepatitis C treatment is so expensive now, preventing a very costly infection becomes much more attractive,” said lead author Dr. Ahmed Bayoumi, a physician at St. Michael’s Hospital and a researcher in its Centre for Research on Inner City Health.

The study builds on findings of a 2012 report which showed that opening three supervised injection facilities in Toronto and two in Ottawa — Ontario’s two largest cities — would be good value for the money. They would reduce public drug use and prevent new hep C and HIV infections.

Since that report’s release, new hep C drugs, with astounding cure rates in excess of 94 per cent, have become available. Two were approved earlier this year under the Ontario Drug Benefit exceptional access program — Holkira Pak and Harvoni.

Prior to that, they were out of reach for most patients because they came with a price tag of up to $60,000.

The new study shows that a Toronto safe injection site has an incremental cost-effectiveness ratio of $10,763 per quality adjusted life year, compared to $31,781 in the 2012 report. This is a technical measurement that assesses the dollar value of a medical intervention, taking into account life expectancy and quality of life.

“Another way to say that in plain English is that if you look at the return on investment, it’s more favourable now than it was in our initial report,” said Bayoumi, who also contributed to the 2012 report.

The new analysis shows there is an 86 per cent chance that one or more supervised injection facilities would be cost-effective in Toronto. It takes into account the number of people who use drugs, how frequently they would use an injection site, the cost of the facility, and the cost and availability of hep C treatment.

Bayoumi said the conclusion is conservative and that the cost would be much lower if the services were incorporated into existing health facilities.
The annual cost of operating a free-standing facility is pegged at $1.5 million for rent, insurance, cleaning and maintenance, and $130 per patient for equipment and personnel.
A 2013 report from Toronto Public Health suggested the city should create supervised injection sites for drug users, integrating them into existing health services.

It is estimated that 10,000 people in Toronto use injection drugs, including heroin, cocaine and crystal methamphetamine.
Richard Elliott, executive director of the Canadian HIV/AIDS Legal Network, said the future of safe injection sites in Canada looks good given mounting evidence supporting their value and the election of a new government supporting their existence.
“We have more evidence that there is a benefit … and a new government that has expressed its support for supervised consumption services,” he said.

Asked whether her office would support opening safe injection sites in Ontario, Health Minister Jane Philpott issued the following statement:
“Our government believes in evidence-based decision making. When properly established and managed, supervised consumption sites have the potential to reduce the harms associated with drug abuse on individual users and communities.
“Decisions regarding applications for safe injection sites are evaluated carefully by Health Canada to ensure health and safety requirements are met,” the statement read.

The Canadian HIV/AIDS Legal Network sent a briefing paper to all MPs on Monday, the eve of World AIDS Day, calling on the federal government to move forward on a number of HIV-related issues, including the scrapping of Bill C-2, which forces proposed injection sites to meet a lengthy list of requirements before opening.
The bill, passed by the House of Commons earlier this year, has widely been viewed as an attempt by the previous Conservative government to impede the operation of Vancouver’s Insite safe injection site and to thwart the opening of new sites.

It requires applicants to consult with police, community members and public health officials and to gather crime statistics before getting an exemption from federal drug laws.
The Conservative government introduced the legislation after the Supreme Court blocked its attempt to close the Insite centre, ruling that health services could not be denied to addicts.
“It would seem like a fairly straight forward, no-brainer kind of move that the government should repeal Bill C-2 and actually get on with issuing the appropriate exemptions to the applications it has received,” Elliott said.

He was referring to applications for a federal health act exemption from a community group in Montreal and from Vancouver’s Dr. Peter Centre.

Story by:  Theresa Boyle

Toronto Star, November 30, 2015.

Click here for the story.

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Expect to hear more about a drug injection site in Ottawa soon

Remember the snarky debate about a safe drug-injection site in Ottawa? writes Citizen columnist Kelly Egan.

Well, because it’s 2015, because of sunny ways, because a new, shaggy-haired sheriff’s in town, expect to hear more sound and fury on the issue, and real soon.

It was the one topic that spontaneously drew applause at the 12th annual community forum sponsored by the Alliance to End Homelessness Ottawa yesterday at the RA Centre. While the Conservative government of Stephen Harper hated the idea and wanted to shut Canada’s only such site in Vancouver, the Liberals are more welcoming.
“With the new Liberal government, there is definitely an appetite to look at it,” said Rob Boyd, director of Oasis, a drug treatment program run from the Sandy Hill Community Health Centre.

Boyd has spent some 25 years treating the drug addicted and is one of city’s most respected voices in the field.

There is a plan to establish the site at Oasis, tied in with other services (methadone clinic, needle exchange, HIV care), but the application wasn’t brought forward because of the hostile regulatory climate.

The Conservatives went so far as to pass Bill C-2 in March, which set up a rigorous set of conditions, effectively blocking the creation of any more safe injection sites in Canada.

Boyd said advocates are hoping the bill will be amended or repealed.
The optimism is not misplaced.

During the election campaign, Liberal leader Justin Trudeau supported the opening of just such a site in Montreal.

Boyd said he expects the proposal will get a community airing in 2016. Though both the mayor and police chief oppose the idea in principle, he hopes a proper explanation will help to persuade them of the health benefits and cost savings.

“I would like to have the opportunity to present the model we’re looking at. I’m not sure it’s well understood because we haven’t articulated it very well yet”— Rob Boyd

There is ample evidence that Vancouver’s safe injection site has prevented overdoses, curtailed the spread of infectious diseases, and steered addicts into treatment. And the Supreme Court of Canada supported its existence. But it has always been contentious because some see it as the government enabling drug addiction and turning a blind eye to criminal activity.
The forum was fascinating for its snapshot on the health of the homeless and the city’s drug scene, the two often intermingled.

Every year in Ottawa, about 50 users die of a drug overdose, and paramedics respond to roughly three calls of suspected overdose every day. It is a fluid situation.

Counsellors have noticed lately, for instance, that opioid users are turning to a powdered form of fentanyl, sometimes with disastrous effects.

Boyd said the fentanyl is mixed with other drugs, like heroin, in such a way that the user doesn’t know the potency of the product. (In August, Vancouver had 16 overdoses in one day from a set of street pills thought to be spiked with fentanyl, which can be 50 times more potent than morphine.)

He estimated there are between 1,500 and 2,000 intravenous drugs users in Ottawa and presented the crowd of about 150 people with a chart that showed overdose deaths in Ontario have soared from 91 in 2000 to 513 in 2013.

There was already a signal that the road to a safe injection site in Ottawa will not be a smooth one.

The city’s medical officer of health, Dr. Isra Levy, attended the forum. His department has taken a neutral position on the issue, “monitoring” the public discussion about safe sites.

“The safe consumption site concept, for me, is a distraction from the larger discussion,” he told the Citizen during a break.

The morning featured a presentation from Dr. Travis Baggett, a physician and researcher who works with the homeless in Boston. One piece of research involved looking at mortality and disease rates among 28,000 patients between 2003 to 2008.

It found that tobacco and alcohol were responsible for a great deal of mortality, much higher, depending on the age group, than drug addiction. In fact, if street people live into their 50s, smoking and booze will likely kill them before drug use does.

And, traditionally, smoking has been viewed as “the least” of their problems — cigarettes even being handed out to street people in the old days as “carrots” to treatment. Yet, as their drug addictions are brought under control, it is the cancers from tobacco and alcohol that may well kill street-involved people.

Many drug programs today, however, include smoking cessation.

Story by Kelly Egan.

Ottawa Citizen, November 25, 2015.

Click here for the  article.

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Harm Reduction Journal Publication

Risk environments facing potential users of a supervised injection site in Ottawa, Canada


Ashley Shaw,  Lisa Lazarus, Tyler Pantalone, Sean LeBlanc, Dolly Lin, Daina Stanley, Caleb Chepesiuk, Sheetal Patel, Mark Tyndall and The PROUD Community Advisory Committee (2015).

APA citation:  Shaw, A., Lazarus, L., Pantalone, T., LeBlanc, S., Lin, D., Stanley, D., Chepesiuk, C., Sheetal, P. & Tyndall, M. (2015). Risk environments facing potential users of a supervised injection site in Ottawa, Canada. Harm reduction journal, 12(1), 49. DOI 10.1186/s12954-015-0083-9

full PDF of the article here.


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