NEXT HOT ISSUE:SAFE INJECTION SITES

In January, Toronto Public Health will embark on one of the most
significant challenges in its history: Taking its first tentative
steps towards establishing a comprehensive policy to deal with the use
of illicit drugs and addiction in the city.

For decades, it's a subject that's been far from the centre of public
policy agenda. It's a police matter, municipalities all over the
continent have said, content to rely on law enforcement to handle it.

The problem is, it hasn't.

And the question now is: How far will Toronto be willing to go to
reduce the harm caused by intractable drug abuse?

The notion of harm reduction is hardly new to the city. Toronto Public
Health has overseen services such as needle exchanges, methadone and
counselling for nearly 20 years.

The Centre for Addiction and Mental Health will soon take part in a
controversial study where a small group of heroin addicts will be
given the drug free. They will inject it under medical supervision, in
an effort to eventually wean them off it. The study is also being
staged in Vancouver and Montreal.

The next, more radical step, one Vancouver has already embarked on,
might be safe injection sites. Mayor Larry Campbell opened North
America's first safe injection site for drug addicts last month.

A former skid-row cop and chief coroner, Campbell isn't used to being
branded a radical. But he was in Toronto a couple of weeks ago,
delivering a message some might find extreme.

"Initially, I wasn't a fan of safe injection sites, either, until I
studied it," said Campbell, who visited model sites in Switzerland and
Germany before committing to the Vancouver facility. "But now, what I
see is addicts not sharing dirty needles or dirty pipes. They're
coming into contact with health-care professionals, which never
happens (otherwise). They're getting counselling. It just makes sense
in every way."

Campbell's view is an articulation of a harm-reduction policy that
accepts addiction as a compulsive medical condition and aims to reduce
health risks by distributing clean needles and medical attention.

The idea of safe-injection sites is among many proposals expected to
be brought forward by disparate voices ? policy makers, health-care
workers, neighbourhood residents and addicts themselves ? beginning in
January, when Toronto Public Health begins work on the policy.

Unlike Vancouver, Toronto's approach to its drug problem has been
scattershot.

Public health contracts out services to 25 agencies that supply safe
injection kits to users. Although the climate has changed enough to
allow the free-heroin study, the city isn't ready to commit to the
aggressive measure of a safe injection site, said Liz Janzen, public
health's regional director.

"Historically, the city has supported harm reduction, and our needle
exchange program is an example of that," Janzen said. "But the extent
and the numbers of strategies, that's still something that needs to be
worked through."

Janzen is among those pushing for the policy. "You have to have some
kind of framework. Otherwise, you have these polarized debates in
various locations without really talking about the whole picture."

Progress will depend on the new administration's support.

The approach advocated by Campbell has the explicit support of only
one mayoral candidate, David Miller. "If you care about people as
people, it's the right choice," Miller said.

The safe-injection site idea is gaining momentum. The federal
government is watching the Vancouver experiment closely.

But on a neighbourhood level, the fear ? of more drug trafficking and
crime ? is palpable.

"We have an illegal product and a harmful product, and what are we
going to do about it? Open up shooting alleys?" said Eva
Curlanis-Bart, of the Garden District residents association, in the
Dundas-Sherbourne area. "It's still a crime, and the cost borne by the
community is enormous."

For Street Health director Lorie Steer, the equation is simple: "These
people are going to use drugs no matter what. ... It's just the
ethical thing to do to keep them alive and help them stay as healthy
as possible."

Steer's agency is one of nine in the city to go beyond the
government-funded strategy of safe injection kits. It's now
distributing "safe crack use kits" ? a glass pipe, safe filters, a
removable mouthpiece ? to address the city's biggest drug problem.

"People who do the needles exchanges, that's what they see ? crack,
crack, crack," she said. But the city has no treatment plan for those
users, nor is there funding for kits given out by the Safe Crack Use
Coalition.

Some like Curlanis-Bart see the coalition's work as simply
facilitating drug abuse: "We have an illegal situation with drugs, and
we say `poor you,' and we pay for some of their habits." They fear
that safe injection sites will leave the area worse.

"The activities that are part and parcel of drug consumption would not
change," Curlanis-Bart said. "They may use there, but then they're out
on the street, looking for more... I'm talking about urinating,
defecating, screaming. The only way you can get rid of it is by
stopping it, period."

But there are no easy answers.

That Ottawa is now supporting new strategies ? giving Vancouver $1.1
million to open its safe injection site ? is an acknowledgement that
the status quo wasn't working, Campbell said.

According to a 2001 solicitor-general's report, 95 per cent of the
$500 million in federal money spent to fight drugs went to policing.

That year, a United Nations report showed that police captured only 5
per cent of the world's illegal drug flow.

"I went to Zurich, and I know it works. Needle Park is gone," Campbell
said of the fears surrounding safe-injection sites.

"What's your preference ? have people shooting up in your backyard,
dropping needles all over the place, creating a public disturbance?
You want them off your streets."