In December 2016, the Windsor-Essex Community Opioid Strategy (WECOSS) Leadership Committee brought together community leaders and key stakeholders across sectors to collectively address rising rates of opioid use in Windsor and Essex County. In line with the recommendations of the WECOSS Action Plan, partners have more recently discussed supervised injection sites (SIS) and their potential to reduce overdose-related morbidity and mortality, public injection, discarding of needles in public spaces, and the transmission of blood-borne infections. In addition, SIS offer access to treatment and withdrawal management services. In Ontario, SIS services are eligible for provincial funding through an application by community organizations to the Ministry of Health to operate a Consumption and Treatment Services (CTS) site. Under the CTS model, funded sites provide wrap-around services that connect clients who use drugs to primary care, treatment, and other health and social services; these sites must include the following;
- supervised consumption and overdose prevention services,
- onsite or defined pathways to addictions treatment services,
- onsite or defined pathways to wrap-around services, and
- harm reduction services.
On April 1, 2019 the Windsor-Essex County Board of Health passed a resolution in support of ongoing public health-led assessment to determine the need for and feasibility of CTS in the City of Windsor. Further to this, the Board of Health endorsed the recommendation that the Windsor-Essex County Health Unit (WECHU) take a lead role in facilitating the completion of an application pending the results of the assessment. Data collection for the WECHU-led community consultations consisted of four phases and was completed on April 26th, 2019. In total 2648 responses to the different components of the data collection yielded a large sample from which to draw a number of conclusions around community readiness which would inform the completion of the CTS application.
In order to receive provincial funding for CTS, applicants must demonstrate their ability to meet federal requirements as well as additional requirements under Ontario’s CTS program. In particular applicants must first demonstrate that they are seeking an exemption to federal regulations (i.e., Controlled Drugs and Substances Act) and demonstrate that they have been diligent in considering the following areas which constitute mandatory sections of the application:
- Local conditions: Includes opioid-related mortality/morbidity, needle distribution data, naloxone distribution data.
- Capacity to provide treatment and consumption services: Preference given to those organizations that currently offer or have the capacity to offer in partnership, onsite access to services.
- Proximity: Location relative to similar services and to vulnerable areas (e.g., schools, child care centres, parks, post-secondary institutions).
- Community support and ongoing community engagement: Consultation conducted with residents, healthcare organizations, local businesses, community groups, and other stakeholders.
- Accessibility: Sites must be compliant with the Accessibility for Ontarians with Disabilities Act, as well as culturally, demographically, and gender appropriate, and strategically located.
Substance use continues to impact communities across Windsor and Essex County (WEC) and in particular the City of Windsor. Of the 36 opioid-related deaths in WEC in 2017, 31 took place in the City of Windsor and approximately half took place in the home. Among these deaths, less than half showed any signs that effort had been made to resuscitate. The rate of Hepatitis C cases, a blood-borne infection for which injectable drug use is a significant risk factor, has increased from 37 cases per 100,000 people in 2014 to 47 cases per 100,000 people in 2018 with the majority of cases coming from the City of Windsor. Among these cases, 63% of those responding to risk factors related to their diagnosis reported injectable drug use.
Data collected through WECHU’s four-phase SIS Community Consultations which involved a community consultation survey, focus groups, key informant interviews, and interviews with people who inject drugs were analyzed and compiled in the Supervised Injection Services Community Consultations Report. The report shows community support for a Supervised Injection Site (SIS) with 61% of online survey respondents indicating that they felt an SIS would be helpful in WEC relative to 33% who did not. Those in support referenced the potential for an SIS to save lives, decrease harm for those who inject drugs, increase community safety, and decrease stigma. Those in opposition to SIS reference the potential to decrease property values in the area, increase crime in the area, normalize drug use and condone illicit drug use. Among focus group participants there was an acknowledgement that WEC is facing a drug crisis and an openness among most participants to the idea of an SIS. Key informant interview responses mirrored these results adding that there was a lack of consensus among key stakeholder groups about the benefits of an SIS and highlighting the importance of key community leaders to work together should an SIS be created. In speaking with people who inject drugs (PWID), 80% of respondents indicated that they were aware of these types of sites and responded either maybe or yes to using a site if one existed in Windsor. Among the 99 respondents, 67% indicated that they were currently injecting drugs in public or semi-public spaces. Survey participants also shared preferred characteristics of an SIS, including access to sterile needles and harm reduction equipment, supervised injection, drug testing, access to health services and counselling, and referrals to treatment.
Given the available local data and the findings outlined in the Supervised Injection Services Community Consultations Report, access to a consumption and treatment site in the City of Windsor would reduce unintentional deaths associated with drug use and decrease the risk for blood-borne infections among those who inject drugs. In addition, such a site has the potential to reduce the amount of improperly discarded needles in public settings. Through an in-depth assessment of the CTS Application as well as Health Canada’s Exemption for Medical Purposes under the Controlled Drugs and Substances Act for Activities at a Supervised Consumption Site Application, WECHU is working on the initial requirements for a CTS in Windsor. Sections of both the provincial and federal applications related to site location however, were outside of the scope of the initial assessment and must be explored further prior to any submission.
Whereas the Government of Ontario announced its funding commitment and endorsement of Consumption and Treatment Services in October 2018, and
Whereas Windsor and Essex County is experiencing significant public health concerns related to the use of opioids and other substance use, including illnesses, deaths, blood borne infections, and public discarding of used needles, and
Whereas Consumption and Treatment Services have the potential to address such public health issues, in addition to reducing health care costs, and
Whereas the Windsor-Essex County Health Unit’s (WECHU) lead role in the Windsor-Essex Community Opioid Strategy and understanding of harm-reduction services in the community, creates an opportunity for the WECHU to lead the successful completion of a comprehensive and collaborative application for Consumption and Treatment Services in our community, and
Whereas the results of the WECHU-led Supervised Injection Services Community Consultations Report demonstrate support and openness among the general public, key stakeholders, and people who inject drugs for an SIS in WEC, and
Whereas the final submission of a CTS application as well as the application for an exemption to the federal Controlled Drugs and Substances Act requires community consultation and the selection of a proposed location in which to operate.
Now therefore be it resolved that the Windsor-Essex County Board of Health supports the submission of a Consumption and Treatment Services Application for the City of Windsor to the Ministry of Health, including the submission of an Exemption for Medical Purposes under the Controlled Drugs and Substances Act for Activities at a Supervised Consumption Site Application required by Health Canada, and
FURTHER THAT an additional comprehensive community consultation be conducted by the Windsor-Essex County Health Unit to determine a suitable and accessible location for a CTS in the City of Windsor.