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Ministry of Health

and Long-Term Care

Ministre de la Sant
et des Soins de longue dure

Office of the Minister

Bureau du ministre


10 Floor, Hepburn Block

80 Grosvenor Street
Toronto ON M7A 2C4
Tel. 416 327-4300
Fax 416 326-1571

difice Hepburn, 10e tage

80, rue Grosvenor
Toronto ON M7A 2C4
Tl. 416 327-4300
Tlc. 416 326-1571


The Honourable Dr. Jane Philpott, P.C., M.P.

Minister of Health
Health Canada
70 Colombine Driveway
Tunney's Pasture
Postal Location: 0906C
Ottawa ON K1A 0K9
Dear Minister Philpott:
As Ontarios Minister of Health and Long-Term Care, I am providing this letter to accompany
the City of Torontos application for an exemption under section 56 of the Controlled Drugs
and Substances Act to provide supervised injection services (SIS) at three existing health
care facilities within Toronto Public Health: The Works, Queen West-Central Toronto
Community Health Centre, and South Riverdale Community Health Centre.
Ontario has some of the highest rates of opioid prescribing in the world. One in every 170
deaths in Ontario is related to opioid use, and amongst adults ages 25 34, this rises to 1 in
8 deaths. Between 2006 and 2013, there were almost 20,000 visits to hospital emergency
rooms related to opioid toxicity, and over 10,000 admissions to hospital (an increase of
almost 25% during that period). In Toronto, between 2004 and 2014, there was a 77%
increase in the reported number of overdose deaths (from 146 in 2004 to 258 in 2014), the
highest annual number to date.
These numbers show the need for urgent action and commitment. As Minister and as a
physician, I support evidence-based policy making and any initiative around making our
communities safer. I believe that community supported and community run SISs will not
only save lives but will also be part of a larger strategy for harm reduction and supports for
people who use drugs.


Ontario has a long-standing and strong commitment to harm reduction programs, which
have proven successful at saving lives and reducing costs to the health care system. One
example is the Needle Exchange Program through which Ontarios local Boards of Health
are required to provide access to harm reduction supplies. We have also taken a number of
steps towards addressing the opioid situation in the province:
Legislation has been enacted to promote appropriate prescribing and dispensing of
opioids [see Narcotics Safety and Awareness Act, 2010, and Safeguarding our
Communities Act (Patch for Patch Return Policy), 2015].
Our Narcotics Monitoring System (NMS), in place since 2012, allows the province to
monitor the prescribing and dispensing of prescription opioids.
High-dose opioids will soon be delisted from Ontarios Drug Benefit Formulary to
promote tapering where necessary for individuals receiving high daily doses of these
The Ministry has increased access to publicly funded naloxone.
We recently announced Ontarios first comprehensive Opioid strategy which includes
harm reduction as an essential component.
However, more can be done to tackle the opioid issue in the community level. The City of
Torontos proposal to add supervised injection services to three health care facilities will
complement the citys continuum of harm reduction programs. The results of local feasibility
studies and needs assessments indicate that in 2015, the three facilities identified in the
Toronto proposal distributed 75% of the needles provided through the Toronto needle
exchange programs. The SIS facilities will be integrated directly into facilities staffed by
health care providers and social service workers, and therefore offer access to primary care,
counselling, treatment services on site, as well as provide clients with referrals to other
treatment services in the province.
It is my opinion that the proposal appears logical and supported by evidence. Furthermore,
it aligns with Ontarios Patients First: Action Plan for Health Care and our strategic plans to
address the growing concerns with opioid misuse and overdose.
More than anything, I believe these initiatives around supervised injection services are an
opportunity to bring together all jurisdictions to tackle addictions and narcotics misuse. I look
forward to the opportunity to work further with you and my counterparts in other provinces
and territories on this pressing issue.
Yours sincerely,

Dr. Eric Hoskins