Transforming
the care of
Viral Hepatitis

The Toronto
Viral Hepatitis
Care Network

HEP C-

What is Hepatitis C
and why is screening important for you?

Check
&
Cure

B-AWARE

What is Hepatitis B
and why is screening important for you?

HEPATITIS FACTS

7000

Estimated number of Years of life lost (YLL) due to premature mortality.

8800

5000

2500

Hepatitis C

Hepatitis B

HIV/AIDS

Influenza

Viral hepatitis is an emerging global epidemic. In Canada, Hepatitis B (HBV) and Hepatitis C (HCV) cause a greater burden of illness than any other infectious disease in the country.

PEOPLE DIE EVERY YEAR DUE TO COMPLICATIONS OF HEPATITIS C

700,000

MORE THAN

PEOPLE WORLDWIDE ARE CHRONICALLY INFECTED WITH HEPATITIS B

240 MILLION

MORE THAN

7000

Estimated number of Years of life lost (YLL) due to premature mortality.

8800

5000

2500

Hepatitis C

Hepatitis B

HIV/AIDS

Influenza

Viral hepatitis is an emerging global epidemic. In Canada, Hepatitis B (HBV) and Hepatitis C (HCV) are, by years lost, the most harmful infectious diseases.

PEOPLE IN ONTARIO INCLUDING THE GREATER TORONTO AREA LIVE WITH CHRONIC HEPATITIS C

150,000

OVER

PEOPLE DIE EVERY YEAR DUE TO COMPLICATIONS OF HEPATITIS B

780,000

MORE THAN

7000

Estimated number of Years of life lost (YLL) due to premature mortality.

8800

5000

2500

Hepatitis C

Hepatitis B

HIV/AIDS

Influenza

Viral hepatitis is an emerging global epidemic. In Canada, Hepatitis B (HBV) and Hepatitis C (HCV) are, by years lost, the most harmful infectious diseases.

PEOPLE WORLDWIDE ARE CHRONICALLY INFECTED WITH HEPATITIS C

150 MILLION

MORE THAN

PEOPLE IN ONTARIO INCLUDING THE GREATER TORONTO AREA LIVE WITH CHRONIC HEPATITIS B

150,000

OVER

OUR CLINICS

ABOUT VIRAL HEPATITIS

MEET OUR TEAM

COMPREHENSIVE IN CARE

1 to 1 service, health education and promotion in communities across the GTA

ACCESSIBLE AND COMMUNITY FOCUSED

Eliminates barriers to full participation. The needs of individuals are of primary importance

INTEGRATING SERVICES

VIRCAN Clinics will have strong connections with health system and community partners

MULTIDISCIPLINARY APPROACH

VIRCAN team will work in collaborative practice to address the health needs of their clients

FIND A VIRCAN LIVER CLINIC

Four Locations in the GTA

Viral Hepatitis Care Network (VIRCAN) is an initiative of the Toronto Centre for Liver Disease part of the University Health Network that provides liver related healthcare services you need, at the convenience you want and the standards you deserve, right to your doorstep. VIRCAN Clinics are conveniently located in 4 locations around the GTA.

Toronto Midtown Liver Clinic
1975 Avenue Rd., 2nd Fl.
Toronto, ON M5M 4A3
T. 416 922 6022
F. 416 927 9100
[email protected]
Map+

Etobicoke Liver Clinic
817 Brown’s Line
Toronto, ON M8W 3V7
T. 416 503 2626
F. 416 503 2665
[email protected]
Map+

Richmond Hill Liver Clinic
328 Highway 7 E., Suite 301
Richmond Hill, ON L4B 3P7
T. 905 771 8821
F. 905 771 8481
[email protected]
Map+

Scarborough Liver Clinic
3030 Lawrence Ave E., Suite 510
Toronto, ON M1P 2T7
T. 416 431 4402
F. 416 431 0762
[email protected]
Map+

Statement on Importance of Maintaining Supervised Consumption Services in Ontario

The Ontario government's recent announcement to close several supervised consumption services (SCS) is deeply concerning and contrary to evidence-based public health strategies. Supervised consumption services have been proven to save lives, reduce the spread of infectious diseases like hepatitis C, and enhance public safety. Their closure will have significant negative impacts on public health.

Evidence of Effectiveness

Reduction in Overdose Deaths: Research demonstrates that supervised consumption services significantly reduce overdose deaths. A study published in The Lancet found that SCSs can reduce overdose mortality by up to 35% in areas where they operate. In Vancouver, where supervised consumption sites have been in place for years, the overdose death rate decreased significantly following their implementation. Local evidence states overdose deaths in the Leslie neighborhood were reduced by 65% with the opening of a supervised consumption service.

Health and Social Benefits: SCSs provide essential health services beyond overdose prevention. They offer access to healthcare, mental health services, and addiction treatment. The British Medical Journal highlighted that SCSs lead to increased uptake of addiction treatment and improved health outcomes among individuals who use drugs. They also contribute to a decrease in public drug use and drug-related litter, thus improving community safety.

Integration with Other Services: Current SCSs offer a network of integrated services, including addiction treatment, mental health support, and harm reduction supplies. The Ontario Roadmap to Hepatitis C Elimination emphasizes the importance of these integrated services in managing hepatitis C and other health issues. HART hubs, as outlined thus far, do not provide an equivalent level of evidenced based, preventative or comprehensive care, which will lead to increased health disparities and unmet needs.

Hepatitis C Transmission and Treatment: SCSs play a crucial role in reducing the transmission of hepatitis C, a serious and potentially fatal liver infection commonly spread through sharing injection drug equipment. According to the Ontario Roadmap to Hepatitis C Elimination, harm reduction services, including SCSs, are essential to achieving the goal of eliminating hepatitis C in the province. The Roadmap emphasizes that supervised consumption services are a critical component in reducing new hepatitis C infections and improving access to treatment. Additionally, access to adequate supplies of equipment is essential in prevention efforts.

Research supports this approach. A study in The International Journal of Drug Policy found that SCSs are associated with a reduction in hepatitis C prevalence among people who inject drugs. Additionally, SCSs facilitate access to hepatitis C testing and treatment. The Journal of Viral Hepatitis reported that individuals who use supervised consumption services are more likely to receive regular hepatitis C screenings and adhere to treatment, leading to better health outcomes and reduced viral load in the population. Preventing hepatitis C, and treating it promptly before progression to liver failure, is a cost saving intervention.

Economic Benefits: The economic arguments for maintaining SCSs are compelling. The cost savings from reduced emergency room visits and hospitalizations due to overdose and other drug-related health issues outweigh the costs of operating these services. A study in Addiction estimated that for every dollar spent on SCSs, there is a return of up to $5 in healthcare savings and reduced crime-related costs.

Community Impact

Public Health Crisis: The opioid crisis continues to be a public health emergency in Ontario, with rising rates of overdose deaths and hepatitis C infections. Closing SCSs and replacing them with HART hubs during this crisis will exacerbate the situation, leading to increased overdose rates and higher transmission of hepatitis C. This will put strain on emergency services and lead to greater health disparities and poorer health outcomes.

Support for Vulnerable Populations: SCSs play a crucial role in supporting vulnerable populations, including individuals experiencing homelessness and those with severe addiction issues. The closure of these services risks removing a critical safety net for those most in need, potentially pushing them further into precarious situations and increasing their vulnerability to both infectious diseases and overdoses. Ontario's own Roadmap to Hepatitis C Elimination emphasizes the importance of supervised consumption services in enhancing testing and treatment for HCV in people who use drugs, and calls for their continued funding and expansion.

Instead of closing SCSs and relying solely on HART hubs, the Ontario government should consider expanding both types of services to ensure comprehensive, continuous support for individuals who use drugs. Investments in these areas would align with the objectives outlined in the Ontario Roadmap to Hepatitis C Elimination and demonstrate a commitment to evidence-based practices that prioritize the well-being of all Ontarians. While increased investment in mental health and housing supports are desperately needed, the proposed HART hubs, combined with the closure of supervised consumption services, do not support the needs of the communities they purport to serve. In fact, many of the services embedded in the proposed HART model are already available at supervised consumption services, specifically those housed in Community Health Centres. Of particular concern is the statement that HART Hubs will not offer needle exchange programs or harm reduction supplies, key pillars of not only HCV prevention, but also numerous other costly infections including HIV, endocarditis, skin, soft-tissue and pulmonary infections.

The evidence supporting the effectiveness of supervised consumption services, and needle syringe programs, is robust and clear. The Ontario government's decision to close these facilities and replace them with HART hubs contradicts the best available research, and has significant consequences for public health and safety, including increased hepatitis C transmission and reduced access to treatment. It is imperative that the government re-evaluate this decision and prioritize policies that are proven to save lives and enhance community well-being.

VIRCAN Team