The Integrated Drugs and Addictions Strategy Community Network recommend that Health, Recreation and Social Services Committee recommend that Council:
1. Endorse Treatment and Prevention/Public Education as the two priority issues requiring immediate attention including:
a. Development of an action plan to increase the capacity of treatment in Ottawa along a continuum of service that addresses identified gaps including outpatient and residential treatment for youth, increased services for diverse groups including withdrawal management, timely access to treatment, management of concurrent disorders and transitional housing.
b. Development of a comprehensive Prevention/Public Education plan that addresses identified gaps by supporting families, improving access to information for local addictions services; alignment of strategies with provincial and federal initiatives; and supports for family functioning.
c. Development of a Stakeholder Engagement Strategy to ensure ongoing input into the development of 1a) and 1b)
2. Endorse the development of issue planning tables to further refine the scope and seek solutions related to:
a. The co-ordination between City services, other service providers and key community stakeholders enabling neighbourhoods to deal with drug-related problems.
b. Balancing the need to address the HIV and Hepatitis C rate among the drug using population in Ottawa while addressing the concerns of the community and the safety of front line workers
3. Direct the Community Network to report back to Health Recreation and Social Services Committee in 6 months with project plans that detail deliverables, time lines and resource requirements to implement short, medium and long term solutions related to Treatment and Public Education.
4. Refer the priority action of crimes as they relate to the use and supply of drugs to Crime Prevention Ottawa to include as part of their work plan
5. Refer the priority action of Affordable housing as it relates to drug and addictions issue to the Corporate Housing Agenda work team.
RECOMMANDATIONS DU RAPPORT
Que le Réseau communautaire pour la Stratégie intégrée de lutte contre les drogues et la toxicomanie invite le Comité de la santé, des loisirs et des services sociaux à recommander au Conseil :
1. De considérer le traitement et la prévention, d’une part, et l’éducation du public, d’autre part, comme les deux priorités exigeant la prise de mesures immédiates qui se traduiront notamment par :
a. L’élaboration d’un plan d’action visant à accroître la capacité des services de traitement offerts à Ottawa de manière à combler les lacunes cernées, et ce, en multipliant les services externes et les centres de désintoxication pour les jeunes ainsi que les services destinés aux divers groupes culturels, comme la gestion du sevrage, l’accès au traitement en temps opportun, la gestion des troubles concomitants et l’accès aux logements de transition;
b. la création d’un plan exhaustif de prévention et d’éducation du public qui comblera les lacunes cernées et prévoira des mesures d’aide aux familles, un accès amélioré aux renseignements pour les services locaux de soutien aux problèmes de toxicomanie, la conformité des stratégies municipales avec les initiatives provinciales et fédérales et la prestation de services de soutien à la famille;
c. l’élaboration d’une stratégie de participation visant à recueillir les commentaires des intervenants tout au long des processus décrits en 1a) et en 1b);
2. De créer des groupes de planification pour mieux adapter la portée de la stratégie et trouver des solutions en ce qui concerne :
a. La coordination entre les services municipaux, divers fournisseurs de services et les principaux intervenants communautaires afin d’aider les quartiers à composer avec les problèmes de toxicomanie;
b. L’établissement d’un équilibre entre la nécessité de réduire le taux de VIH et de l’infection au virus de l’hépatite C chez les consommateurs de drogue d’Ottawa et le besoin de répondre aux préoccupations de la population à cet égard et aux questions liées à la sécurité des travailleurs de première ligne;
3. De charger le Réseau communautaire de faire rapport au Comité de la santé, des loisirs et des services sociaux dans six mois en lui soumettant des plans de projets décrivant les réalisations attendues, le calendrier établi et les ressources requises pour mettre en œuvre des solutions à court, à moyen et à long terme en matière d’éducation du public et de traitement;
4. D’acheminer à Prévention du crime Ottawa les mesures prioritaires à prendre en cas de crime lié à la consommation et à l’achat de drogues afin que ces mesures soient intégrées au plan de travail de l’organisme;
5. De transmettre à l’équipe de travail responsable du programme de logement de la Ville la question prioritaire du logement abordable pour les personnes ayant des problèmes d’alcoolisme et de toxicomanie.
One of the true successes of the first phase of the Integrated Drugs and Addictions Strategy is the establishment and commitment of the Community Network. Never in the history of Ottawa has there been such commitment and dedication by so many to develop and support the ongoing solutions to a local drug and addictions problem. The Community Network has developed an implementation plan to ensure a coordinated approach to dealing with substance abuse problems in the City of Ottawa. Imbedded in the plan is the integration of the 4 pillars through the implementation of cross-sectoral task forces with membership from the 4 pillars. As well, imbedded in the plan is the development and implementation of a strategy to solicit and receive ongoing input from the public and affected stakeholders on resultant key recommendations.
Over the past number of years, funding support to address substance abuse issues have been shrinking with a number of programs being discontinued and many others having been reduced due to lack of resources. Over the same time period, there has been an increase in the demand for services resulting in serious gaps in service provision. Ottawa is now at a critical juncture.
There are over 30,000 people in Ottawa reporting problems of substance abuse (Garabedian, 2002) with only 12% having accessed treatment last year (OMHLTC, 2005). Moreover, substance abuse is costing local taxpayers approximately $625 million every year in lost productivity, premature deaths, increased health care and law enforcement costs (Rehm et al., 2006).
In addition to financial impacts is the significant social cost to substance abuse in our community. Between 22% and 33% of the substantiated maltreatment investigations conducted by Child Welfare Services are found to be a result of alcohol, drug and/or solvent abuse impacting caregiver functioning (Fallon, et al., 2003) and approximately 50% of Ottawa students report first coming into contact with drugs by age thirteen according to a recent survey (Child and Youth Friendly Ottawa, 2006).
With shrinking resources and a growing problem, the question of how to best address the issue needs to be answered. Over the last several months in conjunction with the key stakeholders and the general public, the Community Network of experts established by the Mayor, has identified two key areas upon which we should focus our limited resources.
Treatment and Prevention were the priorities for the public. The benefits of treatment and prevention extend beyond the reduction in substance use problems to areas that are important to the community such as reduced crime, reduced risk of infectious diseases and improved social function.
Municipalities are well positioned to play a leadership role in creating a strategic rather than fragmented approach to substance use problems and as such, ongoing political leadership and support is integral to the ongoing success in phase two of the initiative. Over the next 6 months, the task forces will develop detailed plans and actions to improve the treatment and prevention capacity within the City of Ottawa to positively impact the problems of substance abuse in our community
While most residents in Ottawa can relate stories of extended family members or acquaintances whose lives has been affected by drug and addiction issues, the true scope of the problem has not yet been clearly documented. There is no single study currently in existence that reflects the extent of drugs and addictions in Ottawa. Data from a variety of local, Provincial and Federal sources, however, indicate that over 30,000 individuals in Ottawa, from all age groups, affecting individuals, families and the community in general, reported some form of substance use problem requiring treatment (Garabedian, 2002). Of those 30,000 individuals with problems, slightly more than 12% or approximately 3,725 people participated in community addictions interventions: ranging from early intervention to structured community counselling and treatment in 2005(MOHLTC, 2005). The Ottawa Withdrawal Management (Detoxification) Centre reports on their website that approximately 3000 people are turned away from their facility every year due to lack of capacity (Hamilton, 1997 as cited on Ottawa Detoxification Centre web site).
Based on a recent Ontario Student Drug Use Survey conducted in 2005 by the Centre for Addictions and Mental Health, approximately one-quarter, or approximately 13,000 students in Ottawa report binge drinking (5+ drinks on one occasion) at least once a month, with the equivalent of 4,800 students binge drinking 2 to 3 times in a month and about 16% or the equivalent of 8,500 Ottawa students report symptoms of a drug use problem (Adlaf & Paglia, 2005). An informal survey conducted with local Ottawa students (Child and Youth Friendly Ottawa, 2006) indicated that approximately 50% of those surveyed had tried drugs or had been around others using drugs by the age of thirteen and that 45% of students surveyed had their first contact with drugs in school.
Based on modelled estimates, there are approximately 3,270 intravenous drug users (IDU’s) in Ottawa of which approximately 75.8 % were infected with Hepatitis C (HCV). Ottawa also has the highest proportion of first time HIV diagnoses (based on data from 1985-2003) among IDU’s in Ontario at 26.2% (Millson, Leonard, Remis, Strike, and Challacombe, 2004). In a 2004 study conducted in Ottawa with the homeless, approximately 28% of homeless individuals reported alcohol problems and 39% reported problems with other drugs (Aubrey, Klodawsky, Hay and Runnels, 2004). In addition to generally high rates of substance issues in youth, the homeless and the general population, there are also very high rates of substance abuse among individuals suffering from mental health illnesses. Fifty-three (53%) of individuals with substance use disorders other than alcohol, will experience a mental illness during their lifetime (Concurrent Disorders Network Ontario, 2005). Furthermore, substance use factors highly in the prevalence of high-risk adolescent pregnancy and births with young teen aged mothers. St. Mary’s Home, a residential facility for pregnant teens in Ottawa, estimates that 80% of their clients are young, homeless and pregnant and that substance abuse occurs in most of the referrals to that facility.
The use of alcohol, tobacco and illegal drugs has a substantial impact on the Canadian economy. A report released in March 2006 from the Canadian Centre on Substance Abuse states that the social and economic costs of abuse of alcohol, tobacco and illegal drugs is draining almost $40 billion a year from the economy, through increased pressure on the health care and justice systems as well as lost productivity resulting from disability and premature death. In all, these pressures represent a cost of $1,267 to each individual Canadian. Approximately 37 percent of the yearly economic drain can be attributed to alcohol with illegal drugs such as marijuana, heroin, cocaine and crack accounting for an additional 20 per cent. Using these figures, the cost to the Ottawa economy of alcohol and drug abuse alone can be estimated at approximately $625 million annually (Rehm, et al., 2006). Confirming the pressure on the justice system of illegal substance use, Ottawa Police reported an approximate 60% increase in arrests related to cocaine and heroin between 2004 and 2005 (Ottawa Police RMS, 2005)
The impact of drugs and addictions cannot all be traced financially. For example, in Child Welfare in 2003 it was found that in 22 percent to 33 percent of the substantiated maltreatment investigations, caregiver functioning was impacted by alcohol/Drug/Solvent Abuse (Fallon, et al., 2003). Risky behaviours such as impaired driving are also a result. In 2005, 31.2% of Ontario East Region students from grades 7-12 reported riding with a driver who was drinking alcohol and 20.9% report riding with a driver who had been using drugs prior to driving. Whether through peer influence or parental role modeling, youth are increasingly being put at risk, by those with substance abuse issues. Although changing social norms and graduated licensing have reduced teen drinking and driving, it remains a serious concern for adults (Adlaf & Paglia-Boak, 2005).
The effect of an individual’s use of illegal drugs puts increased pressure on an already burdened health care system and utilizes a large proportion of law enforcement resources. The suppliers of illegal drugs and their associations with organized crime groups adds the possibility of violence when the suppliers of those who engage in illegal substance use, have conflicts which can spill over tragically to innocent family, friends or community members.
A number of challenges in responding to these facts occur across the four pillars of prevention, treatment, enforcement and harm reduction. While the efficacy of prevention policies and practices are supported by research, many prevention programs are characterized by time-limited project-based activity and short-term funding arrangements. There is a lack of comprehensive, long-term prevention infrastructure.
Similarly, treatment interventions for substance dependence are also supported by research. Given the range of treatment needs and the diversity of the population, questions of how much and what kind of treatment is sufficient for a given population or community are tremendously important. It is generally agreed that a variety of flexible and individualized services are required.
On May 11, 2005 Council directed that an Integrated Drug Strategy for Ottawa be developed in response to the need to address the most critical drug-related issues in an integrated way across the whole population. In the summer of 2005, the Mayor of Ottawa established a Community Network bringing together over 50 different community groups comprising service providers, including youth services, local school boards, academics, medical professionals, the business community, concerned parents and media leaders to build a comprehensive and balanced Integrated Drugs and Addictions Strategy (IDAS) for Ottawa residents (A complete list of participating agencies is attached as Document 1). The group met several times in the fall of 2005 to establish the Terms of Reference for the Integrated Drugs and Addictions Strategy that were approved by the Health, Recreation and Social Services Committee (HRSS) on February 16th, 2006.
Integrated Drug and Addictions Strategy (IDAS)
The goal of the IDAS initiative is to support a balanced ongoing strategy to respond to drug and addiction issues in Ottawa by:
Historically, the addictions field has developed from divergent treatment philosophies and approaches. This has resulted in a somewhat fragmented continuum of care. The basis for moving ahead strategically on an integrated and harmonized approach is an understanding that various sectors (e.g. government, business, non-government groups, police, academia and citizen coalitions) need to organize themselves toward a broad response. As a result, the Community Network came together to develop an integrated strategy based on a 4-pillar model.
The Four Pillars Model strives for the integration of strategies to address issues of substance abuse among prevention, treatment, harm reduction and enforcement services. The integration and coordination of strategies is sometimes referred to as the fifth pillar.
During the public consultation, one participant compared the four pillars to the four legs of a chair, suggesting that all four pillars are required in balance to create a strong strategy just as all four legs are required in building a balanced and strong chair. The Four Pillars model seeks to develop recognition and consensus among service providers for the role of each pillar and to support the identification of opportunities for an integrated and coordinated approach.
The issue of increased integration and coordination of the four pillars of prevention, treatment, enforcement and harm reduction was seen as fundamental to the strategy and was confirmed as a priority by the Steering Committee and the Community Network.
Based on the concept of an integrated approach and in an endeavour to get input from a variety of service providers, a one-day session was held, in December 2005, with 18 stakeholder representatives to identify priority issues in Ottawa based on their knowledge of current trends and existing gaps in available service. The Ottawa community has a strong base of community programs to meet the needs of people with substance use problems; however, there is a need to build on the current support system to address critical gaps. In conjunction with this one day session, an inventory was completed that detailed existing services in Ottawa with a brief description of the programs, the sector of the population it supports (if applicable) and capacity numbers where available (on file at the City Clerk’s office). The issues identified in December 2005 and supported by the inventory of services document, were consolidated into themes and then prioritized based on:
§ the degree of control existing with local decisions makers
§ the measurability of outcomes
§ social impact
§ the cost benefit
§ the likelihood of success
Based on these criteria, ten (10) issues, which are listed below in random order, were identified as the highest priority in our community.
§ The lack of detox (withdrawal management) programs available for women, seniors youth and other special interest groups
§ The lack of overall treatment spaces for diverse groups and groups of various ages causing long waiting lists.
§ The lack of residential substance abuse treatment for youth under 16.
§ The difficult access to treatment experienced by individuals with both mental health and addictions issues (concurrent disorders)
§ The lack of affordable housing options for individuals with substance abuse issues including 2nd stage post treatment or transitional housing
§ The lack of a comprehensive public education and prevention program that addresses the needs of individuals over their life span.
§ The need to support family functioning, communication, and education.
§ The rising crimes related to drug use and supply.
§ The requirement to balance the need to address the HIV and Hepatitis C rate among the drug using population in Ottawa while addressing the concerns of the community and the safety of front line workers.
§ The lack of co-ordination between City services, other service providers and key community stakeholders enabling neighbourhoods to deal with drug-related problems.
Subsequent to the identification of the 10 priority issues, research was conducted using local data (where available) to validate the findings and present evidence based practices that could be utilized in Ottawa when developing solutions appropriate for our needs. The 10 issues were then presented to the broader community to prioritize and to further define the scope of the issues.
Through the public input process, emerging from the list of 10 issues were two fundamental community priorities – Treatment and Prevention/Public Education. As a result, the Community Network has identified preliminary goals for these issues and to some degree potential solutions.
Recommendation 1a): Action plan to increase treatment capacity in Ottawa along a continuum of service
Within the continuum of treatment, which is defined as a range of therapeutic services that promote recovery from substance use problems, there are obvious gaps in service provision in the continuum of services within the City of Ottawa. For example, 250 people are turned away from the withdrawal management services at the Ottawa Withdrawal Management (Detoxification) Centre every month. There is no residential treatment facility in Ottawa for youth under the age of 16. There are few services that support diverse populations or for those with concurrent disorders (substance abuse and mental health issues). Likewise, the current system lacks sufficient capacity to support post treatment initiatives that are needed.
Both within the literature and from the input received from the service providers and the general public, there is clear concensus that when an individual suffering from substance abuse issues makes the decision to seek treatment, the service must be readily available. Forcing individuals to wait to access treatment during this vulnerable time can result in a lessening of their resolve to seek treatment as well as placing a burden on family and friends to monitor and support the individual in the interim which could be months. Not only must treatment be readily available, but there is overwhelming acceptance in the field and with the public that one size does not fit all. A full continuum of treatment must be available to deal with a variety of individuals and needs. As well, supports are required after treatment to enable ongoing success. A significant part of any treatment strategy is the support required by individuals once they have completed the formal component of their program (post treatment). Research has shown that access to various community and social services (job, parenting training, etc) during and following treatment are essential to effective treatment (McLellan, 1998).
Withdrawal Management (Detox)
Withdrawal Management Services provide an entry point for people experiencing problems relating to alcohol and other drugs. Stopping heavy, frequent, long-term use of a psychoactive substance (e.g., alcohol, opiates, and stimulants) usually results in withdrawal symptoms. However, in the context of the continuum of care, withdrawal management is seen as much more than ensuring safe withdrawal of the substance(s). It is considered a critical point of contact that may kick start the onset of change for a dependent person.
Currently in Ottawa, there are only two withdrawal management services. With almost 4,000 admissions per year, the Ottawa Withdrawal Management (Detoxification) Centre is the first service in Ottawa and has become the busiest centre of its kind in Ontario. Currently it has a total of twenty beds, 5 of which are dedicated for women. Based on high demand and limited capacity, 250 men and women are refused admission monthly (Hamilton, 1997 as cited on Ottawa Detoxification Centre web site). The second is located at the Royal Ottawa Hospital and has the 'Assessment & Stabilization Unit ' which is a 12 bed Withdrawal Management facility which supports clients whose symptoms require monitoring and support by medically trained staff.
A recent report on the current state and future direction of Withdrawal Management Services (WMS) in the province raise issues on withdrawal management needs for particular populations. (Cathexis Consulting, 2005) Reseach shows that there is a need for addictions and mental health professionals to work closely together when dealing with individuals with concurrent disorders to ensure a coodination of treatment. There is also strong support for providing specialized services for women and elderly people who have safety concerns within the current service delivery model. Youth also require different approaches to withdrawal management and ongoing treatment. Current capacity in Ottawa can not sufficiently accommodate separate or specialized supports for individual client groups.
Detoxification, while viewed as necessary for recovery is not seen as sufficient. Persons who receive detoxification alone have poorer outcomes than those who follow detoxification with treatment and rehabilitation (Saitz, 1998). From the perspective of the health and addiction treatment sector, withdrawal management is a part of the “continuum of care” which help people withdraw from toxic substances and assist the client to develop continuing care plans and facilitates referral to formal and informal care.
Treatment for Diverse Groups
Strong advocacy exists in the continuum of treatment for specialized services for different population groups, such as women, youth, older adults, family members and families, Francophones, ethno-cultural communities, First Nations communities, lesbian, gay, bisexual, transsexual, transgender, two-spirit, intersex and queer (LGBTTTIQ) persons, people with disabilities, people with concurrent disorders, people living with HIV/AIDS, problem gamblers, people involved with the correctional system, injection drug users, opiate users, homeless people, and street youth. Specialized services may be provided in population-specific settings (e.g. women-only services; youth-only services) or as population-appropriate responses within a more generalized treatment environment.
Given the range of treatment needs and the diversity of the population, questions of how much and what kind of treatment is sufficient for a given community are tremendously important. Treatment for any individual must be delivered in the appropriate language, respect culture, sexual orientation, accommodate disabilities and address gender and age differences as well as provide support for additional medical issues that may be present.
Current waiting lists for treatment, the service inventory and gap identification (discussed earlier in this report) all indicate that there is an overall need for treatment and that specific gaps exist in the area of treatment for women, seniors, francophones, those with concurrent disorders and youth.
Treatment for youth under 16
Currently in Ottawa, there are five programs specializing in youth substance abuse treatment none of which have a residential component. Lack of residential treatment for youth is an issue nationally and has been cited as priority issues in Toronto's and Vancouver's Drug Strategies. The nearest available residential treatment facility for Ottawa youth under 16 is located in Thunder Bay Ontario (approximately a 19 hour drive away or the equivalent of driving to the tip of Florida) and has a waiting list of over 3 months. In 2005, 80% of the admissions to the Thunder Bay facility were from outside of their region and 17% of those were from the Ottawa area.
It is commonly acknowledged that youth need to be treated separately from adults for a number of reasons, including: the need for youth treatment to focus on developmental issues not of interest to adults; the inability of youth to explore “childhood issues” which are significant to adults; differences in adult/youth treatment motivation; differing adult/youth perspectives on life and needs; and the risk of youth being exploited in adult treatment settings (Health Canada, 1999, 2001; McLellan & Meyers, 2004).
It is commonly accepted that residential treatment should be available for some youth and needs to be viewed as an important part of a well-developed continuum of services to adequately serve youth with substance use problems. Furthermore, when dealing with youth treatment, its effecacy is greatly improved by providing services to family members - such as parents.
Treatment for Individuals with Concurrent Disorders
Substance use problems and mental health problems often co-occur in individuals, and the term “concurrent disorder” is used in Ontario to refer to this phenomenon. Because “concurrent disorders” are an expression of two health problems that can in themselves vary in form and intensity, this is a complex issue.
Having two separate systems of care has usually meant parallel or sequential services being delivered across the two systems with little or no coordination. This scenario has given rise to a number of systemic problems, including: different funding, planning and governance structures; no common language; different training and certification requirements for staff; lack of routine screening for mental health and/or addiction problems; discriminatory admission criteria which may deny addiction treatment to someone who is using prescribed medication or mental health treatment to someone who is still using substances; different treatment models, and; no focus of responsibility for continuing client care (Concurrent Disorders Network Ontario 2005). These systemic problems result in confusion over where to turn for help and competing perspectives on the primary problem (Health Canada, 2002)
Improvements in the systems are occurring, however the overall effect for consumers has been extreme difficulties in accessing quality care (Health Canada, 2002). Given the high prevalence of concurent disorders among persons with addiction problems and persons with mental health problems, there is a very strong rationale based on best practices to use integrated treatment approaches.
Post Treatment/Continuing Care
The post-treatment or continuing care period is critical to consolidating gains a person has made through the course of their treatment. Whatever the factors that have contributed to a person's homelessness and problematice substance use, these are the types of needs that dominate the caseloads of Ottawa’s residential substance abuse treatment programs. It has been reported that fully eighty percent of clients who use residential addictions treatment services in Ottawa are homeless or at risk of becoming homeless when they enter the program, and that 50% leave residential treatment without housing arranged (Wright, 2002). There is simply not enough transitional housing options for individuals leaving treatment. Bertrand House, a second stage addiction treatment facility which provided housing to Ottawa women closed on May 1, 2006 due to a loss of funding.
Recovery is in jeopardy for persons who are unable to return to stable, secure and affordable lodging. Homeless people surveyed in Ottawa noted that the majority of rooming houses, hostels, shelters – the only affordable options available to them – are in the core area of the city, a high-risk environment for a person wishing to better manage their relationship with substances (Meyer & Estable 2005). Almost all of those surveyed who had successfully completed a residential treatment program “described the importance of transition or second-stage housing immediately after treatment [and] several emphasized that this had made the difference which finally let them break out of the cycle of treatment, relapse, treatment, relapse.”
Lack of transitional housing is not unique to the City of Ottawa, both the Toronto Drug Strategy and Vancouver Prevention Strategy give attention to the need for appropriate housing. In addition to appropriate housing, research has also shown that access to various community and social services (job, parenting training, etc) during and following treatment are essential to effective treatment (McLellan, 1998).
Research has shown that various forms of substance abuse treatment are comparable in their effectiveness to treatments for other chronic conditions such as asthma, hypertension and diabetes. Moreover, the benefits of treatment extend beyond the reduction in substance use problems to areas that are important to the community such as reduced crime, reduced risk of infectious diseases and improved social function. Economic benefits linked to treatment have been shown to be much greater than its costs (Health Canada 1999).
Not suprisingly, five of the top ten issues in Ottawa were related to the need for increased treatment capacity and were identified as priorities during public consultation. Consequently, the Community network recommends that a task force be established to develop a detailed project plan with timelines and resource requirements needed to increase the capacity along the continuum of substance abuse treatment within our community. Specifically, the Community Network identified that the solutions must achieve the following goals:
§ To increase access to medical withdrawal management
§ To have timely and appropriate responses for urgent cases
§ To have services that meet the needs of diverse cultural groups
§ To have a full continuum of services for youth from prevention to residential treatment in Ottawa
§ To simultaneously address addictions and mental health
Through the Consultation process, ideas were presented as a means to achieve these goals. Some of the ideas that will be assessed and developed by a task force include:
§ Increase in post treatment supports such as transitional housing, employment, counselling, reintegration to school supports.
§ Centralized coordination to monitor waiting lists
§ Develop and deliver training on cultural issues using existing resources within the community
§ Develop a residential treatment facility for youth under 16
§ Develop strategies to increase collaboration between Family physicians and service providers around mental health and substance abuse issues.
§ Develop early intervention programs
§ Develop treatment for individuals suffering from HIV/Hepatitis C.
Recommendation 1b): Development of a comprehensive Prevention/Public Education plan
Ottawa Public Health, the Ottawa Police, the local school boards as well as other service providers have public education and prevention components as part of the services they provide; however, erroding funding has resulted in a reduction of programs in our community. For example, there is a significant lack of substance abuse related public education being delivered to youth under 12 in our local schools. Reaching Children and youth is critical to educate them about the harms of substance use and to support good decision making skills.
There are many factors that contribute to the well-being of children and youth, but none play a larger role than parents and families. Support to families is critical to the success of any public education and prevention strategy. Optimizing the preventative role of families by providing support to parents, particularly vulnerable ones, needs to be an integral element in a drug strategy. Currently, educational material, service availability and program descriptions are managed and maintained by the individual providers. This results in difficult navigation for parents, families and users trying to access the appropriate resources to meet their needs.
Too often, prevention efforts have tended toward single-shot, add-on projects that are not sustained over the longer term. Sustainability and evaluation need to be built into prevention plans from the beginning (Roberts & McCall et al. 2001). Prevention activities that become “institutionalized” into the core activities and plans of neighbourhoods, organizations and governments, are more likely to become engrained in community life and result in changed behaviours (anti smoking campaigns and anti drinking and driving campaigns).
Public education and prevention is key to any drug strategy. Through public consultation the need to support families and to develop a comprehensive public education program that addresses the needs of people over their life span were identified as key priorities. Consequently, the Community Network recommend that a task force be established to develop a project plan with timelines and resource requirements needed to develop and implement a comprehensive public education plan including support and education to individuals, families and communities. Specifically, the Community Network identified that the solutions must achieve the following goals:
§ To have a public education and prevention program and available resources for all ages and culture that are easily accessible, and
§ To increase support and awareness education for parents and families affected by addictions.
Through the Consultation process, ideas were identified to help achieve these goals. Some of the ideas that will be assessed and developed by the task force include:
§ Development of a central access point to the system and a mechanism to support people to navigate through the substance abuse services system
§ Provide educational material for parents and teachers to identify signs of substance abuse in children and teenagers
§ Development of an integrated website to support the access to services
§ Development of an age appropriate school based program beginning in the junior schools
§ Development of effective mentoring and peer counselling programs
§ Provision of support in the school (social workers, nurses, addiction counsellors etc)
§ Development of education for the community and parents about high-risk behaviours and links between substance abuse and mental health issues.
Recommendation 1c): Development and Implementation of a Stakeholder Engagement Strategy
Throughout the Public Consultation conducted in April and again at the Community Network meeting in May, there was strong support for the concept of developing a mechanism to facilitate ongoing stakeholder engagement during the development of recommendations in support of treatment and prevention solutions. In support of this idea, a task force will begin immediately to discuss ideas on how best to facilitate the ongoing input from community stakeholders. The task force will examine the potential for such things as ongoing public meetings, websites, focus group meetings and surveys. The resulting strategy and mechanims will be utilized by the Treatment and Prevention/Public Education task forces. This will ensure that ongoing input from appropriate stakeholders such as parents, youth, people using drugs etc. is received with respect proposed solutions and recommendations.
Implementation Plan and Next Steps
One of the true successes of the first phase of the Integrated Drugs and Addictions Initiative is the establishment and commitment of the Community Network. Never in the history of Ottawa has there been such commitment and dedication by so many to develop and support the ongoing solutions to a local drug and addictions problem. The Community Network has developed an implementation plan to ensure the strategy continues to move forward. The model builds on the significant work already developed in phase one to identify the priorities of industry experts and the community at large.
The implementation plan proposed continues to include the support of the community network and identifies an approach, which supports ongoing collaboration of the 4 pillars. The Community Network will continue under its existing membership and will continue to provide direction and to be responsible to Council on implementation requirements. There will be a Steering Committee, which will be a subset of the larger community network, whose members will sponsor projects for both Treatment and Prevention/Public Education. They will be responsible to deliver the solutions to the Community Network, leverage existing relationships to support the projects and will ensure that connections are made with appropriate and existing organizations such as [Champlain Addiction Coordinating Body (CACB), Champlain Mental Health Network (CMHN), Crime Prevention Ottawa, Harm Reduction Coalition]. Three task force teams will be developed. Each one will be multi-sectoral and will have representation from each of the 4 pillars to ensure an integrated approach to recommendation development. Two tasks forces will deliver the solutions identified with respect to Treatment and Public Education/Prevention as previously discussed; the third task force will be responsible for developing and implementing a strategy which will facilitate ongoing stakeholder engagement.
Recommendation 2a) & b): Establish planning tables to:
§ address the issue of coordinating services when addressing drug problems; and
§ address the issue of HIV and Hepatitis C rate among IDU's with the concerns of the community.
Given the limited number of resources and capacity available within the service provision system for drugs and addictions, priorities had to be identified in an effort to focus our resources in an effort to be successful. This in no way reduces the significance of the remaining issues or the need to address them. Consequently, the community network proposes the establishment of two additional planning tables made up of interested parties who will continue to define the specific issues and solicit input from stakeholders with respect to possible causes and potential solutions. These planning tables will ensure that the following issues continue to be developed and will be presented to Council in the next phase of the initiative as required.
§ The requirement to balance the need to address the HIV and Hepatitis C rate among the drug using population in Ottawa while addressing the concerns of the community and the safety of front line workers.
§ The lack of co-ordination between City services, other service providers and key community stakeholders enabling neighbourhoods to deal with drug-related problems.
Recommendation 3: Community Network to report back with detailed project plans related to Public Education and Treatment.
The magnitude of the task to deliver on the goals and objectives for a treatment and prevention strategy will necessitate careful planning to increase the likelihood of success. As such, time will be required to identify which proposed solutions are appropriate and align with existing policies, local program mandates and other iniatives at higher levels of government - hence potential funding - versus those which might require a change in existing legislation. The Community Network propose that time be allocated for extensive planning and that the details, resource requirements as well as potential sources of funding required to implement short, medium and long term solutions be presented to Council in 6 months.
The Community Network has agreed that the final two issues fall within the purview of existing organizations and as such recommend that these issues be referred to those groups for consideration.
Recommendation 4: Refer the use and supply of drugs issues to Crime Prevention Ottawa to include as part of their work plan
Recommendation 5: Refer drugs and addictions related affordable housing issues to the Corporate Housing Agenda work team.
Municipalities point to two ingredients that appear essential in addressing coordination concerns: the need for a drug strategy, and the need for political leadership. Municipalities are well positioned to play a leadership role in creating a strategic rather than fragmented approach to substance use problems.
The Community Network has developed an implementation plan to ensure a coordinated approach for dealing with substance abuse problems in the City of Ottawa. Imbedded in the plan is the integration of the 4 pillars and the development of a strategy to solicit and receive ongoing input from the public and affected stakeholders on resultant key recommendations.
Given the complexity of the issues and various mandates and funding envelopes at all levels of government established to deal with issues related to drugs and addictions, the Community Network, after consultation with the public, propose that two tasks forces be established to further define the details of a comprehensive treatment and public education plan appropriate for the City of Ottawa. Given the time allocated for this phase of the project it was not feasible to have the details of each plan for this report. Over the next 6 months, based on best practices and ongoing stakeholder engagement, the task forces will develop concrete project plans designed to make considerable advances in the areas of treatment and public education. The plans will include detailed timelines, and resource requirements to implement successful solutions.
In March 2006, a community consultation session was held with members of the Community Network as well as a number of other stakeholders such as representatives from the Interfaith Network, the Lifestyle Enrichment for Senior Adults (LESA) program, Mothers Against Drunk Driving (MADD), City for All Women Initiative (CAWI), Corrections (Parole/Probation/Elizabeth Fry/John Howard), First Responders (Fire/Paramedics/By law), Emergency Room Nurses Association, Ontario Students Against Impaired Driving (OSAID), and the Coalition of Harm Reduction. The purpose of the session was to discuss the issues and develop goals and objectives for each of the ten issues.
In an effort to receive further input and ideas around the top issues from the general public, a public consultation was held in April 2006, including three urban (one session was conducted in French) and three rural sessions involving approximately 100 participants to identify the top priorities from among the ten issues. Additional opportunities to provide input and identify priorities were available to the public through paper surveys available at client service centres or on-line through an electronic survey developed and hosted by Keshet Technologies Inc. (a member of the Community Network) but accessible through Ottawa.ca
Consultation with vulnerable or client groups was also held through existing relationships between Community Network members and additional stakeholders to identify the key priorities for those groups. The Housing Branch, Child and Youth Friendly Ottawa (CAYFO), Employment and Financial Assistance Branch, the Lifestyle Enrichment for Senior Adults (LESA) program and the Multi-Cultural representative on the Network organized focus groups and/or circulated surveys with over 200 additional participants. It is recognized that consultation with vulnerable and client groups is vitally important but has been limited. It is also recognized that individuals experiencing substance use problems can be difficult to reach.
This initial consultation with vulnerable or client groups represents only a first step. Efforts to increase the participation of vulnerable and client groups will continue as the strategy goes forward through a stakeholder engagement strategy which is built into implementation plan. A targeted approach involving specific groups such as those in recovery, youth, seniors, people living with HIV/AIDS, people who are homeless or others may be utilized for gaining feedback on specific solutions and implementation recommendations.
Document 1: Community Network Membership List
Document 2: Inventory of Services (On file at the City Clerk’s Office)
Document 3 : Glossary of Terms
Document 4: Reference Material
The Community Network will report back in early 2007 with detailed project and implementation plans for recommendations 1a) and b).
Crime Prevention Ottawa will report back on crimes as they relate to the use and supply of drugs.
Housing Branch will report back on affordable housing as it relates to drug and addictions issues.
Integrated Drugs and Addictions Strategy
Addictions & Problem Gambling Services of Ottawa
Algonquin College Police and Public Safety Sector
Alliance to End Homelessness
Business Leader – O.C.R.I
Canadian Mental Health Association
Centre for Addiction and Mental Health
Chair of the Ottawa Crime Prevention Council
Chair Ottawa Youth Justice Services Network
Champlain Addictions Coordinating Body
Chief of Police
Children’s Aid Society
Children’s Hospital of Eastern Ontario
Conseil des écoles catholiques de langue française du Centre-Est.
Conseil des écoles publiques de l’Est de l’Ontario
Crisis Intervention – Ottawa Hospital
Dave Smith Youth Treatment Centre
Faculty of Medicine, Ottawa Hospital - University of Ottawa
Deputy Chief of Police
Deputy City Manager, Community & Protective Services
Director, Centre for Research on Community Services
Director, Employment & Financial Assistance
Emergency Room Physicians on staff with Ottawa Hospital
Executive Director Crime Prevention Ottawa
Focus Vanier(Action antidrogue Vanier)
Medical Officer of Health
Multicultural Health Representative,
OCCSB Ottawa-Carleton Catholic School Board
Ontario Ministry of Health & LTC - Local Health Integration Network
Ottawa Centre for Research and Innovation
Ottawa Coalition on HIV/AIDS
Ottawa Community Housing Corporation
Ottawa Youth Justice Network
Parent’s Advisory Committee
Parks and Recreation
Pharmacist, Bell Pharmacy
Popcorn Group Operation Go Home
Residential Services, Housing Branch,
Rideauwood, Addiction & Family Services
Roberts Smart Centre
Royal Ottawa Hospital
SEM-ENG International Ltd. (Crime Prevention)
Superintendent of Special Education and Student Services
Superintendent of the French Public School Board
United Way Ottawa
University of Ottawa
Urban Aboriginal Coalition
Young/Single Parent Support Network
Youth Services bureau
Addictions: An 'addiction' is seen as a complex, progressive behaviour pattern having biological, sociological, and behavioural components. It is a compulsion to repeat behaviour, regardless of its consequences. It is an inability to reduce consumption in spite of consequences, harm to self, family, work or school or the community. It is a chronic pattern of behaviour, which includes a craving for more of the drug, or of the initial behaviour, increased physiological tolerance to exposure, and withdrawal symptoms in the absence of the stimulus.
Enforcement: A set of interventions that seek to strengthen community safety by responding to crimes and community disorder issues associated with the importation, manufacturing cultivation, distribution, possession and use of legal and illegal substances.
Harm Reduction: A holistic philosophy that integrates a set of practical coordinated and evidence-based strategies that seek to reduce harm associated with drug and alcohol use to users, children and youth, families and the community at large. The approach can range from safer substance use to abstinence, and the strategies will strive for integration between prevention, treatment, education, enforcement and services.
Illicit Drugs -A psychoactive substance, the production, sale, or use of which is prohibited. Strictly speaking, it is not the drug that is illicit, but its production, sale, or use in particular circumstances in a given jurisdiction (see controlled substances). "illicit drug market", a more exact term, refers to the production, distribution, and sale of any drug outside legal1y sanctioned channels
Prevention: A set of interventions designed to avoid the physical, mental and emotional affects of disease and injury associated with substance abuse. Prevention is more than education. It includes strengthening the health, social and economic factors that can reduce the risk of substance use. This includes access to health care, stable housing, education and employment. Often divided into primary, secondary and tertiary prevention.
Primary prevention seeks to prevent the occurrence altogether i.e. no use.
Secondary Prevention seeks to limit the duration or amount of use before permanent damage occurs.
Tertiary Prevention seeks to minimize complications and premature deterioration associated with use.
Substance Abuse: A destructive pattern of substance use leading to clinically significant (social, occupational, medical) impairment or distress.
Treatment: A set of interventions that seek to improve physical, emotional and psychological health and well-being of people who have an unhealthy dependence on substances.
Adlaf, E., & Paglia-Boak, A. (2005). Ontario Student Drug Survey: Detailed OSDUS findings. Toronto, ON: Centre for Addiction and Mental Health.
Aubrey, T., Klodawsky, F., Hay, E., & Runnels, V. (2004) Findings and Facts: Panel Study on Homelessness in Ottawa. Centre for Research on Community Services. University of Ottawa.
Child and Youth Friendly Ottawa, (2006). Consultation Survey for Ottawa’s Integrated Drugs and Addictions Strategy by the Ottawa Youth Commission. Unpublished manuscript
Concurrent Disorders Network Ontario (2005). Concurrent Disorders Policy Framework. September 2005.
Fallon, B., Trocme, N., MacLaurin, B., Knoke, D., Black, T, et al., (2003). Ontario Incidence Study of Reported Child Abuse and Neglect Centre of Excellence for Child Welfare. Published manuscript.
Garabedian, K. (2002). Canadian community epidemiology network on drug use National capital region report, Ottawa: Canadian Centre on Substance Abuse. Unpublished Survey.
Health Canada. (1999). Best practices - substance abuse treatment and rehabilitation. Ottawa: Minister of Public Works and Government Services.
Mclellan, T. (1998). Research Report. Supplemental social services improve outcomes in public addiction treatment. Addiction, 93(10), 1489-1499.
McLellan, A.T., & Meyers, K. (2004). Contemporary addiction treatment: A review of systems problems for adults and adolescents. Biological Psychiatry, 56(10), 764-770.
Meyer, M. & Estable, A. (2005). Homelessness and Substance Use: Exploring Cross-sectoral Service Needs from the Clients’ Perspective. Steering Committee of the Substance Use in the Homeless Population Working Group of Ottawa. Unpublished manuscript
Millson, P., Leonard, L., Remis. R., Strike C., Challacombe L. (2004). Injection drug use, HIV and HCV infection in Ontario : the evidence 1992 to 2004. Toronto: Faculty of Medicine, University of Toronto. Published manuscript.
Ontario Ministry of Health and Long Term Care, (2005) Agency Operating Plans 2004/05 (2)(B). Toronto: Queen’s Printer.
Ottawa Detoxification Centre (1997). Coming In From the Storm. Retrieved May 2006 from http://www.scohs.on.ca/scope/fall97/p05-e.htm. Online newsletter.
Records Management System, Ottawa Police 2005 Unpublished data
Rehm, J., Baliunas, D., Brochu, S., Fischer, B., Gnam, W., Patra, J., et al., in collaboration with Adlaft, E., Recel, M., Single, E. (2006). The Cost of Substance Abuse in Canada 2002: Highlights. Published manuscript.
Roberts, G., McCall, D, et al. (2001). Preventing substance use problems among youth: A compendium of best practices, Health Canada.
Saitz, R. (1998). Introduction to alcohol withdrawal. Alcohol Health and Research World. 22(1):5-12.
Wright, A. (2002). A Recommended Approach to Supporting Learning and Knowledge Development with Those who Work with People who are Homeless and Using Substances. Ottawa Working Group on Addictions in the Homeless Population. Unpublished manuscript.