5. integrated
drugs and addictions strategy – terms of reference stratÉgie intÉgrÉe de lutte contre les drogue et la toxicomanie –
cadre de rÉfÉrence |
That Council receive this report for information.
RECOMMANDATIONS
DU COMITÉ
Que le
Conseil prenne connaissance du présent rapport.
DOCUMENTATION
1.
Community Network for the Integrated Drugs
and Addictions report dated 19 January 2006 (ACS2006-CCS-HRS-0002).
Report to/Rapport
au :
Health,
Recreation and Social Services Committee
Comité de la santé, des loisirs et des services
sociaux
19
January 2006 / le 19 janvier 2006
Submitted by/Soumis par : Community Network for the Integrated
Drugs and Addictions Strategy/ Réseau communautaire pour la Stratégie intégrée
de lutte contre les drogues et la toxicomanie
Contact Person/Personne resource : Dr. Dave
Salisbury
Medical Officer of
Public Health/Médecin chef en Santé publique
(613) 580-2424
x23681, dave.salisbury@ottawa.ca
SUBJECT: |
INTEGRATED DRUGs and addictions
STRATEGY - TERMS OF REFERENCE |
|
|
OBJET : |
STRATÉGIE INTÉGRÉE DE LUTTE CONTRE LES DROGUES ET LA TOXICOMANIE - CADRE DE RÉFÉRENCE |
REPORT RECOMMENDATION
The Integrated Drugs and Addictions Strategy Community Network recommend that the Health, Recreation and Social Services Committee and Council receive this report for information.
RECOMMANDATION DU
RAPPORT
Que le Réseau communautaire pour la Stratégie
intégrée de lutte contre les drogues et la toxicomanie recommande au Comité de
la santé, des loisirs et des services sociaux et au Conseil municipal de
recevoir le présent rapport à titre d’information.
No sector of Canadian society is untouched by the harms that can result
from problematic use of alcohol and other drugs and substances. Consequently, at its meeting on May 11, 2005
Council directed that an Integrated Drug Strategy for the City of Ottawa be
developed and that the Terms of Reference for the membership of the
working group and the development of the project be brought to Health Recreation and Social Services Committee.
In the summer of 2005, the Mayor of Ottawa established a large Community
Network group comprised of a wide range of service providers, academics,
business and media leaders and special interest groups. This group met several
times in the fall of 2005 and have developed an approach, timelines and a clear
set of deliverables intended to begin to address some of the most critical drug
related issues in Ottawa. The proposed
strategy is a holistic approach that considers the needs of individuals across
all age groups (prenatal to seniors) as well as families and the community at
large.
At the Health Recreation and
Social Services Committee meeting on April 21, 2005, the Committee discussed at
length the Harm Reduction Program and the merits of distributing crack pipe
kits from the Sexual Health Care Centre Clinics. Distribution of crack pipe kits is only one small portion of a
Public Health program which focuses on prevention and harm reduction in the
drug using community but did become the catalyst for a larger discussion on the
issues associated with substance abuse in Ottawa. It became obvious that a large initiative, involving many
community partners, was required to develop a comprehensive drugs and
addictions strategy for Ottawa that would address the four (4) pillars of
substance abuse (prevention, treatment, harm reduction[1]
and enforcement) as well as integration
opportunties among those pillars.
Following the discussion, a motion was put forward "[t]hat the
Health, Recreation and Social Services Committee recommend to Council that
there be an integrated City of Ottawa Drug strategy developed and that the
Terms of Reference for the membership of the working group and the development
of the project come to the Health Recreation and Social Services Committee.
Through the research phase of this report, it became apparent, that there was not one comprehensive study that reflected the extent of the substance use problems specific to Ottawa; however, various service providers in the industry supplied the following information in an effort to illustrate the magnitude of the problem in our community:
According to Health Canada in 1992, substance abuse “… cost Canada an estimated $8.9 billion in direct losses associated with the workforce and administrative costs for transfer payments, prevention and research, law enforcement, and health care. The largest cost was lost productivity due to illness and premature death. During the nineties sharing of needles led to a rise in the rate of infectious disease transmission and more recently, increasing use of crystal methamphetamine and diversion of prescription painkillers such as oxycodone all point to a substantially greater toll on those who use drugs problematically, on families and communities, and on Canadian society in general. Particularly vulnerable are youth, seniors, Aboriginal peoples, and those who live in poverty or have co-occurring mental or physical illness.
No sector of Canadian society is untouched by the harms that can result from problematic use of alcohol and other drugs and substances. All levels of government, Aboriginal organizations, Non-government Organizations (NGO's), industry, addictions, policing and enforcement agencies, and other communities of interest, including academia, legal associations, advocacy and human rights organizations, the medical community, caregivers, those who use drugs, and many others, all have a role to play in addressing problematic substance use.”[11]
As a result, in
the summer of 2005, the Mayor of Ottawa established a Community Network of
citizens representing such groups
(Document 1, Appendix A) to mobilize an initiative and to develop a strategic
approach to address the needs in our community based on issues and trends
specific to Ottawa, while meeting the following objectives:
§ To seek to ensure that residents live in a community increasingly free of the harms associated with problematic substance use;
§ To reduce the demand for and supply of illicit drugs;
§ To contribute to a healthier, safer Ottawa through integrated prevention, treatment, enforcement and harm reduction initiatives;
§ To create supportive environments, which promote the health and resiliency of individuals, families and communities in order to prevent problematic use of alcohol and other illicit drugs;
§ To reduce harm associated with alcohol and illicit drugs to individuals, families and communities across Ottawa;
§ To co-ordinate and integrate comprehensive policies, programs and services that address substance use; and
§ To lobby other levels of government to take action and responsibility for elements of the strategy within their jurisdiction.
The key to Ottawa's Integrated
Drugs and Addictions Strategy is the identification and implementation of
integration opportunities within the four (4) pillar approach to address
substance abuse (previously cited in this report) which will result in a
comprehensive and coordinated approach to dealing with drug problems in our
community.
The Terms of Reference for this initaitive (Document 1) outlines the approach that is proposed to further refine the issues being experienced in Ottawa and to develop concrete recommendations to be presented to Committee and Council as well as an implementation strategy for moving forward on each recommendation.
The Terms of Reference document identifies five (5) phases involved in the development of Phase I of this initiative – planning, development, consultation, recommendations and reporting. Within each phase there exists clear deliverables with timelines for completion. In June 2006, Council will receive a report, which outlines a list of priorities issues, recommendation and mechanisms for implementation in the area of substance abuse in our community. Understandably, it is not possible to identify and resolve every issue as it relates to substance abuse in our community within six (6) months. Also anticipated for June 2006, will be a recommendation for maintaining ongoing collaboration on issues in the area of substance abuse.
“One of the key roles for municipal leaders is to help facilitate and coordinate community mobilization. Municipal authorities can play a vital role by helping existing community groups in their efforts and engaging others in the community to ensure a comprehensive and inter-sectoral response. Their public support of a model municipal drug strategy can generate public awareness of the existence of a problem, and garner support for responding to it.”[12]
According to the Federation of Canadian Municipalities (FCM) “… [m]unicipal governments are strategically placed to respond to substance abuse concerns. The consequences of substance abuse are felt at the municipal level and services are organized and delivered here as well. In addition, local municipalities already play an important role in promoting safe and healthy communities. Municipal leaders are also the link between local communities and senior orders of government that provide funding and other resources to communities to address their substance abuse concerns. For these and many other reasons, municipal officials have a leadership role to play in responding to local substance abuse concerns.”[13] Based on comments from the FCM and the direction received by Council in May 2005, the Mayor and staff have mobilized the community and developed a structure for developing an Integrated Drugs and Addictions strategy for Ottawa. Its purpose will be to identify priority issues in Ottawa, identify gaps in current service provision, identify integration opportunities and mechanisms, and make recommendations in three categories: recommendations for immediate implementation within the current resources, recommendations within the community’s control to implement if additional resources are secured and recommendations for future consideration. Identified in the attached Terms of Reference document is a clearly identified approach, deliverables, timelines and committees membership to achieve this goal.
CONSULTATION
The Steering Committee and Community Network were consulted in the development of this report.
FINANCIAL IMPLICATIONS
There is no financial implication as a result of this report.
SUPPORTING DOCUMENTATION
Document 1: The Integrated Drugs and Addictions Strategy – Terms of Reference.
DISPOSITION
The Community Network for the Integrated Drugs and Addictions Strategy will implement the directions of Council.
Document 1
Integrated Drugs
and Addictions Strategy
The Mayor has hosted several
meetings with Community leaders and City staff to begin to identify next steps
in the approach to developing an Integrated Drugs and Addictions Strategy that
will address the current programs, subsequent gaps and anticipated needs in our
community with respect to the problematic use of alcohol, legal and illegal
drugs. The Integrated Drugs and
Addictions Strategy initiative will include a number of Community leaders and
experts in the development of a comprehensive strategy for implementation. The
proposed strategy is a holistic approach that considers the needs of
individuals across all age groups (prenatal to seniors) as well as families and
the community at large.
The purpose of this initiative is to identify gaps, capacity issues and integration opportunities in the area of prevention, treatment, enforcement, and harm reduction. Based on findings, priority actions will be identified and recommendations will be made to Council. In addition, this initiative will propose strategies for implementing the recommendations as well as recommend ongoing mechanisms to sustain the integration and evaluation of services.
The objectives of Ottawa’s Integrated Drugs and Addictions Strategy are to:
§ Seek to ensure that residents live in a community increasingly free of the harms associated with problematic substance use.
§ Reduce the demand for and supply of illicit drugs.
§ Contribute to a healthier, safer Ottawa through integrated prevention, treatment, enforcement and harm reduction initiatives.
§ Create supportive environments that promote the health and resiliency of individuals, families and communities in order to prevent problematic use of alcohol and other illicit drugs.
§ Reduce harm associated with alcohol and illicit drugs to individuals, families and communities across all age groups (prenatal to seniors) across Ottawa.
§ Co-ordinate and integrate comprehensive policies, programs and services that address substance use.
§ Lobby other levels of government to take action and responsibility for elements of the strategy within their jurisdiction.
· Prevention (including education and communication)
· Treatment
· Enforcement
· Harm Reduction
Definition of 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.
Definition of 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.
Definition of 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.
Definition of 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.
Definition of 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.
Phase |
Activity |
Timelines |
Planning |
Develop membership for each group Develop terms of reference document including objectives of the initiative Terms of Reference Report |
October 2005 – January 2006 |
Content Development |
Compile and analyze available research on issues and services in Ottawa |
15 Dec – April 2006 |
Consultation |
Develop consultation plan Conduct consultation Compile findings |
10 Feb – 10 Mar 2006 |
Strategy Development |
Priority setting Develop recommendations |
10 Mar – 7 Apr 2006 |
Report Development |
Compile Steering Committee recommendations to Committee and Council |
Apr – May 2006 |
Terms of Reference Document
Terms of
Reference Report
§
A report to Health Recreation and Social Services
Committee and Council that will describe the prevalence of substance abuse
issues in Ottawa, resulting impact and the proposed Ottawa Integrated Drugs and
Addictions Strategy structure developed to deal with the issues.
§
Appendix A: Terms of Reference.
Content Development December 15
– April 2006
Compilation of
Available Research in Ottawa
§
A document that outlines a further refinement of the
prevalence in Ottawa based on existing and available research.
§
A document that outlines current service provision in
Ottawa in the area of prevention, treatment, harm reduction and enforcement.
§
A gap analysis of existing service provision.
§
Identification of opportunities for integration.
Consultation 10
February – 10 March 2006
Consultation Strategy
§ A document that outlines:
o Consultation approach
o Objectives of consultation process
o Groups to be consulted
o Role of various advisory structures (eg., parent advisory)
o Consultation schedule
o Presentation material
o Information collection methodology
Strategy Development 10
March – 7 April 2006
Recommendation Strategies
§ A document identifying priorities as identified through the consultation process, resulting recommendations and implementation strategy for going forward. The strategies will be approved by the Steering Committee based on Community Network feedback.
Report Development April
– May 2006
Final Report
§ A report from the Community Network which will outline
o Prevalence
o Impact
o Service provision in Ottawa as it relates to substance abuse
o Priorities identified through consultation
o Recommendations based on three categories
§ Quick wins
§ Short term
§ Future consideration
o Strategies for implementation
o Evaluation Process
Community Network of Community leaders will:
o Establish the vision for the strategy
o Provide direction and leadership
o Act as community champions
o Support activities of the working group by providing data, information and expertise as required.
o Lobby other community leaders in support of an Integrated Drugs and Addictions Strategy.
o Mobilize the community in support of an Integrated Drugs and Addictions Strategy.
o Submit report to Committee and Council
Steering committee will:
o Have expertise in the 4 pillars.
o Be a subset of the Community Network Committee.
o Make decisions based on consensus.
o Be available to meet regularly based on need.
o Be able to bring resources to accomplish the required work of the committee.
o Provide implementation direction on the overall plan
based on feedback from the Community Network.
o Establish the work plan for the working group.
o
Approve
Initiative deliverables based on feedback and on behalf of the Community Network.
Working group will:
o Be knowledgeable in the field of drug use and program delivery
o Analyze existing information and identify gaps in the current service provision in the areas identified in the mandate.
o Identify priorities in our community based on consultation
o Form additional working groups including additional community representation as required to support the initiative
o Complete a benchmark exercise with respect to best practices in program delivery.
o Develop recommendations and actions based on consultation feedback
o Inform the Steering Committee and the Community Network Committee of findings.
Coordination and Integration are the fundamental principles of Ottawa’s Integrated Drugs and Addictions Strategy. This will be achieved at all levels of the initiative structure through the multi-disciplinary participation on Community Network, Steering Committee and Working group. Together, there will be dialogue on the analysis of the current service provision in our community, associated integration points and subsequent gaps. Priorities will be identified through consultation. Recommendations will be developed by the Working Group and submitted to the Steering Committee and the Community Network for consideration. Based on feedback an action plan will be developed.
Organization
Structure
City Council Community Network Community Leaders
& Champions Define the
overall strategy Mobilize the
Community Support Provide direction
to the Steering Committee
Appendix
A
Membership List
Community Network – Individuals involved in setting policy and providing direction in the area of the 4 pillars
Co- chaired by a community
leader with significant knowledge and experience of the subject matter and one
with hands on experience in the area of substance misuse with leadership
skills.
Senior City Staff
Ottawa Police Services
Ottawa Public Health
Political Leaders
Senior Hospital administrators
Directors of Treatment Centres
OCRI
School Boards
Academics
Crime Prevention Council
Parent Representation from the Parent Advisory Committee
Alliance to End Homelessness
Insurance Sector
Rehabilitation Sector
Young Offenders Network
Ottawa Alliance on Impaired Driving
Youth Representatives (Youth Net)
Media Leaders
Popcorn Group
Community Resource Centre
Community Health & Resource Centres
Sandy Hill Community Resource Centre
Young/Single Parent Support Network
Family Service Centre
Urban Aboriginal Coalition
Vanier Focus Community (Francophone Youth)
Cross Sectoral School Boards Network
Centre Director – University of Ottawa Community Evaluation and Research
Pharmacist Network
Centre of Excellence
Diverse Communities
Crisis Management
Mental Health organizations
Local Health Integration Networks
Landlords
Housing
Steering Committee – Individuals involved in managing the operations in the 4 areas.
Chair: Steve Kanellakos, Deputy City Manager of Community and Protective Services
Vice Chair: Alfred Cormier, Centre for Addictions and Mental Health
Deputy City Manager
Police Chief
Medical Officer of Health
Representation from Addictions Agencies
Representation from Additions and Mental Health Organization
Representation from Children’s Advocacy Groups
Working Group - Individuals involved in direct service delivery in the 4 areas
City staff
Treatment intervention workers
Public Health
Police Services
Communications resource
Additions and Mental Health Organizations
Support Resources
Support to the initiative will be provided by:
§ 1/3 resource from Public Health Branch, Deputy City Manager and Police Services
§ 1 resource from the Deputy City Manager of Community and Protective Services’ Office
Glossary
of Terms
Substance Abuse: A destructive pattern of substance use
leading to clinically significant (social, occupational, medical) impairment or
distress.
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
Quick Wins – Describes a solution that can be implemented using the existing resources in a short period of time (less than one year) and is within the control of the groups involved.
Short Term - Describes a solution that can be implemented is additional resources are made available in a short period of time (less than one year) and is within the control of the groups involved.
Future Consideration – Describes a solution that requires further investigation, that cannot be implemented in a short period of time (less than one year) or that may not be within the control of the groups involved.
[1] For this purposes of this
initiative, harm reduction is defined as 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, 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.
[2] Drug Use Among Ontario Students: 1977-2005 (2005), CAMH, p. 179
[3] Drug Use Among Ontario Students: 1977-2005 (2005), CAMH, p.viii
[4] Canadian Community Epidemilogy Network on Drug use, National Capital Region Report, 2002.
[5] Canadian Community Epidemilogy Network on Drug use, National Capital Region Report, 2002.
[6] Adlaf, E.M.; Begin, P. & Sawka, E. (Eds) 2005). Canadian Addiction Survey (CAS): A National Survey of Canadians' use of alcohol and other drugs. Prevalence of use and related harms: Detailed report, Ottawa, Canadian Centre on Substance Abuse
[7] Dr. Robin Walker, Past President of the Canadian Paediatiric Society and Medical Director of Critical Care at CHEO
[8] Injury Severity Score (ISS) is “ a method for describing patients with multiple injuries and evaluating emergency care.” Baker SP et al, J Trauma 14:187-196; 1974
[9] Drug seizure statistics can vary and are based in part by enforcement resources used or targeting of a particular offence.
[10] Ontario Incidence Study of
Reported Child Abuse and Neglect – 2003” authored by Barbara Fallon, Nico
Trocme, Bruce MacLaurin, Della Knoke, Tara Black, Joanne Daciuk, and Caroline Felstiner, Published by the Centre of Excellence for Child Welfare.
[11] Health Canada web site
[12] A Framework for Developing a Model Municipal Drug Strategy. FCM Publication No. 3564E. FCM Website.
[13] A Framework for Developing a Model Municipal Drug Strategy. FCM Publication No. 3564E. FCM Website.