By Sue Tiffin
Published Oct. 30 2018
A comprehensive report detailing what substance use looks like in Haliburton County and how harms associated with substance use are being addressed in the region was presented by Cathy MacDonald substances and harm reduction co-ordinator at an Oct. 18 meeting of the board of health for the HKPR District Health Unit.
As was previously reported in the Echo the HKLN drug strategy Community Priorities 2018 focused on four main pillars: harm reduction prevention and education treatment and justice and enforcement supported by the guiding principles: collaborative; local relevance; evidence-informed; inclusive and accessible; and sustainable.
MacDonald said the objectives of the drug strategy are to foster and coordinate collaboration and partnerships in the substance use field to help reduce the harms associated with substance use avoid duplication of services and share information about best practices and new research related to substance use.
Of 548 community surveys completed online or by paper copy 15 per cent of the results were from Haliburton County 51.1 per cent from City of Kawartha Lakes 29.7 per cent from Northumberland with some other responses coming from areas outside of the three counties mostly from Peterborough. Additionally 79 surveys were held with service providers from 55 organizations.
The Canadian Centre on Substance Use and Addiction and the Canadian Institute for Substance Use Research identified that the highest contributors to the economic costs of substance use related to lost productivity health care criminal justice and other direct costs are alcohol tobacco opi oids and cannabis.
Aside from tobacco MacDonald said alcohol continues to be the substance with the highest use rates as well as the highest cost associated with it.
“Alcohol was shown to cause the most harm in Canada” said MacDonald “contributing to $14.6 billion in cost and in 2015 83 per cent of youth aged 15 to 24 years in Canada reported drinking alcohol. This rate is slightly higher than the rate for adults 25 years and older which is 78 per cent.”
For the years 2015 and 2016 56 per cent of individuals both male and female self-reported a rate of alcohol use that exceeded the low-risk alcohol drinking guidelines for injury and chronic disease.
Since 2003 the number of deaths due to opioid overdoses increased 246 per cent according to MacDonald.
“More than 1250 Ontarians died from opioid-related causes in 2017 and in the first three months of 2018 there have been 307” said MacDonald.
Cannabis was the most frequently used illicit drug although no longer illicit by 12 per cent of the population in 2015. Approximately a quarter of cannabis users reported using it for medicinal purposes.
The rate of cannabis use among Canadian youth between 15 and 24 is 24.4 per cent approximately three times higher when compared to the adult population.
“In Ontario about one in five students in grades 7 to 12 said they used cannabis at least once in the past year” said MacDonald. “Eighty-one per cent of students have not used cannabis at all in the past year.”
Emergency department visits for cannabis overdoses increased from 4.9 visits per 100000 population in 2016 to 10.5 visits per 100000 population in 2017.
“A lot of which speaks to increased potency of what’s out there increased THC levels in cannabis” said MacDonald.
Close to half of HKPR residents aged 18 or older reported having ever used an illicit drug in their lifetime.
“The philosophy and practice of harm reduction is considered a pragmatic evidence-based approach to drug use which seeks to reduce substance use-related harms to individuals and communities without necessarily discontinuing substance use itself” presented MacDonald. “The main goal of harm reduction is meeting a person where they are at with their substance use at any given time and is not about fixing people.”
An outreach worker and peer worker provide services through Fourcast.
The health unit partners with Peterborough AIDS Resource Network for harm reduction programs which include the needle exchange program as well as the naloxone distribution and training program.
Haliburton hosts two sites for naloxone kits the John Howard Society located in Minden and the health unit office located in Haliburton with potentially more organizations to come in the following months.
The needle exchange program is offered at the health unit and other sites in the community are actively being sought.
In 2017 there were 180 interactions with clients. In 2018 there have been 115 interactions and 9300 needles in Haliburton being distributed through fixed sites and through outreach. People picking up supplies do not necessarily have a direct interaction.
The health unit is working on training with police fire and emergency medical services as well as emergency departments and some other hospital departments that are considered high-risk.
“One of the most cost-effective and long-lasting ways to reduce the harms associated with substance use is to prevent them from happening through education and interventions in early childhood and adolescence” said MacDonald.
MacDonald said the health unit has been providing recommendations regarding cannabis legalization both at a provincial level and to municipalities. The health unit has also been working with police and municipalities after getting reports of needles being found in different locations throughout communities. In Haliburton a needle disposal bin has been installed beside the walking path on Maple Avenue across from York Street.
The health unit also participates in a medication take back campaign.
“Trends indicate rising rates of recreational prescription use especially among youth who tend to the get the prescriptions from family medicine cabinets” said MacDonald. “We have events where people can bring in their old prescriptions or their unfinished prescriptions that we can dispose of safely and also advise people that they can attend any pharmacy at any time to get rid of those prescriptions not to keep them around the house.”
MacDonald said staff has just been trained in a Weed Out the Risk program an educational program to address road safety risks of driving under the influence of marijuana for young drivers. The health unit is working to identify and recommend resources to educators and working with school boards around policy development.
The Challenges Beliefs and Changes program a peer-based prevention education program trains senior secondary students to provide the program to Grade 8 and 9 students.
“It’s about making choices it’s about critical thinking and related to substance use and health” said MacDonald.
“Two of the resources we are currently promoting are the lower risk cannabis use guidelines and the promotion of the low-risk drinking guidelines both of which approach from a harm reduction angle giving recommendations on how to reduce the risks associated with substance use rather than an abstinence stance” said MacDonald.
“So we know that people under the age of 25 are particularly vulnerable to THC so we do recommend delaying initiation” she said. “With any substance use if people are going to start using it go low and start slow. And be familiar with the product they’re using which is going to be an advantage of regulated cannabis that you’re going to be aware of the CBD levels as well as the THC levels in the products. Currently with the illicit market you don’t know what you’re consuming.”
MacDonald said making sure people aren’t driving if they’ve consumed combining different substances and have considered the form – smoking versus vaping versus oil for example – they’re choosing to use are also part of the low-risk cannabis use guidelines.
The drug strategy acknowledges the Youth Hub in Haliburton and says it “is another example of a prevention model that can help minimize the harms associated with substance use and reduce the rates of substance use among youth.”
The treatment pillar addresses “the physical emotional mental and spiritual health of people who have concerns related to their substance use or are concerned for another person’s substance use” said MacDonald. “This may include reducing barriers that prevent people from becoming engaged in care and increasing options for recovery and treatment. The aim is not only to improve the health and well-being of individuals engaged in substance use but also to improve the quality of life for families neighbourhoods and communities affected by substance use.”
The Haliburton Fourcast office had 90 people seeking services from 2017 to 2018 while 487 people sought services in City of Kawartha Lakes and 437 people in Northumberland.
Fourcast offers community-based withdrawal management so a person can stay at home to go through withdrawal in a managed and safe way and also Hospital to Home services specific opioid case management services and group supports. Narcotics Anonymous and Alcoholics Anonymous are also in the region.
“The justice and enforcement pillar encompasses interventions that seek to strengthen community safety by responding to criminal activity and safety issues associated with the use manufacturing and sale of legal and illegal substances” said MacDonald. “This also includes social justice and enforcement efforts that address substance use and work with those struggling with addictions as well as other community leaders in the justice enforcement social and health sector to address shared challenges.”
The Good Samaritan Drug Overdose Act allows people who are witness to an overdose situation who may also be engaging in substance use to call EMS without the risk of being charged for simple possession if they are also in possession or engaging in substance use.
The full HKLN Community Priorities Report 2018 can be accessed online at www.hklndrugstrategy.ca or by emailing firstname.lastname@example.org.