The Strategy

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Algoma Community Health Insights

  • Serious mental health issues in Algoma include problematic substance use, self-harm and suicide
  • Rates of hospitalization due to mental health or addictions are continuing to rise in Algoma. Females in Algoma are more likely to be hospitalized than males Young people aged 15 to 24 are more likely to experience mental illness and/or substance use disorders than any other age group (APH, 2018)

Substance Use in Algoma

The Algoma Public Health Unit “Community Health Profile” provides a high-level snapshot of some of the substance use related issues in our community in Chapter 8: Substance Use & Mental Health.

  • The majority of Algoma residents report staying away from illicit drugs (APH, 2018)
  • Nearly 4 out of 10 Algoma residents have used an illicit drug in their lifetime (APH, 2018)
  • 4 out of 10 Algoma residents have used cannabis more than once in their lifetime (APH, 2018).
Used Cannabis More Than Once

0%

Used Any illicit Substance

0%

Used Cocaine

0%

Used Amphetimine or Speed

0%

Used Ecstacy

0%

Used Hallucinogens

0%

Used Solvents

0%

0%

Algoma Youth 12-19 Have Tried Cannabis

Youth Cannabis Use in Algoma

  • Algoma Youth are struggling with unhealthy behaviours such as smoking/vaping tobacco and cannabis. (APH, 2018).
  • 28.3% of Algoma youth aged 12 to 19 years old have tried cannabis. In Ontario overall, 22.9% of youth have tried cannabis (APH, 2018).

Algoma Substance Use Critical Insights

Ranked #8 in the top 15 highest number of opioid poisoning hospitalizations by census subdivision, Canada, 2017 (CIHI,2018).

Ranked #1 as the highest rate of opioid poisoning related emergency department visits compared in Ontario & Alberta with a population of 50,000 -99,999 (CIHI, 2018).

There were 22 deaths due to opioid overdoses in Algoma in 2017 (Public Health, 2018).

2017 Deaths per 100,000 for Algoma was 19.1% - Double the province rate of 8.9% (APH, 2018).

Substance Use During Pregnancy

6.1% of Algoma mothers use alcohol or drugs during pregnancy (APH, 2018). This is comparable to 4.3% of mothers in Ontario. Alcohol and drug use during a pregnancy can lead to fetal alcohol spectrum disorder (FASD) and other serious pregnancy and birth complications (APH, 2018).

1 in 4 Algoma mothers experienced a mental health challenge during a pregnancy or postpartum, most commonly anxiety and/or depression (APH, 2018). This is a higher proportion of mothers compared to Ontario (25.6%versus 15.8%).

Blood-Borne Infections Related to Substance Use

In 2017, there were 83 people diagnosed with Hepatitis C in Algoma, which was the highest number of new cases in a year since 2008 (APH, 2018).

During the 5-year period between 2013 and 2017, Algoma’s rate* of new hepatitis C cases was the highest in the Northeast and in Ontario (APH, 2018).

Algoma Opioid Response to Date

2003-2012

  • 2003 APH Methadone Maintenance *MMT
  • 2003 OATC Methadone Clinic
  • 2010 Leading Mentally Healthy Schools
  • 2012 NEP- Needle Exchange Program Expansion

2013-2014

  • Neighbourhood Resource Centre Education K-Gr 12 Supporting Minds Program
  • Launch Patch 4 Patch Fentanyl Program
  • 1st Annual Recovery Event

2015-2016

  • N’Mninoeyaa Mental Wellness & Minobimaadizing Services
  • Know Your Source Campaign
  • Portable Housing Initiative

2017

  • Road to Recovery Clinic
  • Needle Drop Bin Program
  • Good Samaritan Overdose Act
  • N’Mninoeyaa Mental Wellness & Minobimaadizing Services Expansion
  • Naloxone Distribution
  • Annual National Addictions Awareness Week
  • Youth Outreach Services Expansion
  • Community Homelessness Prevention Initiative (CHPI)
  • Naloxone Kits Expansion to Pharmacies
  • Indian Friendship Centre Addictions Fair

2018

  • “Rapid Access Addiction Medicine” RAAM Clinic
  • Naloxone Kits Expansion to Public Health - Further Education & Awareness
  • Cannabis Awareness
  • Needle Drop Bin Program Expansion
  • Methwatch
  • Safe Meth Smoking Kits
  • Indigenous Child Care + Housing Initiative
  • 1st Annual Silver Ribbon Gala
  • Project H.E.A.T.
  • SAH Proposed Level III Withdrawal Centre
  • Community Advocates for Provincial Federal Funding to Support Opioid Crisis
  • 5th Annual Recovery Event - Venue Change “Rockin’ Out For Recovery”
  • Healing Our Community Forum
  • Family Matters Conference
  • Harm Reduction Conference
  • Naloxone Town Meeting
  • w-5 Steeltown Down Interview

The Social Determinants of Health

The social determinants of health are often considered to be ‘at the heart’ of problematic substance use. These determinants are a broad range of personal, social, economic and environmental factors that influence health. Some of these include income, social status, employment, housing, education, childhood experiences, physical environment, social supports, access to health services, and culture. Along with the determinants of health, are multiple personal and environmental risk factors in life that can lead someone to engage in substance use behaviours.

Some examples of these risk factors include: exposure to problematic substance use in the home, exposure to abuse or trauma, adverse childhood experiences, poor academic achievement, loss of employment, coping ability, and availability of substances. Addressing these root causes of substance use can support healthy behaviours and help to reduce the possibility of substance use in our communities.

Protective Factors

Substance use prevention often focuses on strengthening protective factors, in order to reduce the individual and environmental risk factors.

Some examples include:

  • Building healthy family & peer relationships.
  • Providing supportive school & work environments.
  • Improving individual coping skills to manage stress, emotional trauma, etc.
  • Improving community connections & cultural supports.
Protective Factors

Risk Factors Related to Substance Use Disorders

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Trauma

Youth with a history of child welfare involvement are particularly at risk, as the initial transition out of foster care is associated with increased rates of problematic substance use (Health Canada, 2018).

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Indigenous People

Indigenous peoples are at greater risk of experiencing mental health and substance use issues due to multiple factors, including the intergenerational effects of residential schools, and other devastating consequences of colonization (Health Canada, 2018).

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Homelessness, Injury, Grief, Isolation

Older Canadians are vulnerable to problematic substance use due to unique risk factors such as chronic physical conditions, unexpected or forced retirements, social isolation, and bereavement (Health Canada, 2018).

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Gender

Men are more likely than women to use illicit substances and are less likely to seek support and assistance. Women tend to have lower levels of use than men, but they are more likely to develop related health problems. In 2017, the majority of accidental apparent opioid-related deaths occurred among males (78%) (Health Canada, 2018).

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Mental Health

People with a mental illness are twice as likely to experience problematic substance use compared to the general population (Health Canada, 2018).

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Youth

Youth aged 15 to 24 are more likely to experience substance use related harm, have the highest rates of problem substance use nationally, & illegal drug use last year. Young Adults 18 to 25 have the highest binge drinking rates (Health Canada, 2018).

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Homelessness

Those experiencing homelessness have a much higher rate of problematic substance use compared to the general Canadian population (Health Canada, 2018).

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Sexuality

Evidence shows that gay, lesbian and bisexual individuals are at higher risk of problematic substance use compared to heterosexual individuals. For example, gay, lesbian and bisexual adolescents have been found to be 2 to 4 times more likely to use substances and lesbian and gay adults have been shown to experience higher rates of heavy drinking, compared to their heterosexual counterparts (Health Canada, 2018).

Overarching Recommendations

In addition to opioid-specific interventions the Sault Ste. Marie & Area Drug Strategy recommends addressing Substance Use Disorders inclusive of opioids and Concurrent Disorders. Providing a comprehensive treatment plan specific to the needs of the client and capturing relevant data will further support the ongoing drug strategy initiatives ensuring sustainability by progressive adaptability.

Build Social Connections Using Protective Factors

  1. Advocate, support, and seek opportunities for policies and programs that address poverty, homelessness, housing, and other social determinants of health including both remote and Indigenous communities’ social determinants of health.
  2. Continue to acknowledge, partner, and support the front-line work of addiction, and mental health practitioners. The front-line workers are field experts and welcome the opportunity to share their valued insights captured through their work and any opportunities to evaluate the workload efficiency, and the potential to remove redundancies. Front-line worker informant interviews captured the cascading impact to their daily work responsibilities to include: the challenges of supporting clients without government identification, and the additional time necessary to begin the process, the time limitations with legal-aid and potential coordination to provide time sensitive help.
  3. Encourage participation of people with lived experience during development and implementation of programs, services and campaigns.
  4. Hours of Operation, location of services and transportation needs to access service were concerns captured through informant interviews. Asset mapping to reallocate services and hours should support optimal utilization for any person accessing services. Education should extend beyond the school and echo in the community through coaches, parents, social groups.
  5. Work to reduce stigma related to substance use and addictions.

Information and Communication Technologies (ICT)s

  1. Develop a comprehensive SSM & Area Drug Strategy website to manage the current resources, allow for a central point of access for information and updates, in addition to formalizing a robust information centre merging cross-sector community resources.
  2. Develop a mechanism for ongoing implementation and evaluation of the SSM & Area Drug Strategy.
  3. Explore the use of technology and innovative approaches in treatment, recovery and remission (e.g., online treatment programs, text messaging support services).
  4. Integrate "Information and Communication Technologies" (ICT). E-health (mobile health, tele-health) can play an important role in making services more accessible and person-centered as well as improving the operational systems of care efficiency. Individual, peer, and family services are available with some limitations. Smart recovery, good to talk and other web-based services are also examples of ICT.

Youth Support and Services

  1. Consider the development of a Youth Drug Strategy with a transitional bridge to adult care and engagement plan.
  2. Monitor funding opportunities as they become available with a keen focus on the provincially supported "Youth Wellness Hubs."

Treatment: Access and Equity

  1. Support service should be flexible and compassionate. Lack of money, transportation, phones/internet, hours of operation, and identification are barriers for some people accessing service. Not all people who access service have a cell phone, access to the internet, or identification to obtain a library card to use a public computer.
  2. Support workers at all levels should be providing resources and guidance using plain language free from field of expertise verbiage. Websites, treatment programs, and resource materials revisions should be accommodated within the community agencies. The end user experience is critical.

Prevention & Education

Prevention programs includes strategies and interventions that help to prevent the harmful use of substances. This includes:

  • Reducing individual, family, neighbourhood and community harm from substance use by addressing risk factors and enhancing protective factors.
  • Delaying the onset of first substance use and reducing the incidence (rate of new cases over a period) and prevalence (number of current cases at one time in a population) of problematic substance use and substance dependence.
  • Providing education regarding substance issues, resiliency, and the social determinants of health.

Examples of prevention include supporting the development of programs /curriculum to educate youth regarding the risks/benefits of substance use, offering family and individual mentor programs that build resilience and protective factors, and engaging in the development of municipal policies regarding selling and accessing substances (WGDSC, "Wellington Guelph Drug Strategy (WGDS) Strategic Plan 2017 - 2022," 2017).

Treatment & Recovery

The Treatment and Recovery Pillar supports the development of services and programs to provide options along a continuum of care to support the differing needs of individuals experiencing substance-related issues. These services vary in duration and intensity, ranging from abstinence-based programs to managed use programs, depending on individual client goals. This includes:

  • Providing trauma-informed and recovery oriented practice models of care.
  • Wraparound services from commencement through to remission.
  • Advocating for supportive housing services for people with substance dependency
  • Offering peer-based support services.
  • Building capacity within multiple sectors, including primary care and the justice system, for substance dependency treatment to be identified and offered in a timely and purposeful way (WGDSC, 2017).

Examples of Treatment and Recovery include supporting the development of both community and residential withdrawal management (“detox”) and offering a variety of both inpatient and outpatient treatment services such as community-delivered addiction medicine services, counselling, self-help programs and so on, to meet a wide-range of client needs.

Harm Reduction

The Harm Reduction Pillar provides a health-centred approach to substance use. The principles of harm reduction require that no harm is done to those suffering from substance addiction, and that the focus is on the physical, emotional and relational harms caused by problematic substance use, rather than substance use itself. Customized harm reduction interventions can meet the needs of individuals, families, organizations, or society. This includes:

  • Taking action to reduce the stigma associated with substance use and addiction
  • Building relationships with substance consumers so that the voice of lived experience contributes to all SSMADS projects
  • Advocating for health equity in the delivery of addiction services
  • Seeking opportunities to educate about, and advocate for, harm reduction approaches (clinical, policy-focused, legislative, etc.)

Examples of harm reduction include needle exchange programs, offering overdose education/prevention and safe consumption sites, educating prescribers about opioid substitution therapies, mobile clinics, outreach, and education about naloxone kits so that they are available to anyone who makes a request.

Justice & Enforcement

The Enforcement & Community Safety Pillar recognizes the need for peace, public order and safety. It works to reduce crime and community harms associated with substance use while protecting the vulnerable and preserving and protecting life. This pillar includes local police services as well as the broader criminal justice system of the courts, probation and parole, etc (WGDSC, 2017). This includes:

  • Encouraging working partnerships between police, justice, and social/health service providers to address shared challenges
  • Supporting individuals whose addiction has resulted in criminal activities to find options that can lead to relapse prevention and remission.
  • Developing effective pathways to support community members with substance issues transition safely out of the justice system ("WGDSC", 2017).

Examples of the Community Safety Pillar include Drug Treatment Court, the IMPACT team, advocating for an increase in the supply of Harm Reduction Supportive Housing, and developing case management models to support clients who have been released from custody.