Ontario Harm Reduction Conference April 30 to May 2, 2017 Toronto, Ontario

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1 Ontario Harm Reduction Conference April 30 to May 2, 2017 Toronto, Ontario Views expressed in the attached document do not necessarily represent those of the Ministry of Health and Long Term Care or those of Kingston Community Health Centres. If you have any questions related to the document, you are encouraged to contact the source.

2 From the ground up: preventing opioidrelated harms in Ontario

3 #OHRDP17 #OHRDP17

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6 Urgent? Proportional? Collaborative?

7 Our Vision and Mission Mobilizing the efforts of our community in preventing and reducing crime, victimization and fear of crime and fostering the well-being of everyone.

8 Community Development SECTORS Addictions Domestic Violence Response Focus Populations Regional Chair Community Services Family Support Municipalities Community Reps Community Health Centres Child Welfare WRPS Board Crime Prevention Council Public Health WRPS Chief Local Police Research & Evaluation Regional Council Restorative Justice GVI Warden Crown Attorney Legal Services Neighbourhood Development Mental Health Education Business

9 Our Values We believe in: in preventing crime by addressing the root causes in just and humane approaches to crime and its consequences that we are stronger working together that the community is part of the solution

10 Problematic Substance Use A significant risk factor for crime, fear of crime and victimization

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12 The offender of tomorrow is often the vulnerable child of today

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14 Not for Public Circulation: MDSCNO Only Volkow, Frieden, et al. (2014). Medication-assisted therapies- Tackling the opioid-overdose epidemic. N Engl J Med ;

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16 Pharma research, production and marketing Regulatory Approvals Government and Private Sector Drug Benefit Plans

17 Rx by physicians, dentists etc. Dispensed by pharmacists Consumed as Rx'd and not by patients

18 Personal Third Sector Public Sector Private Sector

19 Ontario drug-related Deaths 1 death / 8 hours 66% involve opioids 735 opioid-related deaths 1 death / 12 hours 28% involve fentanyl

20 Source: Figure produced by the Waterloo Region Crime Prevention Council using data from the Office of the Chief Coroner of Ontario and the Ontario Ministry of Transportation

21 Urgent? Proportional? Collaborative? SARS: 44 in Canada Anaphylaxis: 92 in Ontario in 25 years Ontario roadways: 481 in 2014 Ontario opioid deaths: 674 in 2014 Total opioid deaths : > 7,000

22 Ontario Hydromorph Contin (Purdue Pharma) 1.6million Rx in 2014, up 60% since 2011 MDSCNO 2015

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24 Bootleg Fentanyls Black market pills and powder Uncertain dosage Lethal at very small doses

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29 2008

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32 Oxy to Oxy 2: Impacts and Recommendations Community Forum June 11, 2012 Second Informal Summary Report

33 Regional agencies see sharp rise in heroin use, overdoses Addicts' lack of access to OxyContin blamed for troubling increase Overdose Drug Tuesday September 11, 2012 Chemistry major almost died after taking KITCHENER An aspiring pharmacist Mother who lost son to overdose advocates for access to life-saving drug Police investigate possible heroin link to death at Hamilton-Wentworth Detention Centre Published on Wednesday September 12, 2012 Alexander Nino Gheciu Hamilton police are investigating a possible heroin connection to the death of an inmate at the Hamilton-Wentworth Detention Centre whose body was found Wednesday morning at 6 a.m. Police issued a public warning after at least five people, including three in the jail, experienced medical emergencies in a 24-hour span stemming from use of what was thought to be heroin OxyContin may have to pursue another replaced career after his by explosion of girlfriend almost died of a drug overdose. small-town heroin use Heroin use may be to blame for six recent deaths, police say WATERLOO REGION Six people may have died from heroin overdoses in recent months, Drug as use that of the drug combats increases in overdose the area, Waterloo symptom Regional Police say. can save lives, experts say Dianne Wood, Record staff, Mon Sep Toronto naloxone program reduces drug overdoses among addicts Toronto Star, September 9, 2012 A unique program that puts the power to stop a potentially fatal overdose into the hands of addicts has revived at least 40 people since it was introduced a year ago, Toronto public health officials say. I have just sorrow and fear : Father talks about son s fatal heroin overdose D'Amato: Cold turkey cure for OxyContin abuse gives little support to addicts By Luisa D'Amato Overdose leads to possession charge

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36 Prescription for Life: Improved Management of Accidental Opioid Overdose Emergencies via Naloxone June 1, 2015

37 November 2015 : 80 Signatories

38 April: 234 Signatories

39 WRCPC - OACP

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44 Number of Opioid-related Overdose Deaths in Waterloo Region Year Decedents * No data First Three Months of 2017** 20** Data c/o Office of the Chief Coroner of Ontario * Preliminary data c/o Office of the Chief Coroner of Ontario ** Number of suspected opioid-related overdose deaths c/o Waterloo Region Police Services Chart c/o WRCPC 2017

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48 Rate Rates of Opioid Overdose Deaths, Sales, and Treatment Admissions, United States, Opioid Sales KG/10,000 Opioid Deaths/100,000 Opioid Treatment Admissions/10, Year CDC. MMWR Updated with 2009 mortality and 2010 treatment admission data.

49 Crime-Substance Links Limited ability of criminal justice system to reduce illicit drug supply and demand (CPC 2005) Drug market crackdowns typically increase violence (BC Centre for Excellence in HIV/Aids)

50 FUNDING FOR CANADA S NATIONAL ANTI-DRUG STRATEGY,

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53 If you don't know where you are going, pretty much any road will get you there

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55 Strategic Framework Prevention Harm Reduction Recovery and Rehabilitation Enforcement and Justice Integration

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57 PREVENTION No mass disease or disorder afflicting humankind has ever been eliminated by attempts at treating individuals... prevention is an approach to reducing the future incidence of a condition through proactive efforts aimed at groups, or even a whole society. George Albee (1990)

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64 Heroin was commercially developed by Bayer Pharmaceutical and was marketed for several medicinal uses including cough suppression. Circa

65 The Harms of Heroin Harm Pharmacology Phenomenology euphoria/sedation withdrawal constipation flushing overdose viral infections bacterial infection s violence illegal activity social disintegration X X X X X X X X X X

66 Heroin: A Compound Active Ingredient + Physical Additives (sugar, starch, puddle water, etc.) + Societal Additives (crime, prison, disease, overdose, etc.)

67 Remove the Societal Additives Remove the Physical Additives Heroin What would be left?

68 Heroin Diacetylmorphine dangerous street drug medicine

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71 Prescription for Life #Rx4Life

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77 $2.2 billion / year Personal Third Sector Public Sector Private Sector

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82 Canadian Paediatric Surveillance Program Canadian Nosocomial Infection Surveillance Program Canadian Measles/Rubella Surveillance System Canadian Integrated Program for Antimicrobial Resistance Surveillance Canadian Congenital Anomalies Surveillance Network Canada Communicable Disease Report Canadian Chronic Disease Surveillance System Blood Safety Contribution Program Enhanced National Invasive Pneumococcal Disease Surveillance System FluWatch HIV/AIDS Surveillance IMPACT Injury Surveillance On-Line Lyme Disease Enhanced Surveillance (LDES) System Measles And Rubella Surveillance (MARS) Pilot National Enhanced Invasive Meningococcal Disease (eimd) Surveillance System National Enteric Surveillance Program Notifiable Disease Surveillance On-Line Respiratory Virus Detections/Isolations in Canada STI (Sexually Transmitted Infections) Surveillance and Epidemiology Tuberculosis Prevention and Control Surveillance Reports West Nile Virus Surveillance Information etc

83 Number of Opioid-related Overdose Deaths in Waterloo Region Year Decedents * No data First Three Months of 2017** 20** Data c/o Office of the Chief Coroner of Ontario * Preliminary data c/o Office of the Chief Coroner of Ontario ** Number of suspected opioid-related overdose deaths c/o Waterloo Region Police Services Chart c/o WRCPC 2017

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88 May 18, 2016

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92 Urgent? Proportional? Collaborative? SARS: 44 in Canada Anaphylaxis: 92 in Ontario in 25 years Ontario roadways: 481 in 2014 Ontario opioid deaths: 674 in 2014 Total opioid deaths : > 7,000

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94 For an average time contact: Michael Parkinson Waterloo Region Crime Prevention