"Roadmap for Change"

Roadmap FOR Change

Towards a Safe and Healthy Community

Revised March 2011 THUNDER BAY DRUG STRATEGY STEERING COMMITTEE MEMBERS

CHAIR Ken Allan Dan Mitchell Thunder Bay District Health Unit Superior Court of Justice Councillor Rebecca Johnson City of Thunder Bay Dr. Donald Auger Dr. Paul Mulzer Dilico Anishinabek Family Care St. Joseph’s Care Group PREVENTION PILLAR, CHAIR Alice Bellavance Rose Pittis Jennifer McFarlane Brain Injury Services of Dilico Anishinabek Family Care Thunder Bay District Health Unit Northern Ontario Dr. Gordon Porter Detective Sergeant Randy Belluz Thunder Bay Regional Health HOUSING PILLAR, CHAIR Ontario Provincial Police Sciences Centre Cal Rankin Elaine Burton Tracy Randall-Peters Shelter House Ontario Court of Justice Teen Challenge

ENFORCEMENT PILLAR, CHAIR John Crilly Jim Restall Community Member North West Local Health Inspector Scott Smith Integration Network Thunder Bay Police Service John De Faveri Thunder Bay Catholic District Cindee Richardson TREATMENT PILLAR, CHAIR School Board Alpha Court

Abi Sprakes John Dixon Robert Richardson Thunder Bay Counselling Centre Dilico Anishinabek Family Care The Children’s Aid Society of the District of Thunder Bay Bernice Dubec HARM REDUCTION PILLAR, CHAIR Community Member Cathi Siemieniuk Maureen Twigg Lakehead Public Schools Bill Fawcett Thunder Bay District Health Unit Community Member Janet Sillman St. Joseph’s Care Group, DRUG STRATEGY COORDINATOR Stephanie Hendrickson Thunder Bay Regional Health Community Member Sciences Centre Patty Hajdu Thunder Bay District Health Unit Chief Robert Herman Vince Simon Thunder Bay Police Service Ka-Na-Chi-Hih Specialized Solvent Abuse Treatment Centre Chief Robin Jones Nishnawbe-Aski Police Service Norm Sponchia Bay & Algoma Business Association Kim Karioja Centre for Addiction Wendy Talbot and Mental Health NorWest Community Health Centres

Lawrence Korhonen Councillor Joe Virdiramo AIDS Thunder Bay City of Thunder Bay, Thunder Bay District Board of Health Brenda Letourneau Community Member

Inspector Peter Loree Ontario Provincial Police

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy ACKNOWLEDGEMENTS

Great thanks are due to the The work of creating this drug Finally, we gratefully acknowledge committed leaders that guided the strategy greatly benefited from the the financial and practical support development of this strategy as Lakehead University Social Work received from the Health Canada members of the Steering Committee, program and Lee Brownlee, who Drug Strategy Community Initiatives and in particular, Councillor Rebecca supported HBSW students to fulfil a team of Ranee Chambers, Francine Johnson, for chairing the committee portion of their study requirements Taite and Chito Diorico for with an open mind and an open with this project. Through their demonstrating continued interest heart. placements, Stephanie Hendrickson and concern for the community of and Heather Koller have contributed Thunder Bay. Thanks also to the pillar to many aspects of the strategy sub-commitee chairpersons development. Jen McFarlane, Inspector Scott Production of this report has been Smith, Abi Sprakes, Maureen Twigg Many people reviewed the drug made possible through a financial and Cal Rankin who drew together strategy at numerous points contribution from Health Canada. professionals from their respective providing clear and detailed The views expressed herein do not fields to debate, research and finalize feedback, including Lynda Fraser, necessarily represent the views of the actions contained in this report. Ena DePeuter, John Dixon, Inspector Health Canada. Scott Smith, Michael Sobota, Anne Ostrom and Reggie Caverson.

It is a testament to the enthusiasm of the community that over 350 individual citizens from all walks of life were willing to openly share their thoughts and concerns about drug and alcohol use in Thunder Bay.

Thanks also are due to the Municipal Drug Strategy Coordinators of Ontario, who have offered advice, support and guidance at all stages of the project.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy PILLAR SUB-COMMITTEE REPRESENTATION

AIDS Thunder Bay Indian and Northern Service Canada Affairs Canada Alpha Court Shelter House John Howard Society Brain Injury Services of Northern Shkoday Abinojiiwak Obimiwedoon Ontario (BISNO) Justice Canada Michael Sobota Canadian Mental Health Association Kinne-awaya Legal Clinic Superior Points Harm Reduction Centre for Addiction and Mental Lakehead Public Schools Program Health (CAMH) Lakehead Social Planning Council Three C’s Centre Children’s Centre Thunder Bay Lakehead University Health Services The Children’s Aid Society of the Confederation College District of Thunder Bay March of Dimes Creighton Youth Services District of Thunder Bay Nishnawbe-Aski Police Service Social Services Administration Rebekah Courtney Board (TBDSSAB) NorWest Community Health Centres Dilico Anishinabek Family Services Thunder Bay District Health Unit Ontario Addiction Treatment Centres Dilico Anishinabek Family Services Thunder Bay Catholic District Ontario Native Women’s Association School Board Youth Outreach Program Ontario Works Thunder Bay Counselling Centre Drug Awareness Committee of Ontario Provincial Police (OPP) Thunder Bay Thunder Bay Police Service PACE Thunder Bay Everest College Thunder Bay Regional Health Sciences Centre (TBRHSC) Getting Appropriate Personal and Royal Canadian Mounted Professional Supports (GAPPS) Police (RCMP) Integrated Support Program Services Unit

Royal Canadian Mounted Police (RCMP) O Division Aboriginal Policing Services

St. Joseph’s Care Group Sister Margaret Smith Centre

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy Letter of Transmittal REBECCA JOHNSON, CHAIR

The Thunder Bay Drug Strategy The Steering Committee debated forthright observations, creative Steering Committee is pleased the actions contained in this ideas and solutions have formed to present A Roadmap for report over several meetings. We the backbone of the actions Change: Towards a Safe and didn’t always agree on each and contained in this report. Finally, Healthy Community. every action. However, we believe I would like to recognize the this strategy balances both public coordinator of the project, This report represents a health and public order interests. Patty Hajdu, for her efforts in lengthy process of dialogue conducting the research and and documentation. After The key action in this report is writing and editing this report. obtaining a federal grant from to ensure that the Thunder Bay the Health Canada Drug Strategy Drug Strategy has oversight Our task was to create a Community Initiatives Fund, a from the City of Thunder Bay to community-specific drug strategy community steering group was coordinate implementation of the to address harms associated formed with members from a actions. We are proposing that with substance use in Thunder broad spectrum of the community the City of Thunder Bay place Bay. I am confident that we have including representatives from the Drug Strategy with the Crime created a clear roadmap for organizations who work with Prevention Council to ensure moving forward to address this people affected by substance use. that the strategy is used by the complex issue. community in a comprehensive The Steering Committee began manner. Sincerely, by developing a vision, values and terms of reference. They I would like to take this conducted broad research with opportunity to thank each a wide range of stakeholders to member of the Thunder Bay Drug Rebecca Johnson reach the goal of developing a Strategy Steering Committee for community-based and community- being so generous with your time, Drug Strategy Steering informed plan. energy and ideas for this initiative. Committee Chair Steering Committee members on behalf of the Drug Strategy The Thunder Bay Drug Strategy consistently demonstrated their Steering Committee provides a clear road map to dedication to the project through reduce the harms associated their willingness to meet often with substance use for all citizens and regularly, make suggestions, of Thunder Bay through well- provide contacts, and offer thought out and evidence-based thoughtful feedback to make actions that support eight key the report concise, readable, results stated by citizens as ideal useful and meaningful for our conditions for a healthy city. It community. I also thank all the reflects the wisdom, innovation, community members and local hope and insight from a variety professionals who participated of citizens, community leaders in the focus groups and strategy and others that work on or are sessions. Your honesty and affected by substance use issues.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy THUNDER BAY DRUG STRATEGY: CONTENTS

DRUG STRATEGY VISION, MISSION AND VALUES...... 07

WHY DOES THUNDER BAY NEED A DRUG STRATEGY?...... 08

THE FACTS ON SUBSTANCE USE IN THUNDER BAY...... 10

WHO IS MOST AT RISK FOR ADDICTION?...... 13

THE PROCESS OF CREATING THE THUNDER BAY DRUG STRATEGY...... 15

EIGHT KEY RESULTS...... 15

Result One: The community of Thunder Bay implements actions to reduce harms associated with substance use...... 16 Historic Finn Hall © Lake Superior Visits

Result Two: Thunder Bay is an inclusive city with accessible and appropriate services for its diverse population...... 17

Result Three: all people in Thunder Bay have access to safe, appropriate and affordable housing...... 18

Result Four: Federal and provincial governments set public policy and determine spending priorities that support optimal health for all citizens...... 20

Result Five: all children and youth have optimal success and health...... 23

Result Six: people who use substances have optimal physical, emotional and mental health...... 25

Result Seven: People with substance addictions can get well...... 29

Result Eight: Community members are safe in their neighbourhoods...... 31

CONCLUSION...... 33

APPENDIX I: GLOSSARY...... 34

APPENDIX II: REFERENCES...... 36

APPENDIX III: SUMMARY OF RESULTS AND ACTIONS...... 45

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy THE THUNDER BAY DRUG STRATEGY VISION, MISSION AND VALUES

VISION GUIDING PRINCIPLES To improve the health, safety and well-being of all citizens by working COLLABORATIVE REALISTIC together to reduce the harm caused by substance use. By working together as agencies, We will seek ways to more effectively legislators and individuals, we will use existing community resources, have greater success in preventing services, and processes focused MISSION and addressing substance use- on substance use issues, programs To create a drug strategy for the related issues. and solutions. We will actively seek City of Thunder Bay that reflects the more resources to address gaps that needs and strengths of its citizens. EVIDENCE-BASED cannot be addressed with current The strategy will focus on humane resources. approaches that address the causes While we respect the legal, international and effects of harm associated with and Canadian laws governing the use RESPECTFUL substance use. and distribution of legal and illegal substances, we also work towards We respect the equality, dignity, policies that reflect more reliance on rights and choices of people, science, and less on ideology. families, neighbourhoods and communities. Everyone is important.

INNOVATIVE We are open to new and creative ideas that have promising features “… you take little steps, that’s how you get to and fit within our goals. the top of the mountain.” COMPASSIONATE Focus Group Community Participant Everyone has a story. We value compassion and thoughtful reflection.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy WHY DOES THUNDER BAY NEED A DRUG STRATEGY?

Thunder Bay struggles with higher than average rates of drinking, binge drinking, violent crime, and various chronic diseases and injuries, along with other social and medical problems. Of recent concern is the rise in prescription opiate use by citizens in Thunder Bay, contributing to this city having one of the busiest needle exchange programs in the province, per capita.

City police have appealed to the must stay in a program for several community for new solutions weeks. However, residential to address the issue of public treatment is only one option. People intoxication as managing over 3,000 can also receive treatment that is arrests per year1 causes slower community-based, but community- response times for citizens that need based alternatives available in police services for other reasons. Thunder Bay are not sufficient to provide services to our culturally Treatment for addictions is diverse population. In some cases, traditionally thought of as no suitable treatment programming residential, meaning that the person exists for emerging and specific needs. Many Thunder Bay service providers have indicated that the numbers of individuals seeking “…people have very little hope and they treatment is increasing, without a replace the hope with… alcohol and drugs… corresponding increase in resources. plain and simple.”

Focus Group Community Participant 1 Smith, S. (2010) Thunder Bay Police. Presentation to Drug Strategy Steering Committee, (March 2010)

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy In terms of residential treatment, most options currently available in Thunder Bay are short-term and “It’s really a community problem and the abstinence-based, meaning clients community has to come together and figure are expected to not use substances at all while in treatment. This is it out.” common not only in Thunder Bay, Focus Group Key Informant but across the province, despite the fact that abstinence-based models are not effective for many people with substance addictions. afterwards. Caregivers are in a People trying to recover from particularly difficult position because substance addiction while navigating they often don’t have a safe person the complex social welfare, housing to care for their children while orralee and health systems often cannot attending a residential treatment aul M meet the needs of each provider to program or accessing community-

qualify for help. Things that many of based treatment programs. ark © P us take for granted create significant Treatment providers express obstacles, such as not having enough frustration that people who are able money to pay for the medical exam to access and complete treatment required to enter some residential often return to an environment that treatment programs (not covered by makes recovery very difficult. Without OHIP); not having a safe place to stay

a healthy and supportive environment, Kaministiquia River Heritage P after leaving Balmoral Withdrawal access to safe housing and sustained Management Services (detox) and services, including aftercare, clients before residential treatment begins are at an increased risk for relapse. (sometimes as long as five weeks The synergy of these strategies away); or having to choose between Despite these issues, the outlook for indicates that the community of keeping an apartment or going to Thunder Bay is hopeful. Through the Thunder Bay is on the verge of residential treatment, knowing that a process of developing this strategy, a revitalization that will result in suitable place might not be available a sense of true concern for our city improved health, safety and wellness was evident. With a strong capacity for all of its citizens. to respond to challenges, a deep reservoir of genuine good will, existing partnerships and a diversity of service providers, we are well poised to move forward.

Complementing the Thunder Bay Drug Strategy will be the development of the City’s Crime Prevention Council Strategy.

© Lake Superior Visits Preventing crime and substance use problems through focused programming and services is more effective, sustainable and affordable than incarceration, detention centres, crackdowns and arrests.

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The Facts on Substance Use in Thunder Bay

Many people use substances such as alcohol, drugs, caffeine or tobacco every day. However, some people exceed safe usage and experience legal, health and social problems as a result.

DRUG-RELATED CHARGES trafficking. However, opiate-based prescription drug trafficking is a According to Statistics Canada, the eltonen growing concern. From April 2008 total number of police-reported ki P to March 2009, over 44,000 grams drug offences in Thunder Bay was of prescription narcotics were ark © A 355 in 2007. A large percentage seized in Thunder Bay.3 Prescription of arrests was related to cannabis arina P drug trafficking poses a particular

M (254/355), followed by cocaine challenge to law enforcement (54/355). Heroin accounted for officials trying to contain the illicit only one arrest, and other drugs use of a legal substance. accounted for 46 out of the 355 offences.2 Local police officials point out that illicit drug trafficking is correlated Law enforcement officials in Thunder to violent crime (e.g. competition Bay assert that possession and sale between rival dealers, robberies to of marijuana and cocaine continue to obtain funds for purchases) and also be local trends in drug to property crimes (e.g. break and enters).4

2 dauvergne, Mia. (2009). Statistics Canada. 4 Chief of Police Bob Herman. (25 Mar., 2010). TBT News 3 Inspector with Community Police Services. (Mar., 2010). Addictions and the Impact on Policing and the Community.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy INTOXICATED ARRESTS • oxyContin use is higher for MENTAL HEALTH AND Thunder Bay youth (3.1% ADDICTIONS AT THE THUNDER The arrest rate in Thunder Bay reporting use vs. 1.6% of their BAY REGIONAL HEALTH SCIENCES for intoxicated persons is 2,608 provincial counterparts) CENTRE (TBRHSC) per 100,000, the highest in all of Ontario. It is the leading reason for • Cocaine use is also higher for Mental Health and behavioural arrest in Thunder Bay and comprises Thunder Bay youth (4.1% vs. disorders accounted for 3.5% about half of all arrests. The amount 2.6%) of all ED visits, with the largest of time spent by enforcement proportion of those visits (45%) professionals on the issue of public Substance-related mental health due to psychoactive substance use, intoxication significantly affects the disorders have also shown to compared with 27% provincially. The time available to address other core be higher in our region for both ED sees an average of eight people policing functions.5 adolescent (14 to 19) males (33% as per day due to alcohol or substance compared to 21% provincially) and use or overdose (2830 annual visits). females (18% as compared to 12% THUNDER BAY YOUTH AND This data excludes people with other provincially). SUBSTANCE USE primary medical needs that may be as a result of substance use, such as According to the 2009 Northwestern HEALTH CARE COSTS IN ONTARIO injuries and some chronic diseases. Ontario Student Drug Use Survey, Thunder Bay youth have Besides the indirect costs related 18% of mothers who deliver at a significantly higher incidence of to lost productivity, the single TBRHSC report using substance in substance use as compared to youth largest direct cost associated with pregnancy (narcotics, methadone, in other parts of Ontario.6 substance use is direct health prescription drugs, alcohol). care costs (followed by direct law Neonatal Abstinence Syndrome • Cannabis use among youth in enforcement costs).7 Health care (NAS) is a condition of newborns Thunder Bay is significantly costs in Ontario attributed to who develop an addiction in utero higher than the provincial alcohol, which include intentional/ related to their mother’s substance average (32.6% vs. 25.6%) unintentional injury, chronic disease, use. Infants born with NAS require infectious disease and addiction, high levels of care and account • alcohol use among Thunder are $1.16 billion and health care for 20% of the admissions to the Bay youth is also higher costs attributed to illegal drugs are Neonatal Intensive Care Unit.10 (64.4% compared to 58.2% $373 million.8 Alcohol is said to be provincially), as is the Ontario’s number one drug problem incidence of binge-drinking and alcohol-related injury accounts (29.9%) compared to the rest for $440 million of health care costs of the province (24.7%) in Ontario each year.9

5 Chief of Police Bob Herman. (2010). Presentation to 7 Rehm et al. (2002). The Costs of Substance Abuse 9 Ibid. City Council. in Canada. 10 Thunder Bay Regional Health Sciences Centre. 6 oSDUHS Report (2009) and NWOSDUS (2009). 8 Ibid. (March 2011) Environmental Scan Summary, Strategic Percents are based on substances used in the past Planning Engagement Sessions, March 2011. year (2009).

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy THE EFFECT OF SUBSTANCE SISTER MARGARET SMITH CENTRE USE ON LOCAL SOCIAL SERVICE (SMSC) AGENCIES “It’s pills all over… In 2009/2010, a total of 3,390 individuals received services through I got a lot of friends THE CHILDREN’S AID SOCIETY OF a range of programs crossing the THE DISTRICT OF THUNDER BAY that are on pills…” continuum of care located at Sister (CAS) Margaret Smith Centre and Balmoral Focus Group Key Informant In 2009, 75 to 80% of the 700 Centre of St. Joseph’s Care Group. referrals for assessments for Adults aged 25-54 accounted for protection services were related the majority of clients served at to substance use issues, equating 65%; youth 24 years of age and to between 500 and 560 families. under accounted for 25% of the The CAS estimates that nearly 200 clients served; and older adults children are in care and living apart represented 10%.13 from their families due to substance use, either as a primary or secondary LOCAL ADDICTIONS & MENTAL issue.11 HEALTH TREATMENT SERVICES

Data from 2008/09 shows that the THUNDER BAY COUNSELLING highest percentage age groups CENTRE (TBCC) of clients accessing community In 2009, a total of 787 individuals substance use treatment were had an alcohol and drug assessment 16-24 (25%) and 35-44 years (24%).14 at TBCC (with 119 of these for youth The leading presenting problem under the age of 18). In that same substances were alcohol (78%), year, 467 individuals participated cannabis (36%), cocaine (24%), in community treatment and 282 and prescription opioids (23%).15 individuals were involved in intensive Most clients were self-referred to case management services.12 treatment services (35%), 20% were referred from the legal system, and less than one percent were referred from a hospital.16

11 Information provided by Children’s Aid Society. 13 Information provided by Sister Margaret Smith 15 Ibid. (Feb., 2010). Centre. (Mar., 2010). 16 Ibid. 12 Information provided by Thunder Bay Counselling 14 profile Communities Local Data. (31 Mar., Centre. (Feb., 2010). 2010). Mental Health and Addictions Quality Improvement Forum: Toronto.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy WHO IS MOST AT RISK FOR ADDICTION?

Some people use substances in ways that can cause harm during certain periods in their life such as binge drinking during the college or university years, heavy drinking during a period of unemployment and experimentation with substances during the adolescent years. Others use substances regularly without health or social problems (a beer or two after work, a joint on the weekend). Still others become addicted and use substances daily even when their substance use causes damage to themselves, their families and their communities.

The risk of addiction is related to a and also with other poor health person’s unique circumstances and is outcomes including obesity, some a complex interplay between biology, chronic diseases and cancers, coronary life experiences and social conditions artery disease and chronic pulmonary such as poverty, access to education disease, even after controlling for or experiences of racism. The or without conventional risk factors following are some groups that are at like smoking, air pollution or high higher risk for addictions. cholesterol.17

PEOPLE WHO HAVE HAD ADVERSE YOUTH WHO ARE NOT IN THE CHILDHOOD EXPERIENCES MAINSTREAM

A history of trauma, abuse, alcoholism Youth who have a history of trauma, or drug addiction of a parent, neglect or are in care with the child along with other adverse childhood welfare system or youth justice experiences (ACE) is clearly linked to system are at increased risk to a greater risk of substance addiction, develop addictions. Youth who

17 Felliti, V et. al. (1998) Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy have behavioural problems early PEOPLE WITH MENTAL HEALTH on, frequently skip school or have DISORDERS caregivers who are frequent substance People with mental health disorders users or heavy drinkers are more at are at greater risk for substance use, risk. and have more difficulty accessing services. Sometimes treatment for PEOPLE WHO ARE HOMELESS each issue is provided separately Homeless people face extreme and the person is expected to deal hardship, chronic pain, mental illness, with their substance use problem little or no family support, and have before receiving treatment for their very poor chances of finding and mental health condition. Professionals keeping housing; all contributing are beginning to understand that factors to an increased risk of substance use can be a form of self- addiction. medicating behaviour and services are evolving to address the complex needs of those with concurrent disorders. SEX TRADE WORKERS

Many sex trade workers have PEOPLE WITH WORKPLACE addictions issues that are largely the INJURIES OR OLDER PEOPLE motivating factor for their continued street work. Longstanding injuries, the aches of aging and the pain associated with some chronic diseases can contribute ABORIGINAL PEOPLE to the risk of increased substance use Aboriginal people experience higher by older adults. Social isolation is also rates of addiction stemming from a large factor in the risk of substance intergenerational trauma inflicted use problems for this population. through the process of colonization which is compounded by inadequate services, inequity in resources and discriminatory public policy.

“… drinking is way more highly accepted in the community. If you don’t drink in Thunder Bay, then you’re kind of like an outcast… it’s almost unacceptable if you don’t engage in drinking, at any age.”

Focus Group Key Informant

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THE PROCESS OF CREATING THE THUNDER BAY DRUG STRATEGY

In 2009, city councillors and community leaders from various sectors formed a Steering Committee chaired by Councillor Rebecca Johnson and supported by the Thunder Bay District Health Unit. The Steering Committee held 26 focus groups and three strategy sessions to hear from a wide range of citizens and local professionals about the issues of substance use in Thunder Bay and what solutions should be considered.

Modifying the four pillar approach and/or reduce substance use, support used in other communities, five pillars people to recover from substance were struck to address the issues of addictions, and create an environment prevention, treatment, harm reduction, that increases the health and safety of © Lake Superior Visits enforcement and housing. Each pillar all citizens. met several times to analyze the data gathered from the community Using a framework called results-based and determine potential actions for accountability, data collected through change. The proposed actions were community consultations and strategy studied using the international body sessions was analyzed to determine of research to ensure that they were conditions of well-being that would supported by evidence to have a be present if progress was made positive effect in reducing harms in reducing substance use-related associated with substance use. Taken problems in Thunder Bay. These together, the actions have the potential results are intentionally broad in their to improve the health and well-being vision and include indicators which can of the community of Thunder Bay. be monitored to measure progress towards the stated results. Each result has suggested evidence-based actions EIGHT KEY RESULTS arising from the community, steering The Thunder Bay Drug Strategy committee and pillars measures that proposes eight key areas of work to can contribute to achieving the desired improve our local capacity to prevent key results.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy RESULT ONE

THE COMMUNITY OF THUNDER Community drug strategies that are successful in reducing harm associated BAY IMPLEMENTS ACTIONS TO with substance use have staff dedicated to the task of ensuring that strategy REDUCE HARMS ASSOCIATED recommendations are implemented to ensure lasting change. WITH SUBSTANCE USE.

A coordinated plan will ensure culture-specific research, we are that the collaborative approach well situated to attract professionals recommended by the Drug Strategy to conduct leading research on Steering Committee is implemented, addictions from a northern centre. sustained and supports the goal of reducing substance use related harm INDICATORS OF PROGRESS: in Thunder Bay. eltonen ki P • Ratified Drug Strategy and implementation plan

• City of Thunder Bay staff dedicated to a drug strategy implementation plan Thunder Bay North © A

• drug Strategy included in the renewed City strategic plan

ACTIONS TO ACHIEVE RESULT ONE: The strategic plan for the City of Thunder Bay is due for renewal in 1.1 Create a comprehensive Drug 2011 and there is room to enhance Strategy implementation plan. recommendations and strategies that focus on creating safe 1.2 Create a permanent, neighbourhoods, reducing crime and full-time Drug Strategy racism, and improving opportunities Coordinator position at the for citizens to participate in City of Thunder Bay. community life. The City of Thunder 1.3 Ensure the Drug Strategy is Bay has an ideal structure to help included in the City strategic integrate current and new efforts to plan. improve quality of life for its citizens. 1.4 Seek funding partnerships Thunder Bay is the hub of and opportunities to Northwestern Ontario and provides initiate a Centre of Excellence specialized services to citizens from for Addiction Studies in many northern communities. With Thunder Bay. our local expertise, large body of knowledge related to northern issues and opportunity to incorporate

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy RESULT TWO

THUNDER BAY IS AN INCLUSIVE Boards that have representation from the people they are designed to serve are in CITY WITH ACCESSIBLE AND the position to create more effective and relevant services. By encouraging local APPROPRIATE SERVICES FOR ITS boards and governing structures to reflect the diversity of our population, access, DIVERSE POPULATION. relevancy and program effectiveness can all be increased.

Services are often designed and delivered without input from the people they are intended to serve. Mainstream services must work with • Extent of formal partnerships The result can be programs that Aboriginal communities to improve between the Aboriginal are difficult to access, that don’t quality and access for Aboriginal population and broader sector meet the needs of the population, people. Organizations must make and contribute to stigma or a commitment to hiring Aboriginal ACTIONS TO ACHIEVE discrimination. people, creating a culturally respectful RESULT TWO: and safe environment for staff and clients, and ensuring services are 2.1 Support equitable Aboriginal available that respect differing representation on local boards approaches and needs. The Aboriginal and governing bodies. medicine wheel that espouses a holistic 2.2 Support people who use approach to health is of value to all substances, youth, and people citizens. By incorporating Aboriginal from minority groups to people in the design and delivery of participate on local boards and services, our population stands to governing bodies. receive services that are increasingly comprehensive. 2.3 Support organizations in Thunder Bay to provide culturally safe and appropriate services. INDICATORS OF PROGRESS: 2.4 Create a think-tank of social • Local boards and leadership scientists and Aboriginal leaders structures with equitable to seek solutions and to address Aboriginal, youth or minority severe social problems rooted in representation colonialism and systemic racism.

• Extent of culturally safe and 2.5 Support the work of Diversity engaging services and programs Thunder Bay, the Advisory Committee on Anti-Racism • percentage of organizations with and other groups that address strategic priority/goals relating inclusion to reduce racism, to Aboriginal engagement discrimination and stereotyping.

“We have people who are Aboriginal going to different agencies and there might be one staff person that’s Aboriginal… It’s been tough…” Focus Group Key Informant

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy RESULT THREE

ALL PEOPLE IN THUNDER Safe and affordable housing not only helps people with addictions to BAY HAVE ACCESS TO SAFE, recover, it also helps caregivers provide stable and healthy environments APPROPRIATE AND AFFORDABLE for their children. HOUSING. In Thunder Bay, wait lists for social women fleeing abusive situations In a recent study commissioned housing are long, especially for and those using substances or by AIDS Thunder Bay, over 25% of single person units. Without social alcohol are not welcome. Women substance users contacted said they housing, many people must accept leaving correctional institutions also did not have stable housing. They transient, unsafe or unhealthy have very few options for housing reported staying with friends, at housing, and resort to temporary and supports. hotels or rooming houses, or living solutions such as couch-surfing at on the street.18 friends’ apartments and staying in Thunder Bay has no designated stand-alone shelter beds for youth Solutions must be found that rooming houses or shelters. and no youth-specific supportive improve housing for people Thunder Bay has a very high or transitional housing programs. affected by substance use. It is not number of arrests each year for People under 18 years who receive possible for people to recover from public intoxication. Some cities social assistance must designate an addictions and live healthy lives have turned to managed alcohol adult trustee to receive money on without stable, safe and affordable programs to address this problem. their behalf. Many face economic housing. These programs provide people abuse at the hands of their trustees, who are chronically intoxicated affecting their ability to maintain and homeless a place to stay that secure housing. tolerates or provides small doses of regular alcohol in exchange for improvements in life skills. Creating services that provides consistent, safe shelter for chronically intoxicated people could save over one million dollars annually in policing costs alone.19 Significant resources could also be redirected for other first response providers, withdrawal management services and the emergency department services at TBRHSC.

Few supportive housing options exist for women in Thunder Bay and those available tend to have stringent eligibility criteria. Most facilities are only available for

18 Sobota, M., Tranter, D., Hudson, K. (2010) 19 Chief of Police Bob Herman. (2010). Presentation Engaging Populations at Risk Strengthening to City Council. Connections

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy Housing is one of the most critical factors in a person’s health outlook. People that have affordable, safe “I’m thinking there’s something wrong with this and appropriate housing have fewer picture. I see a young girl, 19 years old and she health problems, including those related to substance use. has no place to go. She’s leaving… she can’t go home because her mother’s an addict… what’s INDICATORS OF PROGRESS: she supposed to do?” • Length of social housing waiting lists Focus Group Treatment Participant

• public intoxication arrest rate

• Number of transitional housing spaces 3.4 Request the District of 3.8 Invest in community Thunder Bay Social Services revitalization models that • Number of supportive Board perform an audit to incorporate a mixed-housing housing units distinguish the services and approach. housing options required for • Shelter space usage rates men, women and youth and 3.9 Streamline the social housing develop an action plan to application. • Number of people designated improve the entire housing as homeless 3.10 Implement a shelter that continuum from shelter to accepts intoxicated clients. • Number of housing units independent living, based on designated for women and community needs. 3.11 Support the development of youth a Managed Alcohol Program 3.5 Increase the availability of residence. housing projects to support ACTIONS TO ACHIEVE people with mental health and 3.12 Implement a storage facility RESULT THREE: addiction problems. program to safeguard personal property for people entering 3.1 advocate for the development 3.6 Improve the range of housing institutional systems or who of a Federal Housing Strategy options available for women are otherwise unhoused. that includes funding for social and youth, including safe and housing. sufficient emergency shelter, 3.13 Create a personal identification case management services and 3.2 Increase basic housing stock (ID) storage program for transitional housing services. through innovation, including vulnerable populations. the possibility of retrofitting 3.7 allocate sustainable 3.14 Create housing options that unused buildings. operational funding to local follow the Housing First emergency shelters based on 3.3 Establish a working group philosophy. adherence to shelter standards to access funding for that promote acceptance and social housing from the inclusion of persons who use Homelessness Partnership substances. Strategy (HPS).

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy RESULT FOUR

FEDERAL AND PROVINCIAL In 2007, the Canada Drug Strategy was changed to focus primarily on GOVERNMENTS SET PUBLIC enforcement. The revised strategy removes alcohol as substance of concern, POLICY AND DETERMINE has a reduced emphasis on prevention, does not support harm reduction as a SPENDING PRIORITIES THAT pillar, and only addresses harms associated with illicit drugs. With the majority of SUPPORT OPTIMAL HEALTH FOR federal expenditures related to substance use directed to the enforcement sector, ALL CITIZENS. programs that work to prevent or reduce harms associated with all substance use are not adequately supported. The actions that we take in Thunder Bay are constrained by the policies, As further evidence that Canada is allows judges to take into account laws and spending priorities of our increasingly relying on enforcement the circumstances of the offence. federal and provincial governments. to manage substance use issues, the Criminalization for substance use By unifying our voice and advocating federal government is in the process offenses has numerous deleterious as a community, we have increased of attempting to pass legislation results including higher rates of capacity to encourage federal and that creates mandatory minimum infectious disease, lack of access to provincial policy and expenditures sentencing for substance related treatment and recovery services and that are based on evidence. offenses. Bill S-10: An act to amend a criminal record resulting in poor the Controlled Drugs and Substances employment outcomes. Act, is currently before the Senate having passed the first reading. The body of evidence surrounding Several of the 14 amendments drug law enforcement initiatives and have the capacity to criminalize an the connection with violent crime increased number of substance users. demonstrates that enforcement The bill would limit judicial discretion initiatives that rely on arrest and in sentencing that removal of traffickers have a direct correlation with the increase of drug- related violence.20

Social assistance rates are not adequate for people to maintain stable housing, access nutritious food and meet basic needs, putting children and families at increased risk of developing substance use problems. To make progress on preventing harms resulting from

substance use, conditions must be created that support Canadians to live healthy, safe, and productive lives.

20 International Centre for Science in Drug Policy. (2010).

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy INDICATORS OF PROGRESS: 4.2 Support the province to release 4.6 Urge the governments of Canada an electronic prescription and Ontario to expand and • Social assistance rates monitoring program (PMP) and increase the availability of harm • Length of treatment wait lists encourage access to training for reduction options in prisons. all prescribers. • Canada Drug Strategy priorities 4.7 advocate for clear and scientific and components 4.3 advocate for increased judicial guidelines for prescription appointments for the District opiates that delineate personal • Federal legislation related to of Thunder Bay to expand use from possession with the substance use the capacity of our local legal intent to traffic. system to offer drug court • Government spending on diversion programs. 4.8 Urge the Government of prevention, treatment, harm Canada to increase efforts to reduction and enforcement 4.4 Call on the federal government educate the Canadian public to withdraw or repeal bills about the legal consequences of • Treatment availability for or legislation that introduces trafficking offences. incarcerated people mandatory minimum sentencing related to possession of 4.9 advocate for publicly funded • Harm reduction services in substances. and insured coverage for correctional facilities alternatives to pain medication 4.5 advocate for the Federal such as massage therapy and • oHIP schedule of allowable Government of Canada to take physiotherapy. treatments a leadership role at national and 4.10 Urge the Province of Ontario to • Sentencing outcomes for international levels to advocate maintain addiction as an eligible trafficking offenses for evidence-based reform of current drug laws, thereby disability under ODSP. • ontario Disability Support allowing municipalities to better 4.11 advocate for the ODSP Program (ODSP) policies respond to drug issues at the application and adjudication local level. • Fetal Alcohol Spectrum Disorder process to be simplified and (FASD) strategies updated.

ACTIONS TO ACHIEVE RESULT FOUR:

4.1 advocate for change at all three levels of government for increased funding for “You know, stable housing and stable food addiction treatment services, and sustainable programming security, income security and a stable support for children and youth that group can help you in your recovery process supports positive social and behavioural development. and your transition process. That is, I think, a really serious gap in this community.”

Focus Group Key Informant

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy

THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy 4.23 advocate for the Governments of Canada and Ontario to “We need to see police going and talking to adequately fund accessible and people… and when kids are having struggles, culturally appropriate treatment and aftercare services for instead of turning to drugs and alcohol, remote northern communities. maybe they’ll turn to the community officers 4.24 advocate to the Province of because they know them.” Ontario to increase funding for the Ontario Works Addiction Focus Group Treatment Participant Services Initiative (ASI) (delivered through the District of Thunder Bay Social Services Adminstration Board) to ensure 4.12 advocate for an increase in 4.18 advocate to the Province of that program capacity meets program/case management Ontario to improve access to community need. support for ODSP applicants methadone through suggestions and recipients. found in the Methadone 4.25 advocate for a review of the Maintenance Task Force Report, parameters of the Northern 4.13 advocate for a review of ODSP such as supporting the licensing Travel Grant to allow for policies that make sustained of nurse practitioners and multiple visits for assessment housing difficult for ODSP reducing barriers for physicians. and treatment of substance recipients, such as the policy of addiction. paying rent in arrears. 4.19 advocate for an increase in social assistance rates from the 4.26 advocate to the Province of 4.14 advocate that the Province of Province of Ontario that reflects Ontario to fund a separate Ontario support physicians to actual cost of living, especially entity to provide medically assist clients of Ontario Works in northern and remote necessary inter-facility transfer to the Ontario Disability communities. transportation for people with Support Program. non-life threatening mental 4.20 advocate for equivalent housing health and addictions issues. 4.15 Call for increased access to allowances through Ontario essential local data about Works and the Ontario Disability 4.27 advocate for changes to the unintentional drug overdose Support Program. Northern Travel Grant so that rates from the provincial and funding may be provided to federal governments. 4.21 advocate for increased alternative transportation emergency utility relief (and providers to provide medically 4.16 advocate to the Province of funding for programs that necessary inter-facility Ontario that responsibility provide relief) for low-income transportation for people with for the FASD population is citizens from the Province of non-life threatening mental coordinated by one central Ontario. health and addictions issues. ministry. 4.22 advocate to the Province of 4.17 Urge the Province of Ontario Ontario for improved primary to revise ODSP eligibility care access for people who use guidelines for the diagnosis of substances. FASD to rely on indicators other than IQ test scores.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy RESULT FIVE

ALL CHILDREN AND YOUTH HAVE By keeping children and youth in school, connected to their neighbourhoods, OPTIMAL SUCCESS AND HEALTH. participating in various activities and engaged with their families, the foundation necessary for every young person to succeed can be improved. Children and youth are more likely to avoid substance use problems if they Children with learning and/or are supported to achieve academic behavioural problems are at risk success, participate in recreational of not completing their education, activities and have healthy and having social problems and becoming involved caregivers. isolated from their school and community. Timely access to diagnosis and support for children with learning and behavioural disabilities can help ensure every child experiences success.

Youth that are found to be involved in substance use at school are frequently suspended. Youth who are alienated from their school community are at greater risk of not completing high school. Diversions to suspension that draw upon a restorative justice framework can improve academic outcomes for young people. INDICATORS OF PROGRESS: • Graduation rates A comprehensive youth strategy for Thunder Bay can assist in • Northwestern Ontario developing localized programs Student Drug Use Survey and neighbourhood initiatives. The (NWOSDUS) data on youth strategy should consider factors substance use rates that increase participation such as outreach, transportation, employment • ontario Student Drug Use options and stipends. Health Survey (Northern Ontario) mental health indicators

“…we see that youth in college don’t know what they’re getting into…they think things like, ‘it’s a prescription it’s got to be okay.’ ”

Focus Group Key Informant

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy 5.9 Encourage a review and enhancement of the Ontario “Not only addiction education… that of course curriculum to incorporate is a key part, but I mean more programs that strength-based approaches that emphasize resiliency, utilize focus on skill development and resiliency skills training and provide arts building, and teaching compassion and peer- programming. to-peer mentorship-type of programs so that 5.10 Increase use of local referral and help resources by educators and kids are taught from a young age.” other professionals.

Focus Group Key Informant 5.11 Encourage schools and school boards to develop evidence- based alcohol and substance use policies that utilize a • School Health Action, Planning 5.2 Conduct an environmental restorative justice framework. and Evaluation System (SHAPES) scan to identify resources and data on youth health indicators gaps in parenting supports and 5.12 Conduct an environmental scan programming for families. of programming and campaigns • School suspension and designed for post-secondary expulsion rates 5.3 provide caregivers with access students. to current and evidence-based • School readiness data information and education 5.13 Improve the range of treatment about how to delay or prevent options for youth to expand • Number of children in care their children from using and enhance off-site, school, • Length of children’s mental substances. community-based and early health wait lists onset approaches. 5.4 Increase access to early • post-secondary admission rates identification and support 5.14 Create a working group to for children with learning and investigate the provision of • Youth employment rates developmental concerns to harm reduction services for improve educational outcomes. youth. • Youth suicide rates 5.5 develop a community youth 5.15 Examine the feasibility of • Child/youth poverty rates strategy for incorporation creating a pool of available and into the City of Thunder Bay screened trustees for youth ACTIONS TO ACHIEVE Strategic Plan. that access social assistance RESULT FIVE: allowances. 5.6 Sustain mentorship programs 5.1 Support school boards through long-term funding 5.16 Create an inter-agency and families to begin drug commitments. neonatal substance use working education based on supporting group to develop strategies positive social and behavioural 5.7 Examine strategies to increase for supporting pregnant development at earlier ages. workplace placements for young women, new mothers who use people without post-secondary substances and their infants to education. improve family health outcomes.

5.8 Increase the use of school space by the community at large.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy RESULT SIX

PEOPLE WHO USE SUBSTANCES Supporting people who use substances to improve their situation can increase HAVE OPTIMAL PHYSICAL, the health and safety of our entire community. EMOTIONAL AND MENTAL HEALTH. Substance addiction is now widely Where a person lives, works and accepted as a chronic, reoccurring plays has a great influence on their condition, much like diabetes or overall health. Some people are heart disease. Like other conditions, born into families with education, whether a person develops a steady and well-paying jobs, financial substance addiction is determined resources, and safe and healthy by physiology, social environment homes. Many others face fewer and personal behaviours. Treating opportunities, less support and addiction is as complex as treating a numerous obstacles that stand in the disease such as diabetes. It requires way of improving their lives. access to medical treatment and an environment that supports the person to make healthier choices. People with chronic disease often relapse and so do people with substance addictions. Part of what makes seeking treatment for substance addiction so difficult People who use substances are at all is the way addiction is viewed in stages in the recovery process. Some comparison with other chronic are not ready or able to reduce their conditions. use or stop using. Some people are ready to make changes, but don’t Poverty is a pressing issue for many know how to begin. Some people citizens in Thunder Bay. Changes in have support and are recovering. industry and economy have led to Others are not using substances at poor job options for many people all or are using far less than they did previously well-employed in sectors at previous times in their lives. such as the pulp and paper industry. Poverty is clearly linked with substance use-related problems.

“Just because I’m an addict doesn’t mean I’m not a person.”

Focus Group Treatment Participant

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy

THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy “I’m an emotional person and when I come here to get help, I expect to get help and not to get treated even worse because that just drives you right back to the street. Because you want someone to care a little bit. If we’re caring about ourselves and we want to make a difference, then help us...”

Focus Group Key Participant

Many people who are poor, in ill- such as sharing supplies, leading INDICATORS OF PROGRESS: health, and facing mental health and to increased risk of contracting • Re-treatment rates addictions problems have a hard infectious diseases. time fitting in with their communities. • Client satisfaction rates There are numerous practical and Between 35 and 50% of intravenous psychological barriers that prevent drug users have experienced a • overdose rates them from getting the services non-fatal overdose in their lifetime. and support they need. Addiction Thunder Bay requires a new • HIV/AIDS/HEP-C is not well understood and myths, approach to reduce the deaths incidence rates stereotypes and realities often shape and disability that occur as a result • Number of re-offending how the community understands of opiate overdose. One of the occurrences substance use. The resulting stigma barriers that prevent drug users from reaching out for emergency help is can affect a person’s ability to recover. • North West LHIN (Local Health the fear of arrest for the possession Integration Network) self-rate Harm reduction services are available of illicit substances. Medical amnesty health and substance use rates in Thunder Bay on a limited basis and programs provide assurance for for specific types of substance use. drug users that if a friend or loved • Reduction in public intoxication Needle exchange hours of operation one is overdosing, they can phone arrest rates can pose problems for people for emergency assistance and not seeking supplies, and access to safer be searched and/or charged for inhalation kits or supplies other than possession as a result of calling for needles is limited. If people are not help. Medical amnesty programs able to access clean supplies easily, it increase the likelihood that someone can result in riskier usage practices, will survive an accidental overdose.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy

THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy ACTIONS TO ACHIEVE 6.5 Encourage community services 6.9 advocate that publicly RESULT SIX: and programs to review their funded and insured policies to reduce barriers to insurance cover the cost of 6.1 Compile current community service for people receiving suboxone as a treatment programs and services that methadone maintenance option for detoxification and provide system navigators, therapy (MMT). harm reduction for opiate case management providers, dependency. and street outreach positions. 6.6 Urge the College of Physicians and Surgeons of Ontario to 6.10 Improve access to safer 6.2 Expand crisis response hold methadone providers inhalation kits. services to address various accountable to adhere to types of addiction-related the Methadone Maintenance 6.11 Examine the feasibility of crises. Guidelines (2005). installing vending machines that supply syringes and 6.3 Ensure adequate primary care 6.7 provide support to people offer expanded disposal sites providers are available in the receiving MMT to become throughout the city. community. self-advocates for proper 6.12 Establish a volunteer base to 6.4 advocate for better discharge treatment and medical care. support the distribution and planning for all people leaving 6.8 Form a working group to pick-up of syringes. correctional facilities and other examine the implementation institutions. of overdose prevention such as the provision of Naloxone, overdose education and institution of a medical amnesty program.

“Once you’re labelled an addict... when you... try to get better, people still look at you as that same way. It’s too much of a small town, you know? It’s a small city.”

Focus Group Key Participant

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy “They wanted me to go for counselling. I think it should just be more accessible to low income people. I don’t have a car and I have a daughter. I don’t have someone to watch my kid. ”

Focus Group Key Participant

6.13 advocate and support access 6.18 Educate the community about to specialized emergency methadone maintenance services for people with mental therapy (MMT) and the health and addictions issues. principles of harm reduction.

6.14 Form a working group to 6.19 Enhance education and determine the fit and feasibility placement requirements for of a supervised consumption students involved in social site. services, enforcement and health-related programs to 6.15 Conduct an environmental include addictions training and scan of programming and outreach experience, including services for seniors at-risk of or intravenous (IV) drug use living with addictions. education.

6.16 Support the development 6.20 promote basic training about of local drug user groups harm reduction, addictions and to provide opportunity IV drug use to professionals for information exchange, that interact with community 6.22 Expand and diversify peer support and personal members. empowerment. needle exchange service by 6.21 Increase ‘one-stop’ access advocating for and supporting 6.17 Encourage and assist the to primary care, basic needle exchange services at business/commerce sector preventative health services, primary health care clinics, to increase opportunities harm reduction services and hospitals, pharmacies and non- for sustainable employment addictions and mental health profit groups. for people recovering from screening system entry points addictions. at accessible or mobile sites.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy

THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy RESULT SEVEN

PEOPLE WITH SUBSTANCE Many people believe that by attending a course of residential treatment, ADDICTIONS CAN GET WELL. a person with an addiction can be cured. However, just like other chronic conditions, treatment is only one part of the recovery process. The goal Assisting people to get healthy behind residential treatment is first to stabilize the individual, and then to help and back to work can increase our the person develop new skills and connect to supportive resources. municipal tax-base and improve our local economic climate. Many people recovering from substance addictions Currently, people addicted to seek employment opportunities that opiates in Thunder Bay have few will help build more stable lives for treatment choices. A full range of themselves and their families. People options is required for the treatment recovering from substance addictions of opiate addiction that includes need opportunities to improve short-term detoxification, tapering, their skills and reintegrate into their in-patient tapering, medical community. detoxification and home-based, assisted detoxification.

Many programs offer services that only partially meet the needs of vulnerable populations with addictions issues. Barriers such as hours of operation, location and types of services available create gaps in service, making the most vulnerable people in our community unable to receive services at all. Childcare is a significant barrier for caregivers attempting to access Upon entering the addictions and complete both residential treatment system, a person should and community-based treatment. be able to easily access other Providers and funders must examine services. Methods such as the how to better integrate children and Integrated Consent to Service, families into the treatment process currently used by some addiction by helping clients access specialized service providers in the community, childcare provisions. need to be expanded and widely implemented to include other Addiction does not affect a person service providers. Increased separately from the rest of their integration of the social service family. Services must be available for sector of Thunder Bay will improve the entire family to receive support. our community’s capacity to deal Treatment that addresses the family with non-physical emergencies and as a whole reduces the risk and relieve the pressure on the Thunder incidence of relapse. Bay Regional Health Sciences Centre emergency department and local enforcement agencies.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy

THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy Support for clients needs to be ACTIONS TO ACHIEVE 7.7 provide treatment options to practical and provide real value RESULT SEVEN: people in custody that include to the community. Treatment methadone maintenance 7.1 Increase the range of treatment outcome measures and consistent therapy, elements of relapse models available, including data collection practices must be prevention and withdrawal longer term residential created and supported to ensure symptom management. treatment, day programs, that resources are spent in ways that enhanced pre-and post- produce the best outcomes. 7.8 Increase the range of treatment supports, culturally detoxification services offered relevant programming and in the city to include hospital- INDICATORS OF PROGRESS: harm reduction or moderation based, community/home • Re-treatment rates approaches. detoxification and youth specific services. • Client exit satisfaction rates 7.2 Support the initiation of a kinship drug and alcohol 7.9 Create a common, shared • Length of treatment wait lists treatment model. process that integrates treatment, social services 7.3 Increase the availability of • access to Methadone and other systems to suitable childcare initiatives to Maintenance Therapy Services facilitate access and provide support caregivers to access more collaborative case • Wait time to assessment and treatment services. management. treatment 7.4 Improve evaluation of treatment 7.10 Request that the Northwest • Reduction in emergency protocols and outcomes. LHIN in partnership with department visits for mental Northwestern Ontario service health and behavourial 7.5 offer pre- and post-treatment providers review the Mental disorders related to substance medical examinations onsite at Health and Addictions system use treatment centres. in Northwestern Ontario for 7.6 advocate to the Province of improved system access and Ontario to ensure full OHIP navigation. coverage for medical exams and administrative costs required to 7.11 Establish a resource pool access treatment programs. of local service providers to connect primary health care with addiction/mental health services.

“When people are discharged, who’s following up on them to make sure that they have the supports – housing, nutrition, that they’re seeing their doctor on a regular basis, and they’re getting integrated into employment or back into education to resume the rest of their lives?”

Focus Group Key Informant

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy RESULT EIGHT

COMMUNITY MEMBERS ARE SAFE Some members of Thunder Bay report that their neighbourhoods experience IN THEIR NEIGHBOURHOODS. high levels of loitering, discarded needles, and prostitution, creating atmospheres of fear and distrust. When people feel their neighbourhoods are Crime and substance use are closely unsafe, they are less likely to use their environments, encourage their children related. Because many commonly to play outside and become increasingly disconnected from community. used drugs are illicit or used illicitly, a criminal element exists to address the supply of these substances to Currently, 50% of all arrests made by meet the demand. Some addicted the Thunder Bay Police Service are users may turn to crimes such for public intoxication. This makes as break and entering, theft or the arrest, transport, lodging and prostitution to purchase the drugs observation of intoxicated persons they use. one of the Police Service’s primary reactive functions. Reducing arrests related to public intoxication will increase time and money available to invest in community policing and crime prevention efforts.

Although the likelihood of contracting an infectious disease from a publicly discarded needle is very slim, needles discarded on streets or in public parks create an atmosphere of fear. Publicly discarded needles also make the Thunder Bay has historically invested community appear dirty and unsafe in community policing initiatives. In for visiting tourists. Citizens unsure recent years, investment in crime of what to do when they find a prevention has been reduced, and needle often call 911 and police more effort and resources have been are sent to pick up the syringe, spent on arrests, dealing with public using precious enforcement time intoxication and reactive policing. better spent elsewhere. By reducing Community policing is an effective the number of publicly discarded model in crime prevention, especially needles, fear and misuse of public as it relates to substance use. With resources will also go down. a strong and connected police presence, community members feel safe, crime is deterred and relationships are built.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy INDICATORS OF PROGRESS: 8.4 provide more needle disposal 8.11 Ensure programming and bins at key sites, including not- treatment options are in place • Violent crime rate for-profit housing complexes. for remote Northern Ontario • perception of safety communities prior to any 8.5 Re-invest in community supply reduction efforts. • property crime rate policing to renew focus on crime prevention. 8.12 provide public education about • Number of police calls for substances, substance use, and needle disposal 8.6 Strike a working committee legislation about substance to investigate the option of use including impaired driving • Number of impaired driving enhancing police presence and promote local helping charges (alcohol and/or drug) with a volunteer corps. resources.

• publicly discarded needle 8.7 Support the Crime Prevention 8.13 Examine the feasibility of counts Council in efforts to increase partnership programs that personal and community match clinical resource teams • public disorder rates responsibility to reduce crime. with enforcement teams to improve health outcomes for 8.8 Investigate the instatement of ACTIONS TO ACHIEVE people who use substances. a Neighbourhood Watch type RESULT EIGHT: of program. 8.1 Encourage users to increase their responsibility to safely 8.9 Train more enforcement dispose of needles through the professionals as Drug use of incentives. Recognition Experts (DREs) to improve detection of impaired- 8.2 Increase education to the by-drug driving. community about how to safely dispose of needles. 8.10 Improve sentencing outcomes for prescription drug 8.3 Examine a shared costs model trafficking through increased for the recovery and disposal judiciary education. of collected needles.

“…because of what’s going on in our neighbourhood, nobody will come and shop any more…reputable businesses have closed their doors because of what’s going on around them.”

Focus Group Community Participant

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy © North of Superior Tourism

THUNDER BAY DRUG STRATEGY: CONCLUSION

Many citizens say they are eager to youth. They are based on direct see progress made on the identified knowledge, local needs, and best issues and strategies. People are practice evidence from around the ready to roll up their sleeves and world. Taken together, they have the take action. This report gives the capacity to dramatically improve the community of Thunder Bay a place lives of not only our generation, but to start. of those to come.

The actions contained in this document come from the true experts in our community: citizens and leaders, professionals and

“I think if you have a very vibrant community that’s full of really cool ideas and really interesting things going on and lots of good synergy, you’ll keep young people here and it will just be a viable, really wonderful place to grow and to live.”

Focus Group Community Participant

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Appendix I: Glossary

CULTURALLY APPROPRIATE CULTURALLY SAFE DRUG TREATMENT COURT

Conforming to a culture’s acceptable Services that are respectful of Court supervised treatment for expressions and standards nationality, culture, age, sex, political people addicted to substances who of behaviour and thoughts. and religious beliefs. Cultural safety have been charged with possession Interventions and educational involves recognizing the caregiver is of, or trafficking in, small amounts materials are more likely to be the bearer of his or her own culture of substances, property offences culturally appropriate when and attitudes, and that caregivers committed to support their drug representatives of the intended consciously or unconsciously exercise use, or with prostitution-related target audience are involved in power over patients. offences. Clients participate in a planning, developing and pilot structured outpatient program testing them. DISCRIMINATION with extensive case management services. Upon successful completion A sociological term referring to the CULTURALLY RELEVANT of the program, clients receive a treatment taken toward or against non-custodial sentence, rather than Recognizing, understanding and an individual of a certain group in incarceration. applying attitudes and practices consideration based solely on class that are sensitive to and appropriate or category. Discrimination is the HARM REDUCTION for people with diverse cultural actual of behaviour towards another socioeconomic and educational group. It involves excluding or Any program or policy designed to backgrounds, and persons of all restricting members of one group reduce drug-related harm regardless ages, genders, health status, sexual from opportunities that are available of individual substance use practices. orientations and abilities. to other groups.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy HOUSING FIRST PHILOSOPHY OPIATES STIMULANTS

A philosophy based on the assertion A drug derived from the opium Uppers; drugs that produce a that housing is a basic right, and poppy (morphine, heroin, opium, temporary increase in activity or should not be denied to anyone, codeine, etc) or a synthetic efficiency of an organism or any of even if they are using alcohol or equivalent. its parts (cocaine, amphetamine, substances in a problematic way. methamphetamine, etc). OPIOIDS INTERGENERATIONAL TRAUMA SUBSTANCE USE Refers to the entire class of drugs The effects of harms that have that bind to the opiate receptors in The use or ingestion of a substance occurred but have not been resolved the brain (which includes opiates). or drug, including alcohol. and have been transmitted from one generation to the next. PRESCRIPTION DIVERSION SYSTEMIC RACISM

Selling or giving away prescribed Any form of racism occurring MEDICAL AMNESTY medication. specifically within institutions such Laws or acts protecting from liability as public government bodies, those who choose to help others RESTORATIVE JUSTICE private business corporations, and who are injured or ill. These laws FRAMEWORK universities (public and private). are intended to reduce bystanders’ This type of racism is impersonal, hesitation to assist, for fear of being An approach to justice that unconscious, unintentional, and sued or prosecuted for unintentional addresses the needs of both the hidden. The basis of systemic racism injury or wrongful death. victims and the offenders, requiring is the consequence (not the intent) of offenders to take an active role in the seemingly neutral rules, policies or process by assuming responsibility METHADONE procedures. for their actions. A synthetic opiate substitute used to SYSTEM NAVIGATORS treat opioid addiction. Methadone SCHOOL-BASED DIVERSION is sometimes used for pain PROGRAMS Someone who works with people management. to help them navigate the complex Alternatives to student suspensions. social service system of services. The intent of these programs is to Neonatal Abstinence keep the student engaged and more Syndrome (NAS) likely to succeed at school. A condition of newborns who develop an addiction in utero related STIGMA to their mother’s substance use. An attribute, behaviour or reputation which is socially discrediting in a particular way: it causes an individual to be mentally classified by others in an undesirable, rejected stereotype rather than in an accepted, normal one.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy ick Spooner hoto: D cKay & the Nor’Westers P t. M M

Appendix II: References

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy Vigilante, K. C., Flynn, M. M., Wallace, A. J. (2005). Early Wilkenson, R., Marmot, M. (2003). Affleck, P. C., Stunkle, J., identification of learning Social Determinants of Health: Merriman, N. A., Flanigan, T. disorders help children succeed. The Solid Facts, (2nd Ed.) .World P.,…Rich, J. D. (1999). Journal of Pediatric Annals, 34(4), 328-9. Health Organization: Geneva. Women’s Health, 8(3), 409-415. DOI:10.1089/jwh.1999.8.409. Weisner, C., Mertens, J., World Health Organization (n.d.) von Hirsch, A., Bottoms, A. Parthasarathy, S., Moore, C., Lu, Psychosocial Rehabilitation – A E., Burney, E., Wikstrom, P-O. Y. (2001). Integrating Primary Consensus Statement. Division of (1999). Criminal Deterrence and Medical Care With Addiction Mental Health and Prevention of Sentence Severity: An Analysis of Treatment - A Randomized Substance Abuse. WHO/MNH/ Recent Research. Oxford: Hart Controlled Trial. The Journal MND/96.2., Geneva. Retrieved Publishing. of the American Medical from http://whqlibdoc.who. Association, 286, 1715-1723. int/hq/1996/WHO_MNH_MND_ Waddell, C., McEwan, K., Shepherd, Retrieved from http://jama. 96.2.pdf C., Offord, D., Hua, J. (2005). A ama-assn.org/cgi/content/ Public Health Strategy to Improve full/286/14/1715 the Mental Health of Canadian Children. Canadian Journal of Werb, D., Wood, E., Montaner, J., Psychiatry, 50(4), 226-233. Kerr, T., Elliott, R., Fischer, B. (2007). Drug treatment courts Wagner, K. D., Valente, T. W., in Canada: an evidence-based Casanova, M., Partovi, S. M., review. HIV/AIDS Policy & Law Mendenhall, B. M., Hundley, Review, 12(2/3). Retrieved J. H.,…Unger, J. B. (2010). from http://www.aidslaw. Evaluation of an overdose ca/publications/interfaces/ prevention and response training downloadFile.php?ref=1278 programme for injection drug users in the Skid Row area of Los Wellesley Institute. (2010). Angeles, CA. The International Precarious Housing in Canada. Journal of Drug Policy, 21(3), 186- Retrieved from http://www. 193. wellesleyinstitute.com/news/ affordable-housing-news/new- report-precarious-housing-in- canada-2010/

White, W. L.(2009). The mobilization of community resources to support long term addiction recovery. Journal of Substance Abuse Treatment, 36( 2),146–158.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy

APPENDIX III: SUMMARY OF RESULTS AND ACTIONS

RESULT ONE: 1.4 Seek funding partnerships 2.3 Support organizations in and opportunities to Thunder Bay to provide The community of Thunder Bay initiate a Centre of Excellence culturally safe and appropriate implements actions to reduce harms for Addiction Studies in services. associated with substance use. Thunder Bay. 2.4 Create a think-tank of social ACTIONS TO ACHIEVE scientists and Aboriginal RESULT TWO: RESULT ONE: leaders to seek solutions Thunder Bay is an inclusive city with and to address severe social 1.1 Create a comprehensive Drug accessible and appropriate services problems rooted in colonialism Strategy implementation plan. for its diverse population. and systemic racism.

1.2 Create a permanent, 2.5 Support the work of Diversity full-time Drug Strategy ACTIONS TO ACHIEVE Thunder Bay, the Advisory Coordinator position at the RESULT TWO: Committee on Anti-Racism City of Thunder Bay. 2.1 Support equitable Aboriginal and other groups that address inclusion to reduce 1.3 Ensure the Drug Strategy is representation on local boards racism, discrimination and included in the City strategic and governing bodies. stereotyping in Thunder Bay. plan. 2.2 Support people who use substances, youth, and people from minority groups to participate on local boards and governing bodies.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy

THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy RESULT THREE: 3.5 Increase the availability of RESULT FOUR: housing projects to support All people in Thunder Bay have Federal and provincial governments people with mental health and access to safe, appropriate and set public policy and determine addiction problems. affordable housing. spending priorities that support 3.6 Improve the range of housing optimal health for all citizens. ACTIONS TO ACHIEVE options available for women RESULT THREE: and youth, including safe and ACTIONS TO ACHIEVE sufficient emergency shelter, RESULT FOUR: 3.1 advocate for the development case management services and of a Federal Housing Strategy transitional housing services. 4.1 advocate for change at all that includes funding for social three levels of government housing. 3.7 allocate sustainable for increased funding for operational funding to local addiction treatment services, 3.2 Increase basic housing stock emergency shelters based on and sustainable programming through innovation, including adherence to shelter standards for children and youth that the possibility of retrofitting that promote acceptance and supports positive social and unused buildings. inclusion of persons who use behavioural development. substances. 3.3 Establish a working group 4.2 Support the province to access funding for 3.8 Invest in community to release an electronic social housing from the revitalization models that prescription monitoring Homelessness Partnership incorporate a mixed-housing program (PMP) and encourage Strategy (HPS). approach. access to training for all prescribers. 3.4 Request the District of 3.9 Streamline the social housing Thunder Bay Social Services application. 4.3 advocate for increased judicial Board perform an audit to appointments for the District distinguish the services and 3.10 Implement a shelter that of Thunder Bay to expand housing options required for accepts intoxicated clients. the capacity of our local legal men, women and youth and system to offer drug court 3.11 Support the development of develop an action plan to diversion programs. improve the entire housing a Managed Alcohol Program continuum from shelter to residence. independent living, based on 3.12 Implement a storage facility community needs. program to safeguard personal property for people entering institutional systems or who are otherwise unhoused.

3.13 Create a personal identification (ID) storage program for vulnerable populations.

3.14 Create housing options that follow the Housing First philosophy.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy

THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy 4.4 Call on the federal government 4.8 Urge the Government of 4.16 advocate to the Province of to withdraw or repeal bills Canada to increase efforts to Ontario that responsibility or legislation that introduces educate the Canadian public for the FASD population is mandatory minimum about the legal consequences coordinated by one central sentencing related to of trafficking offences. ministry. possession of substances. 4.9 advocate for publicly funded 4.17 Urge the Province of Ontario 4.5 advocate for the Federal and insured coverage for to revise ODSP eligibility Government of Canada to take alternatives to pain medication guidelines for the diagnosis a leadership role at national such as massage therapy and of FASD to rely on indicators and international levels to physiotherapy. other than IQ test scores. advocate for evidence-based reform of current drug laws, 4.10 Urge the Province of Ontario 4.18 advocate to the Province of thereby allowing municipalities to maintain addiction as an Ontario to improve access to better respond to drug eligible disability under ODSP. to methadone through issues at the local level. suggestions found in the 4.11 advocate for the ODSP Methadone Maintenance 4.6 Urge the governments of application and adjudication Task Force Report, such as Canada and Ontario to expand process to be simplified and supporting the licensing and increase the availability updated. of nurse practitioners of harm reduction options in and reducing barriers for 4.12 advocate for an increase in prisons. physicians. program/case management 4.7 advocate for clear and support for ODSP applicants scientific guidelines for and recipients. prescription opiates that 4.13 advocate for a review of ODSP delineate personal use from policies that make sustained possession with the intent to housing difficult for ODSP traffic. recipients, such as the policy of paying rent in arrears.

4.14 advocate that the Province of Ontario support physicians to assist clients of Ontario Works transfer to the Ontario Disability Support Program.

4.15 Call for increased access to essential local data about unintentional drug overdose rates from the provincial and federal governments.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy

THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy 4.19 advocate for an increase in 4.25 advocate for a review of the 5.4 Increase access to early social assistance rates from parameters of the Northern identification and support the Province of Ontario that Travel Grant to allow for for children with learning and reflects actual cost of living, multiple visits for assessment developmental concerns to especially in northern and and treatment of substance improve educational outcomes. remote communities. addiction. 5.5 develop a community youth 4.20 advocate for equivalent 4.26 advocate to the Province of strategy for incorporation housing allowances through Ontario to fund a separate into the City of Thunder Bay Ontario Works and the Ontario entity to provide medically Strategic Plan. Disability Support Program. necessary inter-facility transportation for people with 5.6 Sustain mentorship programs 4.21 advocate for increased non-life threatening mental through long-term funding emergency utility relief (and health and addictions issues. commitments. funding for programs that provide relief) for low-income 4.27 advocate for changes to the 5.7 Examine strategies to increase citizens from the Province of Northern Travel Grant so that workplace placements for Ontario. funding may be provided to young people without post- alternative transportation secondary education. 4.22 Advocate to the Province of providers to provide medically 5.8 Increase the use of school Ontario for improved primary necessary inter-facility space by the community at care access for people who use transportation for people with large. substances. non-life threatening mental health and addictions issues. 4.23 Advocate for the 5.9 Encourage a review and Governments of Canada and enhancement of the Ontario Ontario to adequately fund RESULT FIVE: curriculum to incorporate accessible and culturally strength-based approaches All children and youth have optimal appropriate treatment and that emphasize resiliency, success and health. aftercare services for remote utilize skills training and northern communities. provide arts programming. ACTIONS TO ACHIEVE 4.24 advocate to the Province of RESULT FIVE: 5.10 Increase use of local Ontario to increase funding for referral and help resources 5.1 Support school boards the Ontario Works Addiction by educators and other and families to begin drug Services Initiative (ASI) professionals. education based on supporting (delivered through the District positive social and behavioural of Thunder Bay Social Services development at earlier ages. Adminstration Board) to ensure that program capacity 5.2 Conduct an environmental meets community need. scan to identify resources and gaps in parenting supports and programming for families.

5.3 provide caregivers with access to current and evidence-based information and education about how to delay or prevent their children from using substances.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy

THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy 5.11 Encourage schools and school RESULT SIX: 6.8 Form a working group to boards to develop evidence- examine the implementation People who use substances have based alcohol and substance of overdose prevention such optimal physical, emotional and use policies that utilize a as the provision of Naloxone, mental health. restorative justice framework. overdose education and institution of a medical 5.12 Conduct an environmental ACTIONS TO ACHIEVE amnesty program. scan of programming and RESULT SIX: campaigns designed for post- 6.9 advocate that publicly secondary students. 6.1 Compile current community funded and insured programs and services that insurance cover the cost of 5.13 Improve the range of provide system navigators, suboxone as a treatment treatment options for youth to case management providers, option for detoxification and expand and enhance off-site, and street outreach positions. harm reduction for opiate school, community-based and dependency. early onset approaches. 6.2 Expand crisis response services to address various 6.10 Improve access to safer 5.14 Create a working group to types of addiction-related inhalation kits. investigate the provision of crises. harm reduction services for 6.11 Examine the feasibility of youth. 6.3 Ensure adequate primary care installing vending machines providers are available in the that supply syringes and 5.15 Examine the feasibility of community. offer expanded disposal sites creating a pool of available and throughout the city. screened trustees for youth 6.4 advocate for better discharge that access social assistance planning for all people leaving 6.12 Establish a volunteer base to allowances. correctional facilities and other support the distribution and institutions. pick-up of syringes. 5.16 Create an inter-agency neonatal substance use 6.5 Encourage community services 6.13 advocate and support access working group to develop and programs to review their to specialized emergency strategies for supporting policies to reduce barriers to services for people with mental pregnant women, new mothers service for people receiving health and addictions issues. who use substances and their methadone maintenance infants to improve family therapy (MMT). 6.14 Form a working group to health outcomes. determine the fit and feasibility 6.6 Urge the College of Physicians of a supervised consumption and Surgeons of Ontario to site. hold methadone providers accountable to adhere to the Methadone Maintenance Guidelines (2005).

6.7 provide support to people receiving MMT to become self-advocates for proper treatment and medical care.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy

THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy 6.15 Conduct an environmental 6.20 promote basic training about 7.2 Support the initiation of a scan of programming and harm reduction, addictions and kinship drug and alcohol services for seniors at-risk of or IV drug use to professionals treatment model. living with addictions. that interact with community members. 7.3 Increase the availability of 6.16 Support the development suitable childcare initiatives to of local drug user groups 6.21 Increase ‘one-stop’ access support caregivers to access to provide opportunity to primary care, basic treatment services. for information exchange, preventative health services, peer support and personal harm reduction services and 7.4 Improve evaluation of empowerment. addictions and mental health treatment protocols and screening system entry points outcomes. 6.17 Encourage and assist the at accessible or mobile sites. business/commerce sector 7.5 offer pre- and post-treatment to increase opportunities 6.22 Expand and diversify medical examinations onsite at for sustainable employment needle exchange service by treatment centres. for people recovering from advocating for and supporting 7.6 advocate to the Province of addictions. needle exchange services at Ontario to ensure full OHIP primary health care clinics, coverage for medical exams 6.18 Educate the community about hospitals, pharmacies and non- and administrative costs methadone maintenance profit groups. therapy (MMT) and the required to access treatment principles of harm reduction. programs. RESULT SEVEN: 6.19 Enhance education and 7.7 provide treatment options to People with substance addictions placement requirements for people in custody that include can get well. students involved in social methadone maintenance services, enforcement and therapy, elements of relapse health-related programs to ACTIONS TO ACHIEVE prevention and withdrawal include addictions training and RESULT SEVEN: symptom management. outreach experience, including 7.1 Increase the range of intravenous (IV) drug use treatment models available, education. including longer term residential treatment, day programs, enhanced pre-and post- treatment supports, culturally relevant programming and harm reduction or moderation approaches.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy

THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy 7.8 Increase the range of RESULT EIGHT: 8.9 Train more enforcement detoxification services offered professionals as Drug Community members are safe in in the city to include hospital- Recognition Experts (DREs) to their neighbourhoods. based, community/home improve detection of impaired- detoxification and youth by-drug driving. specific services. ACTIONS TO ACHIEVE RESULT EIGHT: 8.10 Improve sentencing outcomes 7.9 Create a common, shared for prescription drug process that integrates 8.1 Encourage users to increase trafficking through increased treatment, social services their responsibility to safely judiciary education. and other systems to dispose of needles through the facilitate access and provide use of incentives. 8.11 Ensure programming and more collaborative case treatment options are in place 8.2 Increase education to the management. for remote Northern Ontario community about how to safely communities prior to any 7.10 Request that the Northwest dispose of needles. supply reduction efforts. LHIN in partnership with 8.3 Examine a shared costs model Northwestern Ontario service 8.12 Provide public education for the recovery and disposal providers review the Mental about substances, substance of collected needles. Health and Addictions system use, and legislation about substance use including in Northwestern Ontario for 8.4 provide more needle disposal impaired driving and promote improved system access and bins at key sites, including not- local helping resources. navigation. for-profit housing complexes. 8.13 Examine the feasibility of 7.11 Establish a resource pool 8.5 Re-invest in community partnership programs that of local service providers to policing to renew focus on match clinical resource teams connect primary health care crime prevention. with addiction/mental health with enforcement teams to services. 8.6 Strike a working committee improve health outcomes for to investigate the option of people who use substances. enhancing police presence with a volunteer corps.

8.7 Support the Crime Prevention Council in efforts to increase personal and community responsibility to reduce crime.

8.8 Investigate the instatement of a Neighbourhood Watch type of program.

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy

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THUNDER BAY THUNDER BAY Drug Strategy Drug Strategy