Community Drug Strategy for the City of Greater Sudbury: A Call To Action

November 2015 2 Community Drug Strategy: A Call to Action A CALL TO ACTION

Substance misuse affects everyone. From the challenges of keeping medications away from children and teens to alcohol misuse in teens and adults; to experimentation with substances and addictions, and accidental poisonings – substance misuse affects all of society. Experimentation with alcohol, marijuana and other drugs can lead to decisions that put lives at risk. Experimentation with substances can also lead to addiction. While prescription drugs are intended to restore and maintain health, they can lead to addiction, crime, financial burdens and injury when not used as prescribed. Illegal drugs and related crimes are a source of fear and destruction in our communities. Business and home robberies decrease a community’s sense of security. Each year, drinking and driving kills and injures people in our community, leaving family and friends emotionally scarred. However we are making a difference. Pregnant moms are aware of the potential harmful effects of drugs on their unborn babies, therefore they avoid drugs. Parents keep medication out of reach of their children. Educators and parents implement programs to build resiliency in youth to help them make decisions to avoid the dangers of experimenting with drugs. Doctors and pharmacists remind their clients about the risks of misusing prescribed drugs. Friends stop friends from driving impaired. And we know that we can all do more. We can: • Learn about drugs that are commonly misused. • Talk to your family and neighbours about what we have learned. • Dispose of any old or unused medications. • Get involved. Our ideas can help find solutions to prevent the initiation of and the harms associated with drug use. • Let people know we care if we are concerned about their use of substances. • Seek professional help for ourselves or someone we love. Together, across all sectors and with an engaged community, we can make a difference. This Community Drug Strategy report has been created through extensive consultation and provides guidance for our next steps. It is our collective CALL TO ACTION.

For the City of Greater Sudbury 3 4 Community Drug Strategy: A Call to Action TABLE OF CONTENTS

A Message from the Community Drug Strategy Steering Committee Co-Chairs...... 6 Executive Summary...... 7 Acknowledgements...... 10 Why Does Greater Sudbury Need a Drug Strategy...... 13 Drug Use Facts in the City of Greater Sudbury...... 15 Risk and Protective Factors for Addiction...... 18 The Process of Creating the Community Drug Strategy for the City of Greater Sudbury...... 21 Key Priorities...... 25

Priority One: Implement Actions to Reduce Harms Associated with Substance Use...... 26 Priority Two: The City of Greater Sudbury is an Inclusive City...... 27 Priority Three: All People have Access to Safe Appropriate Housing...... 28 Priority Four: All Levels of Government set Public Policy that Supports Optimal Health...... 30 Priority Five: All People have the Opportunity for Optimal Success and Health...... 33 Priority Six: People who use Substances have Optimal Health...... 36 Priority Seven: People with Substance Addictions Can Get Well...... 39 Priority Eight: Community Members are Safe in their Neighbourhoods...... 41 Priority Nine: All People Work Collaboratively to Build Safe and Supportive Environments...... 43 In Conclusion...... 44 Definitions...... 45 References...... 46 Additonal Reading...... 49 Appendix A - Drug Strategies in Ontario...... 50

For the City of Greater Sudbury 5 A Message from the Community Drug Strategy Steering Committee Co Chairs

The Greater Sudbury Police Services and the Sudbury & District Health Unit on behalf of the Community Drug Strategy Steering Committee, are proud to release the first comprehensive Community Drug Strategy for the City of Greater Sudbury. The local rates of alcohol use, heavy drinking, and illegal drug use in our city are higher than those for the province overall and impact the health and safety of our City1. The Community Drug Strategy is a Call to Action, providing a community focused strategic map to address the issue of substance misuse. This call to action will require the collective efforts of all members of our community including service providers, public and private institutions and citizens. We encourage you to read this Strategy and to share the information with your colleagues and clients, neighbours and friends. We would also like to take this opportunity to thank the many researchers, policy experts, service providers and community members who have given so generously of their time and expertise to help guide the creation of this strategy map. We look forward to continuing our work together as we implement these strategies to address substance misuse in our community. Together we will build a healthier and safer community free from the many of harms associated with substance misuse.

Dr. Penny Sutcliffe, MD, MHSc, FRCPC Paul Pedersen - M.P.A., Dip.ED, C.M.M. III, C.M.I. VII Medical Officer of Health Chief of Police Sudbury & District Health Unit Greater Sudbury Police Service

1Sudbury Community Foundation, 2014

6 Community Drug Strategy: A Call to Action EXECUTIVE SUMMARY Vision A community working together to improve the health, safety, and well-being of all individuals, families, neighbourhoods, and communities in the City of Greater Sudbury by reducing the incidence of drug use and creating a society increasingly free of the range of harms associated with substance misuse. Goals To fulfill this vision we will actively work to: • Improve community health and address drug-related issues by increasing public awareness of drug use and misuse as a health issue, by providing a range of services including treatment and harm reduction and encouraging a developmental asset building approach to prevention and community development. • Increase community safety across the City of Greater Sudbury by implementing evidence- informed, drug-related crime prevention initiatives. • Encourage partnerships among municipal government, academia, legal, health and human services sectors, the private sector, and the community to share the responsibility for the development and implementation of substance-related strategies and responses. • Ensure ongoing monitoring and evaluation of this strategy. • Encourage all levels of government to take action and responsibility for their elements of the framework within their respective jurisdiction.

For the City of Greater Sudbury 7 Five (5) Foundations

Every building needs a solid foundation. Our drug strategy will be built on five foundations that will be integrated into the plan forming both the support and the structure of our Community Drug Strategy.

Health Promotion and Treatment provides a continuum Enforcement and Justice Prevention of Drug Misuse of necessary interventions work together to strengthen involves providing coordinated, and supports to help people community safety by responding evidence-informed education, regain their health through to crimes and community awareness-raising activities, harm reduction and possible disorder issues associated with developmental asset building abstinence from drug use. legal and illegal drugs. approaches to improve youth Harm Reduction provides Sustaining Relationships resiliency and strengthening local strategies to reduce drug- encourage the development policies related to the prevention related harm without requiring of partnerships between the of drug misuse and its impacts. the cessation of drug use. community, sector organizations, Interventions may be targeted at and all levels the individual, family, community, of government. or society.

8 Community Drug Strategy: A Call to Action Ten (10) Guiding Principles

The following principles reflect the key values and beliefs that shape and direct the actions of the Community Drug Nine (9) Key Priorities Strategy for the City of Greater Sudbury: 1. The City of Greater Sudbury implements actions to reduce Socially Just Determinants of Health and harms associated with The equality, dignity, rights, Health Equity substance use. and choices of individuals, Strategies address the range of families, neighbourhoods, and conditions that affect physical, 2. The City of Greater Sudbury is communities are respected. emotional, psychological and an inclusive city with accessible spiritual health including safe and appropriate services for its Acceptance diverse population. A person’s choice to use or not environment, adequate income, education, appropriate shelter to use substances is accepted 3. All people in the City of Greater as fact. and housing, access to health care, safe and nutritious food, Sudbury have access to safe, Diversity peace, equity, and social justice. appropriate and affordable The diversity of people is Equity in health is promoted. shelter and housing. recognized and incorporated into our responses to substance use Balance 4. All levels of government set issues. Initiatives will be balanced to public policy and determine ensure investments are Equitable Access spending priorities that support appropriate across the four optimal health for all citizens. Universal access to appropriate, strategies of prevention, harm acceptable services and reduction, treatment and 5. All people in the City of Greater resources across the city is enforcement. Sudbury have optimal success promoted and ensured. Accountability and Transparency and health. Participation Clearly defined methods are People are involved in a in place for demonstrating 6. People who use substances meaningful way in the accountability and transparency have optimal physical, social, development, delivery, and toward all stakeholders in emotional, mental and spiritual evaluation of research and relation to drug use. health. programs that are intended to serve them. Building Assets 7. People with substance Community and individual addictions can get well. Partnership strengths are used to build All levels of government, capacity of the community. academia, legal and human 8. Community members are safe in services sectors, the private their neighbourhoods. sector, and the community share the responsibility to 9. Government, businesses, develop and implement agencies, neighbourhoods, strategies and responses. families and all people work collaboratively and in partnership to build safe and supportive environments.

For the City of Greater Sudbury 9 Acknowledgements

Community Drug Strategy Steering Committee Members

Honourary Co-Chairs James Bolan Renée Lefebvre, Dr. Penny Sutcliffe, Living Potential Public Health Nurse Sudbury & District Health Unit Medical Officer of Health Reggie Caverson Sudbury & District Health Unit Centre for Addiction and Allan Lekun Chief Paul Pedersen (2014) Mental Health Deputy Chief Greater Sudbury Police Serivce Greater Sudbury Police Service Megan Decaire Community Drug Strategy Rainbow Crime Stoppers Tracey Leroux Working Group Co-chairs Drug Strategy Coordinator Chief Frank Elsner (2012-2013) Sheilah Weber, Superintendant Greater Sudbury Police Service Greater Sudbury Police Service (2010-2014) Rev. Anthony Man Son Hing Pastor, Church of Christ the King Brenda Stankiewicz, RN, P.H.N. Lucio Fabris Sudbury & District Health Unit Pharmacist Sharon Marunchak Health Sciences North Executive Director This Community Drug Strategy Rainbow Crime Stoppers for the City of Greater Sudbury is Sabrina Grossi the result of years of dedicated Drug Strategy Coordinator Deborah Rousseau planning and action of many (2011-2012) Rainbow Crime Stoppers people. We are grateful to the following for their contribution to Robert Keetch Bourke Smith the creation of this strategy. Inspector Retired Judge Greater Sudbury Police Service Jennifer Amyotte (2010-2014) Peter Thai Greater Sudbury Emergency Pharmacist Medical Services Vicki Kett Reseau Access AIDS Robert Thirkill Anna Barsanti Inspector PAVIS Program Joanne Kohtakangus Greater Sudbury Police Service Family Enrichment Centre Greater Sudbury Police Service Todd Zimmerman Ken Birtch Christine Lebert Inspector Constable Centre for Addiction and Mental Greater Sudbury Police Service Greater Sudbury Police Service Health

In the time needed to develop this drug strategy we were pleased to have worked with Jean Hanson (1950 – 2014), whose insights and vision guided our discussions. A dedicated leader, she was keenly focused on the needs of the community and ways to be inclusive of everyone. Jean’s action-oriented approach to life is reflected in this Drug Strategy.

10 Community Drug Strategy: A Call to Action Acknowledgements

In particular, we are grateful to Tracey Leroux, the Drug Strategy Coordinator (2012 - 2013) who organized meetings, recorded notes and forged community connections to enhance the work of the Community Drug Strategy Steering Committee. Various community agencies reviewed the drug strategy at numerous points providing clear and detailed feedback, including Social Planning Council, Centre for Addiction and Mental Health, Greater Sudbury Police Service and the Sudbury and District Health Unit; we are grateful for your insights. To the many people with lived experiences who eagerly shared their stories and suggestions for change, we offer our heartfelt appreciation. We anticipate that this strategy will help to find the freedom from the harms of substance misuse that you seek. Over 50 agencies in the City of Greater Sudbury enthusiastically and openly shared their experiences, thoughts and concerns about the prevention and harms of, and solutions for drug and alcohol misuse. Your cooperation and collaboration is reflected in the strength of this strategy. We are indebted to the many students from local elementary schools who contributed their photographic talents to visually enhance this document. In particular we wish to acknowledge from Lansdowne Public School: Vanessa, Brayden, Kaitlin, Katana, and Allyssa, from MacLeod Public School: Ryan, and from St. David’s Catholic School: Logan and Luke. In addition to these fine young photographers, we are grateful to Greg Taylor and Brenda Stankiewicz for the use of their photographic work. 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 and especially to the City of Thunder Bay for sharing its Strategy with Sudbury for reproduction and modification. Finally, we gratefully acknowledge the financial support received from the Safer and Vital Communities grant and the Ontario Trillium Foundation. We express our sincere appreciation for their continued interest and concern for the health and safety within the City of Greater Sudbury.

This material has been reproduced or modified with the permission of the Thunder Bay Drug Strategy

For the City of Greater Sudbury 11 “Ok here goes: drug use has completely messed up my life I come from a “normal” family however you describe normal, I have been using since I have been 12 years old, pot and hash at first and then cocaine for the 1st time at 14, intraveneously since 16, I was put on Oxycontin at 25 for a work related injury even though my doctor knew I abused drugs, my life has been hell because of drugs, yes there was help for me, I don’t believe it was the right kind of help, I am a smart, intelligent woman but have never realized my fullest potential because drug addiction has always kept me down, I have been clean from opiates for almost 2 years, but continue to abuse cocaine occasionally, I am healthier and more on control of my addiction now more than ever.” -female

12 Community Drug Strategy: A Call to Action WHY DOES GREATER SUDBURY NEED A DRUG STRATEGY?

Drug misuse is an issue that In the City of Greater Sudbury Technology has changed the way impacts all sectors of society. rates of alcohol use, heavy western society functions. As From the challenges of keeping drinking, and illegal drug use social environments continue medications away from are higher than the provincial to shift and change, so does the children and teens, to alcohol average (Sudbury Community culture of drug use. misuse in teens and adults, to Foundation, 2014). experimentation with substances Alcohol, prescription drug and and addiction, and accidental Substance misuse can lead to illegal drug misuse require poisonings, the misuse of unintentional and intentional separate and yet sometimes substances affects all ages. injuries, various chronic diseases similar approaches and solutions. and economic hardship. Local solutions are needed for While prescription medications The health consequences of local problems. Across Ontario, are intended to restore and substance misuse further burden several communities are maintain health, they can lead the health care system. developing and implementing to addiction, crime, financial strategies to respond to the burdens and injury when not Deaths due to substance various harms and challenges used as prescribed. Business misuse are rising (Clark, 2010). associated with substance misuse and home robberies decrease Treatment centers are at capacity (See Appendix A). the community’s sense of and the demand continues security. Illegal drugs and the (Kohtakanguas, 2011). The City Solving the issues of drug misuse criminal element involved are a of Greater Sudbury is situated requires the cooperation and source of fear and destruction as a distribution point for illegal collaboration of many community in our communities. Sex trade and illicit drugs and narcotics partners and private citizens. is often driven by the need entering Northern Ontario due to Raising awareness and educating to feed an addiction and hide its geographic proximity and easy people about substance emotional hurts. Drinking and access to transportation routes, misuse in the community and driving kills and injures many in which include the Trans-Canada the important roles that we our community annually leaving Highway and Highway 400 play is vital. Police services, family and friends emotionally (Greater Sudbury Police, 2014). enforcement and the criminal scarred. justice system enhance

For the City of Greater Sudbury 13 community safety and are businesses, faith groups, more. These underlying roots necessary to deter the activities educators, primary care, and often lead to ineffective coping of the criminal element. governments work together in a mechanisms, such as substance Treatment services are needed sustained way to find answers to misuse. for those who are addicted. the issues of substance misuse in our communities. It is clear that effective For some, a life of abstinence connections and collaborations may not be possible, requiring By preventing substance beyond the traditional criminal harm reduction services. A recent misuse or reducing the harms justice sector are pivotal to the report from the Public Health of substance misuse in our success of the City of Greater Agency of Canada (PHAC) notes community, the Community Sudbury’s Community Drug that while needle distribution Drug Strategy aims to reduce Strategy process. rose in Ontario in 2012 - 2013, the incidence of violence and the province saw a decrease in injury, chronic disease, sudden By engaging partners in health, the number of new HIV and other death, property crime, violent social housing, education, blood borne illness diagnoses crime, prostitution, other crimes income security and social among people who use injection and victimization in the City of services and considering how drugs over that same period Greater Sudbury. policies, programs and services (PHAC, 2013). interact, we are beginning to The root causes of substance target the social determinants Community education about the misuse frequently include that influence individual and need for harm reduction services family stress, neglect, poverty, community resiliency and is necessary. physical or sexual abuse, poor decision making and substance living conditions, early childhood misuse, including illegal Moreover, the solutions are experiences, unemployment, substance use. found when all people, including low education, illiteracy and family and caregivers,

14 Community Drug Strategy: A Call to Action DRUG USE FACTS IN THE CITY OF GREATER SUDBURY

An environmental scan was drugs in the previous 12 months; Ontario, respectively), compared conducted to understand a figure that is not statistically to 20% for Ontario. Specifically, substance misuse in the Sudbury different from all of Northern the reported rates of non- area. According to the Canadian Ontario (31%) and Ontario (36%). medical use of prescription Community Health Survey When cannabis use is excluded, opioid pain relievers were 9% (CCHS), between 2009 and 2012, the rate of reported drug use in for the SDHU service area, 7% 14% of Sudbury & District Health the previous 12 months among for Northern Ontario and 12% in Unit (SDHU) service area, (which SDHU service area (19%) and Ontario. These differences are includes Sudbury East, Espanola, Northern Ontario (17%) youth statistically significant (CAMH, Manitoulin Island and Chapleau) is significantly lower than that 2013). residents aged 12 and older, reported overall in Ontario (23%) reported using some kind of illicit (Centre for Addiction and Mental In all geographic areas, a large drug in the previous 12 months. Health, 2013). majority (72% to 87%) of student This is significantly higher than users of opioid pain relievers the rate reported for Ontario Youth in the SDHU area and reported getting the pills at overall (12%) (Statistics Canada, Northern Ontario were more home (Boak, Hamilton, Adlaf, & 2009-12). likely to report using alcohol Mann, 2013). (55% and 59%, respectively) and The Ontario Student Drug Use binge drinking (22% and 28% When asked about their driving and Health Survey (OSDUHS) respectively) in the previous 12 habits over the previous 12 collects information from a months compared to Ontario months, 5% of Ontario youth with random sample of youth (grades (50% and 20% respectively). a driver’s license reported driving 7-12) from across Ontario. These results are statistically a vehicle within 1 hour of drinking According to the survey, 34% of significant (CAMH, 2013). 2 or more alcoholic drinks, while youth in the SDHU service area 11% reported driving within an reported using at least one illicit Youth were less likely to report hour of using marijuana or hashish drug (excluding alcohol, tobacco, using prescription medications (CAMH, 2013). energy drinks and steroids) or to get high (16% and 13% for the medical use of prescription SDHU service area and Northern For the City of Greater Sudbury 15 As well, 10% (rates are First Nations communities in the Data gathered from people interpreted with caution due to Sudbury area indicate rising seeking treatment indicates that high sampling variability)* of concerns related to opioid in 2012, 96 people from Sudbury SDHU-area youth with a license addictions. For example in 2008/09, County (Connex Ontario) sought to drive a snowmobile, boat or 801 First Nations people received treatment through the Drug ATV reported doing so within treatment for opioid addiction in Treatment Registry for Oxycontin one hour of drinking two or more the north (in LHIN 13 & 14). This addiction and a further 65 sought alcoholic drinks. This rate is compares to 2094 non-First Nations treatment for narcotic analgesic consistent with the rate reported people. (Caverson, 2010). addiction, for a total of 161 people. by Northern Ontario youth Additionally, 13 people sought (11%*), but is significantly higher In 2013, 482,760 needles were treatment for benzodiazepine and than that reported by youth in returned to the Needle Exchange other prescription drug addiction Ontario overall (6%) (CAMH, program in the City of Greater (Connex Ontario, 2012). 2013). Sudbury. In that same year 682,358 needles were given out. This The number of people seeking While there is little data available represents an exchange rate of 71% treatment for prescription narcotic indicating the scope of drug use (The Point Needle Exchange, 2014). addiction had risen steadily until in our community the CCHS 2011 (Connex Ontario, 2012) (See reveals that 52% of SDHU Figure 1: Number of needles given Figure 2). residents have tried marijuana at out and returned to the Needle least once in their lifetime, this is Exchange Program, 2013 significantly higher than Ontario Needles (42%). Excluding those people 682,358 given out who have tried marijuana at least Needles once, 41% of SDHU residents returned admit to having used illicit drugs 482,760 at some point in their lifetime, this is significantly higher than Ontario (34%) (Statistics Canada, 2009 - 12).

Figure 2 : Population Seeking Treatment for Prescription Narcotic Addiction, Sudbury County Area, 2012

300

243 250

199 200 161 149 150

105 100 Sudbury County area.

50

Number of people seeking treatment in the the in treatment seeking people of Number 0 2008 2009 2010 2011 2012

16 Community Drug Strategy: A Call to Action According to City of Greater year, 93 drug related robberies school or work performance can Sudbury Emergency Medical were reported (GSPS, 2014). be impacted. Services, in 2013, 400 calls were made for drug overdoses while According to the Ontario Court of Depending on how a drug is 1020 calls were made for alcohol Justice, Criminal Court Statistics, used, it can directly affect the intoxication (City of Greater in the Greater Sudbury area, lungs, nose, blood system, Sudbury Emergency Medical approximately 141 people were stomach or other bodily Services, 2014). charged with possession of drugs, functions. The abuse of these while 282 people were charged drugs can lead to sudden death Opioid-related visits to the for drug trafficking between July because of cardiac or respiratory emergency department at Health 2013 and June 2014 (Ontario arrest. Sciences North has been steadily Court of Justice, 2014). increasing to almost double the While marijuana use has been rates from 2003. This rate is The more a person drinks linked to schizophrenia in significantly higher than the alcohol, the greater the risks for some people, the use of many provincial rate (IntelliHEALTH, personal injury or harm through street drugs can lead to brain 2014). See Figure 3. motor vehicle collisions or impairment or mental health violence. Alcohol use over a long issues. Between 2008 and 2012, the time increases a person’s risks for Office of the Chief Coroner some chronic diseases, including Many people use alcohol reported 87 deaths in the City high blood pressure and stroke; together with other substances. of Greater Sudbury due to drug addictions and mental health This results in the intensified toxicity. The average age of issues; and mouth, oesophageal, effect of each drug causing deceased was 44.2 years old. Of stomach, liver, colon and breast severe impairment. these, 79 deaths were related to cancers (Butt, 2011). Illegal drugs are not subject to prescription drug misuse (Office Drug use will distort perception health and safety standards. of the Chief Coroner for Ontario, They may be contaminated with 2014). and change the mood of the user. When drug use leads to pesticides, toxic fungi or other In 2013, 549 drug offences decreased concentration and drugs. charges were laid. In the same causes short-term memory loss

Figure 3: Rate of Opioid-Related Emergency Department Visits, Rate of Opioid-RelatedSDHU and Ontario Emergency 2003-2012 Department Visits Sudbury & District Health Unit and Ontario, 2003 - 2012 100

90

80

70

60

50

40

30

20

10

0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 SDHU 35.3 32.1 34.2 36.3 45.8 56.9 61.9 52.6 72.8 70.7 Ontario 18.3 23.6 25.5 30.5 32.6 38.2 48.0 56.6 59.2 57.4 Year

For the City of Greater Sudbury 17 RISK AND PROTECTIVE FACTORS FOR ADDICTION

Drugs are everywhere. At any misuse substances (Fisher, Imm, Some people, because of their time someone is experimenting Chinman, Wandersman, 2006). life situation are also at risk for with one drug for the first time, substance misuse. Higher risks while another person may be Risk factors for drug misuse groups include older people using the same drug because include: dealing with pain who may s/he believes s/he needs it to feel • Age of first use misuse drugs unintentionally, normal. Some people may drink street workers who use alcohol only on special occasions, • Genetics substances to escape the while others need alcohol • Epigenetics difficulties of their current every day. Some people turn to • Self esteem situation and homeless people prescription drugs to improve who use substance to help them health, others use prescription • Attitudes and beliefs about cope. drugs to get high. Why do some drugs Resiliency is the ability to ‘bounce people become addicted when • Family history of addiction others do not? back’ from difficult situations • Adverse childhood experiences without resorting to harmful Each person’s risk for addiction is • Diagnosed and undiagnosed behaviours to cope. unique. Biology, life experience mental health disorders and social conditions are Family, peers, schools and • Stress factors that can either increase communities can build a person’s risk for addiction • Loneliness relationships that help build or protect that person from resiliency and support positive • Pain from injuries or chronic and healthy development becoming addicted to alcohol disease requiring treatment and drugs. Research has (Ontario Association of Chiefs demonstrated that youth who • Influence of society, media and of Police, 2010). Healthy have more protective factors social media relationships offer social support are less likely to misuse drugs or • Associating with people who and assistance with decision alcohol and, conversely, youth use substances making that can deter substance use. who have fewer protective • The type of drug used factors are more likely to

18 Community Drug Strategy: A Call to Action The more risks a person is Building these developmental Parents and caregivers who are exposed to, the more likely that assets can result in these confident with their parenting person will misuse substances. protective factors (Search skills offer adequate supervision The opposite is also true. The Institute, 2008): and engage in their child’s life more protective factors a can mitigate risk factors. Families person has, the less likely that • Individual skills and strengths can build protective factors and person will misuse substances. • Personal coping skills developmental assets when they: However, there are people who • Positive adult role models are exposed to many risk factors • Practice open communication, and do not misuse substances • Positive self esteem including expectations of and there are others who seem • Self-efficacy behaviours to have the protective factors • Sense of responsibility • Talk about drugs, establish in place, and yet they become clear rules about drug use and addicted. • Well-developed problem solving skills enforce these rules consistently • Success in school • Demonstrate value for family • Values diversity members and offer support • Maintains good health RISK AND PROTECTIVE FACTORS FOR ADDICTION • Exhibits leadership

“When I was a teenager I became addicted to drugs and alcohol. It left a path of sheer devastation in it’s wake. However, eventually I went to a substance abuse treatment centre and found not only hope but recovery as well. Living a life in recovery has given me more than I could have ever asked for. I went back to school and finished an undergraduate degree in psychology. Then I decided that wasn’t enough, so I completed a Master In Business Administration. I am now in my final year of law school, set to graduate in June 2015. The sky is truly the limit when you’re living a clean life.” Serena (First Nations Woman)

For the City of Greater Sudbury 19 Schools can build student success Caring communities: and protective factors when “My use stems from shame. • Welcome youth with easily they: I have lots of past issues. I accessible, community- have no education and I have • Encourage involvement in sponsored activities wasted a lot of my life. Some extra-curricular activities • Offer opportunities to build of it is my fault, but some of • Discuss substance misuse and strong social bonds and a it was my past growing up in offer anti-drug messaging feeling of connectedness the system and not a family. • Create environments that • Demonstrate low tolerance for I wish I had never tried drugs protect against substance violence in the first place. It is hard to misuse ask for help when your life is The Community Drug Strategy in a hole. I know I have lots to Strong social connections will decrease risk factors and can offer protection against offer. I have tried to be clean. increase protective factors in I just blew $4,000 on drugs. substance misuse. This can youth, families, schools and include having one or more close I use just to bury the shame I the community as we develop feel.” friends who offer emotional resiliency in the City of Greater support, long-term friendships Sudbury. Mark, HIV and Hep C positive. and socialization with people who do not use substances.

20 Community Drug Strategy: A Call to Action THE PROCESS OF CREATING THE COMMUNITY DRUG STRATEGY FOR THE CITY OF GREATER SUDBURY

Through the combined leadership ideas to develop the foundation guest speakers who had lived of the Greater Sudbury Police for the Community Drug Strategy. experience with drug use. Service and Sudbury & District Health Unit, the Community Drug A Project Planning Committee The groups were asked to reflect Strategy Steering Committee then worked with these ideas and report on the following to form the vision statement is proud of its many successes questions: and five foundations for the to date. With funding from the Community Drug Strategy for the • What is working in our Safer and Vital Communities City of Greater Sudbury. Project community? Grant, a part time Drug Strategy guiding principles and a timeline Coordinator was hired. Working • What is not working in our were developed. twenty hours per week, the community? Coordinator was tasked with In June 2011, through a series • What are the solutions? organizing community meetings, of foundation-focused meetings • What do you feel powerless keeping meeting notes, and the attended by 50 community about? development of a Substance partners, the ideas that were Misuse Service Directory. proposed at the March 2010 The results of these meetings meeting were further developed. were collated and on June 21, The first phase in our journey 2011 participants were invited began with an initial Community Five foundation-focus meetings to return to a follow up meeting, Drug Strategy meeting. The were hosted at the Canadian learn about the work of the other meeting occurred on March Hearing Society. At each of these foundation groups and to develop 30, 2010 and hosted over 52 five meetings, representatives strategies in seven common key community partners from from each of the five foundations areas: prevention, treatment, harm received an update about the reduction and enforcement, who work of the planning group. They contributed their broad ranging also learned from the stories of

For the City of Greater Sudbury 21 Services: how people interact five foundation areas of the have included large group, with services ranging from Community Drug Strategy, who general audience presentations harm reduction, to treatment expressed interest in being at venues throughout the City and recovery and how agencies involved on the steering of Greater Sudbury reaching interact with each other. committee. This committee a total audience of over 3,000 led the development of the people. Furthermore, additional Funding: seeking funding for Community Drug Strategy for presentations about the the drug strategy and related the City of Greater Sudbury prevention of substance misuse projects. document. have occurred in workplaces and Justice: how the justice system at the invitation of community Since 2010, efforts to raise groups. Elementary school interacts with people who use awareness about substance substances. children attended school-based misuse and the development events including the Values, Policy: reducing substance use of a strategy in our community though policy. Education: creating learning opportunities to reduce substance use. Community: seeking ways to engage the community in the drug strategy. Roots: seeking to reduce the circumstances that lead to substance use. A draft report was written and shared with the planning group. A Steering Committee for the Community Drug Strategy for the City of Greater Sudbury was established with members representing each of the

22 Community Drug Strategy: A Call to Action Influences and Peers (VIP) narcotic awareness. Partners essential elements for creating a program facilitated by the involved with the Community healthy and safe community for Greater Sudbury Police Service Drug Strategy were engaged in everyone. and Racing Against Drugs the planning for this event. facilitated by the RCMP with Because of the political nature community partners. Secondary The Community Drug Strategy of some solutions, federal and students were engaged in has completed three years of provincial policy requirements substance awareness, skill a multi-year process. Engaging were considered, and have been building and advocacy community partners, raising included in this Community Drug presentations through the awareness of the issues and Strategy. educating various segments of P.A.R.T.Y. program at Health Solutions for drug use issues in Sciences North, Safe Graduation our community requires a great deal of time and commitment. our communities are multiple, events, Ontario Students Against complex and continue to shift Impaired Driving events and Raising awareness and with changes in society. As a various other community events. community education are the result schools, parents and many In 2011, fifty physicians from first steps of a community others in the community report across Northern Ontario took development process that will that they often do not know what part in a Centre for Addiction and include skill building, creating to do or where to find help. Mental Health (CAMH) training supportive environments and event focused on prescription policy development. These are

For the City of Greater Sudbury 23 The lack of acknowledgment of harms associated with substance Stoppers, the New Opportunities substance misuse issues contrib- misuse in our community. and Hope Project, and the Second utes to a growing social tolerance Chance Committee. These are for substance misuse. Despite these challenges, the excellent examples of community outlook for the City of Greater mobilization and engagement In other cases, some people are Sudbury is positive. With a efforts geared towards improving not ready to accept help and strong capacity to respond, community health and safety. choose to tackle their issues a deep reservoir of genuine themselves. good will, and a willingness to Additionally, the Ontario Drug work collaboratively to achieve Strategy network continues to Substance misuse in our a collective impact, existing work with communities across community is a vast, far- partnerships and a diversity of this province to promote the reaching and complex issue with service providers, we are well need for local drug strategies, implications for all sectors of poised to move forward. enhance knowledge of the issues society. It will require flexible, and to offer support to members. multifaceted solutions to Complementing the Community address the associated harms. Drug Strategy for the City of The synergy of these strategies Time, insufficient evidence and Greater Sudbury is the Provincial indicates that the City of Greater funding, and until now, the lack Anti-Violence Intervention Sudbury is well positioned to of a coordinated Community Strategy, Poverty Reduction improve health, safety and Drug Strategy, are challenges Strategy, Healthy Communities wellness for all of its citizens. to preventing and reducing the Cabinet, Rainbow Sudbury Crime

24 Community Drug Strategy: A Call to Action Key Priorities

Priority The City of Greater Sudbury implements actions to reduce One harms associated with substance use.

Priority The City of Greater Sudbury is an inclusive city with accessible Two and appropriate services for its diverse population.

Priority All people in the City of Greater Sudbury have access to safe, Three appropriate and affordable shelter and housing.

Priority All levels of government set public policy and determine Four spending priorities that support optimal health for all citizens.

Priority All people in the City of Greater Sudbury have the opportunity Five for optimal success and health.

Priority People who use substances have optimal physical, social, Six emotional, mental and spiritual health.

Priority People with substance addictions can get well. Seven

Priority Community members are safe in their neighbourhoods. Eight

Government, businesses, agencies, neighbourhoods, families Priority and all people work collaboratively and in partnership to build Nine safe and supportive environments.

For the City of Greater Sudbury 25 Priority One

The City of Greater Sudbury implements actions to reduce harms associated with substance use.

A coordinated implementation Actions to Achieve Priority One plan supporting the goals of Indicators of Progress improved community health, 1.1 Community Drug Strategy • Ratified Drug Strategy and is endorsed by the Steering increased community safety and implementation plan enhanced partnerships is ratified, Committee member organizations. implemented and sustained. • Number of dedicated staff hours to support the City of 1.2 Community Drug Strategy Community drug strategies that Greater Sudbury’s Community implementation and evaluation are successful in the prevention Drug Strategy implementation plan is developed. of substance use and reducing plan harm associated with substance 1.3 Track the number of use have staff time dedicated • Community Drug Strategy is dedicated staff hours to support to the task of ensuring that included in the City of Greater the City of Greater Sudbury’s strategy recommendations are Sudbury’s strategic plan, as Community Drug Strategy implemented to ensure lasting well as the strategic plans, implementation plan. change. priorities or directions of other key stakeholders 1.4 Seek funding opportunities The City of Greater Sudbury to support the implementation • Development of a Community has an ideal structure to help and evaluation of the Community Drug Strategy implementation integrate current and new efforts Drug Strategy. to improve the quality of life monitoring and evaluation for all of its citizens. The City plan 1.5 Encourage that the Drug of Greater Sudbury is the hub Strategy is included in the City of of Northeastern Ontario and Greater Sudbury’s strategic plan, provides specialized services to priorities or directions. all citizens from many northern communities.

26 Community Drug Strategy: A Call to Action Priority Two

The City of Greater Sudbury is an inclusive city with accessible and appropriate services for its diverse population.

Community Services will be Actions to Achieve Priority Two designed and delivered with Indicators of Progress 2.1 Encourage equitable input from the people they are • Community Services Boards intended to serve. The intended representation from all will implement a mechanism populations and cultural result is programs that are easy for community engagement to access, meet the needs of the backgrounds on local boards population, and decrease stigma • Number of local boards where feasible. Where not or discrimination. When people ensuring meaningful feasible, encourage boards take part in decision making representation from people to develop mechanisms for they become engaged with the with lived experience, or a community engagement. community. mechanism for community engagement 2.2 Support community Boards of organizations engage partner organizations in the City the people they are designed to • Number of inclusive, safe, of Greater Sudbury to provide serve when considering changes and engaging services and inclusive, safe and appropriate to relevant services (Thunder programs (Thunder Bay Drug services (Thunder Bay Drug Bay Drug Strategy, 2011). By Strategy, 2011) Strategy, 2011). encouraging local boards and • Number of formal governing structures to reflect partnerships between people the diversity of our population living with addictions and where feasible: access, relevancy broader sector and program effectiveness can all be increased. Services must work with people representative of the City of Greater Sudbury’s diverse population to improve the quality of programs and services and access for all. Organizations must make a commitment to create culturally respectful and safe environments for staff and clients while ensuring services are available that respect differing approaches and needs.

For the City of Greater Sudbury 27 Priority Three

All people in the City of Greater Sudbury have access to safe, appropriate and affordable shelter and housing.

In accordance with the Long- of weather extremes. Without leaving correctional institutions Term Affordable Housing Strategy shelter, people who are using have very few options for housing (Ministry of Municipal Affairs and substances continue to be left on and supports. Housing, 2010), the Community the streets to face the elements Drug Strategy recognizes the and are at risk for injury, violence While the City of Greater Sudbury importance for all people in the or arrest for public intoxication. has a youth-specific supportive City of Greater Sudbury to have or transitional housing program, access to safe, appropriate and Some cities, including Thunder more can be done to support affordable shelter and housing. Bay, London and Hamilton, have the needs of at-risk youth. managed alcohol programs to People under 18 years who Safe and affordable housing not address these issues. The City receive social assistance must only helps people with addictions of Greater Sudbury is currently designate an adult trustee to to recover, it also helps planning a managed alcohol receive money on their behalf. caregivers provide stable and program. These programs offer Many face economic abuse at the healthy environments for their people who are chronic users hands of their trustees, affecting children. In the City of Greater and homeless a place to stay their ability to maintain secure Sudbury, wait lists for social that is tolerant of providing housing. housing are long, especially for small doses of regular alcohol in single bedroom units (ONPHA, exchange for improvements in Housing is a key determinant of 2014). Without social housing, life skills and attempts to manage health, and accordingly, the Long- many people must accept alcohol use. The London Police Term Affordable Housing Strategy transient, unsafe or unhealthy Service estimates cost savings encourages communities to find housing, and resort to temporary of $78,000, annually with a local solutions to housing needs. solutions such as couch-surfing at managed alcohol program (South People who have affordable, safe friends’ apartments and staying West LHIN, 2011). and appropriate housing have in rooming houses or shelters. fewer health problems, including While supportive housing options those related to substance use People who are using substances exist for women and men in (Thunder Bay Drug Strategy, may have nowhere to turn for the City of Greater Sudbury, the 2011). shelter, especially during times waiting lists are long. Women

28 Community Drug Strategy: A Call to Action Actions to Achieve Priority Three 3.7 Invest in community Indicators of Progress revitalization models that 3.1 Advocate for the • Number of people on social incorporate a mixed-housing development of a Federal housing waiting lists approach. Housing Strategy that includes • Number of complaints of funding for social housing. 3.8 Streamline the social housing social disorder including public application. 3.2 Advocate for local solutions intoxication in response to the Long-Term 3.9 Support for a shelter that • Number of transitional Affordable Housing Strategy. accepts intoxicated clients of all housing spaces ages. 3.3 Advocate for an increase in • Number of supportive housing basic housing stock through 3.10 Support the Managed units innovation, including the Alcohol Program residence (wet possibility of retrofitting unused shelter). • Number of people using buildings. shelter spaces 3.11 Advocate for a storage 3.4 Support the work of the facility program to safeguard • Number of people identified Sudbury Homelessness Network. personal property for people as homeless entering institutional systems or 3.5 Increase the availability of who are otherwise unhoused. • Number of housing units housing projects to support designated for families, people with mental health and 3.12 Create a program to women and youth addiction problems. store personal identification (ID) for vulnerable populations. • Trustees are held accountable 3.6 Improve the range of housing for their actions (Thunder Bay options available for women, 3.13 Create housing options Drug Strategy, 2011) families and youth, including that follow the Housing First safe emergency shelter, case philosophy (ONPHA, 2013). management services and transitional housing services.

For the City of Greater Sudbury 29 Priority Four

All levels of government set public policy and determine spending priorities that support optimal health for all citizens.

The health of the citizens of for substance related offenses. Foxcourt, Humphreys, & Strang, the City of Greater Sudbury is 2010). determined in part by Bill C-10: Safe Streets and the actions and policies of Communities Act (Parliament Evidence from other jurisdictions municipal government. Policies, of Canada, 2012) and recent globally points to a need for laws and spending priorities changes to the Controlled Drugs enhanced harm reduction of our federal, provincial and and Substances Act, have the initiatives over enforcement municipal governments, influence capacity to further criminalize (Babor et al., 2010) substance users. local decision making (Thunder Social assistance rates are not Bay Drug Strategy, 2011). By Bill C-10 limits judicial discretion adequate for people to maintain unifying our voice and advocating in sentencing which allows stable housing, access nutritious as a community, we have judges to take into account the food and meet basic needs. increased capacity to encourage circumstances of the offence. This puts children and families federal and provincial policy and Criminalization for substance at increased risk of acquiring expenditures that are evidence- use offences can have numerous poor coping strategies such informed. deleterious results, including: as developing substance use In 2005, the National Anti- higher rates of infectious disease, problems. To make progress Drug Strategy was changed to lack of access to treatment, and on preventing harms resulting focus primarily on enforcement a criminal record resulting in from substance use, conditions (Government of Canada, 2013). poor employment outcomes must be created that support (International Centre from citizens to live healthy, safe, and The revised strategy removes Science in Drug Policy, 2010; productive lives. alcohol as a substance of Babor, Caulkins, Edwards, Fischer, concern, has a reduced emphasis on prevention, does not support harm reduction as a pillar, and only addresses harms associated with illicit drugs. With the majority of federal expenditures related to substance use directed to the enforcement sector, programs that work to prevent or reduce harms associated with all substance use are not adequately supported (Treasury Board of Canada Secretariat, 2014). As further evidence of Canada’s reliance on enforcement to manage substance use issues, the federal government has enacted legislation that creates mandatory minimum sentencing

30 Community Drug Strategy: A Call to Action Actions to Achieve Priority Four steps in the drug supply and Indicators of Progress demand chain and that possibly 4.1 Advocate for change at all • Fewer people apply for social contributes to a reduction in three levels of government assistance consumer demand. for increased funding for • Shorter treatment wait lists addiction treatment services, 4.8 Urge the governments of harm reduction initiatives Canada and Ontario to expand • National Anti-Drug Strategy and sustainable prevention and increase the availability priorities and components programming for children of harm reduction options in and youth that supports prisons. • Federal legislation related positive social and behavioural to substance use focuses on development. 4.9 Establish a community plan prevention supporting the safe disposal 4.2 Support the province to of narcotics once a person is • Government spending on release an electronic prescription deceased. prevention, treatment, harm monitoring program (PMP) and reduction and enforcement encourage access to training for 4.10 Encourage the Government of Canada to increase efforts to • Treatment availability for all prescribers. educate the Canadian public incarcerated people 4.3 Encourage continued local about the legal consequences of • Harm reduction services in support for safe medication trafficking offences. correctional facilities disposal initiatives. 4.11 Advocate for publicly funded • Enhanced support for local 4.4 Support local harm reduction coverage for alternatives to pain harm reduction initiatives. initiatives including, but not medication such as massage Examples include but not limited to, the placement of therapy and physiotherapy. limited to needle exchange stand-alone needle collection 4.12 Establish a resource pool of program, Operation Red Nose, bins, provision of naloxone and local service providers to connect crack pipe distribution, etc. Suboxone, and crack pipe distribution. primary health care with • Expansion of publicly funded addiction/ mental health services. allowable treatments to 4.5 Advocate for increased 4.13 Urge the Province of Ontario include funding for bio bins, judicial appointments for the City to maintain addiction as an crack pipes, etc. of Greater Sudbury to expand the capacity of our local legal system eligible disability under Ontario • Sentencing outcomes for to offer drug court diversion Drug Disability Program. (ODSP). trafficking offences programs. 4.14 Advocate for the ODSP • Ontario Disability Support 4.6 Encourage the federal application and adjudication Program (ODSP) policies government to withdraw or process to be simplified and updated. • Fetal Alcohol Spectrum reverse legal measures providing Disorder (FASD) strategies for mandatory minimum 4.15 Encourage an increase in sentencing related to possession program/case management of substances. support for ODSP applicants and 4.7 Advocate for a public health recipients. oriented drug policy approach. This includes a regulatory framework that controls all

For the City of Greater Sudbury 31 4.16 Encourage a review of ODSP 4.19 Revise ODSP eligibility 4.21 Advocate for an increase in policies that make sustained guidelines for the diagnosis of social assistance rates from the housing difficult for ODSP FASD to rely on indicators other Province of Ontario. recipients, such as the policy of than IQ test scores. paying rent in arrears. 4.22 Advocate for equivalent 4.20 Encourage the Province housing allowances through OW, 4.17 Encourage provincial of Ontario to increase access to the ODSP and the Long-Term support for physicians to assist methadone through suggestions Affordable Housing Strategy. clients of Ontario Works (OW) found in the Methadone transfer to the Ontario Disability Maintenance Task Force Report, 4.23 Advocate for increased Support Program. such as supporting the licensing emergency utility relief (and of nurse practitioners and funding for programs that provide 4.18 Call for increased access reducing barriers for physicians relief) for low income to essential local data about (College of Physicians and citizens from the Province of unintentional drug overdose rates Surgeons of Ontario, 2011). Ontario. from the provincial and federal governments.

32 Community Drug Strategy: A Call to Action Priority Five

All people in the City of Greater Sudbury have the opportunity for optimal success and health.

The places where people live, by the family. Early childhood work, play, and learn have an experiences lay the foundation Indicators of Progress impact on their health. for life. Changes in any of these • Secondary School Graduation factors can enhance the health rates Health results from a complex of an individual and subsequently interplay of ‘social and economic the health of the community. • Ontario Student Drug Use and factors, the physical environment Health Survey (OSDUHS) data and individual behaviours and Relationships are key to health. conditions.’ (OPHS, 2008). There Multiple healthy relationships • Ontario Student Drug Use is no single solution for optimal in a person’s life translates to a Health Survey (Northern health, but rather a concerted greater support system available Ontario) mental health data multi-pronged effort that during times of difficulty. A close considers all aspects of where a connection to another individual • School absenteeism/school person lives, works, plays, and can powerfully shape identity attendance learns. and help a person to thrive. • Student achievement and Individual health is impacted by While this is true across the life success income, social status, education, course, cultures and context, • Number of children in care of social supports, social and it is especially true for youth. Children’s Aid Society physical environments, personal Healthy relationships give youth health practices and coping skills, the building blocks to become • Length of children’s mental child development, biology and healthy, caring and responsible health wait lists genetic endowment, access to adults. As a community, creating • Post-secondary admission health services, gender, culture opportunities for youth to feel rates and language (Sutcliffe, Laclé, connected, engaged, responsible Michel, Warren, Etches, Sarsfield and committed is paramount. • Youth employment rates & Gardner, 2007; Ontario Building capacity in our youth Ministry of Health and Long-Term will provide a flow of benefits • Youth suicide/ attempted Care, 2008). It is well documented now and in the future, resulting suicide and self-harm that as income rises, so does self- in more resilient society of the behaviour rates reported health (Sutcliffe et al., future. A resilient community is a • Child/youth poverty rates 2007). healthy community. • Number of developmental People who attain higher Using a community development assets education levels also report approach, the Community Drug better health. People who are Strategy will assess local needs • Attendance at Triple P affected by prejudices either along a multitude of indicators programs because of their gender, race, and develop structures and culture or language report poorer plans to respond to those needs • Results of Resiliency survey health. Personal practices and according to the community’s the ability to form supportive priorities. relationships are often shaped

For the City of Greater Sudbury 33 Actions to Achieve Priority Five into the City of Greater Sudbury 5.18 Conduct an environmental Strategic Plan. scan of programming, curriculum 5.1 Community development and campaigns designed for all approach to build capacity 5.10 Advocated for enhanced students considering relevance and enhance relationships. and stable financial support for to developmental assets and programs to assist at-risk youth substance misuse. 5.2 Raise awareness of the need and young adults. to build developmental assets in 5.19 Encourage the development youth. 5.11 Sustain mentorship of a working group (Town and programs through long-term Gown Association or Safer 5.3 Support school boards and funding commitments. Ontario Drinking Alliance) to families to build supportive 5.12 Examine strategies to enhance community relations relationships and developmental with students in the post- assets. increase workplace placements for young people without post- secondary sector. 5.4 Support ‘readiness for secondary education. school’ strategies with emphasis 5.20 Improve the range of on building developmental 5.13 Encourage community treatment options for youth relationships (Best Start Hubs, use of schools by the community to include off-site, school, Welcome to Kindergarten etc.). at large. community-based, early onset and residential approaches. 5.5 Increase access to early 5.14 Encourage use of ‘Measuring diagnosis and support for what Matters – People for 5.21 Create a working group children with learning Education’ (People for Education, to investigate the provision of and behavioural disabilities to 2014) to incorporate strength- harm reduction services for improve educational outcomes. based approaches that emphasize youth. resiliency, utilize skills training, 5.6 Conduct an environmental and provide arts programming 5.22 Examine the feasibility of scan to identify resources and (Regent Park Focus Youth Media creating a pool of available and gaps in parenting supports and Arts Centre, 2014). screened trustees for youth that programming for families. access social assistance 5.15 Encourage the use of local allowances. 5.7 Provide parents with access referral and help resources to current and evidence-based by educators and other 5.23 Create a registry for information and education about professionals. community volunteers working how to delay or prevent their with youth who have learning or children from using substances, 5.16 Encourage schools and behavioural challenges. in easy to understand language. school boards to develop evidence based alcohol and 5.8 Advocate for access to substance use policies that utilize 5.24 Encourage the use of a early diagnosis and support a restorative justice framework. community development for children with learning approach in the development of and behavioural disabilities to 5.17 Advocate for the programs. improve educational outcomes. assessment of media and advertising for inadvertent 5.25 Foster an asset-building 5.9 Develop a community or blatant encouragement of community. youth strategy based on asset substance misuse. development for incorporation

34 Community Drug Strategy: A Call to Action For the City of Greater Sudbury 35 Priority Six

People who use substances have optimal physical, social, emotional, mental and spiritual health.

Where a person lives, works and Treating addiction is as complex ability to recover. Harm reduction plays has a great influence on as treating a disease such as services are available in the City their overall health. diabetes. It requires access of Greater Sudbury on a limited to medical treatment and an basis and for specific types of Some people are born into environment that supports the substance use. families with education, steady patient to make healthier choices. and well-paying jobs, financial People with chronic diseases The Needle Exchange Program resources, and safe and healthy often relapse and so do people (NEP) based on Best Practice homes. Many others face fewer with substance addictions. Part Guidelines (Strike, Millson, opportunities, less support and of what makes seeking treatment Anstice, Berkely & Medd, 2006) numerous obstacles that stand in for substance addiction so has seen an increased demand the way of improving their lives. difficult is the way addiction is for services, including distribution of supplies, counselling, and/or Supporting people who use viewed in comparison with other chronic conditions. disposing of used needles. Safe substances to improve their inhalation kits are now available situation can increase the Poverty is a pressing issue for distribution through NEP. health and safety of our entire for many citizens of the City community. of Greater Sudbury. Changes Many intravenous drug users in industry and the economy have experienced a non-fatal Drug use and recovery occurs overdose in their lifetime. in a continuum. People who use have led to poor job options for substances may be at various many people. Poverty is clearly The City of Greater Sudbury stages of use and in the recovery linked with substance use- requires a new approach to process. Some are not ready related problems (Rehm, Fischer, reduce the deaths and disability or able to reduce their use or Graham, Haydon, Mann & Room, that occur as a result of opiate stop using. Some people are 2004). overdose. One of the barriers ready to make changes, but Many people who are poor, that prevent drug users from don’t know how to begin. Some in ill health, and facing mental reaching out for emergency people have support and are health and addiction challenges help is the fear of arrest for the recovering. Others are not using have a hard time fitting in possession of illicit substances. substances at all or are using far with their communities. There Medical amnesty programs less than they did at previous are numerous practical and provide assurance for drug users times in their lives. Substance psychological barriers that that if a friend or loved one is addiction is now widely accepted prevent them from getting the overdosing, they can phone for as a chronic, reoccurring disease, services and support they need. emergency assistance and not much like diabetes or heart be searched and/or charged for disease (CAMH, 2014). Like other Addiction is not well understood possession as a result of calling diseases, whether a person and myths, stereotypes and for help. Medical amnesty develops a substance addiction realities often shape how programs increase the likelihood is determined by genetics, the community understands that someone will survive an epigenetics, social environment substance use. The resulting accidental overdose. and personal behaviours. stigma can affect a person’s

36 Community Drug Strategy: A Call to Action people receiving Methadone from marginalized groups to Indicators of Progress Maintenance Therapy. participate on local boards and governing bodies. • Re-treatment rates 6.7 Advocate for a medical • HIV/AIDS/HEP-C incidence amnesty program. 6.17 Support the rates development of local drug user 6.8 Provide support to people groups to provide opportunity for • Number of re-offending receiving Methadone information exchange, occurrences Maintenance Therapy to become peer support and personal self-advocates for proper empowerment. • North East LHIN (Local Health treatment and medical care. Integration Network) data on 6.18 Encourage and assist the substance use and self-rate 6.9 Support the working group business/commerce sector to health to examine the implementation increase opportunities for of overdose prevention such sustainable employment • Patient satisfaction surveys as the provision of Naloxone, for people recovering from overdose education and addictions. • Overdose fatal and non-fatal, institution of a medical amnesty accidental and intentional program. 6.19 Educate the community rates about Methadone Maintenance 6.10 Support distribution of safer Therapy and the principles of Actions to Achieve Priority Six inhalation kits. harm reduction. 6.1 Create an inventory of 6.11 Install free-standing outdoor 6.20 Enhance education and current community programs and needle disposal bins throughout placement requirements for services that provide system the City of Greater Sudbury. students involved in social navigators, case management 6.12 Establish a model based services, enforcement and providers, and street outreach health-related programs to positions. on best practices to support the distribution and pick-up of include addictions training and 6.2 Support the local syringes. outreach experience, including Homelessness Network. intravenous (IV) drug use 6.13 Advocate and support education. 6.3 Expand crisis response access to specialized emergency services to address various types services for people with mental 6.21 Promote basic training of addiction-related crises. health and addictions issues. about harm reduction, addictions and IV substance misuse to 6.4 Ensure adequate primary 6.14 Form a working group to professionals that interact with care providers are available in the determine the fit and feasibility community members. community. of a supervised consumption site. 6.22 Support groups who work 6.5 Advocate for better discharge to support people who use planning for all people leaving 6.15 Conduct an environmental substances and others who work correctional facilities and other scan of programming and to improve their living situations. institutions. services for seniors at-risk of or living with addictions. 6.23 Advocate for a Needle 6.6 Encourage community service Hunters program (Ottawa Public providers to review their policies 6.16 Support people who use Health, 2014). to reduce barriers to service for substances, youth, and people

For the City of Greater Sudbury 37 38 Community Drug Strategy: A Call to Action Priority Seven

People with substance addictions can get well.

Assisting people to get healthy Treatment that addresses the and relieve the pressure on the and back to work can increase family as a whole reduces the Health Sciences North (HSN) our municipal tax- base and risk and incidence of relapse. emergency department and local improve our local economic Currently, people addicted to enforcement agencies. climate. Many people recovering opiates in the City of Greater from substance addictions seek Sudbury have limited treatment Client support needs to be employment opportunities options. A full range of options practical and provide real value that will help build more stable is required for the treatment of to the community. Treatment lives for themselves and their opiate addiction that includes outcome measures and consistent families. People recovering short-term detoxification, data collection practices must be from substance addictions need tapering, in-patient tapering, created and supported to ensure opportunities to improve their medical detoxification and home- that resources are spent in ways skills and reintegrate into their based, assisted detoxification. that produce the best outcomes. community. Many programs offer services Because the City of Greater Many people believe that by that only partially meet the needs Sudbury is centrally located, attending a course of inpatient of vulnerable populations with people from both northern and treatment, a person with an addictions issues. southern communities come here addiction can be cured. However, to access treatment. Local people just like other chronic conditions, Barriers such as hours of often leave this community to treatment is only the beginning operation, length of wait lists escape their triggers during of the recovery process. The for services, location and types treatment and beyond. It is goal behind treatment is to of services available create not enough to offer treatment stabilize the patient, help the gaps in service, making the services for 21 or 28 days and patient develop new skills and most vulnerable people in our expect long term success. connect the patient to supportive community unable to receive services at all. Longer term treatment programs resources. increase the likelihood of success. Childcare is a significant barrier Upon entering the addictions Access to supportive services for caregivers attempting to system, a person should be able for an unlimited term, following access and complete treatment. to easily access other services. treatment enhances long term success rates (Pelletier, 2004). Providers and funders must Methods such as shared consent examine how to better integrate services, currently used by some children and families into the addiction service providers in the treatment process by helping community, need to be expanded clients access specialized and widely implemented to childcare provisions. include other service providers. Addiction does not affect a Increased integration of the person separately from the rest social service sector of City of of their family. Services must be Greater Sudbury will improve available for the entire family to our community’s capacity to deal receive support. with non-physical emergencies

For the City of Greater Sudbury 39 7.5 Offer pre- and post-treatment Indicators of Progress medical examinations onsite at • Re-treatment rates treatment centres.

• Patient exit surveys 7.6 Advocate to the Province of Ontario to ensure full OHIP • Length of treatment wait lists coverage for medical exams and • Methadone availability administrative costs required to access treatment programs. • Length of time from assessment to treatment 7.7 Provide treatment options to people in custody that include • Cost of treatment for methadone maintenance therapy, substance misuse elements of relapse prevention • Availability of childcare and withdrawal symptom management. Actions to Achieve Priority Seven 7.8 Increase the range of detoxification services offered in 7.1 Advocate for an the city to include residential increase in the range of (in-patient), community basis treatment models available, (out-patient/home detoxification) including longer term residential and youth specific services. treatment, day programs, enhanced pre-and post- 7.9 Create a common, shared treatment supports, culturally process that integrates relevant programming and treatment, social services and harm reduction or moderation other systems to facilitate approaches. access and provide more collaborative case management. 7.2 Support the initiation of a kinship drug and alcohol 7.10 Advocate for enhanced treatment model such as the funding for people who need to Alberta model (Governement travel to obtain treatment to get of Alberta: Children and Youth well. Services, 2009) 7.11 Advocate for funding for a 7.3 Advocate for client input comprehensive treatment model regarding the availability of that will address multiple issues childcare initiatives that support for the client. caregivers to access treatment services.

7.4 Improve evaluation of treatment protocols and outcomes.

40 Community Drug Strategy: A Call to Action Priority Eight

Community members are safe in their neighbourhoods.

The City of Greater Sudbury will to use their environments, Although the likelihood of continue to invest in community encourage their children to play contracting an infectious disease safety and well being. outside and become increasingly from a publicly discarded needle disconnected from community is very slim, needles discarded on Crime and substance misuse (Junction Creek Trail-CPTED, streets or in public parks create are closely related. Because 2012) an atmosphere of fear. Publicly many commonly used drugs are discarded needles and other illicit or used illicitly, a criminal The City of Greater Sudbury drug paraphernalia also make element exists to address the has historically invested in the community appear dirty and supply of these substances collaborative community safety unsafe for visiting tourists. to meet the demand. Some and well being initiatives. addicted users may turn to Citizens are often unsure of acquisitive crimes including break A shared and collaborative what to do when they find a and entering, theft or violent commitment to community needle. Outreach workers from crime such as robbery for the safety and well being is an Sudbury Action Centre for Youth purpose of obtaining the drugs effective policing model that are frequently called upon to they use. results in an enhanced level pick up used syringes or provide of community safety. This is training regarding disposal of Some citizens of the City especially true as it relates to used needles in the City of of Greater Sudbury report substance use. Greater Sudbury, although this is that their neighbourhoods not their mandate. By reducing experience high levels Ultimately community and police collaboration will lead to the the number of publicly discarded of loitering,discarded needles, needles, fear among the general violence and prostitution, identification of risk factors and the development and implementation public will decrease (Thunder Bay creating atmospheres of fear Drug Strategy, 2011). and distrust. When people of protective factors to effectively feel their neighbourhoods address the harms associated with are unsafe, they are less likely substance use.

For the City of Greater Sudbury 41 Actions to Achieve Priority Eight 8.6 Improve sentencing outcomes Indicators of Progress for prescription drug trafficking 8.1 Encourage users to increase • Perception of connectedness through increased judiciary their responsibility to safely with community education. dispose of needles through the • Perceived happiness/ use of incentives. 8.7 Ensure programming and satisfaction with community treatment options are in place for 8.2 Increase education to the and services Northern Ontario communities community about how to safely prior to any supply reduction • Neighbourhood and dispose of needles. efforts. community involvement 8.3 Examine a shared costs 8.8 Provide public education • Number of community model for the recovery and about substances, substance use, volunteers disposal of collected needles. and legislation about substance use including impaired driving • Number of volunteer 8.4 Provide needle disposal bins and promote local helping opportunities at key sites. resources. • Involvement with Community 8.5 Commit to deploy Drug 8.9 Provide opportunities for Action Networks Recognition Experts (DREs) to improve detection of impaired- asset/strength building in families • Violent crime rate by-drug driving. and communities. • Perception of safety • Property crime rate • Number of police calls for needle disposal • Number of impaired driving charges (alcohol and/or drug) • Publicly discarded needle counts • Incidents of social disorder

42 Community Drug Strategy: A Call to Action Priority Nine

Government, businesses, agencies, neighbourhoods, families and all people work collaboratively and in partnership to build safe and supportive environments.

Together, we can make a society increasingly free of the Actions to Achieve Priority Nine difference. Substance misuse is range of harms associated with everyone’s issue. From infants drug use. 9.1 Create service and children exposed to the agreements that encourage harms of substance misuse, Indicators of Progress a multi-disciplinary response youth experimenting with tocommunity issues. • Community collaborative substance use, adults who initiatives develop dependence to much 9.2 Encourage on-going communication and collaboration needed medications and seniors • Appreciation for the various between all sectors in the living in fear of crime, the misuse roles and responsibilities community. of substances affects each in this community, leading member of our community. to enhanced inter-agency 9.3 Support new and innovative cooperation As community organizations and approaches to reducing the harms related to substance agencies, government officials, • Community Drug Strategy is misuse in the City of Greater business leaders and people with included in the operational Sudbury. lived experiences share their plans of various community expertise, new understandings agencies and groups are developed and innovative responses are advanced. • Partnerships and service agreements reflect the work Working together helps people of the Community Drug to understand and appreciate the Strategy strengths that each person brings to a situation. These strengths • Community capacity to are the assets to the individual create safe and supportive and the community. These are environments the building blocks to increase • Community approach to community capital to cope with building assets internal and external stresses. Relationships are at the heart of every family, neighbourhood and community. By encouraging open and honest dialogue, relationships are forged. Working together on shared concerns binds people to a common goal. In this case, the goal is improved health, safety, and well-being of all individuals, families, neighbourhoods, and communities in the City of Greater Sudbury by creating a

For the City of Greater Sudbury 43 In Conclusion

Over the course of the creation of this report, it was clear that all participants – whether private or professional – recognize the magnitude of substance misuse issues and the need for a comprehensive community strategy to fix it. This document is a Call to Action for the City of Greater Sudbury. It marks the beginning of coordinated cross-community efforts to improve drug-related health and safety in our community. People are ready to roll up their sleeves and take action. This report not only gives the City of Greater Sudbury a place to start, but maps out very concrete actions in nine key priority areas. The actions contained in this document come from the true experts in our community: citizens and leaders, professionals and youth. They are based on direct knowledge, local needs, and best practice evidence from around the world. Taken together, these actions have the capacity to dramatically improve the health and safety of Sudburians today and for generations to come. You are the key: • Learn about drugs that are commonly misused. • Talk to your family and neighbours about what you have learned. • Dispose of any old or unused medications. • Get involved. Your ideas can help us to find solutions. • If you are concerned about someone’s use of substances, let them know you care. • Seek professional help for yourself or someone you love. Together, we can make a difference. To learn more contact the Sudbury and District Health Unit by phone at 705.522.9200 or email us at [email protected].

44 Community Drug Strategy: A Call to Action Definitions

Acquisitive Crimes Harm Reduction Resiliency Offences where the offender Includes the full spectrum of Is the ability to ‘bounce back’ derives material gain from a responses including preventing or from difficult situations without crime. This may include domestic delaying the use of drugs for people resorting to harmful behaviours. burglary, theft of a motor vehicle, not using them, reducing the harm theft from a motor vehicle and for people who are using them robbery. and ensuring that effective and appropriate treatment is available Drugs in a timely manner.It also includes preventing and remedying the harms Refers to the full range of of drug use experienced by family psychoactive substances used members, neighbourhoods and the in society including alcohol, broader community and reducing prescription drugs, illegal drugs, the economic burden related to drug inhalants, and solvents. misuse.

For the City of Greater Sudbury 45 References

1. Sudbury Community Foundation. (2014). Greater Sudbury’s vital signs, Greater Sudbury’s annual check-up. Retrieved from: http://www.vitalsignscanada.ca/files/localreports/Sudbury_ Report_2014.pdf. 2. Clark, P. (M.D). (2010). Chief Coroner of Ontario (Personal Communication, 2010). 3. Kohtakangas, J. (2011). Bridging the gap: Addressing the barriers for equitable access to mental health services. PHD Candidate. 4. Greater Sudbury Police Services. (2014). GSPS Data Analysis. (R. Keetch: Personal Communication 2014). 5. AIDS Bureau, Public Health Agency of Canada, & Ministry of Health and Long-Term Care. (2013). View from the front lines: Annual summary & analysis of data. April 1,2012-March 31, 2013. Retrieved from: https://www.ochart.ca/documents/2014/VFTFL-2013-ENG.pdf. 6. Statistics Canada. (2009-2012). Canadian Community Health Survey (CCHS). Analysed by the Sudbury & District Health Unit (SDHU) July 2014. 7. Centre for Addiction and Mental Health (CAMH). (2013). Ontario Student Drug Use and Health Survey (OSDUHS). Analyzed by the Sudbury & District Health Unit (SDHU) July 2014. 8. Centre for Mental Health and Addiction. (CMHA). (2013). Drug use among Ontario students, 1977-2013: Detailed OSDUHS findings. Toronto, ON. Retrieved from: http://www.camh.ca/en/ research/news_and_publications/ontario-student-drug-use-and-health-survey/ Documents/2013%20OSDUHS%20Docs/2013OSDUHS_Detailed_DrugUseReport.pdf. 9. Caverson, R. (2010). Prescription opioid-related issues In Northern Ontario. Northern Ontario Area Provincial Centre for Addiction and Mental Health, 1-23. 10. Connex Ontario. (2012). Drug & Alcohol Helpline (DAH) Sudbury Data. (Personal Communication, 2012). 11. Sudbury & District Health Unit. (2013). Needle Exchange Program Data. (G. Sbrega: Personal Communication, 2013). 12. City of Greater Sudbury, Emergency Medical Services. (2013). Service call data. (J. Amyotte: Personal Communication, 2013). 13. IntelliHEALTH Ontario. (2014). Ambulatory Visits Data (2003-2012) and Population Estimates (2003-2012). Extracted: September 2, 2014. 14. Office of the Chief Coroner for Ontario. (2014). Acute Toxicity Statistics for Greater Sudbury (City). 15. Greater Sudbury Police Service. (2014). Crime Data-City of Greater Sudbury. (R. Keetch: Personal Communication, 2014). 16. Ontario Court of Justice. (2014). Criminal court statistics. Retrieved from http://www. ontariocourts.ca/ocj/files/stats/crim/2014/2014-Q2-Offence-Based-Criminal.pdf (pp.42). 17. Fisher, D., Imm, P., Chinman, M., & Wandersman, A. (2006). Getting to outcomes with developmental assets. Minneapolis, MN: Search Institute Press. 46 Community Drug Strategy: A Call to Action 18. Ontario Association of Chief of Police. (2010). Crime prevention in Ontario a framework for action. Retrieved from http://www.mcscs.jus.gov.on.ca/stellent/groups/public/@mcscs/@ www/@com/documents/webasset/ec157730.pdf. 19. Search Institute. (2013). The power of developmental assets. Minneapolis, MN: Author. Retrieved from: http://www.search-institute.org/research/assets/assetpower. 20. Ministry of Municipal Affairs and Housing. (2010). Building foundations: building futures. Ontario’s long-term affordable housing strategy. Toronto: ON. Retrieved from: http://www.mah. gov.on.ca/AssetFactory.aspx?did=8590. 21. Ontario Non-Profit Housing Association (ONPHA). (2014). Waiting lists survey 2014. OHPHA’s report on waiting lists statistics for Ontario. Retrieved from: http://www.onpha. on.ca/onpha/web/Policyandresearch/Waiting_lists_survey_2014/Content/PolicyAndResearch/ Waiting_Lists_Survey_2014/Waiting_Lists_Survey_2014.aspx?hkey=4e2e0fee-e3d3-4c4e- 9d76-252e07060439. 22. South West Local Health Integration Network. (2011). Managed alcohol: housing, health and hospital diversion. exploring a managed alcohol model for the City of London. Retrieved from http://londonhomeless.ca/wp-content/uploads/2013/11/Managed-Alcohol-Report.pdf. 23. Ontario Non-Profit Housing Association (ONPHA). (2013). Focus on housing first.Retrieved from https://www.onpha.on.ca/onpha/web/Policyandresearch/focusON/Content/ PolicyAndResearch/focusON.aspx?hkey=d3c8d411-40bf-413e-9ec7-36c77af84228. 24. Government of Canada. (2014). National Anti-Drug Strategy.Retrieved from http://www.nationa lantidrugstrategy.gc.ca. 25. Library of Parliament. (2012). Legislative summary: Bill S-10: An act to amend the controlled drugs and substances act and to make related and consequential amendments to other acts. Retrieved from http://www.parl.gc.ca/Content/LOP/LegislativeSummaries/40/3/ s10-e.pdf. 26. International Centre for Science in Drug Policy. (2010). Effect of drug law enforcement on drug related violence: evidence from a scientific review. Retrieved from http://www.icsdp.org/ docs/ICSDP%20-%20Violence%20Report%20-%20English%20PL%20summary.pdf. 27. Babor, T. F., Caulkins, J. P., Edwards, G., Fischer, B., Foxcroft D.R., Humphreys, K.,… Strang, J. (2010). Drug policy and the public good. New York, NY: Oxford University Press. 28. Cato Institute. (2009). Drug decriminalization in Portugal: Lessons for creating fair and successful policies. Retrieved from http://www.cato.org/sites/cato.org/files/pubs/pdf/greenwald_whitepaper. pdf. 29. The College of Physicians and Surgeons of Ontario. (2011). MMT program standards and clinical guidelines. Retrieved from http://www.cpso.on.ca/policies-publications/cpgs-other-guidelines/ methadone-program/mmt-program-standards-and-clinical-guidelines .

For the City of Greater Sudbury 47 30. Sutcliffe, P., Laclé, S., Michel, I., Warren, C., Etches, V., Sarsfield, P., & Gardner, C. (2007). Social inequities in health and Ontario public health. Background document.Sudbury, ON: Sudbury & District Health Unit. 31. People for Education. (2014). Measuring what matters. Retrieved from http://www. peopleforeducation.ca/measuring-what-matters. 32. Regent Park Focus: Youth Media Arts Centre. (2014). Retrieved from http://www. regentparkfocus.com. 33. Centre for Addiction and Mental Health. (2014a). Defining addiction, dependence and abuse. Retrieved from https://knowledgex.camh.net/primary_care/guidelines_materials/Pregnancy_ Lactation/Pages/defining_addiction.aspx. 34. Rehm, J., Fischer, B., Graham, K., Haydon, E., Mann, R., Room, R. (2004). The importance of environmental modifiers of the relationship between substance use and harm. Addiction, 99(6). 35. Strike, C., Leonard, L., Millson, M., Anstice, S. Berkley, N., & Medd, E. (2006). Ontario Needle Exchange Programs: Best Practice Recommendations. Toronto: Ontario Needle Exchange Coordinator Committee. Retrieved from: http://www.health.gov.on.ca/english/providers/ pub/aids/reports/ontario_needle_exchange_programs_best_practices_report.pdf. 36. The College of Physicians and Surgeons of Ontario. (2011). Methadone program. Methadone maintenance treatment. Program standards and clinical guidelines. Retrieved from http:// http://www.cpso.on.ca/uploadedFiles/members/MMT-Guidelines.pdf” www.cpso.on.ca/ uploadedFiles/members/MMT-Guidelines.pdf. 37. Government of Alberta: Children and Youth Services. (2009). Kinship care review report. Retrieved from http://humanservices.alberta.ca/documents/kinship-care-review-report.pdf. 38. Junction Creek Trail-CPTED Recomendations-Morin to Mountain/Louis Streets and Hnatyshyn Park Area. (2012). Minutes from March 20, 2012. 39. Thunder Bay Drug Strategy. (2011). Roadmap for change. Towards a safe and healthy community. Retrieved: http://www.thunderbay.ca/Assets/City+Government/ News+$!26+Strategic+Initiatives/docs/Roadmap+for+Change.pdf 40. Pelletier, L. (2004). Evidence based practices and effective program attributes in the treatment of substance use disorders. Conference proceeding. In E.J. Power, R.Y. Nishimi, & K.W. Kizer (Eds.), Evidence-based treatment practices for substance use disorders. Washington, DC. (pp.C1-58). 41. Centre for Addiction and Mental Health. (2014b). Cannabis policy framework. Retrieved from http:// www.camh.ca/en/hospital/about_camh/influencing_public_policy/Documents/ CAMHCannabisPolicyFramework.pdf. 42. Ottawa Public Health. (2014). Needle hunter’s program. Retrieved from http://ottawa.ca/en/resi dents/public-health/healthy-living/what-being-done-about-discarded-needles-our-communities #hunters.

48 Community Drug Strategy: A Call to Action Additional Reading

Butler, D. J. (2009). The chief public health officer’s report on the state of public health in Canada 2009: Growing up well – priorities for a healthy future. Public Health Agency of Canada. Retrieved from http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2009/frrc/pdf/cphorsphc-respcacsp-eng. pdf.

Toronto Drug Strategy Advisory Committee. (2005). The Toronto Drug Strategy: A comprehensive approach to alcohol and other drugs. Retrieved from: http://www1.toronto.ca/city_of_toronto/toronto_public_ health/healthy_communities/files/pdf/tds_report.pdf.

City of Vancouver. (2012). Vancouver Drug Strategy. Retrieved from http://vancouver.ca/people- programs/ four-pillars-drug-strategy.aspx

Public Health Agency of Canada. (2013). OCHART. View from the front lines. Annual summary & analysis of data. Provided by community-based HIV/AIDS services in Ontario. April 1,2012-March 31, 2013. Retrieved from: https://www.ochart.ca/documents/2014/VFTFL-2013-ENG.pdf.

World Health Organization. (2009). WHO Global Health Risks Report: Mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization.

For the City of Greater Sudbury 49 Appendix A: Drug Strategies in Ontario • Kenora Thunder Bay • Lake Superior Lake Michigan Manitoulin First Nations M’Chigeeng • Lake Huron Island Lake Erie Espanola • • Greater Sudbury Southern Owen Sound • Ontario • Muskoka • North Bay Hawkesbury Region • Lake Ontario Northern Ontario Ottawa • Windsor-Essex • Lanark • Smith Falls Sarnia-Lambton • Lake Huron • Chatham-Kent London • Oxford County • Lake Erie Waterloo Region • Brantford • Norfolk • • Guelph and Wellington County • Brant Hamilton • • Haldimand Toronto • • Niagara Region Lake Ontario ■ ■ ■ • Peterborough Community Strategy Implementation Strategy Drug StrategyPlanning Drug

50 Community Drug Strategy: A Call to Action Thank you to the following agencies and groups that contributed to the creation of this document:

Action Sudbury Health Sciences North – Reseau ACCESS Network Withdrawal Management Applegrove Methadone Clinic Services Rockhaven Association des jeunes de la rue Inner City Home Sudbury Action Centre for Youth (SACY) Better Beginnings Better Futures Iris Addiction Recovery for Salvation Army Cambrian College Women ASH Program Social Planning Council Centre de santé communautaire John Howard Society St.Andrews United Church Children’s Aid Society Laurentian University Laurentian University Security Sudbury Alcohol and Drug Church of Christ the King Concerns Coalition Legal Aid Ontario City of Greater Sudbury – Sudbury Catholic District School Emergency Medical Services Methadone Clinic – Larch Street Board City of Greater Sudbury – Social Northern Ontario School of Victims Crisis Assistance and Services Medicine Referral Service (VCARS) Corner Clinic N’Swakamok Native Friendship White Buffalo Healing Lodge, Crown Attorney Centre Whitefish Lake Sudbury Rainbow Crime Ontario Aborigonal HIV/AIDS Whitefish Lake Police Strategy Stoppers Ministry of Children and Youth Everest College Ontario English Catholic Services (MCYS) –Youth Justice Teachers Association Services Family Enrichment Centre Ontario Provincial Police Greater Sudbury Police Services Our Children Our Future Health Sciences North PAVIS – Greater Sudbury Police Health Sciences North – Services Outpatient Addictions & Gambling Rainbow District School Board

For the City of Greater Sudbury 51