1. Opioid Crisis A Call to ACTION
Sarah Ellis, Grey Bruce Health Unit
Dave Roy, Hope Grey Bruce

2. Objectives
Increase awareness of the issue of opioids Be aware of the role that municipal leaders can play in the opioid crisis
The purpose of this presentation is not create alarm or induce panic
The purpose is to understand the realities of the opioid crisis on a Grey Bruce Level and explore the human side of the opioid crisis and the effects on our families and communities
By talking openly about drug use, we can begin to decrease the stigma associated with drug use and develop a collective response that fosters compassion and understanding rather than fear and stigma.

3. WHAT IS AN OPIOID?
Opioids are a family of drugs that have morphine-like effects.
The primary medical use for prescription opioids is to relieve pain.
Opioids can also produce euphoria, making them prone to abuse.
The most commonly misused opioids are prescription drugs.
Opioids are depressant drugs, which means that they slow down the part of the brain that controls breathing.
-Non-prescription – heroin
-Prescription – Fentanyl, Dilaudid, Percocet

4. Opioid Crisis by the numbers...
1 person dies every 12 hours in Ontario from an Opioid overdose
1 in 170 deaths in Ontario is now related to opioid use.
1 in 8 deaths of young adults (25-34 years) is related to opioids.

5. Context: Other deaths in Ontario
481
Motor Vehicle Deaths (2014)
623
Streptococcus pneumoniae (2014)
673
Opioid Related (2014)
Overdoses have overtaken automobile accidents in terms of accidental deaths in Ontario and many other parts of Canada
Ref: 2014 MTO, 2014 PHO, 2014 MOHLTC

6. Grey Bruce
Opioid related Emergency Department visits have tripled over the past 14 years
Acute opioid toxicity rates have increased by 2.5x since 2002
Between 2010 and 2014 Grey Bruce had 9 deaths related to acute fentanyl toxicity
New Opioid tracking tool from Public Health Ontario

7. Rate of Opioid Related Hospitalizations, all ages, all sexes, 2016
Ontario
Grey Bruce
Rate per 100,000
13.7
24.4
Cases
1905 40

8. How did We Get Here? It’s complicated!
Marketing: 1990’s opioids were thought to be ‘safe” pain management tools. In Ontario, prescription narcotic use is 2 to 4 x higher than in other provinces
Gaps in Services – lack of chronic pain clinics, lack of addiction and mental health services – both in patient and in community,
Social Determinants of health – lack of affordable housing, poverty, hopelessness,
Stigma associated with ‘drug users’ – tend to look at drug use as an individual lifestyle behavior rather than a collective community responsibility for all citizens – including those most vulnerable.

9. How did we get here? Clinical Guidelines
Trends in High Dose Prescribing
No increase in addiction or mental health services
Lack of understanding and treatment options for chronic pain

10. The Problem of Opioid Related Harm is:
The Solutions Need to Be:
BIG
COMPLEX
WORSENING
COMPREHENSIVE
TIMELY
EVALUATED

11. Drug use is Happening in our community
Reducing the negative consequences associated with drug use is going to take a collaborative, community response.
The Opioid crisis is a health issue, that can affect all of us – our family, friends and neighbours.

12. What is already Happening in Grey and Bruce?
Crystal Meth and Other Drugs Strategy
Opioid Working Group
RAAM clinic
Needle Exchange Sites
Naloxone Distribution
Harm Reduction Support Group
Events such as: Overdose BBQ, Bring it Back Campaign
Municipal Presentations

13. Next Steps Advocacy for treatment services
Addiction treatment services woefully underfunded/ under resourced
Currently 13 full-time counsellors and 3 part time counsellor to offer services for all of Grey- Bruce
3 full-time counsellors and 1 part-time counsellor to offer services to youth in Grey-Bruce
No ongoing funding to maintain and/or expand RAAM
Difficult to avoid running waitlists, cannot cover all areas in rural environment, transportation issues present as a barrier
Access to supportive primary care can be a problem
Access to substitution therapies is a challenge

14. Next Steps continued.. Develop community opioid response
Increase monitoring and surveillance
Work with physicians, nurse practitioners, pharmacists, dentists about safe prescribing
Public awareness
Education to target groups
Engage municipal leaders

15. What can municipal leaders do?
Understand the opioid crisis as an indicator of overall community health
Avoid stigmatizing people who use opioids
Evaluate the level of harm reduction supports in your community
Do you have a program for community sharps disposal?
Do you have needle exchange services available for residents?
Do you have naloxone available for residents that need it most?

16. What can Municipal Leaders Do?.
Utilize a “Health in all Policies” approach in municipal and county level policies
Advocate for funding to address the root causes of addictions and mental health and the need for increase support for those most vulnerable such as
Safe and affordable housing
Access to health care services in your community
Access to transportation
Childcare and social support programs

17. Questions?