Introduction to Substance Abuse Issues in Canada: Pathways, Health Implications and Interventions

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1 Introduction to Substance Abuse Issues in Canada: Pathways, Health Implications and Interventions Maritt Kirst, PhD Centre for Research on Inner City Health, St. Michael s Hospital OTC Summer Institute on Health Inequities and Urban Health, June 11, 2008

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3 Outline Intro to substance use patterns, harms, costs and policy responses What is harm reduction? Harm reduction programs in Canada Why implement harm reduction? Impact of harm reduction programs in Canada Global harm reduction policy context Canadian harm reduction policy context

4 Continuum of Substance Use to Dependence Substance Use Substance Abuse Substance Dependence Recreational use Excessive use of substance Addiction body s physical response to absence of drug; compulsive use of substance despite negative consequences

5 Percentage of lifetime alcohol & illicit drug use in Canada, 2004 (Adlaf, Begin & Sawka 2005) Alcohol Cannabis Hallucinogens Cocaine Speed Ecstasy Heroin Ontario Quebec BC Canada

6 Substance dependence in Canada In 2002: 641,000 Canadians were dependent on alcohol 194,000 were dependent on illicit drugs (Tjepkema 2004)

7 Risks and Harms Associated with Substance Abuse/Dependence Alcohol-related risks and harms: Cardiovascular disease Cirrhosis of the liver Automobile accidents Mental health problems Alcohol-related suicide Family and work-related problems Illicit drug-related risks and harms: Blood-borne infectious disease Fatal and non-fatal overdose Mental health problems Lung health problems Skin and other tissue infections Family and work-related problems

8 Costs Associated with Substance Abuse in Canada (Rehm, Baliunas, Brochu et al. 2006) In 2002, the social costs associated with: alcohol abuse = 14.6 billion illicit drug use = 8.2 billion Costs include: Productivity losses Health care costs Enforcement costs

9 Policy Response to Substance Use Spectrum of policy responses: Enforcement Criminal and regulatory laws Drug treatment courts Prevention School-based prevention programs Public service campaigns Treatment Pharmacotherapy treatment Cognitive behavioural therapy Harm Reduction

10 What is Harm Reduction? Part of continuum of health promotion Definition: Policy designed to decrease the harms associated with drug use without expecting cessation of drug use Focus is on preventing harms linked to drug use, not preventing drug use itself

11 Goals of Harm Reduction Reduce risky licit and illicit drug use Reduce the spread of infectious diseases (e.g., HIV, Hepatitis B & C, Tuberculosis) Prevent drug overdose deaths Decrease public disorder Decrease public health risk related to discarded dirty drug use equipment Increase access to addiction treatment and other health services (Riley 2005)

12 Harm Reduction Programs in Canada Substitution treatment Needle exchange programs Safer injection sites Outreach-based peer programs Shelter-based managed drinking programs

13 Why implement harm reduction policy? To address serious individual and public health risks/harms related to injection drug use 80, ,000 injection drug users (IDUs) in Canada (Fischer et al. 2005); 41,100 IDUs in Ontario (Millson et al. 2005) 10,000-18,000 IDUs in Toronto (Health Canada 1998)

14 Injection drug use is associated with such health problems as: HIV Hepatitis B Hepatitis C other infectious diseases

15 HIV and Hepatitis C prevalence among IDU (Health Canada 2003, 2004; CCENDU 2004) Vancouver Ottawa/Quebec HIV Hepatitis C Toronto

16 Other injection drug use-related health problems: Endocarditis Skin abscess Fatal and non-fatal overdose

17 Similar harms associated with crack smoking Harm reduction services more recently introduced for crack smoking

18 Why not just addiction treatment? Traditional addiction treatment does not work for everyone Social, psychological, economic, and political/legal factors create circumstances conducive to drug use-related risk and harm

19 If a person is not willing to give up his or her drug use, we should assist them in reducing harm to himself, herself and others (Buning 1993)

20 Impact of Harm Reduction Programs in Canada blood-borne virus transmission equipment sharing behaviour frequency of injections overdose public nuisance alcohol consumption, hospitalization and police encounters access to health and treatment services

21 Global Context: Harm Reduction Around the World First harm reduction programs for IDU were introduced in Europe The US government prohibits the use of its funding for harm reduction Injection drug use is driving HIV epidemics in the following countries: China, India, Indonesia, Iran, Libya, Pakistan, Spain, Ukraine, Uruguay and Vietnam, and Thailand Low availability of harm reduction

22 Harm Reduction in Canada

23 Harm Reduction Policy-Making in Canada Despite scientific evidence of its public health benefits, implementation of harm reduction policy has been challenged by: ideology the stigmatization of those who lack control over their drug use concern over messages (Hwang, 2007; CAMH 2002)

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