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November 2011

      Presenters:
Lori Kerr and Patti Bell
Harm Reduction Coalition in York Region
          Terms of Reference

Definition of Harm Reduction

Basic principles of Harm Reduction

Mandate

Membership

Goals/Objectives

           Harm Reduction in York Region- November 2011
Why Harm Reduction?

                                            If you say that I can’t
                                                 come to your
                                              program because I
                                            am using, then you’re
                                               telling me that I
                                            don’t deserve to heal.
                                            Until I’m clean, I am
                                              not good enough.




    Harm Reduction in York Region- November 2011
Membership




Harm Reduction in York Region- November 2011
Examples of Harm Reduction
  Activities in York Region




       Harm Reduction in York Region- November 2011
Harm Reduction Initiatives
Street Outreach
Education, achievable options
Supplying condoms
Moderate/Controlled using strategies
Needle Exchange & Safe Disposal (Sharps)
Safer Inhalation Programs
Tolerance zones (e.g., Supervised Injection
Sites)
Methadone Maintenance Programs
Prescription of heroin and other drugs
Wet shelters, Dry shelters, managed
Alcohol Programs (MAP)
User groups, peer support
Counselling & Referral
                   Harm Reduction in York Region- November 2011
Why Here?
      Canadian Human Rights Act (June18, 2008)


For all purposes of this Act, the
      prohibited grounds of
    discrimination are race,
    national or ethnic origin,
colour, religion, age, sex, sexual
   orientation, marital status,
 family status, any previous or
   existing mental or physical
     disability and includes
disfigurement and previous or
existing dependence on alcohol
  or a drug, and conviction for
    which a pardon has been
             granted.



                    Harm Reduction in York Region- November 2011
Street Outreach
   In 2010 the van was approached on 916 occasions by persons with
potential addiction or usage issues.

  Some of the more common substances used include oxycontin,
marijuana, alcohol, crack cocaine, etc.

  Of the 916 contacts, 390 accessed the needle exchange program.

  Almost 24,000 clean needles were given out and 192 bio bins.

  Just over 8,000 needles were turned in for safe disposal.


                    Harm Reduction in York Region- November 2011
Street Outreach

  Safer sex
               Food and         Shelter and                                          Referrals
information                                        Health care         Counselling
                clothing         sleeping                                               and
 (condoms                                          information          & support
              distribution         bags                                              linkages
 available)




                             Harm Reduction in York Region- November 2011
York Region Alliance to End Homelessness
Health Care Supports not Currently Available to Homeless and At-Risk People in York Region

Gaps in Existing Health Care Support       Specific Needs Identified

Shelter Needs                              “Wet” Shelter
                                           Year-round Inn from the Cold (emergency shelter)
                                           Supportive housing
Health Centres                             Community Health Centres beyond Vaughan

Safe Spaces or Supplies                    More unscheduled drop-in centres (like Krasman Centre)
                                           Safer use crack kits
Treatment Needs                            Residential withdrawal management/ detox
                                           Street health care services
                                           Mobile foot care
                                           Pediatric care
                                           Dental care
                                           Specialists- reduced waitlists
                                           More nurse practitioners
Quality of Care                            Assurance of confidential care and consultations
                                           Ethno-cultural support (especially in the north)




             Harm Reduction in York Region- November 2011
Needle Exchange Program
What is a Needle Exchange Program (NEP)?
All Health units in Ontario have needle exchange programs
Project YES – York Exchange Services
Services:
    •Needle distribution/safe disposal of used needles
    •Injection supplies
    •Information on safer injection
    •Referrals
    •Condoms & lube
All Services are Free and Confidential


              Harm Reduction in York Region- November 2011
Needle Exchange Program Locations
 Mobile site in partnership with Loft/Crosslinks Street
Outreach van
  Fixed sites:
    Rutherford Guardian pharmacy
    Newmarket Sexual Health Clinic
    Richmond Hill Sexual Health Clinic
    Markham Sexual Health Clinic
    Vaughan Sexual Health Clinic                                      1-905-955-2471




                                                               1-866-553-4053

                Harm Reduction in York Region- November 2011
Current Needle Exchange Program York Region Locations




                 Harm Reduction in York Region- November 2011
Future Needle Exchange Program York Region Locations ??




              Harm Reduction in York Region- November 2011
Blue Door Shelters
                               Board training on Harm Reduction


                          Board supported and approved formal policy


               Management completed York University Harm Reduction Certificate


                               Staff received mandatory training


Internal Harm Reduction Committee to assist with policy implementation and continuing education


              Acknowledgement and education in Blue Door Shelter’s intake process


                      Estimate over 50% of residents use substances to cope


                               On-site sharps disposal containers


               Developed and distribute “Harm Reduction” pamphlet for all clients


                     Harm Reduction in York Region- November 2011
Data from Ontario Harm Reduction Distribution Program
  First wave data is from 2007
    • Surveyed approximately 70 injection drug users
    • Compared York Region to Ontario
  Final report: Ontario Harm Reduction Distribution
   Program Final Outcome Evaluation April 2009
    • http://www.ohrdp.ca/wp-
      content/uploads/pdf/OHRDP.Prov.Rpt_LLeonard.pdf
   Note: statistics from the final study are not included in this presentation since
   the data is not isolated to York Region.




                         Harm Reduction in York Region- November 2011
Injection Drug Use
            In the 6 months before the survey...

          40       36
           35
          30
           25                                 19
Percentage 20                                         17
                            13                                     Ontario
           15                                                      York Region
           10
            5
           0
                Injected daily
                            Injected with a shared needle


                    Harm Reduction in York Region- November 2011
Some first wave results: Ontario/York Region
                Commonly used injected drugs...


                                   44
    Crack
                                  43


                 23
 Morphine
                                           53
                                                                     York Region

                                 41                                  Ontario
Oxycodone
                                           53


                                                                77
  Cocaine
                                                           71

                                 Percentage
                Harm Reduction in York Region- November 2011
Some first wave results: Ontario/York Region
                    Disposal of used equipment...
                                                                  80
             80
             70
             60
             50
                       37
             40                                                            Ontario
Percentage
             30                           26                               York Region
             20                                              13
             10               6                  5
              0
                  Needle Exchange bottle/can Loose
                              Plastic



                            Harm Reduction in York Region- November 2011
Some first wave results: Ontario/York Region
          100
                         80           78
           90
           80
           70
           60
           50
Percentage                                                     Ontario
           40
           30                                                  York Region
           20
           10
            0
                Shared drug smoking
                     equipment



                Harm Reduction in York Region- November 2011
Some first wave results: Ontario/York Region
                Commonly used non-injected drugs...

  Crystal   9
   Meth         15


 Cocaine
                                                                     75
                                                    58

                                                                          78        York
   Crack                                                                            Region
                                                           66


  Alcohol
                                                                          78
                                                                70


Marijuana
                                                                               82
                                                                     74

                                      Percentage
                     Harm Reduction in York Region- November 2011
Data from the Shout Clinic Harm Reduction
           Report, Toronto, 2010
         Conducted by:                                               Funded by:




Shout           Clinic           delivers           The Wellesley Institute advances urban
primary, interdisciplinary care to youth            health        through          rigorous
ages 16 to 24 years through a trauma                research,       pragmatic         policy
informed     and     harm     reduction             solutions, social innovation, and
philosophy.                                         community action.




                          Harm Reduction in York Region- November 2011
Dependency and Addiction Issues
 47% of respondents were (in the past 6 months) unsuccessful
in trying to cut down or quit their drug of choice; 37% were
not interested

50% of respondents used drugs to avoid withdrawal symptom

Low use of drug treatment services




                Harm Reduction in York Region- November 2011
Barriers
   Youth experienced a wide range of barriers to accessing
services and supports and practicing harm reduction, such as:

                                   Policy
                               Structural
                              Attitudinal
                              Knowledge
              Complex & Multi-dimensional

                  Harm Reduction in York Region- November 2011
Recommendations - Harm Reduction,
       Public Health Professionals




Youth emphasized the importance of
                                               90% of survey respondents think that
protecting youth with accessible, and
                                               harm reduction is an appropriate and
appropriate harm reduction services
                                                 useful approach to substance use
    and approaches, rather than
                                                              issues.
 punishing them for their drug use.




                   Harm Reduction in York Region- November 2011
Recommendations - Harm
Reduction, Public Health Professionals
1. Deliver services where and when youth need them

2. Spread the word – better advertisement of services

3. Provide supplies that youth need and will use

4. Relevant program options that are appealing to youth

5. Provide greater access to educational materials and resources

6. A safe place to use – safe injection and consumption sites


                  Harm Reduction in York Region- November 2011
Recommendations for Addiction and Harm
        Reduction Professionals
 Increase options
(for treatment and youth specific programs)
Easier access
Peer-workers and people with lived experience




                     Harm Reduction in York Region- November 2011
Recommendations for Police
 Bring police on board
 Training for police
 Policy reform
 Develop a harm reduction unit as part of TPS
 Effective complaint process and greater police
accountability


             Harm Reduction in York Region- November 2011
Recommendations for Mental
        Health Professionals
 Tackle social stigma and promote mental health services
 More responsive services
 Program options
 Positive relationships




                  Harm Reduction in York Region- November 2011
Harm Reduction in York Region- November 2011
Why Harm Reduction?
      By promoting
    Harm Reduction
    we will have safer
      and healthier
    communities as a
       result of our
    combined efforts


Harm Reduction Coalition of York Region Website:
      http://hrcyr.posterous.com
             Harm Reduction in York Region- November 2011
The Future for York Region

  Expansion of needle                                                    Safer disposal of used
                                Education! Education!
 exchange sites in York                                                   equipment/sharps
                                     Education!
       Region                                                                  containers



                                   Harm Reduction                        Making our dreams a
  Policy and procedure             Coalition of York                        reality, having
    development for                Region expanding                      everybody “meeting
      organizations                membership and                        people where they’re
                                       activities                                 at”

                          Harm Reduction in York Region- November 2011
Harm Reduction in York Region- November 2011

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Harm Reduction Coalition in York Region

  • 1. November 2011 Presenters: Lori Kerr and Patti Bell
  • 2. Harm Reduction Coalition in York Region Terms of Reference Definition of Harm Reduction Basic principles of Harm Reduction Mandate Membership Goals/Objectives Harm Reduction in York Region- November 2011
  • 3. Why Harm Reduction? If you say that I can’t come to your program because I am using, then you’re telling me that I don’t deserve to heal. Until I’m clean, I am not good enough. Harm Reduction in York Region- November 2011
  • 4. Membership Harm Reduction in York Region- November 2011
  • 5. Examples of Harm Reduction Activities in York Region Harm Reduction in York Region- November 2011
  • 6. Harm Reduction Initiatives Street Outreach Education, achievable options Supplying condoms Moderate/Controlled using strategies Needle Exchange & Safe Disposal (Sharps) Safer Inhalation Programs Tolerance zones (e.g., Supervised Injection Sites) Methadone Maintenance Programs Prescription of heroin and other drugs Wet shelters, Dry shelters, managed Alcohol Programs (MAP) User groups, peer support Counselling & Referral Harm Reduction in York Region- November 2011
  • 7. Why Here? Canadian Human Rights Act (June18, 2008) For all purposes of this Act, the prohibited grounds of discrimination are race, national or ethnic origin, colour, religion, age, sex, sexual orientation, marital status, family status, any previous or existing mental or physical disability and includes disfigurement and previous or existing dependence on alcohol or a drug, and conviction for which a pardon has been granted. Harm Reduction in York Region- November 2011
  • 8. Street Outreach In 2010 the van was approached on 916 occasions by persons with potential addiction or usage issues. Some of the more common substances used include oxycontin, marijuana, alcohol, crack cocaine, etc. Of the 916 contacts, 390 accessed the needle exchange program. Almost 24,000 clean needles were given out and 192 bio bins. Just over 8,000 needles were turned in for safe disposal. Harm Reduction in York Region- November 2011
  • 9. Street Outreach Safer sex Food and Shelter and Referrals information Health care Counselling clothing sleeping and (condoms information & support distribution bags linkages available) Harm Reduction in York Region- November 2011
  • 10. York Region Alliance to End Homelessness Health Care Supports not Currently Available to Homeless and At-Risk People in York Region Gaps in Existing Health Care Support Specific Needs Identified Shelter Needs “Wet” Shelter Year-round Inn from the Cold (emergency shelter) Supportive housing Health Centres Community Health Centres beyond Vaughan Safe Spaces or Supplies More unscheduled drop-in centres (like Krasman Centre) Safer use crack kits Treatment Needs Residential withdrawal management/ detox Street health care services Mobile foot care Pediatric care Dental care Specialists- reduced waitlists More nurse practitioners Quality of Care Assurance of confidential care and consultations Ethno-cultural support (especially in the north) Harm Reduction in York Region- November 2011
  • 11. Needle Exchange Program What is a Needle Exchange Program (NEP)? All Health units in Ontario have needle exchange programs Project YES – York Exchange Services Services: •Needle distribution/safe disposal of used needles •Injection supplies •Information on safer injection •Referrals •Condoms & lube All Services are Free and Confidential Harm Reduction in York Region- November 2011
  • 12. Needle Exchange Program Locations Mobile site in partnership with Loft/Crosslinks Street Outreach van Fixed sites: Rutherford Guardian pharmacy Newmarket Sexual Health Clinic Richmond Hill Sexual Health Clinic Markham Sexual Health Clinic Vaughan Sexual Health Clinic 1-905-955-2471 1-866-553-4053 Harm Reduction in York Region- November 2011
  • 13. Current Needle Exchange Program York Region Locations Harm Reduction in York Region- November 2011
  • 14. Future Needle Exchange Program York Region Locations ?? Harm Reduction in York Region- November 2011
  • 15. Blue Door Shelters Board training on Harm Reduction Board supported and approved formal policy Management completed York University Harm Reduction Certificate Staff received mandatory training Internal Harm Reduction Committee to assist with policy implementation and continuing education Acknowledgement and education in Blue Door Shelter’s intake process Estimate over 50% of residents use substances to cope On-site sharps disposal containers Developed and distribute “Harm Reduction” pamphlet for all clients Harm Reduction in York Region- November 2011
  • 16. Data from Ontario Harm Reduction Distribution Program  First wave data is from 2007 • Surveyed approximately 70 injection drug users • Compared York Region to Ontario  Final report: Ontario Harm Reduction Distribution Program Final Outcome Evaluation April 2009 • http://www.ohrdp.ca/wp- content/uploads/pdf/OHRDP.Prov.Rpt_LLeonard.pdf Note: statistics from the final study are not included in this presentation since the data is not isolated to York Region. Harm Reduction in York Region- November 2011
  • 17. Injection Drug Use In the 6 months before the survey... 40 36 35 30 25 19 Percentage 20 17 13 Ontario 15 York Region 10 5 0 Injected daily Injected with a shared needle Harm Reduction in York Region- November 2011
  • 18. Some first wave results: Ontario/York Region Commonly used injected drugs... 44 Crack 43 23 Morphine 53 York Region 41 Ontario Oxycodone 53 77 Cocaine 71 Percentage Harm Reduction in York Region- November 2011
  • 19. Some first wave results: Ontario/York Region Disposal of used equipment... 80 80 70 60 50 37 40 Ontario Percentage 30 26 York Region 20 13 10 6 5 0 Needle Exchange bottle/can Loose Plastic Harm Reduction in York Region- November 2011
  • 20. Some first wave results: Ontario/York Region 100 80 78 90 80 70 60 50 Percentage Ontario 40 30 York Region 20 10 0 Shared drug smoking equipment Harm Reduction in York Region- November 2011
  • 21. Some first wave results: Ontario/York Region Commonly used non-injected drugs... Crystal 9 Meth 15 Cocaine 75 58 78 York Crack Region 66 Alcohol 78 70 Marijuana 82 74 Percentage Harm Reduction in York Region- November 2011
  • 22. Data from the Shout Clinic Harm Reduction Report, Toronto, 2010 Conducted by: Funded by: Shout Clinic delivers The Wellesley Institute advances urban primary, interdisciplinary care to youth health through rigorous ages 16 to 24 years through a trauma research, pragmatic policy informed and harm reduction solutions, social innovation, and philosophy. community action. Harm Reduction in York Region- November 2011
  • 23. Dependency and Addiction Issues 47% of respondents were (in the past 6 months) unsuccessful in trying to cut down or quit their drug of choice; 37% were not interested 50% of respondents used drugs to avoid withdrawal symptom Low use of drug treatment services Harm Reduction in York Region- November 2011
  • 24. Barriers Youth experienced a wide range of barriers to accessing services and supports and practicing harm reduction, such as: Policy Structural Attitudinal Knowledge Complex & Multi-dimensional Harm Reduction in York Region- November 2011
  • 25. Recommendations - Harm Reduction, Public Health Professionals Youth emphasized the importance of 90% of survey respondents think that protecting youth with accessible, and harm reduction is an appropriate and appropriate harm reduction services useful approach to substance use and approaches, rather than issues. punishing them for their drug use. Harm Reduction in York Region- November 2011
  • 26. Recommendations - Harm Reduction, Public Health Professionals 1. Deliver services where and when youth need them 2. Spread the word – better advertisement of services 3. Provide supplies that youth need and will use 4. Relevant program options that are appealing to youth 5. Provide greater access to educational materials and resources 6. A safe place to use – safe injection and consumption sites Harm Reduction in York Region- November 2011
  • 27. Recommendations for Addiction and Harm Reduction Professionals Increase options (for treatment and youth specific programs) Easier access Peer-workers and people with lived experience Harm Reduction in York Region- November 2011
  • 28. Recommendations for Police Bring police on board Training for police Policy reform Develop a harm reduction unit as part of TPS Effective complaint process and greater police accountability Harm Reduction in York Region- November 2011
  • 29. Recommendations for Mental Health Professionals  Tackle social stigma and promote mental health services  More responsive services  Program options  Positive relationships Harm Reduction in York Region- November 2011
  • 30. Harm Reduction in York Region- November 2011
  • 31. Why Harm Reduction? By promoting Harm Reduction we will have safer and healthier communities as a result of our combined efforts Harm Reduction Coalition of York Region Website: http://hrcyr.posterous.com Harm Reduction in York Region- November 2011
  • 32. The Future for York Region Expansion of needle Safer disposal of used Education! Education! exchange sites in York equipment/sharps Education! Region containers Harm Reduction Making our dreams a Policy and procedure Coalition of York reality, having development for Region expanding everybody “meeting organizations membership and people where they’re activities at” Harm Reduction in York Region- November 2011
  • 33. Harm Reduction in York Region- November 2011

Editor's Notes

  1. Lori introduction of self and work; Patti introduction of self and work;
  2. ******* Give out handout *******Harm Reduction Coalition of York Region Terms of Reference Philosophy  - The Harm Reduction Coalition of York Region acknowledges its support of the following definition and basic principles of harm reduction: Definition “Harm reduction can be defined as a set of practical strategies with the goal of meeting people ‘where they are at’ to help them reduce harm associated with risk taking behaviour.” Basic Principles of Harm Reduction: Harm reduction philosophy considers risk taking behaviour as a natural part of our world and suggests that our work should be focused on minimizing the harmful effects of the behaviour rather than focusing on the cessation of the behaviour. Harm reduction philosophy supports the involvement of individuals in the creation and/or delivery of programs and services that are designed to serve them. These programs and services must be offered in a non-judgmental and non-coercive manner.Harm reduction philosophy recognizes the impact of issues such as poverty, classism, racism, homophobia, social isolation, past trauma, and other social inequities on both people’s vulnerability to and capacity for effectively dealing with risk taking behaviour. This definition and the basic principles of harm reduction come from research of the AIDS Committee of York Region which acknowledges the definition currently used by the Canadian AIDS Society.Mandate To promote, advocate for and support best practice policies, programs and initiatives that aim to reduce harms associated with risk taking behaviours, including substance use.Membership A Working Group of community members, groups and organizations representative of the diversity of York Region who are committed to harm reduction and Principles noted in these Terms of Reference.A Steering Committee of agency representatives with decision-making authority, supportive of harm reduction philosophy, whose role is to advise and support the Working GroupGoals/Objectives To develop and strengthen partnerships between organizations and/or individuals who believe in harm reduction.To increase the awareness of harm reduction philosophy of the public, service providers, politicians and legislators.To increase the awareness of and accessibility to harm reduction strategies, approaches and programs in York Region. To identify and act on harm reduction priorities is identified by the community.
  3. This is a sample only of harm reduction activities in the Region, not a comprehensive list.
  4. Because it is the law to not discriminate.
  5. What is a Needle Exchange Program (NEP)?Needle exchange programs help reduce the harms associated with injection drug useNeedle  Exchange Programs (NEPs) are a form of harm reduction, as they aim to reduce the spread of HIV/AIDS and Hepatitis B and C among injection drug users. Sharing needles and other equipment water, filters, etc) are high risk activities for transmitting HIV/AIDS, Hepatitis B/C, and other blood-borne infectionsAll Health units in Ontario are mandated to provide needle exchange programsYork Region’s Community & Health Services needle exchange program is called Project YES – York Exchange ServicesProject YES offers:Needle distribution/safe disposal of used needles Injection suppliesInformation on safer injectionReferrals to addictions, health and social servicesCondoms & lubeAll Services are Free and Confidential Distribute project YES cards
  6. ***** Give out handout *********
  7. *** Give out handout ****
  8. Survey done across province, York Region participated in the first 2 of 3 waves.
  9. Reinforce importance of Harm Reduction
  10. Identifies that injected drug use is a significant issue in York Region and across the Province.
  11. Highlights need for safer disposal
  12. In Toronto many harm reduction practices are supported by the City of Toronto, Public Health and Police Services.
  13. Except for Crystal Meth, York region has a higher utilization rate of non-injected drugs than the province of ontario
  14. They focused on youthExample of a comprehensive report from our neighbours. Trends identified here are also common to York Region.
  15. Do we think it is similar in York Region???
  16. Youth acknowledged what’s working well in regards to services and supports, and identified a number of barriers and gapsPolicy Barriers: Lack of funding and support for harm reductionZero tolerance policiesRestrictive eligibility criteria Structural Barriers: Limited and inconvenient hours of operation Limited and inconvenient locations of service delivery Lack of transportation resources Waiting times and waiting lists Lack of program options and the power to choose No health card or health care coverage Attitudinal Barriers: Social stigma and discrimination Social networks Staffing and interpersonal relationships Knowledge Barriers: Lack of knowledge of services and support Lack of knowledge and concern for risks Complex and Multi-Dimensional Barriers: Homelessness and instability Fear of policeDo we think it is similar in York Region???
  17. Reinforce the 90% think Harm Reduction is helpful.
  18. #1:After hour services and non-downtown areas, shelters, drop-ins, CHCs and areas where youth use and hang out.#3: Greater access to existing supplies and meth, snorting and drug testing kits#4: Expansion of existing NE, outreach and mobile servicesVending machinesPrograms designed for specific groups (i.e. LGBT)Peer and mentoring programs Individual and political advocacy supportHarm reduction: support groups for people living with mental health issues, HIV/AIDS, and Hepatitis C counselling and crisis intervention supportive housing, shelters and hostels for youth who use drugs #5:A variety of educational mediums (i.e. verbal, internet, brochures, etc)Strong visuals and accessible languageYouth involvement in design/production#6:The list of reasons given by youth for why this is an needed resource is detailed in the report. Research regarding Insite supports this recommendation.
  19. Increase options:   Youth-specific programs and treatment options (youth-only detoxification centres or at minimum, youth-specific beds within the current system). Options of residential or out-patient programs, and group or individual counselling. Range in program options that include abstinence as well as harm reductionA holistic approach to supporting youth in reducing or quitting substance use; and in the delivery of after-care need to expand to include assisting youth in re-integrating into the community by securing housing, income, primary health care, and linking youth with employment, educational and recreational opportunitiesEasier Access: Reducing waiting time and increasing the flexibility of programs and services Youth-friendly intake procedures, self-referrals, informal assessments, drop-in services, and flexible hours More local services and programs availableLived Experience:Youth described feeling more comfortable talking about their use of substances and other issues with someone who has been through similar experiences themselves.
  20. Policing issues was consistently named as an important issue for youth in the interviews and focus group Bring police on board in regards to harm reduction – four pillar approach Training for police: on working with homeless and street-involved youth and harm reduction Policy reform: police will not confiscate or destroy harm reduction supplies Complaints process – educate youth and service providers re: new independent police complaint process (OIPRD)
  21. Proposal is for coordinated response throughout the Region on Harm Reduction practices and to build effective strategiesWe are doing good work, we are learning from our neighbours and other research. We want to expand our knowledge base