The document discusses harm reduction initiatives in York Region. It provides an overview of harm reduction principles and activities in the region such as needle exchange programs, street outreach, and education efforts. Data is presented comparing drug use and harm reduction practices in York Region to Ontario overall. Recommendations are made to expand access to harm reduction services and supplies for youth and increase education and training on harm reduction for various groups.
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
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
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
Lori introduction of self and work; Patti introduction of self and work;
******* 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.
This is a sample only of harm reduction activities in the Region, not a comprehensive list.
Because it is the law to not discriminate.
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
***** Give out handout *********
*** Give out handout ****
Survey done across province, York Region participated in the first 2 of 3 waves.
Reinforce importance of Harm Reduction
Identifies that injected drug use is a significant issue in York Region and across the Province.
Highlights need for safer disposal
In Toronto many harm reduction practices are supported by the City of Toronto, Public Health and Police Services.
Except for Crystal Meth, York region has a higher utilization rate of non-injected drugs than the province of ontario
They focused on youthExample of a comprehensive report from our neighbours. Trends identified here are also common to York Region.
Do we think it is similar in York Region???
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???
Reinforce the 90% think Harm Reduction is helpful.
#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.
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.
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)
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