Reducing the Harm Associated with Injection Drug Use in Canada

Appendix C - Actions For A Comprehensive Strategy

A comprehensive strategy requires partners to work together towards common goals and strategic directions over both the immediate and the long term. It requires integration, coordination, and complementarity of a diverse array of strategies at the local, provincial/territorial, national, and international levels. This section provides a range of immediate and long-term, multifaceted initiatives to reduce the harm associated with injection drug use. These initiatives are presented within a framework for action addressing the areas of prevention; outreach; treatment and rehabilitation; research, surveillance, and knowledge dissemination; and national coordination. The actions highlighted in bold text represent actions to be undertaken immediately. The remainder is intended to reduce harm in the longer-term.

1. Prevention

• Develop and enhance initiatives that address the underlying factors and conditions that put people at risk of misusing drugs, particularly by injection.
  
• Develop and enhance initiatives that address the underlying factors and conditions that put people at risk of engaging in unsafe injection practices.
  
• Develop and enhance initiatives that focus on high risk youth and the prevention of injection drug use.
  
• Identify gaps in existing prevention programs to respond effectively to the particular needs of populations such women, youth, prisoners, the homeless, and Aboriginal peoples.
  
• Develop tools and resources to enable individuals, families, and communities to acquire knowledge, change attitudes, develop skills, and adopt healthy behaviours.
  
• Enhance substance misuse prevention efforts that take into consideration the population health approach, e.g. marginalization, disparate social and economic status, levels of education and employment status, and other underlying issues.
  
• Continue the development of healthy child development strategies that provide the best opportunities for parents and children to improve their life circumstances and that prevent child abuse and other family violence.
  
• Provide training to those involved in prevention activities, such as outreach workers, teachers, health professionals, peer helpers, enforcement officials, and staff of correctional facilities.
  
• Develop interventions that identify at-risk school-aged children (ages 5-18) and provide them with the necessary tools to assist them to reconnect to the school/community setting e.g. literacy skills, anger management.

2. Outreach

• Work with law enforcement, justice, all levels of government, community groups and others to enhance the implementation, accessibility and effectiveness of needle exchange programs and address the barriers in all settings in Canada, including the consideration of pilot projects in correctional facilities.
  
• Support outreach and networking initiatives at all levels to foster and increase harm reduction initiatives, increase access to effective health, social and treatment and rehabilitation services, and enhance social integration and reintegration (e.g. prisoners returning to their communities upon release from a correctional facility).
  
• Foster the involvement of people who use drugs by injection and drug user networks in reducing the harms associated with injection drug use.
  
• Develop innovative outreach approaches and use peer outreach workers to disseminate information to hard-to-reach populations and to encourage people who use drugs, particularly youth and young adults, to seek appropriate treatment services.
  
• Develop evidenced-based material that are sensitive to the needs and circumstances of people who inject drugs on the promotion of supervised injection practices, safer sex practices, and infectious disease prevention.
  
• Assist existing outreach networks to include harm reduction services such as needle exchange programs, vaccination against Hepatitis A and B, Pneumovax, tuberculosis testing and Directly Observed Therapy (DOT), if required, testing and treatment for sexually transmitted diseases, HIV testing, and assistance with Antiretroviral therapies.
  
• Enhance links between health and enforcement to ensure that the two sectors are working together to achieve complementary goals.
  
• Foster the capacity of needle exchange programs, pharmacies, and health services to recuperate used needles.

3. Treatment and Rehabilitation

• Increase the availability of and address barriers to effective substance misuse treatment and rehabilitation programs, including methadone maintenance treatment, in all settings, including correctional facilities.
  
• Support, in principle, clinical trials to assess the treatment effectiveness of the prescription of heroin, LAAM, buprenorphine, and other drugs in the treatment of people who inject drugs.
  
• Ensure that programs and services meet the needs of people who use drugs, including individuals with multiple substance use problems and mental illnesses, and take into account gender, age, geographic location, disability and ethnicity.
  
• Ensure that substance misuse treatment and rehabilitation services, HIV/AIDS, and hepatitis B and C medical care and treatment, and adjunct services such as housing and employment are linked.
  
• Explore the issue of effective pharmacological treatment for cocaine addiction.
  
• Ensure curricula for health and other relevant professionals include injection drug use issues.
  
• Provide training to health professionals, particularly in the area of methadone maintenance treatment, in collaboration with associations of health professionals and other relevant institutions.
  
• Promote and increase training for emergency room personnel to respond to crisis situations, such as overdose so that persons in crisis have access to appropriate treatment by first line service providers.
  
• Create and make available opportunities for job training and education for people who have been stabilized.
  
• Address barriers, such as discrimination, marginalization, and coercive measures to develop effective interventions for people who inject drugs, taking into account the special circumstances of those with HIV and/or hepatitis C.

4. Research, Surveillance, and Knowledge Dissemination

• Monitor innovative approaches used in other countries to address injection drug use and assess their applicability to the Canadian context.
  
• Develop a framework for reporting regularly using agreed-upon indicators on injection drug use and its consequences, develop the tools necessary to collect and disseminate the relevant data and information, and monitor progress made to address this critical issue.
  
• Establish a task group consisting of (at a minimum) law enforcement, justice, health and social services, addiction and community perspectives to conduct a feasibility study of establishing a scientific, medical research project regarding a supervised injection site in Canada.
  
• Improve surveillance of the injection drug use situation and its consequences in Canada through data collection, targeted studies, and research to assess causes, co-factors, and effectiveness of interventions.
  
• Enhance knowledge dissemination and education regarding injection drug use, its determinants and its health and social effects for health and social service professionals, enforcement and justice officials, persons who inject drugs, inmates in correctional facilities and the community at large.
  Conduct research on Canadians' attitudes regarding harm reduction principles and specific harm reduction strategies.
  
• Establish links with organizations working with drug/steroid use and sports to obtain information about the use of steroids and similar drugs by injection and about effective interventions.
  
• Support research initiatives and monitor local, national and international experiences to gather evidence on the effectiveness of innovative approaches.
  
• Conduct qualitative and ethnographic research to better understand issues, such as current needle use behavior, and disseminate the results as widely as possible.
  
• Examine what works and what does not work to establish best practices in prevention, outreach, treatment and rehabilitation.
  
• Undertake research to examine the links between injection drug use, HIV/AIDS, and hepatitis B and C to develop appropriate responses.
  
• Support evaluation and implementation of new approaches, such as drug treatment courts, to respond to the need for diversion programs and alternative measures and to address injection drug use as a health issue.
  
• Develop, apply, and monitor the application of ethical standards for the involvement of people who inject drugs in all facets of research.
  
• Enhance the capacity of public health authorities and networks, such as the Canadian Community Epidemiology Network on Drug Use (CCENDU), to operate as an effective national surveillance system and early warning network.
  
• Develop innovative mechanisms to disseminate evidence-based information, such as electronic bulletin boards and satellite conferences.

5. National Leadership and Coordination

• Provide leadership and coordination to establish an intersectoral, multi-level national dialogue regarding injection drug use.
  
• Provide leadership and collaborate with colleagues from other ministries/departments/jurisdictions to promote the adoption of policies and practices that reduce the harm associated with injection drug use.
  
• Foster intersectoral action through mechanisms such as the Health and Enforcement in Partnership (HEP) initiative to achieve the objectives of this framework for action.
  
• Provide leadership and support to ensure adequate attention and funding for strategies to reduce the harm associated with injection drug use.
  
• Recognize that action is required at all levels, including federal government, provincial/territorial governments, non-governmental organizations, and communities, and in a variety of jurisdictions, including public health, addictions, HIV/AIDS, hepatitis C, Aboriginal peoples, corrections, mental health, social housing, justice, enforcement, education, and employment sectors