Building Capacities to Respond Post-legalization - tophc.ca · We would like to begin by...

A PUBLIC HEALTH APPROACH TO CANNABIS

Building Capacities to Respond Post-legalization

The Voice of Public Health La voix de la santé publique

THE ONTARIO PUBLIC HEALTH CONFERENCE | MARCH 21ST, 2018

• None of the presenters at this session have received financial support or in-kind support from a commercial sponsor.

• None of the presenters have potential conflicts of interest to declare.

DISCLOSURE OF COMMERCIAL SUPPORT


THE ONTARIO PUBLIC HEALTH CONFERENCE | MARCH 21ST, 2018 3

WELCOME

We would like to begin by acknowledging that the land on which we gather is the traditional territory of the Haudenosaunee, and most

recently, the territory of the Mississaugas of the New Credit First Nation.



WELCOME

The territory was the subject of the Dish With One Spoon Wampum Belt Covenant, an agreement

between the Iroquois Confederacy and the Ojibwe and allied nations to peaceably share and care for

the resources around the Great Lakes. This territory is also covered by the Upper Canada Treaties.



WELCOME

Today, the meeting place of Toronto (from the Haudenosaunee word) is still the home to

many Indigenous people from across Turtle Island and we are grateful to have the

opportunity to work in the community, on this territory.

6 THE ONTARIO PUBLIC HEALTH CONFERENCE | MARCH 21ST, 2018


CANADIAN PUBLIC HEALTH ASSOCIATION (CPHA)

Our Vision A healthy and just world Our Mission CPHA’s mission is to enhance the health of people in Canada and to contribute to a healthier and more equitable world. www.cpha.ca

http://www.cpha.ca/




1. Explore and enhance knowledge related to cannabis use and co-use with other substances, including available resources, programs, services and capacity building opportunities. 2. Identify the gaps of service providers related to using data to inform service delivery, harm reduction strategies for cannabis use, and organizational and community capacity building strategies.



1 OPENING AND WELCOME Introduction and pre-session evaluation Discussion of objectives

A PUBLIC HEALTH APPROACH TO CANNABIS Cannabis primer - regulatory approach CPHA project overview What is a public health approach Small group activity and group discussions

A COMMUNITY RESPONSE TO CANNABIS Key themes from CPHA’s community consultation sessions Challenges and gaps identified by CPHA Small group activity and share back

CLOSING AND NEXT STEPS Ongoing activities Project timeline Closing and post-session evaluation

TODAY

2

3

4




CANNABIS PRIMER - REGULATORY APPROACH WHAT IS A PUBLIC HEALTH APPROACH

SMALL GROUP ACTIVITY AND GROUP DISCUSSIONS


2



SOURCE: CENTRE FOR ADDICTION AND MENTAL HEALTH (2014): CANNABIS POLICY FRAMEWORK.



THE ‘10 Ps’ OF CANNABIS LEGALIZATION

CPHA PROJECT PRIMER

• Production • Types of products, # of

producers • Profit motive

• Non-profit, ‘for-benefit’, for-profit distributors or state monopoly

• Co-location of retail • Promotion • Prevention

• $$ • Policing and enforcement

• What takes priority?

• Penalties • Criminal or civil

• Potency • Thresholds for THC, CBD,

extracts • Purity

• Production standards, mixed products

• Price • Permanency

• Adaptability is key

(Source: Beau Kilmer, 2013)




Current Federal Bills Bill C-45: An Act respecting cannabis and to amend the Controlled Drugs and Substances Act, the Criminal Code and other Acts Bill C-46: An Act to amend the Criminal Code (offences relating to conveyances) and to make consequential amendments to other Acts

CANNABIS PRIMER




Federal regulation of cannabis • The Federal Government released its proposed approach to the

regulation of cannabis on November 21, 2017. The proposed regulations were open for public consultation; closed on January 20, 2018.

• The regulations cover:

CPHA PROJECT PRIMER

Source: Proposed Approach to Regulation of Cannabis, Government of Canada (2017). Accessed from: https://www.canada.ca/en/health-canada/programs/consultation-proposed-approach-regulation-cannabis/proposed-approach-regulation-cannabis.html

• Licences, Permits and Authorizations

• Security Clearances • Cannabis Tracking System • Cannabis Products

• Packaging and Labelling • Cannabis for Medical

Purposes • Health Products and

Cosmetics with Cannabis

https://www.canada.ca/en/health-canada/programs/consultation-proposed-approach-regulation-cannabis/proposed-approach-regulation-cannabis.html)

https://www.canada.ca/en/health-canada/programs/consultation-proposed-approach-regulation-cannabis/proposed-approach-regulation-cannabis.html)




Should the proposed Cannabis Act come into law in 2018, each province and territory will be left to create legislation on several key items, for example: Age: minimum age of 18 yrs (discretion to increase) Personal cultivation: number of personal plants (4) (further restrictions can be applied) Consumption: where and how cannabis may be consumed (restrictions and requirements to be set locally)

CANNABIS PRIMER



CPHA PROJECT PRIMER

Legal Age Retail Model Consumption of Cannabis Home Grow Personal

Possession Driving

Ontario 19 Public, standalone, retail outlets

and online sales

Allowed in private

residences, prohibited in

public, workplaces, and

vehicles; exemptions for

medical cannabis consumption

Permitted indoors,

prohibited outdoors

30g for adults, 0g for minors; must

be sealed and inaccessible to

people in a vehicle

Zero tolerance for young

(under 21 yrs) and novice (G1,

G2, M1, M2) drivers, aligned

with current alcohol

sanctions





The goal for the CPHA project is to improve the capacity of the health and social service providers in communities

across Canada to apply a public health approach to cannabis (and other substances) using trauma- and

culturally-informed lenses.

CPHA PROJECT PRIMER




This project seeks to assess the needs and inform the design of capacity building resources for health and social service providers through: 1) Ongoing Environmental Scanning 2) Key Informant Interviews 3) Community Consultations across Canada 4) National Expert Reference Group

CPHA PROJECT PRIMER




CPHA PROJECT

CANNABIS

AUTHORIZED FOR MEDICINAL

PURPOSES RETAIL

PERSONAL GROWING ILLEGAL



The aim of CPHA and this project is to

‘normalize conversation, not consumption’




• The project endeavours to help health and social service providers to take a public health approach to cannabis

CPHA PROJECT




CPHA - A Public Health Approach to the Legalization, Regulation and Restriction of Access to Cannabis (https://www.cpha.ca/public-health-approach-legalization-regulation-and-restriction-access-cannabis)

CANNABIS PRIMER

https://www.cpha.ca/public-health-approach-legalization-regulation-and-restriction-access-cannabis

https://www.cpha.ca/public-health-approach-legalization-regulation-and-restriction-access-cannabis



CONSULTATION HOSTS

CPHA PROJECT



NATION-WIDE CONSULTATIONS

Type of Provider # Social Worker 84 Educator 53 Addictions and/or Mental Health Provider 46 Nurse 42 Criminal Legal Officer 35 Health Promoter 33 Youth Provider 20 Physician 17 Government Employee 15 Medical Health Officer 11 Pharmacist 12 Paramedic 5 Harm Reduction 4 Management 77 Other 50

Total 504




Type of Organization # of Providers

Regional 125

Provincial/ Territorial 114

Non-Profit 101

Education 60

Criminal Legal 40

First Nations, Inuit, and Métis 24

Other 40

Total 504

CONSULTATION PARTICIPANTS



• 23 consultations scheduled Consultations in every province and territory

• Participants traveled from 63 communities to attend the consultations




HEALTH PROMOTION AND HARM REDUCTION




Health promotion and cannabis • Experts identify the need for an approach to cannabis

related health promotion messaging that: • Includes harms, but does not exaggerate or fixate on them • Focuses on the place of cannabis in a person’s life and

their goals with use

HEALTH PROMOTION & HARM REDUCTION

Sources: CPHA, 2017; Here to Help, 2013; Rottach et al., 2009




Harm reduction and cannabis • Harm reduction refers to the policies and practices focused on

reducing the problematic effects of substance use • Harm reduction is the only global drug policy response that has

proven to save lives and money at the same time as increasing quality of life

• Examples of familiar harm reduction interventions: seat belts, air bags, helmets, Smart Serve, needle exchange programs, smoke-free public spaces


Sources: Erickson et al., 2002; Stone & Sander, 2016




• A focus on the harms not on the substance

• Acceptance that there are benefits and consequences of substance use

• A focus on decreasing more immediate harms versus striving for a drug free society

• The need to give people choice and access to a broad range of options for safety and health

• A focus on what the person sees as their most immediate need

• Acceptance that small gains add up over time

• Recognition that people know what is best for them

• Recognition that people are doing the best they can with what they have


Harm reduction principles





Source: Centre for Addictions Research of BC, 2012

Cannabis health promotion and harm reduction examples






Cannabis health promotion and harm reduction examples




Canada’s Lower-Risk Cannabis Use Guidelines (LRCUG): • Published June 23rd 2017 in

American Journal of Public Health • Ten recommended guidelines related

to cannabis consumption • Brochure for the public currently

available on Centre for Addiction and Mental Health website





If it doesn’t make sense here… …why would it make sense when you drive?



ACTIVITY 1: IDENTIFYING GAPS OF SERVICE PROVIDERS

• Each table, identify a recorder and reporter • Discuss the questions as a group • Capture the key points made by the group on the

worksheet provided (recorder) • Be prepared to share with the large group • Submit the completed worksheet

GROUP ACTIVITY



ACTIVITY 1: IDENTIFYING GAPS OF SERVICE PROVIDERS

• Identify which sectors are represented at your table

• What are your thoughts on cannabis legalization and how it might impact your practice/organization, and the health and social services sector?

• What do you perceive as a gap or challenge as it relates to supporting/applying a public health approach in the context of cannabis legalization?

GROUP ACTIVITY




KEY THEMES FROM CPHA’S COMMUNITY CONSULTATION SESSIONS CHALLENGES AND GAPS IDENTIFIED BY CPHA

SMALL GROUP ACTIVITY AND SHARE BACK

A COMMUNITY RESPONSE TO CANNABIS

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Competency Domains The health and social service provider will be able to…

• Apply a public health approach in their practice • Demonstrate knowledge of Cannabis • Ability to have evidence informed conversations about cannabis • Awareness of cannabis-related data • Work in collaboration with providers to support a community

response





Capacity Gaps

• The “gaps” between the desired and current capacity of health and social service providers to take a public health approach to cannabis have been interpreted and described to identify possible capacity building focus areas

• Capacity building focus areas have been identified in relation to the desired practice for health and social service providers




CPHA PRIORITIZED FOCUS AREAS

CAPACITY GAPS



ACTIVITY 2: ADDRESSING CAPACITY GAPS

• Each table, identify a recorder and reporter • Discuss the questions as a group • Capture the key points made by the group on the

worksheet provided (recorder) • Be prepared to share with the large group (reporter) • Submit the completed worksheet

GROUP ACTIVITY



ACTIVITY 2: ADDRESSING CAPACITY GAPS

• How could CPHA make progress in addressing these gaps? What tools and resources are needed?

• Are you aware of any tools and resources addressing these gaps that currently exist?

• What tools and resources are you using currently to address these gaps?

GROUP ACTIVITY




CPHA PROJECT TIMELINE WORKSHOP EVALUATION

THANK YOU & CONTACT INFORMATION

NEXT STEPS AND CLOSING

4



PROJECT ACTIVITIES

• Data analysis

• Community Consultations

• Survey of Providers

• Website: www.cpha.ca/resources

• Pot and Driving

• Central resource

• Community and Summary Reports


http://www.cpha.ca/resources



SPRING 2017: Community consultation pilot host sites and Expert Reference Group (ERG) recruited

SUMMER 2017 • Initial (online) meeting with ERG facilitated • Community consultations facilitated with three pilot

volunteer communities: Kingston, York, and Ottawa • Canada-wide community consultation sites recruited

SPRING 2018 • Community consultation data/reports will be analyzed for

themes and findings summarized • Expert Reference Group will be engaged in a facilitated

review of community consultation findings • Case studies (2-4) will be created to communicate

community consultations findings

SUMMER - FALL 2018 • Capacity building learning tools and resources will

be refined

FALL 2017 - WINTER 2018 • Community consultations will be facilitated across Canada • Community consultation reports will be generated and

shared with each community

SPRING - SUMMER 2018 • Capacity building learning tools and resources will be

created based on the community consultation findings • Capacity building learning tools and resources will be

pilot tested with volunteer communities


CPHA PROJECT TIMELINE

FALL 2018: Capacity building learning tools and resources will be shared for Canada-wide community access




Greg Penney Director of Programs [email protected] Lisa Wright Project Officer [email protected]

Thomas Ferrao Project Officer [email protected] Christine Pentland Project Officer [email protected]

THANK YOU & CONTACT INFORMATION

mailto:[email protected]




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