2436913

Regional Municipality of Waterloo

Community Services Committee

Minutes

Tuesday, June 6, 2017

11:25 a.m.

Regional Council Chamber

150 Frederick Street, Kitchener

Present were: Chair G. Lorentz, L. Armstrong, E. Clarke, D. Craig*, S. Foxton, T.

Galloway, D. Jaworsky, H. Jowett, K. Kiefer, J. Mitchell, J. Nowak, K. Redman, K.

Seiling, S. Shantz, S. Strickland, and B. Vrbanovic*

Declarations of Pecuniary Interest under “The Municipal Conflict of Interest Act”

None declared.

Presentations

PHE-IDS-17-05, Waterloo Region Substance Use Study Highlights

Dr. Hsiu-Li Wang, Associate Medical Officer of Health, advised the Committee that the

previous substance use study was conducted in 2008. She explained that this report

presents the findings of the study and that report PHE-IDS-17-04, Enhancing Harm

Reduction Services in Waterloo Region presents further actions for implementation in

relation to harm reduction.

Grace Bermingham, Manager, Information and Planning Infectious Diseases, Dental

and Sexual Health and Adele Parkinson, Health Promotion and Research Analyst,

provided a presentation outlining the findings from the Waterloo Region Substance Use

Study. A copy of the presentation is appended to the original minutes. G. Bermingham

stated that the 2008 study was the baseline study that informed the creation of the initial

CS Minutes - 2 - 17/06/06

2436913

drug strategy. She noted that the recent study placed a greater emphasis on input from

individuals using substances than the 2008 study.

A. Parkinson gave an overview of the key findings of the study including that

methamphetamine has moved from an emerging issue to an established substance that

is readily available. She further noted that opioid use continues to be prevalent and

often begins with pain management issues. A. Parkinson informed the Committee that

study participants recommended the creation of a safe injection site, increasing access

to supplies and disposal options, and improved services to support individuals

transitioning back to the community from jail, hospital, or treatment.

Responding to questions, G. Bermingham stated that the study was not designed to

determine the percentage of youth in the Region that have used illicit substances

however the study noted that vulnerable youth are the ones being harmed by illicit

substances.

*B. Vrbanovic left the meeting at 11:52 a.m.

In response to a question from the Committee, Dr. Liana Nolan, Commissioner and

Medical Officer of Health, noted that Public Health has struggled to obtain real time

accurate data on overdoses in the community. She explained that the bulletins that

have been released by Public Health to date are based on information from Police and

Paramedic Services which is currently the best data available. However, staff are

working with the coroner to improve the data that is available.

Received for information.

Delegations

PHE-IDS-17-04, Enhancing Harm Reduction Services in Waterloo Region

a) Marian Best, Addictions Programming Director, Simcoe House Cambridge

Shelter Corporation

M. Best encouraged the Committee to see addiction as a chronic relapsing disease that

often coincides with mental illness. She stated that addiction is not just a problem

experienced by homeless individuals and that many people begin consuming opioids

with a prescription. She noted that personal shame and persecution discourages people

from seeking treatment and stated that a supervised injection site is necessary. A copy

of her statement is appended to the original minutes.

*D. Craig left the meeting at 12:17 p.m.

b) Violet Umanetz, Manager of Outreach, Sanguen Health Centre

CS Minutes - 3 - 17/06/06

2436913

V. Umanetz appeared before the Committee on behalf of the Sanguen Health Centre. A

copy of her statement is appended to the original minutes. She stressed that drug use

is a complex issue but that it is important to ensure that everyone is safe. She stated

that often people will use public bathrooms for injecting drugs because they do not want

to die and they know they will be found there. She stated that harm reduction services

are not about condoning drug use but are necessary to ensure community safety. She

encouraged making more services and supplies available on evenings and weekends

and creating a safe place to use.

In response to a question from the Committee, V. Umanetz stated that a local

pharmacist who heard that individuals who chose to smoke methamphetamine were not

accessing services has provided the funding for the methamphetamine pipes that have

been distributed by the Sanguen Health Centre.

c) Jenn Boyd, Harm Reduction Coordinator, Aids Committee of Cambridge,

Kitchener, Waterloo & Area (ACCKWA)

J. Boyd stated that requests for ACCKWA’s services have been growing despite cuts to

funding. She stated that the increase in opioid use in the Region represents a significant

risk for an increase in the spread of HIV. She noted that stigma remains the key issue

for HIV diagnosis and that gender inequality makes women more vulnerable. She

advocated for increasing harm reduction services and recommended locating them with

other services such as the food bank to allow women to access services without the

fear of judgment.

d) Lindsay Sprague, Coordinator, Waterloo Region Drug Strategy

L. Sprague appeared before the Committee on behalf of the Waterloo Region Drug

Strategy (WRDS) to support the report’s recommendations. She presented a letter

of support that is attached to the original minutes. She stated that the Substance

Use Study will assist the future work of the WRDS and encouraged the Committee

to endorse the report’s recommendations.

e) Christine Padaric,

Kathy McKenna, Public Health Nurse, read a letter submitted by Christine Padaric. A

copy of the letter is attached to the original minutes. C. Padaric’s letter explained the

affects that substance use has had on her family and encouraged the availability of

naloxone kits, and access to both supportive services and safe injection sites.

G. Bermingham provided a presentation on the proposed harm reduction strategy as a

part of the (WRDS). A copy of the presentation is appended to the original minutes.

She provided an overview of the current harm reduction program including the needle

syringe program and noted that associated harms continue to occur including

overdoses, blood borne infections and stigma for users. She stated that the Harm

CS Minutes - 4 - 17/06/06

2436913

Reduction Coordinating Committee has been involved in the creation of the strategy

and has endorsed the recommendations in the report including the investigation of the

feasibility of supervised injection services.

The Committee thanked staff and the members of the Harm Reduction Coordinating

Committee for their work and encouraged similar presentations to the councils of the

area municipalities.

In response to a question from the Committee, L. Nolan noted that a broad discussion

needs to occur so that the greater community is aware that staff are investigating

supervised injection services. She stated that staff will return with an interim report

before seeking approval.

Moved by E. Clarke

Seconded by L. Armstrong

That the Regional Municipality of Waterloo endorse the Harm Reduction strategy

of the Harm Reduction Coordinating Committee, to enhance harm reduction

services in Waterloo Region, as outlined in report PHE-IDS-17-04 dated June 6,

2017, including:

Exploring the feasibility of supervised injection services in Waterloo

Region;

Working with health care providers to improve their knowledge of harm

reduction and capacity to serve individuals who use substances;

Identifying and working with new community partners to provide harm

reduction services; and

Exploring opportunities and funding to expand outreach/mobile initiatives

in the community (e.g. peer programs and the Sanguen Van) to better

reach priority populations and rural communities.

Carried

Reports – Public Health and Emergency Services

PHE-17-04, Update and Next Steps regarding the Modernized Ontario Standards for

Public Health Programs and Services, Accountability and Organizational Requirements

Received for information.

Reports – Community Services

CS Minutes - 5 - 17/06/06

2436913

CSD-EIS-17-06, The Working Centre Community Dental Clinic Funding Request

Joe Mancini, Director, The Working Centre appeared before the Committee to clarify

issues related to their funding request. He noted that The Working Centre submitted a

budget that represented a fully funded clinic. They did not expect that the Region would

cover the full amount but were hoping for a partnership with the Region on the clinic. He

noted that they are happy that the report indicates that the dental clinic can bill for

Ontario Works (OW) and Ontario Disability Support Program (ODSP) services. J.

Mancini questioned the rationale in the report for separating dental care and

preventative care; noting that filling cavities can be a part of a harm reduction approach.

In response to a question from the Committee, J. Mancini stated that the majority of the

individuals receiving services at the dental clinic are on social assistance and that the

clinic would like to bill for those services to the discretionary benefits fund.

Douglas Bartholomew-Saunders, Commissioner, Community Services, provided an

overview of the request made by The Working Centre. He noted that the clinic can bill

the Region for services performed, but they must be in line with the OW regulations. He

explained that if the Region was to fund services outside of the OW regulations it would

require the funds to be taken out of the discretionarily benefits fund, which would result

in reductions elsewhere. He further noted that the provincial government is currently

looking at reorganizing in this area and recommended waiting for this to occur before

making any changes.

In response to a question from the Committee, D. Bartholomew-Saunders confirmed

that a report on the discretionarily benefits fund will be coming to the next meeting.

Moved by K. Seiling

Seconded by S. Strickland

That the Regional Municipality of Waterloo continues to work with The Working

Centre Community Dental Clinic within the policies of the Ontario Works

discretionarily benefits and that staff continues to work with the Waterloo Region

Oral Health Coalition in its efforts to raise awareness of adult oral health needs to

the Ministry of Health and Long Term Care

Carried

CSD-DES-17-01, Community Services Annual Report (2016)

D. Bartholomew-Saunders noted that page fourteen of the Annual Report that was

CS Minutes - 6 - 17/06/06

2436913

provided to the Committee, incorrectly states that the Region provides $4.5 million

above and beyond provincial funding for discretionary benefits rather than $1.5 million.

He noted that it has been corrected for other copies of the report.

Van Vilaysinh, Social Planning Associate, provided a presentation on the 2016

Community Services Annual Report. A copy of the presentation is appended to the

original minutes. She noted that Community Services has adopted an integrated

approach to service delivery. This is reflected in the reporting of data based on key

quality of life areas rather than based on departmental divisions.

In response to a question from the Committee, D. Bartholomew-Saunders stated that

the data that has been gathered is being used for reporting to funders but can also be

rolled into the Wellbeing Waterloo Region index.

Received for information.

CSD-HOU-17-12/COR-TRY-17-55, Updated Building Condition Audit and Capital

Reserve Analysis for Community Housing Providers

Deb Schlichter, Director, Housing Services, stated that Building Condition Audits are

conducted every 5 years to quantify the capital repair needs and financial shortfall for

Community Housing Providers. She noted that there is currently a gap of approximately

$180 million. She explained that the recommendation is designed to remind senior

levels of government of the need for affordable housing supply and to consult with

Community Housing Providers on how to distribute funds in the Community Housing

Investment Fund.

Moved by J. Nowak

Seconded by S. Foxton

That the Regional Municipality of Waterloo approve the following actions

regarding Community Housing capital reserve requirements, as outlined in report

CSD-HOU-17-12/COR-TRY-17-55 dated June 6, 2017:

a) Request the Province of Ontario and Canada Mortgage and Housing

Corporation provide adequate and sustainable funding to Community

Housing Providers in Waterloo Region;

b) Forward a copy of report CSD-HOU-17-12/COR-TRY-17-55 to MPs and

MPPs representing Waterloo Region, the Ministry of Housing, the Ministry

of Infrastructure, the Chair of Canada Mortgage and Housing Corporation

(CMHC), the Association of Municipalities of Ontario (AMO), the Ontario

Municipal Social Services Association (OMSSA) and all community

CS Minutes - 7 - 17/06/06

2436913

housing providers in Waterloo Region; and

c) Direct Regional Staff to undertake a consultation process with housing

providers to determine an allocation process for the Community Housing

Investment Fund (CHIF) and report back to Community Services with a

recommended allocation.

Carried

Information/Correspondence

a) Council Enquiries and Requests for Information Tracking List was received for

information.

Other Business

Chair G. Lorentz stated that the mock disaster that was recently held for the new

paramedics was a successful event.

The Committee requested that staff provide a report at the next Committee meeting on

the decision to stop testing beaches at the Grand River Conservation Authority.

Next Meeting – June 20, 2017

Adjourn

Moved by K. Keifer

Seconded by S. Foxton

That the meeting adjourn at 1:45 p.m.

Carried

Committee Chair, G. Lorentz

Committee Clerk, T. Brubacher

Waterloo Region

Substance Use Study (2017)

Grace Bermingham, Manager of Information and Planning

Adele Parkinson, Health Promotion & Research Analyst

Infectious Diseases, Dental and Sexual Health Division

June 6, 2017

Goal: To gather quantitative and qualitative data to

provide a profile of current substance use in

Waterloo Region

Why conduct the

study?

• Update to the Baseline Study of

Substance Use released in 2008

Identify changes and emerging issues

People who use substances

• 388 surveys completed

• 52 interviews

Health and Social Service Sector

• 25 people in 4 focus groups

• 6 interviews with leadership

Law Enforcement

• 16 people in 3 focus groups

Who participated?

Survey demographics

Education

Graduated from college/university 44%

Have some college/university 24%

Main source of income

Full-time or Part-time 50%

Social assistance (Ontario Works, ODSP) 27%

Full-time students 14%

Annual Income

Less than $15,000 36%

Less than $25,000 49%

Key findings

• Types of substances used and related themes:

Methamphetamine use

Opioid use

Fentanyl use

Patterns of substance use in youth

• Harms faced by people who use substances

• Strategies to address harms

• Summary of changes and emerging issues

Substance

Alcohol 88%

Cannabis 84%

Substances associated with recreational events

(aka "club drugs" e.g. LSD, Ecstasy) 46%

Cocaine 43%

Prescription Opioids 36%

Methamphetamine ( Crystal Meth) 31%

Benzodiazepines 29%

Amphetamines 24%

Crack 17%

Heroin 17%

Top ten substances used

• Use was "emerging" in 2008; well

established now

• Linked to significant harms

including poor mental and physical

health

• Linked with more "outward"

challenging behaviours

• Highly available and inexpensive

• Switching from heroin,

crack, opiates to

methamphetamines

Methamphetamine use Use

"The easiest drug

you can get. Every

corner I turn I hear

somebody, “hey you

want meth, I’m

looking for meth,

this meth, that

meth”, like, it’s bad"

- Person who uses

substances

• Continues to be prevalent

• Less likely to seek supportive

services

• For some, illicit use began after

prescriptions were discontinued

• Emergency department visits

increased by 17% between 2005

and 2015

Opioid use "I often ask people,

was this originally

because of pain

management? And

they say “yea it was. I

hurt my back. I have

an injury” Due to past

injuries, pain. That’s

how they became

dependent"

- Service provider

• Intentional and unintentional use

• 13% reported using non-

prescription fentanyl

• Spike in number of fatal and

nonfatal overdoses linked to

fentanyl

Fentanyl use "With the fentanyl,

you never know what

you’re getting now.

You do like a point

one day and then

you do a quarter of a

point the next day

and drop because

[of] the fentanyl – it’s

like they’re cutting it

with steroids. You

know what I mean?

They’re cutting it

with a stronger

opioid"

- Person who uses substances

"A lot of the heroin is cut with

fentanyl. Cocaine too. It’s the

wild west of drugs"

- Law enforcement personnel

• 126 people under age 25 completed the survey

• Youth who are not in school use higher risk drugs

• More experimental

Patterns of substance use in youth

Substance Full-time

Students

Not full-time

students

Prescription opioids - 24%

Cocaine - 37%

Methamphetamines - 33%

Benzodiazepines 16% 20%

"Club drugs" (e.g. ecstasy,

L.S.D.) 39% 41%

Amphetamines 12% 28%

• Risk of overdose

• Risk of infections

• Inadequate housing

• Food insecurity

• Poor physical health

• Poor mental health

Harms faced by people

who use substances

• Safe place to use

• Increased access to supplies

• Increased disposal options

• More and enhanced treatment services and health care

• More and enhanced mental health services

• More housing options

Strategies proposed by

study participants

• Improve services through collaboration, intersectoral

planning

• Build capacity of service providers in mainstream

services for people who use substances

• Provide services for people as they transition from

treatment, hospital and jail to community

• Address issues facing youth

Community-wide strategies

• Methamphetamine use is well established and is

causing significant harms

• Fentanyl use is linked to spike in overdoses

• Injection drug use is more common

• Access to health care and supportive services is more

challenging

• Youth not enrolled in school have unique substance

use patterns and needs

Changes & emerging issues

• Region of Waterloo Public Health and Emergency

Services and community partners will continue to

provide current harm reduction programming.

• Detailed findings shared with Harm Reduction

Coordinating Committee to inform the work of the group

• Findings shared with Region of Waterloo and external

partners to inform and support their work

Next Steps

Craig Ambrose Waterloo Region Police Services

Ruth Cameron ACCKWA

Sharon Deally-Grzybowski Waterloo Drug Treatment Court

Sandy Dietrich Bell oneROOF

Aaron Fisher Community member

Chris Harold Region of Waterloo Public Health (past)

Shirley Hilton Waterloo Region Police Services

Sonya Lamb Community member

Jennifer Mains The Working Centre

Rachel McHugh Community member

Pam McIntosh House of Friendship

Colin McVicker Sanguen Health Centre

Coba Moolenburgh St. Mary's Counselling

Sarina Randall Grand Valley Institute for Women

Sheila Roewade Canadian Mental Health Association

Kassandra Rushton Waterloo Drug Treatment Court

Andrew Sardella Region of Waterloo Public Health (past)

Denise Squire Woolwich Community Health Centre

Additional thanks to Dr. Carol Strike and Dr. Peggy Milson for academic guidance

Finally, thank you to the participants who trusted us with their stories.

Questions?

BIO-PSYCO-SOCIAL MODEL

Addiction is a PRIMARY neurological, chronic disease. It is primary means it is not due to something else

like anxiety, depression, ADD/ADHD or Bipolar Disorder) It offers a reward system to the brain which

causes problems biologically, socially and psychologically (CAMH).

It is neurologic in that it affects the Brain and the spinal cord and it is Chronic as it is a cycle of relapse

and those trying to stop using can’t. Often it is difficult to figure out primary vs. substance induced

secondary psychiatric disorders (CSAM 2014). Sometimes mental health issues contributed to substance

use and substance use can increase the risk of developing mental health issues.70% of people struggling

with addiction have a mental health issue. This explains the struggles of those trying to stop, and the

challenges some face in mainstream mental health and addiction services.

Addiction Recovery is not about willpower.

Addiction is often seen as moral failure which often results in negative stigma which perpetuates guilt

and shame, which increases the cycle of addiction. It is not a moral failing. Somehow addictive

substances are on a hierarchy of acceptance. Because of the shame and guilt few will seek assistance or

medical help which is rooted in the recovery movement history especially from mainstream services

where negative experiences in the health care system increases feelings of worthlessness. As a side

note…the most consumed addictive substance is caffeine worldwide.

Often people will tell you they feel the most normal when they use, which demonstrates it is a coping

mechanism to deal with life. Avoiding the thoughts and emotions and masking with substances is

something that progressively gets worse as higher tolerance builds, but often it is exactly what happens

and people tend to avoid and isolate once addiction sets in. It numbs the emotional scars and pains,

whether of historical trauma or choices that has led to negative consequences.

There are classification of substances including stimulants which speed up the respiratory system like

cocaine and crystal meth and depressants which slow down the respiratory system like opioids and

alcohol. In both of these types of substances only molecules separate the drugs to alter their effect.

Both will give feelings of euphoria.

Surprisingly over the years, many people who have walked through our doors experienced their first

opioid after playing a sport usually in high school, whether that was on a school or on a rep team, be it

hockey, soccer, baseball, lacrosse, ringette or football field. This is also where some started

experimenting more with other substances and alcohol. The Social part of the equation is easy to see

when we are a part of something and feel pulled into doing something we wouldn’t normally do. Peer

pressure, and low self-esteem are huge indicators in first experimentation.

In 2006 Simcoe House was opened in Cambridge to service the increasing demand for those struggling

with addiction. At one time 70% of those seeking our services were homeless, now it is a 60-40 percent

split from the community. Primarily over the years we witnessed prevalent drug use from cocaine, to

smoking crack, to opioid addiction to crystal methamphetamine as well as the increased use in heroin

and fentanyl.

During the spike of opioid addiction, I witnessed many women in custody who had never committed

crimes prior to becoming addicted to opioids, usually initially prescribed by a dentist or surgeon or

physician. Opioids were seen as a safe reliable effective pain killer and it still is. However after 6 days

the body may become dependent and without proper prescribing the risk of dependence is high. Most

likely if you are prescribed an opiate longer than 6 days, statistics show you could be on it for a year. The

withdrawal from an opioid is so intense, extreme flu like symptoms, vomiting, diarrhea, restless legs,

pain and insomnia people will do anything for relief. The withdrawal is the main reason people continue

to use. One pill or one hit immediately relieves these symptoms. It is extremely important to work with a

physician for proper tapering and dosing.

With no-way to alleviate the pain of withdrawal, often alternative sources were found. A person who

is addicted to or dependent upon, psychoactive substances faces daily physical, psychological

and social struggles. When opioids became harder to find, heroin became the next alternative.

When it comes to substance use, many people ask why, why do people access drugs when not

prescribed?

Some are dealing with life problems, in the wrong place at the wrong time and pick up, some are

predisposed biologically genetically to addiction.

Risk factors which may lead to dependence and subsequently addiction include: physical and

emotional pain, trauma, a history of abuse and poverty a lack of social inclusion, low self-esteem.

Measuring the negative consequences of substance or alcohol will help determine the severity of the

problem. Impact on family, friends, legal issues, loss of relationships, financial problems and health

problems are all indicators of negative consequences. These consequences may mean little however to

the person who is using substances to cope with physical or emotional pain.

When a person enters withdrawal from any drug (a hangover for example is actually withdrawal), it

separates substances from addictive behaviours’. The brain triggers the response to use again and once

the drug is consumed it immediately begins to alleviate the withdrawal symptoms.

The Social ramifications of drug use include, isolation, loss of friends and family, loss of work, rejection

by society, judgement. I can tell you that no one feels more guilt and shame than the person with the

addiction, there is nothing any of us can say or do to make them feel worse than they already do. An

addicted parent does not love their children any less than those of us who do not have addictions.

.

I have never met anyone who planned on becoming addicted to drugs or alcohol, licit or illicit. I have

never met anyone who planned to turn their lives or the lives of their family or community members

upside down just for the hell of it. Once addicted, they face personal persecution, shame, guilt and are

subject to more risk of harm. Stigma stops people from accessing services. As a community there is

nothing more important than saving lives, reducing the harm and coming together to move people

forward. If we can start to look at addiction as what someone has instead of using this definition of addict

or alcoholic to define someone, we might be able to reduce the stigma and be more open to less moral

judgement. These people are also mother’s fathers, sisters, brothers, aunts, uncles, nieces and nephews.

They are lovers of sports and dance and art. They are lawyers and doctors, carpenters and factory

workers. They are us, they have a health issue and are deserving of treatment, whether that is harm

reduction services or abstinence and they deserve us as a community to support them to help save their

lives.

These past two years we have seen a significant increase in overdose experiences and overdose deaths. In

any given week, we hear of at least one significant experience resulting in hospitalization. More often

lately we are hearing of overdose deaths. It is simply wrong to see so many people dying for something

that is preventable if they had a safe place to go.

There is no place in our region where substance users can go safely to use. People are hiding their drug

use, poking in parks, public, restaurant and shelter bathrooms, unsafe buildings and unsafe houses or

apartments often putting themselves in physical and emotional danger.

It is hidden because of the threat to lose their basic human rights such as food and shelter. It is hidden

because of the negative stigma and name calling, the threat of losing basic health care, the threat of losing

relationships they value, their children and their families.

They hide their use for fear of incarceration, and they fail to call for help when necessary due to possible

arrests. See an arrest just attributes to further loss, loss of freedom, loss of family, possibly the loss of

income, loss of self-respect or any dignity they might have had, if any at all. This provides further

difficulties down the road, with trying to find a job that will hire you without a records check which costs

hundreds of dollars to obtain a pardon and years of waiting before you can even apply.

It is not uncommon for me to hear from people in recovery that a safe site is necessary. Prior use of

substances had significant risks, but the risks now are higher and people are dying earlier without a

chance to work on recovery. When we hear of 22, 23, 24, 25, & 27 year olds, experiencing multiple

overdoses after trying multiple times to stop using, we need to recognize that conventional trends need to

change in order to support systems of care that meet people where they are at. Only then will we be able

to continue with other recovery based models.

In closing, a young women who first walked through my doors in our early years, represents the struggle

of addiction. After accessing multiple programs, and staying substance free for several years, she relapsed

and is back out. She is a struggling hurting vulnerable young lady who has experienced all the street

horrors and isolation but has a family who continues to hope. She is hiding again, in alley’s and

bathrooms, hoping people don’t notice her…her words “ If all the love in the world could heal me, I

would have been healed a thousand times over, from my father alone” Her story is not unique, it is

unfortunately common, men and women like you and I who have families that love us, who have done

everything we have asked them to try; residential treatment, counseling, church, meetings, meditation,

yoga, and the list goes on and on. When do we start to recognize addiction is not a choice, we need to

provide safer services for people who use, to offer hope for a better future.

June 6, 2017

Thank you for the opportunity to speak this morning. My name is Violet Umanetz and I am here representing the entire team at Sanguen Health Centre, the agency where I work.

Sanguen is an agency that works primarily with people who use drugs. Our team promotes harm reduction, inclusion, and a sense of connection, and we focus strongly on helping people maintain or improve their health. My role on the team, specifically, is to manage our outreach program and the Community Health Van.

As you might imagine, working with people who use drugs has given me a unique perspective on substance use in our region. It may surprise you to know that most of my clients are resilient, intelligent, hilarious, generous, kindhearted, gentle, and caring. I have an intense amount of affection for them – and, without exaggeration, I can say that they are some of the best people I have ever known. Through their openness and willingness to share their stories with me, I have learned that druguse is a complex issue – that goes far beyond the drug itself. I enjoy what I do - far more than any previous job I've held - and I consider it a privilege to work in harm reduction.

On the flip side, when I'm not working, I am a parent to two teenagers and one young adult. I am a homeowner in Kitchener. I have a dog that enjoys long walks on trails, I regularly use our parks, I visit local businesses, and all of my family members are involved in a variety of activities across the city. I want our Region to continue to grow, and thrive, for the benefit of my family and others.

So, how do I reconcile those two perspectives?

I know that drug use in our community exists and will always exist. I also know that, currently, some ofthat drug use impacts negatively on our community in a number of ways – things like improper needle disposal, new hepatitis C infections, and a staggering number of fatal overdoses over the past year. I believe it is possible to make changes in our community to reduce these negative impacts – and I would like us to move towards those changes.

Every single member of our community, regardless of who they are and whether they use drugs, deserves to be safe and healthy and connected. When formal opportunities to do so are unavailable, people do the best that they can.

Let me give you an example: I have received many calls from private businesses across Waterloo Region asking me to help solve the problem of substance use in bathrooms. Curious, I asked clients why they were choosing to use those locations. What they told me was that they didn't want to die – that they knew if something went wrong, if they were to overdose, there would be someone there to call 911. They felt they had no other options.

Bathrooms are not clean, nor safe. The employees of our local businesses are not trained, nor qualified, to help.

And as you know, the number of fatal overdoses in our region continue to steadily increase.

I can't tell you the effect that those deaths have had on me, on my team, on the people who work in our community. I have cried in meetings, in my car, over dinner with my family, in my office.. we have lost so many good people. People who never had the chance to recover. Overdose deaths are preventable.

Of course, overdose is not the only concern. Hepatitis C, HIV, blood infections, endocarditis.. all preventable.

Health care, for people who use drugs, is often a disaster. There is so much shame and stigma attached to drug use. There's a lack of understanding about addiction and dependency. People become incredibly unwell and wait far too long - ending up in the emergency room for something that could have been easily treated had they seen a health care practitioner early. We know, from our workon the Community Health Van, that people want to be healthy but have often had so many negative experiences that they'd rather live in pain, fearing literal death, than once again endure judgement andshame.

Accessing social services can be a similar experience. Asking for help, facing judgement, being lookeddown on as a result of substance use... so, instead, waiting until things are dire and desperate. Being afraid to reach out for support.

On The Community Health Van, each week, we meet with more than 250 people in under 6 hours. Most of these visitors struggle to access many of the incredible services that are available in our community – including harm reduction, health care, social services, food. The nurses on the Community Health Van provide testing and treatment for hepatitis C, offer vein and wound care, and offer non-judgemental advice and health care support to people who use drugs. We have distributed more than 600 naloxone kits through The Van since January of this year. We have distributed, and retrieved, thousands of syringes. Through a private donor, we have distributed thousands of pipes for people who use methamphetamine.

Harm reduction is not about condoning drug use. It is not about saying that drugs are okay, or pretending there are no dangers associated with them. Harm reduction is looking someone in the eyesand truly seeing them for who they are – and knowing that drug use is such a small part of a person. Harm reduction is about keeping our community safe and healthy.

What I wonder is this: what would it look like, in our region, if people who used drugs didn't feel shame or embarrassment – and, instead, felt cared-for. Loved. Like they mattered. Like part of our community. What would it look like if clients could speak openly to someone about their drug use, to not feel judged, and to feel supported and understood? To ask for help and receive it quickly and in a way that works for them?

We have never changed anything using shame. Or stigma. Or judgement. We can only change things by asking those directly affected what they need – and then demonstrating compassion in our response.

I say that it's a privilege to work with my clients – and it is. They are the most resilient, strong, capable people I have ever met. Most have lived through intense trauma, experienced marginalization beyond my wildest imagination, and continue to survive. They have so much insight to offer our community if we are willing to listen.

People who use drugs are as concerned with the well-being of our cities as anyone else. They tell me that they need more harm reduction services – services in the evenings and on weekends, additional supplies, more education. Clients tell me that they need a safe, clean place to inject or use their substances – a place other than a bathroom. They tell me that they want more places to safely dispose of syringes. They want the ability to access physical and mental health care, and addiction treatment, rapidly, and with few barriers.

We need to listen.

The problems we are seeing – substance use related harms in our community – are now beyond whatwe can handle solely through our existing outreach programs. We need to expand the work we are

doing – for Sanguen, this means funding and staffing for more nights out on The Van to reach out to the most marginalized of our community members and to provide more options for all clients.

To be very clear, the agencies that work with people who use drugs are doing a phenomenal job providing care – and I feel comfortable including Sanguen Health Centre in that – but there is so muchmore we could be doing as a community. Our clients, our neighbours, our friends, our community members are telling us what they need.

We – my team, and all of us in the Region – cannot afford to lose more good people.

Thank you.

Violet Umanetz, Manager of Outreach

on behalf ofSanguen Health Centre & The Community Health Van29 Young Street EastWaterloo, ON N2J 2L4519-603-0223info@sanguen.com

Dear Chair Geoff Lorentz and Members of the Community Services Committee,

On behalf of the Waterloo Region Integrated Drugs Strategy, I would like to congratulate and thank the Region

of Waterloo Public Health and Emergency Services for their good work on both the Substance Use Study and

recommendations regarding the expansion of harm reduction initiatives.

This comprehensive study will help to inform the future work of the Drug Strategy by providing us with

important data into where the needs are in the community and how best to support individuals in Waterloo

Region who are active in their substance use.

Harm Reduction, as one of the four pillars of the Drug Strategy, has a vital role to play in community and

individual safety. In particular, expansion of harm reduction programming and initiatives impacts all of us at the

individual level. Harm Reduction meets individuals where they are at and provides vital information and tools to

keep them safer in their substance use. Harm Reduction also impacts us at the community level by providing

clean equipment, safe places to dispose of equipment, reducing stigma, and encouraging health equity and

dignity for individuals who are active in their substance use.

The Substance Use Study and the recommendations made here today will help the Waterloo Region Integrated

Drugs Strategy move forward with our work of reducing problematic substance use and its associated harms. It

also supports and builds on the original 99 recommendations made across the four pillars of Justice and

Enforcement, Prevention, Harm Reduction and Rehabilitation and Recovery.

As active participants in the Harm Reduction work of Region of Waterloo Public Health, we look forward to the

continuation of this partnership and supporting additional harm reduction programming as it rolls out. We feel

strongly that Supervised Injection Services will be a significant and vital piece of Harm Reduction work with far

reaching impacts for people using substances and for the safety of our community. We ask that you endorse the

recommendations made here today and we thank the Committee for the opportunity to speak in support of

these reports.

On behalf of the Waterloo Region Integrated Drugs Strategy Steering Committee,

Lindsay Sprague Coordinator, WRIDS

Dr. Michael Beazely Chair, WRIDS

44 Francis St. South, Kitchener ON, N2G 2A2 Email: lsprague@kdchc.org Website: www.waterlooregiondrugstrategy.ca

Dear Members of Council Thank you for this opportunity to speak to you today about my personal experience with addiction and overdose as it relates to my family. I am sorry that I cannot be there in person as this topic is very important to me, but work commitments prevent me from attending. My family has experienced the negative consequences of drugs and addiction in a couple of ways. In 2013, my 17 year old son Austin died of a fatal dose of Morphine while in the company of a drug dealer and five other individuals. The drug dealer gave the lethal dose to my son by crushing the pill for him, and holding it to his nose, demanding that he snort it. Once my son began exhibiting signs of distress, the others struggled with what to do. They researched online the signs of an overdose to determine if that was what was happening. They put him in a bathtub of cold water; they laid him on his side in case he continued to vomit. They talked about calling 911 but the drug dealer threatened the lives of anyone who would consider doing so. They all went to sleep hoping Austin would sleep it off. In the morning, they found Austin near death, with ashen skin and blue lips. It was only then that they called 911. Seven days later Austin died in hospital of brain death. A completely preventable death, had action been taken hours sooner. This was the one and only time Austin had taken an opiate drug. In 2013, at the time of Austin’s death, my only other son, was - and still is today - an intravenous drug user. He is tormented by his addiction, which started because of issues with anxiety. Drugs made him feel comfortable in his skin. Drugs helped him cope with school and his social anxiety. Today, at age 25, he struggles with his recovery as it is very hard work. He hates himself for being an addict and having occasional relapses. More than anything, he wants to be normal. He wants to be able to get an education, he wants to be able to hold a job, he wants to have a girlfriend. Everyday is a struggle for him to cope with daily living – things most of us take for granted. He does not want to be an addict; he does not want to have this burden that consumes his thoughts 24 hours a day. No one chooses to do so. Since Austin’s death, I have become involved on a number of committees with the Waterloo Region Public Health Department to provide input into harm reduction services I believe our community needs based on my experiences. Our high school students desperately need drug education in order to increase awareness of what opioids are, signs and symptoms of an overdose and what to do if someone is overdosing. We need to provide families, caregivers and teachers with information about opioids in an effort to prevent fatalities. This includes ensuring that everyone that feels the need to have a Naloxone kit can obtain one easily, and that Naloxone forms part of every first aid kit including having a kit in every high school. Our community needs more resources for those actively using drugs but who want help. If someone is ready to step forward to ask for assistance with their recovery, they need rapid access to compassionate, educated individuals and programs that will provide them with the support system and tools to become whole again. For those not ready to take the step towards recovery, we need to provide them with an environment to obtain supplies and use their drug safely.

We also need to educate others about the recent amendment to the Good Samaritan Act, which, as of May 4, 2017, provides immunity to those who call 911 in an overdose situation. Had this law been in place in 2013, there is a good chance Austin would be alive and well today, as well as countless others in our community and across our country who have perished in the presence of others, because witnesses were too afraid of police involvement. We need to work harder to communicate this message. There are concrete things that we as a community can do to decrease harm in our community. Every individual in our community should be valued. Drug use – whether prescribed or used recreationally, is ingrained in our culture. Let’s work together to put the structures in place to educate and protect our community members. Overdose does not discriminate – it can happen to anyone’s family. Thank you for this opportunity to speak today. Christine Padaric skateforaustin@gmail.com www.skateforaustin.com 519-501-7246

ENHANCING HARM

REDUCTION SERVICES IN

WATERLOO REGION

Alyshia Cook, Health Promotion & Research Analyst

Grace Bermingham, Manager of Information and Planning

Infectious Diseases, Dental and Sexual Health Division

June 6, 2017

Waterloo Region Integrated Drugs

Strategy

Prevention

Harm Reduction

Recovery and Rehabilitation

Enforcement and Justice

Coordinating Committees:

Harm Reduction

Coordinating Committee

Priorities

• Expanding harm reduction programs and

services

• Increasing public awareness of topics related to

substance use

• Develop and implement a harm reduction-

specific strategy for the health care sector

Harm Reduction

Programming In

Waterloo Region

• The Needle Syringe Program

• Overdose prevention initiatives

• Improving sharps disposal

• Peer programs and outreach

(fixed and mobile)

• Fatal and non-fatal overdoses

• Blood borne infections

• Opioid crisis

• Stigma and discrimination

• Public substance use and improper needle

disposal

Persisting harms and

gaps in services

Impact of the opioid

crisis in Waterloo

Region

• Emergency Department visits increased by 55.4

per cent between 2015 and 2016

• Paramedic Services responding to an average of

43 opioid overdose related calls per month

• 28 suspected opioid related deaths since January

• Naloxone is distributed by Public Health, Sanguen

Health Centre and participating pharmacies

• 1,200 naloxone kits distributed from January to

April 2017

• Naloxone administrations by Paramedic Services

doubled between 2015 and 2016

Naloxone distribution and

administration

• Lifetime HIV treatment costs: $250,000

• Hepatitis C treatment costs: up to $110,000

• Devastating impact on quality of life

• The impact of crystal meth use on individuals and

community

Blood borne infections

and crystal meth use

• Harm Reduction Coordinating Committee

reprioritized their work to focus on enhancing

harm reduction services in response to:

Opioid crisis

Local substance use data and trends

Work happening in other jurisdictions

• Federal and provincial joint statement

Support for harm reduction, including supervised injection

services

Need to enhance harm

reduction services

Supervised Injection

Services (SIS)

Legally sanctioned,

medically supervised

facility where individuals

are able to consume illicit

drugs intravenously.

SIS With Exemption

SIS Awaiting Exemption

SIS Planning in Progress

Supervised Injection Services

in Canada

1. Explore the feasibility of supervised injection services

2. Work with health care providers to improve knowledge

and capacity to serve individuals who use substances

3. Identify and work with new community partners to

provide harm reduction services

4. Expand outreach/mobile initiatives to better reach

priority populations and rural communities

Recommendation:

Endorse the enhancement of

harm reduction services

Community

partnership approach

AIDS Committee of Cambridge, Kitchener, Waterloo & Area

Cambridge Shelter Corporation

House of Friendship

Kitchener Downtown Community Health Centre

Region of Waterloo Community Services - Housing

Region of Waterloo Public Health

Sanguen Health Centre

St. Mary’s Counselling Service

Towards Recovery Clinics/Ontario Addiction Treatment Centres

Four community members

QUESTIONS?

Community Services Annual Report (2016)

Community Services Committee

June 6, 2017

Quality of Life Key Areas

1. Economic Well-Being

2. Social Inclusion and Equity

3. Physical and Emotional Well-Being

4. Skills Development

5. Relationships

Key Changes

In the past… 2016 Report

Information presented by division with stories presented in a separate section.

Information and stories woven throughout the report by quality of life key areas.

Program and service data presented as they are typically collected or mandated.

Program and service data presented as they relate to quality of life outcomes.

Community Partners not well highlighted.

Highlights the outcomes in partnership with Community Partners.

Next Steps

Support the work of departmental integration through a shared measurement framework that:

– Is outcomes-based and client-centered

– Includes our partnerships with community

– Measures the effectiveness of programs and services

– Identifies the approach to continuous improvement