Long Description

1.3 CHANGING THE LANGUAGE OF “ADDICTION”

Stigmatizing Words Fact Sheet by the Canadian Centre on Substance Abuse.

Stigmatizing words are common in our day-to-day language and are a barrier to treatment and recovery from substance use disorders. What you say “Abuser; Drug habit; Addict; Drug user.” What people hear “It’s my fault; It’s my choice; There’s no hope; I’m a criminal.” By choosing alternate language, you can help break down the negative stereotypes associated with substance use. Instead of “Abuser; Addict; Drug habit; Former or reformed addicted,” Try “Person with a substance use disorder; regular substance use, substance use disorder, person in recovery or long-term recovery. “Think before you speak. because all walks of life are affected by our words. Join the Conversation #AllWalksofLife Logo: “Canadian Centre on Substance Use and Addiction.” Evidence. Engagement. Impact.

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1.4 RACE, STIGMA AND SUBSTANCE USE

Flow chart on how colonialism leads to addiction by First Nations Health Authority

Colonialism [has led to]

  • Residential schools
    • Fear & shame
    • Isolation
    • Helplessness
  • The 60’s Scoop
    • Detachment
    • Loss of identity
    • Loss of rights
  • Land theft
    • Poverty
    • Lack of housing
    • Loss of freedom

[Have led to]

Trauma/Grief/Loss/Stress

Addiction

  • Drugs
  • Alcohol
  • Pain
  • Gambling
  • Sex
  • Exercise
  • Food
  • Work
  • Caffeine
  • Phone/Tech

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Flow chart on how community leads to connection by First Nations Health Authority

Community [has led to]

  • Family & friends
    • Love
    • Inclusion
    • Purpose
  • Culture & tradition
    • Identity
    • Power
    • Attachment
  • Nation & territory
    • Stability
    • Relationships
    • Autonomy

[Have led to]

Healing/Joy/Bonding/Peace

Connection

  • Safety
  • Love
  • Creativity
  • Empowerment
  • Contribution
  • Purpose
  • Responsibility
  • Generosity
  • Emotions
  • Integrity

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3.1 Overview

Controlled Drugs and Substances Act by the Government of Canada Legislation

Controlled Drugs and Substances Act
S.C. 1996, c. 19
Assented to 1996-06-20
An Act respecting the control of certain drugs, their precursors and other substances and to amend certain other Acts and repeal the Narcotic Control Act in consequence thereof Her Majesty, by and with the advice and consent of the Senate and House of Commons of Canada, enacts as follows:
Short Title
Short title
1. This Act may be cited as the Controlled Drugs and Substances Act.

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3.2 Opioids (an overview)

Opioid- and stimulant-related harms in Canada by the Government of Canada

Number and rates (per 100, 000 population) of total apparent opioid toxicity deaths by province and territory in 2021 (Jan to Mar).

  • Canada 1, 772 number of deaths
  • British Columbia 517 number of deaths Includes deaths related to all illicit drugs including, but not limited to, opIoids
  • Alberta 353 number of deaths
  • Saskatchewan 49 number of deaths
  • Manitoba N/A number of deaths
  • Ontario 722 number of deaths
  • Quebec 99
  • number of deaths Includes deaths related to all illicit drugs including, but not limited to, opIoids
  • New Brunswick 7 number of deaths
  • Nova Scotia 13 number of deaths
  • Prince Edward Island 1 number of deaths
  • Newfoundland and Labrador 5 number of deaths
  • Yukon 5 number of deaths
  • Northwest Territories 1 number of deaths
  • Nunavut suppressed number of deaths

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Program Overview [Infographic] by NS Take Home Naloxone Program

Program Overview

September 2017-September 2019

1-Minute Snapshot

The Take Home Naloxone Program has had a successful debut, with high uptake, positive feedback and evidence of saving lives.

“The THN Program opens the door for connections to take place so that people living with substance use disorder feel like someone is in their corner, helping and caring about them!’
– Anonymous

Quick Stats

# kits distributed by pharmacies 5, 396
# of kits distr., other than pharmacies 4, 000+
# of people trained by THN program 2, 642
# of used kits reported to program 71
average # of used kits reported/month 3
% trainees that are service providers 60%
% of trainees who have witnessed overdose 30%
# of total website page views since launch 18.9K

Key Interviews

Themes that emerged from targeted interviews with first responders were:

  • Access
  • Education.
  • Stigma, and
  • Scope of Practice

All individuals interviewed agreed that the program was helping to save lives. Conversations about naloxone and harm reduction present opportunities to address stigma around opioid use and people who use substances, and contribute to an improved public image of acute care providers and pharmacists.

Where kits were used, by region

Western Zone

  • 1% Shelburne County
  • 1% Kings County

Northern Zone

  • 4% Cumberland County
  • 6% Colchester County
  • 3% Pictou County

Eastern Zone

  • 17% Cape Breton Regional Municipality
  • 1% Richmond County

Central Zone

  • 28% Halifax Regional Municipality

[Other Stats]

  • No Answer 28%
  • Other Counties 4%
  • First Nations 3%
  • Unknown 1%
  • Prefer not to say 1%

“I would recommend naloxone to another”

  • Strongly Agree, 91%
  • Agree, 2%
  • Strongly Disagree, 7%

“I felt better knowing that naloxone was available, since you never know when you can save a life from an
overdose.”
– Anonymous

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Additional Resources Chapter 3

The Sacred Traditional Tobacco for Healthy Native Communities infographic by the National Native Network.

Sacred Traditional Tobacco for Healthy Native Communities

A Balanced Community for Health

  • Tribal leadership support & engagement
  • Cultural connectedness & healing
  • Community engagement
  • Youth leadership & youth-led advocacy

Dance Grounds: Use only traditional tobacco. Do not allow cigarette smoking.

Community Centre: Enact tribal ordinance that disallows harmful tobacco use inside building
and 25 feet outside building. Encourage traditional tobacco for gifts and offerings at ceremonies and events.

Tribal Council and Government Center: Enact tribal tobacco policies that will improve community health. Prioritize and support positive community health initiatives.

Tribal Clinic: Provide direct support to quit with culturally specific cessation.

Retail/Convenience Store: Eliminate sale of flavored tobacco and e-cigarette products Limit marketing of commercial ensure youth do not have access.

Native Language Camp: Engage community with knowledge of cultural practices for traditional
tobacco use.

Community Tobacco Garden: Grow traditional tobacco and provide education for community members.

Signage: Use signage to promote traditional American Indian cultural values around tobacco and solutions.

School: Incorporate traditional tobacco knowledge and practices into education.

Logo: “American Indian Cancer Foundation.”

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4.2 Routes of administration

Drug Delivery Methods by Genetic Science Learning Center.

Rapid drug delivery changes these brain regions, altering gene expression and neural circuitry in a way that could accelerate the transition to addiction.

  1. This brain region is affected during both the smoking and snorting of a drug.
  2. These three brain regions are less affected during the snorting of a drug.

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4.5 The impact of substances on the brain

The Structures of Neurotransmitters by Compound Interest

The Structures of Neurotransmitters

Adrenaline

  • Fight or flight neurotransmitter
  • Produced in stressful or exciting situations. Increases heart rate & blood flow, leading to a physical boost & heightened awareness.

Noradrenaline

  • Concentration neurotransmitter
  • Affects attention & responding actions in the brain, & involved in fight or flight response. Contracts blood vessels, increasing blood flow.

Dopamine

  • Pleasure neurotransmitter
  • Feelings of pleasure, and also addiction, movement, and motivation. People repeat behaviours that lead to dopamine release.

Serotonin

  • Mood neurotransmitter
  • Contributes to well-being & happiness; helps sleep cycle & digestive system regulation. Affected by exercise & light exposure.

Gaba

  • Calming neurotransmitter
  • Calms firing nerves in CNS. High levels improve focus; low levels cause anxiety. Also contributes to motor control & vision.

Acetylcholine

  • Learning Neurotransmitter
  • Involved in thought, learning, & memory. Activates muscle action in the body. Also associated with attention and awakening.

Endorphins

  • Euphoria neurotransmitters
  • released during exercise, excitement, & sex, producing well-being & euphoria, reducing pain. Biologically active section shown.

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5.3 Compulsive eating, sexual behaviours, & internet use

Maslow’s Hierarchy of Needs, Simplified by Androidmarsexpress

[Bottom to Top]

Physiological needs: food, water, warmth, rest (basic needs)

Safety needs: security, safety (basic needs)

Belongingness & love needs: intimate relationships, friends (psychological needs)

Esteem needs: prestige, feeling of accomplishment (psychological needs)

Self-actualisation: achieving one’s full potential, including creative activities (self-fulfillment needs)

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7.1 Overview

Opioid deaths map of Canada by Public Health Agency of Canada

Number and rates (per 100, 000 population) of total apparent opioid toxicity deaths by province and territory in 2021 (Jan to Mar).

  • Canada 1, 772 number of deaths
  • British Columbia 517 number of deaths Includes deaths related to all illicit drugs including, but not limited to, opIoids
  • Alberta 353 number of deaths
  • Saskatchewan 49 number of deaths
  • Manitoba N/A number of deaths
  • Ontario 722 number of deaths
  • Quebec 99
  • number of deaths Includes deaths related to all illicit drugs including, but not limited to, opIoids
  • New Brunswick 7 number of deaths
  • Nova Scotia 13 number of deaths
  • Prince Edward Island 1 number of deaths
  • Newfoundland and Labrador 5 number of deaths
  • Yukon 5 number of deaths
  • Northwest Territories 1 number of deaths
  • Nunavut suppressed number of deaths

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Key developments since Portugal decriminalized drugs in 2001 by Statista

Then & Now Portugal’s Drug Decriminalization
Key developments since Portugal decriminalized drugs in 2001

Overdose deaths

1999 369
2016 30

New HIV diagnoses due to injecting

2000 907
2017 18

Number of people incarcerated for drug offences

1999 3, 863
2017 1, 140

Sources: TheLancet, drugpolicy.org, EMCDDA, VHPA

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7.3 The “war on drugs”

Drug War in Canada infographic by Canadian Centre for Addictions.

Drug War in CANADA

If one were attempting to list the worst policy blunders of the past century, the War on Drugs would be somewhere between Vietnam and Prohibition. Even Stephen Harder, a virulent opponent of decriminalizing drugs, conceded as much in 2012, saying, “the current approach is not working.” Canada’s drug policy has received attention recently, with Justin Trudeau’s pot admission and Peter MacKay’s consideration of ticketing options for marijuana possession. While ending the trillion-dollar boondoggle that is the War on Drugs gains momentum in the United States, Canada is moving in the opposite direction, however, with a war on drugs-lite. Like most things Canadian, it is less extreme that its U.S. counterpart, but its existence should unsettle all Canadians. Illicit drug sales are still somewhere between $7 billion and $10 billion a year while law enforcement costs are over $2 billion annually. The combined value of these expenditures is greater than Canada spends on First Nation health services, veterans’ health care, health research, and public health programs, combined. On the streets, possession of hard drugs has increased by 89 per cent over the last ten years. Passed in 2011, increased existing mandatory minimum sentences for drugs, doubled the maximum penalty for manufacturing Schedule II drugs like marijuana, and failed to include a legislative exception for mental illness and other extenuating circumstances.

Arrests:

  • 103, 757 Drug offences in Canada in 2014
  • 57, 314 For Cannabis possession
  • 10, 696 For trafficking/production/distribution

Convictions:

  • 43% of cannabis possession charges resulted in convictions
  • 16% of adult convictions for marijuana possession resulted in custody sentence
  • 19% Canadians used marijuana or cannabis in the past year
  • 24% will use it once it’s legal

The Canadian government spends more than $50 billion annually policing its citizens’ drug habits, spending three times as much on each inmate as it does on each student. Canada’s War on Drugs also extends deep into South America where Ottawa has joined Washington’s failed military campaigns to dismantle drug cartels. Canada has a presence in Colombia, Belize, and Brazil, as well as the Central American states, where Ottawa is giving aid and training troops. In 2012, Stephen Harper announced the Canada Initiative for Security in Central America (CISCA), a $25 million program in Latin America.

Logo: “Canadian Centre for Addictions.”

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8.3 Indigenous approaches

Common Cultural Interventions by Canadian Institute of Health Research

Common Cultural Interventions

  • Fasting ceremony
  • Naming ceremony
  • Talking circle
  • Tell Creation Story
  • Dancing
  • Storytelling
  • Elders
  • Feast for our ancestors/loved ones who have gone on
  • Medicine people/traditional practitioners
  • Use of natural foods/medicines
  • Hunting/fishing/hide making
  • Cleansing/sweat lodge ceremony
  • Prayer
  • Singing
  • Social/cultural activities
  • Language
  • Land based activity
  • Dream interpretation
  • Traditional teachings/education
  • Ceremonial practice (unspecified)
  • Give away dances/ceremony
  • Use of cultural instruments

Common interventions specific to my community include: [blank space to answer the question yourself]

It is said that what the Great Spirit gave to his/her children to live in this physical world in a good way, was given forever. This means that the answer to addressing substance use issues exists within Indigenous culture.

Culture is the facilitator of spiritual expression. One’s spirit desires to live life to the fullest. A connection to spirit is essential and primary to wellbeing. Cultural interventions are therefore essential to wellness. Cultural interventions such as ceremonies attend to the whole person, while other interventions may have more specific focus. Cultural interventions are facilitated by individuals who have sanctioning of their skills and knowledge in culture because they live the culture and have been recognized by both the cultural teachers/community and the Spirit to lead or facilitate a certain cultural activity.

However, some cultural interventions, generally those that are not ceremonial, do not require this level of expertise. An example is the use of sacred medicines for smudge, although this differs across cultures. All cultural interventions require a level of cultural competency that is in compliance with the culture of the people on that land. Critically important is to know that there is not “one” culture because culture is defined by the land, language and nation of people. Treatment centres offer culture through their treatment programs based on the culture of the people where the treatment centre is located. Clients participating in the treatment programs may experience cultural interventions different from their own culture. Cultural interventions then become an introduction to culture and are always facilitated with an encouragement to clients to “go home and find their own way”.

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10.3 Prevention and early intervention

Public health interventions for the prevention of problematic substance use in youth by the Government of Canada

[Bottom to Top]

  • Create more equitable social and economic conditions
    • reduce socio-economic inequalities and provide investment in early childhood development and care
  • Promote positive social norms, communicate risks and reduce exposure
    • implement policies that create the conditions for lower-risk use of substances

Population-level Interventions (broadest impact)

  • Develop skills and resilience for youth and their families
    • deliver programs that develop social and emotional skills for youth and their families, and that support youth decision-making
  • Intervene early for youth that need support
    • support individual youth at risk for problematic substance use and intervene early in their substance use pathway

Individual-level Interventions (targeted impact)

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