The Windsor-Essex Community Opioid and Substance Strategy (WECOSS) was developed in response to the opioid crisis with the vision of creating a local response plan relevant to the issues in Windsor-Essex County. The Strategy aims to address substance use at the local level through a set of community-driven actions and activities. It is a multi-year strategy led by a diverse network of community organizations and people with lived experience (PWLE) using substances. 

The fourth annual report provides an overview of the activities undertaken throughout the Strategy in its fourth year of implementation (2021). The report describes the community impacts of substance use, the original WECOSS Action Plan (2018), the recent WECOSS Modernization Recommendations (2021), activities identified for implementation in year four, progress made on these activities, and future direction of the Strategy. The report will also highlight the continued efforts that have been made by the WECOSS to respond to and mitigate the ongoing impacts of the COVID-19 pandemic on people who use substances in the community.

• WECOSS Action Plan (2018)
• WECOSS Modernization (2021)

The fourth year of the Strategy has demonstrated the WECOSS’ continued commitment to developing innovative and responsive strategies to address the unique needs of people who use substances during the ongoing COVID-19 pandemic (Figure 1).

In 2021, a comprehensive evaluation of the WECOSS was conducted to assess the level of awareness and early impact of the WECOSS in the community to date (2018 – 2021), to evaluate the WECOSS’ strategy design, and to identify areas for strategy improvement. In response to the alarming rise in the number of community alerts issued through the WECOSS’ Opioid and Substance Notification System in 2021, the WECOSS Leadership Committee also organized an Emergency COVID-19 Response Meeting in May of 2021 to review the specific impacts of the COVID-19 pandemic and to discuss a response and recovery plan tailored to the immediate needs of people who use substances in the region. The results collected through these activities were used to generate a set of recommendations designed to strengthen and modernize the foundation of the WECOSS using a collective impact approach. The report also identified priority areas of focus for the Strategy in 2022 and beyond.

The WECOSS Modernization Recommendations supported the establishment of a WECOSS Data-Sub Group in order to foster shared measurements across the Strategy and to support future evaluation efforts. Stakeholders who participated in the WECOSS Evaluation (2021) also reinforced the critical need to create additional spaces to meaningfully engage people with lived experience across the Strategy by developing a formal Peer Advisory Committee. These activities will be prioritized as the WECOSS strives to implement the Modernization Recommendations in 2022 and in subsequent years (Figure 2).

Figure 1 - WECOSS STRATEGY IMPLEMENTATION FOR 2021

Figure 2 - WECOSS STRATEGY IMPLEMENTATION FOR 2022

WECOSS Action Plan Guiding Recommendation Three: Provide early education and prevention about opioids and other substance use.

Goal: To engage youth in the development of health promotion programming related to substance use, starting with the creation of messaging, identification of youth-relevant dissemination channels, and finally to the delivery of education strategies in the school setting.

Summary of Activities: In 2021, the Youth Engagement Subcommittee continued Phase 2 of its implementation of the Higher Education campaign. Phases 1 and 2 of the social media campaigns were run consecutively on SnapChat from November 2019 through September 2021. Messages were organized into three themes: The “dark side of drugs”, which focused on negative aspects of drug use with students (e.g., addiction can affect anyone); “See the signs”, which focused on identification of substance use issues; and “How you doin?”, which focused on checking in on your friends and knowing where to access help for substance use. A new wecoss.ca webpage, Your Voice Speaking for You, was created. The most popular images from Phase 1 and 2 of this social media campaign were used to develop a toolkit for local educators, which was distributed to school boards and community agencies. An evaluation of campaigns will be completed in 2022 and will inform future approaches undertaken to address substance use.

Measurable Outputs:

• More than 2,000,000 SnapChat impressions occurred in 2021. Impressions resulted in 10,252 swipe ups for the reader to find out more information and connect youth to supports. Since 2019 there have been more than 6,500,000 views and 30,000 swipe ups.
• Instagram reach from the campaign was 28,000.
• Toolkits have been distributed to School Boards
• A survey was developed to evaluate the effectiveness of the social media campaigns.
  • The social media campaign was reported to increase respondents knowledge of substances with 63% of participants (n=32) indicating they learned something new from the social media messages
  • 35% of respondents looked for more information about substances after seeing these messages, 71% of respondents said they know of resources they can reach out to for substance use support or help.
  • Nearly 60% of respondents reported that campaign messages made them think twice about using substances.

WECOSS Action Plan Guiding Recommendation: Support healthcare providers to play a key role through appropriate prescribing practices, patient education about opioids and overdose prevention, and other pain management options.

Goal: To determine best practice for physician and patient education related to prescribing opioids to treat acute and chronic pain.

Summary of Activities: Two educational opportunities for local healthcare providers were promoted as part of this ongoing work to support healthcare providers. The target audiences were local nurse practitioners and members of the Essex County Medical Society (ECMS). The first educational opportunity was Safer Opioid Prescribing (University of Toronto) and the second was Chronic Pain and Opioid Stewardship (Project ECHO). Education sessions were held in Winter and Spring of 2021. Project partners are currently working to identify data on prescribing practices by healthcare provider (HCP) groups with the support of WECHU’s Epidemiology & Evaluation department. This information is needed to determine which healthcare providers to plan targeted education. Work is also ongoing to engage with the Essex County Dental Society regarding opioid prescribing practices education, as well as with local primary care healthcare providers on identified topics related to care for patients experiencing complex substance use issues.

Measurable Outputs:

• More than 450 local healthcare providers were provided opportunities to engage in continuing education for opioid prescribing and pain management.

Next Steps: In 2022, a survey will be administered to local primary care healthcare professionals to identify key substance use topics and resource types for continuing education, and educational materials will be prepared and disseminated based on identified needs.

WECOSS Action Plan Guiding Recommendation Three: Provide early education and prevention about opioids and other substance use.

Goal: To raise awareness of the importance of proper storage and disposal of medications in the home – including the importance of returning expired prescriptions for safe disposal to a local pharmacy.

Summary of Activities: Medicine Cabinet Clean Out posters to raise awareness about proper medication disposal and storage were prepared. Key messages included the importance of returning expired medications to the pharmacy because this practice can save lives and reduce harm from improper medication use. Printed posters were mailed alongside a letter of introduction to local medical clinics, and were also provided to the Essex County Pharmacists Association, the GECDSB, and Windsor Police Service shared posters throughout the community. A wecoss.ca webpage for the Medicine Cabinet Clean Out campaign was developed for launch in early 2022 to provide information and downloadable campaign materials in English and French, as well as to share key messages and link out to additional external resources. The MCCO campaign will continue through 2022.

Measurable Outputs:

• 75 Medical Clinics across Windsor-Essex received a Medicine Cabinet Clean Out Campaign poster for their practice.

WECOSS Action Plan Guiding Recommendation: Addressing stigma associated with problematic substance use through the development of supportive policies and education of healthcare professionals, community organizations, and the public.

Goals: To bring attention to the opioid, substance, and overdose crisis in the community.

Summary of Activities: Pozitive Pathways Community Services (PPCS), in collaboration with the WECOSS Harm Reduction Working Group, launched a 14-Week Summer Awareness Campaign that was designed to increase awareness about the stigma associated with substance use and to humanize the opioid, substance, and overdose crisis in the community. Campaign activities included the launch and/or promotion of an LMP Anti-Stigma Campaign website, 13 videos and 5 podcasts that shared the unique perspectives of diverse community stakeholders on the crisis and/or heightened awareness about the campaign, and a series of online and in-person vigils and memorial events designed to honour those whose lives have been lost to the overdose crisis. Five LMP-specific webinars were also offered over the course of 2021 on the topics of Consumption and Treatment Services, Introduction to Harm Reduction, Opioids and Naloxone, and Drug Decriminalization and Legalization.

Measurable Outputs:

• 1,789 page views on the LMP website between July 5th and October 14th of 2021.
• 31 content posts were created to promote the Summer Campaign events, activities, and resources, with a total of 85,042 people reached on Facebook, 2,398 accounts reached on Instagram, 40,342 impressions on Twitter, 3,822 views on Linked-In, and 6,220 impressions on YouTube.
• 234 community members participated in the LMP webinars.

Next Steps: The LMP Anti-Stigma Campaign has concluded as of 2021. An evaluator has been hired to complete the final evaluation of the campaign, with a report to be produced in 2022. The LMP Anti-Stigma Campaign website will also continue to serve as an ongoing resource for the community.

WECOSS Action Plan Guiding Recommendation: Increase access to a variety of harm reduction options, such as non-abstinence based programs that accept clients using medication-assisted therapies, safer drug use equipment, and mobile outreach activities, for people who use opioids and those affected by people who use opioids.

Goals

• To engage the community in selecting a suitable and accessible location for a Consumption and Treatment Services (CTS) site in the City of Windsor.
• To apply for and to establish a local CTS site that meets the needs of people who use drugs in the community.

Summary of Activities: The Windsor-Essex County Health Unit (WECHU), in partnership with the WECOSS Harm Reduction Working Group and the CTS Stakeholder Advisory Committee, continued in its search for a suitable and accessible location to host a local CTS site. A site assessment of over 30 potential sites that met the mandatory criteria set in the provincial and federal CTS/Supervised Consumption Services (SCS) applications (as well as locally established eligibility criteria) was conducted. This site assessment was used to rank and condense the list of potential site options to two candidate sites – 101 Wyandotte Street East and 628 Goyeau Street. Crime Prevention through Environmental Design Audits conducted by the Windsor Police Service found that both of the candidate sites would lend themselves sufficiently to establishing manageable “Safe Consumption Zones”, whereby public safety can be maintained with any identified risks to be mitigated. As such, the WECOSS launched a site-specific community consultation on June 17th of 2021 to assess community perceptions about the feasibility and acceptability of establishing a potential CTS at either of the candidate sites. A new CTS page on the WECOSS website was also developed to launch the consultation.

Measurable Outputs:

• A community survey with a total of 448 survey responses
• 13 key informant interviews with business and agency stakeholders operating within a defined radius from the sites
• 7 focus groups with area stakeholder groups
• 3 Virtual Town Hall meetings that allowed community members to ask questions and voice concerns to a panel of expert speakers, with a total of 53 registrants.
• Results yielded local support for the creation of a potential CTS at either of the candidate sites.

Next Steps: In 2022, the results collected through the site-specific community consultation will be used to guide the selection of one candidate CTS location to submit for approval through the provincial and federal application documents. While these applications are in the process of being fulfilled and approved, the WECHU will complete and submit an application to Health Canada to establish and operate a temporary Urgent Public Health Need Site at the selected location until it can be transitioned into a longer-term CTS.

WECOSS Action Plan Guiding Recommendation: Increase access to a variety of harm reduction options, such as non-abstinence based programs that accept clients using medication-assisted therapies, safer drug use equipment, and mobile outreach activities, for people who use opioids and those affected by people who use opioids.

Goal: To support a local system of Needle Syringe Programs (NSP) in order to improve the lives of people who use drugs by providing improved access to harm reduction supplies and health and social services.

Summary of Activities: In the midst of the COVID-19 pandemic, Pozitive Pathways Community Services (PPCS) continued to support the harm reduction needs of the community through the provision of NSP services and supplies. Supplies were distributed at three in-person locations in the City of Windsor and through two mobile delivery programs. In early 2021, PPCS also received a Second Harvest Food Grant that allowed the organization to provide food packages to clients on the last Wednesday of each month. By December of 2021, the in-centre food packaging service had increased its offerings from monthly, to bi-weekly, to weekly due to ongoing demands for the service. In response to local needs identified by residents in the Glengarry area of the City of Windsor, a street outreach partnership was also developed between the PPCS NSP and CommUnity Partnership in order to provide harm reduction supplies and one-on-one education to people who use substances in the areas surrounding the Housing and Homelessness Help Hub.

Measurable Outputs:

• 14,266 client transactions were recorded by local NSP sites and mobile delivery programs.
• 3,723,831 harm reduction supplies were distributed (excluding condoms, dental dams, and lube), including 720,771 sterile needles.
• As of December 2021, approximately 200 food packages were distributed monthly to clients through the in-centre food packaging service.  

WECOSS Action Plan Guiding Recommendation: Increase access to a variety of harm reduction options, such as non-abstinence based programs that accept clients using medication-assisted therapies, safer drug use equipment, and mobile outreach activities, for people who use opioids and those affected by people who use opioids.

Goal: To track the number of needles collected from the needle disposal bins installed across the region.

Summary of Activities: Systematized data collection for needles collected through the needle bins installed across the region continues to be incorporated into the work of the WECOSS. Data about the usage of these bins can be used to inform local needs and programming.

Measurable Outputs:

• Approximately 61,004 needles were collected through the needle disposal bins installed across the City of Windsor.

Next Steps: Moving into 2022, this systematized data collection process will become one of the activities centered under the WECOSS Data Sub-Group.

WECOSS Action Plan Guiding Recommendation: Increase access to a variety of harm reduction options, such as non-abstinence based programs that accept clients using medication-assisted therapies, safer drug use equipment, and mobile outreach activities, for people who use opioids and those affected by people who use opioids.

Goals:

• To recruit organizations to the Ontario Naloxone Program (ONP) and train organizational champions how to operate the program.
• To increase community literacy around how to respond to an overdose.

Summary of Activities: As part of the Windsor-Essex County Health Unit’s (WECHU) commitment to increasing access to local harm reduction services, naloxone kits and training continued to be provided to eligible organizations through the delivery of the ONP and the ONP – Expanded Access Program (ONP-EA). Given that COVID-19 restrictions and other resource demands disrupted the traditional delivery of the ONP in 2021, the WECHU created a series of asynchronous training videos that could be accessed by various program leads for the purposes of educating their staff about naloxone administration. The WECHU also continued to work with various community agencies to recruit other partners into the ONP over the course of 2021.

Measurable Outputs:

• 18 community organizations were actively involved with the ONP, 4 of which were on-boarded or re-trained during the ongoing COVID-19 pandemic.
• 1,065 nasal spray naloxone kits were distributed by community partners involved with the ONP.
• 2,820 individuals were trained on naloxone administration by participating community partner organizations.
• 557 injectable and 3,395 nasal spray naloxone kits were distributed by pharmacies across the region, for a total of 3,952 kits distributed.

Activity – Official Position Statement on Safe Supply

WECOSS Action Plan Guiding Recommendation: Increase access to a variety of harm reduction options, such as non-abstinence based programs that accept clients using medication-assisted therapies, safer drug use equipment, and mobile outreach activities, for people who use opioids and those affected by people who use opioids.

Goals:

• Develop an Official Position Statement on Safe Supply that outlines the WECOSS’ shared vision and position on safe supply initiatives.
• Use the Official Position Statement on Safe Supply to advocate for increased funding and access to safe supply initiatives at the municipal, provincial, and federal levels.

Summary of Activities: Safe supply initiatives significantly improve health outcomes by transitioning people who use drugs from the toxic unregulated drug market to legally prescribed pharmaceutical-grade substances within a regulated healthcare context. In 2021, the WECOSS Harm Reduction Working Group discussed that the development of an Official Position Statement on Safe Supply for the WECOSS could be marked as a foundation for incorporating future safe supply projects and advocacy initiatives throughout the Strategy. As such, a position statement was drafted by this working group in 2021 for the review and approval of the WECOSS Leadership Committee (WECOSS-LC).

Measurable Outputs:

• 1 Official Position Statement on Safe Supply was drafted for the review and approval of the WECOSS-LC.

Next Steps: In early of 2022, the Official Position Statement on Safe Supply was approved by the WECOSS-LC as a declaration of the Strategy’s support of safe supply initiatives. To view the position statement, please click here.

WECOSS Action Plan Guiding Recommendation: Work with provincial partners to advocate for increased funding to expand the capacity of the local substance use treatment system.

Goals:

• To optimize processes used to assess and screen clients for treatment and recovery services.
• To support streamlined access to treatment and recovery services.

Summary of Activities: As part of a sustainment strategy, Hôtel-Dieu Grace Healthcare, in collaboration with the Centre for Addictions and Mental Health and the WECOSS Treatment and Recovery Working Group, continued to deliver virtual training sessions to local service providers on how to administer the Global Appraisal of Individual Needs Short Screener (GAIN-SS). The GAIN-SS is a tool that can assist in the referral process by assessing the client’s most pressing psychological, behavioural, and personal needs. The tool can then be used to support clients in navigating and accessing relevant resources, services, and treatment, as well as to assess client change over time. Use of the tool by service providers allows for more streamlined access to appropriate care options.

Measurable Outputs:

• 6 virtual GAIN-SS training sessions were held in 2021, with 55 individuals taking the training for the first time and 23 taking it as a refresher class
• 19 GAIN-SS training sessions have been held to date as of March 17th, 2022, with 197 individuals taking the class for the first time and 24 taking it as a refresher class

WECOSS Action Plan Guiding Recommendation: Work with provincial partners to advocate for increased funding to expand the capacity of the local substance use treatment system.

Goal: To promote treatment and recovery options to key target groups, including people who use substances, their loved ones, and other health and social service professionals.

Summary of Activities: The Windsor-Essex County Health Unit (WECHU), in collaboration with the WECOSS Treatment and Recovery Working Group, assessed options for embedding Connex Ontario’s provincial database of publicly-funded substance use, mental health, and gambling/gaming services directly onto the WECOSS website, as per the data agreement established between the WECHU and Connex Ontario in 2020. The vision for this activity was to leverage the Connex Ontario database in order to create and maintain an accessible inventory of local treatment and recovery services on the WECOSS website. After further investigation of the digital methods available for transferring and organizing the data onto the website, it was decided that other strategies should be assessed for creating and maintaining a local program and service inventory.

Next Steps: Other strategies for creating, maintaining, and promoting a sustainable inventory of treatment/recovery and supportive service options on the WECOSS website were discussed with the working group in late 2021. As per consultation with the group, the proposed direction forward for this project in 2022 was to:

• Continue to link to Connex Ontario’s service inventory on the WECOSS website
• Complete a comprehensive review of the local “Get Help with Drug, Alcohol, and Other Addictions” inventory on the WECHU website and update its contents
• Transfer and post the updated inventory directly onto the WECOSS website
• Determine a method and time interval to monitor/review the inventory for ongoing updates
• Promote the WECOSS inventory through various promotional and networking channels

These activities will be a priority for the WECOSS Treatment and Recovery Working Group in 2022.

WECOSS Action Plan Guiding Recommendation: Work with provincial partners to advocate for increased funding to expand the capacity of the local substance use treatment system.

Goal: To implement the Breaking Free Online (BFO) program across relevant, publicly funded community organizations in Windsor and Essex County.

Summary of Activities: BFO is an e-learning software that helps clients to achieve and maintain abstinence from substances. In 2021, Hôtel-Dieu Grace Healthcare (HDGH), in collaboration with the WECOSS Treatment and Recovery Working Group, facilitated a community roll-out project aimed at implementing BFO across eligible organizations in Windsor-Essex County. Interested organizations were trained on the implementation and use of BFO at the agency-level and were subsequently provided with service codes, a BFO toolkit, and tablets (as needed) to begin registering clients with the program. During the implementation phases, a Community of Practice was developed with clinical leads from each of the participating organizations in order to provide a shared platform for service providers to ask questions and to discuss barriers and facilitators related to the program’s success. As part of the project’s conclusion, HDGH also secured the resource support of the Homewood Research Institute to conduct a third party evaluation of the initiative.

Measurable Outputs:

Evaluation Findings (April, 2019 – December, 2021)

• 390 clients from 16 community organizations activated an account with BFO.
• The retention rate for clients who started with BFO was 95.6%.
• 86% of clients who were actively engaged with BFO interventions and were abstinent at baseline assessment had maintained abstinence at the time of their most recent “progress check”.
• 64.7% of clients who were actively engaged with interventions on BFO demonstrated clinical improvement in their level of substance dependence, as measured by the Severity of Dependence Scale.

WECOSS Action Plan Guiding Recommendation Eight: Redefine the role for enforcement agencies and other first responders to build “public safety-public health” partnerships for a safer and healthier community.

Goal: To strengthen community safety and address substance use-related crime by taking a coordinated approach among neighborhood groups, police, municipal and peer leaders, and other community stakeholders.

Summary of Activities: Progress on this project has been impacted by the ongoing response to the COVID-19 pandemic. For most of 2020 and 2021, the Windsor Police Services’ Community Service Officers were reassigned to the Patrol Division due to COVID-19. During this time, other project activities continued. Community Safety Handbooks, designed for residents to use to assess their own property for safety concerns, were distributed during Crime Prevention Week at Devonshire Mall and are available for Windsor residents. In addition, local crime data continued to be shared to inform the WECOSS surveillance and monitoring system. Data sharing is useful to community stakeholders and is used for program planning and local responses to crime patterns within neighbourhoods.

Measurable Outputs:

• 500+ Community Safety Handbooks were handed out during Crime Prevention Week November 7th- 13th 2021 at Devonshire Mall.

WECOSS Action Plan Guiding Recommendation Eight: Redefine the role for enforcement agencies and other first responders to build “public safety-public health” partnerships for a safer and healthier community.

Goal: To raise the profile of local enforcement agencies as a “community resource” by increasing public awareness of the community outreach role of law enforcement, with a key focus to educate and raise awareness among at-risk populations.

Summary of Activities: The Working Group developed a social media communication plan and campaign to promote awareness of Crime Stoppers, the Good Samaritan Drug Overdose Act (GSDOA), and the important role of naloxone in harm reduction in the local community. The GSDOA offers legal protections for people who seek the help of emergency services during an overdose, and is designed to help reduce fear associated with police attending overdose events to encourage people who witness an overdose to use emergency services. GSDOA posters were updated and disseminated by WPS Community Services at events and at community centres. A letter was sent to local municipalities to assess interest in promoting the WECOSS on their websites. This promotional work will continue in collaboration with the Prevention & Education Working Group in 2022.

Measurable Outputs:

• 100 GSDOA posters distributed by Windsor Police Service Community Officers
• 20,199 reached for 8 organic Facebook posts to raise awareness of the GSODA, naloxone, and Crime Stoppers