The third annual report provides an overview and highlights the activities undertaken through the strategy in its third year of implementation (2020). The impacts of COVID-19 have affected everyone, but for those who use substances and organizations that support them, these impacts have been heightened. The report will identify some of these impacts and examine how WECOSS and its partners were able to respond to this second public health crisis. This report also includes the WECOSS Action Plan, activities identified for implementation in Year 3 and progress made on these activities despite the significant effects of the pandemic, as well how emerging needs in the community are being incorporated into the Strategy.

The Windsor-Essex Community Opioid and Substance Strategy (WECOSS): An Action Plan for Our Community (Action Plan) outlines a set of eight overarching recommendations with associated short and long-term actions. These guiding recommendations to reduce the harms and enhance the quality and range of services and supports for substance use issues across the region guide the work of the Strategy. Individual Working Groups representing each of the four pillars of the Canadian Drugs and Substances Strategy (Health Canada, 2018) action these recommendations.

Further detail about the short and long-term actions associated with each recommendation can be found in the Action Plan Strategy document

THE WORKING GROUPS

The WECOSS-Leadership Committee serves as the backbone of the overall strategy through its support of the vision, direction, and advancement of key advocacy activities, while the four pillar-based working groups have been tasked with implementing the strategies outlined in the Action Plan:

• Prevention and Education
  Preventing or delaying substance use and prevent problematic substance use. Projects or activities focus on reducing the factors that increase the risk of developing substance use issues and increase protective factors, including promoting healthy families, stigma reduction education and awareness initiatives.
• Harm Reduction
  Reducing the health, social, and economic harms associated with substance use by respecting the rights of those who use substances, and increasing awareness regarding lower risk use. Harm reduction approaches reduce the spread of communicable diseases, prevent overdose harms and deaths, increase contact with healthcare providers, and reduce consumption of illicit substances in unsafe settings.
• Treatment and Recovery
  Improving the physical and emotional well-being of people who use substances or have used substances. These include a continuum of services and interventions, such as counselling, residential programs, and community-based withdrawal programs.
• Enforcement and Justice
  Strengthening community safety by responding to crime and disorder in the community related to substance use and increasing coordination between law enforcement and health services.

The third year of the Strategy has demonstrated the WECOSS-Leadership Committee and partner agencies’ commitment to meeting people who use substances where they are at. This means creating new and sustainable solutions to reduce the impacts of related social and health concerns, which are so critical during unprecedented times. The impacts of COVID-19 have presented new challenges, but WECOSS partner agencies have strived to keep the well-being of people who use substances at the forefront by being solution-oriented and compassionate.

Strategy Improvements and Sustainability

Since the inception of WECOSS, an evaluation plan has formed the basis of how we measure the WECOSS collaborative and the pillar working groups’ progress. In 2020, a larger evaluation plan of the WECOSS strategy was designed to assess the level of awareness and early impact of the WECOSS in the community. The evaluation will be conducted in early 2021 to update the original WECOSS Action Plan to ensure it remains focused on emerging needs. Input will be gathered from stakeholders affected by the opioid crisis and other substance use issues.

Key informant interviews will be conducted to hear from WECOSS partner agencies and people with lived experience, along with an online community survey to hear from the public and WECOSS partner agencies. The results from this evaluation will help determine the strategic direction for WECOSS in the coming years.

Covid-19 Response

The double burden of COVID-19 and the ongoing opioid overdose crisis has meant that healthcare, harm reduction, and other frontline service providers have been challenged with addressing two significant health crises in parallel. The existing evidence base about COVID-19 and its intersection with substance use disorders was generally limited, but new information and supports have quickly emerged. WECOSS partner organizations worked together and used emerging best practices to support people who depend on substances and addressed their unique needs in a variety of ways during the pandemic.

The WECOSS website was quickly modified at the start of the pandemic to provide information regarding COVID-19’s health and social impacts on those who use substances. The website continued to be a centralized hub of reliable and timely information. Additions to the website included an up-to-date listing of local treatment and support services available during the pandemic, as well as guidance documents for primary care, pharmacists, and treatment providers with best practices for supporting those use substances during the pandemic.

Information sharing with the community and service providers remained critical over the past year and social media campaigns during COVID-19 were used to highlight information about how to access relevant services during the pandemic, along with critical education and awareness events such as International Overdose Awareness Day (August), National Recovery Month (September), and National Addictions Awareness Week (November).

WECOSS partner organizations rapidly modified their programs and services to respond during the pandemic to support clients and patients. The responsiveness and adaptations will be highlighted throughout this report.

Opioid and Substance Use Notification System

Ongoing implementation of the communication and emergency response systems between public health, emergency and health services, and other community stakeholders remains critical to the WECOSS. In 2020, there were three (3) community alerts issued as a result the Opioid and Substance Use Notification System (OSUNS).  These alerts are issued when there is a need to increase awareness and mobilize community organizations that serve people who use substances, in order to improve and strengthen overdose prevention and harm reduction activities.

Data from the Office of the Chief Coroner for Ontario showed a 38% increase in suspected drug-related deaths in Ontario in the first three months of the pandemic compared to the monthly average in 2019 (Public Health Ontario, 2020). Similar increases were seen locally, in Windsor and Essex County (WEC).  In fact, in 2020, there were 304 opioid-related emergency department visits in WEC, 55 more than were reported in 2019. In 2020, WEC also had the highest number of opioid overdoses since reporting began in 2007, with 348 overdoses, as well as the highest number of opioid-relates deaths with a total of 64 deaths.

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, through to the delivery of education strategies in the school setting.

Summary of Activities: The Youth Engagement sub-group continued to Phase 2 of its implementation of the Higher Education campaign. Social media posts were finalized in September, with eleven new messages launched on SnapChat. Additional funding was brought forward, which allowed the SnapChat campaign to be extended until the end December 2020. The messages fell into three themes: The “dark side of drugs”, which focused on negative aspects of drug use which students may not consider (e.g., everyone is susceptible to addiction); “See the signs”, which focused on how to identify a substance use problem; and “How you doin?” which focused on checking in on your friends and knowing where to access help, if needed.

The most popular images from Phase 1 and 2 of this social media campaign will used in the development of a toolkit. The package containing the posts in various formats will be released to the school boards for their application at school, as well as other community agencies. In light of COVID-19 and at-home learning, a new slide format will be included so that teachers can insert the slide in their online lessons. Schools can also use them on their own social media accounts and TVs in schools. Snapchat and other platforms will be used to continue the campaign into July 2021.

Measurable Outputs:

• 2,981,856 SnapChat impressions in Phase 2 with these impressions also garnering almost 10,000 swipe ups for the reader to find out more information.
• 28,912 Instagram reach (total number of unique accounts who saw this content) clicked the link connecting them to support

WECOSS Action Plan Guiding Recommendation [TWO]: 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: The Health Care Provider (HCP) Education subgroup developed a WECOSS branded flyer to promote two different existing education opportunities for HCPs, ECHO Ontario Chronic Pain/Opioid Stewardship and University of Toronto’s Safer Opioid Prescribing education programs. A guidance document for HCPs about where to refer patients in Windsor and Essex County for pain management (e.g., pain clinics) is being developed, along with information and resources on local treatment and harm reduction services. The promoted education opportunities will be held in winter and spring 2021. These education sessions were shared with Essex County Medical Society members and local nurse practitioners, and other relevant providers were encouraged to participate. The HCP Education sub-group is working to plan for other future online education opportunities for local providers.

Measurable Outputs:

• 460 + healthcare providers were offered 2 education options on opioid prescribing and pain management

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

Goal: To implement an awareness campaign to address the stigma associated with substance use and harm reduction approaches, that promotes inclusive and non-stigmatizing language.

Summary of Activities: The Label Me Person anti-stigma campaign has been crucial to enhancing the public’s understanding of substance use disorders and harm reduction. Pozitive Pathways Community Services have been innovative in adapting the campaign during the pandemic. In-person workshop moved to webinars and podcasts. The podcasts were streamed through Podbean, Tune-In Alexa, Amazon Music, Apple Podcast, Google Podcast, and Spotify. A series of videos, “View from the Front Lines” were also produced and designed to compliment the campaign by presenting varying perspectives of community stakeholders. Final editing on four videos representing two streams of community stakeholders (Enforcement & Justice and Treatment & Recovery) were completed. Two more streams are in production (Residents and Harm Reduction). Additional community education workshops are planned throughout 2021 and will be held virtually.

Measurable Outputs:

• 6 Podcast episodes including personal journeys from those with lived experience, with 196 Downloads and 200 listeners in total
• 320 listeners across two Label Me Person podcast sneak peeks
• 4 Webinars, with 154 participants across all educational webinars
• 4 Videos - “View from the Front Lines” that present the perspectives of community stakeholders

WECOSS Action Plan Guiding Recommendation [FIVE]:  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 establish a CTS facility in City of Windsor that meets the needs of people who inject drugs by promoting safe injecting practices and providing access to health and social services

Summary of Activities: The CTS Stakeholder Advisory Committee met several times during the past year. It held a meeting in October to discuss some of challenges faced with finding a potential site to situate the CTS facility. The committee members were able to conduct a situational analysis to gain better understanding of possible enablers and barriers surrounding the project and devise strategies to response to identified risks.

Two potential locations for a CTS facility in downtown Windsor – 101 Wyandotte Street East and 628 Goyeau Street were identified. A site-specific community consultation process will take place in Spring 2021. The purpose of the consultation will be to assess the community’s overall perceptions and acceptability of a CTS facility at both of the potential locations. The results of this community consultation process will be used to inform the selection of one potential location for a CTS facility in downtown Windsor. The location that is selected will be submitted through applications to Health Canada and the Ontario Ministry of Health & Long-Term Care for approval of a local CTS site.

Measurable Outputs:

One (1) situational analysis to gain a better understanding of possible enablers and barriers surrounding the project

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

Summary of Activities: Pozitive Pathways Community Services (PPCS) has continued to work and communicate with the community to meet harm reduction needs in a COVID-19 environment. This work has included support for the Isolation and Recovery Centre and the homelessness day programs at Waterworld that were opened to respond to community needs resulting from the pandemic. PPCS has also created an infographic to highlight key statistics of the Yellow Umbrella Needle Syringe Program (NSP), and will continue to prepare such infographics on a semi-annual basis. The agency will also be using the results of a report from the Canadian HIV/AIDS Legal Network (2020) on the Good Samaritan Drug Overdose Act. These include lessons learned from an Ontario study that was conducted to evaluate familiarity and perceptions of the Good Samaritan Law among people who have experience with drug use. This information will be used to inform the services PPSC provides in the community.

Measurable Outputs:

• 9587 Needle Syringe Program transactions in 2020

Goal: To reduce to the number of improperly discarded syringes and sharps in neighborhoods across Windsor and Essex County, by providing education and sharp disposal bins.

Summary of Activities: This project has concluded, but the systematized data collection process for needles collected from these bins will continue to be incorporated into future work of the WECOSS. Needle disposal bins are an ongoing key harm reduction approach and the data about the usage of these bins can be used to inform local needs and programming. The Health Unit has provided a heat map to the Leamington Substance Use Committee. This information could be used to support where the needle boxes could be placed in that community.

Measurable Outputs:

• 5 Additional Needle Disposal Bins purchased for installation in Leamington, for a total of 19 Bins across WEC.

Goal: To recruit organizations to the Ontario Naloxone Program (ONP) and train organizational champions on how to order and dispense naloxone for clients. Promoting points of access for naloxone and increasing community literacy around how to respond to an overdose are secondary goals of this project.

Summary of Activities: In response to COVID-19, there has been new expanded access to Naloxone by the Ministry of Health and Long-term Care - Ontario Naloxone Program Expanded Access (ONP-EA). The Health Unit actively worked with various community-based agencies to recruit potential partners to the ONP-EA. The Windsor-Essex County Health Unit continued, along with other ONP leads, such as Pozitive Pathways Community Services, to provide naloxone and training to existing ONP partner agencies.

Some of the community partners that have been on boarded were WE Trans Wellness and Windsor Police Services, and Essex-Windsor EMS. The addition of these organization has been very positive as they are key partners in addressing substance use related health and social issues. Existing partners, have continued to be provided with Naloxone kits and refills, training in overdose response and prevention, as well as harm reduction education materials for clients.

Measurable Outputs:

• 653 Naloxone Nasal Spray kits and 240 individual refill kits distributed to target populations
• 21 Ontario Naloxone Program sites trained, including those under the new Expanded Access
• 35,675 Naloxone kits distributed by pharmacies and mental health and addiction services

WECOSS Action Plan Guiding Recommendation [SEVEN]: 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 those who are using substances, their loved ones and other health and social service professionals.

Summary of Activities: In 2020, an agreement was signed between the Windsor-Essex County Health Unit and Connex Ontario. This agreement allows Connex Ontario’s database, a searchable list of publicly funded substance use treatment and support service organizations across Ontario, to be embedded in the WECOSS website.

Over the course of the last year, the WECOSS website has continued to be a centralized hub of information. The website was rapidly updated to reflect where to access help and support during the pandemic, including a specific listing of community agencies and their modified hours and services. Local helplines were also added, as well as information for accessing online 12 step meetings. Developing promotional materials about wecoss.ca and the resources it contains has been identified as an important activity for 2021.

Measurable Outputs:

• 4 Specialized COVID-19 information sections on wecoss.ca were created to support, people who use substances, pharmacists and healthcare providers, treatment and recovery providers, and harm reduction agencies
• 20 community agencies and their modified pandemic response services were added to wecoss.ca

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

Goal: To optimize processes used to assess and screen clients for treatment services, and support streamlined access to these services.

Summary of Activities: As part of a sustainment strategy, training community agencies on how to administer the Global Appraisal of Individual Needs (GAINs) Short Screener (GAIN-SS) tool has continued. Training took place virtually, with two sessions held on October 15, 2020. Partners that have this training allows the Staged Screening & Assessment process to be streamlined. At these training sessions, providers identified the need for more information about where to direct clients with a substance or process addiction issue (e.g., gambling). In response, a resource has been prepared for providers with this pathway information. Other actions to improve integration of services in the region, included discussions with the Centre for Addiction and Mental Health and the South West Detention Center (SWDC) to address specifically how SWDC can best operationalize the GAIN-SS to transition those being released. Improved integration and access to services in the region continues to be a priority area of focus of the WECOSS.

Measurable Outputs: 

• 2 virtuals GAIN SS training sessions were held, with 29 Individuals trained
• 13 GAIN-SS training sessions total and 142 participants trained to date

WECOSS Action Plan Guiding Recommendation [SEVEN]:  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 community organizations in Windsor and Essex County. BFO is an e-learning software that helps clients to achieve and maintain abstinence from substances through online access to a toolkit of psychoeducation, recovery resources, and evidence-based behaviour change techniques

Summary of Activities: The Breaking Free Online (BFO) program has been implemented locally at the House of Sophrosyne and was implemented broadly at Hôtel-Dieu Grace Healthcare (HDGH). This web-based support is especially beneficial with the treatment service modifications resulting from the pandemic. There are plans for a community rollout of access to BFO for relevant community organizations in Windsor and Essex County. Multiple internal sessions were held with HDGH departments and some Canadian Mental Health Association staff to obtain staff engagement, determine appropriateness for the program, and the potential modes of implementation. Internal training sessions with Breaking Free took place across various HDGH programs. Homewood Research Institute is set to evaluate the implementation of Breaking Free in the region.

Measurable Outputs: 

• 194 House of Sophrosyne clients have participated in BFO to date
• 11 Hôtel-Dieu Grace Healthcare departments trained on Breaking Free program
• 3 Hôtel-Dieu Grace Healthcare clients enrolled following launch (Dec. 18 – Dec. 31, 2020)
• 1 community wide implementation and research evaluation plan for Breaking Free Online

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: The Windsor Police Services’ community service officers who were assigned to manage the different locations in Windsor were reassigned to the Patrol Division due to COVID-19. During this time, while officers were unable to engage with their previously assigned neighbourhood groups, other project activities continued. The Community Safety Handbooks, designed for residents to use to assess their own property for safety concerns, were printed. These resources are now available for Windsor residents. Importantly, local crime data continued to be shared to inform the WECOSS surveillance and monitoring system. This data is useful to stakeholders and can be used for planning of programs and local responses.

Measurable Outputs:

• 2,000 Community Safety Handbooks printed to assist residents in assessing their properties for safety concerns.

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: Project leads attended virtual Drug Treatment Court (DTC) meetings to discuss how the newly revised DTC brochure could be disseminated in a strategic manner. Creation of a communication strategy was paused due to resource allocation during the COVID-19 pandemic, including changes in staff. This work will restart in early 2021. A key deliverable of this project includes a media campaign regarding the Good Samaritan Drug Overdose Act (GSDOA). Project plans include adapting existing content from the Ontario Provincial Police’s GSDOA campaign, as well as promoting Crime Stoppers, and local mental health and police teams (e.g., COAST). New, integral community partners, have joined this working group, including the addition of Windsor Police Service probation and parole and Canadian Mental Health Association’s Justice Court Support staff.

Closing

Community partners have worked together to effect positive change in our community for those that use substances. This work has remained a priority, throughout the pandemic. This past year has shown the imperative of centering the needs of those who use substances at the forefront of all the activities and actions of the WECOSS, as we move forward together, as a community.