The opioid crisis has impacted communities of all sizes within Ontario and across Canada. The Windsor-Essex Community Opioid and Substance Strategy (WECOSS) was initially developed to address this crisis by creating a local response based on existing best practices, community feedback, and engagement of people with lived experience using substances (PWLE). This local response prioritizes the health and wellbeing of all people in Windsor and Essex County by promoting evidence-based practices across the four pillars of the Canadian Drugs and Substances Strategy: Prevention, Treatment, Harm Reduction, and Enforcement (Health Canada, 2018). Through ongoing community dialogue, the emergence of additional local data, the Leadership Committee of the WECOSS expanded its scope to include other substances, becoming a poly-substance strategy. Opioids remain the current priority but efforts have not been limited to addressing a single substance in isolation.

This annual report provides an overview and highlights the activities undertaken through the strategy in its first year of implementation (2018).  It describes the public health issues and community impacts of substance use, the WECOSS Action Plan, the activities identified for implementation in Year One, and progress made on these activities.

The Windsor-Essex Community Opioid and Substance Strategy (WECOSS): An Action Plan for Our Community (Action Plan) was created to formalize a clear set of overarching recommendations with associated short and long-term actions. This Action Plan includes a set of eight guiding recommendations to reduce the harms associated with opioid use and enhance the quality and range of services and supports for substance use issues across the region. Following the completion of the Action Plan, individual Working Groups representing each of the four pillars of the Canadian Drugs and Substances Strategy (Health Canada, 2018) began to action the recommendations in January of 2018.

THE GUIDING RECOMMENDATIONS

The Action Plan proposed a set of key recommendations, and includes corresponding short and long-term actions. Further detail about the suggested 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 and 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.

In its first year of implementation, the Windsor-Essex Community Opioid and Substance Strategy (WECOSS) brought together community partners across sectors to begin developing and applying interventions to address the growing issue of substance use in Windsor and Essex County. By utilizing available data and research, reviewing existing and best practice strategies, and engaging with residents and PWLE, the activities undertook in the first year relate to the unique needs of Windsor and Essex County. Some projects, due to the nature of their scope and the timing in which the work was initiated, will not make reference to measurable outputs. Where this is the case, a list of next steps has been provided.

2018 Activity Summaries
Foundational Activities

WECOSS.ca: A Central Information Hub

In alignment with the vision of creating a community in which substance use issues are well understood and guided by the principles of collaboration and community engagement, the WECOSS.ca website was created with links to community resources, information about the strategy and projects, and education about overdose prevention and harm reduction. Acting as the central hub for residents, health professionals, and community decision makers, WECOSS.ca provides one point of access for updates, information, and community supports related to substance use, while concurrently serving as the database through which the Leadership Committee can access meeting minutes and other project materials.

Surveillance and Monitoring System

To provide more accurate and timely information on substance use-related health outcomes and inform community partners on areas to improve local programs and services, the WECHU expanded its local surveillance efforts to identify harmful impacts of opioids and other illicit substances. In 2019, a partnership between Windsor and Essex County regional hospitals and WECHU was initiated to improve the quality and timeliness of opioid-related hospitalization data. The outcome of this collaboration would effectively reduce the time to receive this information from approximately one year to one month. Also, the establishment of data sharing between law enforcement is underway, most notably with the Ontario Provincial Police. The WECHU continues to work with paramedic services to further investigate responses to substance use related dispatch calls. Currently, a webpage containing a variety of information on the morbidity, mortality and use of harm reduction services is being developed by WECHU.

Peer Engagement Subcommittee

One recommendation that runs across the work of all WECOSS projects is the importance and value of peer engagement and meaningful involvement of people with lived experience (PWLE) with substance use. During development of the strategy, feedback from the community consultations and review of best practices in other communities both highlighted the importance of involving PWLE.

Initially, a guidance document based on best practices was developed to determine how to engage with peers and the WECOSS Leadership Committee determined an appropriate model for ongoing peer engagement. As a result, each working group included members representing PWLE and two separate meetings were held that were exclusive to PWLE, in which direction on projects and plans for 2018-2019 were discussed.

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 programs in the school setting. Given the recent legalization of cannabis, the initial focus of the project will be on cannabis; however, the program will be adaptable for use with other substances.

Summary of Activities: Led by senior-level administrators from the three largest school boards in the region and supported by the coordinating efforts of WECHU staff, preliminary activities focused on recruitment of youth to develop substance-specific messaging. By utilizing a youth engagement framework, messaging content and communication mechanisms will ensure they meet the needs of the target population.

Next Steps:

• The formation of group(s) consisting of high school aged students representing a diverse population from across Windsor and Essex County
• Youth-led message development
• The dissemination of messaging throughout the region in public, Catholic, and French-speaking schools

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

Goal: To develop an anti-stigma campaign, including public education sessions to address the stigma associated with substance use. This campaign would promote inclusive and non-stigmatizing language, creating a community forum to dispel myths around harm reduction approaches and encourage the community to see themselves as agents of change in addressing the opioid crisis.

Summary of Activities: In partnership with the AIDS Committee of Windsor, local community renewal groups developed messaging for an anti-stigma campaign, called Label Me Person. A funding proposal was developed and disseminated to community agencies and funding was secured with an implementation timeline set for 2019.

Nest Steps:

• The Solcz Family Foundation has provided generous funding to support project implementation
• Label Me Person  messaging and campaign resources will be finalized
• Recruitment of peers to support development of campaign messaging and workshop content

WECOSS Action Plan Guiding Recommendation [THREE]: 

Provide early education and prevention about opioids and other substance use.

Goal: To develop a primer that provides journalists and other communication professionals with important facts regarding opioids and other substance use and harm reduction approaches. This primer includes guidelines for reporting on these topics in ways that encourage understanding and decrease stigma around substance use disorders. This primer will play a central role in promoting and supporting key messages associated with the Strategy.

Summary of Activities: Best practice health communication approaches were utilized in developing content for a web-based resource located on the WECOSS.ca website.

Measurable Outputs:

• A web-based media primer that can be accessed by media and communications professionals at local organizations

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 survey primary care practitioners to determine knowledge, awareness, and use of best practices for opioid prescribing and alternative pain management options. A review of existing evidence will be used to determine best practice for prescribing opioids and patient education through primary care practice.

Summary of Activities: This project was initiated late in 2018, but strong leadership from several healthcare organizations have helped to set a clear course for this project. An examination of local data on prescribing practices by healthcare and dental providers will help to identify key targets for education and awareness raising initiatives.

Next Steps:

• Matrix/inventory of existing education resources for both healthcare providers and patients’ resources
• Survey of healthcare providers to determine gaps in education related to prescribing practices
• Development of educational program that addresses gaps in knowledge
• Dissemination of educational program

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 engage the community and key stakeholders to assess perceptions, concerns, and acceptability of supervised injection services (SISs) in WEC, with a focus on Windsor.

Summary of Activities: Research Ethics Board clearance was obtained in Fall 2018. Consultation included focus groups with key stakeholders, an in-person survey with persons who inject drugs, and an online survey with the general public.

Measurable Outputs:

• 2,483 fully completed (2,738 total) + 60 paper surveys
• 5 focus groups with 27 attendees (current)
• 18 key informant interviews

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 opioid substitution therapies, safer drug use equipment, and mobile outreach activities, for people who use opioids and those affected by people who use opioids.

Goal:  To expand  local Needle Syringe Programs (NSP) to improve the lives of people who use drugs by increasing opportunities for positive health outcomes, as a result of improved access to health and social services, as well as harm reduction supplies. This harm reduction approach also supports prevention of transmission of blood borne viruses and pathogens between individuals (HIV, HCV and other STBBI’s).

Summary of Activities: Restructured two different Public Health Unit Needle Syringe Programs to create one regional program.  AIDS Committee of Windsor’s addition of new harm reduction staff has allowed for the development of new systems within the agency to support the deployment of additional NSP sites with greater efficiency. Additional sites are planned for 2019. The new mobile outreach van (Yellow Umbrella) has allowed for distributing materials throughout our region.

Measurable Outputs:

• 1 Yellow Umbrella  mobile outreach van to distribute harm reduction supplies
• 4 additional NSP sites established

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 opioid substitution therapies, safer drug use equipment, and mobile outreach activities, for people who use opioids and those affected by people who use opioids.

Goal: To reduce the number of improperly discarded syringes and sharps in neighborhoods across Windsor and Essex County by providing sharp disposal bins. The purpose of these disposal bins is to help lessen the risk for members in the community to come into contact with items that have been improperly discarded.

Summary of Activities: The Municipal Bin Advisory Committee was formed. Members include Windsor Police Services, healthcare agencies, community organizations, business improvement associations, neighbourhood groups, and City of Windsor staff. The committee worked to implement 11 of the proposed 19 sharps kiosk goals, which included: determination of the placement (e.g., based on 311 data, and site evaluations according to Crime Prevention through Environmental Design principles) and purchase and installation of these kiosks, as well as public education on how to dispose of a sharp if found in the community. Further work will collect aggregate data to understand the greater impact of this initiative.

Measurable Outputs:

• 1 educational poster on proper needle disposal
• 7 additional bins were installed by the City of Windsor for a total of 11 bins.

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 opioid substitution therapies, safer drug use equipment, and mobile outreach activities, for people who use opioids and those affected by people who use opioids.

Goal: To increase community access to naloxone by adding to the number of trained, partnering organizations involved in the Ontario Naloxone Program (ONP) and increased public awareness of local points of access to free naloxone.

Summary of Activities: The Ontario Naloxone Program (ONP) offered through the Windsor-Essex County Health Unit, distributes naloxone to eligible community organizations for their clients who use opioids or are at risk of an opioid overdose, and their friends and families. Key activities in this project included: outreach to community organizations to recruit them for the ONP; development of promotional materials for local naloxone access points.

Measurable Outputs:

• 2 community resources developed to promote local naloxone access points 
• 15 new Ontario Naloxone Program sites recruited
• 3,679 Naloxone kits or refills distributed in Windsor and Essex County through the Ontario Naloxone Program in 2018

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 raise awareness about treatment and recovery options for key target groups, including those who are using substances and their loved ones and other health and social service professionals.

Summary of Activities: A review of the research literature on care pathways was completed to determine what elements needed to be included in an evidence based care pathway. A community resource (poster and fact sheet) was produced for the public that outlines the continuum of care of available treatment and recovery options. The resource package was disseminated to local healthcare providers including family physicians and dentists to post in their reception areas, along with fact sheets to provide to their patients and clients.

Measurable Outputs:

• Treatment Roadmap to Recovery resource
• 300 (+) resource packages delivered to healthcare providers

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 review and optimize current processes used to assess and screen clients for treatment services, including examining how best to position recently added staff at Community Withdrawal Management Services, as well as Addictions Support Workers, and a Chronic Pain Case Manager, to support streamlined access to treatment and recovery services.

Summary of Activities: A current state analysis and mapping of the assessment and referral process took place in early 2018. Opportunities for improvement to the existing system were identified, including the implementation of a coordinated staged screening approach that begins with community agencies. The Global Appraisal of Individual Needs (GAINs) has been determined to be an effective tool in the screening and assessment process for accessing substance use services in Ontario. Education has been provided to staff at specific community agencies related to the use of the GAINs-Short Screener (GAINs-SS) tool, to support more seamless and streamlined access to appropriate services.

This community wide initiative is creating the foundation necessary for a coordinated access model for delivery of addiction services-it is a system where there is no wrong door, but where all doors lead toward an established and comprehensive service delivery model that is easily accessible and responsive to the needs of individuals and families with addiction.

Measurable Outputs: 

• 4 GAINS-SS education sessions offered to local community health agencies
• 36 staff at 16 community organizations trained on GAINS -SS tool. An additional 16 organizations will receive GAINs-SS training by May 2019.

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 through partnerships using a coordinated approach between neighborhood groups, police, municipal and peer leaders and other community stakeholders as a means to address opioid-related crime and other substance use issues.

Summary of Activities: In the City of Windsor, four community groups were already established. A critical review of the evidence for best practices on police-community collaborations was prepared to guide and set forth recommendations. Partnerships were formalized to ensure each will have ongoing membership from a designated Community Resource Officer (Windsor Police Service). These officers can be a visible and direct resource for a given neighborhood and will also work with the community group to proactively identify and address local concerns.

Measurable Outputs:

• 1 report outlining best practices on police-community relations prepared to guide community collaboration
• 4 Windsor Police Service Community Resource Officers assigned and participating in formalized partnership with 4 community groups for a safer community

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 through a variety of communication channels.

Summary of Activities: The Good Samaritan Drug Overdose Act  provides some legal protection for people who experience or witness an overdose and seek help by calling 911 in an overdose situation. To promote the Good Samaritan Act a poster was developed in collaboration from all 4 local enforcement agencies. Additional work included promoting the services of the Mental Health Response Unit and COAST (a multidisciplinary team that includes a social worker and plain clothes police officer with training to deal with those experiencing a mental health crisis), as well as the 24/7 crisis phone line to the public and community agencies that work those with mental health and substance use issues.

Measurable Outputs:

• 1000 Good Samaritan Drug Overdose Act  posters were printed and the majority have been distributed throughout Windsor and Essex County
• 3 social media channels (Facebook, Instagram and Twitter) and corporate websites were used to increase public awareness of the elements of the Good Samaritan Drug Overdose Act

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 investigate the feasibility of additional programming that diverts people from the Justice System to appropriate social and health supports by further incorporating drug related cases into diversion programs.

Summary of Activities: Initial work on this project involved an informal examination of the existing Drug Treatment Court (DTC) in the City of Windsor. The project lead was invited to join the local drug treatment court committee. Participating in this committee’s meetings illuminated that at the present time, there is no way to increase the frequency of DTC.  Specifically, an increased number of spots available in DTC would impact and apply more pressure on those community providers already at the table.

Next Steps:

• To examine the potential to have diversion programming in areas outside of Windsor, such as the Leamington area
• To provide education to frontline staff at enforcement agencies about the role DTC can play in a client's life

While WECOSS addresses certain collaborative opportunities related to substance use there have been and continues to be considerable investment and support for people who use substances as well as their families, and friends in Windsor and Essex County. The list below is not exhaustive and highlights just some of the many efforts that are ongoing within our community.

AIDS Committee of Windsor (ACW):

Needle Syringe Program (NSP): Provides sterile unused needles, safe inhalation kits, and education surrounding wound and abscess care, safer injection information and risk reduction strategies.

Mobile Outreach: Harm Reduction staff provide weekly harm reduction outreach services to predetermined locations within Windsor-Essex and Chatham-Kent.

Naloxone Program: Naloxone kits are available along with education about how to recognize the signs of overdose and how to administer Naloxone.

Safe Sharps Disposal: In an effort to improve public health and safety, education is on how to properly dispose of sharps and the locations of sharp disposal bins in the community.

Community Education Sessions: A variety of presentations are offered in the community to inform and educate on the basics of harm reduction principles and various harm reduction programs and resources. Some of the presentations include "Women & Harm Reduction and HIV Testing: Assessing Your Risk".

Brentwood Recovery Home

Community Addiction Treatment (Adolescents only): Community addiction treatment for youth 13-16 years of age.

Residential Addiction Treatment (Adult and Youth): Treatment for men and women 16 years of age and older. Program duration is 21 - 90 days as well as aftercare and supports for family and friends of persons challenged by addiction.

Crime Stoppers

Anonymous Reporting: An opportunity for the public to provide information anonymously about those that are dealing drugs in our respective communities. The information is sent to local police for investigation and should it result in enforcement activity, the tipster may qualify for a cash reward of $50-$2000.

Downtown Mission

Phoenix Recovery and Wellness Program: The program is a 12-week outpatient substance use day-program with a harm-reduction person-centered approach with separate men’s and women’s programming.

Women Supporting Women (in partnership with Downtown Mission and ACW): A chance to talk for women who use drugs or engage in sex work and to access harm reduction supplies and menstrual hygiene products.

Hôtel-Dieu Grace Healthcare

Center for Problem Gambling and Digital Dependency: Both residential and outpatient treatment services available for individuals that are impacted by gambling, gaming, and/or problematic internet use related concerns.

Community Withdrawal Management Services: Chemical dependency counsellors support those who prefer to undergo withdrawal at home or in another safe, supportive environment.

Concurrent Disorders Treatment Program: A mental health and addictions outpatient program designed for any resident 16 years of age or older, whose health is affected by a diagnosed mental health concern and substance related misuse/dependency.

Residential Withdrawal Management Services:  A residential program for people who need monitoring of their withdrawal symptoms and/or a structured, safe environment to stop using.

Remedial Measures Program (Back on Track):  Clients are provided assessment, education, treatment and follow-up interview as part of the Ministry of Transportation remedial measures requirements for drivers convicted of impaired or warn range driving.

Windsor Addiction Assessment and Referral Services:  This community based agency provides servicing to individuals aged 16 and older who are concerned or experiencing problems and/or negative consequences related to substance use. This service determines eligibility for publically funded addiction programming and access to outpatient treatment groups for addictions.

Legal Assistance of Windsor

Legal Representation:  Additional social work supports are offered to address many of the root causes of addiction and homelessness, including income instability, evictions and criminal injuries compensation.  

Ontario Provincial Police

Mental Health Response Unit:  Two person units (one police officer and one crisis worker) follow up with people that had police contact or have been referred by a member of the public, linking them with services in their community (e.g., AA, counselling or shelters).

School Boards in Windsor-Essex

Substance Use Prevention and Education: Schools are partnering with the Health Unit and all local police agencies to provide education about cannabis to high school and elementary school students.  It is a joint presentation by the health unit and the local police agency that serves the school (OPP, Windsor Police or LaSalle Police).

Windsor Essex Community Health Centre

Addiction Support Workers and STEPS: Addiction Support Workers provide individual and group therapy services to persons affected by substance use via the S.T.E.P.S. (Stability Through Education Prevention and Support) Program. This program offers harm reduction, relapse prevention, community referrals, assessment, treatment planning, mental health referrals, and supports for family members of individuals with addiction issues.

Community Outreach: Health Promotion team available to provide outreach (e.g., presentations) to community partners, work places, and schools.

L.E.A.P. (LaSalle Empowerment Assistance Program):  Partnering with Lasalle Police, this peer support group is accompanied by an Addiction Support Worker for individuals between the ages of 18 and 25 and their loved ones.

Naloxone Program: Naloxone kits are available along with education about how to recognize the signs of overdose and how to administer Naloxone.

Not My Kid: Mental Health & Addiction Events:  Hosted to help destigmatize addiction by providing education on prevention, facilitating system navigation for treatment options, the opportunity to receive naloxone training and hear lived experiences of community members.

Outpatient Addictions Program at weCHC Teen Health Site: This program offers psychotherapy to youth aged 12-24 who are concerned about their alcohol or drug use.

Psychotherapist/Addiction Support Counsellor at weCHC Teen: Free counselling for individuals 12-24 years of age at weCHC Teen Site (1361 Ouellette Ave).

Windsor Police and LaSalle Police Services:

C.O.A.S.T. (Community Outreach and Support Team): Windsor Police Services provides two officers and Hôtel-Dieu Grace Healthcare’s Community Crisis Centre provides two crisis workers to work in partnership in operating two Community Outreach and Support Teams. This service will be extended to LaSalle and Amherstburg with a LaSalle Police Service officer and an officer with Windsor Police Services operating in Amherstburg.

Windsor Regional Hospital

Mental Health Program: Provides acute services 24/7 for patients 16 years of age or older. Services include emergency psychiatric assessments through the Emergency Department, as well as admission into the Mental Health Program.

Multi-Disciplinary Team: Specific to addiction services, the agency liaises with community partners as part of a patient discharge process. Nurses, social workers, occupational therapists, family practice physicians, and psychiatrists work together to support patients with mental health and addiction issues.