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. The Strategy aims to address substance use through a community-driven action plan. It is a multi-year strategy led by a diverse network of community organizations and people with lived experience (PWLE) using substances. 

The second annual report provides an overview and highlights the activities undertaken through the strategy in its second year of implementation (2019).  It describes the community impacts of substance use, the WECOSS Action Plan, the activities identified for implementation in Year Two, progress made on these activities, and future direction of 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 second year of the Strategy has demonstrated the community partners’ and WECOSS-Leadership Committee’s commitment to the ongoing development and implementation of a community-based substance strategy that will reduce the burden of related social and health concerns in our community, through individual and collective action.

Making a Difference: How Are We Measuring Progress?

In 2019 an evaluation strategy for WECOSS was developed. The purpose of this evaluation is to identify and measure where and how the WECOSS collaborative and the pillar working groups’ efforts prevent, reduce and eliminate health and social harms related to substance use in Windsor and Essex County.  Specifically, the evaluation will measure the processes, outcomes and longer-term impacts of addressing the WECOSS recommendations through a four-pillar approach. 

Measuring the Strategy will support and improve plans and partnerships needed to enhance the quality of services and supports for substance use in the region.

Project Summaries 2019

Foundational Activities

Opioid and Substance Use Notification System

The development of a communication and emergency response systems between public health, emergency and health services, and other community stakeholders is central to the WECOSS.  As the coordinating and resource agency for the WECOSS, the Windsor-Essex County Health Unit’s existing Ministry mandated activities support addressing substance use through data monitoring and surveillance activities. These activities support a system which provides accurate and timely information on substance-use related emergency department visits in Windsor and Essex County (WEC).

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 response and increase overdose prevention and harm reduction activities. In 2019 there were nine (9) community alerts issued as a result the Opioid and Substance Use Notification System (OSUNS).

Peer Engagement

Meaningful engagement of people with lived experience with substance use (PWLE or peers) continues to ensure that local activities are reflective of the needs of those they are intended to help. Peer involvement in WECOSS working groups aided in decision making throughout the year and dedicated sessions were organized throughout the year. Some ideas that were implemented included:

• Sending overdose alerts by email to subscribers in the community
• Posting overdose alerts as community notices at central locations

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: Group interviews with over 150 students in local school boards guided the development of the 2019 Higher Education strategy, which focused on the influence of cannabis legalization on youth behaviours as well as the dangers of consuming substances from an unknown source. In 2019, Higher Education consisted of social media on the SnapChat and Instagram platforms.

Implementation of the Higher Education strategy began on November 25, 2019, through a media event at the Teen Health site of the Windsor-Essex Community Health Centre. Social Media advertisements were purchased targeting specific demographics and geographic areas (i.e., 13 – 25-year-old, male and females in Windsor-Essex County). The user had the ability to “swipe up” on the ad to be redirected to a landing page offering support for substance use and mental health concerns. The campaign model is scalable and will be adapted for use with other substances beyond 2019.

Measurable Outputs:

• 960,643 SnapChat impressions (total number of times a user saw the advertisements)
• 28,312 Instagram reach (total number of unique accounts who saw this content)
• 10,252 swipe ups (number of times a user looked for further information)

Next Steps:

• Evaluation and subsequent development of new messaging guided by another set of group interviews in the school setting
• School and community-based implementation of Higher Education messaging

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: In July 2019, the Opioid Prescribing Practices among Primary Healthcare Providers (HCP) online survey was disseminated by a local advisory table of healthcare providers, in collaboration with members of a community governed primary care and public health partnership. The intent of this survey was to assess HCPs knowledge and use of best practices for opioid prescribing and alternative pain management options. The results of the survey facilitated the development of locally relevant education and resources for providers and their patients. A report of the survey results highlighted some of the knowledge and practice gaps identified.

Measurable Outputs:

• 49 HCP completed the Opioid Prescribing Practices among Primary Healthcare Providers survey

Next Steps:

• Development of a module-based education program with a curriculum that addresses the gaps identified in the survey results, along with information about local substance use resources and services for patients.

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: Implementation of the Label Me Person (LMP) campaign began with the recruitment of staff and peers to develop campaign messaging and workshop content. The campaign launched on Wednesday, September 25th, 2019, at Windsor Regional Hospital by introducing the three main components of the campaign: a community education display, a media campaign that features the personal narratives of people with lived experience with substance use (PWLE), and community education workshops on harm reduction approaches and the importance of using non-stigmatizing language.

Measurable Outputs:

• 530 visitors educated at community display in three community organizations
• 54 Attendees at  five educational workshops
• 9 Peers trained to support the work of the LMP campaign and share their experiences in a meaningful way in the community
• 6 Peer stories gathered to help the community have a better understanding of the experiences of people who use substances

Next Steps

• Additional community education workshops are planned throughout 2020 and will be held at various locations across Windsor and Essex County.
• Stakeholder narratives will be expanded to include PWLE, narratives from community residents and from service providers.

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 and assess community and key stakeholders’ perceptions, concerns, and acceptability of supervised injection services (SISs) in Windsor-Essex.

Summary of Activities: The Supervised Injection Services Community Consultations Report was prepared and results presented to the Board of Health on September 19, 2019. The Board of Health passed a resolution to move forward with a SIS (federal requirement) and Consumption and Treatment Services (CTS) (provincial requirement) applications for a SIS led by WECHU. The full consultation report is posted on the Windsor-Essex County Health Unit’s website.

Measurable Outputs

• 61% of community survey respondents said an SIS would be helpful to Windsor and Essex County.
• 2520 surveys completed by the general public
• 99 in-person interviews or surveys completed with People Who Inject Drugs
• 5 in person focus groups conducted
• 20 key informant interviews with community stakeholders

Next Steps: This work includes providing more education to the community about substance use disorders and harm reduction approaches, along with a formalized community consultation process to determine a potential location for an SIS/CTS. A Program Coordinator has been hired to lead this consultation process.

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 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: New NSP sites added, along with additional routes for the mobile outreach van, allowed for wider distribution of harm reduction materials in Windsor and Essex County. Ongoing distribution of harm reduction equipment across Windsor and Essex County and statistics collected will ensure local programs are further developed and implemented based on reliable data.

Measurable Outputs:

• 708,697 Total Needles Distributed in 2019
• 369,761 Total Needles Returned in 2019
• 3,476,752 Total harm reduction supplies/ kits distributed in WEC in 2019

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 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: A systematized data collection process for needles collected from these bins has been created to increase understanding of the local picture and impact of this initiative. Ongoing public education on how to properly dispose of a sharp if found in the community has also been a key activity with “I Found a Needle” education posters being disseminated.  These posters were modified for young people and all posters translated to Arabic and French.

Measurable Outputs:

• 101,432 needles collected from all community needle disposal bins in 2019
• 704 reports were made to the City of Windsor’s 311 service related to needles found in the community (June 2018 to Feb 4, 2020).
• 2 educational posters for young people and adults on proper needle disposal (one for both City and County)
• 2 language translations (Arabic and French)  for all educational posters

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 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: The Ontario Naloxone Program (ONP) is offered locally through the Windsor-Essex County Health Unit, which conducts outreach to community organizations and acts as a hub for partners’ ordering and reporting of kits. A paid radio campaign was launched to correspond with disproportionately high rates of overdose over a short period in 2019. The campaign focused on how to respond to an opioid overdose and where to access a naloxone kit.

Measurable Outputs:

• 18 Ontario Naloxone Program sites trained
• 6109 Naloxone kits or refills distributed in Windsor and Essex County through the Ontario Naloxone Program in 2019.
• Two (2) social media campaign promoting naloxone
  • 20724 Facebook reach (total number of unique accounts who saw this content)
  • 55584 Facebook reach (total number of unique accounts who saw this content https://www.wecoss.ca/annual-report2019/treatment-and-recovery

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: A community resource for the public that outlines the continuum of care of available treatment and recovery options, was updated to include information about Rapid Access Addiction Medicine clinics. This updated resource was disseminated to local healthcare providers including family physicians and dentists. Additional work was initiated to create a resource that outlines referral pathways to address needs that may surface through the completion of the GAIN Short Screener such as comorbidity of a mental illness.

Next Steps

• Establish a healthcare and social service provider care pathway. An initial step is to create a community listing of local service agencies where clients can be referred based on preliminary screening and assessment.
• Partner with ConnexOntario to provide access to a database of treatment providers directly on the wecoss.ca website

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: The training of relevant community agencies on how to administer the Global Appraisal of Individual Needs (GAINs) Short Screener (GAIN-SS) tool which streamlines the Staged Screening & Assessment process when used.  Training of community agencies supports the future state of a coordinated access model for delivery of addiction services, a system where there is no wrong door for those looking for treatment and recovery supports and services.

Measurable Outputs: 

• 9 GAIN Short Screener (GAIN SS) training sessions held
• 113 Individuals trained
• 36 Agencies trained

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 engage people who have experienced an opioid overdose and provide education on overdose prevention (e.g., naloxone kits) and information and support to access local treatment and recovery options.

Summary of Activities: Relevant service providers and agencies were recruited and briefed on the role for an Opioid Overdose Response Follow Up Strategy (OORS) and participated in the development of a model for Windsor and Essex County. Creation of processes and strategies to provide responsive access to addiction treatment for these clients is a key project goal. Timely access to withdrawal management services and medication for opioid use disorder (e.g., buprenorphine or methadone) are also envisioned as a part of this community response.

Measurable Outputs: 

• 14 community stakeholders collaborated to create an OORS to support those who have recently overdosed, with treatment and harm reduction services

Next Steps:

• Partnerships established between Essex-Windsor Emergency Medical Service and mental health and addictions response units
• Resource package created for program staff and for dissemination to clients

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 by taking a coordinated approach with neighborhood groups, police, municipal and peer leaders and other community stakeholders, to address substance-related crime and associated issues.

Summary of Activities: Four existing formalized police-community partnerships are using a crime prevention approach, Crime Prevention through Environmental Design (CPTED) to understand how the built environment influences community safety. Crime statistics for each of the neighbourhoods are collected and used to identify areas for CPTED audits to be conducted. Recommendations resulting from the audits have been implemented and primarily included modifications to alley lighting, and traffic calming measures, as well as bush trimming to reduce issues related to visibility. A CPTED audit information brochure is currently under development to support this work.  This brochure be available electronically so it can be translated into other languages to allow residents equal access to this information.

The four police-community partnerships have been successful in developing community rapport and actively participate in community festivals and events where the presence of police officers would be appropriate.  Officers continue to be actively involved with regular patrols in the neighbourhoods as well as becoming actively involved in community events.

Measurable Outputs:

• 20 Crime Prevention Through Environmental Design audits done to date
• 201 Recommendations, 27 implemented
• 19 Special Events occurred within the formalized partnerships

Next Steps:

• Pre and post CPTED audit statistics will be examined to assess the effectiveness of implemented environmental changes.
• Officers to remain at the neighbourhood level and continue to engage with the Safety Committees and BIA’s.

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.

Summary of Activities: In addition to the ongoing promotion of The Good Samaritan Drug Overdose Act new materials have been developed to promote local diversion programming options (e.g., drug treatment court). To support this work The Windsor-Essex Treatment Services: Alcohol and Drug Treatment Options pamphlet has been developed as well as an updated Drug Treatment Court brochure. All local enforcement agencies have provided their frontline staff with these resource materials to provide to those at risk or who have been charged with offences. In addition, new recruits and local frontline officers were provided information on the importance of using non stigmatizing language to help break down negative stereotypes associated with substance use disorders.

Next Steps:

• Forging new connections in each community to continue the work of community safety audits.
• Investigate intersection of this project with the development of the Community Safety and Well-Being Plan that has been mandated by the province.