by Jewel Bailey - CAMH
It’s National Addictions Awareness Week, a perfect time to take a closer look at how to tackle alcohol and other substance-related harms. In Ontario, we’ve been grappling with challenges such as the opioid overdose crisis, alcohol-related harms, and the uncertainties surrounding the legalization and regulation of cannabis. These are complex public health problems that demand comprehensive solutions.
As a knowledge broker in EENet’s Health Promotion Resource Centre (part of the Provincial System Support Program at the Centre for Addiction and Mental Health), I’ve been working on various provincial mental health promotion policy initiatives. One consistent theme? We can’t keep focusing on treatment. We have to address risk and protective factors and create environments that support health and well-being.
Interestingly, when it comes to mental illness and addictions, research shows that people are more sympathetic and less stigmatizing to those with mental illness than those with addictions, who are often seen as having made an individual choice. But let’s talk a bit about the role of the environment pertaining to the opioid overdose crisis.
Opioid medications are a type of painkiller. Some can be purchased over the counter, while others are prescribed by a dentist or doctor. In Ontario, there has been an overprescribing of opioids, the doses are high, and the period of use set by physicians is longer than needed. Some have argued that these factors have contributed to the opioid epidemic. According to Public Health Ontario, opioid-related deaths have soared to 136 percent since the early 2000s. In 2016, 865 Ontarians died from opioid-related causes. This is an example of how the practice and regulatory environment can contribute to poor health outcomes. However, the provincial government has created Ontario’s Strategy to Prevent Opioid Addiction and Overdose and has increased access to naloxone kits which are used to prevent opioid overdose.
Environment can also have an impact on harmful alcohol use. It is well established that increased physical availability of alcohol contributes to increased consumption and alcohol-related harms. Close to 1.5 million Ontarians (15%) reported consuming alcohol in harmful/hazardous ways within the past year, based on the 2015 CAMH Monitor report. The 2015 Ontario Student Drug Use and Health Survey showed that hazardous/harmful drinking increases with grade. Harmful alcohol use is associated with a range of social, health, and financial costs and is the leading cause of death and disability in the province.
Tackling harmful alcohol use requires a multi-pronged approach that focuses on building the skills of individuals, working with communities to address issues such as social norms around alcohol use, intervening in different settings, and influencing the policy environment.
Another substance of public health interest is cannabis. Some find the legalization and regulation of cannabis to be concerning, while for others, this is a welcome move by the federal government. After all, banning people from possessing, producing, and trafficking in cannabis, and criminalizing those who use it, have not stopped cannabis consumption. On the other hand, legalization with little regulation can contribute to increased use with significant social and health harms. The federal government has proposed a model which includes both legalization and regulation. Ontario is already thinking ahead, and created the Safe and Sensible Framework to Manage Federal Legalization of Cannabis. This plan outlines what the provincial government will do to manage the use and sale of cannabis.
Cannabis-related harms increase with use, and when a person starts at an early age. Frequent use is associated with dependence, mental health problems, and impaired driving. Adolescents who use cannabis often are also vulnerable to health harms. The CAMH Cannabis Policy Framework recommends a public health approach for preventing cannabis-related harms. This entails addressing the underlying determinants of health, and focusing on health promotion and prevention. I am really convinced as a knowledge broker in mental health promotion that these are some of the major strategies for tackling substance use problems.
As we discuss solutions to problematic substance during this week, let’s not focus only on individual-level actions, but let’s consider the multiple environments people are surrounded by (family, community, policy) and use these as intervention points. By positively influencing the environment we will certainly have an impact at the individual level.
PS: Here is a list of resources you can use when working with clients or program users, or for planning or policy development: