Developing a Response to Opioid Misuse and Overdose for NS & Cannabis Legalization College of LPNs May 25th, 2018

Two Linked Issues Almost 20 years of increased prescribing of opioids resulting in large numbers of people developing dependency Recent appearance of illicit fentanyl and other synthetic opioids as part of street drugs Linkage - changes in OxyContin shifted people to fentanyl - need to deal with those currently dependent on opioids carefully to minimize shifting to street sources - prescribed opioids role in addressing “toxic” street drugs Requires immediate steps to save lives plus addressing longer term systemic issues

National & Provincial Overview Affecting all P/Ts; most severe in BC, Albert and Ontario Provincial 2011 to 2015: average 60 (53-67)opioid overdose deaths/yr. mostly Rx. opioids; often mixed 12 involve Rx. Fentanyl; 3 heroin 1 death from illicit fentanyl in 2015 2016: 58 confirmed & probable deaths 4 deaths from illicit fentanyl; 3 from U-47700 multiple police seizures of fentanyl, usually as “fake” OxyContin tablets 2017 (Jan – Dec): 69 confirmed/3 suspect overdose deaths 2 deaths from illicit fentanyl; 1 from U-47700

Actions to Date Provincial Enhanced monitoring of opioid overdose deaths Public awareness Sustained funding for harm reduction ($ 1.7 M K) – needle exchange, safer consumption, connection to primary care and substance use treatment and social support Sustained funding for ($610 K) – THN in community settings & pharmacies, corrections, police, EHS Multi-year funding for OUD treatment – MH&A, Direction 180 and primary care Annual $400 K prescriber education on opioids, benzos

Cannabis Legalization in Canada: The Journey to July Summer 2018

A Fast Paced Journey: Summer 2018 : Cannabis is legalized October 2015: Federal Election June 2016: Task Force created. Discussion paper released. December 2016: Task Force Report April 13, 2017: C-45 and C-46 introduced April 18, 2018: NS Cannabis Control Act is passed Summer 2018 : Cannabis is legalized “To boldly go where no man has gone before” Captain Kirk

Going Forward: Who’s Driving? Canada Nova Scotia Production and licensing Retail and Distribution Seed-to-sale tracking system Public consumption Medical marijuana system Enforcement Home cultivation Age limit

C-45 Cannabis Act protect young persons Purpose of the Act: protect young persons Provide for the licit production of cannabis to reduce illicit activities Reduce the burden on the criminal justice system in relation to cannabis Provide quality controlled supply; Enhance public awareness.

Cannabis Act – C-45 18 + can possess 30 g or less of dried cannabis in public(or equivalent) Young person with more than 5 g of cannabis will be subject to YCJA A household is prohibited from possessing more than 4 cannabis plants Production is the responsibility of the federal government; Provinces have the responsibility to sell Public consumption

Cannabis Act – C-45 Legal cannabis products that can be sold include dried cannabis, cannabis oil, fresh cannabis, cannabis plants, cannabis plant seeds. Ticketable offences for between 30-50 g, 5-6 plants. A cannabis tracking system will be established.

Provincial Considerations What should the minimum age be? What retail model should be used? What will be the rules on public consumption? What provincial response should apply for youth possessing under 5 g What is the definition of a ‘dwelling house’? Will supply meet the demand?

Bill C-46: Impaired Driving An Act to amend the Criminal Code (offences relating to conveyances) and to make consequential amendments to other Acts Reforms the entire impaired driving regime in the Criminal Code, not just for cannabis impaired driving. Strengthens existing drug impaired driving laws Creates new per se drug offences Allows for new tools to detect drug impaired drivers

Bill C-46: Impaired Driving An Act to amend the Criminal Code (offences relating to conveyances) and to make consequential amendments to other Acts Authorizes mandatory roadside alcohol screening Creates escalating mandatory fines for high BAC Eliminates/limits defences that reward risk taking behavior and make it harder to enforce laws against drinking and driving. Clarify Crown disclosure requirements Permit an earlier enrolment in a provincial ignition interlock program.

Provincial Considerations “What administrative sanctions can be applied?” “How many oral screening devices are needed?” “Who can use the oral fluid drug screeners?” “Who takes the blood sample?” “What is the lab capacity?” “What training is required?”

Provincial Legislation: Cannabis Control Act The legislation is made up of 4 parts: Cannabis Control Act (two parts) NEW Liquor Control Act Amendments Smoke Free Places Act Amendments Motor Vehicle Act Amendments Dissolves interim Cannabis Corporation and transition to NSLC Makes consequential amendments to: Safer Communities and Neighbourhoods Act Summary Proceedings Act Insurance Act Education Act

NS Model Minimum Age is 19 NSLC will be the sole authorized retailer 9 stores – 8 co-located, 1 stand-alone Under 19s will not be allowed in the part of the store that sells cannabis Enhanced Smoke-free Places Act to cover more areas where smoking of both tobacco and cannabis is prohibited including beaches, trails, sports fields Youth who possess under 5 grams of dried cannabis will have it confiscated, ticket and/or restorative justice 4 plants per dwelling house is allowed Strict administrative sanctions for drug impaired drivers Provisions for landlords and tenants

Possible Potholes: Constitutional challenges related to drug impaired driving Legalization of edibles Co-use of alcohol and cannabis Seed to sale tracking system Supply issues Outcome Monitoring

Next Steps: Senate votes on C-45 June 7, 2018 Then goes back to House of Commons for approval Provinces need to implement retail frameworks when cannabis is legal Edibles become legal 12 months from now Next big challenge! Adapt and evolve as we learn more