1. The State of the Node in Saskatchewan
Canadian Research Initiative in substance misuse
Calgary, Alberta
June, 2016

2. Current Affairs Current Trends Opioid related deaths
Take Home Naloxone
IVDU & HIV
First Nations Prescription Drug Abuse Initiative

3. Current Trends Alcohol continues to dominate for treatment admissions.
Stimulants: dominance of crystal methamphetamine over cocaine and methylphenidate.
Opioids: emerging challenges with illicit fentanyl but continued predominance of prescription opioids.

4. Patterns of Opioid Use

5. Office of The Chief Coroner (2015)

6. Office of The Chief Coroner (2015)

7. The Really Bad News… W18 & W series synthetic opioids
Highly concentrated, 100 x more potent than fentanyl.
Small amounts are more easily shipped from China, without detection.
High profit margin, more motivated sellers.
Unresponsive to naloxone: potency or structure?

9. Next Steps Provincially
Naloxone to become a non-prescription drug in July 2016.
A prescription will not be required, but MH&A involvement and a training certificate will.
Ministry will provide kits and naloxone at no cost.
Regina Qu'Appelle, Sunrise, Prairie North and Prince Albert Parkland all in discussion.
Each will have to explore the balance: use THN as an outreach and engagement strategy for MH&A, without unnecessarily impeding access.
2nd strategy will have kits available through pharmacies. Cost yet to be determined.
Pharmacist to train. Content under discussion, including linkage to MH&A services.

10. HIV & IVDU
Saskatchewan continues to have the highest rate of HIV in the country, in some communities matching that of Nigeria.
> 70 % is transmitted by IVDU.
AIDS mortality remains significant due to the chaos of ongoing substance use and the inability to consistently take Anti-Retroviral Therapy.
Concurrent Public Health / Infectious Disease / Addiction systems of care have emerged as Best Practice models but uptake is inconsistent.
Health Canada has adopted a community consultation approach to testing that has resulted in significant regional gaps in surveillance and care.

11. Saskatchewan’s investments into Prescription Drug Abuse
FNIHB Saskatchewan Region

12. Partners
FNIHB SIIT Battle River Treaty 6 Cree Nation Treatment Haven Leading Thunderbird Lodge Opaskwayak Cree Nation Saulteaux-Pelly Agency White Buffalo Treatment Centre College of Physicians & Surgeons

13. Overview
First Nation Inuit Health Branch (FNIHB) in collaboration with partners aims to build and enhance existing services and community capacity to address PDA consistent with Honouring Our Strengths: A Renewed Framework to Address Substance Use Issues among First Nations People in Canada and the First Nations Mental Wellness Continuum. This includes focusing on areas that include • Front line Awareness, Prevention and Skills Training • Enhanced Case Management for clients • Targeted Treatment of PDA • Capacity Developments Team • Increased community access to subject matter experts • Cultural Awareness and Safety training for prescribing Doctors • Enhanced Cultural programming to support holistic approaches to PDA treatment

14. Moving Forward Improved clinical implementation: National CPGs
Clinical Care Pathways, including pharmacotherapy, within Primary Care Assess – Counsel – Prescribe - Connect
A continuum of care within a chronic disease model, including community support.
Deconstruct and implement Primary Care Alcohol SBIRT:
Screening, Intervention, Pharmacotherapy, Referral and Support