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

2. 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

3. 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 death from illicit fentanyl in 2015
2016: 58 confirmed & probable deaths 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

5. 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

6. Cannabis Legalization in Canada: The Journey to July Summer 2018

7. 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

8. 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

9. 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.

10. 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

11. 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 g, 5-6 plants.
A cannabis tracking system will be established.

12. 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?

13. 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

14. 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.

15. 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?”

16. 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

17. 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

18. 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

19. 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