www.ccsa.ca • www.ccdus.ca Early Warning in Canada: Focus on the Canadian Community Epidemiology Network on Drug Use (CCENDU) Matthew Young and Zachary Patterson Canadian Centre on Substance Use and Addiction
Presentation overview • About the Canadian Centre on Substance Use and Addiction (CCSA) • About Canada • Monitoring New Drug Trends in Canada • Sentinel Surveillance in Canada • The Canadian Community Epidemiology Network on Drug Use (CCENDU) • What it is and how it works • Alerts and Bulletins that have been issued • Impact • Current initiatives • Advantages and disadvantages of this model • Lessons learned www.ccsa.ca • www.ccdus.ca 2
Acknowledgement This work is made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada. www.ccsa.ca • www.ccdus.ca 3
About CCSA • Visi sion: A healthier Canadian society where evidence transforms approaches to substance use. • Missi ssion: To address issues of substance use in Canada by providing national leadership and harnessing the power of of evidence to generate coordinated action. • Val alue Prop opos osition on: : CCSA was created by Parliament to provide national leadership to address substance use in Canada. A A trusted counsel, we provide national guidance to decision decision makers by harnessing the power of research, curating curating knowledge and bringing together diverse perspectives. perspectives. www.ccsa.ca • www.ccdus.ca 4
National Priorities and Areas of Action Children & Youth Problematic Substance use & Co- Cannabis occurring Issues National Framework for Canada’s Prescription Indigenous Drugs People Action (2005): Canada’s National Collective action Framework for Action for collective Monitoring & Alcohol Surveillance impact Workforce Impaired Development Driving Treatment & Recovery 5 www.ccsa.ca • www.ccdus.ca
About Canada 35 million one of the highest per- capita immigration rates in the world 59.7 % English 23.2 % French 6.6 % other 2 nd largest country in the world six different time zones one land border 6
About Canada (cont.) 13 provinces and territories large differences in data collection on drug use across provinces provincial police forces, as well as one national police force health care administered by province 7
About Canada (cont.) Dru rug g use e Alcohol – about 1 in 4 report report > 3-4 drinks at one time in past year Cannabis very popular – 1 in in 10 report past year use, 1 1 in 4 among young adults Opioid pain relievers – 14.9 % 14.9 % report past year use. use. ~0.3% report past year year non-medical use Drug use trends more common north– south than 8 than east-west
Monitoring New Drug Trends in Canada • Self-report surveys (Health Canada) • Enforcement data (Health Canada) • Internet monitoring (Health Canada) • Opioid overdose surveillance (Public Health Agency of Canada and Canadian Institute for Health Information) • Poison Centre Exposures [regional Poison Control Centres and the Canadian Surveillance System for Poison Information (CSSPI)] • Sentinel surveillance (CCSA) www.ccsa.ca • www.cclat.ca 9
Sentinel Surveillance in Canada 10
This information is then collated and assessed for CCENDU is a sentinel surveillance network made up of risk at the national level. If warranted, CCENDU representatives across Canada. Each site coordinator issues alerts to: collects quantitative and qualitative information on drug • Law enforcement harms from: • First responders Local data sources (e.g., poison control centres, • • Healthcare practitioners coroners); • Treatment providers Anecdotal reports from those directly • • People who use drugs working with drug-using populations • Others (e.g., law enforcement, harm These bulletins and alerts provide information reduction programs) and about new drug trends and advise what people who use drugs. Quebec can be done to prevent Institut National de Northwest Territories and reduce harms. Santé Publique du Government of Northwest Territories Montreal Québec Agence de la santé et des services Yukon sociaux de Montréal Government of Yukon Newfoundland and Alberta Labrador Alberta Health Memorial University of Newfoundland British Columbia Nova Scotia BC Centre for Disease Control Nova Scotia Health Authority Saskatchewan College of Physicians and Manitoba Surgeons of Saskatchewan Ottawa Addictions Foundation of Toronto Manitoba Sandy Hill Community 11 Toronto Public Health Health Centre
Alerts and Bulletins Agreed upon operating procedure for handling information and contributions between CCENDU site coordinators and CCSA SCs review draft of SC complete reviews Bulletin SCs summary provide respond and approval within 5 CCSA CCSA provides within 5 working makes distributes feedback working days necessary CCSA summary CCSA within 5 days. CCSA sends SCs revisions, collates to each posts final working request for distribute and unstructured respective CCENDU days Non- information to request to distributes Failure to information site Bulletin on responsive SCs across local draft of respond to provided by coordinato CCSA sites are Canada network complete Non- this each SC r for website excluded Bulletin to responsive request review/app from the SCs for cities are within the roval. Alert/ approval excluded designated Bulletin from the timeframe Alert/ will be Bulletin perceived as [passive] approval www.ccsa.ca • www.ccdus.ca 12
The rise of overdose deaths involving fentanyl and the value of early warning **Reproduced with permission from the Canadian Society of Addiction Medicine.
CCENDU’s Impact Number of people who have subscribed to receive CCENDU Alerts and Bulletins 1508 1497 1486 1475 1464 1453 1430 1410 1390 1341 1223 1191 1171 1151 1131 1111 1091 1012 980 926 878 836 786 741 687 615 579 508 463 421 349 296 260 234 193 www.ccsa.ca • www.ccdus.ca 26
CCENDU’s Impact (cont.) CCENDU Subscription by Sector Canadian Border Serives 1% Law Enforcement Community Group 5% 5% Public Health Addictions Agency 20% 17% Federal Government Aboriginal 2% 1% Provincial Government 4% Pharmacy Municiple Government 20% 1% Universities/Colleage Business s/Researchers/Stud… Media 2% Social Work NGO 1% 3% 6% www.ccsa.ca • www.ccdus.ca 27
CCENDU’s Impact (cont.) Since 2012 • Over 850 media stories published that referred to CCENDU alerts or bulletins • Alerts and bulletins downloaded > 125,000 times from CCSA’s website • Alerts and bulletins cited in domestic and international reports and releases including those by: • Government of Canada • International Narcotics Control Board • Royal Canadian Mounted Police • Canadian Harm Reduction Policy Project www.ccsa.ca • www.ccdus.ca 28
Current Initiatives Network growth and capacity building Ensuring the network is appropriately represented nationally; • Establishing connections and relationships with stakeholders at • the community level, along with key organizations in Canada Working with CCENDU site coordinators to increase capacity to • monitor and report substance use trends within their jurisdictions Sharing contacts – Building relationships – Networking and network development – Terms of Reference – In-kind support – www.ccsa.ca • www.ccdus.ca 29
Current Initiatives (cont.) Updating Bulletin on Deaths Involving Fentanyl in Canada, 2009–2014 Canada is facing an epidemic of opioid • overdose deaths, with fentanyl playing a large role in this trend; Currently no formal quantification of the • number of fentanyl-related deaths; 2015: High impact bulletin which garnered • >44,000 downloads, 650+ media stories, and international recognition; Working with colleagues at Public Health • Agency of Canada, Health Canada, and Canadian Institute for Health Information to enhance monitoring of fentanyl-related deaths . www.ccsa.ca • www.ccdus.ca 30
Advantages of Sentinel Surveillance Relatively inexpensive • Sensitive • Flexible • In-depth, meaningful qualitative data • Partnerships at the community, provincial/territorial • and national level www.ccsa.ca • www.ccdus.ca 31
Disadvantages of Sentinel Surveillance Specificity is not as strong as sensitivity • Capacity for local level monitoring is • heterogeneous Volunteer network • Sensitivities around data and information • sharing Barriers accessing non-public information • www.ccsa.ca • www.ccdus.ca 32
Lessons Learned Don’t release “hurry up and panic” bulletins • Quantum mechanics of surveillance • Potentially negative impact when “story” comes • across as comparing jurisdictions to one another, instead of looking at bigger picture www.ccsa.ca • www.ccdus.ca 33
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