KFL&A Board of Health takes stand against provincial government on substance use
The use of mood-altering substances like cannabis, alcohol, opioids, tobacco and vaping products in the Kingston, Frontenac, Lennox and Addington (KFL&A) region was discussed, and some shocking statistics uncovered, at the most recent meeting of the KFL&A Board of Public Health.
At its meeting on Wednesday, May 22, 2024, the board heard a summary of the exhaustive 2023 report entitled 'Balancing Act: An All-of-Society Approach to Addressing Substance Use and Harms' (Balancing Act) by Ontario’s Chief Medical Officer of Health (CMO), Dr. Kieran Moore. After receiving local statistics on the use of these psychoactive substances, the board fully supported Moore’s positions despite the provincial government’s lack of willingness to act.
The report
KFL&A Medical Officer of Health (MOH) Dr. Piotr Oglaza introduced Daphne Mayer, KFL&A Public Health Program Manager for Substance Use Health and Wellbeing, who provided a summary of Moore's key recommendations in Balancing Act, as well as explanations of what the data showed about substance use and harms in the KFL&A region.
She began by saying Moore's report reminds us that mood-altering substances like cannabis, alcohol, opioids, and tobacco and vaping products that contain nicotine (also called psychoactive substances) are widely used in Ontario. Some people use them for enjoyment; others use them to reduce anxiety, relieve depression, manage pain, and cope with stress and trauma. Most Ontarians who use these substances do so without seeming to harm their health or well-being. Still, for many reasons, some people experience real damage to their health, lives, and relationships.
Moore’s report focuses on the four substances that are having the greatest impact on the health of Ontarians: tobacco/vaping products, alcohol, cannabis, and opioids.
Image by Victoria via Pixabay.
Smoking continues to be the leading preventable cause of cancer and premature death in Canada. Mayer said, “In 2020, about 14 per cent of adults were current smokers, [which] means they smoke daily or occasionally.”
The report states that, on average, each year in Ontario, smoking is responsible for 17 per cent of deaths, 8.7 per cent of hospitalizations, and 3.4 per cent of emergency department (ED) visits. “But that said, we are encouraged by the ongoing decline of smoking rates over time across all age groups,” Mayer said.
However, "while there are fewer people who are smoking, more people are vaping, and often they're vaping nicotine,” Mayer indicated. “Vaping has increased over the last 10 years among adults. And while there has been a little bit of a downward trend among youth since its peak in about 2019, we still have about 13 per cent of Ontario students reporting vaping in the previous 12 months.”
Referring to her next slide, Mayer noted, “When we think about cannabis, we often think about pre-legalization and post-legalization use, but cannabis use started increasing [before] legalization and has been steadily increasing, with about half of Ontario adults reporting using cannabis in their lifetime.”
Cannabis use among Ontario youth has been declining since 1999, she noted, “but we still have about one in six students reporting and using cannabis in the previous 12 months.”
Image by tatlin via Pixabay.
Next, she stated that eight out of 10 Ontarians reported drinking alcohol and one-third of grade seven to 12 students reported drinking alcohol in the past year.
“In an average year, alcohol use in Ontario was estimated to contribute to 4.3 per cent of deaths 2.1 per cent of hospitalizations, and 3.7 per cent of emergency department visits,” Mayer noted.
During the COVID-19 pandemic, she said, Ontario's drinking habits “changed a little bit” with alcohol, “and Ontarians reported drinking more than those in other provinces. And there has been an increase in riskier drinking behaviours such as binge drinking over the past 10 years.”
Finally, Mayer reported, “the drug poisoning crisis continues.” Opioid-related deaths and ED visits in Ontario have been increasing since 2015, with almost a doubling of deaths between 2019 and 2021.
The financial cost
Mayer emphasized a very important discussion point when talking about substance use and associated harms: the cost to society.
Mayer's presentation reported that in 2020, substance use attributable costs in Ontario were $14.9 billion. “That includes... health care costs, lost productivity, criminal justice, and other direct costs.” She pointed to a graph mapping the upward trends of costs associated with the four substances. Graphic via KFL&A Public Health.
She reported that in 2020, substance use attributable costs in Ontario were $14.9 billion, noting, “That includes things like health care costs, lost productivity, criminal justice, and other direct costs.”
Mayer pointed to a graph mapping the upward trends of costs associated the four substances, saying, “I want to draw your attention to 2020 at the end, and the substantial economic burden of alcohol, which represents almost half of that $14. 9 billion and slightly. ******
To address the brunt of harms and costs associated with substance use, Mayer conveyed the recommendations made in Moore’s report: “First, we invest in both the upstream and downstream factors driving substance use harms, and then, when we're doing that, we balance people's autonomy to use substances with the social benefits as well as those economic costs.”
It is important for Public Health and other governing bodies to convey the risks and ask people to reduce their harm, but it is imperative that it be done “in a compassionate and non-stigmatizing way,” Moore’s report emphasizes.
“And we also need to continue ensuring that the life-saving services are available for people who use drugs,” she noted.
Moore’s report underscores the importance of recognizing that this must be a societal response, because the health system cannot do it alone, Mayer said.
“To that end,” she continued, “he acknowledges the different harms and challenges [associated with] each substance and is calling for four multi-pronged substance-specific strategies for Ontario.”
With that, Mayer took the board through important local substance use and harm data.
KFL&A substance use stats
“We don't have great local vaping data," Mayer noted, "but... KFL&A is pretty much similar to the rest of Ontario in terms of smoking rates. What that means in KFL&A is that tobacco-related harms are estimated, in an average year, [to be] 17.5 per cent of deaths, 9.4 per cent of hospitalizations, and 3.8 percent of ED visits.”
Next, she pointed to the Canadian guidance on alcohol and health risk levels for both KFL&A and Ontario from 2019 to 2020. Across a continuum of risks related to health outcomes, she explained, KFL&A residents were significantly at high risk. One to five residents fall into the category of high-risk, which is significantly higher than in Ontario as a whole.
“This is a group of folks who are drinking seven or more drinks per week... [which is] putting them at increased risk for health harms such as cancer, heart disease, and stroke,” said Mayer.
It is estimated that four per cent of deaths, 1.9 per cent of hospitalizations, and 3.6 per cent of emergency department visits are related to alcohol, Mayer said.
Of KFL&A residents, 56 per cent reported using cannabis in their lifetime, which is significantly higher than in Ontario, she reported, “and one way we can look at the harms is cannabis-related emergency department visits.” She provided a graph that made it clear that cannabis-related ED visits were much more numerous here in the region than in entire Ontario population.
Graphic from Mayer's presentation via KFL&A Public Health.
“What this [graph] doesn't show us," Mayer said, "is that KFL&A has higher rates than Ontario [as a whole] across all age groups except zero to 12-year-olds." KFL&A has the highest cannabis use [in the province] among 19 to 25-year-olds and 13 to18-year-olds, she explained.
Lastly, Mayer reported that KFL&A opioid-related death rates, ED visits, and hospitalizations are higher than those of the entire Ontario population.
Mayer explained that substance use occurs on a spectrum: people who do not use any substances are at one end, while at the other end are people who have a substance use disorder. However, it is most important that “we recognize that people can find health and well-being anywhere along the spectrum of use,” she said.
Public Health’s role is to recognize and work across the scope of public health interventions --- prevention, health promotion, health protections, harm reduction, and monitoring and reporting --- to reduce the burdens of harms associated with substances, Mayer expressed.
The discussion
Board member Dr. David Pattenden pointed out a piece of information that he felt “boards like ourselves should always have." Noting that "the treatment of lung cancer has not improved” over the last century, Pattenden illustrated this with a personal anecdote, finishing, “They still have the same outcomes with the treatment of lung cancer. [When the public see the] fact that smoking is decreased, they think that must mean there is less lung cancer --- [but that is not] happening.”
Kingston City Councillor Brandon Tozzo noted that the current provincial government seems to be at odds with Moore's recommendations: “This is a government that brings on 'Buck-a-Beer,' and this is a government that is allowing more alcohol in corner stores.” He said the position of Public Health versus that of the Doug Ford government makes it seem like they are “on two different planets.”
“I think that this government doesn't seem to be listening to the evidence that so clearly demonstrates that this is a problem,” Tozzo continued. “I've tried mocktails; they're awesome... So maybe the government needs to try a mocktail or two.”
Frontenac County Councillor Judy Greenwod-Speers picked up where Tozzo left off, saying, “It's not just the Ontario government; it is also the federal government. When you look back historically, we know that for every 10 cents that you raise the price of cigarettes, there is a percentage drop in smokers. And yet, we see something like vaping, that we know is growing exponentially, and it gets a $0.17 increase... they are just not on that page at any level of government.”
She suggested there should be a retreat or conference put on by Public Health for MPs and MPPs “so that they can become better educated … We've got to... educate the politicians because if we don't, they're going to keep missing the game. And by the time they catch up... we've got a whole other generation hooked irrevocably. I really think that we need to… educate these people so they can start passing the right pieces of legislation.”
Kingston City Councillor Conny Glenn asked if the cannabis statistics included medical marijuana use. Mayer replied that they only show recreational use, noting, "I will say that for KFL&A, that has not changed post-legalization. So our numbers were relatively similar pre-legalization and remain the same.”
Glenn then asked about opioids: "Have we done any investigation on what potentially are the root causes for such a high level of opioid use here in KFL&A? … I think demographics matter. From a personal professional side, working with a number of our veterans, there are high level of pain issues due to a lot of injuries. And unfortunately, I think, across the province, we are failing in the treatment of pain and consideration for how we do that... I think people rely on opioids far too heavily without really good medical management due to the unfortunate state of health care. “
Mayer said there was not great data on that subject yet, “but we certainly know that the impact of trauma and childhood adverse events is a significant contributor to why people use substances.”
“As a group we need to back up Dr. Moore,” said Board Chair Wes Garrod. “The Balancing Act is quite clear and specific about the issues and the concerns. And it is unfortunate, as was pointed out, that the politicians are not there. [Premier] Doug Ford and Minister [of Health Sylvia] Jones did not come out in support. But most of us know [Moore] has integrity, and he is not going to back down. And as a board, we cannot back down. These are the facts for KFL&A, and we need to put this motion on the table and pass it with support.”
Decision to support
With that, the Board of Health passed a motion to commend Moore's report and acknowledge his leadership in his call for a collective response to address the burden of harms associated with substance use, stating that the KFL&A Board of Health urges the Government of Ontario to adopt the evidence-informed all-in-society approach to address substance use and the associated harms. Most urgently by developing the four provincial strategies aimed at addressing the harms of substance use in Ontario:
1. Reinvigorate the Smoke-Free Ontario Strategy, focusing on populations and regions with high rates of tobacco use. Expand the strategy to create a comprehensive, coherent public health-oriented framework for regulating vaping and all nicotine-containing products.
2. Develop a comprehensive cannabis strategy designed to reduce cannabis-related harms, focusing on youth and young adults who have the highest rates of cannabis use.
3. Develop and implement a comprehensive alcohol strategy designed to reduce alcohol-related harms in collaboration with stakeholders, including local public health units and the alcohol regulatory system, and in consultation with the alcohol industry.
4. Develop and implement, in collaboration with stakeholders --- including people with lived or living experience with substance use --- a comprehensive strategy designed to reduce opioid-related harms.
And that this be sent in correspondence to Premier Doug Ford, copied to:
Sylvia Jones, Deputy Premier and Minister of Health
Michael Tibollo, Associate Minister of Mental Health and Addictions
Ric Bresee, MPP Hastings - Lennox and Addington
Ted Hsu, MPP Kingston and the Islands
John Jordan, MPP Lanark-Frontenac-Kingston
Loretta Ryan, Executive Director, Association of Local Public Health Agencies
All Ontario boards of health
The KFL&A Public Health Board of Health meets monthly. Find out more information about t
Michelle Dorey Forestell, Local Journalism Initiative Reporter, Kingstonist.com
