FORUM on Corrections Research

Coming together on substance abuse is a beginning, staying the course is progress, and working together is a success¹

Michel Perron² and Beth Pieterson³
Canadian Centre on Substance Abuse and Health Canada

No part of Canadian society is untouched by the harms that can result from problematic use of alcohol and other drugs and substances. The human toll is unquantifiable, and the health, social and economic costs considerable - 23 billion dollars a year, in fact, according to a recent report by the Canadian Centre on Substance Abuse called The Costs of Substance Abuse in Canada 2002.⁴

Addressing the myriad issues resulting from problematic substance use is a shared responsibility and, for perhaps the first time, all sectors are rising to the challenge and joining together as partners to develop a National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada. The partnership includes Aboriginal organizations; non-governmental organizations; industry; all levels of government; addictions, policing and enforcement agencies; and other communities of interest, including academia, legal associations, advocacy and human rights organizations, the medical community, caregivers, those who use drugs, and many others.

At a national forum held in Montreal in June 2005, a broadly representative group of stakeholders agreed on the underpinnings of the National Framework for Action, including a vision statement, principles, goals and priorities. Health Canada and the Canadian Centre on Substance Abuse were co-sponsors of an extensive national consultation process that had paved the way for this Montreal meeting. Now, they are working with the National Framework partners to seek endorsement of the Framework by their respective ministers, boards and governing bodies. As well, partner organizations are being asked to identify areas and issues within the Framework where they may want to play a more active role or assume leadership. A longer-term governance model spelling out roles and responsibilities within the Framework is expected to emerge following a meeting in early 2007.

Background

In 2001 and 2002, we heard a series of clear and compelling messages about the need for a more co-ordinated approach to substance abuse in Canada. Three pivotal reports emanating from the Office of the Auditor General (2001),⁵ the Special Senate Committee on Illicit Drugs (2002),⁶ and the Parliamentary Committee on Non- Medical Use of Drugs (2002)⁷ each made a strong case for greater federal leadership and some kind of well-articulated national plan of action to address issues of problematic substance use. We did not have long to wait for the federal response: with the renewal of Canada’s Drug Strategy (CDS) in May 2003 came the promise of $16.4 million over five years for leadership and related activities as part of a total CDS commitment of $245 million.

The process

In April 2004, Health Canada, its CDS partners (Public Safety and Emergency Preparedness Canada, the Department of Justice Canada and Foreign Affairs Canada) and the Canadian Centre on Substance Abuse (CCSA) embarked on a broad, multi-stakeholder consultation process to gauge support for developing a national plan of action. Cross-Canada roundtable meetings began in May 2004 and involved a total of 450 stakeholders. Meetings were held in Fredericton, with representatives from all four Atlantic provinces; Toronto; Winnipeg, with Manitoba and Saskatchewan participants; Edmonton; Vancouver; Whitehorse, with representatives from the Yukon and Northwest Territories; and Iqaluit. Two additional roundtables were held in Ottawa, one for representatives of national nongovernmental organizations and one for federal partners.

The consultations provided an opportunity to begin discussing and exploring key elements for a framework, including:

• a vision, principles and goals for national action;
• strategic priorities and directions that could allow for coherent planning, delivery and evaluation of activities;
• roles, responsibilities and accountabilities of jurisdictions and other stakeholders;
• mechanisms to ensure co-ordination and facilitate collaboration and partnerships among jurisdictions and sectors; and
• the kind of environment within which funding could be leveraged.

A number of key issues consistently emerged during the consultations, and these became the subject of a separate series of (ongoing) thematic workshops aimed at establishing a current base of knowledge for the Framework. Experts gathered to identify priorities and to make recommendations in the areas of alcohol policy, youth, policing and enforcement, corrections and offender populations, addictions workforce development, Fetal Alcohol Spectrum Disorder, and research.

Reaching consensus

General consensus on all key aspects of the National Framework was reached at the national forum in Montreal in June 2005. A broadly representative group of 100 stakeholders worked diligently to arrive at wording that all partners could agree on. The Framework is described in a document called "Answering the Call."⁸ It contains the following vision statement: "All people in Canada live in a society free of the harms associated with alcohol and other drugs and substances."

The document also identifies nine principles that underpin the Framework, including the view that "problematic substance use is a health issue," that "human rights are respected," that "those most affected are meaningfully involved," that "action is knowledge-based, evidence-informed and evaluated for results," and that "reducing the harms associated with alcohol and other drugs and substances creates healthier, safer communities." Other principles relate to accountability and partnerships and the critical role of health promotion, prevention, treatment, enforcement and harm reduction in successful responses to problematic substance use.

The Framework identifies two overarching goals:

1. To create supportive environments that promote health and resiliency of individuals, families and communities in order to prevent problematic use of alcohol and other drugs and substances; and
2. To reduce the harms associated with alcohol and other drugs and substances to individuals, families and communities across Canada.

The Framework targets 13 priorities in three broad categories:

1. To address specific issues;
2. To build supportive infrastructure; and
3. To address the needs of key populations.

Specific issues include increasing awareness and understanding of problematic substance use; reducing alcohol-related harms; addressing Fetal Alcohol Spectrum Disorder; preventing the problematic use of pharmaceuticals; and addressing enforcement issues.

Infrastructure priorities deal with sustaining workforce development; implementing a national research agenda and facilitating knowledge transfer; improving the quality, accessibility and range of options to treat harmful substance use including substance use disorders; and modernizing legal, regulatory and policy frameworks.

Priorities to address the needs of key populations include focusing on children and youth; reaching out to Canada’s North; supporting First Nations, Inuit and Métis communities in addressing their needs; and responding to offender-related issues.

Looking ahead

Validation of the National Framework in Montreal set a new phase in motion. For the 2005-2006 fiscal year, CCSA and Health Canada will continue to act as an informal secretariat, managing and assisting Framework partners to seek organizational endorsement of the Framework, to identify and participate in ongoing thematic workshops that address specific priority issues in the Framework, and to identify areas where partners may wish to become more active or take a leadership role.

Partners are already stepping forward to assume leadership on specific issues. These include the Addictions Foundation of Manitoba (addressing stigma and public awareness); the Alberta Alcohol and Drug Abuse Commission, Health Canada and CCSA (alcohol); the Public Health Agency of Canada (Fetal Alcohol Spectrum Disorder); Public Safety and Emergency Preparedness Canada (synthetic drugs and marijuana grow ops); Health Canada (research); and CCSA (addictions workforce development).

The National Framework for Action provides an umbrella under which specific national strategies can be developed to address commonly identified priorities. It increases the possibilities for support at all levels and across all sectors; enables better planning and utilization of resources for enhanced effectiveness; and establishes a common frame of reference.

The Framework provides us with a means to move forward by capitalizing on the knowledge and experience residing in provincial, regional and municipal strategies and by exploiting existing networks. The shared ownership of the Framework provides opportunities for leaders to emerge while, at the same time, advocates have increased ability to forge partnerships in developing new strategic plans or bolstering existing ones.

The National Framework for Action is a bold and ambitious venture, unprecedented in its scope and intent. It has progressed further than many people might have thought possible, but it still has some distance to go. In fact, the goal of the National Framework for Action is not to reach a prescribed destination, but to provide a mechanism for ongoing dialogue among the many thousands of people who devote their lives and careers to the task of eliminating or reducing the harms associated with the abuse of alcohol and other drugs and substances.

For more information on the National Framework, visit: www.nationalframework-cadrenational.ca.

¹ This article is an edited version, with some updated information, of an article written by the authors in 2005.
² Chief Executive Officer, Canadian Centre on Substance Abuse, Suite 300, 75 Albert Street, Ottawa, Ontario K1P 5E7.
³ Director General, Drug Strategy and Controlled Substances Programme, Health Canada, 123 Slater Street, Ottawa, Ontario K1A 1B9.
⁴ Released in the spring of 2006, this report can be found on the CCSA web-site at www.ccsa.ca.
⁵ Office of the Auditor General. (2001). Report of the Auditor General of Canada on Illicit Drugs - The Federal Government’s Role. Ottawa, ON: Government of Canada.
⁶ Special Senate Committee on Illegal Drugs. (2002). Report of the Special Senate Committee on Illegal Drugs - Cannabis: Our Position for a Canadian Public Policy. Ottawa, ON: Senate of Canada.
⁷ House of Commons Special Committee on Non-Medical Use of Drugs. (2002). Report of the House of Commons Special Committee on the Non-Medical Use of Drugs (Bill C-38). Ottawa, ON: Government of Canada.
⁸ The National Framework - and "Answering the Call" - can be found at: www.nationalframework-cadrenational.ca