Canada is dealing with a toxic drug crisis; on average there are 21 opioid toxicity deaths each day⁽¹⁾. The unregulated drug supply has become increasingly toxic and unpredictable. Algoma, like other regions in Northern Ontario, is experiencing disproportionately higher rates of opioid-related harms compared to the rest of Ontario.

Algoma Public Health (APH) collects and analyzes relevant data to monitor trends over time, priorities, and health inequities related to substance use. APH has a mandate to support the reduction of harm associated with substance use, as outlined by the Ontario Public Health Standards. Public health units also support the development of local opioid response plans under the Harm Reduction Program Enhancement (HRPE). This report is intended to provide communities in Algoma with the information needed to take collective action.

This report provides a deeper understanding of how the toxic drug crisis is experienced in Algoma. It includes epidemiological data as well as input from people with lived and living experience (PWLLE), family and/or friends of people who use(d) drugs, and community partners from a variety of sectors which were gathered through interviews and workshops. APH acknowledges the limitations of the data. First, the data primarily represents perspectives from people living in Sault Ste. Marie, a more urban setting. Second, the perspectives from PWLLE reflected in this report are not representative of all people who use drugs (PWUD). Only people who access services were included, so there continues to be a gap in understanding the needs of PWUD who are not accessing services. We recognize the importance of involving PWLLE throughout the process of community priority-setting, however this group was not well represented in the Community Action on Toxic Drugs Workshop.

Finally, we did not ask for any identifiable information when speaking with PWLLE, therefore we are unable to provide Indigenous-specific data which could be helpful for community partners working with Indigenous populations. Indigenous populations are disproportionately impacted by the toxic drug crisis due to historic and ongoing colonial policies and practices that have caused intergenerational trauma, eroded culture and language and created barriers to accessing quality care^{(2, 3)}. Provincial data shows that compared to non-First Nations people, First Nations people are prescribed opioids for pain more often and are nine times more likely to visit a hospital for an opioid-related toxicity⁽²⁾.

Evidence-informed practices across the continuum of care are discussed to support a comprehensive strategy that addresses the wide range of social-ecological factors that influence drug use. Recommendations are made for how communities and partners could apply this evidence to their work.

To move forward, next steps for a local response plan are proposed based on the local context, community input, and current evidence. Working collaboratively across sectors with kindness and respect will be essential for success. Everyone has a role in supporting the health and wellbeing of people who use(d) substances.

The toxic drug crisis tragically continues to cause immense suffering in our communities. Algoma consistently has one of the highest rates of substance-related harms in the province. We face many challenges in the North and experience this crisis differently. This report seeks to identify our unique needs and strengths and suggest how we can tailor our local response to address those needs.

As a community, we can change the narrative about people who use drugs and approach substance use through a health and human rights lens. People cannot be well when they feel ashamed, hopeless, or abandoned. As a community we must be open-minded to the many reasons and influences that can lead to substance use disorders and recognize that every person’s journey to recovery looks different. Supporting a wide range of evidence-informed practices from prevention and harm reduction to treatment and recovery is important to meet people where they are at and provide them with the resources they need.

Substance use-related harms, including deaths, are largely preventable. By working together, across all sectors and levels of government, we can improve health outcomes and offer hope. To do this, actions must be grounded in the needs of people who use drugs and led by people with lived and living experience. They are the ones who know what works. APH is privileged to have been able to speak with people with lived and living experience of substance use and family and/or friends of people use(d) drugs to gain a deeper understanding of their experiences and what they feel is required to better support and protect people who use drugs.

There are numerous agencies and organizations working tirelessly everyday to support people who use drugs. We are thankful to all the community partners who shared their knowledge and expertise during the interviews and workshops. This is just the beginning of our collective action. We are stronger when we all work together.