April 10 Board of Health Meeting Summary
Written by Communications, April 16, 2019
Expanding Opioid Substitution Treatment with Managed Opioid Programs
Dr. Salvaterra shared the latest information about the opioid crisis which continues to devastate communities nationwide and is affecting people from all demographics, age groups, and socio-economic backgrounds. The Peterborough area is no exception, ranking fourth highest in Ontario in the rate of opioid-related deaths between 2013 and 2016. In addition, visits to Peterborough’s emergency department (ED) for opioid poisoning increased 142% from 2014 to 2017. So far in the first three months of 2019, Peterborough has reported more suspected opioid-related deaths than were recorded for all of 2018. Dr. Salvaterra explained our local drug strategy is based on four pillars: prevention, harm reduction, community safety, and treatment. Considering the urgency of the opioid crisis, Dr. Salvaterra asked for the Board of Health’s support in advocating for a leading-edge treatment called a Managed Opioid Program (MOP). MOPs enable doctors to administer pharmaceutical-grade heroin or hydromorphone in a clinical setting to appropriate patients. Research shows that pharmaceutical-grade opioids administered only in clinics by physicians is an effective second-line treatment option, especially for chronic users who respond poorly to conventional treatments such as methadone or suboxone. It can also reduce opioid-related deaths. Where MOPs have been implemented in other jurisdictions, Dr. Salvaterra noted that the increased clinical costs are offset by significant savings in the criminal justice system. The Board of Health agreed to send a letter to the Minister of Health and Long Term Care asking for funding to implement MOPs in Ontario. The Province of Ontario recently announced a $102 million funding agreement with the federal government for drug treatment. If funds are made available to Peterborough, the existing Rapid Access to Addiction Medicine clinic located downtown could become a pilot site for a MOP, with support of the Central East-LHIN and Public Health Ontario.
2019 Oral Health Report – Highlights
Patti Fitzgerald, Manager of Child Health Services presented the highlights of the 2019 Oral Health Report. She pointed out how the effects of poor oral health go beyond localized pain in the mouth, and can include systemic challenges, for example, there are proven linkages between periodontal disease and preterm low birth weight babies, cardiovascular disease, strokes, diabetes and respiratory disorders. Poor oral health can also lead to negative social outcomes, as people with missing or traumatized teeth may have diminished ability to gain employment or avoid laughing, smiling or conversation or contact with others. Peterborough Public Health’s (PPH) oral health program includes screening primary school students in 47 schools across the City and County of Peterborough. PPH is exploring the delivery of a fluoride varnish program for targeted populations who do not live in areas with community water fluoridation. Approximately 350 children are identified each year with urgent oral health care needs. PPH also runs the Community Dental Health Centre located at 185 King St. in downtown Peterborough. The clinic books 330-400 appointments each month and provides treatment for clients who are eligible for financial assistance through various government-funded programs. PPH’s oral health program also administers the Dental Treatment Assistance Fund (DTAF) which provides limited funding for urgent dental treatment to adults who don’t have access to any form of dental benefits. DTAF is funded through donations and assisted 702 individuals between 2015 and 2018. The report also showed that there are 1,000 visits per year to the PRHC emergency department because of urgent dental needs. The report revealed that 52% of older adults (age 65 and over) do not have access to any form of dental insurance.
Research Project: Health in All Policies
Dr. Ketan Shankardass presented his Health in All Policy (HiAP) research project that he is leading together with his team from St. Michael’s Hospital and Dr. Rosana Salvaterra. Health inequities continue to be a major factor determining population health outcomes. For example, in Ontario life expectancy is five years lower for men and two years lower for women who live in low income neighbourhoods when compared to those who live in higher income areas. Dr. Shankardass explained how HiAP ideally requires government policymakers to use an integrated approach instead of working in siloes. To that end, HiAP benefits from having a focus beyond the healthcare sector. The research team received funding from the Canadian Institutes of Health Research for a four-year project that will study HiAP initiatives in Quebec and Ontario municipalities, including Peterborough. They will explore what conditions enable HiAP approaches gain traction, and what strategies enabled them to succeed.
Safe Sewage Program Disposal Program Update
Donna Churipuy, Director of Public Health Programs, provided an overview of the current safe sewage inspection and re-inspection programs. The Board of Health approved the recommendation to request that the County of Peterborough extend the current agreement with Peterborough Public Health for up to one year and strike a working group with County staff to explore the needs and interests of municipalities and consider options for future program delivery. Program reserves will be used to keep fees at the current rates until the working group has completed its work and made recommendations for the future.
Reducing the Impact of Vaping Products Advertising
PPH staff participated in the Health Canada consultations regarding “Potential measures to reduce the impact of vaping products advertising on youth and non-users of tobacco products”. These potential federal measures proposed limits on advertising of vaping products, including the places where advertisements can be placed, the content in advertisements, the display of vaping products in certain retail locations; and, the inclusion of health warnings on vape products. This topic is of great local concern as vaping is creating a new generation of youth addicted to nicotine that may lead to a resurgence in smoking or create new public health problems, reversing decades of progress. In 2016, 24.1% of high school students in Peterborough City and County had tried an e-cigarette. PPH program staff, school administrators, and educators all suspect this number to be much higher in 2019 than it was in 2016. These anecdotes are supported by the increased number of calls PPH staff have received from concerned parents and educators about vaping. One local school even went so far as to remove the doors from bathrooms to prevent students from vaping inside. In its submission to Health Canada, PPH suggested restrictions could be strengthened to further protect Canadians, particularly youth and young adults, from the harmful effects of vaping products. Recommendations included restricting in-store and online advertising of vaping products, and standardized packaging without branding.
The next meeting will take place on Wednesday, May 8, 2019 at 5:30 p.m. in the Curve Lake Health Centre / Oshkiigmong MnoBmaadziwin Gamiing, located at 38 Whetung Street East, Curve Lake First Nation.