Community
and Protective Services Committee
Comité des services communautaires et de protection
3 December / le 3 decembre, 2009
Submitted by/Soumis par: Steve
Kanellakos, Deputy City Manager/
Directeur municipal adjoint,
Community and Protective
Services/Services communautaires et de protection
Contact
Person/Personne ressource : Dr. Isra Levy, Medical Officer of Health
Ottawa Public Health/Santé
publique Ottawa
613-580-2424
x 23681, isra.levy@ottawa.ca
SUBJECT:
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OBJET :
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Rapport sur
l’intervention intégrée en ce qui a trait aux aiguilles jetées |
That Community and Protective
Services Committee receive this report for information.
Que le Comité des
services communautaires et de protection reçoive ce rapport à titre
d'information.
Ottawa Public
Health (OPH), with the assistance of numerous City of Ottawa departments, has
successfully implemented a comprehensive and integrated response to discarded
needles. More needles have been recovered and retrieved in the first three
quarters of 2009 than during all of 2008. Collaborative action amongst OPH and
City partners, as well as surveillance by Needle Hunters and successful use of
needle drop boxes has resulted in a 141% needle retrieval rate when compared to
the number of needles distributed by the Site Clean Needle and Syringe Program.
Since June 2008, significant action has been
taken to reduce community exposure to discarded needles. Key initiatives
include:
·
Re-invigorating
the Integrated City Wide Response
to Discarded Needles Committee, thereby streamlining all City of Ottawa
services that deal with discarded needle issues and complaints;
·
Implementing
a rapid response protocol to deal effectively with needle pick-up requests;
·
Expanding
the Needle Hunter Program to increase discarded needle surveillance capacity;
·
Reaching
out to schools and local businesses to raise awareness of needle safety; and
·
Increasing
the number of needle drop boxes in Ottawa to improve access to safe needle
disposal for all residents.
OPH and its partners recognize and acknowledge the legitimate health, safety and quality of life impacts that discarded needles pose in the community. To ensure that the integrated response plan continues to be adequately funded and successfully meets the needs and demands of residents, a review of the program is being undertaken to determine longer term funding requirements. Findings from the review will be provided to Council by the end of the first quarter in 2010.
Ottawa Public Health’s goal continues to be to promote public health and to eliminate the exposure to health hazards in the community associated with discarded needles and other drug use related equipment.
Santé publique Ottawa (SPO) a mis en oeuvre
avec succès une intervention globale et intégrée à l'égard des aiguilles
jetées. Ainsi, plus d’aiguilles ont été retrouvées et récupérées au cours des
trois premiers trimestres de 2009 que durant toute l’année 2008. La
collaboration entre SPO et les partenaires de la Ville, la surveillance de
l’Équipe de ramassage des aiguilles et l’utilisation efficace des boîtes-dépôt
prévues à cette fin ont engendré un taux de récupération des aiguilles de
141 p. 100 par rapport au nombre d’aiguilles distribuées dans le
cadre du Programme sur les aiguilles et les seringues propres.
Depuis
juin 2008, des mesures importantes ont été prises afin de réduire
l’exposition de la collectivité aux aiguilles jetées un peu partout. Parmi les
principales initiatives, mentionnons les suivantes :
·
donner un nouveau souffle au comité responsable du
plan d’intervention intégrée à l’égard des aiguilles jetées à l’échelle de la ville et ainsi restructurer tous les services
de la Ville d’Ottawa qui touchent aux questions et aux plaintes relatives aux
aiguilles jetées;
·
mettre en place un protocole d’intervention rapide
pour traiter efficacement les demandes de ramassage des aiguilles;
·
étendre le Programme de ramassage des aiguilles
pour accroître la capacité en matière de surveillance des aiguilles jetées;
·
mener des activités de sensibilisation sur la
sécurité se rapportant aux aiguilles dans les écoles et les entreprises
locales;
·
augmenter le nombre de boîtes-dépôt à Ottawa pour que l’élimination sécuritaire des aiguilles soit
davantage à la portée de tous les résidents.
SPO et ses partenaires reconnaissent les
conséquences sérieuses que les aiguilles jetées peuvent avoir sur la santé, la
sécurité et la qualité de vie des résidents. Ainsi, pour être en mesure de
continuer à répondre aux demandes et aux besoins des résidents, un examen du
programme de ramassage des aiguilles a été entrepris. Il a pour objet de
déterminer les exigences en matière de financement à long terme du plan
d’intervention intégrée. Les résultats de l’examen seront soumis au Conseil
avant la fin du premier trimestre de 2010.
Santé publique Ottawa a pour objectif de
promouvoir la santé publique et d’éliminer l’exposition de la collectivité aux
risques sur la santé que posent les aiguilles jetées ou tout autre matériel
servant à l’usage de drogues.
BACKGROUND
In June 2008, Council approved a comprehensive action plan outlined by Ottawa Public Health (OPH) to reduce the impact of discarded needles in the community. The action plan was built upon the following key components:
· Reinvigorating a City-wide integrated response;
· Program enhancements;
· Partnerships and community liaison; and
· Realigning organizational accountabilities
An interim report was provided in March 2009 to update members of Ottawa’s Board of Health with progress on key initiatives of the action plan. The purpose of this report is to provide further updates on commitments as well as fulfill Council's direction to report back in the fall of 2009.
DISCUSSION
More needles have been recovered and retrieved in the
first three quarters of 2009 than during all of 2008. Collaborative action
amongst Ottawa Public Health and City partners, as well as surveillance by
Needle Hunters and successful use of needle drop boxes has resulted in the
recovery of approximately 516,242
needles (table 1). To date in 2009, 366,895 sterile needle syringes have
been distributed through service contacts with Site Clean Needle Syringe
Program clients, making the needle retrieval rate 141%.
Table 1 - Estimated number
of needles retrieved via response strategies
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Estimated number of needles retrieved |
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Source of Needles |
2006 |
2007 |
2008 |
Jan. 1 to Sep. 30, 2009 |
|
Needle Drop Boxes |
158,641 |
178,155 |
229,400 |
180,000* |
|
Needle Hotline |
----------------------- |
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247 |
3,546 |
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Other City Services |
142 |
615 |
1,280 |
124 |
|
Needle Hunters |
1,381 |
1,414 |
3,350 |
3,339 |
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Site Clean Needle Syringe Program |
211,377 |
228,558 |
273,415 |
329,233 |
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Total |
371,541 |
408,742 |
507,692 |
516,242 |
* Number of needles
recovered via needle drop boxes from January 1 to October 8, 2009
The Integrated City Wide Response to Discarded Needles Committee
(ICWRDNC) was re-invigorated in July 2008 after a 6-year hiatus. The Committee
serves as a mechanism to bring together all City of Ottawa services that deal
with discarded needle issues and complaints. The Committee’s membership
includes staff from Surface Operations, Solid Waste, By-law Services, Police
Services, Parks and Recreation, Transit Services, Public Health, and
Communications and Customer Services. Each representative acts as a liaison to
ensure committee decisions and recommendations are carried forward within their
department.
One
of the most notable achievements of the ICWRDNC was the development of a
discarded needle response protocol. Under this protocol, when a member of the
public calls to request the removal of a discarded needle, it is removed in a
timely manner, the request for service is documented, and the retrieved needle
is tracked in order to accurately tabulate statistics on needle finds in
Ottawa.
The
collaborative and effective action of this group has been noted by the
community and was recently profiled in an article published in the Ottawa
Sun attached as Document 1. In early November 2009, the ICWRDNC was also
selected as a runner-up for Crime Prevention Ottawa’s Community Safety Award.
On
July 1, 2008, a direct hotline for needle pick-up requests became operational.
The hotline is monitored and operated by OPH staff 24 hours a day, seven days a
week. Since implementation, the hotline has evolved to serve mostly as a
mechanism for City partners to refer requests for needle retrieval in order to
ensure a rapid response time. The 3-1-1 City Call Centre continues to serve as
the main point of contact for Ottawa residents.
Approximately
97% of the needles retrieved by City personnel from January 1 to September 30,
2009, were retrieved by OPH staff following calls and referrals to the hotline.
The vast majority of requests for needle retrieval
have been responded to within 60 minutes.
Proactive Surveillance & the Needle
Hunter Program
OPH staff that respond to needle retrieval requests also conduct routine surveillance of known discarded needle hotspots. In total, up to 15 locations are monitored daily throughout the spring and summer. In order to ensure effectiveness and efficiency, geo-mapping is used to analyze hotspots.
The primary surveillance component of the City’s integrated response to discarded needles is the Needle Hunter Program. Needle Hunters consist of teams who regularly walk through identified priority neighbourhoods to retrieve discarded needles.
In 2008, the Needle Hunter routes expanded from three areas to four to encompass ByWard Market/Lowertown, Centretown, Hintonburg plus Vanier. The Needle Hunter Program commences in early spring of every year and continues until snowfall in winter months makes it prohibitively difficult to conduct surveillance. From late March to September 2009, Needle Hunters retrieved 3,339 discarded needles.
Needle Drop Box Program
Needle drop boxes are currently available at 26 sites in Ottawa for safe disposal of used needles and syringes. Since Council’s approval of program enhancements in June 2008, new needle drop boxes have been installed at the Elizabeth Bruyère Centre, Causeway Work Centre, Saint Vincent Hospital and Centre 507. As of early October 2009, approximately 180,000 needles have been safely disposed of via needle drop boxes this year.
Comprehensive Web Package
Council
directed OPH to ensure statistics concerning the numbers of needles distributed
and retrieved annually are made available on the City’s website. The website
went live on March 9, 2009. To date, the website has received 427 visits to the
English site and 116 visits to the French site. The website can be accessed at
the following link: http://ottawa.ca/residents/health/environments/needles/index_en.html.
The Site Clean Needle and Syringe Program (SCNSP) is a Mandatory Health Program and has been in operation since 1991. Public health professionals with the SCNSP educate injection drug users on how to dispose of needles safely and the risks of not doing so. Clients are also provided with safe disposal containers as well as information on various safe disposal methods available in Ottawa. From January to September 2009, the SCNSP retrieved approximately 329,233 needles during service encounters with clients.
Further to
enhancements approved by Council in June 2008, the SCNSP conducted a review of harm reduction
counselling strategies by analyzing current practices, exploring mechanisms to
improve counselling efficiencies and investigating best practices. This
innovative endeavour included stakeholder interviews with frontline staff, a
survey of 200 SCNSP clients, key informant interviews with 10 needle exchange
programs across Canada and a comprehensive review of the literature. Over the
next year, service delivery and counselling strategies will incorporate review
findings.
Feasibility Study of Single-Use, Safety
Syringes
OPH experienced significant challenges in securing a proponent to conduct a single-use, safety syringe feasibility study. These challenges were compounded by the fact that there are a limited number of appropriate agencies to conduct the study in what is essentially a niche market. In July 2009, consultants were recruited to revise market research information regarding single-use syringe products. This exercise revealed that there are products currently available that may meet OPH requirements. Additional studies will be explored to assess if these products can be successfully implemented without overriding the objectives of the program.
Raising Awareness of Safe
Disposal & Needle Safety
Promoting safe disposal of needles is integral to reducing the number of discarded needles in the community. Also, from 2008 onwards, several presentations have been given to local business staff, City of Ottawa employees and to staff in all Ottawa-area school boards.
In addition to presentations, resources on needle safety for elementary school children have been developed. A curriculum-based lesson plan for teachers on needle safety as well as posters and brochures have been developed for schools in priority neighbourhoods in order to educate students on the dangers of discarded needles.
Partnerships & Community Liaison
Building new partnerships and strengthening existing relationships was identified in 2008 as an important mechanism to gauge community perspective, keep abreast of stakeholder concerns and improve research capacity within OPH.
A Tripartite
Committee was created to establish collaborative relationships between Ottawa
Police Services, Ottawa Public Health and Community Health Centres. This
committee serves as a venue to exchange information and discuss and resolve
challenges. The committee first met in April 2009 and is currently organizing a
forum, which will facilitate discussions amongst front-line staff regarding perspectives, professional obligations and
experiences.
The
Needle Distribution and Retrieval
Consultative Group (NDRCG)
links community needs and perspectives to relevant OPH programs. Member
representation includes clients as well as representatives from local community
agencies, community associations and a local Business Improvement Association.
In 2009, membership was expanded to broaden input from stakeholders and a
detailed work plan has been developed.
Over the past 12 years, the ability of OPH to be responsive to emerging issues associated with injection drug use has been strengthened by a research partnership with the University of Ottawa. Research findings from the I-Track and Social Network studies have guided program expansion initiatives, policy review and in turn, improved service delivery. For example, research findings identified the lack of availability and accessibility of supplies as the main causes of drug use equipment sharing among men and women who inject drugs. These findings were instrumental in securing additional provincial funding to expand service hours of the Site Clean Needle and Syringe Program.
Next Steps
To ensure the continued coordination of City
services related to discarded needle retrieval, management of the discarded
needle hotline, integration of best practice counselling strategies, execution
of further single use safety syringe studies and further expansion of the
Needle Drop Box Program, Ottawa Public Health is undertaking a review of the
program to determine longer term funding requirements. Findings from the review
will be provided to Council by the end of the first quarter in 2010.
CONCLUSION
Through the implementation of a comprehensive action plan, OPH, in collaboration with colleagues across the City and the community, has responded to local needs and has developed workable solutions that have reduced the community’s exposure to discarded needles.
OPH and its partners recognize and acknowledge the legitimate health, safety and quality of life impacts that discarded needles pose in the community. Significant progress has been achieved, however, to ensure that the plan is adequately funded and continues to successfully meet the needs and demands of residents, a review of the program is being undertaken to determine longer term funding requirements. Findings from the review will be provided to Council by the end of the first quarter in 2010.
Ottawa Public Health’s goal continues to be to promote public health and to eliminate the exposure to health hazards in the community associated with discarded needles and other drug use related equipment.
RURAL IMPLICATIONS
There are no specific rural implications associated with this
report.
CONSULTATION
In 2009, the Ottawa-Carleton Pharmacists Association (OCPhA) approached
OPH with concerns regarding statements made in the April and June 2008 reports
to Council. Public Health staff and the President of the OCPhA have met and
discussed the concerns identified. A letter from the OCPhA is attached to this
report (Document 2). OPH would like to clarify the statement in question and
indicate that it was not intended to place the burden of discarded needles on
the shoulders of local pharmacies. The statement was intended to indicate that discarded
needles on the street may be from sources other than the Site Clean Needle and
Syringe Program. OPH apologizes for the lack of clarity in the original
statement and will endeavour to address any further concerns from the OCPhA and
other stakeholders.
LEGAL/RISK MANAGEMENT IMPLICATIONS
There are no legal/risk management impediments to implementing the recommendations in this report.
FINANCIAL IMPLICATIONS
There are no financial implications associated with this report.
SUPPORTING DOCUMENTATION
Document 1 – Ottawa Sun Article – No Needles in Sight
Document
2 – Ottawa-Carleton Pharmacists Association Statement
DISPOSITION
Ottawa Public Health will action any direction
received as part of consideration of this report.
City's
downtown cleanup efforts paying off
Last Updated: 24th July 2009, 11:49pm
Downtown residents were up in arms
a year ago over the number of discarded drug needles on the streets.
This year, there hasn’t been a peep.
As it turns out, it’s not because there are fewer needles being handed out to
an estimated 5,000 intravenous drug users.
The difference is they’re all
being picked up.
In fact, the Sun toured the
downtown core last year and found dozens of needles in less than an hour. We
went out again twice this week and couldn’t find one. Not even a discarded
needle wrapper.
Denise Killick, 43, has been
outspoken about the issue in the past, but said she hasn’t found any needles
this year.
“There is definitely an
improvement in me not finding needles in the neighbourhood here. I have not,
this year, found one needle. That’s good news,” said Killick, who lives on the
corner of Besserer and Nelson streets. “Obviously, the needle hunters are doing
their job.”
Another downtown resident, Chris
Grinham, found hundreds of needles last year, but now he struggles to find two
or three a month.
“And I really had to look for
those three,” said Grinham.
Last year, he was critical of the
needle hunters’ work. Now, he applauds their efforts and the city’s.
The city’s 16 needle hunters do
targeted sweeps of the Vanier, Hintonburg, Centretown and Lowertown areas,
where dirty needles have a history of showing up in parks, alleyways, streets
and front lawns.
“We have increased a route in the
Lowertown area with the needle hunters,” said Siobhan Kearns, manager of
environment, health protection and outbreak control for Ottawa Public Health.
Kearns also credits the creation
of an integrated needle retrieval system, which was developed after the
community made an uproar over the dirty needles.
“That is a city-wide response to
discarded needles. All city partners that may encounter discarded needles sit
at the table with us together and we problem-solve and share issues,” she said.
She said a summer student, hired
last year, has picked up 599 needles since June 28. The student picked up about
250 needles last year.
The needle hunters have already
collected 1,511 syringes this year, compared with 3,287 all of last year (from
about April to December).
“The needle hunter employees are
fabulous and really know their routes,” Kearns said.
There are also black boxes placed
strategically throughout the city.
Nearly 230,000 needles were
returned via the medical drop boxes last year.
More than 500,000 needles were
collected in 2008, compared with nearly 300,000 in 2007.