Results at a Glance - Horizontal Evaluation of the Canadian Drugs and Substances Strategy

Office of Audit and Evaluation
August 2023

Program context

The Canadian Drugs and Substances Strategy (CDSS) aims to provide a comprehensive, collaborative, compassionate and evidence-based approach to drug policy. The CDSS replaced the National Anti-Drug Strategy launched in 2006 and included harm reduction as a core pillar of the strategy alongside prevention, treatment, and enforcement. The CDSS covers a broad range of legal and illegal substances, including cannabis, alcohol, and opioids, among others.

In 2018, the federal government launched the "Addressing the Opioid Crisis" initiative (Opioid Initiative), a complementary horizontal initiative that received some reallocated funding from the CDSS. The CDSS and the Opioid Initiative are overseen by the Minister of Mental Health and Addictions and Associate Minister of Health. Health Canada (HC) is the lead department for both initiatives and supported by 15 other federal departments and agencies.

Spending

CDSS: $741.6M over five years
Opioid Initiative: $80.9M over five years

Evaluation approach

The evaluation examined activities under both initiatives and focussed on progress towards delivering on Pillar objectives, areas of risk and need, as well as the effectiveness of the governance structure and external engagement.

Evaluation methods

• Document and file review
• Comparative analysis
• Literature review
• Financial data review
• Data analysis
• Surveys
• Key informant interviews

What the evaluation found

Overall, the CDSS and Opioid Initiative have helped to frame substance use as a public health issue and contributed to expanding access to harm reduction and treatment services across Canada through regulatory actions and other funded activities. Despite notable efforts, substance use related harms and deaths continue to rise at an alarming rate. The COVID-19 pandemic also exacerbated the overdose crisis due to more people using substances in isolation, reduced access to support services and a more potent and toxic illegal drug supply.

Given the urgency of the crisis, prevention activities and collaboration to address the root causes of substance use were limited and much of the Strategy's focus has consequently been on illegal drugs. While the overdose crisis should continue to be a priority, the evaluation found that other substances should be better addressed under the CDSS. Specifically, given the long-term health and economic impacts, alcohol use was identified as a gap in the Strategy and as an area of risk and need that requires prevention efforts, including targeted approaches for specific populations (e.g., youth).

Moreover, the CDSS has supported ongoing efforts to decrease diversion of drugs; however, the increasing toxicity of illegal drugs is an ongoing issue. Specifically, there are challenges with increasing importation of precursor chemicals used in the illegal drug production at the borders and the regulatory regime's capacity to keep pace with the composition of chemicals produced and sold by organized crime groups.

While the federal government has made significant progress in supporting the development of a wide range of evidence-based tools for members of the federal Health Portfolio and their partners, gaps were identified with respect to disaggregated surveillance data. There is also limited information to effectively measure the Strategy's impact to address drug and substance use as a health and social issue.

Finally, the evaluation found that despite positive collaboration between horizontal partners, there are still challenges within the governance structure that limit effective coordination. In terms of external engagement, the establishment of the Persons with Living and Lived Experience Council was a key success; however, greater representation of people along the spectrum of substance use treatment and recovery is needed, and from more diverse backgrounds.

Recommendations

1. Address the prevalence of alcohol use and harms [Health Canada and PHAC].
2. Enhance prevention and outreach efforts for higher-risk groups to address the root causes of substance use [Health Canada and PHAC].
3. Contribute towards addressing evidence gaps to get a more comprehensive national and regional picture of substance use issues and the domestic illegal drug supply, as well as a better understanding of the impact of services and supports [Health Canada and PHAC, in collaboration with all CDSS partners].
4. Enhance the performance measurement strategy to align better with the CDSS's outcomes, including a review of performance indicators to focus more on the impacts of activities [Health Canada, in collaboration with all CDSS partners].
5. Review the governance structure to clarify roles and responsibilities, and streamline it where possible, while still facilitating ongoing information sharing between partners and all levels of government [Health Canada, in collaboration with all CDSS partners].
6. Work to better understand the domestic illegal drug supply, including its growing toxicity, and the tools that are needed to support more effective law, border, and health responses [RCMP and Public Safety Canada, in collaboration with Health Canada and CBSA].