Canada-New Brunswick Emergency Treatment Fund Bilateral Agreement
HER MAJESTY THE QUEEN IN RIGHT OF CANADA (hereinafter referred to as "Canada" or "Government of Canada") as represented by the Minister of Health (herein referred to as "the federal Minister")
- and -
HER MAJESTY THE QUEEN IN RIGHT OF NEW BRUNSWICK (hereinafter referred to as "New Brunswick" or "Government of New Brunswick") as represented by the Minister of Health herein referred to as "the New Brunswick Minister")
REFERRED to collectively as the "Parties"
WHEREAS, Canada and New Brunswick agree that Canada is in the midst of an opioid crisis that has had a significant effect on many communities, that has claimed the lives of thousands of Canadians from all walks of life, that has had a devastating impact on many Canadian families, and the Emergency Treatment Fund is designed to augment treatment services through one-time funding in response to the opioid crisis;
WHEREAS, Canada and New Brunswick agree that immediate action and collaboration is needed among governments to help reduce harms and deaths associated with problematic substance use, including opioids;
WHEREAS, the governments of Canada and New Brunswick have committed to work together to further address the opioid crisis, in full respect of their respective jurisdictional responsibilities, and recognizing that the Government of New Brunswick has the primary responsibility for the design and delivery of substance use disorder treatment and response services in New Brunswick, the one-time Emergency Treatment Fund is intended to augment services and New Brunswick will be required to sustain any ongoing initiatives as required;
WHEREAS, Canada has established a transfer payment program called the Emergency Treatment Fund to provide one-time funding to the provincial and territorial governments for the development and delivery of treatment services for problematic substance use, including opioids;
WHEREAS, Canada authorizes the federal Minister to enter into agreements with the provinces and territories, for the purpose of promptly and effectively responding to the opioid crisis and problematic substance use through the Emergency Treatment Fund;
WHEREAS, The Regional Health Authorities Act authorizes the New Brunswick Minister to enter into agreements with the Government of Canada under which the Government of New Brunswick undertakes to use the funding provided by Canada under the Emergency Treatment Fund for the provision of treatment services for problematic substance use, including opioids;
AND WHEREAS, New Brunswick is responsible for the provision of treatment services including to Indigenous populations accessing treatment services off-reserve.
NOW THEREFORE, Canada and New Brunswick agree as follows:
1.1 The Parties are committed to protecting the health and safety of all Canadians through a compassionate and collaborative approach to addressing problematic substance use. The objective is to support single or multi-year projects that will improve access to evidence-based treatment services.
1.2 The purpose of this Agreement is to provide financial support from Canada to New Brunswick to target treatment services for problematic substance use, including opioids. This funding will support single or multi-year projects that will build on and enhance existing initiatives, capacity, and priorities.
2.0 Emergency Treatment Services
2.1.1 Canada and New Brunswick agree that over the period of this Agreement, with financial support from Canada, New Brunswick will address local, regional, and system priorities to reduce opioid-related harms and deaths by further building on and enhancing New Brunswick treatment services and programs to improve the availability and accessibility of treatment for problematic substance use towards achieving the objectives of:
- To increase access to treatment for substance use issues and opioid use disorder
- To increase access to new and innovative approaches to treatment of substance use and opioid use.
- To enhance the continuum of care in addiction services in order to offer a comprehensive approach to those individuals with substance use and opioid use issues.
New Brunswick's approach to achieving these objectives is set out in its Action Plan attached as Annex 1.
2.2 Eligible Areas of Investment
2.2.1 New Brunswick agrees to allocate funds provided by Canada under this Agreement in one or more of the following eligible areas of investment:
- support initiatives that will establish, build on, or enhance existing treatment approaches;
- encourage further implementation of innovative treatment solutions;
- recognize the importance of broader strategies to support access to treatment services by enhancing health care providers' knowledge of best practices.
2.2.2 The types of initiatives for which New Brunswick agrees to use the funding may include: enhancements or expansion of existing treatment approaches such as opioid agonist treatments (e.g., methadone, buprenorphine/naloxone), withdrawal management products (e.g., opioid agonist taper and alpha2-adrenergic agonists), oral Naltrexone, psychosocial treatment interventions, and counseling services; innovative treatment solutions such as wrap-around care and injectable agonist therapies; and, implementation strategies to enhance health care providers' knowledge of best practices (alcohol, cannabis, and tobacco are excluded).
2.2.3 Treatment services specifically to address alcohol, cannabis, and tobacco are excluded from this funding.
2.2.4 Types of eligible expenditures may include:
- Operating costs;
- Capital costs;
- Training, professional development and related investments;
- Information technology and related investments; and,
- Other costs that in the opinion of the Parties are essential for the completion of the project and achievement of results.
2.2.5 Canada and New Brunswick also agree to promote, define, and deliver identifiable innovative approaches to treatment service delivery.
3.0 Period of Agreement
3.1 This Agreement shall come into effect upon the last signature being affixed and will remain in effect until March 31, 2023, unless terminated in writing by Canada or New Brunswick, in accordance with the terms and conditions set out in section 11. Funding provided under this Agreement, in accordance with section 4, will cover the period from April 1, 2018 to March 31, 2023.
3.2 Canada and New Brunswick concur that the purpose of this time-limited, one-time Agreement is to help New Brunswick more rapidly ramp up or otherwise augment treatment initiatives in light of the opioid crisis, and that ongoing funding for enhanced initiatives established under this Agreement are to be sustained by New Brunswick.
4.0 Financial Provisions
4.1 The funding provided under this Agreement is in addition to, and not in lieu of, that which Canada currently provides to New Brunswick through the Canada Health Transfer in order to support health care services within New Brunswick. Furthermore, this funding is in addition to and not in lieu of those funds that Canada has already provided to address problematic substance use and the opioid crisis.
4.2 Allocation to New Brunswick
4.2.1 Canada has designated the following maximum one-time amount of funding to be transferred in total to all provinces and territories under this Agreement: $150,000,000 for the period starting on April 1, 2018 and ending on March 31, 2023.
4.2.2 The final total amount to be paid to New Brunswick will be calculated using the following formula:
(F –G x 500,000) x (0.33K/[N-P] + 0.33L/Q + 0.33M/R), where:
F is the total one-time funding amount available under this initiative;
G is the number of provinces and territories receiving only the minimum baseline funding (i.e., provinces and territories for which this funding allocation formula results in an allocation of less than $500,000);
K is the total population of New Brunswick, as determined using the 2017 population estimates from Statistics Canada;
L is the number of apparent opioid-related deaths in New Brunswick as determined using 2016 data from the Public Health Agency of Canada's National Report on apparent Opioid-Related Deaths in Canada (based on P/T reporting);
M is the number of opioid poisoning hospitalizations in New Brunswick as determined using 2016-17 data from the Canadian Institute for Health Information's Annual Report on Opioid-Related Harms (based on P/T reporting);
N is the total population of Canada as determined using the 2017 population estimate from Statistics Canada;
P is the total population of province and territories receiving only the minimum baseline funding, as determined using the 2017 population estimate from Statistics Canada;
Q is the total number of apparent opioid-related deaths in Canada, as determined using 2016 data from the Public Health Agency of Canada's National Report on Apparent Opioid-Related Deaths in Canada; and,
R is the total number of opioid poisoning hospitalizations in Canada as determined using 2016-17 data from the Canadian Institute for Health Information's Annual Report on Opioid-Related Harms (based on P/T reporting).
4.2.3 New Brunswick agrees to match Canada's contribution at a 1:1 ratio, with the exception of the first $250,000 in federal funding, for which no cost-sharing is required. New Brunswick's matching contribution shall be the equivalent to Canada's contribution less $250,000 and, as outlined in Annex 1, can include eligible expenditures made specifically for treatment related to problematic substance use as of January 1, 2016. New Brunswick agrees to make reasonable efforts to ensure that previous and ongoing funding from Canada under, pursuant to, or through other programs or agreements shall not be used to match Canada's contribution under this Agreement.
4.2.4 Based on the formula described in section 4.2.2, New Brunswick's estimated share of the amounts identified in section 4.2.1 will be:
|Fiscal Year||Amount to be paid to New Brunswick||Amount to be cost shared by New Brunswick|
4.3 In this Agreement, "Fiscal Year" means the period commencing on April 1 of any calendar year and terminating on March 31 of the immediately following calendar year.
4.4.1 Canada's contribution under this Agreement as set out in 4.2.4 will be paid within approximately 30 business days of both Parties' signatures being affixed to this Agreement.
4.4.2 New Brunswick must spend the entire amount of Canada's contribution by no later than March 31, 2023.
4.4.3 New Brunswick must spend the entire amount of New Brunswick's matching contribution by no later than March 31, 2023.
4.4.4 Payment of Canada's contribution under this Agreement is subject to an annual appropriation by the Parliament of Canada for this purpose.
4.5 Repayment of overpayment
4.5.1 Canada and New Brunswick agree that every effort will be made to ensure that the calculation of Canada's contribution installment to New Brunswick and New Brunswick's calculation of cost-matched funds will be accurate.
4.5.2 In the event payment made to New Brunswick exceed the amount to which New Brunswick is entitled under this Agreement, the amount of the excess is a debt due to Canada and New Brunswick shall repay the amount to Canada within 90 calendar days of written notice from Canada.
4.6 Repayment of unmatched funds
4.6.1 In the event that New Brunswick does not clearly demonstrate that funds have been cost-matched to the federal funding on a 1:1 ratio less $250,000 by March 21, 2023 in accordance with section 4.2.3, including funding announced as of January 1, 2016, New Brunswick agrees to repay the unmatched funds to Canada within 90 calendar days of written notice from Canada.
4.7 Use of Funds
4.7.1 Canada and New Brunswick agree that funds provided under this Agreement will only be used by New Brunswick in accordance with the areas for investment outlined in section 2.0 of this Agreement and detailed in Annex 1.
5.0 Accountability and Reporting
5.1 Action Plan
5.1.1 New Brunswick has completed and shared its Action Plan for the years 2018-19 to 2022-23 of federal funding with Canada, as set out in Annex 1. Upon signature of this Agreement by both Parties, New Brunswick will publicly release its Action Plan which:
- Provides an overview of the opioid crisis and treatment for problematic substance use in New Brunswick;
- Identifies specific priority areas for investment and objectives, which builds upon the progress to date in delivering treatment services;
- Highlights those investments New Brunswick will make in a cost-shared manner equivalent to the federal contribution less $250,000 including initiatives implemented as of January 1, 2016;
- Outlines the indicators and specific targets that New Brunswick will use to track progress and report on annually according to their planned investments.
5.1.2 The Action Plan may be amended by New Brunswick with mutual consent from Canada in a manner consistent with the spirit and intent of this Agreement if deemed necessary by New Brunswick to reflect shifts in approach necessitated by changing circumstances or priorities. Such amendments will be done in accordance with section 9.1 and will be made publicly available in accordance with section 7.2.
5.2.1 Within 90 days of both Parties signing this Agreement, New Brunswick agrees to:
- Provide all available baseline data on the agreed-to indicators; and
- Describe any initiatives being undertaken in Fiscal Year 2018-2019 as outlined in the Action Plan.
5.2.2 Beginning in Fiscal year 2019-20 and by no later than October 1 of the subsequent Fiscal Year during the Period of this Agreement, New Brunswick agrees to:
- Report to the people of New Brunswick and to Canada annually on the results and expenditures of the Emergency Treatment Fund allocation until March 31, 2023. The report shall show separately the results attributable to the funding provided by Canada under this Agreement and results attributable to funding provided by New Brunswick.
- Provide to Canada an audited financial statement of revenues received from Canada under this Agreement during the preceding Fiscal Year
- The revenue section of the statement shall show the amount received from Canada under this Agreement during the Fiscal Year.
- The total amount of funding used for programs and services under section 2.2.
- If applicable, the amount of any amount carried forward by New Brunswick under section 4.6.
- If applicable, the amount of any surplus funds that are to be repaid to Canada under section 4.7.
The financial statement shall be prepared in accordance with Canadian Generally Accepted Accounting Principles and the audit shall be performed by the New Brunswick Auditor General or his/her delegate, or by an independent public accounting firm registered under the laws of New Brunswick and shall be conducted in accordance with Canadian Generally Accepted Auditing Standards.
5.2.3 Canada, with prior agreement from New Brunswick, may incorporate all or any part or parts of the said report into any public report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.
5.3.1 New Brunswick will ensure that expenditure information presented in the annual report is, in accordance with New Brunswick standard accounting practices, complete and accurate.
5.4.1 As per established policies and processes with respect to program effectiveness, New Brunswick may evaluate programs and services receiving funds provided under this Agreement and make public the results of any such evaluations.
6.0 Long-Term Collaboration
6.1 Canada and New Brunswick agree to share and release data as available, and to share knowledge, research and information on effective and innovative practices in treatment programs, to further support the development of and reporting on outcomes.
7.1 Canada and New Brunswick agree on the importance of communicating with citizens about the objectives of this Agreement in an open, transparent, effective and proactive manner through appropriate public information activities.
7.2 Canada will make publicly available up-to-date Emergency Treatment Fund bilateral agreements entered into with all provinces and territories, including any amendments, on a Government of Canada website.
7.3 Each government will receive the appropriate credit and visibility when investments financed through funds granted under this Agreement are announced to the public.
7.4 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the bilateral agreements.
7.5 New Brunswick agrees to give Canada 10 days advance notice and advance copies of public communications related to this Agreement, and results of the investments of this Agreement.
8.0 Dispute Resolution
8.1 Canada and New Brunswick are committed to working together and avoiding disputes through government-to-government information exchange, advance notice, early consultation, and discussion, clarification, and resolution of issues, as they arise.
8.2 If at any time either Canada or New Brunswick is of the opinion that the other Party has failed to comply with any of its obligations or undertakings under this Agreement or is in breach of any term or condition of the Agreement, Canada or New Brunswick, as the case may be, may notify the other party in writing of the failure or breach. Upon such notice, Canada and New Brunswick will endeavor to resolve the issue in dispute bilaterally through their designated officials at the Assistant Deputy Minister level (hereinafter "Designated Officials").
8.3 If a dispute cannot be resolved by Designated Officials, then the dispute will be referred to the Deputy Ministers of Health for Canada and New Brunswick, and if it cannot be resolved by them, then the federal Minister and New Brunswick Minister shall endeavor to resolve the dispute.
9.0 Amendments to the Agreement
9.1 This Agreement, including the attached annex, may be amended at any time by mutual consent of the Parties. To be valid, any amendments shall be in writing and signed, in the case of Canada, by the federal Minister, and in the case of New Brunswick, by the New Brunswick Minister.
10.0 Equality of Treatment
10.1 During the term of this Agreement, if another province or territory, except the province of Quebec, negotiates and enters into an Emergency Treatment Fund agreement with Canada, or negotiates and enters into an amendment to such an agreement and if, in the reasonable opinion of New Brunswick, any provision of that agreement or amended agreement is more favorable to that province or territory than the terms set forth in this Agreement, Canada agrees to amend this Agreement in order to afford similar treatment to New Brunswick, if requested by New Brunswick. This includes any provision of the bilateral agreement except for the Financial Provisions set out under section 4.0. This amendment shall be retroactive to the date on which the Emergency Treatment Fund Agreement or the amendment to such an agreement with the other province or territory, as the case may be, comes into force.
11.1 Canada may terminate this Agreement at any time if the terms of this Agreement are not respected by New Brunswick by giving at least 12 months written notice of its intention to terminate. New Brunswick may terminate this Agreement at any time if the terms of this Agreement are not respected by Canada by giving at least 12 months written notice of its intention to terminate.
11.2 As of the effective date of termination of this Agreement under section 11.1, Canada shall have no obligation to make any further payments to New Brunswick after the date of effective termination.
11.3 As of the effective date of termination of this Agreement under section 11.1, New Brunswick will repay federal funds on a pro-rated basis after the date of effective termination.
11.4 As of the effective date of termination of this Agreement under section 11.1 New Brunswick agrees to return any federal funding not cost-matched by New Brunswick consistent with section 4.2.3 and section 4.7.1.
12.1 Any notice, information or document provided for under this Agreement will be effectively given if delivered or sent by letter, postage or other charges prepaid. Any notice that is delivered will have been received in delivery; and, except in periods of postal disruption, any notice mailed will be deemed to have been received eight calendar days after being mailed.
The address for notice or communication to Canada shall be:
70 Colombine Drive
Brooke Claxton Building
Ottawa, Ontario, K1A 0K9
The address for notice or communication to New Brunswick shall be:
PO Box 5100
Fredericton, New Brunswick, E3B 5G8
13.1 This Agreement, including Annex 1, comprise the entire agreement entered into by the Parties with respect to the subject matter hereof.
13.2 This Agreement shall be interpreted according to the laws of Canada and New Brunswick.
13.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of New Brunswick shall be admitted to any share or part of this Agreement, or to any benefit arising therefrom.
13.4 If for any reason a provision of this Agreement that is not a fundamental term is found by a court of competent jurisdiction to be or to have become invalid or unenforceable, in whole or in part, it will be deemed to be severable and will be deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.
13.5 The English and French versions of this Agreement, when signed, are equally authoritative.
SIGNED on behalf of Canada by the Minister of Health at Moncton, New Brunswick this 10 day of August, 2018.
The Honourable Ginette Petitpas Taylor, Minister of Health
SIGNED on behalf of New Brunswick by the Minister of Health at Moncton, New Brunswick this 10 day of August, 2018.
The Honourable Benoît Bourque, Minister of Health
Annex 1 to the Agreement
New Brunswick Action Plan
An overview of the opioid crisis and treatment in New Brunswick
In New Brunswick, drug related overdose is a growing public health concern. Opioid drugs such as fentanyl are an increasing concern in the province. In response to rising concerns with opioid related harms, the Government of New Brunswick has established surveillance mechanisms to ensure that information related to understanding and preventing overdoses and overdose deaths related to opioid use is accessible and timely.
In the most recent "Surveillance of Apparent Opioid Overdose in New Brunswick, 2017, quarter 4", data collected by Ambulance New Brunswick, NB Emergency Departments (Regional Health Networks), and the Chief Coroner's Office shared with the Office of the Chief Medical Officer, show a rise in opioid overdoses. Year over year increases in opioid related overdoses are documented. Some of these highlights include:
- Naloxone dosage increased from 0.4mg to 0.8mg and there was also an increase in repeat doses required
- Naloxone was administered to 282 cases of suspect opioid overdoses in 2017, averaging 23.5 per month
- A shift to the younger age groups was noted with 44.7% of suspect opioid overdoses occurring between the ages of 20-39, compared to 34.6% for the five-year historical average
There has been an increase in suspect opioid overdose in all age groups compared to the five-year historical average
Graph 1. Number of suspect opioid overdoses where naloxone was administered and number of patients that responded to naloxone, yearly in New Brunswick, 2012-2017 (Data source: ANB, Janurary 16, 2018).
|Year||Number of patients where naloxone was administered||Number of patients that responded to naloxone|
New Brunswick's Department of Health is currently working on a broader project with the overall goal of enhancing Addiction and Mental Health Services by focusing on improving the client experience and modernizing the treatment options. In conjunction with this broader initiative, the proposed interventions will allow New Brunswick to focus more specifically on opioid use and misuse.
Specific priority areas for investment which builds upon the progress to date in treatment services
Additional interventions are required to address substance use issues and opioid dependence in New Brunswick. While the rates of opioid related overdoses are not as elevated as in some other provinces, New Brunswick has seen an increase in opioid related deaths over the past five years suggesting the trend is making its way to eastern provinces of the country. As such, the Department of Health is poised to assume a leadership role in collaborating with key stakeholders and partners in reducing the individual, community and societal harms associated with opioid misuse and dependence pre-emptively as what is being referred to as the opioid crisis makes its way to eastern provinces of the country. The following priorities are being proposed:
Priority area 1: Support initiatives that will establish, build on, or enhance existing treatment approaches:
Before building on or enhancing treatment approaches, there is a need to enhance addiction treatment, there is a need to ensure the most critical foundational treatment option is able to answer to the needs and offer care that will follow individuals through their recovery journey and ensure a continuum of care that can address the various needs. One region in particular has seen steady population growth but no additional resources build into the system to handle the increase in demand that is now stressing the system in this particular hub region. Increases in awareness and stigma reducing efforts, along with rising concerns about increasing rates of opioid dependency are significant contributing factors to this situation that challenge timely access to services.
As a first step, there is a need to ensure that the base foundation in addiction services is solid, well-resourced and build on sound evidence in the field. Any process or service enhancements are difficult to accomplish and present challenges from the onset when foundational resources are not currently able to meet current demand.
Enhancing access to quality care within withdrawal management facility
Withdrawal management services exist in all regions of the province; however one region is significantly challenged with insufficient physician hours given in the face of increasing the complexity of the situations for which individuals are requiring care. This is resulting in much lower occupancy rates and therefore reducing access to this important health care service.
The following activities will be accomplished in order to help enhance access to withdrawal management services. An approved contract to ensure physician coverage within the withdrawal management service will ensure dependable and consistent physician coverage to the detox center. It is anticipated that this increased access to quality care will commence in August 2018 and will lead to enhanced quality of care within withdrawal management facility as well as to increased access to care. It is also anticipated that the Emergency funds will cover from August 2018 to March 2019 and from April 2019 to March 2020.Operational improvements can be made that will make addiction treatment more accessible and therefore provide treatment to more individuals in need. It is expected that this will augment occupancy rates by 3% by March 2019. This initiative is expected to enhance or improve access for 50 people seeking treatment in a withdrawal management facility.
Increasing access to community based treatment in New Brunswick for individual counselling including providing access to those involved in the justice system
The outpatient counseling community treatment services continue to be the most utilized service in New Brunswick for substance use. Gaps have been identified in order to ensure timely access to care. A total of 14 FTE social worker positions are required in order to enhance outpatient treatment options in New Brunswick. Specific target areas have been identified through monitoring the access to treatment after referral for those identified as high and medium priorities. These positions would also increase access to care for vulnerable populations.
Rates of substance use issues, opioid disorders and mental health issues are higher in justice involved individuals than with the general population. They present with complex needs and represent a particularly vulnerable population especially as it relates to opioid overdoses once released from custody if they have not received care for substance and opioid use issues while incarcerated. Adding clinical resources in strategic areas will allow for increased access to substance use treatment for individuals while they are incarcerated, help reduce risk of overdose and will help ensure important continuity of care with community based services. In order to enhance addiction treatment, there is a need to ensure the most critical foundational treatment option is able to answer to the needs and offer care that will follow individuals through their recovery journey and ensure a continuum of care that can address the various needs. This work would commence in September 2018 until end of March 2020 providing the opportunity to have a provincial plan for sustainability.
The expected outcome for this indicator is to increase access to treatment for substance use disorder and to reduce the wait times for services in New Brunswick, especially for individuals presenting with high risks/ high needs. This will also help ensure that the foundation of community addiction and mental health services is built upon and focuses on evidence based practices and helps individuals on their recovery journey by offering a wraparound service and connecting with key partners on the continuum of care. This initiative is expected to reduce the wait times for services by 5 (days) from the current average wait time of 47.8 (days). This will help ensure clients are receiving services within the time frame specified in provincial operational guidelines. The goal of this initiative is to increase the percentage of cases seen within priority target. This rate is currently at 53% and this initiative will help ensure our services reach its target of 57% of individuals seen within targeted time frame. It is expected that by 2020 it will reach 65%.
Priority area 2: encourage further implantation of innovative treatment solutions:
Provide access to an Intensive Day Treatment service which is an innovative treatment option that will be available in New Brunswick
The Intensive Day Treatment is a recent investment from the province of New Brunswick. This non-residential intensive day treatment service is intended to help those suffering from complex addiction or concurrent needs by providing longer term, intensive wraparound services within a multidisciplinary team. Recovery based activities are also included in this service type. This service is scheduled to be available in the fall of 2018 and this work will be on-going. The location for this service needs to be secured which will be on a bus route and accessible within an urban setting in New Brunswick. The overall intended outcome is to increase access to an innovative model of care based on best practices for those struggling with substance use issues. This service will be implemented with a focus on following individuals on their recovery journey. This service is expected to benefit 80 clients in 2018-19. This service is not yet operational in NB. The province has invested dedicated funds with a targeted start date of September 2018. Indicators are being developed for this service and data will be available in the fall 2018. It is expected that this program will provide a new and innovative service to 80 individuals by March 2019.
Increase access to Opioid Replacement Therapy
Opioid Replacement Therapy has been available in New been Brunswick for a number of years; however services have primarily been dispersed in the larger urban centers. Over the last year, the Community Addiction Services in the Vitalité Health Network have started offering Opioid Replacement Therapy in the northern, rural part of the province, with limited resources. The availability of, and demand for, this treatment option in these regions has grown and the need for supporting counseling services to enhance this treatment is increasing as well. In response to this, three (3 FTE's) will be implemented in the Vitalité Health Network from September 2018 until March 2020. The expected outcome will be to increase access to supportive treatment along the continuum of care for opioid use disorder in these areas of the province. This initiative is expected to increase access to opioid replacement therapy. The approximate distinct number of individuals receiving either methadone or buprenorphine/naloxone for Opioid Replacement Therapy (ORT) is estimated at approximately 3500. It is expected that by next year an additional 100 people would have access to opioid replacement therapy in New Brunswick.
New Brunswick cost-share
The province of New Brunswick has made some investments in the treatment of substance use disorder over the last two years. These efforts were part the Family Plan 2018 (New Brunswick Family Plan Framework Document, 2017) which had a focus on supporting those with addictions and mental health needs (Brunswick, New Brunswick Family Plan supporting those with addictions and mental health challenges, 2017).
Attached below is a table illustrating the amounts that the Province of New Brunswick has invested in enhancement initiatives within addition and mental health services within the above mentioned priority areas which align with Health Canada's Emergency treatment and bilateral agreement.
|Health Canada Priority area||Initiative||Expenditure plan for New-Brunswick contribution (investments)||Expenditure plan for Emergency Treatment Fund (Health Canada contribution)|
|2017-2018||2018-2019||2019-2020||2021-2022||2022-2023||Total New Brunswick||2018-2019||2019-2020||Total Health Canada|
|Support initiatives that will establish, build on or enhance existing treatment approaches||Enhancing access to quality care within withdrawal management facilities and residential rehabilitation facilities||-||$454,100||$404,100||$304,100||$304,100||$1,466,400||$24,360||$48,720||$73,080|
|Increasing access to community based treatment in New Brunswick for individual counseling including providing access to those involved in the justice system.||$100,000||$90,000||$90,000||-||-||$280,000||$670,000||$1,340,000||$2,010,000|
|Increase access to opioid replacement therapy||-||$200,000||$100,000||-||-||$300,000||$124,958||$149,000||$273,958|
|Encourage further implantation of innovative treatment solutions||Provide access to an intense day treatment service which is an innovative treatment option that will be available in New Brunswick||$100,000||$421,345||$451,345||$291,345||$291,345||$1,555,380||$135,000||$270,000||$405,000|
|Recognize the importance of broader strategies to support access to treatment services by enhancing health care providers knowledge of best practices||-||-||$350,000||$345,000||-||-||$695,000||-||-||-|
|Total per fiscal period||-||$200,000||$1,515,445||$1,390,445||$595,445||$595,445||$4,296,780||$954,318||$1,807,720||$2,762,038|
|Name of Initiative||Description||Expected Results||Performance Measurement||Expenditure Plan|
|Outline how federal funding will be allocated, by fiscal year.|
Enhancing access to quality care within withdrawal management facility
A withdrawal management facility exists in the Saint John region; however, the hours of physician access for this program are deemed insufficient for the complexity of the situations for which individuals are requiring. This activity will include:
|The expected outcome for this investment is to have enhanced quality of care within the withdrawal management facility in the Saint John region as well as an increased access to care.||
Indicator: # and % increase in bed utilization rates.
Bed utilization rates are currently being measured in New Brunswick within the withdrawal management facilities. This performance indicator will be measured to increase the use of available beds. This data is currently being captured through the existing information system used for Addiction and Mental Health which is called Client Service Delivery System (CSDS). This information is captured on a quarterly and yearly basis.
Indicator: Number and percentage of population accessing publicly funded treatment when seeking treatment services for substance use disorder (excluding alcohol, cannabis, and problematic gambling)
This will also be measured for the various services offered in Community and Addiction Services including withdrawal management, outpatient counselling, and residential rehabilitation program.
Increasing access to community based treatment in New Brunswick for individual counselling including providing access to those involved with the justice system.
The outpatient counselling community treatment services continue to be the most utilized service in New Brunswick for substance use issues. Gaps have been identified in order to ensure timely access to care. A total of 12 FTE's is required in order to enhance outpatient treatment options in New Brunswick. Specific target areas have been identified through "monitoring the access to treatment after referral" for those identified as high and medium priorities.
These positions would also increase access to care for vulnerable populations. Justice involved individuals and those incarcerated are often impacted by substance use issues. This would allow for increased access to substance use treatment while they are incarcerated. In order to enhance addiction treatment, there is a need to ensure the most critical foundational treatment option is able to answer to the needs and offer care that will follow individuals through their recovery journey and ensure a continuum of care that can address the various needs. This work would commence in September 2018 until end of March 2020 providing the opportunity to have a provincial plan for sustainability.
The expected outcome for this indicator is to increase access to treatment for substance use disorders and to reduce the wait times for services in New Brunswick, especially for those presenting with high risks/ high needs.
This investment is also expected to ensure the foundation of community addiction and mental health services focuses on evidence based practices and helps individuals on their recovery journey by connecting with key partners on the continuum of care offering wraparound services.
Indicator: average amount of time required for individuals to access treatment for problematic substance use after referral (by type of treatment service) (excluding alcohol, cannabis, and problematic gambling)
This indicator will measure for improvement in community based addiction treatment in New Brunswick. This data is currently being captured through the Client Service Delivery System (CSDS).
Indicator: Percentage of cases seen within priority target days per acuity of the situation. The goal of this initiative is to increase the percentage of cases seen within priority target.
Indicator: number and percentage of population accessing publicly funded treatment when seeking treatment services for substance use disorder (excluding alcohol, cannabis, and problematic gambling)
Provide access to an Intensive Day Treatment which is an innovative treatment option that will be available in New Brunswick.
The Intensive Day Treatment is a recent investment from the province of New Brunswick and this nonresidential intensive day treatment is intended to help those suffering from complex addiction or concurrent needs. This service is scheduled to be available in the Fall of 2018 and this work will be on-going. The location for this service needs to be secured which will be on a bus route and accessible within a city in New Brunswick.
Increased access to an innovative model of care for those struggling with substance use. This service will be implemented with a focus on following individuals on their recovery journey.
An indicator to measure an increase in the availability of innovative treatment models for problematic substance use will be developed and included in this work. (excluding alcohol, cannabis, and problematic gambling).
The Client Service Delivery System (CSDS) will be designed to capture the data on this indicator. Utilization data of this treatment option will be captured.
Increased access to Opioid Replacement Therapy in Vitalité Health Network.
Opioid Replacement Therapy has been available in New been Brunswick for a number of years, however services have dispersed in the larger centers. Over the last year, the Community Addiction Services in the Vitalité Health Network have started offering treatment with limited resources. The availability of the treatment in these regions has grown and the need for supporting counseling services to enhance this treatment is growing. Three (3 FTE's) will be implemented to the Vitalité Health Network. These positions would be implemented in September 2018 until March 2020.
Increased access to supportive treatment along the continuum of care for opioid use disorder in the areas of the province.
Indicator: number and percentage of people accessing publicly funded opioid replacement therapy in New Brunswick through the Prescription Monitoring Program.
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