Canada-Ontario Emergency Treatment Fund Bilateral Agreement

BETWEEN:

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 ONTARIO (hereinafter referred to as “Ontario” or “Government of Ontario”) as represented by the Minister of Health and Long-Term Care herein referred to as “the Ontario Minister”)

REFERRED to collectively as the “Parties”

PREAMBLE

WHEREAS, Canada and Ontario 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 Ontario 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 Ontario 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 Ontario has the primary responsibility for the design and delivery of substance use disorder treatment and response services in Ontario, the one-time Emergency Treatment Fund is intended to augment services and Ontario 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 Ministry of Health and Long-Term Care Act authorizes the Ontario Minister to enter into agreements with the Government of Canada under which the Government of Ontario 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, Ontario is responsible for the provision of treatment services including to Indigenous populations accessing treatment services off-reserve.

NOW THEREFORE, Canada and Ontario agree as follows:

1.0 Purpose

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 Ontario 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 Objectives

2.1.1 Canada and Ontario agree that over the period of this Agreement, with financial support from Canada, Ontario will address local, regional, and system priorities to reduce opioid-related harms and deaths by further building on and enhancing Ontario treatment services and programs to improve the availability and accessibility of treatment for problematic substance use towards achieving the objectives of:

  1. Enhancing existing treatment approaches; and
  2. Implementing strategies to enhance access to treatment services

Ontario’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 Ontario 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 Ontario 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; 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 Ontario 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 Ontario, 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 Ontario concur that the purpose of this time-limited, one-time Agreement is to help Ontario 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 at the discretion of Ontario.

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 Ontario through the Canada Health Transfer or in lieu of any other funding provided in order to support health care services within Ontario. 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 Ontario

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 Ontario 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 Ontario, as determined using the 2017 population estimates from Statistics Canada;

L is the number of apparent opioid-related deaths in Ontario 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 Ontario 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 Ontario 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. Ontario’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. Ontario 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, Ontario’s estimated share of the amounts identified in section 4.2.1 will be:

Table 1: Allocation
Fiscal Year Amount to be paid to Ontario Estimated matching amount to be paid
[or has been paid as of January 1, 2016] by Ontario
2017-2018 $0 $16,730,000
2018-2019 $51,097,477 $0
2019-2020 $0 $7,500,000
2020-2021 $0 $27,000,000
Total: $51,097,477 $51,230,000

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 Payment

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 Ontario must spend the entire amount of Canada’s contribution by no later than March 31, 2023.

4.4.3 Ontario must spend the entire amount of Ontario’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 Ontario agree that every effort will be made to ensure that the calculation of Canada’s contribution installment to Ontario will be accurate.

4.5.2 In the event payment made to Ontario exceeds the amount to which Ontario is entitled under this Agreement, Canada will inform Ontario within 90 days of identifying this error; the amount of the excess is a debt due to Canada and Ontario 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 Ontario 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, Ontario 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 Ontario agree that funds provided under this Agreement will only be used by Ontario 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 Ontario 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, Ontario will publicly release its Action Plan which:

  1. Provides an overview of the opioid crisis and treatment for problematic substance use in Ontario;
  2. Identifies specific priority areas for investment and objectives, which builds upon the progress to date in delivering treatment services;
  3. Highlights those investments Ontario will make in a cost-shared manner equivalent to the federal contribution less $250,000 including initiatives implemented as of January 1, 2016;
  4. Outlines the indicators and specific targets that Ontario will use to track progress and report on annually according to their planned investments.

5.1.2 The Action Plan may be amended by Ontario with mutual consent from Canada in a manner consistent with the spirit and intent of this Agreement if deemed necessary by Ontario 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 Reporting

5.2.1 Within 90 days of both Parties signing this Agreement, Ontario agrees to:

  1. Provide all available baseline data on the agreed-to indicators; and
  2. 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, Ontario agrees to:

  1. Report to the people of Ontario and to Canada annually on the results and expenditures of the Emergency Treatment Fund allocation until the earlier of: a) March 31, 2023; or b) the end of the Fiscal Year in which the entire amount of Canada’s contribution and Ontario’s matching contribution has been spent. The report shall show separately the results attributable to the funding provided by Canada under this Agreement and results attributable to funding provided by Ontario.
  2. Provide to Canada an audited financial statement of revenues received from Canada under this Agreement during the preceding Fiscal Year
    1. The revenue section of the statement shall show the amount received from Canada under this Agreement during the Fiscal Year.
    2. The total amount of funding used for programs and services under section 2.2.
    3. If applicable, the amount of any amount carried forward by Ontario under section 4.4.
    4. If applicable, the amount of any surplus funds that are to be repaid to Canada under sections 4.5 and 4.6.

The financial statement shall be prepared in accordance with Canadian Generally Accepted Accounting Principles and the audit shall be performed by the Ontario Auditor General or his/her delegate, or by an independent public accounting firm registered under the laws of Ontario and shall be conducted in accordance with Canadian Generally Accepted Auditing Standards.

5.2.3 Canada, with prior agreement from Ontario, 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 Audit

5.3.1 Ontario will ensure that expenditure information presented in the annual report is, in accordance with Ontario standard accounting practices, complete and accurate.

5.4 Evaluation

5.4.1 As per established policies and processes with respect to program effectiveness, Ontario 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 Ontario 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.

7.0 Communications

7.1 Canada and Ontario 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 agreement. Canada agrees to give Ontario 10 days advance notice and advance copies of public communications related to this Agreement, and results of the investments of this Agreement.

7.5 Ontario reserves the right to conduct public communications, announcements, events, outreach and promotional activities about this bilateral agreement. Ontario 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 Ontario 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 Ontario 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 Ontario, as the case may be, may notify the other party in writing of the failure or breach. Upon such notice, Canada and Ontario 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 Ontario, and if it cannot be resolved by them, then the federal Minister and Ontario 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 Ontario, by the Ontario 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 Ontario, 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 Ontario, if requested by Ontario. 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.

11.0 Termination

11.1 Canada may terminate this Agreement at any time if the terms of this Agreement are not respected by Ontario by giving at least 12 months written notice of its intention to terminate. Ontario 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. The date at least 12 months after written notice of termination will be the “effective date of termination”.

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 Ontario after the date of effective termination.

11.3 As of the effective date of termination of this Agreement under section 11.1, Ontario will repay federal funds on a pro-rated basis, the amount of federal funds not expended on initiatives set out in Annex 1 in accordance to the agreed schedule of expenditure, as of the effective date of termination.

11.4 As of the effective date of termination of this Agreement under section 11.1 Ontario agrees to return any federal funding not cost-matched by Ontario consistent with section 4.2.3 and section 4.7.1.

12.0 Notice

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
Ottawa, Ontario, K1A 0K9

The address for notice or communication to Ontario shall be:

Patrick Dicerni, Assistant Deputy Minister
Strategic Policy and Planning Division
Ministry of Health and Long-Term Care
Hepburn Block – 8th Floor, 80 Grosvenor Street
Toronto, Ontario, M7A 1R3
Email: patrick.dicerni@ontario.ca

13.0 General

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 Ontario.

13.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of Ontario 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 This Agreement is drafted in English at the request of the Parties. Les parties ont convenu que le présent Accord soit rédigé en anglais.

SIGNED on behalf of Canada by the Minister of Health at Toronto, Ontario this 23rd day of January, 2019.

The Honourable Ginette Petitpas Taylor, Minister of Health

SIGNED on behalf of Ontario by the Minister of Health and Long-Term Care at Toronto, Ontario this 23rd day of January, 2019.

The Honourable Christine Elliott, Deputy Premier, Minister of Health and Long-Term Care

Annex 1 – Ontario Action Plan

Introduction

Ontario’s health care system serves over 13 million people at various stages of their lives. The government is committed to improving the delivery of health care for the people of Ontario. The government will continue to work with frontline health care providers to develop innovative solutions that ensure the sustainability of the health care system.

Ontario is developing a comprehensive agenda of policies and programs to help address the dramatic increase in opioid addiction and overdoses in the province.

Quick Facts:

  • Increases in opioid prescribing have made Canada among the highest countries in per-capita opioid consumption, and Ontario among the highest provinces in opioid prescribing.Footnote 1
  • More than 7,000 Ontarians died of an opioid overdose between 2007 and 2017, the majority unintentionally.Footnote 2
  • In 2017, there were 1,265 recorded opioid-related deaths. This is a 46% increase from the number of deaths in 2016.Footnote 3
  • In 2017, there were 7,764 emergency department visits, compared to 4,427 in 2016, representing a 75% increase.Footnote 4 In 2017, there were 2,142 hospitalizations related to opioid toxicity, compared to 1,909 in 2016, representing a 12% increase.Footnote 5

It is understood that the federal government’s current efforts on the opioid crisis are centered on working with provinces and territories to implement harm reduction approaches and to increase access to treatment; support innovative approaches to address the crisis; and to address stigma related to opioid use. In addition, the federal government is working towards finding new approaches to reduce opioid-related deaths and prevent futures tragedies.

This new emergency treatment funding agreement between Ontario and the federal government will serve to enhance the work the province is already doing in this joint priority public health area and will further improve access to evidence-based treatment services for the opioid crisis.

Overview of Ontario’s Opioid Crisis Response

Ontario is working to implement a diverse range of initiatives to address the opioid crisis and provide assistance to people who use drugs, suffer from pain conditions, or are suffering with opioid use disorder. This includes work in four main areas:

  • Appropriate prescribing and pain management
    • Initiatives focused on ensuring that prescribers have the knowledge and tools to prescribe opioids effectively, and on building the health system’s capacity to effectively treat people with acute or chronic pain.
  • Treatment for opioid use disorder
    • Expanding access to a range of treatment services and support for people with an opioid use disorder, including specific investments into culturally-appropriate care for Indigenous communities.
  • Harm reduction
    • Supporting policies and programs that reduce the harms associated with drug use, such as overdose or the transmission of blood-borne infections, while connecting people who use drugs to primary care, treatment and rehabilitation, and other health and social services.
  • Surveillance and reporting
    • Making improvements to the quality and quantity of data available on the impacts of the opioid crisis, including the development of a comprehensive performance measurement framework.

Ontario’s Vision

Ontario envisions a health care system that is flexible, focused on quality and efficiency, and meets the health care needs of people where and when they are needed. This additional funding will:

  • Improve access to treatment for all those suffering with opioid use disorder;
  • Support diverse treatment needs, including those of Indigenous people; and,
  • Improve integration and coordination of care.

Ontario’s investments, together with this federal funding, will help to improve and build upon the province’s capacity to respond to the opioid crisis in areas of joint federal and provincial interest.

Areas for Investment and Overview of Expected Outcomes

The following areas for investment will be supported by federal funding:

  1. Enhancing existing treatment approaches
  2. Implementing strategies to enhance access to treatment services

A description of specific initiatives under each area and their expected outcomes are provided below.

1. Enhancing Existing Treatment Approaches

Federal funding will support the following initiatives:

  • Expanded treatment options for opioid use disorder, including new or enhanced services targeted to local needs of the Local Health Integration Networks (LHINs); and,
  • Culturally appropriate care for Indigenous people through new/expanded Indigenous-led treatment and healing centres and mental health and wellness services.

Currently, few emergency departments or hospitals in Ontario initiate treatment for opioid use disorder, even for individuals presenting with a life-threatening complication of their opioid use, such as overdose or endocarditis. Since people who experience such complications frequently end up in the hospital or emergency departments, clinicians in these settings need to be able to provide interventions that reduce the risk of death and increase the patient’s likelihood of engaging in treatment.

Additionally, chronic systemic underfunding of the community-based addictions system has left many clients with opioid use disorder without access to essential supports and long-term treatment to address the underlying causes of their addictions. In order for people presenting in hospitals and family practices to be linked to long-term care, new investments are also required to address significant treatment gaps in the current community-based addictions system.

Planned new investments into addictions treatment services will allow for improvements to treatment services and supports that are most needed in regions across Ontario. The Ministry is providing LHINs with funding, which is allocated based on local needs. This funding is supporting increased access to Rapid Access Addiction Medicine (RAAM) clinics, including: creating new sites or expanding existing sites; community and residential addictions treatment services including withdrawal management services; and hiring new health and social services professionals with expertise in helping people manage addictions, allocated to local organizations at the discretion of the LHINs.

In addition to the services described above, there is an urgent and high need for mental health and wellness services, including opioid disorder services, which are designed to meet the unique needs of Indigenous people, families and communities. Culturally appropriate supports across the continuum of care are essential as Indigenous communities are impacted by intergenerational trauma and experience a higher incidence of mental health and addictions issues. This includes opioid-related deaths, which are four times higher among First Nations people compared to the general population. As a result, the Ministry is investing in new and expanded Indigenous-led Mental Health and Addictions Treatment and Healing Centres, and Indigenous-led mental health and wellness programs and services. These investments are part of the response to the Truth and Reconciliation Commission’s report and Calls to Action, and priorities identified by Indigenous partners.

Expected Outcomes:
  • Expanded programs, provider capacity and frontline workers at the community level to increase access to comprehensive treatment for opioid use disorder;
  • Indigenous-led services and healing and treatment centres are developed and implemented, which help address opioid-related mental health and addictions issues of Indigenous people, families and communities.

2. Implementing Strategies to Enhance Access to Treatment Services

Federal funding will support the following provincial initiative:

  • Create and/or increase pathways for people who use drugs to treatment services.

Currently, there is a lack of integration across some harm reduction, mental health, treatment, chronic pain management and social service programming in Ontario, as well as lack of integration of these programs within the broader health care system.

This funding would help to facilitate access, for persons who use drugs, to non-judgmental health and social services by strengthening integrated pathways with harm reduction services such as new Consumption and Treatment Services (CTS).

Ontario’s new CTS will connect clients who use drugs to the help they need by providing:

  • On-site or defined pathways to addictions treatment and rehabilitation services; and
  • On-site or defined pathways to primary care, mental health and other health and social services.

Evidence and feedback from public health and mental health stakeholders indicates that there is a very short window of opportunity following emergency treatment, to convince an individual to seek additional care or treatment. Evidence also suggests that those who use drugs face barriers and stigma when accessing the care they need. Offering wrap around services that provide immediate access to programs on-site will help reduce barriers to accessing services, including treatment, and will help improve health outcomes for persons who use drugs. It will also be important to offer services that are based on local community needs.

Expected Outcomes
  • On-site or defined pathways from CTS to addictions treatment and rehabilitation, primary care, mental health, housing, employment and other health/social supports.
  • Expanded access to counselling and mental health services, social services, and primary care through integration with harm reduction programs based on local community needs.

Expenditure Plan

Table 2: Expenditure Plan
Initiatives Expected Results Performance Measurement 2018-19 2019-20
($millions)

1. Enhancing existing treatment approaches

  • Enhancing targeted local responses (funding more than 100 organizationsFootnote 6 to meet local treatment needs and to support appropriate care for opioid use disorder), including:
    • Rapid Access Addictions Medicine (RAAM) clinics;
    • Community and residential withdrawal management services;
    • New health and social service professionals specializing in addictions.
  • Reduced wait times for addiction treatment
  • Increased number of patients receiving opioid agonist therapy (OAT)
  • Reduced burden on hospitals
  • Number of clients served through RAAMs
  • OAT prescribing rates
  • Number of opioid-related overdose deaths, and emergency department visits.
27.0 13.5
  • Expanding support for culturally appropriate care for Indigenous communities.
  • This funding will support:
    • 10 Indigenous-led mental health and addictions programs and services.
    • 3-4 Indigenous-led Indigenous mental health and addictions Treatment and Healing Centres.
Short-term:
  • Indigenous youth, adults, and families experience improved access to culturally safe residential treatment closer to home.
Medium-term:
  • Indigenous Services Providers funded through these initiatives have an improved capacity to respond to the mental health and addictions needs of Indigenous communities.
Long-term:
  • Indigenous communities experience improved MH and A outcomes and mental wellbeing.
Note: MOHLTC is working with Indigenous partners to develop culturally appropriate performance measures for these initiatives.

Initial list of indicators:

  • Number of First Nation/ Indigenous communities served
  • Number of Indigenous specific MH and A programs available in Ontario
  • Number of people on waitlists for culturally appropriate treatment
  • Number of culturally appropriate treatment beds
  • Number of individuals transferred outside of community for high acuity mental health care
  • Increased self-reported mental health and wellness status from clients
   

2. Implementing strategies to enhance access to treatment services

  • On-site or defined pathways to health and social services including treatment through integrated services at Consumption and Treatment Services (funding will support up to approximately seven CTS sites)
  • Increased connection to addiction treatment and rehabilitation
  • Increased connection to primary care, health and social services
  • Decreased incidents of drug-related overdose deaths
  • Reduced burden on hospitals
  • The provision and uptake of addictions treatment and wrap-around services (e.g. detox, opioid agonist therapy, primary care, mental health services)
  • Number of overdoses reversed/treated and emergency service calls
0 10.6
SUB-TOTAL 27.0M 24.1M
Total Ontario Share – Federal Opioid Funding 51.1M

To match Health Canada’s contribution to addressing the opioid crisis in Ontario, the Ministry is planning to continue funding key initiatives that will provide better access to treatment for those who need it, including:

  • Funding to LHINs to improve access to treatment in communities across Ontario in a way that is targeted to local need; and,
  • Culturally appropriate care and pathways to treatment for Indigenous communities.

Since January 2016, Ontario has spent over $16.6 million in new funding to improve access to addictions treatment as part of the response to the opioid crisis.

Select Ontario expenditures on treatment services for matching investment:

Table 3: Ontario Matching Investments
Eligible Treatment Service: Provincial Expenditures from January 2016 to
March 31, 2021
Funding to LHINs to improve access to treatment $16.4M (2017-18)
$7.5M (2019-20)
$21.0M (2020-21)
Culturally appropriate pathways to treatment for Indigenous communities $6M (2020-21)
Addiction mentorship opportunities for physicians to enhance access to high-quality treatment $0.33M (2017-18)
Total Eligible Provincial Expenditures: $51.23M

To monitor the impacts of these and other investments that Ontario has made to address the opioid crisis, Ontario is currently tracking and publicly reporting a number of data points on the status of the opioid crisis, as well as the impact of the current response to the crisis. The currently reported measures include:

  • Opioid related mortality
  • Opioid related emergency department visits
  • Opioid related hospitalizations
  • Utilization of prescription opioids and opioid agonist therapy
  • Number of distributed naloxone kits
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