Opioid Symposium: What We Heard Report

Executive Summary

The Opioid Symposium was held on September 5 and 6, 2018, in Toronto. The Symposium brought together 200 participants including federal, provincial and territorial ministers and officials; researchers, health experts and medical practitioners; representatives from Indigenous communities; members of law enforcement, public safety and corrections organizations and over 50 people with lived and living experience related to opioid use. The event was also webcast with over 1,600 views throughout the two days.

This “What we Heard” report provides a synthesis of the dialogue over the two days. It represents the diverse range of perspectives shared and the key themes that were discussed during the event:

  • Examining the Factors That Lead to Problematic Substance Use
  • Learning from People Directly Impacted by the Opioid Crisis
  • Addressing Stigma Associated with People Who Use Drugs and People Living with Chronic Pain
  • Impacts of the Opioid Crisis on Indigenous Communities
  • Federal, Provincial and Municipal Armchair: Responding to the Opioid Crisis
  • Innovative Approaches to Treatment and Prevention
  • Compliance and Enforcement

Background and Context

The high number of opioid-related overdoses and deaths in recent years is a national public health crisis. In response to this complex crisis, the federal government is taking a leadership role by using all of its available tools, working with provinces, territories and other partners across the country. The Government of Canada is taking a comprehensive, collaborative and compassionate public health approach focused on prevention, treatment, harm reduction and enforcement, which is supported by a strong evidence base. Progress has been made to reduce barriers to treatment, such as facilitating methadone prescribing and use of medical heroin, implementing harm reduction measures, addressing transparency of marketing practices from opioid manufacturers and distributors and improving access to treatment services through an Emergency Treatment Fund for provinces and territories. For an overview of the actions taken by the Government of Canada to address the opioid crisis, please visit: Federal Actions on Opioids.

In the first half of 2018, 2,066 apparent opioid-related deaths occurred. This means more than 9,000 lives were lost between January 2016 and June 2018 related to opioids. No one level of government or single sector can address this complex social, health and safety issue alone. Addressing the current overdose epidemic is a shared responsibility and requires collaborative action by many stakeholder groups and all levels of government across health, public safety, social, legal and economic sectors. Building on the actions taken to date, the Opioid Symposium sought to bring together partners and stakeholders from across the country to further discuss how to make progress on reversing the trend of the national overdose epidemic.

Opioid Symposium

The Opioid Symposium was hosted by the Honourable Ginette Petitpas Taylor, Federal Minister of Health, with support from the Canadian Centre on Substance Use and Addiction and the Centre for Addiction and Mental Health, and in association with the Globe and Mail, on September 5 and 6, 2018, in Toronto. The Symposium brought together 200 participants including federal, provincial and territorial ministers and officials; researchers, health experts and medical practitioners; representatives from Indigenous communities; members of law enforcement, public safety and corrections organizations and over 50 people with lived and living experience related to opioid use. The event was also webcast with over 1,600 views throughout the two days. The Opioid Symposium agenda is available online.

The objectives of the Symposium were to:

  • place the voices of people with lived and living experience at the center of the discussion
  • promote increased access to treatment and harm reduction
  • recognize the different aspects of the opioid crisis and discuss opportunities for collaboration

The Symposium also included focused consultation sessions on restricting the marketing and advertising of opioids and the launch of the Canadian Drugs and Substances Strategy. Feedback from these sessions has been included in Health Canada's broader public consultations on these topics.

The opioid crisis affects people of all ages, backgrounds and professions. Bringing together diverse groups of people through this Symposium will help identify gaps that we need to fill to effectively address this public health crisis. Too many lives have been impacted by the crisis. We need to do more. It is my sincere hope that together we will be able to build on our individual actions to mount a better collective response.” (The Honourable Ginette Petitpas Taylor, Minister of Health)

Summary of Discussion

This report summarizes the proceedings, discussions and outcomes from the Opioid Symposium. It represents the diverse range of perspectives shared and the key themes that emerged during the event. The views expressed are those of the participants and do not necessarily reflect those of Health Canada or the Government of Canada.

Snap Shot Sessions

As we come together to take stock of the opioid crisis and discuss our growing but still incomplete understanding of all the factors at play, we are encouraged by the diverse participation at this symposium. The many voices represented here will help us respond in a way that will make a real difference in the lives of those with problematic substance use.” (Dr. Theresa Tam, Canada's Chief Public Health Officer, speaker, Setting the Context: Telling the Data Story)

Minister Petitpas Taylor opened the Symposium, welcoming participants and setting the context for the discussions to follow. Over the course of the two days, the Symposium featured plenary “Snap Shot” talks which highlighted particular topics. Dr. Theresa Tam, Canada's Chief Public Health Officer, presented Setting the Context: Telling the Data Story which situated the opioid crisis as the biggest public health crisis since AIDS in the 1990s, one which is now impacting Canadian life expectancy, and continuing to grow. While there has been an emphasis on improving data to help inform regulatory, funding and program decisions, Dr. Tam indicated that it is important to continue to fill remaining gaps and learn from the lives lost.

Darryl Gebien, currently a non-practicing emergency room physician in long-term recovery, presented a Snap Shot entitled How Fentanyl Changed My Life. Speaking from the perspective of someone who has both experienced and perpetuated stigma from health care toward people who use drugs, he indicated his position that problematic substance use is not a moral failing, but rather an illness, with a strong relationship with mental health.

Dr. Samuel Weiss, Scientific Director, Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research (CIHR) presented a Snap Shot on Building the Evidence Base, outlining work being done by CIHR collaboratively with partners to build new knowledge in the areas of greatest need, and to apply implementation science to translate knowledge into better practice and policies.

The final Snap Shot, I Died Six Times – Let's End the Stigma of Harm Reduction, was presented by Guy Felicella, a Harm Reduction Educator, who shared his personal experiences with harm reduction, and called on Symposium attendees to approach the response to the opioid crisis with empathy, understanding and compassion.

Examining the Factors That Lead to Problematic Substance Use

The best prevention is not really specific to drugs alone… but rather encompasses interventions that address the social context that keep young people marginalized and excluded.” (Dr. Rebecca Haines-Saah, panelist, Examining the Factors That Lead to Problematic Substance Use)

The Symposium was also structured around concurrent panel discussions, which brought together a diversity of views on each theme.

The opening panel, moderated by Dr. Tam, discussed factors that lead to problematic substance use in order to identify potential areas for action on prevention. Panelists noted that responding to the increasing rate of opioid-related deaths requires a focused response, but that there is also a need to look beyond the crisis. They indicated that shifting attention upstream to prevention is essential for a long-term solution to the opioid crisis and addressing substance use issues more broadly. While the opioid crisis is impacting individuals and communities across Canada, it was noted that specific populations are more represented among opioid-related hospitalizations and deaths including Indigenous Canadians, people living in lower-income neighbourhoods, who are homeless, incarcerated or recently released, living with chronic pain or living with poor mental health. Participants emphasized the need for:

  • investments in the social determinants of health, particularly in Indigenous communities
  • systems change through collaborative program planning and policy development
  • increased access to comprehensive mental health and social supports
  • evidence-informed actions and communications targeting youth, leveraging technology and social media

Learning from People Directly Impacted by the Opioid Crisis

Our community is reeling with grief and loss.” (Rick Sproule, moderator, Canada Is In Crisis: What Needs to Change and How We Can Get There)

The first series of concurrent sessions included four panels organized by the Canadian Association of People Who Use Drugs, Moms Stop the Harm, Community Addictions Peer Support Association, and Pain BC and the Chronic Pain Network. The passion and urgency of the calls to action issued by participants with lived and living experience reflect the very real and devastating impact of the crisis. It also highlighted the importance of listening to the people most impacted by the crisis, and meaningfully involving them in developing effective solutions. That includes people who use drugs, family members, peer workers, people in recovery, and people living with chronic pain.

Participants expressed the need for increased support for peers, family members and others impacted by opioid overdoses. For example:

  • individuals using drugs and their families expressed a need for access to timely, relevant information about risk and harm reduction in order to increase their own safety and the safety of their loved ones
  • in the absence of access to coordinated services, family members of those who have died spoke of being left to support one another and fill gaps themselves
  • it was noted that peers are responding to increasing levels of need for front-line supports while in a constant state of grief and loss, and that most work by peers is unpaid, unsupported, and unrecognized, resulting in high levels of burnout
  • some participants reported being limited in the supports they receive due to the criminalization of drug use, and asked the federal government to consider decriminalization

Panelists from the chronic pain community discussed how the opioid crisis, and the response to it, has had significant consequences on chronic pain patients, including increased stigma and reduced access to treatment services, including access to pain medications. Participants noted that opioids are an important tool to help some individuals manage their chronic pain, and that patients also need to have better access to treatment services, such as physiotherapy and integrated healthcare services. Some indicated that while prescription guidelines are helpful in providing physicians with the confidence to prescribe opioids in this context of increased scrutiny, there are variations in how prescribers are implementing the guidelines.

Addressing Stigma Associated with People Who Use Drugs and People Living with Chronic Pain

If you're in the workplace and using drugs, right now, you suffer the same stigmas. You have to be on the down low. And as long as we're on the down low, we're going to have to take more and more unnecessary risks and put ourselves in danger.” (Garth Mullins, panelist, Changing the Conversation in the Workplace)

The theme of stigma was echoed throughout the two day Symposium. A series of concurrent sessions looked at barriers stemming from stigma in a range of settings: through and in the media, in the healthcare system, in treating chronic pain, and in the workplace.

Panelists noted that people who use drugs face stigma and discrimination. Some participants expressed that stigma persists despite increasing recognition that drug use is a health rather than criminal justice issue, which can create barriers to the effective implementation of prevention, harm reduction and treatment measures. Participants emphasized their views that:

  • people who use drugs continue to be criminalized, and without decriminalization, people who use drugs will continue to face stigma
  • stigma and the fear of prosecution can cause people to use drugs alone, increasing the risk of death due to overdose
  • individuals who provide services to people who use drugs also feel stigmatized
  • peer support work is undervalued and often excluded from the health care dialogue
  • using people first language and sharing stories of hope, resiliency and recovery will help
  • the media and employers have important roles to play in educating the public, changing the conversation and increasing supports for those impacted by opioids

Panelists living with chronic pain shared how the opioid crisis has brought attention to the issue of chronic pain but has also resulted in increased stigmatization of those who use opioids for the management of chronic pain. Participants reported facing scrutiny for what may be viewed as drug-seeking behaviour, or for potentially using prescribed substances problematically. This stigma has sometimes made it difficult for people with chronic pain to access the medications and treatment services they need.

Impacts of the Opioid Crisis on Indigenous Communities

First Nations people [in British Columbia] are five times more likely than non-First Nations to experience an overdose event, and three times more likely to die due to an overdose.” (Dr. Shannon McDonald, panelist, Increasing Access to Substance Use Disorder Treatment and Prevention Services in Indigenous Communities)

The second day of the Symposium opened with a panel discussion on the current impact of the opioid crisis in Indigenous communities across Canada. Panelists reported that there is a lack of available national data to indicate the impact of opioids on Indigenous peoples in Canada; however the data that does exist suggests that Indigenous peoples are disproportionately impacted, and that Indigenous women especially face higher overdose rates.

Participants discussed how Indigenous communities continue to rebuild and recover from the negative effects of colonization and residential schools, including inter-generational trauma. They indicated that although the opioid crisis is just one indicator of collective pain, it demands special attention because of its severity and impact on the individual, family, and communities of those affected. Participants emphasized the need to recognize, support, and foster the strength and resilience of First Nations individuals, families, and communities that have and continue to address this crisis that has devastated and overwhelmed communities.  

Participants noted the following with regard to services and supports:

  • there is a shortage of services and supports available in-community, including specialized substance use programs and service providers
  • there are programs and approaches that have had a positive impact such as community-based buprenorphine-naloxone programs and programs providing youth cultural awareness and empowerment
  • the response must be grounded in the cultural world-view of First Nations people, and draw on a strength-based and holistic approach
  • the diverse nature of First Nations people requires that all programming must be community developed to meet the unique contexts and needs of the community

Federal, Provincial and Municipal Armchair Discussion: Responding to the Opioid Crisis

If we know that criminalization is a barrier to health and we are in a public health crisis, and we know the war on drug has been an absolute failure, why not end it now? This government may not have created the war on drugs, but you do continue to enforce it. Right now you have the opportunity to create history and end it.” (Leila Attar, panelist, Examining the Factors That Lead to Problematic Substance Use)         

The Honourable Ginette Petitpas Taylor, federal Minister of Health, the Honourable Bill Blair, federal Minister of Border Security and Organized Crime Reduction, the Honourable Judy Darcy, Minister of Mental Health & Addictions, British Columbia, His Worship Gregor Robertson, Mayor of Vancouver and His Worship John Tory, Mayor of Toronto, discussed the impact of the opioid crisis in their jurisdictions and the need for national collaboration across governments as part of a public health-focused response. Minister Petitpas Taylor emphasized that the opioid crisis is an extremely complex problem without a single solution, and that no one level of government can handle this alone. The panelists from British Columbia shared their experiences gained from that jurisdiction being at the leading edge of the opioid response, and the need for innovative approaches, some of which have now been adopted across the country. The need for adequate treatment and harm reduction services was echoed across the experiences in different jurisdictions, and progress on funding treatment services and establishing supervised consumption sites was noted. Several panelists also commented on the importance of addressing stigma, as well as the need for discussion of access to a safe drug supply.

During this session, several audience members called on elected officials to consider the decriminalization of drugs, building on comments made during other panels. Some participants pointed to the Portuguese model as an opportunity to inform and put in place a made-in-Canada approach to decriminalization. Panelists acknowledged that decriminalization alone will not solve the problem of the contaminated supply.

Innovative Approaches to Treatment and Prevention

No one organization, no one level of government, can deal with this crisis alone.” (Rita Notarandrea, moderator, Treatment for Substance Use Disorder)

Next, four panels looked at treatment and prevention across a number of areas: new practices in correctional services, treatment and prevention in Indigenous communities, treatment for substance use disorder and treatment for chronic pain.

Panelists discussed how a range of mental health and substance use services are required to respond to the diversity of personal characteristics, goals, and experiences of people who use drugs. Participants emphasized that services for mental health and substance use should be an accepted and resourced part of standard health care across Canada. Some indicated that a holistic approach to services includes prevention, early intervention, harm reduction, treatment, and continuing care, and that this approach is not limited to specialized health services. For example, workplace programs supporting those returning to work following an absence related to substance use are an important part of continuing care.

Participants commented that effective services are supported by evidence, and include trauma-informed (e.g. emphasis on trust, emotional safety, collaboration, choice, strength, and resiliency) and culturally appropriate approaches. It was noted that there is a need to recognize that there is a strong evidence base for effective treatment, including for harm reduction services, and also to recognize that treatment success should be measured according to improved quality of life and well-being, not only abstinence.

Speakers across panels noted gaps in access to services, for example:

  • need for more treatment services such as physicians and pharmacies providing opioid agonist treatment
  • access to substance use treatment in Canada is not equal, and timely services are sometimes limited to those who are able to pay for private treatment
  • many people fall through gaps in the system due to age, gender, criminal justice involvement, or finances
  • barriers can be created by exclusion, eligibility and participation criteria such as concurrent disorders and frequent drug testing
  • support is needed for those facing the trauma of loss, including peers, family, and first responders
  • those who have survived overdose, and their families, may also require services for physical and mental health impacts
  • Canada's prison population has a disproportionally high level of substance use issues, but has reduced access to services both in the institution and on transition back to the community

Participants made several suggestions to improve the management of chronic pain in Canada:

  • comprehensive, integrated, coordinated, and publicly-funded care options that include medication, physical therapy, and psychological therapy
  • improved training of health care providers with regard to pain management
  • physician access to timely information on appropriate opioid prescribing practices, as well as options for and availability of other treatment services
  • increased collaboration between chronic pain and substance use service providers
  • leadership to ensure proper resourcing and coordination, including a national pain strategy
  • research to fill knowledge gaps related to pain management
  • development of a standardized way to measure pain
  • consideration of the unique needs of Indigenous pain patients

The urgency of the opioid crisis requires a rapid response that embraces innovative solutions, and brings the necessity – and opportunity – to drive change. With opioid deaths taking place due to the contamination and unknown potency of street drugs, participants urged the need to consider options for safe supply. The key calls to action were:

  • support the implementation of low-barrier, easily accessible harm reduction services wherever they are needed
  • provide access to a safe supply of pharmaceutical-grade opioids

Compliance and Enforcement

The three things that are important to me in this whole area are compassion, collaboration and courage. Looking at [problematic substance use] as a medical disorder rather than a moral failure and approaching each person as a human being. And if we look at it through that lens, we can get through a lot of stigma and overcome a lot of hurdles that we have.” (Deputy Chief Tim Farquharson, panelist, New Approaches to the Opioid Crisis in Law Enforcement from the Front-lines)

The final concurrent sessions examined how the criminal justice and law enforcement systems play an important role in an integrated, collaborative response to the opioid crisis. Panel discussions focused on: addressing the illegal supply of opioids, new approaches to front line law enforcement and therapeutic and restorative practices in the justice system. Participants recognized that the opioid crisis is a complex problem requiring a collaborative and comprehensive solution, in order to see the individual as a whole rather than attempting to compartmentalize different needs, or excluding individuals with complex needs that cut across sectors.

Participants noted the:

  • need for addressing illegal supply in collaboration across domestic and international partners
  • opportunity for those working at the front lines of these systems to work in support of harm reduction and diversion initiatives

Conclusions and Next Steps

Minister Ginette Petitpas Taylor closed the Symposium by recognizing the importance of collaboration and extending her appreciation for the diverse views expressed during the two-day event.

Health Canada and federal partners will move forward taking into account what was heard during the symposium, including the following actions: 

  • exploring the establishment of a Pain Task Force
  • addressing the stigma associated with opioid use
  • exploring options for safer alternatives to the contaminated drug supply

Participating Organizations

  • Academic Pain Directors of Canada
  • Action Atlantic Pain Society
  • Addictions Foundation of Manitoba
  • Assembly of Seven Generations
  • Association québécoise de la douleur chronique
  • Association québécoise pour la promotion de la santé des personnes utilisatrices de drogues
  • British Columbia Association for People on Methadone
  • British Columbia Centre for Disease Control
  • British Columbia Centre on Substance Use
  • British Columbia Ministry of Mental Health and Addictions
  • British Columbia, Ministry of Health
  • Canada Border Services Agency
  • Canada Health Infoway
  • Canada Post
  • Canadian Agency for Drugs and Technologies in Health
  • Canadian Arthritis Patient Alliance
  • Canadian Association of People who Use Drugs
  • Canadian Association of Social Workers
  • Canadian Centre on Substance Use and Addiction
  • Canadian Chiropractic Association
  • Canadian Drug Policy Coalition
  • Canadian Federation of Medical Students
  • Canadian HIV/AIDS Legal Network
  • Canadian Institute for Health Information
  • Canadian Institutes of Health Research
  • Canadian Medical Association
  • Canadian Mental Health Association
  • Canadian Nurses Association
  • Canadian Pain Society
  • Canadian Police Association
  • Canadian Psychological Association
  • Canadian Public Health Association
  • Canadian Research Initiative in Substance Misuse
  • Canadian Society of Addiction Medicine
  • Casey House
  • Centre for Addiction and Mental Health
  • Centre for Health Evaluation & Outcome Sciences
  • Centre on Drug Policy Evaluation
  • Chronic Pain Association of Canada
  • Chronic Pain Network
  • Chronic Pain Support Services
  • City of Surrey
  • College of Family Physicians of Canada
  • College of Physicians and Surgeons of Saskatchewan
  • Community Addictions Peer Support Association
  • Construction Industry Rehab Plan
  • Correctional Services Canada
  • Dalhousie University
  • Department of Justice Canada
  • Dilico Anishinabek Family Care
  • Direction 180
  • Direction régionale de santé publique de Montréal
  • Dr. Peter AIDS Foundation
  • Eastern Ontario Pain Lifestyle Education Centre
  • Faces and Voices of Recovery Canada
  • Families for Addiction Recovery
  • Federation of Medical Regulatory Authorities of Canada
  • Felicella Consulting
  • First Nations Health and Social Secretariat of Manitoba
  • First Nations Health Authority
  • Fraser Health
  • Fred Victor
  • Fresh Start Recovery Centre
  • Get Prescription Drugs off the Street Society
  • Health Canada
  • Indigenous Services Canada
  • Individuals with lived and living experience with chronic pain
  • Individuals with lived and living experience with opioid use
  • Inspire by Example
  • Law Enforcement Assisted Diversion, Public Defender Association, Seattle Washington
  • Manitoba Health Seniors and Active Living
  • Matsqui-Abbotsford Impact Society
  • McMaster University
  • Mental Health Commission of Canada
  • Ministère de la Santé et des Services sociaux du Québec
  • Moms Stop the Harm
  • moms united and mandated to saving the lives of Drug Users
  • Moss Park Overdose Prevention Site
  • National Association of Pharmacy Regulatory Authorities
  • New Brunswick, Department of Health
  • Northwest Territories, Department of Health and Social Services
  • Nova Scotia Department of Health and Wellness
  • Nova Scotia Native Women's Association
  • Nurse Practitioner Association of Canada
  • Office of the Chief Coroner of Ontario
  • Ontario HIV and Substance Use Training Program
  • Ontario Pain Foundation
  • Ontario Provincial Police
  • Ottawa Inner City Health
  • Pain British Columbia
  • Pain Society of Alberta
  • Paramedic Association of Canada
  • Parents Empowering Parents Society
  • PEOPLE Centre
  • Peterborough Police Service
  • Pine River Institute
  • Pivot Legal Society
  • Public Health Agency of Canada
  • Renascent
  • Research Center of the Centre hospitalier de l'Université de Montréal
  • Royal Canadian Mounted Police
  • Saskatchewan, Ministry of Health
  • Say No For Nick
  • South Riverdale Community Health Centre
  • Statistics Canada
  • Temagami First Nation
  • The Globe and Mail
  • Toronto Public Health
  • Université Laval
  • University Health Network
  • University of British Columbia
  • University of Calgary
  • University of Toronto
  • Vancouver Area Network Of Drug Users
  • Vancouver Coastal Health
  • Victoria Police Department
  • Waterloo Regional Police Service
  • Waypoint Centre for Mental Health Care
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