Canada-Saskatchewan 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 SASKATCHEWAN (hereinafter referred to as "Saskatchewan" or "Government of Saskatchewan") as represented by the Minister of Health herein referred to as "the Saskatchewan Minister")
REFERRED to collectively as the "Parties"
PREAMBLE
WHEREAS, Canada and Saskatchewan 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 Saskatchewan 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 Saskatchewan 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 Saskatchewan has the primary responsibility for the design and delivery of substance use disorder treatment and response services in Saskatchewan, the one-time Emergency Treatment Fund is intended to augment services and Saskatchewan 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 Executive Government Administration Act authorizes the Saskatchewan Minister to enter into agreements with the Government of Canada under which the Government of Saskatchewan 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;
WHEREAS, Saskatchewan is responsible for the provision of treatment services including to Indigenous populations accessing treatment services off-reserve;
AND WHEREAS, the Government of Canada is responsible for the provision of treatment services to Indigenous populations accessing treatment services on-reserve.
NOW THEREFORE, Canada and Saskatchewan 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 Saskatchewan 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 Saskatchewan agree that over the period of this Agreement, with financial support from Canada, Saskatchewan will address local, regional, and system priorities to reduce opioid-related harms and deaths by further building on and enhancing Saskatchewan treatment services and programs to improve the availability and accessibility of treatment for problematic substance use towards achieving the objectives of:
- Enhancing existing treatment approaches;
- Supporting innovative treatment solutions; and
- Supporting strategies to enhance access to treatment services.
Saskatchewan'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 Saskatchewan 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 Saskatchewan 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 Saskatchewan 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 Saskatchewan, 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 Saskatchewan concur that the purpose of this time-limited, one-time Agreement is to help Saskatchewan 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 Saskatchewan.
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 Saskatchewan through the Canada Health Transfer in order to support health care services within Saskatchewan. 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 Saskatchewan
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 Saskatchewan 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 Saskatchewan, as determined using the 2017 population estimates from Statistics Canada;
L is the number of apparent opioid-related deaths in Saskatchewan 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 Saskatchewan 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 Saskatchewan 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. Saskatchewan'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. Saskatchewan 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, Saskatchewan's estimated share of the amounts identified in section 4.2.1 will be:
|
Fiscal Year |
Estimated amount to be paid to Saskatchewan |
Estimated amount to be paid by Saskatchewan since January 1, 2016 |
|---|---|---|
|
2018-2019 |
$5,001,075 |
$7,433,000 |
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 Saskatchewan must spend the entire amount of Canada's contribution by no later than March 31, 2023.
4.4.3 Saskatchewan must spend the entire amount of Saskatchewan'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 Saskatchewan agree that every effort will be made to ensure that the calculation of Canada's contribution installment to Saskatchewan will be accurate.
4.5.2 In the event payment made to Saskatchewan exceeds the amount to which Saskatchewan is entitled under this Agreement, the amount of the excess is a debt due to Canada and Saskatchewan 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 Saskatchewan 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, Saskatchewan 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 Saskatchewan agree that funds provided under this Agreement will only be used by Saskatchewan 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 Saskatchewan 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, Saskatchewan will publicly release its Action Plan which:
- Provides an overview of the opioid crisis and treatment for problematic substance use in Saskatchewan;
- Identifies specific priority areas for investment and objectives, which builds upon the progress to date in delivering treatment services;
- Highlights those investments Saskatchewan 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 Saskatchewan will use to track progress and report on annually according to their planned investments.
5.1.2 The Action Plan may be amended by Saskatchewan with mutual consent from Canada in a manner consistent with the spirit and intent of this Agreement if deemed necessary by Saskatchewan 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, Saskatchewan 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, Saskatchewan agrees to:
- Report to the people of Saskatchewan 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 Saskatchewan.
- 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 Saskatchewan under section 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 Saskatchewan Auditor General or his/her delegate, or by an independent public accounting firm registered under the laws of Saskatchewan and shall be conducted in accordance with Canadian Generally Accepted Auditing Standards.
5.2.3 Canada, with prior agreement from Saskatchewan, 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
Saskatchewan will ensure that expenditure information presented in the annual report is, in accordance with Saskatchewan standard accounting practices, complete and accurate.
5.4 Evaluation
5.4.1 As per established policies and processes with respect to program effectiveness, Saskatchewan 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 Saskatchewan 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 Saskatchewan 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 Saskatchewan 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.
7.6 Canada agrees to give Saskatchewan 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 Saskatchewan 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 Saskatchewan 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 Saskatchewan, as the case may be, may notify the other party in writing of the failure or breach. Upon such notice, Canada and Saskatchewan 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 Saskatchewan, and if it cannot be resolved by them, then the federal Minister and Saskatchewan 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 Saskatchewan, by the Saskatchewan 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 Saskatchewan, 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 Saskatchewan, if requested by Saskatchewan. 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 Saskatchewan by giving at least 12 months written notice of its intention to terminate. Saskatchewan 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 Saskatchewan after the date of effective termination.
11.3 As of the effective date of termination of this Agreement under section 11.1, Saskatchewan 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 Saskatchewan agrees to return any federal funding not cost-matched by Saskatchewan 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 Saskatchewan shall be:
Ministry of Health
3475 Albert Street
T.C. Douglas Building
Regina, SK
S4S 6X6
13.0 General
13.1 This Agreement, including Annex 1, comprises 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 Saskatchewan.
13.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of Saskatchewan 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 Ottawa, Ontario this 8 day of November, 2018.
The Honourable Ginette Petitpas Taylor, Minister of Health
SIGNED on behalf of Saskatchewan by the Minister of Health at Regina, Saskatchewan this 13 day of November, 2018.
The Honourable Jim Reiter, Minister of Health
Annex 1 – Opioid Emergency Treatment Fund Saskatchewan Action Plan
Overview of drug-related harms and treatment in Saskatchewan
Drug-related harms, particularly those related to opioids and crystal methamphetamine use, are an increasing burden on the healthcare system in Saskatchewan. Opioids are involved in a significant proportion of all Drug Toxicity Deaths in Saskatchewan (see Figure 1). Saskatchewan had 80 opioid-related deaths of accidental or undetermined cause in 2016; a 6% decrease from 2015. There were fewer than half as many fentanyl-related deaths in 2016 (9) as 2015 (21). The data from 2017 are incomplete; however, 14 fentanyl-related deaths have been identified to-date.
Figure 1. Accidental and Undetermined Drug Toxicity Deaths by drug type (non-fentanyl opioid-related, fentanyl-related, non-opioid), 2010-2016 [Source: Saskatchewan Coroners Service, closed cases of Drug Toxicity Deaths]
![Accidental and Undetermined Drug Toxicity Deaths by drug type (non-fentanyl opioid-related, fentanyl-related, non-opioid), 2010-2016 [Source: Saskatchewan Coroners Service, closed cases of Drug Toxicity Deaths]](/content/dam/hc-sc/images/services/substance-abuse/prescription-drug-abuse/opioids/responding-canada-opioid-crisis/emergency-treatment-fund/saskatchewan-2018/fig1-eng.jpg)
Figure 1 - Text Description
|
Year |
Number of Fentanyl-related deaths |
Number of non-Fentanyl, opioids-related deaths |
Number of non-opioid-related deaths |
Total |
|---|---|---|---|---|
|
2010 |
2 |
43 |
12 |
57 |
|
2011 |
3 |
52 |
8 |
63 |
|
2012 |
7 |
48 |
14 |
69 |
|
2013 |
10 |
47 |
10 |
67 |
|
2014 |
9 |
52 |
12 |
73 |
|
2015 |
21 |
64 |
13 |
98 |
|
2016 |
9 |
71 |
16 |
96 |
Opioid overdoses of a more serious nature lead to inpatient hospital stays. In 2017-18, there were 178 inpatient stays of Saskatchewan residents due to Significant Opioid Poisoning of an Accidental or Undetermined cause (see Figure 2). The number of inpatient stays due to opioid poisoning increased 78% from 2012-13 to 2015-16, and have since decreased 9% since 2015-16. While Saskatchewan has been less affected by the fentanyl crisis than some other provinces, clusters of fentanyl overdoses and deaths are occurring regularly in Saskatchewan and are at risk of increasing due to proximity to Alberta and British Columbia.
Figure 2. Inpatient hospitalizations of Saskatchewan residents for significant opioid poisoning due to accidental or undetermined cause, 2012-13 to 2017-18 [Source: Discharge Abstract Database (DAD)]
![Inpatient hospitalizations of Saskatchewan residents for significant opioid poisoning due to accidental or undetermined cause, 2012-13 to 2017-18 [Source: Discharge Abstract Database (DAD)]](/content/dam/hc-sc/images/services/substance-abuse/prescription-drug-abuse/opioids/responding-canada-opioid-crisis/emergency-treatment-fund/saskatchewan-2018/fig2-eng.jpg)
Figure 2 - Text Description
|
Year |
Number of inpatient hospitalization from accidental or undetermined opioid poisoning |
|---|---|
|
2012-13 |
110 |
|
2013-14 |
116 |
|
2014-15 |
166 |
|
2015-16 |
196 |
|
2016-17 |
182 |
|
2017-18 |
178 |
Crystal meth use has also increased during this time period. While the number of admissions to alcohol and drug treatment services has remained relatively stable, there has been a significant increase in the number of individuals who have disclosed crystal meth use upon admission (see Table 1).
|
Year |
Total Provincial Admissions |
Percent of Clients Using Crystal Meth |
|---|---|---|
|
2011-12 |
32,766 |
2.55% |
|
2012-13 |
31,473 |
3.08% |
|
2013-14 |
33,498 |
5.22% |
|
2014-15 |
32,325 |
8.76% |
|
2015-16 |
30,891 |
15.23% |
|
2016-17 |
27,172 |
22.66% |
The Government of Saskatchewan is committed to providing a continuum of services to help people struggling with addictions. A full range of drug treatment services are available across the province, including: outreach services, outpatient treatment in over 50 centres, detoxification, inpatient treatment, long-term residential services, and day treatment.
Opioid Substitution Therapy (OST) is available to patients with opioid dependence; allowing them to discontinue opioid use without experiencing withdrawal symptoms. Trained physicians provide OST by prescribing methadone or buprenorphine/naloxone (Suboxone) accompanied by counseling and connecting individuals to other health and social supports. Suboxone was added to the Saskatchewan Formulary on January 1, 2017 to increase access to a methadone alternative that prescribers note is safer and less prone to cause an overdose. Despite the increase in the number of physicians trained to provide OST in Saskatchewan, barriers to accessing services remain. To increase access to OST, the Saskatchewan Ministry of Health funds the College of Physicians and Surgeons of Saskatchewan to recruit, train, and monitor OST prescribing physicians in the province. And effective Fall 2018, nurse practitioners will also be eligible to prescribe OST.
Saskatchewan has also recently directed investments in mental health and addictions towards enhancing addictions medicine services in Prince Albert and northern Saskatchewan. This existing initiative will result in more physicians in Saskatchewan having an addictions medicine specialty designation, ensure more patients have their addictions needs managed in their community, and support the development of an on-call rotation that will provide consult supports to physicians, clinics, and hospitals. These enhanced addictions medicine services will play an important role in the community of Prince Albert, while providing consultation to other allied health professionals in the surrounding communities and the north, where the burden of addictions is significant.
The investments in the treatment of opioid use disorders described below build on existing treatment capacities and align with Saskatchewan's commitments in the Joint Statement of Action to Address the Opioid Crisis. Investments to improve treatment for substance misuse more broadly fits with the Ministry of Health's Mental Health and Addictions Action Plan; particularly the system goals to enhance access and capacity and support recovery in the community; create person and family-centered and coordinated services; and respond to diversities. These investments will increase treatment access and success for opioid use disorder and crystal methamphetamine use.
Priority areas for investment
Enhancing existing treatment approaches
- Healthcare provider capacity building through training in Trauma Informed Practice and other complementary skills to support the treatment of substance use disorders. The target audience includes physicians, nurses, pharmacists, addiction counsellors, and outreach staff.
The vast majority of individuals who have problems with opioid misuse and addiction have current or past experiences of trauma and violenceFootnote 1. Trauma Informed Practice is an approach to healthcare that recognizes the prevalence and impact of trauma on lives of persons with substance use disorders. Trauma-informed care promotes treatment and healing by providing safety, choice, and control in health services. This approach can improve engagement with healthcare services; creating opportunities for people with problematic substance use to access treatment for substance use as well as addressing mental health concerns and other healthcare needs. The Centre of Excellence for Women's Health in British Columbia has worked collaboratively with the Family Treatment Centre in Saskatchewan, with support from the Saskatchewan Ministry of Health, to pilot the integration of trauma-informed practices into substance use services, programs, and policies, and to support aftercare recovery within the community. These funds will support the expansion of Trauma Informed Practice to healthcare settings across the province.
Training funds will also be used to build healthcare provider capacity in other complementary skills to support the treatment of substance use disorders including best practices guidelines or protocols.
Expected outcomes: More healthcare providers trained in complementary skills like Trauma Informed Practice to improve quality of care and retention in treatment programs.
Supporting innovative treatment solutions
- One-time funding to the Saskatchewan Health Authority and Community Based Organizations for equipment, infrastructure, renovations, and/or software to increase treatment access, facilitate remote treatment services, or promote wrap-around care in the treatment of opioid or crystal meth dependence.
Some examples of initiatives that might be funded include:
- Telehealth equipment and software to facilitate remote OST prescribing for rural, northern, or remote areas;
- Renovations of facilities to support the integration of Trauma Informed Practice; and
- Infrastructure improvements for transitional housing spaces, remote support for clients between detox and treatment programs, or new treatment beds.
Funds will be allocated to service providers based on local needs assessments, innovative approaches, and expected impact on access to treatment and retention in treatment programs.
Expected outcomes: Increased access to treatment and improved retention in treatment programs.
Supporting strategies to enhance access to treatment services
- Funding to regulatory agencies to recruit, train, and support Opioid Substitution Therapy prescribers (physicians and nurse practitioners). This includes mentorship of new prescribers and the development of educational resources (i.e. online training).
These funds will top up existing funding the Saskatchewan Ministry of Health provides to the College of Physicians and Surgeons of Saskatchewan for a three-year surge in recruitment, training, and mentorship activities for new OST prescribers (both physicians and nurse practitioners). It will also allow for the development of new educational resources for OST prescribers and addictions medicine more broadly.
Expected outcomes: Increased access to OST through more OST prescribers.
- Development of crystal meth specific resources and training. Funds will support knowledge development, translation, and dissemination for evidence-based treatment of crystal meth dependence. Activities will include training of trainers in Cognitive Behavioural Therapy and Motivational Interviewing for addictions counsellors, and subsequent credentialing for addictions counsellors across the province who provide treatment to crystal meth users.
A Crystal Meth Task Group, co-led by the Saskatchewan Ministry of Health and Saskatchewan Health Authority, has developed a work plan to improve treatment capacity for persons using crystal meth. The work plan will address challenges in withdrawal management, detoxification, and treatment, including risks to staff and client safety; and reduce gaps in transition points between treatment services. These funds will support the implementation of work plan activities and development of resources and training.
Expected outcomes: Increased capacity to treat patients who use crystal meth.
Cost-sharing by the Government of Saskatchewan
A few selected investments the Government of Saskatchewan has made to support OST access are presented in Table 2 below. Drug costs for methadone and Suboxone, managed care fees to physicians for providing OST, and existing funding the College of Physicians and Surgeons of Saskatchewan to support the recruitment, training, and mentorship of OST prescribers over the last three years has amounted to approximately $7,433,000.
|
Description |
2016-17 ($000s) |
2017-18 ($000s) |
2018-19 ($000s) |
Total over 3-years ($000s) |
|---|---|---|---|---|
|
Funding to the College of Physicians and Surgeons of Saskatchewan to recruit, train, and mentor OST prescribers |
33 |
33 |
79 |
145 |
|
Methadone drug costs |
1,509 |
1,572 |
1,500Footnote * |
4,581 |
|
Suboxone drug costs |
82 |
247 |
200Footnote * |
529 |
|
Methadone managed care fees |
741 |
677 |
680Footnote * |
2,098 |
|
Suboxone managed care fees |
12 |
34 |
80 |
|
|
Total |
2,377 |
2,563 |
2,493 |
7,433 |
|
||||
Expenditure Plan
Action plan initiatives will begin in the 2019-20 fiscal year. A multi-year financial table indicating the allocation for each initiative is presented below.
|
Description |
Expenditure Plan |
||||
|---|---|---|---|---|---|
|
2018-19 ($000s) |
2019-20 ($000s) |
2020-21 ($000s) |
2021-22 ($000s) |
2022-23 ($000s) |
|
|
Nil |
85 |
85 |
85 |
Nil |
|
Nil |
1,000 |
925 |
900 |
900 |
|
Nil |
250 |
250 |
250 |
Nil |
|
Nil |
90 |
90 |
90 |
Nil |
|
Total Expense |
Nil |
1,425 |
1,350 |
1,325 |
900 |
Monitoring and Evaluation
To monitor progress in the implementation of the action plan and evaluate outcomes, the following indicators will be tracked, in addition to more specific indicators described in the performance measurement table below (see Table 4):
- average amount of time required for individuals to access treatment for problematic substance use after referral (by type of treatment service);
- % of population accessing publicly funded treatment when seeking treatment services for substance use disorder; and
- # of people accessing publicly funded opioid substitution treatment.
|
Name of Initiative |
Description |
Expected Results |
Performance Measurement |
Expenditure Plan How federal funding will be allocated, by fiscal year. |
||||
|---|---|---|---|---|---|---|---|---|
|
2018-19 ($000s) |
2019-20 ($000s) |
2020-21 ($000s) |
2021-22 ($000s) |
2022-23 ($000s) |
||||
|
Healthcare provider capacity building (e.g. Trauma Informed Practice) |
Healthcare provider capacity building through training in Trauma Informed Practice and other complementary skills to support the treatment of substance use disorders. The target audience includes physicians, nurses, pharmacists, addiction counsellors, and outreach staff. This will allow province-wide expansion of a new training programs. |
More healthcare providers trained in complementary skills like Trauma Informed Practice to improve quality of care and retention in treatment programs. |
|
Nil |
85 |
85 |
85 |
Nil |
|
Innovative Treatment Solutions for remote treatment and wrap-around care |
One-time funding to the Saskatchewan Health Authority and Community Based Organizations for equipment, infrastructure, renovations, and/or software to increase treatment access, facilitate remote prescribing or promote wrap-around care in the treatment of opioid or crystal meth dependence. Funds will be allocated to service providers based on local needs assessments, innovative approaches, and expected impact on access to treatment and retention in treatment programs. |
Expanded access to treatment services for individuals with opioid dependence and improved retention in treatment programs. |
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Nil |
1000 |
925 |
900 |
900 |
|
OST prescriber recruitment, training, and mentorship |
Funding to regulatory agencies to recruit, train, and support Opioid Substitution Therapy prescribers (physicians and nurse practitioners). This includes mentorship of new prescribers and the development of educational resources (i.e. online training). This funding allows a three-year surge in activities, on top of existing funding the Ministry of Health provides to the College of Physicians and Surgeons of Saskatchewan. |
More health care providers qualified to provide OST and faster access to OST for patients. |
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Nil |
250 |
250 |
250 |
Nil |
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Resources and training for treatment of patients using crystal meth |
Development of crystal meth specific resources and training. Funds will support knowledge development, translation, and dissemination for evidence-based treatment of crystal meth dependence. Activities will include training of trainers in Cognitive Behavioural Therapy and Motivational Interviewing for addictions counsellors, and subsequent credentialing for addictions counsellors across the province who provide treatment to crystal meth users. |
Increased capacity to treat patients who use crystal meth. |
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Nil |
90 |
90 |
90 |
Nil |
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