Issue #32 Febuary 2024

[This issue includes a modified and updated excerpt from “Buzz Kill: The Corporatization of Cannabis”.  NOW AVAILABLE at or at your local independent bookstore. They could really use the support.

In the previous issue, I covered harms from drug use in several types of settings. In this issue, I explore information on characteristics of people who attend drug treatment programs.

In 1978, when I joined the Hamilton Centre of The Addiction Research Foundation of Ontario, I had three responsibilities. One was to provide assessment and counselling for people with drug problems. Another was to organize and provide education programs on drugs and drug problems for the public and staff of various health and social services. The third was to work with drug treatment programs to develop a more coordinated treatment system that would provide better care more efficiently for people. That was the most difficult part of the job. One of the things that made it challenging was that there was almost no program level data available that could be leveraged to make systemic changes based upon client needs. We would hold monthly system planning meetings, hosted by the local hospital-based program that provided everybody with lunch. Too often the cost of that ‘no such thing as a free lunch’ was that the hospital-based program got its way in the decisions that were made. There were no data to support doing otherwise. I was not happy with that arrangement and began to think about alternatives.

The idea was to collect a standard set of information on each person who came into a local drug treatment agency for help and to then combine that information across agencies to create a unified system view of client characteristics and unmet needs. A unique client ID allowed us to track people across agencies while protecting their anonymity. This was a feature that did not exist among other evolving sources of client information. Beginning in 1985, I ran a pilot test of the system with the help of the staff at the local drug assessment and referral service. Satisfied with the results, the data collection system was expanded to include six agencies. I produced short, focused reports beginning in 1986 and a first full report to the community in 1988 under the name The Substance Abuse Monitor (SAM). Ultimately, we were able to convince as many as ten of the thirteen local drug treatment programs to participate.

Each year, through 1995, SAM produced an annual report that was used in the system planning meetings to make recommendations for service improvement. The recommendations were now based on actual client information. In 1996, the project produced a series of reports – each on a specific sub-population including women, youth, seniors, and those with specific problems such as mental health issues, multiple-drug problems, homelessness, disabilities, developmental handicaps, and victims of physical and sexual abuse. The information was helpful in improving services for youth and for women, including one of the first women’s withdrawal management services in the province of Ontario.

I published two academic papers on SAM – one of which, published in Addiction, described how SAM was developed, operated, and used to generate recommendations for tangible service development. I was asked to provide consultation on an Addiction Research Foundation project to expand the project from Hamilton to the entire province of Ontario. That happened. The system evolved to cover almost all drug treatment programs in the province. After almost four decades following the establishment of its prototype in Hamilton, it is still running as The Drug and Alcohol Treatment Information System (DATIS) and is operated by the Centre for Addiction and Mental Health in Toronto. DATIS has retained many of the features of the prototype including the unique client identifier. I still use the data in my presentations and writing.

People who enter drug treatment programs are not representative of the general population in terms of their drug use and problems. This clinical population shows us drug problems in their most concentrated form. It is also in the clinical population where drugs such as cannabis, cocaine, crack, opioids, and amphetamines become more prominent as problem substances. DATIS gives us this picture.

The most recently available data from DATIS are for calendar year 2022. After a substantial reduction in the number of people entering treatment programs in Ontario during the covid pandemic, admissions have now returned to pre-pandemic levels. In 2022, 65,033 individuals sought treatment for a drug problem at one of Ontario’s 188 reporting treatment programs. Alcohol remained the leader with 38,815 clients identifying it as one of their problem substances. Cannabis leads a distant second tier at 21,589 followed closely by cocaine/crack at 21,088. Opioids/opiates were identified by 18,096 clients and tobacco by 14,886. Benzodiazepines, crystal methamphetamine, hallucinogens, and amphetamines comprise a third tier. Given the high prevalence of polysubstance problems, these counts are not mutually exclusive.

There is no ongoing Canada-wide monitoring system for treatment agencies. However, similar data were collected in a Canada-wide study over a two-year period in 2016-2018. It ranked problem substances named by people entering a treatment program. Overall, alcohol was ranked highest. It was followed in sequence by cocaine, cannabis, opiates, and amphetamines. Not only are those ranks very similar to the current Ontario profile, they are also very similar to the profile we saw in Hamilton almost four decades earlier. Some things do not vary much – in space or time.

One of the key questions arising from cannabis legalization in Canada is whether cannabis would become a problem in the general population and in the clinical population. We know from the data from CADS & The CAMH Monitor, as explored in the previous issue of this newsletter, that it already was a problem – second only to alcohol. The more pertinent question is whether cannabis would become a greater problem following legalization.

One of the problems for assessing the impact of cannabis legalization in Canada is that it corresponded with the covid pandemic. There is no clean way to separate the effects. If there is an increase in problems, it is unlikely to happen immediately. Any drug problem for an individual person has a gestation period. If there is an increase in cannabis-related problems in the general population, it is not likely to manifest as a tsunami crashing upon the shores of our health care system, including specialized drug treatment programs. We should expect there to be a dormancy period followed by a slowly rising tide. Not a tsunami, but an increased pressure on an already under-resourced system.

In the next issue of DPA, I will explore drug dependence. It’s a prevalent problem, but not as prevalent as many people believe. There are other ways in which drug use manifests as problems.

Mike DeVillaer
Hamilton Ontario Canada
February 29 2023