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									                                                                                                     Saskatchewan Population Data

                                                                                       amongst the provinces Saskatchewan has the highest rate of:
                                                                                          alcohol dependence - 4.0% or approximately 31,000 aged
                                                                                         15+

  Youth Drug Detox and                                                                   alcohol abuse - 8.5% or approximately 64,000 aged 15+


     Stabilization Act                                                                 illicit drug dependence rates for Saskatchewan
                                                                                             0.8% or approximately 6,000 aged 15+
                                                                                             equal to the Canadian average

                                                                                                                                        Well- being-
                                                                                   (Canadian Community Health Survey, Mental Health and Well-being- Statistics
                                                                                      Canada, 2002)




          Saskatchewan Population Data                                                  Saskatchewan Population Data

Saskatchewan is below the national average in many alcohol                    Total cost of alcohol and illegal drug abuse in Saskatchewan was $ 777.3M in 2002.
use categories, but slightly higher in                                            Costs              Saskatchewan                    Manitoba                           Canada
    hazardous drinking (13.8%),
                                                                                                 Alcohol         Illegal       Alcohol         Illegal         Alcohol            Illegal
                                   other’
    experiencing harm because of other’s alcohol use (35.7%)
                                                                                                                 Drugs                         Drugs                              Drugs
        family and marriage problems, being insulted and humiliated,
       serious arguments or quarrels, verbal abuse, physical                  Costs per               $503           $265           $450           $235              $463               $262
       altercations, and physical assault.                                    Capita
                                                                              Direct health      $118.2M          $36.7M       $113.9M         $34.8M         $3,306.2M         $1,134.6M
Saskatchewan is below the national average in cannabis (41.0%                 care costs
                                                          lifetime)
lifetime, 11.4% past year) and many illicit drug (14.2% lifetime) use
categories including cocaine/crack (8.0% lifetime), speed (4.5%               Direct law         $100.6M          $77.4M       $116.5M         $87.1M         $3,072.2M         $2,335.5M
lifetime), ecstasy (2.6% lifetime), and hallucinogens (10.6% lifetime),
                                                                 lifetime),   enforcement
but higher in illicit drug-related harm to self (24.4% past year) including
                      drug-                                                   costs
                                                            financial
physical, friendship and social life, home and marriage, financial harm       TOTAL*             $508.7M        $268.6M        $518.4M        $270.0M       $14,554.0M          $8,244.3M

 Canadian Addiction Survey 2004
                                                                              * Total includes other direct and indirect costs not listed. The Costs of Substance Abuse in Canada 2002, Canadian
                                                                              Centre On Substance Abuse, March 2006.




                  Saskatchewan
            Alcohol and Drug Programs                                                                    Environmental Scan
2005-
2005-06, Saskatchewan Health provided funding of                                       after declining for many years, substance abuse by young
approximately $30.2M for alcohol and drug services                                     people is increasing
                                                                                       multiple substance use is common among youth who abuse
276 Alcohol and Drug treatment beds:                                                   drugs
   168 Inpatient beds (including 18 youth beds),                                                                         province’
                                                                                       northern Saskatchewan, with the province’s most rapid
    99 Detoxification beds                                                             population growth and highest percentage of youth,
     9 Long-term Residential Service beds
       Long-                                                                           experiences the highest rate of substance abuse
    15 Facilities                                                                      rate of substance abuse is highest in the aboriginal population
                                                                                       and first use occurs at a younger age in this population
                                                                                                                                               youth-
                                                                                       abuse of solvents is more prevalent among aboriginal youth-one
                                   community-
50 regional health authority and community-based outpatient                            in five aboriginal youth has abused solvents, with a third of
                                                       throughout
service facilities for youth and adult clients located throughout
the province                                                                           users under age 15




                                                                                                                                                                                                   1
                    Environmental Scan                                                                      Environmental Scan
                 street-
    homeless or street-involved people have very high rates of                                              at-      multi-         hard- to-
                                                                                                increase in at-risk, multi-problem, hard-to-reach client
                                                                  and
    alcohol and drug abuse, are difficult to engage in treatment, and                           populations
    frequently present with multiple problems
                                                                                                   injection drug users
    estimated 3,500 – 4,000 injection drug users in Sask
        risk of contracting and spreading HIV and Hepatitis B and C                                pregnant addicted mothers
        through needle sharing and unsafe sexual activity is significant                           street-
                                                                                                   street-involved youth
        prevalence of Hepatitis C approaching 50% amongst IDU
                                                                                                present new challenges to the A&D and human service systems
                                                            Substance
Best Practices: Treatment and Rehabilitation for Youth with Substance Use Problems, Health
    Canada, 2001
                                                                                                need to enhance collaboration and integration, and provide a
Northern Health Strategy, Saskatchewan Health, 2002; Canadian Community Health Survey –
                                                                 Community                      more holistic and seamless continuum of services
                                                                    Survey
    Cycle 1.1, Statistics Canada, 2002; Canadian Community Health Survey – Cycle 2.1,
    Statistics Canada, 2003
                                                                                                target outreach, prevention, stabilization, treatment and harm
Best Practices: Substance Abuse Treatment and Rehabilitation, Health Canada, 1999
                                                               Health                                                 high-
                                                                                                reduction services to high-risk populations
                                                     Blood-
AT RISK – Recommendations for a Strategy on HIV, Blood-borne Pathogens and Injection Drug
                                           Blood-
    Use, Provincial Strategy Team on HIV, Blood-borne Pathogens and Injection Drug Use,
    Saskatchewan Health, 2002




                    Environmental Scan                                                                      Environmental Scan
Probability of Alcohol Dependence by RHA                                                     Lifetime Illicit Drug by RHA




Source: Canadian Community Health Survey – Cycle 1.1, 2000/01                                Source: Canadian Community Health Survey – Cycle 2.1, 2003




                              Project Hope                                                                           Project Hope
    Premier’
    Premier’s Project Hope announced August 4, 2005                                                                                            2006-
                                                                                                Provides $13.3 million across the province for 2006-07.
     three-
     three-year plan to prevent and treat substance abuse
    based on the 15 recommendations contained in the report                                                                                             initiative.
                                                                                                There is an additional $3.1 million for the Secure Care initiative.
                                  Community,
    Healthy Choices in a Healthy Community, by Legislative
    Secretary on Substance Abuse Prevention and Treatment
    Graham Addley                                                                                                                                             other
                                                                                                And an additional $2.2 million allocated for initiatives with other
                                                                                                departments (DCR, Justice, and CPS).
    target populations:
        Youth                                                                                   This represents an increase of over 60 per cent in substance
        Aboriginal                                                                                                                            2004-
                                                                                                abuse prevention and treatment funding since 2004-05.
        Street-
        Street-involved
        Northern residents




                                                                                                                                                                      2
                       A&D Initiatives                                                         A&D Initiatives
                     Residential Treatment                                                       Treatment
Expand treatment capacity                                             Expand treatment capacity

  12 bed youth stabilization unit in Saskatoon area (6 interim beds
                                                               beds     street-      multi-
                                                                        street-front multi-service outreach centre in Prince Albert and
  at Calder Centre – Saskatoon)                                         Saskatoon
                                                                        enhance youth outpatient and outreach services in Regina and
                                                               area
  15 bed residential youth treatment facility in Prince Albert area     North Battleford
                                               Center–
  (6 interim beds at Pineview Terrace Youth Center– PA)
                                                                        enhance methadone services in Prince Albert and Saskatoon
  12 bed brief detox unit in Regina
                                                                        injection Drug Use Programs
  6 bed social detox centre in Prince Albert
                                                                        Drug Treatment Court – Regina
  Family-
  Family-centered treatment in Saskatoon                                integrated substance abuse programs for offenders (Corrections
                                                                        & Public Safety)
  Secure Care (Youth Drug Detox and Stabilization Act)




                       A&D Initiatives                                                        A&D Initiatives
                    Northern Saskatchewan                                                    Treatment Supports

Expand treatment capacity                                               More flexible treatment supports for individuals
                                                                        and families
  community mobile treatment programs in Mamawetan Churchill
  River and Keewatin Yatthe RHAs                                        therapeutic foster programs for substance abusing youth
                                                                        home respite services for families
  enhance youth outpatient and outreach services in Mamawetan           transition housing programs for youth and adults
  Churchill River and Keewatin Yatthe RHAs




                                                                             Youth Drug Detox and Stabilization Act


                                                                        The Youth Drug Detox and Stabilization Act was proclaimed
                                                                        on April 1, 2006
                                                                                                                                      for
                                                                        developed to provide families and care providers with options for
    The Youth Drug Detox and                                            accessing services on behalf of youth who are unwilling or
                                                                        unable to engage in voluntary service for severe substance
         Stabilization Act                                              abuse or substance dependence
                                                                                                 resort--
                                                                         is to be used as a last resort-- after all other attempts at
                                                                        substance abuse treatment have failed.




                                                                                                                                            3
       Youth Drug Detox and Stabilization Act                                            YDDSA – Court Application


Criterion for youth                                                      Approved applicant
  Youth is suffering from severe drug addiction or drug abuse;             may lay an information before a judge of the Provincial Court
  Youth is at risk of serious harm or damage to himself or herself,
                                                           herself,        stating that they believe
  or to another person;                                                        a youth is suffering from severe drug addiction or drug abuse
                                                                               and
  Youth is in need of detainment to ensure his or her safety or thethe         is at risk of serious harm or danger to himself or herself or to
                                                youth’
  safety of another person or to facilitate the youth’s detoxification         another person
  and stabilization; and
   Youth should be examined by a physician to determine whether            approved applicant includes:
  or not the youth should be admitted to a detox facility or receive
                                                             receive          youth’
                                                                              youth’s parent
                                                                              persons with whom that youth has a close personal
  detox and stabilization services.
                                                                              relationship
                                                                              youth workers




               YDDSA – Court Application                                                  YDDSA Police Guidelines


Judge                                                                    Apprehension

  if satisfied on reasonable grounds that the youth should be            With Warrant:
  examined by a physician to determine whether or not the youth
  should be admitted to a detoxification facility or receive               judge will notify police that a warrant has been issued to
  detoxification and stabilization services                                apprehend a youth based on information received from an
       make arrangements with a physician who is to conduct the            approved applicant
       examination                                                         police will apprehend the youth and transport him/her to the
       issue a warrant to apprehend the youth                              physician for assessment
       cause the youth to be taken to the physician where the youth        police contact physician named in the warrant from the
       may be detained and may be examined by that physician.              physician roster for assessment as soon as possible.
                                                                           assessments required to be completed within 24 hours of
                                                                           apprehension




                   YDDSA Police Guidelines                                                YDDSA Police Guidelines


Apprehension                                                             Assessments
Without warrant:                                                           Act requires the assessment certification of two physicians
                                                                           before a detox or community order is issued
  if a police officer determines there is an immediate risk or
  danger to a youth:
                                                                               Police are responsible for conveyance of apprehended youth
      police may apprehend the youth and transport him/her to the              for both assessments
      physician for assessment                                                 In some cases this will take place locally if a second
      police contact physician named in the warrant from the                   physician is available
      physician roster for assessment as soon as possible.                     In other cases it will be necessary to transport the youth to
      assessments required to be completed within 12 hours of                  the Secure Youth Detox Centre
      apprehension




                                                                                                                                                  4
                YDDSA -Physician Guidelines                                                          YDDSA -Physician Guidelines

Assessments by a Physician                                                            Type of Order
  Issuance of a Community Order or Detoxification Order                                 Based on the assessment information, the physician will
  requires an examination by and the opinion of two physicians.                         determine if the youth
  in most cases, the first physician will conduct an initial                               meets the criteria for a Community Order (section 11), a
  examination, then request an examination and opinion from a
  second physician                                                                                         Order(section
                                                                                           Detoxification Order(section 12) or
  Act does not limit this role to any particular physician group or
                                                                 or                        does not meet the criteria for an order
  specialty
      Saskatchewan College of Physicians and Surgeons
      physician roster
         physicians with particular experience in the relevant
         medical areas, and
         who are likely to be accessible to complete the
         assessments identified in the Act




                YDDSA -Physician Guidelines                                                          YDDSA -Physician Guidelines

   Criteria for Detoxification and Community Orders                                      Criteria for Detoxification and Community Orders
  (a) the assessed youth:                                                                  (cont’
                                                                                           (cont’d)
      (i) is suffering from severe drug addiction or drug abuse and
                                                           stabilization;
      requires detention to facilitate detoxification and stabilization;
      (ii) is likely to cause harm to himself or herself or to other                    (b) other measures are not available or are not adequate to
      persons, or to suffer substantial mental or physical                              sufficiently allow the assessed youth to facilitate the assessed
      deterioration, if he or she does not detoxify and stabilize;                      youth’
                                                                                        youth’s detoxification and stabilization; and
      and(iii) is either:                                                                                                                              the
                                                                                        (c) it is in the best interests of the assessed youth to issue the
            (A) unable to fully understand and to make an informed                      order
            decision respecting his or her need to detoxify or
            stabilize; or
            (B) unable or unwilling to take steps to begin recovery
            from drug addiction or drug abuse or to reduce the risk of
            harm to himself or herself or other persons;




                YDDSA -Physician Guidelines                                                          YDDSA -Physician Guidelines

   DSM-
   DSM-IV criteria for substance dependence                                              DSM-
                                                                                         DSM-IV criteria (modified) for severe substance abuse
      A maladaptive pattern of substance use, leading to clinically
      significant impairment or distress, as manifested by THREE (or                     A) A maladaptive pattern of substance use leading to clinically
                                                                12-
      more) of the following, occurring at any time in the same 12-month                    significant impairment or distress, as manifested by TWO (or
      period:                                                                                                                          12-
                                                                                            more) of the following, occurring over a 12-month period:
   1) Withdrawal                                                                                                                                          major
                                                                                             1) Recurrent substance use resulting in a failure to fulfill major
   2) Tolerance                                                                                  role obligations at work, school, or home
   3) The substance is often taken in larger amounts or over a longer period than                                                                     physically
                                                                                             2) Recurrent substance use in situations in which it is physically
      was intended                                                                               hazardous
                                                                   down
   4) There is a persistent desire or unsuccessful efforts to cut down or control
      substance us                                                                                          substance-
                                                                                             3) Recurrent substance-related legal problems
   5) A great deal of time is spent in activities necessary to obtain the substance          4) Continued substance use despite having persistent or
   6) Important social, occupational, or recreational activities are given up or
                                                                                                 recurrent social or interpersonal problems caused or
      reduced because of substance use                                                           exacerbated by the effects of the substance
   7) The substance use is continued despite knowledge of having a persistent
                                                                         persistent      B) The symptoms have never met the criteria for substance
      or recurrent physical or psychological problem that is likely to have been            dependence for this class of substance
      caused or exacerbated by the substance




                                                                                                                                                                   5
           YDDSA -Physician Guidelines                                                 YDDSA -Physician Guidelines

When assessing, the 1st physician:                                           Upon issuing a detox order.
                                                              following
   is required to contact Official Representative immediately following
   the assessment                                                            the 1st physician will:
   contact Health region addictions services to facilitate                      Contact the facility to determine bed availability
   involvement/support
        Assessment; community orders; case management; follow up
                                                                                The second physician
   is encouraged to forward any relevant medical information to the             Give written notice of an order to the youth, the parents, the
   second physician and/or the detox facility                                   approved applicant, and the Official Representative for the
   Should understand involvement in voluntary services should                   health region where the youth will be detained for
   always be encouraged                                                         detoxification
   where possible, should obtain info from family members, friends,
   educators, community youth workers and health care professionals
   to assist in the assessment process.




           YDDSA -Physician Guidelines                                                 YDDSA -Physician Guidelines

The 2nd physician:                                                           The Detoxification Order:
   Serve in the role of most responsible physician for the youth                Once issued by 2 physician, terminated five days after the
   during their stay at the designated facility.                                date it is issued.
   Will act in a consultative role to professionals providing                   The order may be renewed for up to two additional 5-day
                                                                                                                                      5-
   services contained in the Detoxification Order.
                                                                                periods if, in the opinion of any two physicians, the
Secure Youth Detox Centre - Regina                                              conditions continue to apply.
Physician responsibilities                                                      May be overturned by the physician who issued the order or
  medical status exam; mental status exam; prescribe                            be overturned by the Review Panel.
  medications; consultation with multi disciplinary team; on
  call for physical and mental health emergencies; phone
  consultation to GP's; phone consultation to facility staff;
  referrals for specialist consultation; second assessment and
  renewals to extend stay; attend Review Panels; discharge
  planning




           YDDSA -Physician Guidelines                                       YDDSA - Official Representative Guidelines


Secure Youth Detox Centre - Regina                                        Responsibilities
   Interim solution – 6 beds located at former unit of the Paul                                                                        appeal
                                                                            ensure that involuntary youth are aware of their rights of appeal
   Dojack Centre                                                            and to assist them in exercising their rights.
                                                                            understand and interpret the applicable legislation and assist
   Staffing                                                                 assessed youth with review panel hearings
       24/7 physician coverage                                              balance between the rights of the individual and those of the
       program manager                                                      family and community.
       nurse supervisor                                                   Right to be Informed
       4.2 full time psychiatric nurses                                     following an examination the physician who conducted the
       5 full time youth workers                                            examination must immediately contact an official representative
                                                                            for the region to inform him/her that an examination of a youth
       several part time nurses and youth workers                           has been conducted.
       8 hours of addictions consultation and 4 hours of                    on being contacted, the official representative must immediately
       psychological consultation per week contracted from                  contact the youth who has been examined.
       RQHR




                                                                                                                                                 6
    YDDSA - Official Representative Guidelines                                              YDDSA - RHA Guidelines


Appeals                                                                    Reviewing the roles of Addiction Services in RHAs

  upon receipt of a notice of a detoxification order or a community
                                                          community          upon apprehension youth will be conveyed for assessment by a
                                                                             physician within 24 hours
  order the official representative shall visit the assessed youth
                                                                             Health Region Addictions Counsellors may be contacted by the
     as soon as is reasonably practicable                                    physician
     advise the assessed youth about the right of appeal                        facilitate continued involvement and collateral support with the
     provide any assistance that the official representative                    youth
     considers necessary to enable the assessed youth to initiate               initiate service involvement
     an appeal, if the assessed youth wishes to do so                           physician consultation
                                                                                direct involvement in assessments
                                                                             RHA addictions counsellors available from 9a.m. to 5 p.m.,
                                                                             Monday to Friday
                                                                             after hours and on weekends physicians may call the Secure
                                                                             Youth Detox Centre




                 YDDSA - RHA Guidelines                                              YDDSA - Review Panel Guidelines


Addiction Services roles regarding                                         Review Panel:
                        Follow-
Community Orders and Follow-Up                                             Authority
Community Order:
  RHA addictions counsellors will collaborate with physicians and            Minister appoints a review panel for each youth drug
  other health care and service professionals, whenever possible,            detoxification and stabilization region
  to establish service options contained in the Community Order
                                                                             Review panel shall consist of three persons
      provide a case management function with respect to Community              at least one of who must be a physician
      Orders
      endeavour to see the youth within one (1) working day of receiving        at least one of who must be a lawyer
      notice from the physician
Detox Order Follow-Up:
              Follow-                                                        An alternate member may be appointed for each member of a
  RHA addictions counsellors will endeavour to provide follow up             review panel
  services to youth discharged from the Youth Secure Detox
  Facility on a voluntary basis




          YDDSA - Review Panel Guidelines


Function

  investigation of appeals submitted by persons pursuant to Act
  against an involuntary detoxification order or a community order
  hearings are called whenever an assessed youth, official
  representative or a parent of an assessed youth has submitted a
  written appeal to the chairperson
  hearing is convened with the appellant and other persons
  considered by the review panel to be affected by the appeal to
  testify or produce evidence relating to the appeal, if they
  express a desire to attend.
  Review Panel will determine whether or not the criteria for the
  detoxification or community order have been reasonably met
  decision of the Review Panel must be submitted within two
  business days of the appeal request




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