Table 2 Proportion of support and opposition responses for policy options for substance use grouped by modified Nuffield Council on Bioethics Intervention Ladder categories for policy influencers and the general public in the 2019 Chronic Disease Prevention Survey, n (%)
Nuffield Intervention Ladder category | Policy and Level of Support Strongly Oppose: StO Somewhat Oppose: SoO Somewhat Support: SoS Strongly Support: StS | Alberta | Manitoba | ||
|---|---|---|---|---|---|
General Public n = 1648 | Policy Influencers n = 204 | General Public n = 1770 | Policy Influencers n = 98 | ||
Rung 2 – Provide Information | Dedicate more funding for substance use education and prevention programs and updated curricula in elementary and high schools (Q54.2) | NA | StO: 2 (1) SoO: 11 (5.7) SoS: 77 (39.7) StS:104 (53.6) | NA | 3 (3.2) 2 (2.1) 38 (40.4) 51 (54.3) |
Develop public information campaigns on evidence-based treatment options for people living with substance use disorders (Q54.5) | NA | StO: 4 (2.1) SoO: 9 (4.7) SoS: 89 (46.1) StS: 91 (47.2) | NA | 3 (3.4) 2 (2.2) 35 (39.3) 49 (55.1) | |
Rung 3 – Enable Choice | Develop medical school curricula, medical association guidelines, and professional development programs to train health care practitioners about their responsibility to counteract stigma towards people who use drugs (Q54.1) | NA | StO: 12 (6.4) SoO: 13 (7) SoS: 84 (44.9) StS: 78 (41.7) | NA | 5 (5.3) 6 (6.3) 33 (34.7) 51 (53.7) |
Develop screening tools and interventions to identify and assist students at risk of developing substance use disorders or experiencing substance-related harm (Q54.4) | NA | StO: 1 (0.5) SoO: 8 (4.1) SoS: 86 (43.9) StS:101 (51.5) | NA | 3 (3.3) 1 (1.1) 39 (42.9) 48 (52.7) | |
Implement specialized inpatient and outpatient addiction medicine care in hospital facilities(Q54.7) a, b | StO: 109 (7.1) SoO: 156 (10.2) SoS: 641 (41.8) StS: 628 (40.9) | 5 (2.6) 15 (7.8) 94 (48.7) 79 (40.9) | 65 (3.9) 107 (6.4) 650 (39) 844 (50.7) | 3 (3.3) 6 (6.7) 44 (48.9) 37 (41.1) | |
Facilitate access to substance use services for children and adults involved with the criminal justice system (Q54.8) | NA | StO: 9 (4.8) SoO: 13 (6.9) SoS: 79 (41.8) StS: 88 (46.6) | NA | 7 (7.4) 2 (2.1) 39 (41.5) 46 (48.9) | |
Implement harm reduction interventions like sterile syringe distribution and supervised consumption services in correctional facilities (Q54.9) | NA | StO: 42 (22) SoO: 22 (11.5) SoS: 75 (39.3) StS: 52 (27.2) | NA | 13 (14.8) 14 (15.9) 26 (29.5) 35 (39.8) | |
Create publicly-funded permanent supportive housing units for those living with severe substance use disorders (Q54.10) a | StO: 259 (16.9) SoO: 273 (17.8) SoS: 537 (35) StS: 464 (30.3) | 31 (16.8) 28 (15.1) 78 (42.2) 48 (25.9) | 180 (10.9) 271 (16.4) 602 (36.5) 598 (36.2) | 9 (10.1) 12 (13.5) 35 (39.3) 33 (37.1) | |
Create more social supports (e.g., child care) for women that are accessing substance use services (Q54.11) | NA | StO: 7 (3.7) SoO: 16 (8.5) SoS: 71 (37.6) StS: 95 (50.3) | NA | 3 (3.2) 4 (4.3) 35 (37.6) 51 (54.8) | |
Increase the number of harm reduction services (e.g., needle exchange programs, substitution therapies, supervised consumption sites) (Q54.12) | NA | StO: 33 (17.6) SoO: 27 (14.4) SoS: 69 (36.9) StS: 58 (31) | NA | 8 (9.2) 12 (13.8) 33 (37.9) 34 (39.1) | |
Expand the scope of practice for pharmacists to take on a larger role in providing medications for treating opioid addiction for patients (Q54.13) | NA | StO: 7 (4) SoO: 19 (10.7) SoS: 88 (49.7) StS: 63 (35.6) | NA | 3 (3.4) 12 (13.8) 40 (46) 32 (36.8) | |
Increase access to injectable medications for treating opioid addiction (e.g. hydromorphone) for people with severe opioid use disorders (Q54.14) a, b | StO: 244 (16.5) SoO: 210 (14.2) SoS: 511 (34.5) StS: 515 (34.8) | 21 (11.3) 23 (12.4) 85 (45.7) 57 (30.6) | 157 (9.9) 185 (11.6) 619 (38.9) 630 (39.6) | 6 (7.1) 9 (10.6) 45 (52.9) 25 (29.4) | |
Support qualified physicians to prescribe limited quantities of prescription opioids as a harm reduction measure for people dependent on street-sourced illegal fentanyl or other opioids (Q54.15) | NA | StO: 17 (9.8) SoO: 27 (15.6) SoS: 64 (37) StS: 65 (37.6) | NA | 8 (9.3) 7 (8.1) 41 (47.7) 30 (34.9) | |
Prohibit exclusionary zoning policies that prevent sterile needle exchange programs or supervised injection facilities within municipalities (Q54.16) a, b | StO: 324 (22.9) SoO: 242 (17.1) SoS: 390 (27.6) StS: 458 (32.4) | 33 (19.4) 50 (29.4) 54 (31.8) 33 (19.4) | 246 (16.6) 259 (17.5) 405 (27.4) 569 (38.5) | 14 (18.7) 14 (18.7) 26 (34.7) 21 (28) | |
Promote the practice of Screening, Brief Intervention, and Referral to Treatment in primary care settings (i.e., early intervention protocol to assess severity of substance use and appropriate level of treatment) (Q54.17) a | StO: 45 (3) SoO: 81 (5.4) SoS: 640 (42.9) StS: 727 (48.7) | 3 (1.6) 8 (4.3) 95 (50.5) 82 (43.6) | 29 (1.8) 72 (4.4) 675 (41.4) 853 (52.4) | 0 (0) 3 (3.4) 40 (44.9) 46 (51.7) | |
Improve access to medications for treating opioid addiction in provincial correctional facilities (Q54.18) | NA | StO: 24 (12.5) SoO: 8 (4.2) SoS: 86 (44.8) StS: 74 (38.5) | NA | 6 (6.8) 7 (8) 33 (37.5) 42 (47.7) | |
Allocate more public funding for pharmacotherapies to treat people with substance use disorders (e.g., methadone, buprenorphine) (Q54.19) a | StO: 207 (13.7) SoO: 249 (16.5) SoS: 571 (37.8) StS: 484 (32) | 17 (9.6) 29 (16.4) 79 (44.6) 52 (29.4) | 124 (7.5) 231 (14) 683 (41.5) 609 (37) | 6 (7) 11 (12.8) 41 (47.7) 28 (32.6) | |
Increase access to harm reduction services (e.g. sterile syringe distribution, supervised consumption services, peer outreach) for people who are not ready or able to access treatment (Q54.20) | NA | StO: 33 (17.7) SoO: 22 (11.8) SoS: 70 (37.6) StS: 61 (32.8) | NA | 7 (7.7) 9 (9.9) 40 (44) 35 (38.5) | |
Improve integration of medications for treating opioid addiction and other pharmacotherapies for substance use disorders within primary care (Q54.21) | NA | StO: 7 (3.8) SoO: 8 (4.3) SoS: 78 (42.2) StS: 92 (49.7) | NA | 3 (3.4) 6 (6.9) 43 (49.4) 35 (40.2) | |
Rung 4 - Guide Choices by Changing the Default Policy | Develop programs for teachers to connect students who violate school substance use policies with prevention and treatment services (Q54.3) | NA | StO: 4 (2) SoO: 8 (4) SoS: 79 (39.9) StS: 107 (54) | NA | 4 (4.1) 1 (1) 32 (33) 60 (61.9) |
Create funding for First Nations, Métis, Inuit, and urban Aboriginal communities to ensure culturally appropriate and community-driven programming and resources (Q54.22) | NA | StO: 26 (13.4) SoO: 23 (11.9) SoS: 74 (38.1) StS: 71 (36.6) | NA | 7 (7.5) 7 (7.5) 41 (44.1) 38 (40.9) | |
Rung 7 - Restrict Choice | Limit or cap the amount of publicly funded drug coverage for high dose opioid prescriptions (Q54.6) | NA | StO: 14 (8.3) SoO: 30 (17.9) SoS: 71 (42.3) StS: 53 (31.5) | NA | 5 (6.2) 16 (19.8) 30 (37) 30 (37) |