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OPIOID SYMPOSIUM:What We Heard Report

Health Canada is the federal department responsible for helping the people of Canada maintain and

improve their health. Health Canada is committed to improving the lives of all of Canada's people

and to making this country's population among the healthiest in the world as measured by longevity,

lifestyle and effective use of the public health care system.

Également disponible en français sous le titre :Symposium sur les opioïdes : Rapport « Ce que nous avons entendu »

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© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2019

Publication date: March 2019

This publication may be reproduced for personal or internal use only without permission provided the source is fully acknowledged.

Cat.: H14-306/2019E-PDFISBN: 978-0-660-29476-6Pub.: 180772

Please note: This report is intended to summarize the spirit of the proceedings and discussion that took

place at the Opioid Symposium, held in Toronto on September 5th and 6th, 2018. Every effort has been

made to capture feedback and comments.

TABLE OF CONTENTEXECUTIVE SUMMARY ...................................................................................................................... 3

Background and Context ...............................................................................................................4

Opioid Symposium .......................................................................................................................... 5

SUMMARY OF DISCUSSION .............................................................................................................. 6

Snap Shot Sessions ......................................................................................................................... 6

Examining the Factors That Lead to Problematic Substance Use ...................................... 7

Learning from People Directly Impacted by the Opioid Crisis ..............................................8

Addressing Stigma Associated with People Who Use Drugs and People Living with Chronic Pain ......................................................................................... 10

Impacts of the Opioid Crisis on Indigenous Communities .................................................... 11

Federal, Provincial and Municipal Armchair Discussion: Responding to the Opioid Crisis ................................................................................................. 12

Innovative Approaches to Treatment and Prevention ......................................................... 13

Compliance and Enforcement .................................................................................................... 16

CONCLUSIONS AND NEXT STEPS ................................................................................................. 17

PARTICIPATING ORGANIZATIONS ................................................................................................. 18

OPIOID SYMPOSIUM: WHAT WE HEARD REPORT

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EXECUTIVE SUMMARYThe 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


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Background and ContextThe 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.

https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/federal-actions/overview.html


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Opioid SymposiumThe 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)

https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/responding-canada-opioid-crisis/opioid-symposium-2018/agenda.html

https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/responding-canada-opioid-crisis/advertising-opioid-medications/symposium-summary.html

https://canada-preview.adobecqms.net/en/health-canada/programs/consultation-strengthening-canada-approach-substance-use-issues.html


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SUMMARY OF DISCUSSIONThis 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 SessionsMinister 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.

“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


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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 UseThe 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

“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


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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 CrisisThe 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.

“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


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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.


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

“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


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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 CommunitiesThe 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.

“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


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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 CrisisThe 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

“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


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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 PreventionNext, 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

“No one organization, no one level of government, can deal with this crisis alone.”

Rita Notarandrea, moderator, Treatment for Substance Use Disorder


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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


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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


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Compliance and EnforcementThe 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

“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


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CONCLUSIONS AND NEXT STEPSMinister 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


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PARTICIPATING ORGANIZATIONSAcademic 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


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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


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First Nations Health Authority

Fraser Health

Fred Victor

Fresh Start Recovery Centre

Get Prescription Drugs off the Street Society

Health Canada

ILLICIT

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


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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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