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Substance Misuse – Alcohol, Tobacco, Vaping, Cannabis and Opioids Information for Physicians

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This page has information and tools regarding substance use that can be helpful for physicians.

Asking your patients about substance use

  • Brief conversations with patients about substance use is important to understanding their overall health. It also helps identify potential impacts on current or future health issues.
  • Halton Region Public Health recommends that healthcare providers routinely ask all patients about substance use and assess their risk level. Discussions with patients who have no/low risk provide opportunities for promoting healthy lifestyle behaviors and raising awareness of harm reduction strategies.

How Halton Region Public Health supports physician offices

Halton Region Public Health partners with physicians to help prevent and reduce substance misuse by:

  • collecting and analyzing relevant data and providing reports
  • developing and sharing resources
  • identifying priority populations and reducing health inequities

We also collaborate with physicians and share evidence-based practices to:

  • promote well-being, including healthy living behaviours
  • develop effective public policy
  • create supportive environments

Alcohol

  • The World Health Organization has listed alcohol as one of the top five global risk factors for death and disease. It is a causal factor in over 200 disease and injuries, including cancer and other chronic diseases.
  • Canada’s Low-Risk Alcohol Drinking Guidelines (external PDF) advise adults 25-64 about how to minimize such risks.
  • Alcohol is an important issue in Halton—46 per cent of adult residents consume more than the recommended daily limits. This puts them at higher risk for significant health and social harm.
  • You can assist in reducing alcohol-related harm by asking patients about their alcohol use and addressing any concerns early. Effective intervention and treatment can help those who drink alcohol to increase abstinence and reduce negative impacts.

Fetal Alcohol Spectrum Disorder

Fetal Alcohol Spectrum Disorder (FASD)

  • Extensive research shows there is no safe level of drinking during any stage of pregnancy. Alcohol can harm fetal development and result in Fetal Alcohol Spectrum Disorder (external link).
  • Halton Region Public Health encourages healthcare providers to discuss alcohol use with all girls and women of childbearing age. Research shows that five to 10-minute counselling sessions can help identify real or potential alcohol problems and reduce alcohol consumption by up to 30 per cent during pregnancy.
  • The best advice to tell a woman who is pregnant or planning to become pregnant is that there is no safe amount or type of alcohol to drink. Discussing any concerns about alcohol use or exposure can help her abstain or reduce alcohol use. Awareness of any fetal alcohol exposure will allow for proper monitoring, follow-up and referral to developmental services.
  • Learn more: Managing Alcohol Use in Pregnancy Toolkit (external link)

Screening

Screening

  • Routine screening helps you assess a patient’s daily and weekly consumption patterns and alcohol-related risks. Based on the information gathered during screening, you can:
    • tailor interventions
    • identify risk factors for current and/or future illnesses
    • refer patients to appropriate health and other community resources
  • Screening may also inform individualized preventative measures, which have proven effective in reducing alcohol-related risks.
  • Learn more: Screening and Assessment of Alcohol Use Risk (external link)

Treatment

Treatment

Patients seeking support for alcohol use can be referred to:

 

Tobacco

One of the most important actions people can take to improve their health is to quit smoking, as it remains the leading preventable cause of death and disease. As of 2018, 16 per cent of residents aged 20+ were current smokers in Halton Region.

Screening

Screening

  • Halton Region Public Health encourages healthcare providers to ask every patient their smoking status. Frame the conversation using the VBA (very brief advice) (external PDF) method: ask, advise and act.
  • The most effective strategy for smoking cessation is a combination of counselling and pharmacotherapy.

Very Brief Advice on Smoking

  30 seconds to save a life

  •   ASK AND RECORD SMOKING STATUS
    • Is the patient a smoker, ex-smoker or a non-smoker
  •   ADVISE ON THE BEST WAY OF QUITTING
    • The best way of stopping smoking is with a combination of counselling and pharmacotherapy.
  •   ACT ON PATIENT’S RESPONSE
    • Build confidence, give information, refer, prescribe.
      • Refer to counselling, internet programs, telephone quit lines, or prescribe pharmacotherapy.

Treatment

Treatment

Patients seeking support with quitting smoking can be referred to:

 

Vaping

Vaping can lead to nicotine addiction, which is especially problematic among children and youth who are more susceptible to the harmful effects of nicotine. Vaping product use is growing rapidly among youth, and there is limited research on the safety and long-term health effects of vaping products.

The aerosol produced from a vaping product can contain harmful chemicals and heavy metals. Health Canada (external link) advises that youth, persons who are pregnant, and those who do not currently vape should not vape. Canadians should not use vaping products obtained illegally.

Screening

Screening

  • Health care providers are in a unique position to educate about the health risks associated with vaping. Consider asking all patients if they have used or tried vaping products. Assess vaping history from patients presenting with any of the following symptoms as it may indicate vaping-associated lung illness (external link):
    • cough, chest pain, shortness of breath
    • abdominal pain, nausea, vomiting, diarrhea
    • fever, chills, weight loss
  • Report any severe lung illness suspected to be related to vaping products to the Ontario Ministry of Health (external link).

 

Cannabis

Non-medical cannabis use is legal in Canada, but there are health risks associated with its use. Canada's Lower-risk Cannabis Use Guidelines (external PDF) advise adults about how to minimize such risks.

Since legalization, more people are trying cannabis for the first time. Cannabis use among older adults (age 65 and older) has been accelerating at a faster pace than other age groups.

Screening

Screening

Treatment

Treatment

Patients with cannabis use concerns can be referred to:

 

Opioids

Opioid use remains an important public health issue. There are continued concerns over the non-medical use of prescription opioids, recreational use of opioids (such as heroin) and the lacing of street drugs with powerful opioids (such as fentanyl) without users’ knowledge.

The rates for opioid-related harm in Halton are lower than provincial rates. However, there has been steady increase in both Halton and Ontario in the past decade for opioid-related emergency department (ED) visits, hospitalizations and deaths.

Screening

Screening

Before beginning opioid therapy for pain management, use a screening tool to assess a patient’s risk for misuse of opioids:

Treatment

Treatment

Free and confidential information for patients about opioid treatment options in Halton is available at:

For patients who are not ready to stop using opioids, consider sharing these harm reduction messages to reduce their risk:

  • Never use alone. Having another person nearby can save your life.
  • Know your tolerance. Use a small amount of a drug first to check the strength. Remember that any drug can be cut with, or contaminated by, other drugs, which can be harmful or fatal.
  • Carry naloxone, a drug that can temporarily reverse an opioid overdose. Naloxone is available free-of-charge at:
  • Call 911. An overdose is a medical emergency. Under Canada’s Good Samaritan Drug Overdose Act (external link), if you seek medical help for yourself or for someone else who has overdosed, neither of you will be charged for possessing or using drugs, nor will anyone else at the scene.

Reporting

Reporting

Halton Region monitors opioid use in the community. The Region’s overdose early warning system enables rapid detection of situations involving opioids that require a public health or community response through data collection and surveillance, and by collaborating with community partners including first responders and hospitals. Opioid reporting provides a monthly snapshot of opioid activity in Halton Region.

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