The problems with the Problem Address Framework

As one of several community groups that have united in opposition to the Multi-Stakeholder Approach to Problem Addresses (MSAPA), the Campaign for Safer Consumption Sites in Ottawa would like to clarify our reasons for condemning this initiative.

CSCS Ottawa is a grassroots collective of individuals who want to see increased health services for those struggling with drug addiction in our nation’s capital. We are composed of academics, frontline workers, and people with history of substance abuse. We believe people who use drugs have a right to health and self-determination, which includes access to safe and secure housing options. We believe in pragmatic policy that is evidence-based. 

These are the three core reasons we object to the Problem Address Framework:

1. It challenges honest relationships between clients in need and service providers: Due to the criminalization and stigmatization of drug use, people who use drugs will not seek care if they do not feel safe. Concern has already been raised about privacy limitations within the PAF, as multiple stakeholders are encouraged to disclose sensitive information without their clients’ consent. We believe client confidentiality is essential to maintain honest communication and effective service delivery, particularly in health care settings.
2. It undermines pragmatic harm reduction strategies such as secondary distribution: In municipalities such as the Greater Toronto Area, formalized secondary distribution (peers providing equipment and information) out of residential units has been an innovative response to agency limitations (e.g. hours of operation). Ottawa Public Health has recognized that access to harm reduction equipment remains a challenge for people who use drugs in Ottawa, and has suggested formalizing secondary equipment distribution by people who use drugs here (1). Such secondary services provided in Ottawa could be negatively characterized by this framework as a “Problem Address” despite functioning as a community health service.
3. It ignores a clear solution to many community concerns: If agencies want to reduce public drug use and drug equipment litter, provide an alternative to illicit drug use in residential units, and encourage access to addiction treatment, then they should support the creation of safer consumption sites in Ottawa. International research has demonstrated the positive impacts of supervised injection services on clients and communities in Canada and around the globe.

(1) Ottawa Public Health – Harm Reduction Needs Assessment Forum (2014, report prepared by Aideen Reynolds)