B.C.'s harm-reduction and addiction treatment systems plagued by gaps

In the same week that the province’s decriminalization rollout marked a shift in drug policy, grim figures from the B.C. Coroners Service — which show people continue to die in near record numbers due to the toxic drug supply — laid bare the gaps in the province’s harm reduction and addiction treatment system.

The approach to filling those gaps varies widely depending on where you sit on the political spectrum.

The B.C. Liberals say the NDP government is focused on handing out “publicly supplied addictive drugs” instead of investing in a publicly funded treatment and recovery system. The B.C. Greens say the 2,272 drug toxicity deaths last year are a clear sign that the province’s harm-reduction strategies — which include prescribed opioids to replace toxic street drugs — aren’t reaching enough British Columbians, particularly in rural and remote parts of the province.

And the province’s mental health and addictions minister says the NDP inherited a broken system and is trying to build a comprehensive model of substance use and mental health care from the ground up.

Advocates say it is a mistake to politicize the province’s drug policy and that harm reduction and treatment exist on a spectrum, all aspects of which continue to be woefully underfunded.

Dr. Paxton Bach, co-medical director of the B.C. Centre for Substance Use, said there is a narrative that public dollars can be invested in either harm reduction or treatment as if the two approaches conflict with each other.

“Once we start down that pathway, we’ve already lost,” Bach said Tuesday after Chief Coroner Lisa Lapointe released the drug toxicity numbers. “The reality is that we don’t need to invest in one strategy but a spectrum of care that our patients desperately deserve.”

Bach, an addiction medicine physician at St. Paul’s Hospital, said he has patients who have been in treatment or recovery for weeks, months, even years. If they have a relapse, it’s important that they have safer alternatives to toxic street drugs to prevent them from a fatal overdose.

B.C. Liberal leader Kevin Falcon accused the government of focusing solely on harm reduction which keeps people in the grip of addiction.

“Harm reduction is just a small fraction of what should be a comprehensive approach,” he said.

On Thursday, Falcon laid out a “radical shift in direction” for B.C.’s addictions treatment system. He said if he becomes premier, his government would spend nearly $1.5 billion over three years to build an “accessible no-cost recovery-oriented system of care for anyone struggling with addiction issues.”

Falcon said he would triple the capacity at the 105-bed Red Fish Healing Centre, located on the site of the former Riverview Hospital, which treats patients with severe and complex mental health and addictions.

The plan would include mandatory treatment for people who are a harm to themselves or others, Falcon said. He would also like to see a province-wide centralized waitlist for addiction treatment so the government has a better grasp on how many more beds are needed to respond to the shortfall.

On Tuesday, Lapointe decried the fact that B.C. has no data on how long the waitlists are for the province’s 3,260 publicly funded substance use beds or the outcomes for people who use them.

“There is still no provincial framework for regulation and reporting on outcomes, so we don’t actually know across the province where those beds are,” Lapointe told reporters. “We don’t actually know what it means when a bed is funded. How many people does that help? What are the outcomes for those people?”

Asked about the missing data, Jennifer Whiteside, B.C.’s minister of mental health and addictions, acknowledged the province needs better access to treatment bed waitlists, but gave no timeline for how soon that could be available.

“We need to do some groundwork with health authorities and with our partners in order to have the information we need in order to be able to provide that information,” she said.

Bach said people in Vancouver typically wait several weeks to enter detox, which is “an eternity for someone who is continuing to use drugs and maybe is vulnerable to so many different harms over that time.”

From there, if the person wants access to a publicly funded bed-based treatment program, they are facing a wait of three or four months.

“Which means once they finish their detox they are left in limbo while waiting to actually access the treatment program they are seeking,” he said.

Harm reduction advocates have cautioned against detox for people using opioids because if they relapse after a period of abstinence, they are at higher risk of overdose from potent street drugs. That is why many in addictions medicine have opted for harm-reduction measures such as opioid agonist therapy which provides prescription-grade opioids such as methadone, hydromorphone or suboxone to manage people’s addictions.

Garth Mullins, a drug user who spent at least a decade using heroin before he was prescribed methadone in 2002, said abstinence-based treatment doesn’t work for everyone. That is why he advocates for low-barrier access to non-toxic opioids to stop people from dying, something which is in especially short supply in more rural and remote areas of the province.

“I went to 12-step (programs). I went to all these things. That sh– didn’t work for me. I never got abstinent and clean,” said Mullins, an activist with the Vancouver Area Network of Drug Users. “You end up with that problem if you’ve been abstinent for a while, then you slip, and your tolerance has changed and you die.”

Guy Felicella, a peer clinical adviser with B.C. Centre on Substance Use in Vancouver, said the debate between harm reduction and treatment has been reduced to political grandstanding.

“If we just think that sending people to treatment is going to be the answer, then we are going to fail more people again,” said the 53-year-old who has been sober for 10 years following a decades-long heroin addiction.

It’s one part of the solution, Felicella said, but equally important is second-stage housing to support people after treatment and publicly funded counselling to deal with the underlying trauma related to the addiction.

“My kids wouldn’t be alive without harm reduction, and I wouldn’t have the life that I have today. Gone are the days where it’s either/or. It’s both.”

kderosa@postmedia.com

1. B.C. toxic drug deaths in 2022 were almost as high as the record set a year earlier

2. Decriminalization alone is not enough, experts warn

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