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A five-point plan to end the drug poisoning crisis in B.C.

A five-point plan to end the drug poisoning crisis in B.C.

Keir Macdonald, CEO of Phoenix Society

7,072.

That is how many people British Columbia has lost to poisoned drugs since the beginning of 2016.

This week marks exactly five years since the provincial government declared a public health emergency over the tainted and toxic illicit drug supply.

Back in 2016, alarm bells were ringing because the number of deaths due to the toxic supply of drugs in B.C. was skyrocketing. We would soon learn that fentanyl, a synthetic opioid 40 to 50 times more potent than pure heroin, was the culprit. In 2015, the year preceding the drug poisoning crisis, 529 British Columbians lost their lives to drugs. That spiked to 991 in 2016.

If that was deemed a state of emergency, it is hard to find strong enough words to describe the tragic situation today, as deaths have continued to rise at tragic and alarming rates in the years that have followed. In 2017, 1,493 people lost their lives, then another 1,550 in 2018. While the year 2019 saw a decrease in deaths, to 985, the COVID-19 pandemic resulted in an almost-doubling of fatalities from 2019 to 2020 (to 1,724).

Sadly, this year is shaping up to be equally grim. In the first two months of 2021, 329 people have already been lost. That means that right now, more than five people are dying every single day in this province. Even estimating conservatively, we are on track to surpass last year’s death toll. This is B.C. alone. Nationally, more than 17,600 Canadians died of overdose from the start of 2016 to June 2020.

It’s time we begin treating the drug poisoning crisis with the same level of attention, emergent response and financial backing that the COVID-19 pandemic has received. If we want to truly address this epidemic, bold steps must be taken quickly. There is literally no time to waste. Necessary steps that will save lives, and keep our mothers, fathers, sisters, brothers and friends alive to see tomorrow. Some of the ideas we are proposing have been discussed for years but have been slow to implement or have not yet received approval. All are vital to helping slow and prevent the unnecessary loss of life we are experiencing.

1) Significantly enhance access to pharmaceutical alternatives to contaminated supply

We often hear this crisis referred to as an overdose crisis, but in reality it is a drug poisoning crisis. One of the primary causes of overdose is the contamination of the illicit drug supply.  Providing pharmaceutical alternatives to a contaminated supply or “safe supply” could significantly reduce the number of drug poisonings crisis. This approach is the pharmaceutical replacement of things people are buying on the street. There are regulated, known, safer equivalents to almost everything, including opioids, stimulants and benzodiazepines.

The program has been slow to roll out, but Minister of Mental Health and Addictions Sheila Malcolmson promises action on “safe supply.” So far this year, fentanyl has been detected in 87 per cent of those who have died.

But we recognize there are also many questions about this practice. There is little published data directly supporting its safety or benefits or cost-effectiveness when delivered outside of a supported environment such as the Crosstown Clinic in Vancouver. There has been little indication as to whether the provincial medical, nursing and pharmacy colleges will truly support it, and some prescribers fear being disciplined if they adopt it, especially given the fact that professional guideline panels have been encouraging less use of opioids and the tapering of high-dose opioid prescribing.

In February, $15 million in federal funding for four safer supply projects was announced for B.C. These four projects, in Vancouver and Victoria, will provide people with substance use challenges with a safer, medical alternative from a licensed prescriber, while simultaneously connecting them with health and social services, including treatment.

In a perfect world these services would be delivered by trained health professionals in an environment where other services like primary care, housing or treatment could be accessed. We should continue to invest in the expansion of Injectable Opioid Agonist (iOAT) and Tablet iOAT treatment services. iOAT is an evidence-based option within continuum of care for people with opioid use disorder, often at high risk of overdose.

An expansive and accessible supply of regulated and clean substances would mean those struggling in the throes of addiction wouldn’t be forced to turn to the illicit market today. It will keep people alive, which is where we must start.

2) Decriminalize the possession of illegal drugs

Decriminalization of the possession of opioids and other illicit drugs is one step that’s being hailed by many experts in the field as a solution. The predominately criminal-justice-based approach to substance use that exists in Canada today has given the overwhelming balance of power to law enforcement, in the context of attempting to prevent harms from substances.

Evidence has shown that this approach has had the opposite effect and has substantially increased harms. Law enforcement and health officials now recognize that we “cannot arrest its way out of the overdose crisis.”

Last summer, the Canadian Association of Chiefs of Police issued a report last summer calling for called for the decriminalization the possession of small amounts of drugs for personal use, stating that “merely arresting” people is ineffective and that police forces are inconsistent when it comes to handling cases of possession. Earlier this year, our own B.C. government urged Ottawa to decriminalize drug possession after the record-breaking year for overdose deaths here.

People who attempt to access help for substance use and experience external stigma are less likely to seek help in the future. Stigma matters because it undermines the response to the drug poisoning crisis in B.C. at every turn. The current regime has resulted in the criminalization of hundreds of thousands of British Columbians whose only “crimes” were the desire or need to use illegal substances. It negatively impacts the lives of people and the ability of some individuals to receive or access basic health care (e.g. treatment) and social needs (e.g. housing, employment).

Outside of the obvious benefits, the financial savings to our criminal justice system that would result from decriminalization can’t be ignored: The number of people charged with drug possession of non-cocaine, non-heroin drugs in Canada more than tripled to 13,725 in the past decade to 2019, according to Statistics Canada. The number of people charged with heroin possession almost quintupled, to 1,043. If this funding currently spent on the criminal justice system was re-directed to health and social services we could truly help so many more people.

3) Double the funding for non-profit run supportive recovery facilities

Did you know that services providers receive approximately $65-$75 a day to fund an emergency shelter bed or supportive housing unit in B.C. while supportive recovery operators receive just $35.90 per bed? How does this happen?

It means that emergency shelters, which provide necessities such as food and shelter, receive twice the level of funding than supportive recovery operators do. As a result, recovery providers are often forced to decide how best to ration those funds and rather than being able to offer a breadth of programming, such as counselling, life skills and a whole lot more. Many are forced to focus on food and shelter and do the best they can with the little that is left. This is an unsustainable model and it needs a significant shift and enhanced level of investment. Rarely are shelter or supportive housing providers required to service the cost of a lease or pay a mortgage, so there are literally tens of thousands of dollars in additional costs that supportive recovery facilities must factor into their operating budget and yet receive a fraction of the funding.

These cost estimates – from the Canadian Centre on Substance Use – are compared to an average of $96-a-day for a federal half-way house bed, $199-a-day for a provincial prison bed, and a whopping $315-a-day for federal prison stays.

It’s alarming that supportive recovery beds receive by far the least of all of these services, yet arguably could do so much more to support people as they are one of the best environments to help someone in treating their addiction, heal their trauma, and move forward in life. There are over 120 registered supportive recovery facilities operating across the B.C with roughly 1,000 beds, significantly more than the level of licensed treatment and recovery beds.

Rather than acting on calls for more treatment and supportive recovery beds, we could start by doubling the funding that non-profit supportive recovery providers receive, from $35.90 to $70 per-person per-day. This investment would bring these services into line with current funding levels received by other shelter and housing providers and be better able to deliver more of the services provided for under the changes to the Community Care and Assisted Living Act for supportive recovery homes that came into effect in December 2019.

4) Provide access to mental health and substance use services in every supportive housing building

The public may be surprised to learn that supportive housing facilities do not always include mental health and addiction services to those living there.

This is a missed opportunity. While we wholeheartedly agree with B.C.’s “Housing First” strategy, we must look at what Housing First in it truest and purest form really is, and how that differs from what is currently funded. The Housing First strategy involves putting a roof over someone’s head, wrapping services around individuals to stabilize them, then promoting self-sufficiency with the goal of reintegration into the community.

The logic is sound; this Housing First model, by its definition, involves moving people experiencing homelessness, particularly those experiencing chronic homelessness, rapidly from the street or emergency shelters into stable and long-term housing with support. The premise is that stable housing provides a platform to deliver services to address issues frequently faced among the chronically and episodically homeless. And the goal is to encourage housing stability and improved quality of life for persons served by “Housing First” and, to the extent possible, foster self-sufficiency.

The provincial government deserves credit for the unprecedented investment in housing through the Rapid Response to Homelessness Initiative and the new 2,500 Supportive Housing units they have committed to. But what these programs sadly lack are mental health and substance use services. For these services to truly meet the recommendations and standards established by Housing First under the At Home Chez Soi study, housing should offer services that integrate treatment for both substance use and mental illnesses.

Across B.C. in 2020, 84.5 per cent of the 1,724 drug toxicity deaths have happened indoors. Roughly 56 per cent of those occurred in private residences (965) and 26.2 per cent in “other” residences (452) – a category that includes social and supportive housing, SROs, shelters, and hotels. The picture becomes more alarming when we delve into Vancouver’s statistics, a city which is home to the largest amount of supportive housing and shelter beds in the region. In Vancouver Coastal Health Authority, “other” residences were the most common place of illicit drug toxicity deaths (47.6 per cent), followed by private residences (35.2 per cent) between 2018 and 2021.

That means 619 out of the 1,300 people who died of illicit drug toxicity in Vancouver Coastal Health over that time frame lost their lives in these “other” private residences. There is no better entry point to integrate mental health and substance use services than through supportive housing. BC Housing’s investment in the bricks and mortar needs to be matched with operational funding from the health authorities to private these vital supports.

5) MSP coverage for registered counselling and psychology services

All Canadians have struggled with mental health during the COVID-19 pandemic, and of course, this includes marginalized populations.

An Ipsos Reid poll released in February found that the second wave of the pandemic exacerbated the mental health struggles of individuals on a grand scale. The results indicate that the majority of Canadians (56%) say they are feeling increased stress or anxiety as a result of COVID-19. Struggles with addiction have also been exacerbated by the pandemic; this is best evidenced by the dramatic spike in toxic drug deaths we have experienced over the past year.

Making registered counselling and psychology services free through MSP is long overdue. These supports currently come at a significant cost. The British Columbia Association of Clinical Counsellors has recently adjusted the rates for Counsellors in BC to a rage of between $120-$150+GST per session. Even those who have private benefits through work typically only receive enough for a handful of sessions per calendar year. Whilst there have been some new investments in free services from the provincial government, we can and must do better.

While these supports have not traditionally been part of what we consider health care, B.C. Psychological Association (BCPA) is rightfully arguing their services should be integrated into the primary care system. Imagine the long-term change if individuals had easy, timely access to mental health supports.

As Erika Penner, a director with the BCPA has told the media, “the result would be happier and healthier people, reduced prescription medication and overall health care savings.”

It’s hard to argue with that.

Complex challenges require comprehensive solutions. It’s time to get serious and bold about how we approach the drug poisoning crisis. One more life lost is too many.

Keir Macdonald is the CEO of Phoenix Society. He has extensive experience leading social service agencies, establishing and delivering vital programs for those most in need. He is a strong advocate for positive social change in the realms of housing, homelessness and recovery. Social justice has been a lifelong passion of Macdonald’s. Prior to his work in the non-profit sector, he worked with BC Housing and earlier focusing on international law and human rights initiatives.

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