The committee met at 9:01 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Good morning, everybody. My name is Niki Sharma. I’m the Chair of this committee. I just want to welcome all of our guests here today.

We’re all on the territory of the Coast Salish people — the Tsleil-Waututh, Musqueam and Squamish. I wanted to acknowledge that at the start.

We have a whole crew from a whole bunch of ministries. We’ll ask you to identify yourself when you’re speaking so people that are listening cawn hear who you are.

I’ll maybe just go through the committee members so they can introduce themselves to you. I’ll start with Mike.

Go ahead.

M. Starchuk: Mike Starchuk, Surrey-Cloverdale.

R. Leonard: I’m Ronna-Rae Leonard. I’m from Courtenay-Comox.

P. Alexis: Pam Alexis, Abbotsford-Mission.

S. Bond (Deputy Chair): I’m Shirley Bond, the MLA for Prince George–Valemount.

T. Halford: Trevor Halford, Surrey–White Rock.

S. Furstenau: Sonia Furstenau, Cowichan Valley.

D. Routley: Doug Routley, Nanaimo–North Cowichan.

N. Sharma (Chair): Wonderful.

I’ll pass it over to you, and maybe you can introduce everybody and get started.

Briefings on
Drug Toxicity and Overdoses

MINISTRIES OF
MENTAL HEALTH AND ADDICTIONS,
HEALTH,
SOCIAL DEVELOPMENT AND
POVERTY REDUCTION,
EDUCATION AND CHILD CARE,
LABOUR,
ATTORNEY GENERAL AND
MINISTRY RESPONSIBLE FOR HOUSING

C. Massey: Absolutely. Good morning, everybody. So happy to be here. My name is Christine Massey, and I’m the Deputy Minister for the Ministry of Mental Heath and Addictions. I’m joined by my colleague.

S. Brown: Steve Brown, Deputy Minister of Health.

C. Massey: I’ll introduce the rest of my colleagues that are here.

To my right, I’ve got Darryl Sturtevant. He is an ADM in the Ministry of Mental Heath and Addictions and also holds a position of ADM in the Ministry of Health doing that coordinated work that we need to do.

To his right is Darrion Campbell. Darrion is the executive director of our overdose emergency response centre. And to his right is Trevor Hughes, deputy minister of the Ministry of Labour.

Then moving to my left, I’m joined by Angela Cooke, associate deputy minister for the Ministry of Attorney General responsible for the housing and construction stan­dards; Jennifer McCrea, assistant deputy minister, Ministry of Education; and finally but not least, Robert Bruce, executive director in the Ministry of Social Development and Poverty Reduction.

I’ll describe a bit how we’ve organized our presentation today. We’re here to present the work we’ve done across government to respond to the toxic drug emergency as well as the broader mental health and substance use system of care. I’ll do most of the presentation. Some of my colleagues will jump in and present some information specific to their slides. I figure I probably have about 45 minutes for our total presentation, and then I know we have lots of time for questions and answers.

I also thank you for your territorial acknowledgment, MLA Sharma. I do also want to start by acknowledging I’m grateful here to be doing this presentation on the unceded traditional territory of the Musqueam, Squamish and Tsleil-Waututh First Nations.

If you move to slide 3, this provides the outline of the presentation, the main sections today. What I hope is that by the end of the presentation, the committee will have a good understanding of how the province has responded to date to the toxic drug crisis and how we’ve evolved our response as the crisis itself has evolved.

[9:05 a.m.]

I also hope to show you how the response fits in with all of the work we’re doing to build the mental health and substance use system of care. I’ll speak, towards the end, to our current work priorities and some of the work that we still have ahead of us.

This discussion this morning focuses, really, on the health and social responses to the crisis. I know you’ll have a presentation from Public Safety and Solicitor General this afternoon on law enforcement aspects, and I’m really hoping this overview will also set you up well for the presentations with the health authorities tomorrow, where you will hear more specific examples. After I give you the provincial overview, you’ll hear what’s happening in each of the regions.

Fundamentally, I hope that this work will help the committee understand what has been done to date and inform its recommendations to government about where it should go next.

I’m going to move straight into slide 5 and some of the data that we have in front of us. But before I do, we’re going to talk a lot about some of the data. It’s worth pausing for a moment to recognize that each of these deaths represents a member of our communities — a family member who was loved and was part of their community. That’s not always evidenced when we talk about the numbers, but I do want to acknowledge that.

I know you will have seen some of this data in different forms from previous presenters, and you’ll probably see it more. The importance here is that we really ground ourselves in the data. There is no argument about the data in front of us. That’s not always the case in all public policy issues and social issues. But we have some really good foundational data that we all share.

Slide 5 demonstrates the number of deaths from toxic drugs and how that has changed over time. You’ll see, marked here in 2016, the date of the declaration of a public health emergency. You can see that that was declared after a steep increase in the number of deaths. And that year, there were 993 deaths.

That declaration sparked an intensification of the province’s efforts, and we started to see some benefit from that effort. You see a decline there starting in 2019. Then you see 2020 marks the COVID-19 pandemic and a sharp increase.

We know that COVID-19 disrupted people’s social networks, the services they had available to them, and these really had also an impact on people who use substances. We also saw a significant increase in the toxicity of the drugs that were available on the streets.

Now, as we’re moving into seeing the COVID-19 pandemic subside somewhat with the vaccinations that we have and other measures, the toxic drug crisis continues, and the number of deaths continue to increase.

Moving to slide 6, we’ve all seen the media stories about overdose deaths that often illustrate their story with pictures of the Downtown Eastside here in Vancouver. But we all know that that’s not illustrative of the issue. As this map shows, it’s a provincewide concern. This map breaks the data down by health service delivery area, which is the smallest data unit available to us. It shows — between April 2021 and March 2022 — the five areas where we saw the highest rates of toxic drug deaths.

I think it’s worth noting that each of these regions are quite geographically and demographically diverse, yet they have different social and service delivery contexts, yet they’re still unified by having these high rates of deaths.

Moving to slide 7, this slide describes the types of populations where we see a disproportionate impact of the toxic drug crisis. You’ll have heard a couple of weeks ago from Dr. Nel Wieman, when she presented with Dr. Henry, about the impact on status First Nations people — the disproportionate impact that is felt on them.

I can’t really improve on the words of Dr. Wieman, who I’ll echo here, that the reasons for this disparity in deaths are complex and varied, but they’re grounded in colonialism and racism. Dr. Wieman shared with you some of the ongoing impacts of colonialism as they relate to this crisis and some of the work we continue to do with First Nations partners.

We also see that males comprise a disproportionate number of deaths, 77 percent of all drug toxicity deaths in B.C.; and 74 percent of those who died were between the ages of 30 to 59.

[9:10 a.m.]

As you heard from Dr. Gustafson last week, it’s the leading cause of death for those aged 19 to 39 and the second-leading cause of potential years of life lost in B.C.

You’ll notice, from this slide, that most of those who are dying are of working age. In fact, we see that 35 percent of those who died were employed at the time of their death. And of those who were employed, half of them were in the trades.

Slide 8 speaks to some of the social factors that we know increase the risk of dying from drug toxicity. This data is drawn from a sample called the provincial overdose cohort, which we follow to provide us a deeper understanding by linking data from various sources. It gives us greater insight as to who is dying and why.

This data shows that people who live in extreme poverty are 33 times more likely to die of illicit drug toxicity than those who don’t live in extreme poverty. My colleague from Social Development and Poverty Reduction will speak a little bit to this more later in our presentation. We also know, from this same cohort, that 44 percent of those who died had received social assistance one month before their death. But of course, they only represent 4 percent of the population.

Being recently released from prison increases risks compared to other residents of B.C., and 62 percent of those who died between 2017 and 2021, almost two-thirds, also experienced concurrent mental health disorders. Using alone is also very risky.

Lastly, over three-quarters of those who died were found to have more than one illicit substance present at the time of their death, the most common being fentanyl, cocaine, methamphetamine, benzodiazepine or another opioid or another stimulant. We know people use both stimulants and opioids — sometimes together, sometimes separately at the different time of the day or different days.

Slide 9. You’ll have heard a bit about this data when the chair of the death review panel, Michael Egilson, spoke to you about this finding. It looked at people who died from illicit drugs and whether they were engaged with the health care system. This shows that three-quarters of those who died did have previous contact with the health care system, including 30 percent who had ten or more health visits within three months.

I just want to highlight this data, because it shows us the power of data linking and doing more research to gain more insight to better inform our response about who is dying. To us, this data shows us that there are more opportunities to dive deeper into this data to see how we can better engage with people when they do present to the health care system and that we need to continue to do the work to expand the mental health and substance use system across the province.

I’ll now turn it over to Robert Bruce to speak to their work, their research, on slide 10.

R. Bruce: As Christine mentioned, income and disability assistance clients are greatly overrepresented in the illicit drug overdose population. Forty-four to 50 percent of all fatal overdoses are current or recent ministry clients, and up to 61 percent of non-fatal overdoses are ministry clients. But they only represent about 4 percent of the total population, and actually about a quarter of those are young children, so we if exclude them, it’s even smaller.

We also know that cheque distribution days — for example, tomorrow — result in a significant increase in overdoses, about 40 percent, in the week following, when we release our cheques. We do know that that puts…. Not only does it mean more people overdosing; it also means greater pressure on our first responders.

To try to figure out why our clients are at much greater risk and what we can do about it, we’ve participated in two research projects over the last few years.

The first one is being conducted by Prof. Lindsey Richardson from UBC, and she is looking at: can we change timing and frequency of how we release our cheques? So right now we release our cheques…. Almost every client gets a cheque at the same time, usually the last Wednesday of the month. So she’s studying whether if we gave them so that different clients get them throughout the month, and also if instead of getting one cheque, they get multiple cheques — what impact that has.

Her initial findings show that it does reduce overdoses, but there is a significant side effect of increased violence and interaction with police. So that study is ongoing.

[9:15 a.m.]

The second one that my branch is leading is the one that Christine mentioned. We’re using the drug overdose cohort at B.C. Center for Disease Control, and we matched our clients to Health and a bunch of other data sets. What we’ve done is…. After we’ve controlled for as many factors as we can identify — for example, recently released from jail, demographics, history of mental and physical health issues and prescription history — our SDPR clients are 33 times at greater risk of experiencing an overdose. That doesn’t mean poverty itself is the driver of that. It probably contributes some of it.

Our next stage of the research is to figure out why our clients are at greater risk. Can we predict who is at greater risk, and most importantly, can we do an intervention?

C. Massey: Turning to slide 11, Robert started to speak to some of the drivers around poverty, and we know there are a number of drivers that contribute to the toxic drug crisis. First and foremost — what people might call the proximal cause — of course, is the toxic illicit drug supply. We continue to see increasing concentrations of fentanyl and increasing prevalence of carfentanil within the supply. As you’ve heard, we’re seeing benzodiazepines, which are a type of sedative, and other substances.

These factors increase the intensity of the overdose risk. We all know, for instance, that naloxone only works against opioids. It doesn’t have any impact on benzodiazepines. Benzodiazepines, depending on what you have and what you’ve taken, can create a prolonged sedating effect, meaning that people need to be monitored for longer periods. These two drugs can interact with each other in a way that intensifies the effect of the other drug, again increasing the risk of overdose.

COVID-19, of course, created more risk. We saw drug intensity and drug toxicity increase, and we also spoke about the interruption of social networks and disruptions to health care services. Many people who use drugs have well established their own networks to help protect them, and many of those were disrupted during COVID-19. Then during COVID-19, we saw economic vulnerability increase, and we saw stress increase. We know that use of substances like alcohol increased use, and we can probably expect the same occurred with illegal substances.

On this slide, you’ll see “mode of consumption.” That refers to the changing ways that people are choosing to consume their drugs, which require different types of responses from us. Many of the overdose prevention services and supervised consumption sites that we’ve put in place were done for people who inject drugs, but more and more we’re seeing that inhalation or smoking is becoming the preferred method to take drugs. To have an inhalation site can be more complex to set up because you need more ventilation, and you need more protections for the staff that are there.

We’re also seeing what’s called polysubstance use, or the use of multiple substances at one time. That could be deliberately or not, depending on what you’re expecting in your drug supply. We just have less evidence and guidance on how we should support people using multiple drugs at different concentrations, and that just presents more challenge to clinicians and others that are supporting them.

On a systemic level, criminalization, racism and stigma are also primary drivers. Each of these factors prevents people who use drugs from seeking out and looking for the support they need. Fear of criminalization creates barriers for people to access services.

Of course, racism in the health care system has been well documented. It creates barriers for Indigenous, Black and other people of colour for accessing supports in ways that they find culturally safe. This can mean that people from BIPOC communities just simply choose not to access care because they’ve had such terrible experiences in the past.

This is even compounded more when you’re talking about substance use, which in itself is stigmatizing. That stigma can lead to social withdrawal, using alone or just avoiding disclosure to your family, loved ones or maybe your longtime family doctor. You’re not going to disclose your substance use.

[9:20 a.m.]

We also know that stigma permeates all sorts of other parts of society. It can guide policies, making it difficult to establish the types of services we need locally and harm reduction services in some communities.

Slide 12 simply summarizes the information I’ve reviewed in this section. I’d say that the complexity of the issue is striking. I know that Dr. Henry spoke to this, and she had a powerful slide that showed a systems map of the problem. Now, nonetheless, complexity doesn’t mean we can’t act, so I’m going to move now to talk about some of the actions that we’ve taken.

Moving to slide 14, A Pathway to Hope is what grounds our work. The vision that is laid out in Pathway to Hope is government’s goal of building a mental health and substance use system of care across the province. It describes the need for investment across the continuum, from prevention and harm reduction to treatment, and the four pillars of the plan are described here.

Slide 15 emphasizes how important our partnerships are with Indigenous peoples to Pathway to Hope. That partnership is embedded in all of our work in Pathway to Hope. Our partnership is underpinned by a commitment to self-determination, strengthening cultural safety and humility of the services we’re providing, and adopting a distinctions-based approach. We’re fortunate, in B.C., to have the First Nations Health Authority to work alongside us to ensure that the services for First Nations are First Nations–led, so the FNHA is embedded in the governance models that we have for our provincial overdose response.

The province has allocated $24 million over three years to support our partnership with FNHA and to support their response to the drug poisoning emergency. We also work, of course, with Métis Nation B.C. to support culturally relevant services and anti-stigma campaigns, and the B.C. Association of Aboriginal Friendship Centres is also one of our key partners.

Slide 16 demonstrates what you see here, in that we have a cross-government response. The role of my ministry, the Ministry of Mental Health and Addictions, is to lead and coordinate that response across government as well as some of our key partners like the health authorities, BCCDC and BCCSU. We all have a role to play in this response, and you’re going to hear from many of these partners already, and more to come.

On slide 17, one of the actions that we committed to in Pathway to Hope and was spoken to in the death review panel is the development of a framework for the substance use system of care. The purpose of this framework is to describe all the elements we need to ensure that people with substance use challenges experience seamless and cohesive care, ultimately, where every door is the right door.

We’ve been working on this framework with a number of key partners, including health authorities, people with lived and living experience, and experts. This framework will try to articulate a shared vision for how we build this system, identifying what the core services we need are, and how they need to work together. The development of this framework is well underway, and we hope to have it released by the end of the year.

I do want to acknowledge that there’s a lot of information on this slide, and much of it will be covered as we move through the presentation, so I’ll leave it for you to review at your leisure. However, it is intended to illustrate all the different services that are required to ensure that we have a system that matches the different needs of individuals, because every individual’s journey is different.

This includes starting with prevention and showing how harm reduction services, like safer supply, can work alongside other supports, like treatment, to ensure that people in B.C. are able to enter into the system and access the supports they need when they need them. However, of course, we’re not waiting for this framework to be done to make investments to start addressing some of the gaps that we know are there.

Slide 18 presents some of our work in the form of a timeline since the toxic drug crisis was declared, alongside some of the work that we’ve done. It’s not intended to be a comprehensive listing of all the work we’ve done. However, what we’re trying to illustrate here is that we’ve had, over time, to escalate our response and change our response as the crisis itself has changed and continued to worsen.

I’m not going to go through all the actions here, because I’m going to touch upon most of them in the coming slides. But I think it’s worth pausing for a moment on the actions taken in 2020, when the COVID pandemic emerged.

[9:25 a.m.]

In 2020, when we were facing a dual public health emergency, we saw that urgent action needed to be taken in all aspects of society and the health care system, and the response to the toxic drug crisis was also one of those areas.

We did a number of key things in that year. We released the first phase of our prescribed safer supply policy. It’s known as risk mitigation guidance, and it was a document that was to guide prescribers and others who support people who use drugs — how they could support them while they needed to isolate or separate themselves from other services that they needed to depend on. That was released in March 2020, and I just want to emphasize how quick that was, given what was happening at the time, and how novel this type of practice is. It was remarkable in a number of ways.

Also in 2020, in September, Dr. Bonnie Henry issued an order that authorized RNs and registered psychiatric nurses to prescribe drugs to help reduce overdose risk. This is a significant shift in the scope of practice for nurses and a first in Canada. We’re doing work to enable this work in three phases, and I’ll talk a bit more about that in the coming slides.

We launched the Lifeguard App that helps people who are using alone, and then we also invested with funds to help enhance services on the ground.

I’m going to move on to slide 19. What this slide is meant to illustrate is that our work spans an entire continuum — from prevention, harm reduction, treatment and recovery and systems of support. Then we’ll speak to our overdose response priorities. As other presenters have said, given the complexity of the issues in front of us, no single action will solve the toxic drug crisis. We simply have to act on all fronts.

I’m going to start with prevention, on slide 20, and some of the work occurring in schools. The Ministry of Health has partnered with the Ministry of Education and Child Care to implement the mental health in schools strategy. It’s an approach that embeds positive mental health in all aspects of the education system. The goal of this work is to prevent kids from initiating substance use and to raise awareness by providing education to students, to families, and to educators.

There are resources available through the ERASE program too, which Jennifer will speak to in a moment. We’ve invested $15 million over three years for this work.

Part of that strategy is a program called the ABCs of substance use. It’s a school approach to preventing substance use–related harms. It’s targeted to youth and pro­vides expanded youth substance use screening and prevention programs.

I’m going to turn it over to Jennifer to speak more about this on slide 21.

J. McCrea: Thanks, Christine.

I, too, would like to recognize that we’re on the traditional territory of the Musqueam, Squamish and Tsleil-Waututh people this morning.

I am a mom — my daughter’s friends have died from substance use — recognizing what roles schools can play in helping to stop the trajectory of young people in our province. It starts with school connectedness. We know that outside of the family unit, school connectedness is the number one protective factor for young people in our province.

We also know that socioemotional learning and mental health promotion embedded right into the curriculum is key. From K to 10 in our physical and health education, that is embedded right into the curriculum, so students learn about the services, the supports, the protective factors of how to protect themselves, how to protect their friends, what influencing factors increase substance use, what the potential harms are and what potential emergency responses could look like for young people in our schools.

We know that families are key, so through the ERASE program, which stands for expect respect and a safe education, we have expanded this work to ensure that we’re looking at harm reduction information from a research base to provide families and young people tools that they need. Within that piece of work, there’s a “Report it” tool, where young people or families can reach out and report if they need help or if one of their friends needs help.

[9:30 a.m.]

One of the things that we also know through this work is that teachers need resources and supports, so we have partnered to do a fair bit of work to understand where those gaps are and what those different resources are that teachers need in our province right now to help support them.

We’re doing that work around expanding our resources but also really looking at what else could be needed. How do we take a whole-child approach when a young person is in need? How do we stop the trajectory, but then, how do we circle that young person so that they don’t become a stat in a coroner’s report?

It is looking at how we do tailored approaches for community by those communities. Our school district officials know their communities, so how do we provide a provincial lens and support? How do we invest money into keeping that school and that education program going when a young person may be in treatment? How do on-the-ground supports really respond to that community?

Partnering with our ministries through the mental health in schools strategy, we’re taking a really deep dive. We invest, through the Ministry of Education — in addition to the $50 million — $186 million a year into mental health and substance use for schools.

C. Massey: I’m going to now move into harm reduction, starting on slide 22. Harm reduction is important to address where substance use is occurring. It focuses on keeping people safe and minimizing the risk of death, disease and injury associated with that substance use, while recognizing that the substance use behaviour may continue, despite the risks. These services not only keep people alive, but they provide support to encourage positive change in people’s lives, while addressing those broader harms.

Expanding the reach of those harm reduction services remains a priority of our provincial response. Naloxone is available at no cost to people who are at risk of illicit drug poisoning and people likely to witness and respond to a drug poisoning event. That’s available through the BCCDC. They have a program called the take-home-naloxone program. You can see from the stats on this slide that the demand for the take-home-naloxone kits is high and continues to increase.

Naloxone has saved many lives, but sadly, we know that many people use alone. In these cases, naloxone is not useful, because there’s nobody to administer it.

This is where the app has been so important. B.C. emergency health services supports the Lifeguard App. It’s equipped with a timer, and it automatically alerts 911 dispatchers when a person is unresponsive and unable to turn off the alarm in the event of a drug toxicity event. Since it was launched in May 2020, we’ve seen nearly 9,000 app users, unique users, and over 100,000 sessions. It has prompted 130 emergency responder calls, and 27 lives have been saved by reversing overdoses.

I’m going to move to slide 23. In addition to naloxone and the Lifeguard App, we’re also expanding access to prevention services that offer observed injection and inhalation services in those communities that have been hardest hit by the drug poisoning crisis. These sites don’t just offer overdose prevention but other services, like drug checking, so people can analyze their drugs.

The number of sites has significantly increased. We had one site in 2016, and we have 40 today, many of which are supported by a ministerial order that was put in place that authorized B.C. emergency health services and health authorities to provide these services on an emergency basis. Sites are operating in all the health authority regions, and you’ll hear more about that. We have not had a single death occur at an overdose prevention site in B.C.

The final element of our harm reduction package which I’d like to draw your attention to is the acute overdose risk case management. The goal here is to improve the referrals for individuals who we know are at risk of an overdose and to support their connection to the services they need. For example, B.C. emergency health services recently implemented a project where they refer people who have declined transport to hospital after an overdose, and they’ll refer them to access supports in their community.

[9:35 a.m.]

We have done some modelling to look at the impact of our actions in harm reduction. Modelling that was done by the BCCDC tried to estimate the number of deaths averted by the combination of naloxone overdose prevention services and opioid agonist treatment, which I’ll speak to in a moment. We saw, between April 2016 and December 2020, over 6,100 deaths averted.

Slide 24 offers a map showing where drug checking is available. Drug checking, of course, is so important where illicit drug supply is so toxic. Drug checking allows clients to submit a drug sample for analysis and learn what it contains, which is really important when the drug supply is so unpredictable.

Drug checking works to reduce deaths when the information it provides to the client actually changes someone’s behaviour — for instance, the information means that that person chooses to use less or perhaps not use alone and therefore reduces their risk of drug poisoning. It also gives us really important information in the health system about the patterns of the drug supply. You’ll probably have seen alerts in your community about particularly toxic batches of drugs, and those are some of the sources of that information.

I’m going to move now to start to talk about treatment, starting on slide 25. I’m first going to speak about opioid agonist treatment. This is an evidence-based treatment. There’s a strong evidence base for it. It’s a standard of care. You’ll have heard of it — for instance, methadone treatment or Suboxone. Those are some of the first-line medications. It’s used when substance use gets to a point where it becomes a disorder, and it’s diagnosed as opioid use disorder.

It’s really the most challenging form of substance use disorder. It’s complex medical condition when it gets to that point, and treatment is often required to address it. We have estimates that suggest over 100,000 British Columbians have opioid use disorder, but not all of those people are diagnosed. Those are estimates. We know that there is no one form of treatment and recovery. There are many pathways to addiction. We are trying to create as many pathways in and out so people can find the right treatment that works for them.

The way that OAT treatment works is it prevents withdrawal and reduces cravings for opioids. It’s been shown to help stabilize people’s lives and reduce their use of illicit substances and the harms that go with that illicit use. Increasing the number of people with opioid use disorder who are engaged and retained in opioid agonist treatment is a key priority I’m going to speak to in a bit.

Since mid-2016, after the declaration of the public health emergency, we’ve been tracking the number of people on opioid agonist treatment, and it’s been steadily increasing. This is thanks to training more people who are comfortable offering that kind of treatment as well as improvements to coverage by PharmaCare and compensation for physicians.

Slide 26 speaks to a couple of priorities with respect to treatment and recovery. We want to both increase the quality of treatment and recovery services across the sector and increase access to services.

I’m going to start by speaking about quality. This is focused on bed-based services. Bed-based services are one option for treatment and recovery. They’re generally appropriate for people who require a higher intensity of services to address complex or acute mental health or substance use problems.

With quality, since 2017, the Ministry of Mental Health and Addictions and the Ministry of Health have been partnering to improve the regulations and improve the capacity of this sector to meet those regulations.

There was a new assisted-living regulation brought into force in 2019 that set new health and safety requirements for all registered assisted-living residences. That meant that they needed to ensure that employees had necessary training, skills and qualifications and provide program and policy information up front to clients so that individuals and families can make better-informed choices.

In September 2021, we also published new service quality standards for registered supportive recovery services. These standards build from that regulation and establish more guidance for delivery of high-quality care. They’re based on the available research evidence.

[9:40 a.m.]

Health authorities are incorporating those standards into the contract language for the contracts they have for clients going into those types of services. We know there’s a lot more to do to modernize this sector, and we’re continuing to look at ways to enhance inspections and how we can further improve oversight and standards.

Moving to slide 27, we’ve also been working to enhance access to those services. Those have been done primarily through making new investments in expanding the number of beds available. That includes more beds in Indigenous-led treatment and recovery services, and more services for youth and adults. We’ve made investments in Budget 2019, and Budget 2021 was marked by the most significant investment to date, $132 million over the fiscal plan to set up 195 new substance use beds. We now have 105 new beds for adults, which are fully operational across the province. Altogether, since 2017, we’ve opened 280 adult and youth treatment beds.

I’m now going to move into what we call systems of support. Health services are just one part of how we’re responding to the ongoing drug toxicity crisis. We also need to provide broader social support, which includes addressing the broader conditions under which people are living, addressing stigma and mobilizing community resources. This includes income and housing supports, social and emotional learning for kids, and keeping people safe and supported at work.

To speak to some of the supports, I’m going to turn to Robert Bruce again, from the Ministry of Social Development and Poverty Reduction, for the information on slide 28.

R. Bruce: SDPR has several policies and processes to try to minimize the amount of cash that’s in the hands of people who are stricken with addictions, because we know that leads to greater overdoses. We support direct deposit. We encourage clients to use direct deposit, and the vast majority of our clients do that. We also encourage our clients to sign up so that we can pay the landlords directly, and about half of our clients do that.

For clients that demonstrate that they have severe trouble, difficulty in managing their funds, if they continually come back to the office and say that they lost all their money, that they can’t afford rent and can’t afford food, we will try to administer those clients, which means we could be paying them daily. That’s a purely manual process, so we try to do that only when absolutely necessary.

As Christine mentioned, we pay per diems for clients in licensed residential treatment facilities and support recovery homes. We also provide these clients with a comforts allowance to encourage them to stay in the shelters, in these facilities. Also, during COVID, when we provided a $300 supplement to all income and disability assistance clients, we actually provided that to our clients in supportive recovery homes and residential care facilities to encourage them to stay in those facilities and not leave them to come back onto assistance.

C. Massey: Thank you, Robert.

For the next slide, slide 29, I’ll turn to Angela Cooke.

A. Cooke: Good morning, everyone.

I come to you today from the unceded territory of the Musqueam, Squamish and Tsleil-Waututh.

As my colleague DM Massey alluded to on slide 18, what I’d like to do today is to provide some more context at the start of 2020, when we were in the height of the first wave of COVID.

You will be aware that Minister Eby was given the mandate to lead the government’s efforts to address homelessness by implementing a homelessness strategy. We know that the government has invested significantly in homelessness across the province, and the numbers continue to increase, as does the complexity.

Obviously, during COVID-19, we saw a number of people lose their incomes, their support networks and their homes, and people were often displaced from shelters and institutions. This compounded the drug toxicity crisis and also the affordable housing crisis as well.

[9:45 a.m.]

The homelessness strategy builds on the growing body of research and prior investments, such as the $7 billion in 2018 as part of the B.C. 30-point plan and the 2019 poverty reduction strategy. The homelessness strategy brings together these investments and plans with a framework to tackle the long-standing issues and service gaps, and the strategy has totally been developed with cross-ministry coordination to ensure that immediate actions and a plan to develop systemic changes are in place.

As part of Budget 2022, you will see that $633 million was placed to address the immediate needs and long-term planning to reduce homelessness. This includes $170 million to increase health supports to the Ministry of Health and to support housing access and inclusion and service navigation.

We also have been provided with $254 million as part of a permanent housing plan, and that’s to support the 3,000 people that, as a result of COVID, needed to be housed within temporary accommodation, as part of the pandemic, to ensure that they do not return to homelessness.

There has also been the introduction of a rent support supplement program that increases payment to $600 dollars a month for more than 3,000 people over the next three years, with the first phase of 500 people receiving support in the fiscal year of ’22-2023.

Also, the province is supporting a community integration specialist through my colleagues in SDPR. Again, that’s to ensure that we are able to access people experiencing homelessness and to provide them with the relevant supports necessary.

Also, through B.C. Housing, we’ve provided $4 million in encampment supports to ensure that we’re engaging and supporting people better, with better food and sanitation and storage and ensuring that they do get access to safe supply and to reduce the level of violence that people experience in those types of living environments.

We’ve worked very closely, as well, with our colleagues in MCFD to ensure that we’re supporting the number of youth transitioning out of care to also ensure that they don’t end up in homelessness and are also making sure that we’re trying to minimize their risk of engaging in drug use.

The key strategies as part of this integrated framework are that we hope, through the housing lens, to support my colleagues in the Ministry of Mental Health and Addictions to ensure that there is an integrated framework that provides service navigation, health services, mental health and substance abuse services that are culturally appropriate to support Indigenous and BIPOC people and to ensure that their relevant personal care, food and basic supports are in place.

I would say that housing is the nucleus of being able to address a number of the issues presented today, because if people have housing, we know that that does lead to improved outcomes and helps to support the strategies that my colleagues in Mental Health and Addictions are trying to achieve.

Also, finally, I’d like to share that within B.C. Housing facilities, in a limited number of sites, there are supports provided to tenants and clients in their own homes to be able to access safe supply and overdose prevention sites. Primarily, this is to ensure that people have the safety within their own homes and with supports in place. It provides a much more dignified way for individuals who are engaging in drug use.

C. Massey: The next slide touches on complex care housing, again building on what Angela said — the im­por­tance of housing to help stabilize people. I think many of you are familiar with complex care housing. It’s meant for those people for whom supportive housing doesn’t provide enough supports — often people with concurrent mental health and substance use challenges or other complex needs.

[9:50 a.m.]

These are voluntary services, and they’re not treatment-focused. This is long-term housing, or people’s homes with extra supports. If people need to step away for intensive treatment, they can do so, and they can come back without fear of losing their home and continuing that cycle of homelessness.

You’ll see some details here about the complex care housing model. To date, projects have been announced in Vancouver, Abbotsford, Surrey, Victoria, Langley, Fraser South, Bella Coola and Powell River, and we’re going to have announcements of additional projects in the coming months.

Slide 31 speaks to the work we’re doing to build a system of care for children, youth and young adults. This is a very busy slide, and I could probably spend an entire morning just on this. But I simply want to convey here that the intent is to build an integrated mental health and substance use system that meets the needs of children and youth and young adults and that they have to work together across the system of care.

You’ll see at the centre of the slide are the integrated child and youth teams and that they connect to lower-intensity services at the bottom of the slide and higher-intensity services at the top of the slide. Some of the work here is under development, like the integrated child and youth teams, and some of it is well underway, like the Foundry teams. I’m happy to return to provide more information on this particular part of our work or provide more information in written form.

The last part of our supportive environment is underpinned by knowing that the strength…. We have strength in community, and we need to address stigma. On slide 32, I’ll speak first to the Provincial Peer Network, which is a group of organizations led by people who use drugs. They are leading work that responds to the needs of their own communities. They are working to build community and a sense of belonging and to provide input into our policies and other levels of government and programming and how that’s best designed to serve them.

Through this network, we’re providing funding to 25 groups and working with them to strengthen collaboration and information-sharing to ensure that our provincial services are responding to the needs of the people who are using those services. I will say that the work with peers is built into all aspects of our work, and we’ve also developed a peer curriculum that allows peers to take a particular course to allow them to better understand and work in health care contexts.

We’re also supporting community action teams — we call them CATs — in 36 communities. They work with regional health authorities to help lead and coordinate on-the-ground planning and community projects to address the drug emergency. The goal is to build on community strengths and address local challenges to save lives, address stigma and enhance the capacity of communities to support people who use substances.

Both the network and the CATs are supported by our community crisis innovation fund. We have $6 million a year, and it funds one-time community-led projects that provide an innovative approach to locally driven responses. One funded project I’ll just draw your attention to is the municipal harm reduction education project. It was led with a partnership with one of the community action initiatives and the B.C. Centre for Disease Control, and it helps local governments enable a harm reduction response in their communities by training their staff and doing convening groups.

Finally, I’ll talk about the provincial stigma campaign. You’ll probably have seen some of these ads. They’ve evolved and been refreshed over time. The goal is to shift public perceptions and to understand that substance use is a health issue, not a moral or a crime issue. It uses digital and traditional media. We also have a number of powerful partnerships with professional sports teams, such as the Vancouver Canucks, B.C. Lions and the Whitecaps, and the representatives from those teams can speak so powerfully to their fans.

I’m now going to turn it over to Trevor Hughes to speak to the Ministry of Labour’s work.

T. Hughes: Thank you, Christine, and good morning to the members of the committee.

I share the territorial acknowledgment for the lands that we’re on today.

The Ministry of Labour is responsible for WorkSafeBC, and WorkSafeBC. has responsibility for the regulation of occupational health and safety standards in workplaces but, importantly for the purposes of today’s discussion, is involved in the treatment and return to work of workers who get injured in the course of their employment.

[9:55 a.m.]

Why this is significant is, of course, workers with severe injuries can at times be prescribe opioids for pain management, and WorkSafeBC, over the last number of years, has done a number of partnerships with the Ministry of Health, along with physicians, to try to reduce the prescribing of opioids.

They have a number of other programs that relate directly to benefits that workers get. For example, they now only reimburse workers’ prescriptions for pain management due to workplace injury for four weeks. It can be extended depending on the circumstances. And then they’ve developed a harm-reduction strategy along with other treatment programs for workers who, in the course of an injury, do develop a longer-term connection or perhaps an addiction to opioids. Since 2017, they’ve established that there is a 30 percent reduction in the amount of opioids that are being prescribed to injured workers as measured in their claims.

Then, of course, the next piece of this is to deal with the stigma connected to usage and treatment, particularly in areas where we know the demographics point out that there are risks — for example, construction. We know that there are users in the construction sector, and it’s connected in part to the demographics of largely men 25 to 49. So there are a number of partnerships that WorkSafeBC has engaged in. Of course, government has funded partnerships with the B.C. Construction Association as recently as January to get the message out and to figure out how we can deal with the stigma and make sure workers are aware of the treatment programs that exist for them.

The last thing I’ll leave you is a program that WorkSafe has developed called Not Just a Prescription Pad, which is a program that they have with doctors to try to encourage them to head to alternates to opioids, so that it isn’t just a default — not just your prescription pad — so that we’re not setting workers down this path of addiction.

C. Massey: Thank you, Trevor.

Slide 34 simply summarizes the discussion we’ve had on that section. I’ll move straight into the legal framework. I thought that before I jumped to some of our current priorities, it would be helpful to speak to the way drugs are regulated in Canada.

Slide 36 shows that there are multiple layers of regulation: federal, provincial and also professional standards of practice, where the independent regulatory colleges are involved. All of that is nested within an international system of drug control that Canada has signed on to — treaty obligations.

Of course, the province doesn’t control federal regulation, and it has indirect control over the professional practice that is regulated by colleges. Individual health care providers are guided by their colleges and the professional standards of practice that they put out around where they are comfortable in having their practice.

Slide 37 identifies the main statutes involved in drug policy, with the federal statutes at the top, followed by the provincial statutes. These are the main ones engaged in prohibiting possession and trafficking of illicit drugs and the regulation of prescription drugs.

You may hear presenters refer to a section 56 exemption. That refers to a section of the federal Controlled Drugs and Substances Act, which allows the federal minister to make an exemption to that act for medication, scientific or public interest purposes. For example, this is the section that enabled supervised consumption sites.

On slide 38, this outlines some of the key regulatory actions that the province has been able to take within our legal authority, within our jurisdiction. I’ll just draw a couple to your attention.

You heard Dr. Henry speak about the December 2016 order of the Minister of Health to enable regional health boards to provide overdose prevention services within their respective regional boundaries. That was done at the time because there was not quick enough federal action to enable that. That has since been resolved, but the order stands.

Also, in September 2020, Dr. Henry issued the order to authorize nurses and registered psychiatric nurses to become prescribers for drugs that are regulated federally. This is a good example of how the province can act within its jurisdiction, because the federal statute requires that the drugs be dispensed by a prescriber, and in this case, Dr. Henry was able to expand who is a prescriber in B.C.

Moving to slides 39 and then 40, I’m going to speak to you about the strategic priorities of our current response and how those are evolving to meet the trends of the current substance use and drug toxicity.

[10:00 a.m.]

Slide 40 speaks to improving access. We all know that there are gaps in access and that it’s challenging for people to overcome the barriers to access the services they need. People living in rural remote communities are faced with significant challenges in accessing appropriate services, culturally safe services.

There are many reasons for this, from health human resource challenges, increased concerns about anonymity in small communities and additional need for culturally safe care for First Nations and Indigenous communities. We also know that there are some municipalities where services are not established due to stigma or concern or fear about the services and the people who will use those services.

Where access to physical services can be challenging to implement, we are exploring virtual care as an option. We’re actively working with First Nations Health Authority to implement virtual care services, and we continue to explore how we can expand virtual care services for other parts of the province.

Even in those areas of the province where services are available, stigma and discrimination, as we’ve talked about, can be an issue. Then racism, which we’ve spoken about, is also a concern. That’s why our partnership with First Nations partners is so critical.

I also want to talk about the challenges we have around the specific subpopulations, so the broad diversity of people who use substances. One of those that we’ve talked about is people who work in trades. We’ve been really impressed with some of the trades and construction associations stepping up over the last year and approaching us to support their work in improving awareness and reducing stigma at the workplace.

We were able to support work from the Vancouver Island Construction Association. They’ve got a project called Tailgate Toolkit that they will be expanding across the province. We’ve been happy to support that work.

Slide 41 is just a reminder and a different illustration of the shocking increase in the presence of fentanyl. That has led directly to what you’ll see in slide 42, which is our work on prescribed safe supply. This is our attempt to implement a safe supply in the province within our provincial jurisdiction, where it has to be done by a prescriber, to address the need to separate people from the illicit toxic supply.

We’re the first province to implement this prescribed safer supply policy. We’re doing it in a phased approach. You saw the first phase of the policy in March 2020 in response to COVID. In that first phase, we had over 12,000 patients receive some form of medication. It also provided us with some important early learnings that are informing what we’re doing now.

The preliminary findings from the first phase showed a 76 percent decrease in mortality in people who received medications in that first phase, through COVID. That was compared to a matched control group. The clients who received those medications also reported many benefits, including being able to focus on health and well-being and just generally seeing their lives stabilize.

The second phase of our policy is what we call B.C.’s prescribed safer supply policy. It was released in July 2021, with broad engagement with the medical community and people with lived and living experience. It’s an enabling document and is guiding the health authority programs to stand up prescribed safe supply in the health authorities. I know you’ll hear more on this tomorrow.

Our initial focus is on fentanyl products to compete with the illicit supply of fentanyl that is so dangerous. We’ve got just over $22 million over three years to support that implementation in the health authorities. I will say that it’s been slow to ramp up, slower than we want. This is brand-new policy in Canada, and we’re learning, also, from federally funded programs, which have been doing safer supply since July. They’re called the SAFER programs. You may have heard of them in Vancouver and Victoria.

I do want to note that prescribed safer supply is a novel practice for many prescribers. It’s not treatment-focused. It’s not what physicians are used to doing. It’s meant to replace an illicit drug supply through a health care model that can also address other health care needs of the clients who come forward.

[10:05 a.m.]

We’re continuing to refine our implementation of this work through two key ways. First is expanding access as we ramp up the health authority implementation, and secondly, supporting prescribers so that they can learn more about this program and how they can feel confident in doing this work safely.

Evaluation is also critical, and we’ll be doing a strong evaluation of this work, and that’ll help build our confidence and refine our approach.

I won’t say that challenges won’t remain. For instance, First Nations people are disproportionately affected, yet accessing a prescriber and a prescribed safe supply can be a challenge. So we’re working with First Nations Health Authority, who is consulting their communities on how best to do this work.

Moving to the next slide, our next area of priority. I’ve spoken about the preference to smoke and inhaled drugs. So we are looking to ramp up the availability of inhalation services. We’ve got 13 sites to date, and of course, we need more.

I will also note that we’ve also been trying to support and expand what’s known as episodic overdose prevention services. That’s an on-demand overdose prevention service so that someone can be supported wherever they might need an on-demand witnessing of their use. Right now we’ve got 21 of those services in B.C. You’ll hear more about the First Nations Health Authority’s work in this area tomorrow.

Slide 44 speaks about decriminalization and our application. We’re proud to be the first province that’s applied to decriminalize small amounts of illicit drugs for personal use. As we’ve talked about, this is a significant part of addressing the stigma.

This slide highlights the key features of our application. I will flag that we are not decriminalizing the drugs; we’re decriminalizing the people. So this is not legalization. Trafficking remains illegal under this model. It’s about personal use for personal possession.

I’m just going to keep moving quickly, because I know I’m over time.

Slide 45 speaks to the work we want to do on optimizing access to opioid agonist therapy. As I spoke to earlier, this is a strong evidence-based therapy. It’s often the first line of therapy for people with opioid use disorder, and it can be a significant step in someone’s recovery journey. So we need to improve access and expand the number of providers so that more people can access this service.

The next priority that we are focusing on is nurse prescribing. As I’ve mentioned, we’re doing this in phases. The first phase is having nurses engaged in prescribing opioid agonist therapy. So this is part of our optimizing OAT and increasing the number of access points for it.

We saw the first phase as two types of medication that you see in OAT. Phase 2 is other OAT medications that you’ll recognize, like methadone as well as Kadian. And then phase 3 will be looking to moving into prescribed safe supply.

Slide 47 provides a summary of the information. I hope I’ve been able to show how we’ve pushed our work in this area to brand-new areas that have never been tried before, from decriminalization to nurse prescribing to prescribed safe supply, as we’ve tried to respond to the toxic drug supply as it’s evolved. We’re committed to continue that work.

Dr. Réka Gustafson spoke about evidence-informed work, because we don’t have time for the standard clinical trials that take years. That’s also informed our approach to trying new things.

The last couple of slides speak to the work we know we need to continue to do. Slide 49 identifies our commitment to keep pushing ahead on a number of fronts: prescribed safer supply; nurse prescribing; working with people who are most at risk, so some of the subpopulations; and working with people with lived and living experience. I can’t emphasize enough how important that is.

Slide 50 talks about working with municipalities, since a lot of those services need to be located in key areas in municipalities. We need to work with them to ensure they’re comfortable locating those services, continuing our work to build out the substance use system of care.

Finally, I want to note that we’re also carefully considering all the recommendations from the most recent death review panel. We were encouraged by many of those recommendations that show us we’re on the right track, but we need to accelerate and intensify.

We think many of our current efforts are well aligned with the recommendations of the death review panel, so we’re working on a comprehensive response to the coroner, which we’ll be sure to share with this committee so that that will inform your recommendations to government about where to next.

Thank you very much for your attention, and we look forward to the discussion.

N. Sharma (Chair): Thank you for going over all of that very comprehensive material — and everybody pitching in for the response.

I think we’re going to take about, I’d say, five minutes, or maybe five to ten minutes, for a break right now. People can gather their thoughts.

Why don’t we come back at 10:20.

The committee recessed from 10:10 a.m. to 10:20 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Welcome back, everybody. We’re going to get started on questions. We have lots of time for questions, which is great. What I think we’ll do is go to each member that has a question, and maybe give two questions and then put yourself back in the line. We’ll go through that way to try to get through all of them.

MLA Bond, I think your hand was up first.

S. Bond (Deputy Chair): Thank you to all of you for being here today. I think it speaks volumes that deputies are here. That speaks to the significance of the issue. That isn’t always the case at committees. So we’re really grateful that you’re here, and we appreciate your efforts. I think the questions aren’t about criticism. They’re about understanding, and that’s really important.

I have to admit that something in this presentation…. There has been a similar thread through all of them. Obviously, data is data, and we look at that. As you pointed out, Christine, there is no argument with the data. Something that’s new for me is the real definition of who is at risk, because in order to sort out how to respond, we actually need to figure out who is most at risk.

For me, the newer information today is about Social Development clients. It’s not really been articulated previously that when you look at the number of people dying, we’re getting pretty close to half of the people who die being clients of the Ministry of Social Development.

If you add to that the fact that trades and construction workers are also a much higher percentage of the people that are at risk and die — obviously, First Nations people as well — and then you add in the fact that 30 percent of the people who die have been in contact with health care providers ten-plus times in the three months before they die, it seems to me that we’re narrowing the funnel. The funnel is narrowing down, in many ways, where the response needs to take place.

I have to admit that the Social Development angle for me today…. We’re researching how people are receiving their financial support. But when you look at the numbers of people dying that are Social Development clients, to me, there needs to be a pretty significant all-hands-on-deck, targeted approach.

Construction and trades is another one. You know, we talk about: “There is a tailgate kit.” But we know that the…. I guess I’m finding it difficult to actually articulate the question. It seems clear that intensive, focused strategies need to be put in place to deal with where the highest number of people are dying.

Maybe I was asleep at the wheel, but the Social Development piece was a lightbulb for me today. It makes sense because of the factors that lead up to a person dying of an overdose. Perhaps somebody can respond to me about what is being done to look at very targeted, intensive, urgent reaction, other than looking at when clients receive their payment.

C. Massey: I think you’ve zeroed in on where some of our response is heading. In the emergency response, we’ve stood up a number of services meant to broadly respond and provide services. But the more that we dig into the data, and the more we realize there are different subpopulations…. You need to speak to those populations in different ways. You would speak to SDPR income assistance clients and provide different services than you would to people employed and functioning, despite their addiction that they may be hiding.

This is some of the work we want to do with my colleague in the Ministry of Health and with SDPR. There’s a lot of data-matching and data-linking we can do in digging into some of that data. For instance, that contact with the health care system. Was it in emergency rooms? How many hospitals was it? Which hospitals? Then you almost have a case-finding kind of opportunity there to really target the resources. We’re learning more, exactly as you said, MLA Bond, about the subpopulations and their risk.

[10:25 a.m.]

S. Bond (Deputy Chair): I guess I’ll just say, because I want to respect the other members of the committee and the Chair’s direction….

Identifying who’s most at risk and then being intentional and urgent about those responses…. This isn’t a surprise. For example, when we look at the death review panels and some of their commentary, one of the biggest criticisms is that the scale of response hasn’t been sufficient. I’ll give some more thought to your response, Christine. I just have to say that for me, that was something that I think we need to be paying attention to.

My second question, as the rules permit. One of the things that you mentioned today is that drug testing works. Then I look at the map of where drug testing is available. I’m wondering if a cost-benefit analysis, looking at how quickly we are adding drug-testing capability and if we are aligning that capability, for example, with the five highest-death health service areas…. There is one big part of the province that has very few services available, yet we know the numbers if you look at some of the geographic areas noted.

What is the plan related to drug test capacity across the province? Is it being aligned with the areas where we see…? You stop and think about Indigenous British Columbians. We know that women, in particular First Nations women…. My point is: are we lining up the steps? I’m assuming. I don’t know about cost-benefit. Maybe you could speak to: is it expensive? Why isn’t it being ramped up more quickly?

C. Massey: Absolutely. I’ll start, and then I’ll turn to Darryl to expand and Darrion about what we know about drug testing.

First of all, in terms of the technologies available, they range from a fentanyl strip, which any individual can use but is not very sensitive…. It tells you, yes or no, the presence of fentanyl. That’s useful for someone, for instance, who has a sample of cocaine and is not expecting an opioid in their drug. That fentanyl strip would be helpful. It’s not helpful for people who are opioid addicted and are probably expecting fentanyl, and it doesn’t tell them how much fentanyl and if that’s going to kill them. That’s kind of widely available, and I think you’ve heard about those strips in your previous deliberations.

Then the rest of the technologies are technical ma­chines. They require somebody with some technical training to administer and some staff support, and that gets into some of the challenges you see with where we have blanks on that map in the province, where there aren’t services because of the challenges of getting the staffing into those areas, where there’s enough volume for those drug-testing services.

D. Sturtevant: Hi. Darryl Sturtevant.

I acknowledge the traditional territories as well.

In terms of the machines, there are a variety of machines that are available. They range in cost from $50,000 to $350,000. They’re large machines. They’re not very mobile. They require specific power supports, etc., so that part of it is that they’re pretty stationary in that way, along with the technical pieces.

We do have a section 56 exemption that allows for distribution in terms of sending test results or having drugs tested at one site but having the actual machine in another site so that it’s just-in-time kind of testing. You can get access to those machines even though you’re not actually physically present in the community where that machine may exist.

The $350,000 PMS spectrometer machine is new technology, and it’s demonstrated to be quite effective in terms of actually identifying compounds within substances in minute details. So it is actually showing some really good promise in terms of its ability to inform what someone has in whatever substance they are presenting or testing.

[10:30 a.m.]

S. Furstenau: There’s a lot to work through here, for certain. Like my colleague MLA Bond, the data on Social Development and Poverty Reduction, the number of people dying who are linked to the system…. So 4 percent of the population, 44 percent of deaths, and then the other piece of information there was that 33 percent of deaths are people living in extreme poverty.

I was a little surprised to hear, Robert, you being somewhat dismissive of poverty as an aspect of this. I think it’d be great for you to elaborate a little bit more on that. With that kind of data, I see this very much as a poverty crisis and that the deaths related are a symptom of that crisis. I’m curious. That would be my first question.

In addition to that, considering what we’ve heard, particularly in our constituency office, and what I’ve heard from people around the province around the experience of being in the system…. Whether it’s MCFD or Social Development and Poverty Reduction or CLBC, these systems can themselves be quite traumatizing for people.

I’ve heard a lot this morning about more and more systems. I would like some reflection, maybe, from the panel on the intersection of so many systems into people’s lives: the loss of dignity, the loss of sense of personal sovereignty, the entrapment of extreme poverty. The fact is that the current rates for people living in poverty or on disability are very low. With the cost of living rising at the rate it is, even more so now, and that entrapment, what does that contribute to this crisis that we’re seeing?

R. Bruce: Sorry. I didn’t mean to be dismissive of poverty. I just didn’t want it to be seen as a simple solution to a very complex problem. We know that there are a bunch of factors that contribute to people being on income and disability assistance and struggling with addictions. We know of undiagnosed mental health, brain injury, trauma and probably a bunch of more things that we still don’t know about.

So what we are trying to do is…. How do we break apart that 33 times — it’s 33 times greater risk — so that we can say: “Here are the factors that we know, and this is how much is poverty.” We do know from academics and external research that giving large sums of money to people can have its own problems.

One of the things…. We are getting new data for 2020. We just onboarded 2020 data, so all that research was 2015 to 2019 data. That’ll allow us to look at the impact of COVID. It’ll allow us to look at the impact of providing $300 per month to all income- and disability-assistance clients. I know that academics are looking at the impacts of the CERB benefits, which were much greater than what we provided. We’ll start to see how much is poverty and how much is other things. Then we will be able to say: “Yeah, this is a better model.”

S. Brown: Just to kind of add to the discussions that we are having, to what you just said about systems…. The worry there is that people are interacting with all these systems — that’s what MLA Bond says as well — but people are not picking the individuals up and caring for them and coordinating care for them. One of the issues or challenges we’ve got is how we actually engage with individuals as individuals, holistically, and begin to now look at coordination, not simply that they’re passing through an emergency department or through SDPR.

[10:35 a.m.]

We actually need to get engaged with them, and we don’t feel as though we are getting the penetration and linkage that we need to do, whether it’s into the workplaces, as you’re talking about, SDPR or the health system. So it’s having that care coordination.

We think there’s a gap there, and we’re trying to think how we link with the individuals as people, holistically — looking at the multiple systems that are engaging with them — and actually begin to offer some level of support.

It’s then challenging to the other example that you gave, which is the geography and the dispersal. Where do you…? How do you coordinate, which is what we’ve been talking about? Some mixture of face to face, virtual…. How do we actually get that in place?

I think that is a gap we’ve got. The penetration we’ve got, because you look at all the activity about the penetration we’ve got into the population who is struggling with this, isn’t there. It’s not because we switched that around and began in a different way.

In terms of what we talked about…. I mean, it’s not the right wording, but having we’re some problem with a little…. It's the wrong way to frame it, but we’re having some problem with a patient registry, which we've got in a number of other health areas, where you understand who the individuals are, who they are interacting with, where their interfaces area. Now you can begin to do increased coordination of the care.

That’s something we’re struggling with. How do we actually think that through in a different way?

S. Furstenau: We heard a lot this morning about treatment and recovery systems. I’m just going to bring the comments of the coroner into this conversation from what we heard in our last meeting. She told this committee…. These are her words:

“The one thing that has become very, very clear to us and we didn’t know…is that there is no evidence basis for treatment and recovery in this province…. Any of you could open a treatment and recovery centre. You may have some background in treatment for substance use; you may not. You may have struggled….

“Provided that you meet the building codes for the area you live in…there is no regulation around treatment that you utilize. It can be yoga and herbal tea…psychoanalysis…group therapy. And because there are no reporting requirements, we actually don’t know what’s effective. It’s a huge gap in our knowledge.”

Those are pretty strong words from our chief coroner about the lack of evidence-based treatment in this province. Then we hear of $144.5 million into treatment and recovery centres.

I’m very keen to hear from you. What are the conditions for public funding going to any treatment and recovery centre? What are the outcomes that are expected? How is that being measured? How are we moving to an evidence-based and properly regulated treatment and recovery realm in this province?

C. Massey: The work we have done to date that I spoke a little about — the new regulations for assisted living and the new standards that health authorities are building into their contracts — are all direct responses to the first death review panel that the coroner put out. I think that was 2017. That work continues. There’s no question that there’s more work to be done.

In terms of the evidence basis for addictions and recovery, that is not an issue unique to B.C. in the sense that the evidence base for this area, broadly, just internationally, is still evolving. This is not an area of the health care system that has received the same degree of research and attention that other areas of health have, for all of the same reasons that we have been discussing — the stigma. But that research is evolving.

Now, to support the work. We want, in B.C., to move our system to build on as much of the evidence that is out there as possible. When we’ve made new investments in treatment and recovery, they have gone in two ways: to the health authorities, who then, through their standards and their clinical oversight, provide contract to existing experienced providers out there…. There are some very good operators out there who can demonstrate their results.

We have also issued investments through request-for-proposal processes, utilizing experts in the area like the Canadian Mental Health Association, B.C., to assist us in adjudication.

[10:40 a.m.]

We have made certain requirements for those new funding…. Like accepting patients who are on OAT as a condition of funding. That has not always been well received, particularly for some programs that are abstinence-focused. That’s been one that’s been debated, but that’s been a feature of our funding conditions, and then a number of other criteria. We’d be happy to forward the conditions for those RFPs, for instance.

Now that we’re putting that new funding out, we’re able to stipulate the kind of data we want for those new funding investments. We’re going to start to see some of those reports coming at the end of this year, I believe. End of this year, we’ll get some of the enhanced reporting that we think is going to set the stage for what we need more broadly from the whole system. But this is where we’re starting with our new investments, where we can set the expectations at the front end about the kind of data we need to be collected and to start analyzing.

P. Alexis: Thank you for asking that question. It was on my list as well, so I appreciate that. I have a follow-up for that one, but I’ll speak to another one first.

With respect to the stats around inhalation and how the infrastructure isn’t right for that method, what are we doing about that? That’s obviously a barrier, because we know that we don’t see deaths in this setting, but if they’re not using the setting because they’re choosing a different method, and we’re not equipped to do that, what are we doing? How are we addressing that?

C. Massey: Thank you for that question.

I’ll turn to Darrion Campbell.

D. Campbell: Hi, I’m Darrion Campbell.

I’ll echo the territorial acknowledgments of my colleagues.

Inhalation, as we heard, is a phenomenon that’s hap­pened fairly recently, in the movement away from injection towards smoking. As noted in the PowerPoint, we have 13 inhalation sites in the province. We are working with health authorities, through whom we flow the funding to establish more of the inhalation sites.

As Christine noted, one of the challenges is having workers in the inhalation site in a safe way. So there’s quite a bit more infrastructure required — thinking about fans, thinking about fume hoods, those kinds of things.

I think you’ll hear about one tomorrow in Victoria on Pandora Avenue that Vancouver Island Health Authority has implemented in a shipping container. Other health authorities are looking at unique, creative approaches like that to meet those demands.

Some of the inhalation facilities that health authorities currently have are outdoor. They involve tents or glassed-in rooms to enable that safety while keeping people, both workers and clients, safe as well. So it is more of a challenge than the straight injection services, but we’re working with the different health authorities to help them move forward.

Another piece we are working on is episodic overdose prevention services. That might be where someone…. They desire to use, and they will have a worker go out with them outdoors so that they can do the drugs that they’re going to do but in an observed way, so that they can remain safe. So we’re working on an episodic inhalation protocol with the BCCDC to enable people to remain safe. That’s, of course, available and doesn’t require the infrastructure I outlined earlier as well. We’re really trying to have a variety of approaches to meet people where they’re at.

P. Alexis: Okay. Thank you for that.

With respect to complex care and the number of new spaces that we’re creating, do we need different treatment centres to match the complex care client?

C. Massey: When you’re thinking about the treatment that is needed for concurrent disorders, yeah. Complex care housing, like I said, is meant to be someone’s home, and we manage and support people with the conditions they have, but someone may decompensate or have a crisis and may need to leave for treatment. That’s where we need the health authorities to have the facilities to accept those people, whether it’s residential treatment….

[10:45 a.m.]

The Provincial Health Services Authority, which you’ll hear from tomorrow, and Providence Health Care have some of the most specialized high-intensity services. The new Red Fish Healing Centre, for instance, was designed to be state-of-the-art for dealing with concurrent health disorders. It added a few more spaces to what was the Burnaby addictions treatment centre, but it has improved the outcomes just by the environment and some of the structured way in which the interventions can be provided. But there are undoubtedly more such supports.

We also need to pay attention, for instance, to people with brain injuries. A brain injury can be a side effect or an outcome of repeated overdoses and administration of naloxone. So we need to look long term for what the care for those clients may be. It may be complex care housing. It may be something else.

T. Halford: Just a couple quick things. Well, one quick thing and then a question. I’m just following up on MLA Furstenau’s comments. The fact that both of you referenced that it was 4 percent of the population, when we’re talking about social development, I think…. I have trouble with why that statistic would get tabled in this form.

I understand that when we’re talking about the numbers and the amount of people that we are seeing loss of life from that area…. But when we use the word that it’s only 4 percent of the population, to be honest, it’s disappointing to hear. I don’t think it’s necessary to highlight what percentage of the population. I don’t think it benefits us. I wanted to actually say that, because it didn’t sit well with me both times it was said.

Overall, when I look at the numbers and we look at the demographics, especially in young males, and we were talking about the construction sector, one of the things that I hear…. It was talked about in early education and things like that — but just overall access to mental health supports. I didn’t get comfort in this presentation that there’s an adequate handle on that, especially when we’re talking about that demographic that is getting hit very, very hard right now.

Quite often I hear, and I’d assume others in this room would hear, that a lack of services in the mental health capacity is really causing some issues right now. Whether it’s a wife trying to get a husband into counselling or it’s access to a family doctor that can do a referral — just the lack of mental health support. I didn’t see it adequately highlighted here. I’m just wondering if you can comment on that.

C. Massey: Yeah, absolutely. So there’s no doubt that we have more demand for mental health services than we’re able to provide. I can happily provide, in a written follow-up to the Clerk, more information on the investments we’ve made, to date, on mental health, if that would be helpful.

With respect to young men, it raises a really good question as to what is behind those numbers and the trades in particular. It speaks to some of the discussion we were having earlier about the need to get more information about those subpopulations and find out what’s driving those deaths so that we can provide the services appropriately.

For instance, with men in the trades, is it because they’ve become inadvertently addicted to an opioid that’s been given to them as a pain medication? Is there an underlying mental health concern that’s untreated? We need more of that information to ensure that we’re providing those supports to that subpopulation as best as possible, and supports that speak to that population in a way that they will respond to and reach out for.

R. Leonard: Thank you for putting all of this together and giving us that kind of a framework for this discussion. I, as everyone else, have many, many questions. I know that you have a breadth and depth of experience that you’re bringing to help us tackle this situation from our perspective.

[10:50 a.m.]

I want to talk about, particularly around the issue of the construction and trades and recognizing that there’s this broad continuum of…. Well, it’s not a continuum. It’s just a broad spectrum of people who have challenges around the use of opioids and other substances.

There’s this intersection between who’s using it and their interaction with the health care system. Trevor, you spoke about the prescribing doctors. There was this switch — we talked about this in an earlier session — when there was this overuse of opioid prescriptions that was resulting in more deaths. The immediate reaction of the health care system was to shut down that, which only resulted in this, what I see in my office regularly, as people then turn to the street, to the unsafe supply.

When I’m reading about and hearing from Trevor about how it’s being managed, the use of opioids, it raises some flags for me. I’m curious about that evidence-based way of moving forward. Somebody has got an injury. After four weeks, their access to safe supply is cut off, but their pain is not gone. The notion of stigma around seeking the drugs that will relieve their pain or what kind of alternatives there are that people will respond to positively…. I’m just wondering if that has really been explored further.

Is it the right way? Tell me how it’s the right way. Maybe that’s the more positive way of putting it.

T. Hughes: Thank you for the question. I think that there are two pieces to it, from a WorkSafeBC perspective. The first is recognizing that WorkSafeBC doesn’t prescribe the opioids. It’s the doctors in the health care system that do, and then WorkSafeBC gets involved with the claim management and figuring out how to get folks back to work, ideally in the pre-injury job.

So somebody gets an injury. They need pain treatment. The idea behind four weeks is to not have somebody get an addiction to opioids as the result of a workplace injury. The four weeks can be extended in certain circumstances, depending on the nature of the injury and the pain management. But there is a strategy in place to make sure that workers are transitioning away from opioids to other pain management therapies. They’re not just saying, after four weeks: “We’re not going to help you manage your pain anymore.” Hard stop.

We’re working with the health care system to try to figure out how to do those alternative therapies to deal with harm reduction and making sure we don’t have people ending up with an opioid addiction because of a workplace injury.

Christine.

C. Massey: Yeah, you’re absolutely right. We’ve learned a lot since we saw the kind of mismarketing of the opioids for wide use, and the medical profession has learned a lot about how to prescribe, how not to prescribe, how to wean someone off of those drugs. Those are exactly the right questions.

I think, when Providence comes tomorrow to speak…. They have a really excellent program that they’ve created around the management of opioids — when people are discharged from hospital, perhaps with a prescription, how doctors are advised to manage that. They’ll be able to speak well to that part, because that is also part of the prevention picture that we didn’t speak about today.

R. Leonard: I’ll switch gears to another topic, and that’s around the high proportion of people on social assistance. I think I want to help social assistance recipients feel a little bit better. If you could tell me what percentage of…. As Trevor said, 4 percent of the population is on social assistance. But what’s the percentage of people on social assistance who are overdosing? I just don’t want everybody on social assistance to be further stigmatized when it’s not necessarily…. I mean, not everyone on social assistance is a drug user.

[10:55 a.m.]

R. Bruce: I don’t have that number with me, without doing some kind of complex math in my head, but we can definitely get that. But yeah, it’s definitely not the 160,000 singles and families we have. It’s going to be a much smaller proportion of that.

R. Leonard: Thank you.

D. Routley: I appreciate the information about the disproportionality of the issue — whether it’s First Nations women, First Nations, Indigenous people generally, social assistance recipients, all of it — because I see it as kind of the social determinants of addiction and overdose. So I appreciate that. I would expect that it could contribute to developing a strategy of predictability and targeting, and I’d like to hear about what sort of elements are used in order to build a system of prediction and intervention.

Then, Robert, I think it was you who said an effort to predict and identify clients who struggle…. I wonder what priorities you would use to make those identifications, and how you would respond.

R. Bruce: We have no information on our clients, at the client level, on who has additions or who has overdosed. The only information we have is the anonymous data in the B.C. Centre for Disease Control.

My researchers are trying to identify what the characteristics are, what the patterns are that appear in our clients that have severe addictions and problems with overdose, and then see if we can use that in our main system so that we can just identify those at risk. Everything would be voluntary, because we have no authority to do anything. It would be to offer interventions, to offer treatments, things like that.

C. Massey: I can simply add to that, and it speaks to the need. Stigma is a big part of it — some of the systems that MLA Furstenau spoke about — around people feeling safe and supported to disclose and to ask for help and trusting that that help is going to respond to their needs.

There’s a lot of work we need to do to make sure that those services have those features, and then — as Deputy Brown spoke to, once someone is responded to by the system — that someone helps to knit together all the services that they need for them, because that’s very difficult for someone right now.

M. Starchuk: Thank you to the panel. I think I’m going to narrow it down to one topic, just for brevity. Robert, you had talked about cheque day and the 40 percent increase. As a person that was in local government before, in Surrey, we had this anecdotally. We thought that Bylaws and other people were busier, those fire guys were busier, on those days that it happened.

Now you’ve got the data that kind of shows us. You’ve got the data that…. You’re looking at multiple cheques. I assume that you’re looking at other provinces and at how it affects them. It can’t be anything that’s just a B.C. product that’s there. We know that this is going to happen. This is a definite correlation that’s there. How do we work in a safe supply, or a place for them to use and not worry about the stigma? We know it’s happening. It’s kind of like when the gates to the concert just open up: where are these people going to go?

R. Bruce: I can talk to the first part. I’ve been in the same job for thirty years, and when I started, everybody knew about the cheque day as welfare Wednesday, Mardi Gras, all the inappropriate terms, right?

Everybody, a lot of the academics that came to us, said: “We believe the answer is pretty simple. Just change how you pay your cheques.” It was Lindsey Richardson who said: “I really want to test this.” And we did, too, because besides the complexity for our system, to change how we pay…. We have a very old legacy system that’s designed to cut cheques on the weekend prior to the last Wednesday of the month.

[11:00 a.m.]

It was a surprise. I remember getting my first phone call from Lindsey, saying: “This is not at all what we expected.” There were so many other things that were going on. It just shocked her but didn’t shock me that clients wanted to get out of the program because their friends were getting a cheque on Tuesday and they weren’t getting theirs till Thursday. And the violence starts because the dealers said: “I don’t know what you’re talking about. I know exactly when you get your cheque,” right? We publish.

That led to kind of an awakening of: it’s not a simple problem. The level of violence surprised us. We weren’t surprised that there were going to be some challenges by the participants in the program, because it is a fundamental change. We’ve paid the same way since the 1980s, and to change how we pay was very disruptive, because clients all work together. They know when they get their cheques. They have that comfort: “Okay. We all know when the cheque is going to be produced.” When people were getting it off-cycle, it really caused some problems.

The one thing Prof. Lindsey Richardson did recommend is offering choice. That’s something…. It would be a challenge for us, for 160,000 clients right now. But as we move into our new payment system, it’ll be there. We still have to pay rent close to the end of the month, otherwise clients could run into problems if they get their payments too early. So there is some opportunity, moving forward, to help clients that do want choice, but it would have to be on kind of an as-needed basis right now.

N. Sharma (Chair): I have a couple of questions, and then we’ll go to round two. My first one is just based on the increasing toxic supply that’s hitting people and that graph that we’ve seen over and over again that sees the deaths go up. When we talk about the safe supply and responding to that toxicity…. I want to learn about that — how we match the toxicity in the safer options or the alternatives to keep people alive.

You mentioned and we’ve learned a little bit about the different types of drugs that are being used and how it makes it…. I just want to know: how do you respond or match that with what we offer or what we can offer to keep people alive? How does that show up in the harm reduction sites or the prescribed safe supply?

You said a couple of things that struck me as well about how the drug testing kits can offer somebody that doesn’t know there’s fentanyl in there to say: “There is, so I’m not going to take it, because I wasn’t seeking it.” Or it can say, if they were seeking it, that they could do it not alone. Hopefully, they would use it when they were in the presence of somebody that would be there.

Just how do we match that toxicity with our response? It seems to be the key driver of that upwards curve.

C. Massey: Yeah. It’s something I’ve thought a lot about as well, because we are competing with an illegal system that, in many ways, doesn’t seem to care as much about the outcomes for people, whereas we need to match that with drugs that will be powerful enough to hold people and keep them away from the illicit drug supply. If it doesn’t offer them the similar relief that they’re seeking, they will supplement whatever the health care system is offering them with something from the illegal market.

Government can never be as quick and nimble as an illegal market, so we have to provide prescribers with guidance about how to safely administer fentanyl products, knowing that people may have other drugs in their system. They may have other complex needs that mean they’re on other medications.

A lot of the work that Darrion and his team does is work with the B.C. Centre on Substance Use. They’re specialized in this area. They do a lot of the clinical protocols that help to guide the prescribers. That takes times to develop before people will have the confidence to start, say, eschewing fentanyl patches or other forms of fentanyl.

Do you want to add anything else? That’s good?

[11:05 a.m.]

D. Campbell: No, I think it’s a really good summary, Christine.

As mentioned, we work with the B.C. Centre for Substance Use to develop those protocols and are adding more fentanyl products to the prescribed safe supply availability, if you will, as we’ve seen the toxicity in the drugs — both in fentanyl concentration but also including more and more benzodiazepines, which proves to be very challenging for naloxone as well. But it’s something that, as Christine notes, we continue to work with them on, those protocols, to give prescribers the protocols to follow as they prescribe them to their clients.

N. Sharma (Chair): I guess my next question’s a bit of a follow-up. Maybe something we learned that…. Am I right to say that because of the mix of the drugs that are out there, naloxone is declining in its effectiveness? I know it’s still saving lives, and it looks like it is, and there has been success in distributing that out there. But is its effectiveness declining because of the mix of drugs that are showing up?

The next one is…. We learned about this. I think it was the B.C. Centre on Substance Abuse that talked a co-op model. There was a new federal exemption for kind of, it sounded like, a compassionate care situation. I just wonder what you think about that kind of a model and that approach.

C. Massey: On the effectiveness of naloxone, I don’t know that we have good data on it yet, but there’s lots of concern. We are hearing reports from first responders saying that they have to use more and more doses of naloxone to revive someone, and that’s probably because of the sedating effects of benzodiazepines that are also in the drug. So that’s a concern.

On the co-op model that BCCSU spoke about, it’s tough for me to talk about it, because we haven’t really seen the full model yet. What they’re doing is that they want to have this model based on without a prescriber. That’s something outside the province’s authority, so they have to apply to the federal government to be able to issue these drugs.

I believe they’re looking at starting with opioids and possibly heroin. They want to issue them without a prescriber, so they need the federal government to give them an exemption for that. They are, as I understand, working through what that would look like, what controls are in place, what the criteria are for access, etc. It’s tough for me to issue an opinion until we’ve seen their model.

N. Sharma (Chair): We’ll go to the next round.

T. Halford: I’ll direct this to Deputy Brown.

The coroner’s spoken in the past just of the reluctance of physicians to prescribe. I just want an update on how those conversations are going. Obviously, I assume, you probably share that same viewpoint that Coroner Lapointe had. But how is the ministry dealing with that in terms of working with physicians — either educating physicians or how you’re placing physicians? Just on the ongoing, if you are seeing a reluctance to prescribe…. If so, how are you guys trying to manage that?

S. Brown: I think it’s an ongoing process of dialogue and, for many prescribers, the balance between harm reduction and treatment. And then the harm reduction — if they perceive what they’re prescribing is doing further harm — is a moral dilemma for them. So the ongoing dialogue to get the right balance — that you’re not permanently prescribing something that you think is doing harm but you’re actually helping a person to move away from that harm — is a difficult one.

I don’t think there’s an easy solution to it. We’ve been building out, as you’ve seen from Christine’s presentation, the number of prescribers. That is building out steadily, but it’s slow. Also, the number of people accessing care is actually quite small compared to the size of the population.

So you’re identifying the problem. I don’t think there’s an easy or quick fix where we can actually tell people to prescribe in terms of through the colleges. We’re definitely working with the college in terms of trying to provide safe guidelines and work with the professions in terms of moving ahead.

[11:10 a.m.]

But it’s a dilemma, Christine. I think it’s fair to say, for many prescribers, and there’s very active debate about whether we’ve swung too far one way or what the risks are of what we’re doing that we’re actually continuing. It’s a very active debate.

I don’t know, Christine, if you have got….

C. Massey: I can just speak to a couple of specific things we’ve done. We did commission a report from a medical ethicist to speak to the ethics of prescribed safe supply and if that fits within the physician’s “do no harm”— that professional practice standard that many adhere to. We’d be happy to share that as a follow-up to the committee.

Under Darrion’s leadership at the overdose emergency response centre, active discussions with Doctors of B.C. — the association of physicians, which is very supportive — to try to get more communication out to physicians and prescribers, to give them more information, to inform their practice, and doing things like communities of practice and working on the evaluation and just getting as much information out there. It will be a process.

S. Bond (Deputy Chair): Such a complex and heartbreaking issue for, I’m sure, all of you and all of us.

I want to link to the death review panel, the most recent one. Today we have received some new data and statistics, although the theme is the same in each of the presentations. When the death review panel was released, one of the things that it emphasized was the need to….

I will just read this sentence, because I don’t know how…. Let me read it, and then we can talk about it. “Develop and implement a strategic management and governance framework that sets clear goals, targets and deliverable time frames for reducing the number of illicit drug toxicity events and deaths.” It then goes on to talk about identifying the roles and responsibilities provincially with health system partners and with the health authorities, both regionally and locally, for implementing the plan.

To me, that’s pretty basic. It’s set targets, clear goals, and then assign them. There’s a responsibility chart as to who’s going to deliver what. Those of you who have worked with me in the past know that that’s an important process.

I’m wondering why there is such a reluctance or why those recommendations are not seen as helpful in the sense that, today, we’ve heard a lot about the principles. We’re monitoring. We’re going to do this. I think what the coroner and the death review panel is saying is that you have to set targets and goals, make them specific and assign somebody to that responsibility.

We’re going to hear from health authorities, but in essence, it’s one big system. As Stephen referred to earlier, there are points of contact for many of the people who die throughout that system. Yet somehow the ability to find specific, targeted approaches is not there for many of those British Columbians.

Maybe just speak to us, as a committee, about: are there targets and deliverable time frames, for example, for expanding drug testing across British Columbia? We heard the cost. The cost of potentially not using them is that someone loses their life. I get that there’s a fiscal imperative, but there’s a much bigger imperative.

Is there a plan? If there is, there shouldn’t be reluctance about doing what the death review panel asked to be done.

Then I have one other follow-up question about that, Chair, when I get the opportunity.

C. Massey: I do want to emphasize that we are looking at all the recommendations of the death review panel. I hope you don’t see that focus that we’re providing and the time we’re taking to dive into them as reluctance. For the plan that they’re requesting…. For some of it, we…. Some of it does exist, for instance, with nurse prescribing.

[11:15 a.m.]

We have targets for the number of nurses that we want trained for prescribed safe supply. We have targets for the health authorities, for the number of clients they will be serving, for the amount of funding that they provided, along with the timeline. That all exists. Probably haven’t communicated well or put it all in one place.

I would say that there are other areas where there are gaps, so we don’t have targets, for instance, on drug testing. I would say drug testing has been treated as an emergency response.

We were just talking about, the other day, how it has really just exploded from where it just had a presence at festivals — where people might be using drugs and wanting to test their drugs before having some fun and entertainment — but then has moved into a response to the toxic drug crisis. A more intentional approach to drug testing may be warranted in providing some of those targets. And some of what we discussed today about data analysis — can we provide some targets for that?

I would say the health authorities know their roles and what they’re accountable for through the funding instructions that we provide them. So I think we have some of it. We have more to do, and that’s certainly something we’ll be pulling together.

One of the things we see in terms of working as a system — you’re absolutely right; it’s one system with the health authorities — is that we’ve had very good coordination and work on our emergency response with the staff level at the health authorities. They’re all working really well. Darrion has a number of groups that he works with.

But we saw a gap at the senior levels, so Darryl Sturtevant is convening a meeting of all ministry ADMs and vice-presidents of all the health authorities responsible for mental health and substance use to focus on all the needs of the system, including this. That is part of the way we’ll improve the governance to speak directly to what the coroner pointed out.

S. Bond (Deputy Chair): Well, I appreciate that answer. I think you’ve identified that there are things being done that the death review panel is asking to be done, and there are also gaps.

From my perspective, it does need to be in one place. It needs to be an overarching framework, where identifying gaps isn’t something that…. It’s important to identify gaps, and all of us should see that as a part of the positive response here. If there are gaps, we need to close them. If we don’t have that overarching framework that has metrics and data and measurement, people will continue to ask what’s being done and why it isn’t being done.

From my perspective, I simply think there needs to be a sense of willingness to say: “If we are doing these things, then lay it out. And if we’re not, then let’s figure out how we close those gaps.” That’s what the death review panel, both in 2017 and now, is saying — that there needs to be that overarching sense of: “This is what’s being done.”

My second question relates to all of this in that we have heard from many of the presenters already, and we’re going to continue to hear from them about the need for this to be treated in a similar urgent manner to COVID.

The two responses you gave me were, “We’re doing it, and there are gaps. There are things we are doing, and maybe we could put it all in one place” — that is exactly what the death review panel is asking for — and then secondly: “Maybe we haven’t communicated as well.” That’s exactly what people want to see. They want regular updates so that we’re not waiting every month for the latest death toll. What is being done? You know, conversations about education and prevention — that matters a lot.

Is there contemplation of taking an approach that shares information publicly, frequently, specifically about the reaction and the response to the opioid crisis, which we are now six years into?

C. Massey: We are looking at the data that we have available publicly. Some of that’s on the BCCDC website — the same place that we relied upon for a lot of the information that we were looking for during COVID. It has a lot of the indicators, such as OAT retention, number of prescribers — some of the key things for some of our strategic priorities that I spoke to.

It would not speak to, for instance, what’s happening in schools and the breadth of that work. That’s a much bigger project, but it was one of the recommendations from the death review panel. We’re looking at all of them.

[11:20 a.m.]

M. Starchuk: A couple of things that are kind of related, and they go back to the testing. As a person who was a hazmat technician and used a spectrometer, I understand the value that’s there as opposed to test strips, where the person that’s using sometimes is not willing to give up some of what their drug is to be able to do that test. So I make the assumption that the spectrometer is not actually consuming anything, that it’s actually testing it in this manner. There’s no consumption of the drug that’s there?

D. Campbell: Do you mean the machine?

M. Starchuk: The machine itself.

D. Campbell: The machine uses a small sample of the drug — a very small amount, yes.

M. Starchuk: Okay. So that takes me back to when you have a supervised consumption site and the inhalation sites that are there. We’re seeing an increase in the number of people utilizing that method for ingesting it. I didn’t see inside of here the number of fatalities for those people that are going that way. I’m sure that that number is there.

Is the issue around inhalation dose, because you can’t measure the dose because it’s inhalation? That’s the answer I was looking for.

C. Massey: That has not been raised to us as a challenge.

S. Furstenau: Again, kind of harkening back to the presentations we’ve had so far, there’s been a pretty significant and consistent emphasis on bringing our attention to…. Drug use happens on a spectrum, and there is, as you’ve talked about this morning, opioid use that can be very damaging and very problematic to people. Then there’s drug use for people that is at the other end of the spectrum and doesn’t bring with it all the kinds of concerns that have been raised.

Today’s presentation is Ministries of Health and Mental Health. Of course, Health has a pretty significant emphasis on treating drug use as a health issue. Yet, when we look at…. We were asked by the coroner to watch a video about prohibition before our last presentation, and the role that prohibition plays in creating an economic system and economic outcomes. The economic outcome of prohibition when it comes to the illicit drug market in B.C. is obviously a pretty significant amount of economic activity that is happening that is outside of our regulated economic sphere.

We know that it’s attached not only to distribution of drugs. It’s attached to our housing crisis. It’s attached to a number of economic outcomes that are also problematic. Today we’re hearing about a health care response to a problem that is not all about health care but also has this very significant economic aspect to it. The health care response on an individual or even on a systemic level, obviously, does not solve the economic issue that’s created by prohibition.

We’ve talked about decriminalization of small amounts of substance use, but I think there is this inherent kind of contradictory aspect to all of this. This afternoon, we’re going to hear from the Ministry of Public Safety, with the mandate being to work with police to address serious crime in B.C. communities, including cracking down on those who distribute toxic drugs. Now, of course, we know that some of the people distributing toxic drugs are also drug users themselves, so we’re saying, “let’s not have stigma here,” but then we have stigma here.

Pulling it back to this, do you think that beyond a health care system response…? The Chair asked about compassion clubs, and we’ve seen that be a response that ultimately led to legalization of marijuana. Can we actually solve this crisis if we stay in a prohibition, criminalization model?

[11:25 a.m.]

C. Massey: I think I know the video you’re speaking of. I think it’s called the Iron Law of Prohibition or something like that, but I’ve seen some of that same information.

You’re absolutely right. We are moving deliberately to try to talk about drug use not as a law issue or a moral issue but as a health issue. So that’s exactly what you saw today.

In terms of whether we ought to be on the path to legalization of all drugs, I can’t really speak to that. That would be something…. I don’t know if you’re contemplating having the federal government, Health Canada, speak to this committee, but that is certainly something within their purview.

It would have to be, I think, probably a national approach. I would really look forward to the deliberations of this committee as to whether we think society is prepared for that kind of work.

I’m just thinking about the lead up to cannabis. I can only speculate about what would be needed for…. I think what you’re suggesting is the legalization of illicit drugs.

S. Furstenau: If I may, I’m not actually suggesting an outcome. I’m asking whether, in the current model that we have — of a prohibition-based approach to illicit drugs — we are able to address the depth of this crisis. The prohibition, in itself, contributes to the crisis.

This will just be my follow-up. In terms of the legalization of cannabis, what kind of data do we have when it comes to cannabis use, when it comes to harms related to cannabis use? What do we know about the impacts of that — the legalization of cannabis?

I could also take us back to alcohol. We know that prohibition of alcohol did not prevent people from using alcohol. It just increased harms. So we have a historical analysis there. But on the cannabis front, I’d be interested to hear what the outcomes have been.

C. Massey: I don’t have that information with me on the impacts of cannabis. We do have it. In fact, Public Safety and Solicitor General monitors that work, along with public health. We can endeavour to follow up and get that for the committee.

I don’t know that PSSG this afternoon will be prepared to answer those questions. I think they were going to focus on law enforcement and drug trafficking.

P. Alexis: I’m just going to bring it to my community for a second. I’m representing the valley.

A Voice: Which valley?

P. Alexis: The Fraser Valley. In my community, 40 percent of those employed work in the trades. We are deeply impacted by the number of deaths in that sector, because we see it.

The other part is that we have a large Southeast Asian population, and we’re seeing more and more incidents in the community. So there are two things going on.

We know that there are some cases that have resulted because of an injury and all of that. But there are lots of cases where that’s not the case. It’s just choice in the trades. It’s almost like we need a re-education of what it means to be in the trades. I don’t want to say that it’s acceptable, but it’s the norm, often, that this is what is going on. It’s a terrible thing.

With respect to the South Asian community…. I’ve got two things happening, so if we could have two different responses. Are we seeing enough culturally sensitive supports? These parents are completely blindsided. They have no idea where to go and who to turn to. I think we can bring it up later on today, but maybe it’s gang-related activities. That’s a whole other issue.

[11:30 a.m.]

If we could, just for a second, look at my community, as far as the valley goes. I think those are the two issues that we’re struggling with. I know too many parents who have lost kids, young men that were working in the trades sector, that didn’t necessarily have an injury that they were recovering from.

I just want a response to that and then a culturally sensitive…. What’s happening there and how are we approaching this?

T. Hughes: Thank you for the question.

I focus my response primarily on the treatment issues that associate with injured workers, which means you’re kind of past what could have been done before that. WorkSafeBC’s ability to deal with that is connected to linking with worker advocacy groups, employer associations, and so on, because it’s really about stigma and education. So WorkSafeBC has partnered with a number of organizations to do that.

Government has, on its own, funded some of these. Christine talked about the tailgate, if I’ve got it right.

C. Massey: Yup. The toolkit.

T. Hughes: I think I mentioned in my comments the January announcement about that.

Is there more that can be done there? Absolutely. It requires employers to step up. It’s not unlike the work that’s being done with respect to mental health in workplaces. Employers are needing to take steps to make sure that workplaces are safe for workers’ mental health. They’re working to figure out how employers can provide more services in that respect.

It’s the same thing here. Are there more partnerships that can be undertaken between WorkSafeBC, employer associations, worker groups, and so on? Absolutely, yes. It’s about education. It’s about stigma. It’s about access. It’s about a number of those pieces. Once they get in the WorkSafeBC door, because there’s actually an injury, we have some more levers and tools in that context. When you go earlier on, everybody needs to be involved in that. I think that perhaps is a good segue to you.

C. Massey: Yeah. The need for culturally appropriate services and information is critical. I completely agree with you. We have done some work in that area but not nearly enough. I spoke about our anti-stigma campaigns. An earlier iteration of one of our campaigns was called Courageous Conversations, and it specifically had those materials translated into a number of languages for kitchen table conversations within families.

We have a lot more to do to provide and support those conversations to deal with the stigma — and more education. If our application on decriminalization is approved, I think it will present a good opportunity to have more of those conversations, to talk about why decriminalization is needed, why it’s a health issue. We will always be looking for those opportunities and where those entry points are.

R. Leonard: On slide 9, you talk about the connection with the health care system and 75 percent not seeking treatment prior to their passing. They’ve had contact with health professionals, many visits. It’s not treatment-focused. The crisis is happening before that point.

I know that in my community there’s been work done to try and get the episodic services available in hospitals. What is the challenge? Why is it not able to happen? I think that’s my first big question.

S. Brown: I think the issue with the visits is something that Darryl’s pursuing right now. Why were they visiting? While the frequency may be up, it may not have been anything to do or any declaration of any struggling with any kind of substance use. We don’t know that right now, so we’re trying to understand what the interface is.

Now, would the interface change if we were asking people? But to the stigma issue…. How many people would declare? You’ve got the same issue with alcohol and other substances. Do people declare? Do they think they’ve got a problem? Do they believe they’ve got a problem?

[11:35 a.m.]

I think it’s the interface with the health system. We’re trying to understand it. Darryl’s actually trying to do some work right now, trying to understand: what were the visits for? Were they in any way related to substance use, or were they for other health issues because of the social determinants that people are dealing with in health issues?

We don’t know the answer to it. I think it gets to, partly, what MLA Furstenau was also saying, which is: when do you think you’ve got a problem or not? We do know that drugs, just like alcohol, can lead to problems for a subset of the population. This issue of who we’re trying to help and where…. Right now we have discussions all the time about: how many people, really, are we talking about here? We’ve got this notional number, this 100,000 reference — the people who would theoretically be diagnosed with a substance use disorder. How many more people are actually on the recreational side?

In this instance…. I think the point that you’re making, MLA Furstenau, is that because I can go to a liquor store and buy alcohol, I’ve got some assurance it’s safe. Right now I can’t go anywhere and buy a drug and believe it’s safe. So you’ve got a social dilemma, a political dilemma around the legalization, which many people are advocating for.

I think it would be interesting to see, with the mari­juana, the cannabis, just these concerns about: does it lead to more? Are there going to be unforeseen consequences of what we’ve done? I’m assuming the answer we’re going to get is that it’s early days. I think there’s some data, but it’s early days yet.

You’ve got the bigger question here then, because you’ve got not just one but multiple substances. And actually moving into that space, economically, for a society is a big move. I think that’s subject to a lot of debate in terms of nobody knows where that will go. I think we’ve got the one example here in North America of the prohibition.

I don’t know what the answer is. I think it’s going to be a political debate without a clear answer. And the risk-taking, if that was to be the way…. In the meantime, we’ve got the challenge of: how do we link to people? How do you link to the person?

To MLA Alexis’s point, in the trades where, culturally, with recreational and just in with the culture…. And not just the trades. It’s other areas where the culture is there, and it’s recreational and maybe the weekend, and: “I don’t think I’ve got a problem.” But you’re actually dicing right now with death, just because of the supply. It’s super difficult. I mean, we’re struggling. The health side of this is that we think there’s high risk, ergo health is an important part of trying to actually provide a solution for you. To do that, we need to find a way that makes it safe for people.

This may also be a cultural issue as well. How safe is it? I go back to my own experience early on when we were dealing with AIDS and how risky it was for somebody to actually declare.

We’ve had the same issue with mental illness, generally. “How risky is it for me to declare I’ve got a mental illness?” How do we make it safe and confidential for a person to say: “I think I may have a problem; I’m worried”? And they have a safe place where they can go and actually, then, get what we were talking to earlier — a level of coordination as opposed to a series of episodic encounters with various parts of the system.

I think we’re struggling with it. There’s not an easy solution here. You look at all the elements. I look at them and think: the elements are there, to what MLA Bond said, of a comprehensive system. But getting the right balance of those and having those connect with the right people, I think, is just a genuine challenge. I really do think it’s a complex challenge for us.

N. Sharma (Chair): Did you have another…?

R. Leonard: Yeah. The other piece, from the previous slide, was that two-thirds of the folks who have overdosed and not made it through have had mental health challenges. That’s obviously a figure that you have because they’ve connected with the system. We know that they had mental health challenges. People have mental health challenges all the time that are not identified.

I’m trying to…. I guess I may be inappropriately doing this, but I’m assuming that a lot of the folks that made it to the health care system are amongst those with mental health challenges.

[11:40 a.m.]

I’m wondering. I was around when dual diagnosis came into being. It was that connection between mental health and substance use. If you can just maybe help us understand a little bit more around not the treatment side but those early stages, where there’s going to be challenges — without seeking treatment but having mental health challenges. What is our system doing? What are we doing, in terms of the urgency of the challenges that we’re facing today?

C. Massey: I think you’re asking about how we address any mental health problems early, before they spiral into addiction problems. Is that what you’re…?

R. Leonard: Well, I don’t know which comes first. It’s kind of like when you find yourself out on the street without a roof over your head: if you didn’t have a problem before, you get one pretty quick. I’m just curious. We’re dealing with this spiralling overdose crisis. We know there’s the issue around toxic drug supply, but we’re also dealing with human beings who have some real challenges that play into those decision-making processes.

C. Massey: Yeah, absolutely. I just want to start my comments by…. Of course, mental health doesn’t always lead to addictions, just to make that distinction. It’s more of a Venn diagram, perhaps. I don’t know that we know exactly that the people who showed up for treatment were looking for mental health supports, and that’s part of the reason that we need to find out more about why they showed up.

Part of what we need to build out are systems where we’re identifying problems early and intervening early, because we see the trajectory. Some of what leads to addictions is…. We’ve heard a lot around untreated trauma. It may be adverse early childhood events, which the early childhood data points quite prominently to as leading to problems later in life.

As is the case when you have some of this data come to the fore, it raises even more questions. It’s like: “Well, now that we know this, we need to know even more.” I think the death review panel spoke to the need for more work on the data, and I think some of what we’re discussing here also makes the case for that as well.

N. Sharma (Chair): I have a couple questions, and then I think we’ll see if there are any more for the next round.

My question is really about the chart that you have on page 17, because I really feel like this would be instructive, at least from my perspective, on what your overall viewpoint of the system of care you’re building is. I want to understand, particularly, the top part, where you have harm reduction weaving in and the different pillars and how they line up. Maybe just a few minutes on that, just to help us understand.

Particularly, you talked a little bit about the investments in Foundry. Where does that show up on here? How does that…?

C. Massey: Like I said, it’s a complicated slide, and there’s a lot buried in there. I’ll also say that it talks about the adult substance use system of care. That’s why you wouldn’t see Foundry, necessarily, in there.

Darryl will speak to the work that his team is leading on this, building out this vision for a system.

D. Sturtevant: This work that you’re seeing here in front of you really started from the first recommendations from the death review panel in 2017, where they asked us to do some work to build out what a substance use system of care would be. It has evolved over time. There’s been an expert group of individuals who’ve been brought together to inform this, pretty extensive literature reviews, lots of engagements — health authorities, other providers out there — to really build this out and look at the evidence of what those things are that would be important to have as part of a whole system.

[11:45 a.m.]

What this is trying to also depict is how harm reduction intertwines with the system. Harm reduction is both a front door and a safety net. It’s a front door, sometimes, into the system, and sometimes, it’s also the safety net for when you fall out of the system. That reflects, more or less, how you see that episodic data of those who are actually involved in substance use. It aligns with where the areas are. You’ll see in here primary care, acute care, bed-based services.

It does take that overall perspective. It does try to identify — we’ll call them jellybeans, in the centre — those areas in the system where we’re saying that these are the things that need to be in place and how we then have to connect across the system in order for that to meet those individual needs, recognizing that individuals have a wide spectrum of need. How they come to the system, how they enter the system and what they need from the system will be different throughout that journey and throughout their experience.

This is work that we have underway. As Deputy Massey mentioned earlier, we hope to get this formally approved by the end of this year and out. Then this would be part of what we would do to address, I would say, some of the gap analysis that would need to be there. That’s work that we would have to assess to see: what do we have here? What’s working in here? Where do we need to develop linkages here? Where are there gaps? Where are there further things we should be looking at building out?

S. Brown: If I can just add, I think that then gets part of the way to MLA Bond’s comment, which is that we need a comprehensive plan that’s clearly articulated. I think this will get us…. Then we can take this and actually apply it geographically to the local service delivery areas and then begin to say: “What levels of service do you need, based on the population?”

And understand where there’s…. I think there was…. One of the comments in the previous sessions talked about making sure that we’ve got the density of services in the community that’s required, based on need. I think we can get there by elaborating on this. That would then lead to having very specific, service-level targets and deliveries as well as, I think, critically evaluating which ones are actually getting results and what kinds of results we’re getting — which, I think, is still a gap for us in many areas.

N. Sharma (Chair): Okay, thank you. That was helpful.

My next question is about…. I guess it’s tied in a little bit to federal-provincial but also best practices in general. One thing we’re learning is that we have a lot of experts in the province that are on the forefront, maybe, of figuring out what solutions there are to the opioid crisis and the toxic drug supply.

My question is: do you know of any other best practices outside of B.C.? Do you tap into other resources? Part of the things that we’re going to do as a committee is to try to get that information, and I wanted your perspective on that, if you see anything outside of this jurisdiction.

The other one is that I just want to know, really specifically, what part of your view of a success is held in the federal hands right now, where we would need their approval or it’s in their jurisdiction to do? We are probably going to bring in, at some point, federal representatives, and I just really would like to know that, from your perspective.

C. Massey: Absolutely. Speaking to other jurisdictions and also the expertise that we have in B.C., we absolutely look to other jurisdictions to see elements of their response. But we always have to bring it back to what’s happening in B.C. and the specific nature of the illegal drug market.

The drugs that we have prevalent in B.C. and Alberta are not the same that are causing issues in other parts of the country. For instance, Saskatchewan sees more methamphetamine, I believe, whereas B.C., Alberta and the Yukon — the Yukon also recently declared a public health emergency — are also seeing similar concentrations of fentanyl and carfentanil. Our responses have to be calibrated to the nature of the crisis here in B.C., and B.C. does have an impressive degree of expertise in delivering these types of services.

Some of it is just because of the history of B.C., the Downtown Eastside. We’ve just had a long history of intense drug use in that area, just part of where B.C. is located on the drug markets in our coastal location. We have lots of experienced, front-line service providers, like the Portland Hotel Society, PHS.

You will hear tomorrow from Vancouver Coastal Health, which works with a lot of those front-line providers and has a lot of expertise. The B.C. Centre on Substance Use is also at the forefront, some of whom you heard from BCCDC.

[11:50 a.m.]

I do agree that we have a lot of expertise here about what will work in B.C., given the specific characteristics of our drug toxicity crisis, while we also look to other parts of the world. The work on decriminalization, for instance, pioneered…. I think lots of people speak of Portugal. We’ve been interested in that.

Other models of the Portuguese model we didn’t incorporate into our application to Health Canada — for instance, their mandatory treatment referrals. You’ll see in our application to Health Canada that we talked about voluntary referrals to services. We have to adapt to what we know will work in B.C. as we look around the world.

Then in terms of the federal government…. I think one of the things you’d be interested to hear about from Health Canada relates to the work you heard about from Cheyenne Johnson at BCCSU, and you may hear others talk about a non-prescriber model for safe supply. That is some­thing outside of the provincial jurisdiction. It’s something the BCCSU would need a federal exemption from their laws to support. So it would likely be worth inquiring with them as to whether that is something they’re prepared to examine.

The federal government has a program — we affectionately call it SUAP; I think it stands for the substance use and addictions program — through which they fund a number of pilot programs to fund innovative approaches. That’s where we have seen some federal prescribed safe supply projects that are doing very good work.

T. Halford: Just two things. We had the opportunity to meet with the B.C. Psychological Association last week. I think it was the second or third time that we’ve had the opportunity to meet with them — great presentation.

When we’re talking about the mental health aspect of it, just if we can get an update on…. I know that they’ve spoken to, I think, both ministries — and where that may stand in terms of their proposal.

The second question I have is actually just around some of the challenges. I think, Christine, we talked about this in estimates. It’s the challenges around staffing. It seems to me that the intentions are good. The announcements are out there. The funding is there. You just can’t staff — not the ministry, but there seems to be inadequate staffing, which is holding up, actually, a lot of these beds getting opened. So if you can talk about the challenges there — if there’s a plan in place to try and combat that. My understanding is that the recruitment or staffing is actually really prohibiting opening a lot of facilities or fully opening the facilities that you guys have announced.

I’ll leave it with those two.

S. Brown: With respect to the psychologists, we’re looking at that still. I think we just canvassed it a week or so ago.

What we have done is build into the primary care strategy the ability to add counselling, including psychologists within the counselling services, into the primary care networks. There have been a fair number of individuals. It’s probably the largest area of recruitment.

I think what’s going to be critical with that is also one of the other issues that has been raised, which is: what are the standards and what are the treatments or therapies that we’re actually using and evaluating to see whether they’re effective or not? That’s a piece of work that we’ll be focusing on in the coming few months.

I think they’re building on it, and the other piece that we have been canvassing is also trying to look at the evidence base, which is mixed, in terms of the so-called top therapies — the value of those and what role they might play in terms of treatment and how they have to be complemented with other medical interventions just because of the chemistry involved in some of the substance use issues. So we’re looking at whether we can establish…. It was part of the talking about the model of what the treatment modalities are that we’re supporting and evaluating as we move forward.

C. Massey: I’ll speak a bit about staffing and then also turn again to Deputy Minister Brown to talk about the health human resource strategy work.

There’s no question that staffing is a problem across the health sector, across the province. I would say it’s slowing down some of our work in opening beds. It hasn’t brought anything to a halt. It’s just more challenging to find people.

Where we can use different practitioners to provide the services — absolutely looking to that. I think some of our protection from some of those staffing challenges is deploying as many professionals as possible in the model so that we’re not limited by one profession — nursing, for instance.

[11:55 a.m.]

Also, in the way we’re expanding the number of prescribers who can do different things so that we’re not just held to physicians — for instance, for OAT. And virtual care can also expand reach. So there are a number of strategies we need to address. I think staffing, while we’re managing to cope right now, is going to become harder and harder; there’s no question.

S. Brown: I think — as we’ve also come to this recently — there’s not an easy or fast way through the HHR crisis that we’re facing. It’s not just here but across the country and, in fact, in most of the world right now, in terms of the capacity.

I think what we’re looking at, as to what Christine said, is alternate providers, looking at whether we want to expand further the HCAP program with additional training that we can build in so that people can begin to kind of focus on particular areas such as substance use or mental health and build out that capacity more quickly. Those are faster programs that have greater capacity to produce more people more quickly through training, so you’ll see more of that in the coming months as we try to work our way through the HR issues.

N. Sharma (Chair): A little bit of help with that. You said HCAP?

S. Brown: Oh, sorry. It’s just in terms of…. It’s for care aides. It’s a health care aides program that was introduced. I think it’s about 4,000 or 5,000 people. We still think there’s capacity there, and we’ve been gradually expanding that out away from just the long-term care and looking at where else it may be useful, particularly in this area. It could be a value-add in this area, in terms of some of the social care and supports that are going to some of the beds that we’re looking at in this area.

P. Alexis: Also on treatment beds. For many years, there were very few options with respect to treatment beds, so many people had to go to private care. It’s an enormous cost. I still have parents come to me to say, “We’ve had to put out X number of dollars,” because there just aren’t any public treatment beds available. The other part of it is that public treatment beds offer a 28-day course or stay, which often isn’t enough, so the person returns to the community and returns to their familiar surroundings, where drug use may be prevalent.

I know we’ve got issues with respect to staffing in every sector. It’s not just health. How are we addressing those two things? So increasing the number of treatment beds in…. I’m going to use the valley as an example, the Fraser Valley. And are we looking at increasing the stay in the public treatment beds? We know that it’s often a revolving door, that they’re in and out, in and out, and not really seeing results. That may come back to our evidence-based approach, ultimately, as where we want to see success. Can we talk about that a little bit?

C. Massey: Yeah, absolutely. We’ve all heard about the wait-lists for access to treatment beds. Part of our work has been trying to expand the publicly available beds. In some cases, in some of the previous funding we’ve provided, we’ve actually converted, so to speak, some privately owned beds to publicly managed beds.

The 28-day limit is not something imposed by the ministry. It may be something about the services particularly available to you in the Fraser Valley, but there are longer stays available, depending on a client’s needs.

I would also say that the investments we’ve made have not just been in that treatment bed. We know you need…. We’ve been making investments across the continuum of substance use treatment, which we say can include withdrawal treatment — so that’s the detox — and then you can move into treatment. And then after, the aftercare supports are very important. So directly to your point — because if someone is not getting supports to continue the gains they’ve made in treatment and go back to some situations or influences that are not helpful, it’s a revolving door, as you said.

[12:00 p.m.]

We recognize that there are gaps in that continuum for substance use treatment and have been trying to make investments in that entire continuum. Obviously, still more to do.

Then you were talking about staffing. The only other thing we haven’t mentioned on staffing is just the use of peer workers. They’re not going to replace clinical staff, but they do have a role, particularly in this area, which is so stigmatizing. Having someone who’s been through it…. Perhaps they’re the person who greets you in the waiting room and convinces you to stay until you see somebody. Perhaps they’re the one doing some of the history because you’re more comfortable speaking with them.

Like I said, we have a peer-training curriculum to help people understand how to work in the health care system. But that’s just another example of some of the creative approaches we can take to try to lessen the pressure on some of the more formally educated, credentialed….

S. Brown: I think to what Christine said, as well, if I can just add…. I think it gets back to what we were talking about earlier, about a continuity-of-care plan. These handoffs, when you’re on a wait-list, and then you’re exiting, and then you’re on another wait-list, and then you’re on another wait-list…. That’s where those handoffs, the gaps….

Christine and I, and Darryl, have been having some discussions with a couple of the HAs about whether we can introduce something later this year, which actually begins to really give some level of coordination so that, in fact, there is a care plan. You’re not going from one wait-list to another wait-list to another wait-list, which actually is just not going to work.

We’ve got to identify who we’re working with and then have much more coordinated care plans that go across these different…. And allow, also, to move back. It’s not just that you go out. You’re not, then, back to square one on a wait-list to try to get back in.

We’re trying to look at how to put that…. As you can imagine, it’s a tricky thing to actually operationalize. Really, our focus right now…. We’re having some serious discussions about how we can do that in a coordinated way with much more sharing of information and care planning that would be used for some of the people who are really struggling — to make sure that they’ve got a clear pathway.

P. Alexis: Can I ask a question? Do the people that are seeking treatment connect more with someone who’s got lived experience, as opposed to the professional? Can you do more with those lived experience that would help with the continuum and staying on course, ultimately?

I’m just wondering if we’re being shortsighted at all in the use of that lived experience. Is it something where they could take on a larger role, with respect to the staying-the-course kind of thing?

I don’t know. I’m just thinking out loud.

C. Massey: I think it’s absolutely worth pursuing. I don’t know that we have a lot of the evidence for it, but certainly, anecdotally, we know that that’s the kind of environment that people experiencing substance use find welcoming.

P. Alexis: It’s all about connections, isn’t it?

C. Massey: These are relationship-based services.

S. Bond (Deputy Chair): As far back as December 2016 the House of Commons actually had a health committee that reported out on the opioid crisis in Canada. At the time, Dr. Henry was one of the witnesses there, as were a number of people from B.C. One of the things that she paid particular attention to was public education. If we’re going to make a difference and save lives, we have to bring the public with us.

Her quote was very helpful in that day and age, and I’m assuming it is the same today. She said: “I think we do need to talk to people in a very forthright and open way about drugs, about their uses, their benefits and their harms so they can make those informed decisions. When we do it right, we’ve seen that it works.”

What emphasis is the cross-ministry approach taking to public education? Without that, we can have all of these meetings and conversations as long as we want. But that was in 2016. We don’t have those conversations. We have conversations about this issue, tied to the reports that come out once a month.

[12:05 p.m.]

We heard today that prevention is embedded in curriculum. Having said that, teachers have very full plates. I remember from my day in the ministry. They’re asking us to take things off their plates, not add things to them. Maybe speak to us a little bit about public education. From my perspective, it’s hard to find a conversation about this in the public domain.

Ironically, the current Minister of Mental Health and Addictions was on that health committee in 2016, so would have a lot of familiarity with the other recommendations, which sound unbelievably similar to the ones that we’re talking about today. The links to mental health supports were critical in 2016. They are today. The other quote, by the way, that’s really helpful, from a professional in there, is: “You can’t fix it if you don’t measure it.” I think all of us agree with that.

I mean, one of the things that I’m going to continue to press for is that sense of: where are the metrics, the measures and the connections?

Stephen, to your point and the earlier point, the death review panel actually talks about the connection between visits to health care providers and mental health and drug use. Somewhere there’s data that does link those visits pre-death. So I guess public education, and we’re not going to fix it if we don’t measure it. Can you just speak to those two issues for me?

C. Massey: Public education. Right now it’s not front and centre. I completely agree with you. So in terms of inquiries to our ministry from media, they tend to be focused on that day that the coroner’s report comes out, and then there’s a renewed interest for a couple of days, and then it wanes. I will say that B.C. is unique in that we are one of the…. I don’t know of any other province that has that monthly release of data to provide that level of information. So we’re being proactive there.

Could we do more public education? I completely agree. We have work that we do through the Ministry of Mental Health and Addictions and our StopOverdose site. But how do you find people to take that up? We use all the social media channels and targeting. But there’s probably more that could be done.

I think about public education campaigns that have had an impact — the Bell Let’s Talk campaign, for instance, where you have known public leaders speaking out about their own mental health views. Some of the progress that’s been made in addressing mental health stigma through some of those broad campaigns with trusted spokespeople…. I’d say addiction stigma is behind that. We don’t have that same level of people championing that work.

Some of the work we’re doing with the professional sports teams starts us off in that direction. That’s very targeted to some of the fans of those teams, many of whom are male and in that demographic that we’re trying to speak to. But if the committee has other suggestions for us, we’re happy to look at those, because I agree with you. The conversation is not where we need it to be.

In terms of “you can’t fix it if you don’t measure it,” I absolutely agree. That’s why we want to continue to do the work on data and digging into that data that was pointed out in the death review panel. As I said, it raises more questions. Once you have that data, you say: “Well, now I need to know why those people showed up. What were they asking for? Did they get it, or were they referred to someone? Was there a warm handoff, or were they sent out with a prescription or something?”

S. Bond (Deputy Chair): I guess I’ll just say that I think that we do need to be intentional about the public education side of this, because it’s actually what goes on between the monthly reports that’s going to make a difference. It does need to start young — our youth. As Dr. Henry pointed out, even back in 2016, it’s also about the potential harm and risk, actually having the courage to say: “You know what? This has probably got some risk for you, and it’s probably not a good idea for some reasons.”

[12:10 p.m.]

She talked about benefit and harm. I just think that unless…. I certainly understand and respect the stigma side of this. But it’s our job, and one of the major threads in that report was about leadership. It was about, in that case, national leadership. But it is about standing up and talking about both benefits and harms in an intentional way. I think that’s why there’s such frustration from many of the people we’ve heard from already — and there will be more — that with COVID, there was extraordinary effort expended.

While there was some debate about the data and what was released and what wasn’t, at least there was that opportunity for British Columbians, every single day, to know this was a problem. Whether we debate what was said or not is part of this process, but when there is silence between two monthly reports, people fill in the gaps themselves. Again, that’s why, when we look at what the death review panel talks about, it is to embrace that same process that gives people as much information.

I very much appreciate your response, that we don’t have this, or we don’t have that, and it wouldn’t talk about this. Well, we could make it talk about that if that was something we decided to do.

Like what’s going on at school. Parents are busy folks, and there is stigma attached. If they have to ask for that information, and we talk about families being provided with information, how many of them are going to do that? If they know that there’s the ABCs and there’s ERASE and all of those things…. But the chances of getting that down so parents know where to access it and manoeuvre the system…. Anyway, I simply think that when we look at some of the charts in this report, for me, it describes the problem. The problem is that it’s complex, multifaceted, and when a person looks at that chart, they probably don’t even know where to begin.

I really want to emphasize the need for us to have this conversation in a way that gives access to as much information as possible — the benefits, the harms, what’s available — and be willing to embrace the fact that there are gaps.

J. McCrea: Thank you, MLA Bond. On the ERASE strategy, there are a number of things. We do have parent sessions, and we did find through COVID that by being able to offer it virtually, we had a big attendance.

The other thing that we have been doing is student sessions around online safety, but then that also gets into other areas. We heard gangs earlier, so we have a very strong partnership with Public Safety and Solicitor General. If a parent is concerned about a young person’s activity or baseline changing, where do they reach out for help? How do they reach out for help?

Same with the student sessions. In our last student session, what is really encouraging is that teachers are logging in as full classes. We were able to reach 3,000 kids in one session, so being able to say: “Here are the harms. Here is what to watch out for. If you’re worried, here’s where to go. Here are some tools and resources. Teachers, because it is the core competencies and it’s in curriculum, here are resources and tools.” By extension, here’s where to reach out if you’re concerned about a young person.

I would say that the very strong partnership that we have — with Health, with Ministry of Children and Family Development and with Ministry of Mental Health and Addictions — looking at the mental health in school strategy as a complete piece of wrapping around that young person, and how, when a young person needs mental health supports or substance use supports…. Are all of those systems starting to work together? That is very much a piece of work that we’re doing under the integrated child and youth care work. We’re bringing those systems together in the province.

S. Bond (Deputy Chair): Are you going to continue the virtual despite the fact that we’ve moved away, if that’s working?

J. McCrea: Yeah, very much so. We’re looking at the combination of both, because we also are having a high turnover of employees in the education system. So where do we bring in some of the professionals for that face to face in that learning? Also, where it worked for the youth and parents, how do we continue to grow and build that?

S. Furstenau: Great. Following up on MLA Bond’s…. I’m really keen to talk about the education system as well.

[12:15 p.m.]

One of the concerns I have right now, and I brought this up in estimates as well, is hearing from schools and school districts where funding for counsellors or psychologists is being cut back. Then I see $186.3 million on mental health and substance use supports in the education system, and I wonder about the disconnect. If we’re putting that much funding into the education system for mental health, substance use supports, shouldn’t that be specifically for people who are in the schools and accessible to the students, where those needs are really going unmet in so many ways?

I had a classroom of 33 grade 8 students. Several of them were on the roster for getting access to the school psychologist, but she was covering three or four schools. She was in our school one day a week. There are dozens of kids in that school. It translated into, really, virtually nothing in terms of access for those students.

Following on MLA Bond’s comments, I think all these plans and systems and all these things…. Shouldn’t we be translating that into: this is the number of psychologists and counsellors available in schools at all times, and this is the baseline that we are going to meet? When I asked about this in estimates, it was: “Well, school districts get to allocate their funding the way they….” If this is actually a cross-ministry approach, shouldn’t it have really specific outcomes that are being achieved and measured so that we can be assured?

Again, we are all hearing from parents who are saying: “I can’t find mental health supports for my child. It doesn’t exist in my community.” So just a comment on that. These kinds of funds…. Shouldn’t they be translating into people on the front lines?

J. McCrea: Thank you, MLA Furstenau, for the question.

A couple of different pieces. Of course, you know collective agreements, and there are numbers in there around how many counsellors per how many number of kids, so working through those pieces that are in place, in addition to the money that is available.

The $186 million plus goes towards, very much, young people with a designation for a “serious mental health illness” category and intensive behaviour. There is a large sum of that money that goes towards designated students, that goes into the school districts.

It also helps support the education program — we talked about school connectedness — when young people are in treatment. We have a provincial resource program in the province, where if a young person is in a treatment facility or is in hospital…. How do we stay connected to that so that some of those dollars go towards those pieces?

In addition, we were able, through the province, to be able to put more money into mental health services in the districts, so the districts could decide what they need around mental health supports. Is it people? Is it training? What does that actually look like? There has been $10 million put into that through the COVID years.

I’m also a parent whose daughter has a designation of severe mental health, so what do you do as you navigate? I am in a position of having resources and experts and people to ask, and other families don’t. How do we, right from the school base level — even the child care piece; we’re the Ministry of Education and Child Care now — support a family through the entire system?

My goal in supports is that they don’t become the stats, that they aren’t at the end-user, that we are doing the promotion and prevention piece. It does take people. We do have shortages right around the province of specialized people to do these services.

It is really that system approach that Christine has talked about that we do need to address. I do know that school districts are making very difficult decisions around their budgeting process.

S. Furstenau: Just further to that, on the access to information and education for young people. I had a high school student reach out about a year ago who had lost a friend recently to drug poisoning.

[12:20 p.m.]

She indicated…. Urban high school in the capital regional district Her experience was that there was very little to none in terms of access to information about drug use, about the harms, that met her and her peers where they were at. One example of this — and I’ve talked with him and heard from the presentations he does — is Guy Felicella, who is part of the death review panel, and the approach that he takes.

Can you speak a bit to that? Sometimes these programs and — again, as a teacher — the websites and the resources and the packages are very different from somebody like Guy, lived experience, who’s going to come in and be able speak to youth in a way that they’re going to connect with. I know there are examples of that with sexual health education, as well, where we can bring in experts.

Is that part of the funding? Is that happening at a level that you think is really serving the youth and high school students in terms of where they’re at right now?

J. McCrea: I think, through COVID, we have seen the schooling happen in different ways. I think that some of those in-class presentations with people with lived experiences haven’t occurred in the same way, so I think that is a piece of work.

We also have a number of…. We get the reports in from all of the school districts on how they’ve used all of the mental health money, so we are looking through at where school districts are making progress. How do they know…? To the point around metrics, it’s fine to say: “Oh, yeah. We brought in five speakers.” But what was the outcome that came from that? Did we see an increase in people asking for supports? Did we see extra resources being produced, anything like that? We’re working through those reports right now.

The other piece we’ve talked about a little bit here, too, at the adult end but also at the youth end is that peer-support model, so youth talking to youth, youth supporting youth. That is a big piece that we are seeing growing as well.

R. Leonard: One of the things I remember when the Internet became a thing was that information is not knowledge. We can have a whole bunch of information thrown at us, but it doesn’t make a difference.

What clicked for me was that we’re hearing about the number of overdose deaths, but we have this whole framework for this system of care, and there’s so much that is being done and has been done for a long time in different ways. But I would say that woven through this system of care now, in today’s world, is the harm reduction piece, which is evidence based.

I’m just wondering, on top of those monthly reports of how many deaths and where they are, if there are metrics around the effectiveness of things — like the ones that didn’t die, the ones that found treatment, the ones that actually succeeded. Another trigger for me was around the OAT retention problem. I keep thinking about just what it is we should be measuring — to relay to the public not just the tragedy of overdose deaths but what can be done. I think that’s part of that — helping to reduce stigma.

That’s a question. The other piece of it was…. I know that we heard earlier around the risk-mitigation guide, and one of the barriers has been in finding, within the health care system, those who will buy in to the prescribing model. I just was reading on one of your slides how it has increased from 17 prescribers to almost 1,100 prescribers.

I’m just curious about that piece around the professionals who have that capacity to provide safe supply. Is there a trajectory there that is going to see more impact if that risk-mitigation guidance is making an impact?

[12:25 p.m.]

C. Massey: I’ll start, and then I’ll turn to Darrion to talk about what’s been contributing to the prescribers increasing and what we know about who is taking on that type of practice.

I take your point. This can be a despairing type of topic. What do you do? It feels so complex. But like I said, complexity doesn’t mean we can’t act.

It’s hard to prove a negative — you know, who didn’t die. I think I spoke briefly about how we had some modeling work by those mathematical whizzes at the BCCDC about the impact of some of those evidence-based interventions. It was overdose prevention sites, naloxone and OAT. They were able to demonstrate over, I think, a three- to four-year period that 6,100 deaths were averted. We’re trying to get that modeling updated, because we’ve put in place so many new things.

The challenge, of course, is that all these new things we’re putting in are what Réka Gustafson called evidence informed. We are building the evidence as we go, so trying to demonstrate the impact is a rolling issue. We’ve just got the preliminary results for the risk-mitigation guidance — that phase 1 of our prescribed safe supply, where I talked about how we saw a reduction in death of about 74 percent compared to people who didn’t get medications there.

We need more of that and disseminating it. That is underway. It’s embedded in all of our work. Because it is so new, we have to have evaluation happening at the same time that the practice is rolling out.

Darrion, do you want to speak about prescribers?

D. Campbell: Sure. I think we mentioned a little bit of this before, but I’ll mention it again and add to it.

As Christine mentioned, we are working with Doctors of B.C. as well as the college around the information that’s out there around prescribed safe supply. One of the pieces we’re also doing is working to develop those guidelines for prescribers so that they can have their comfort. We talk about evidence, and the medical community is very evidence based and really wanted to have solid foundational evidence prior to moving towards the practice.

This has been an interesting piece of an iterative practice, where we’ve implemented…. We’re looking at evidence, and we’re honing, as we go forward. That’s certainly something that we’re working on, and as I say, working with B.C.’s physicians.

One of the pieces that we’re really doing around specific prescribers is actually working with health authorities to have dedicated physicians in place in some of their prescribed safe supply programs so that those physicians are quite focused on that prescribing as well.

If we think about it, there are community prescribers and then there are sort of specific health authority programs — working on both of those perspectives to try to, to your point, have the community awareness and the prescribing increase at the same time as those more dedicated, specific programs.

N. Sharma (Chair): Okay. I’m going to…. I think I have the last question.

Oh, did you have another question? I didn’t catch your hand. Go ahead.

M. Starchuk: Thank you, Chair.

Just on the whole issue on data collection. I think you mentioned earlier on — like globally, this isn’t a whole bunch of a data pool that’s out there. We talked about treatment and recovery beds, and we talked about what the ALR had done and the updates that were there and some per-diem funding that was increased that was there.

By and large, operators are left to fend for themselves, so to speak. We will hear it, and I hear it, from the operators in my jurisdiction: “We can only do so much, because we’re only getting $35.90 a day.”

I guess my question is more about: are we working with the other provinces that are in this like-minded thing to create a database that just runs from left coast to west coast to be able to do that kind of work? If everybody is collecting it in the same manner at the same time, it must have a bigger benefit.

C. Massey: Yes. There is national work underway to try to standardize how each province collects data. As you can imagine, each province has grown their mental health and substance use system in their own way. It hasn’t been a focus for national data collection.

There is a working group of federal-provincial-territorial officials that are slowly working on that, I would say. That’s not proceeding quickly. This is where people start to argue about data definitions and that sort of thing.

[12:30 p.m.]

The other thing I will say is that this issue of collecting data and increasing the quality of the mental health and substance use operators of the facilities is an issue across all provinces. We just had a recent meeting of deputy ministers responsible for federal-provincial-territorial Ministers of Health, and mental health and addictions was a prominent topic.

All provinces are trying to get a handle as to how better to regulate and have oversight of this sector. We’re not alone in B.C. in that. It didn’t have a lot of attention and was allowed to just grow independently. Hence, here in B.C., we see a lot of private operators, as we’re trying to grow the public system. So we are looking to each other.

Alberta has done some work. They’re a bit ahead of us, and we’re learning from what they’ve done to try and inform where we might go next as well.

N. Sharma (Chair): The final question for you from me is about the housing and the complex care.

It sounds like, through a lot of the work that you’re presenting and where we’ve received recommendations, that it’s a lot about bringing data together across ministries — people to gather information and understanding of the person, I think — as you mentioned, Stephen — rather than where they interact. I just was thinking that the complex care housing or the program provides, I think, maybe a good opportunity to have all those systems come together and a person that’s stably housed.

The question, I guess, has two parts. There is a safe supply program that was piloted — which you mentioned, I think, Angela — about, actually, somebody that’s housed being tied into other programs. Is there going to be more of that?

The second question is: do we know that there’s an overlap between some of the data that we saw about who the people are that are dying and the percentages that we had, and the people that are being housed in the complex care? We know that if they’re the same people…. They’re on SDPR. I don’t know.

I’m wondering. Are they same the people? Once we get them housed, is there an ability to bring all of that together, all of the work together, to kind of understand things or stabilize a person or learn about which programs are working and that kind of thing?

C. Massey: Super interesting points.

The complex care housing, again, is a new service. We built evaluation into it, because we know we’re probably going to need to tweak it and adjust it as we go to see how it’s successful — if we’re getting and supporting the people that need to be supported. Part of the supports that are in there are some of the harm reduction supports we’ve talked about, whether that’s an inhalation site or a supervised consumption site. There may be opportunities to bring in prescribed safe supply. We’ll be looking at all those opportunities to connect services.

The health authorities are running complex care housing, because it’s the gap in health supports that was really the issue that was missing for this population. Our friends at B.C. Housing are very good at providing supportive housing, but this population needed those extra health care supports.

Are they the same people? Fascinating question. I think that’s one we’ll write down for some further work. They very well could be. It’ll be built into our evaluation data collection.

A. Cooke: Just to add to your question around the safe supply, as DM Massey has alluded, there are a number of sites within B.C. Housing locations where safe supply programs are operating. I think we continue to work with them to understand what potential operating challenges they have with this current program. What is their capacity and ability to be able to expand, again, recognizing that there are challenges in terms of being able to staff these sites and also taking into account any feedback that we receive from local communities as to where those sites are located?

N. Sharma (Chair): Okay. I think those were all the questions. We had a lot of questions and answers.

I just want to thank you, on behalf of the committee, for, I think, what was a really, really deep dialogue about some of the work that you’re doing. First of all, thank you, all, for your work and for coming here today and talking about it in this presentation. It was a lot to go through, and I know you had a lot of questions. So I appreciate that.

On behalf of British Columbians in general…. I know that this is a really big crisis for a lot of families out there. The work that you’re doing every day and the work this committee is doing to try to solve complex problems…. Thank you for all of that effort.

I just want to thank the committee members for all of the really great questions, which I thought got at a lot of different aspects of the crisis.

Enjoy your lunch.

If we have any other questions, we know who to go to. So thank you.

To the committee members, we have lunch coming in at 12:45, I believe. The next actual formal presentation is at two. That’s when PSSG is coming by. Until then, recess.

The committee recessed from 12:35 p.m. to 2 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Welcome. This afternoon we have folks from PSSG to present.

I’m going to go around, and maybe the committee members can introduce themselves to you, and you can introduce yourself.

A reminder that we’re all on the traditional territory of the Coast Salish peoples, the Tsleil-Waututh, Musqueam and Squamish.

I’m going to start from this end.

Go ahead, Mike.

M. Starchuk: Mike Starchuk, Surrey-Cloverdale.

D. Routley: Doug Routley, Nanaimo–North Cowichan.

S. Chant: Susie Chant, North Vancouver–Seymour.

R. Leonard: Ronna-Rae Leonard. Good to see you all again.

P. Alexis: Pam Alexis, Abbotsford-Mission.

N. Sharma (Chair): Niki Sharma, Vancouver-Hastings.

S. Bond (Deputy Chair): I’m Shirley Bond. I’m the MLA for Prince George–Valemount.

T. Halford: Trevor Halford, Surrey–White Rock.

S. Furstenau: Sonia Furstenau, Cowichan Valley.

N. Sharma (Chair): Okay. Everybody has a copy of your presentation here. We’ll let you go through it, and then we’ll have some time for questions and answers.

MINISTRY OF PUBLIC SAFETY
AND SOLICITOR GENERAL

W. Rideout: Great. Good afternoon. Thank you for having us here. My name is Wayne Rideout. I’m assistant deputy minister and director of police services for the province of B.C. My colleague Brian Sims is the executive director of serious and organized crime, one of the seven divisions within the policing and security branch within the Ministry of Public Safety and Solicitor General.

We’ve come here to discuss the toxic drug and overdose crisis and the role of the ministry and the role of the police in this province in combatting and addressing this tragic situation.

Before I begin, I’d just like to point out that we are not the police. My role is to superintend the police, and I’ll talk to you a little bit more about that later. I do have a policing background, but I would encourage you, when it comes to some of the specifics about drug enforcement and some of the challenges that the police face on a daily basis, to at least consider hearing from them directly at some point.

The police and the British Columbia Association of Chiefs of Police have been very much engaged in the challenges of the toxic drug supply and the tragedies related to deaths that are occurring from that. They’ve engaged since the beginning, and they have done a lot of significant work. There is a committee, and there are some leaders within the police chiefs that have done a lot of great work. They bring another element to this conversation, particularly around where harm reduction and enforcement both converge and collide at times.

As a bit of a background, I’m going to talk a little bit about the Police Act and how policing works in British Columbia. Some of you have a better understanding than others, and it’s a bit complicated — the structure of policing in B.C. My responsibility is as the director of police services and my role to superintend — and some of the ministry-mandated initiatives around the toxic drug supply, prevention, intervention and decriminalization.

Very quickly, the Minister of Public Safety and Solicitor General has obligations under the British Columbia Police Act, and the one that primarily links to policing and law enforcement is the responsibility to ensure adequate and effective policing and law enforcement in the province.

There are a number of corresponding sections in the Police Act that provide structure to policing — police boards, police board governance, what the RCMP is responsible for, the cost of policing, efficiency in policing — and it really does, at a very high level, map out policing in British Columbia. Most of you will be aware that there were recently recommendations from the Special Committee on Reforming the Police Act and refining what we believe is a fairly old and outdated act. There are a lot of revisions required. So that work…. We’ll be examining that in the very near future.

I have obligations under the Police Act, under part 8, as the director of police services, and that includes, on behalf of the minister, to superintend policing and law enforcement functions in the province of British Columbia.

I also have a variety of powers related to policing standards that are very specifically outlined within the act, and to be perfectly honest, they’re somewhat limiting. The ability to apply standards is only in some areas. One of the recommendations that was made to the special committee was to expand that standard-making authority in the future.

The legal framework…. I believe you have that very complicated slide in front of you. It is complicated, but it really does demonstrate provincial responsibility for policing and federal responsibility.

[2:05 p.m.]

When we talk about drug enforcement and harm reduction, gang violence, organized crime, from a policing perspective, they mesh. They come together. I refer to it as the three tiers of organized crime enforcement. The federal government is responsible for the RCMP. British Columbia has a relationship with Canada and contracts the RCMP, pursuant to a contractual arrangement, but the RCMP does operate under federal legislation and federal Treasury Board guidelines. That does, to a degree, limit our direct control with the RCMP. That said, we have a very good relationship, and we are able to, more often than not, come to a synergistic approach on provincial priorities.

The federal government oversees the CBSA, which plays an important role in drug interdiction and disruption into Canada and British Columbia. The federal government also directly oversees what I refer to as the federal RCMP. In this province, approximately 900 RCMP officers are here but report directly to national headquarters in Ottawa. They are responsible for transnational organized crime, overseas operation, the interdiction of drugs, toxic drugs, precursors and chemicals from foreign countries through drug cartels from around the world, and organized crime.

They work on a national targeting model, and they work with international partners to try to disrupt the supply chain and conduct enforcement operations, both abroad and in Canada, but at a very high strategic level.

The RCMP provincially are part of what we call the provincial policing service agreement. They are in contract with British Columbia. There are approximately 2,550 provincial police officer positions in this province to provide front-line policing and a host of supporting functions, including drug enforcement, organized crime enforcement through the CFSEU, homicide investigations and front-line detachments right across the province.

Many municipalities contract with the RCMP to be their municipal service. Basically, they buy a municipal police department through contract with the RCMP. We know that we’ve got many communities in this province that use the RCMP for their local police departments.

We also have 11 independent police agencies in the province servicing 12 communities, Esquimalt and Victoria being one police department servicing two municipalities. They are governed by municipal police boards that are, in turn, governed by the B.C. Police Act.

We also have what we call designated policing units: the Stl’atl’imx police, a self-administered police agency; the Metro Transit Police; as well as the CFSEU OCABC, which we’ll be talking about a fair bit today. It falls under the Police Act under a separate category called the designated policing unit.

We are fortunate in this province, unlike other jurisdictions across Canada. The RCMP municipally, provincially and federally, as well as our 11 agencies, get along very well. They are connected at a very high level. A lot of that flows from some of the challenges of the past, both at the B.C. Association of Chiefs of Police and the B.C. Association of Municipal Chiefs of Police.

With respect to enforcement around gangs, guns and organized crime, they get along well. They’re coordinated. They speak to each other on a regular basis, and they have a very symbiotic and supportive relationship, which is not necessarily replicated across the country.

I’ve kind of touched on my responsibilities. In the interests of time, we do inspections of structures of policing, ensuring adequate and effective levels of policing across the province. We ensure compliance with policing standards — for example, standards with respect to police stops or what was formerly referred to as carding.

One of the things that my branch will be doing in the upcoming year is conducting a review to ensure compliance with those standards that were implemented about two years ago to make sure that police agencies are, in fact, complying with them. We do conduct reviews on crime problems, such as the Lower Mainland gang conflict, to ensure that the police are being effective in the work they’re doing to the degree that they can be.

With respect to some of the ministry’s mandates on toxic drugs, we have been instructed to work with the police to address the serious crime in B.C. communities, including cracking down on those who distribute toxic drugs on the streets.

[2:10 p.m.]

While policing represents an important component of the province’s broader strategy to combat illicit drug overdose, it is widely recognized there is no quick fix to toxic drug distribution and associated gang violence. The reason that we will use the terms gang violence and organized crime is that they are connected. The violence that you often hear about on the streets of Vancouver and elsewhere in this province is connected to drug trafficking conflicts — turfs, territories.

The approach by much of law enforcement in this province is to tackle it holistically to try to identify those that are engaged in trafficking narcotics or money laundering or firearms violence. It tends to all come together in that enforcement because they have illegal guns to support their illegal drug trafficking rings and generating money, so it all comes together. So the strategy tends to be holistic in nature, trying to be as efficient as possible. Rather than chasing solely a commodity, chasing those that are facilitating the activity itself.

Fentanyl continues to be one of the most significant driving factors of the opioid crisis. As I think you’ve heard, the B.C. Coroner’s Service preliminary data indicates that 79 percent of the drug toxicity deaths in 2022 and 86 percent in 2021 were as a result of fentanyl itself.

We did see a slight decline in the ability of organized crime to infiltrate Canada’s borders during the COVID pandemic due to the reduction of travel at the borders and the increased scrutiny by law enforcement at the borders. Sadly, if you look at the statistics, that did not have a corresponding effect on deaths.

Perhaps a good juncture to talk about…. No matter how much drugs you seize, how much you stop abroad or in this country, it’s very challenging to stop enough to make a difference to the deaths on the streets and the tragedies that occur because there’s simply so much of it out there.

As many of you have likely heard, when you’re talking about fentanyl…. Pure fentanyl, for many years, came in through the mail in packages no bigger than this. So when you imagine trying to interdict that size of a commodity and make a significant difference, it’s almost impossible.

We also note that organized crime is very good at adapting to police techniques and successes. You close down one route, you close down one technique, and they find another. We saw the same thing in money laundering.

We are also alive from police information and intelligence that the supply of fentanyl and other toxic drugs that used to come from abroad, whether it be from China or through Mexico, now are often manufactured here in British Columbia or elsewhere in Canada. They bring in the chemicals and precursors and manufacture it here, locally.

There are a number of initiatives that the branch has been responsible for over the past few years. That includes ensuring that the police have naloxone. There are over 700 documented successes where the police, just the police, administered naloxone on the streets of communities in British Columbia. We support and work with the RCMP and policing partners on what we refer to as the clandestine laboratory enforcement and response team — that is, CLEAR. Those are the specialists you see on TV when they find a chemical lab or something in some of our communities. They don the gear, they go in, and they can dismantle these labs in a safe supply.

But that’s not all they do. They generate intelligence. They do proactive work to try to identify who these people are. They follow chemical trails. In other words, they follow intelligence, and they do investigations that give them clues as to who may be accumulating chemicals and precursors for the purposes of amassing an illegal laboratory. They do a lot great work there.

[2:15 p.m.]

We’ve also funded the anti-trafficking task force, which is situated in the CFSEU, combined forces special enforcement unit of British Columbia; and OCABC. That is a dedicated team of investigators and support staff that target the gang and organized crime figures that are dealing in drugs and firearms. They’ve had significant success, and I’ll talk a little bit about that shortly.

The branch is also responsible for, and my colleague oversees, situation tables. He oversees, actually, most of what we’re going to talk about here today, so I’ll take a lot of credit for his good work. But situation tables and intervention circles — these are community-based initiatives in which social services, Health, Mental Health and Addictions, the police and Education get together and identify communities at risk and those at risk within communities and try to find collaborative solutions and preventive solutions in local communities. The branch funds communities that are interested in this approach.

The idea is that if individuals are at risk — at risk of dying or at risk of being in front of the courts for survival crimes or crimes of opportunity — the appropriate subject-matter experts can be brought together to find solutions that are humanitarian in nature and that can get people, perhaps, off the streets. Take away the homelessness, the vulnerability, and get them the kind of supports that they need.

I think it’s a very good program. We seem to be getting lots of interest in expanding. There are approximately 15 in the province now, and we’re growing to, I think, about 19 soon. We did the work on the successful Pill Press and Related Equipment Control Act a number of years ago, which was to try to make it illegal for people to possess pill presses and make their own fentanyl tablets. That’s been in effect for some time.

We have three communities that are doing police referrals to treatment, pilot projects to study the pathway away from the police to health and addictions counselling. Those communities are demonstrating some success and, I think, will provide a model for where we need to go in the future.

Last but not least, the province, in 2012, went to what we call the PTEP model, the provincial tactical enforcement priority model, and that became a provincial policing standard in the last several years. That is a targeting model in the province where the police identify people that are engaged in organized crime, gang violence, and drug trafficking that is the highest risk to public safety — a lot of it in the convergence of violence and drug trafficking. We provide funding and coordination to numerous police agencies across the province — pretty much all of them, at this point.

We force multiply by using the central intelligence on what we know about who’s at risk, and then we…. Say Dawson Creek will target somebody who is a high risk to their community. Surrey will target people in their community. People on the north Island will target theirs. Basically, we’re in a position to identify who’s creating the most…. Essentially, prolific offender management for gangsters is really what it is, but it’s been a very successful program with lots of documented success.

Just to give you some sense of the funding. CFSEU and OCABC, which is the province’s organized crime agency, are a 70-30 cost share with Canada, and the total funding for that organization is about $83 million a year. There are approximately 500 employees that work out of the RCMP headquarters, but it is a completely integrated team. All police agencies in this province participate in that, and it’s one of a kind in the country. They have satellite offices in Kelowna, Prince George and Victoria, and they do a lot of great work. It’s all coordinated.

Within that $83 million envelope, we fence funding to ensure alignment with our priorities. So $3.7 million, specifically, for the anti-trafficking team that exists there for firearms and drug interdiction, and an additional $5 million for the provincial tactical enforcement priority, the targeted gangs and guns offenders. An additional $1 million is allotted for the independent police, the 11 municipal, on top of what they already participate in.

Vancouver police will enjoy the benefit of the $5 million funding when they’re targeting individuals, but we do have an additional $1 million that we provide as well. We’re now in the last year of five years in this province of enjoying what was referred to as the gangs and guns violent action funding from Canada.

Regrettably, we were not able to allot those funds directly to the RCMP, because it is a federal organization. So we’ve had to find very ingenious ways of dividing the funding and funding streams to be the most useful.

[2:20 p.m.]

I’m very confident that the way we have organized that funding and positioned our various programs in support of gang-organized crime and violence and drug trafficking has been very unique and has yielded some really interesting results. Not in every single program, but in many of them, it has been very successful. This is the last year, and we’re very hopeful that Canada will come back to the table with additional funding. We got $50 million over five years, I believe, approximately.

A Voice: Sorry. Could you repeat that number?

W. Rideout: I think it was $30 million. Sorry, I’m wrong. I overestimated. It’s $31 million or $32 million. We added it to some provincial funding. I think it was over $50 million in total that we applied — specific funding for gangs, guns and gang violence.

The CFSEU is managed by a board of governance. It targets right across the province. They do investigations. They do complex, covert operations on individuals who are related to gangs, organized crime and trafficking. They also are the ones that are out in the uniforms. They know who the gangsters are. They’re very much not afraid of the gangsters. They find them. They are out pulling them over, where the law permits it, and ensuring that their life of gangsterism is not an easy one and that they find themselves in front of a police officer whenever it’s justified.

The idea there is not only to disrupt that activity and the violence that flows from it. It is to identify youth that may be getting involved in gangs at an early age and then path them over to another program we have, which is referred to as the gang-exiting program, as well as to seize guns and drugs. They do a lot of that.

Just to give you some sense of some outputs from CFSEU-BC. This is just the one unit. I just want to remind you that most police agencies also have parallel gang enforcement teams or drug teams in their departments, so this is just the one centralized piece. But each department will have its own statistics. Kelowna will have theirs. Vancouver will have many. Prince George. Everybody is engaged in this activity.

In 2020 to 2021, the CFSEU-BC seized 29 kilograms, almost 30 — 29.81 kilograms — of fentanyl. They seized 129 firearms that were categorized as gang firearms. The total seizures for that year were 784 kilograms of potentially toxic drugs.

I just want to draw your attention to a number, if you have the graphic in front of you. I’ll just use the firearms one at the bottom, because I think it’s illustrative of some of the interesting analysis that the branch is trying to evolve to. The value of a gun is about $700 on the street. Perhaps, if you bought it as a gangster, you might pay double for that, $1,500.

We’re often challenged to demonstrate success in policing. When you seize a gun, what does it mean? Well, it takes a gun off the street that’s illegal, because all these guns are against the law. But we’ve done a lot of analysis with academics, and we look at what we’re referring to as the social return on investment — the harm that was caused to not occur as a result of the seizure. That can be applied both to narcotics but also to all kinds of organized crime commodities like laundered money and, in this case, firearms.

We assess that the seizing of 129 guns that were designed and destined for gangsters — to be used in gang activity, which is, ultimately, violence — has a social-economic cost of $46 million. When that firearm turns into a shooting or turns into a murder, and you look at the costs of prosecution and incarceration and hospitalization and affects on families and lifelong grief and counselling, it just grows and grows exponentially. We start to look at what these things cost. You’ll often hear the police say: “We seized a kilo of cocaine, street value of $300,000 or half a million dollars.” That’s what you’ll see on TV.

[2:25 p.m.]

But what we’ve begun to focus on…. The challenge of prosecuting in the courts has become very daunting. The laws are strict. The laws around getting charge approval are strict. Then the process to go through the courts is extremely long and tedious and fraught with all kinds of challenges where the police can make a mistake.

It’s important. We should never stop doing that. There’s an absolute need to prosecute people who are committing these crimes. But there’s also value in beginning to position our strategy against organized crime and gangs and drugs around prevention, around measuring our actions and what we caused not to happen, because I believe that the return on investment — particularly the social-economic return on investment — is exponentially greater on what we cause not to occur.

It’s very true when you look at the concept of money laundering. You can go after somebody and prosecute them for money laundering. It’ll take five years, and you may or may not get a prosecution. If you stop them from doing it at all, the cost is virtually nothing. It’s trying to figure out how to do that in an effective way.

So those are some of the analyses that we’re trying to do in the branch to put better metrics behind the investments around enforcement. There is a drug harm index that we use to try to measure the social-economic return on investment with respect to drugs as well.

We’re working on an organized crime strategy in the province to try to coordinate all efforts. That is advancing in anticipation of the Cullen commission recommendations as well as the special committee recommendations and trying to merge them together too.

There is no national strategy to combat organized crime, which is somewhat shocking. I think we will probably be the first in the country to develop our own. The goal there will be to align the various police agencies around not just enforcement but resilience and target hardening and trying to do some of the things I just talked about around making it very difficult for some of these people to operate in a way that is economically efficient and produces greater results.

I just want to really quickly talk about the PTEP. As I mentioned, we invest $5 million a year that we allocate out to police agencies across the province, above and beyond their base funding, to target individuals that we know are causing mayhem on our streets, and an additional $1 million straight to the independents.

There’s a slide there entitled “PTEP results.” If you look at some of the statistics, I hope you’ll agree that they’re somewhat impressive. We have 106 agencies in this province in 2020 and 127 so far this year that are participating. We’ve identified, sadly, though, 326 groups that are engaged in harm activity in the province. We’ve seized $1.9 million in cash.

On our social-economic return-on-investment analysis, when you seize $1 of gang or organized crime money, it’s worth $11 in return, because that money is reinvested into the drug stream. So it’s extremely important to seize those funds as well, and we look at some of the downstream costs seized.

The ministry has also worked on prevention with the Ministry of Mental Health and Addictions, participating with the overdose emergency response centre and the Drug Overdose and Alert Partnership. Our branch led a monthly opioid call, and has since the beginning of the crisis, with all police agencies and leaders in the province to ensure coordination and to address any needs they may have. That continues till today.

Naloxone funding, I’ve touched on. The police were supplied naloxone kits from the beginning of the crisis. The funding did expire, but we’re working with our partners in the Ministry of Health to reinstate that. At this time, the branch is continuing to fund naloxone kits for all the police in British Columbia.

One of the other mandates that we have is to work with the Minister of Mental Health and Addictions and interested municipalities to expand the successful situation-table model and connect front-line workers. I’ve talked briefly about that. They meet bi-weekly. They’re very successful, and I think it is a model that we can use to connect ministries and subject-matter experts to find better solutions that are outside of the courts, but on a local basis.

[2:30 p.m.]

I’m moving fast, because I see my light has changed colours on me. The last mandate is to work with the Minister of Mental Health and Addictions and Attorney General and Minister Responsible for Housing to fast-track the move to decriminalization by working with police chiefs to push Ottawa to decriminalize small amounts of illicit drugs. We have been working on that for some time with our ministry colleagues at Health and Addictions. We brought together the chiefs of police, subject-matter experts with policing and health experts — very fulsome consultations and communications across all the various involved parties.

I can say that the police chiefs in this province have been very supportive. They agreed a long time ago that the idea of prosecuting individuals for simple possession was really, frankly, a waste of time and call it a de facto decriminalization, because the minister had suggested it wasn’t in the best interests of anyone.

Now, there are some cases in which you can find the charge of simple possession on the books across the province, but our analysis suggests that those cases are often concurrent to other criminal matters. They’re not just simple possessions on their own. But the police have been very supportive of the concept and continue to be supportive of the concept of a multi-pronged approach around, really, a pathway to care and are supportive of the concept of decriminalization as part of a suite of options in this area.

They issued a report in July of 2020 on their views on drug decriminalization, and we have continued to work with them extensively since that time. You’ll see in a photograph here, just to give you some sense of drug quantity, a slide entitled “Decriminalization, a police perspective.” Again, I would encourage you to hear from the many law enforcement drug experts that we have in this province, because I’m not one of them. But the photo illustrates 15 bags of what the police advise represent one point of fentanyl. It doesn’t mean that that’s pure fentanyl in one of those bags. It just means it’s a mixture of fentanyl and what would often be referred to on the street as cut agent or buff. It’s then ingested.

We are hearing that the average person who uses drugs will either use one of these bags per ingestion or about a half. What you’re seeing there is one point or — I struggle with the math a little bit — 15 milligrams. The police originally came out with a concept that they thought that any threshold for decriminalization should be about one milligram, and this represents 1.5, just to give you some sense of context and quantity as far as that would look like.

We believe there are studies that show most…. I mean, the use of drugs is different in different parts of the province and by different people. There is no one-size-fits-all. That’s for sure. It’s really hard for me to assess what an average person who uses drugs would need at a given time.

I think that the key from the policing perspective, which is the one that we tend to represent, is that when it comes to decriminalization, when it comes to the challenge around drugs and toxic drug supply, there is a recognition that enforcement is not going to get us out of the harm that these toxic drugs are doing. We can’t enforce our way out of it. We can’t get enough chemicals and toxic drugs. We can’t stop enough at the border. We can’t arrest enough drug dealers. We can’t find enough of it to really make a dent in the problem of people dying.

We should still continue to enforce against those that are operating in securing narcotics and drugs from overseas, trafficking it nationally, internationally, locally. It does fuel the gang violence and organized crime violence that exists in this province, so the problem converges together.

[2:35 p.m.]

We are not of the belief that if we even had 15 times the resources of law enforcement that we have today that we could solve the problem from a law enforcement perspective.

Brian, anything that you’d like to add or I left out?

B. Sims: I think you’ve captured it.

N. Sharma (Chair): Thank you.

We’ll go to questions.

I see MLA Halford.

T. Halford: One or two?

N. Sharma (Chair): Why don’t we just do two at a time right now, and we’ll see how many we can get through. We have about an hour.

T. Halford: Thanks for the presentation. Just in terms of the aspect of decriminalization, I know that when the province applied for it, it was 4.5 grams. I think the provincial minister said recently that the feedback that she’s gotten from Ottawa is that they’re looking at somewhere in the neighbourhood of about 2.5 grams. That’s a pretty big discrepancy. I’m looking at your chart, and the visual aid is quite helpful.

I saw the bullet there that since, I think, July 2020, law enforcement has come out in support of decriminalization. That makes sense. But if you’re able to speak in terms of that discrepancy of when it was applied for — 4.5 — and then the feedback now that it’s looking that it’s going to be much less than that, any direct rationale from Ottawa on why that would be so considerably less. Or does that meet the RCMP’s expectations about decrim?

W. Rideout: I think, to say direct: no direct communication with myself or my branch, frankly, or the ministry. I think what we believe has taken place is that…. Law enforcement, of course, are both local and part of national associations. With the RCMP, they’re part of a national RCMP that deals directly with the federal minister and deals with the government of Canada.

My belief is that their original recommendation was one, and I think the philosophy was: “Go low; go slow” — like: “Let’s start off easy and work our way up.” These exemptions, I’m told, are about a year of length, and we’ll work our way up. That was my understanding, not necessarily a shared belief beyond police. There were many, many views on what the threshold should be from many different groups.

The police had a view on this issue. They have some concerns around other aspects of decriminalization — around public consumption, for example. They very much believe that there needs to be some rules and laws pertaining to public consumption of narcotics and the age.

But they also recognize that what they have been doing isn’t working, so they were open to some flexibility on the threshold. The threshold was the subject of much discussion. When it went to Ottawa, my belief is that there were other conversations that likely took place at national levels around what that threshold may be.

I can tell you, though, that BCACP and the police leaders in this province are genuinely supportive of decriminalization as part of a number of options. The concept of it being humanitarian, to not charge people for this issue and trying to be sensitive to people’s health issues — they’re on board. They need something to do, so if they’ve got somebody who’s at risk, it’s the pathway to care that’s critical. It’s the safe supply that’s equally critical. Trying to combine all of these into a suite of options is, I think, their position. One without the other is a step in the right direction, but it’s not going to be the solution. I think that this is the piece that we hear from them on a repetitive basis.

With respect to the threshold being at the 2.5 level, it is my belief that the police in British Columbia have come to a place where they believe that that’s workable.

I know that doesn’t completely answer your question, because some of that’s out of my….

T. Halford: No, no. It goes a long way.

I’ll have more. My second question is…. You know, we’re just coming off the police committee, and I know you spoke there, as well, and our just-previous presenters.

[2:40 p.m.]

In terms of prevention, just the importance of getting to individuals early, primarily in the education sector, are you guys working with the Ministry of Education in terms of potential outreach? I know sometimes there’s actually a dedicated police officer that is the school liaison. I’m a big believer that those initiatives work. Developing a good, positive relationship with law enforcement goes a long way. Is that outreach something that you’re discussing with Education and the Ministry of Mental Health and Addictions?

W. Rideout: Well, not so much with Mental Health and Addictions. We actually have a program that already exists. It’s referred to as ERASE. It’s funding that we do through the ministry, through the gun and gang violence action fund.

I agree with you. The idea is to identify youth at risk through indicators. The situation table model that I described…. They have a similar model for what we call Safer Schools and Safe Schools within the Ministry of Education. It’s quite effective on the violence front. I think they’re also using it around…. “This young person is on a trajectory for trouble, and we can help them.”

There’s $1.5 million funded annually for ERASE and Safer Schools Together. The idea there was to take anti-social behaviour as a whole…. Originally it began when we had challenges, around 2013-14, with young people that might be becoming radicalized to violence around extremism. Then it evolved that, well, this same methodology works for gangs and gangs and guns. The idea that they get lured into this…. How can we identify them and find a way to pull them back out? It’s also, of course, suicide prevention. It is bullying. It is all of those things.

That program exists through the Ministry of Education, through the Safe Schools program. I, for one, believe a lot in that concept. They use some tools. Social media is an extremely great tool to identify youth that are starting to be influenced in a negative way. So trying to identify them early and pull them out is exceptionally important.

The challenge of the school liaison officer is an interesting one. We have seen, if you will, in the aftermath of the George Floyd tragedy in the States and other incidents a couple of years ago…. A lot of schools got rid of their school liaison officers. That’s a decision of the local community and school board. That, to me, is a situation that is…. It varies across the province. We have them in many areas, and we don’t in others.

To me, there was benefit in those programs. I’m hopeful that as we continue to rebuild confidence in policing…. Some of that work will come from some of the efforts of the special committee and the work that will flow from that. We’ll get to a place again where some of those relations will grow to a place where we can maybe put some of those officers back in those communities that didn’t want them any more.

N. Sharma (Chair): We’re going to try to get through as many questions as we can. I’ll just ask for people to keep their questions, and the answers, as brief as possible.

S. Chant: I’m only allowed two, right? I’ve got more.

N. Sharma (Chair): Two. Then we’ll put you in the second round.

S. Chant: Okay. One is…. A couple of times during previous presentations, we’ve heard of the effect of drugs for personal consumption being seized. Therefore, the individual is basically doing something to get another set of drugs — whatever that is — which may be further harm, etc.

I’m wondering if we’ve gotten beyond that now. I know that was happening quite a lot a while back. I’m feeling like it’s not as much, and I just wanted to ask where your feeling is on that.

W. Rideout: I agree with you. I think it’s still a problem. I believe the police, in the de facto decriminalization that I spoke about…. They’re not charging them. They were still seizing the drugs, and that has the corresponding problem.

I think the police have evolved, and I think they’re recognizing the harm that flows from that. The challenge they face is the worry…. If they leave the drugs in the person’s possession and it is a toxic supply, now they’ve left something on the person that killed the individual. They really struggle with that issue. Next thing you know the IIO is called out. They were the last person in contact, and now they’re under investigation.

[2:45 p.m.]

It gets to be a bit of a challenging circumstance for police. That’s why structure, policy, standards and a framework will kind of give them a bit more comfort.

The same thing is…. You stop a car. There are drugs, and there’s also a gun. Now what do you do? You’re going to take the gun, obviously, because that’s illegal. Are you going to leave the drugs there with someone who had a gun? I don’t think so. My belief would be…. That sort of takes it to a new place, if I have both an illegal gun and drugs.

These are all little pieces that have to get worked out.

S. Chant: My second question. You actually led to it quite nicely. My assumption, coming from wherever I come from, is that firearms that are seized are destroyed. Is that correct?

W. Rideout: Yes. First, we trace them. We try to figure out where they came from. We try to figure out who the gun traffickers are. They’re ultimately destroyed. They don’t go back to anybody.

S. Chant: They don’t go in the police auction. That is what I’m asking, I guess. Sorry, joke. I was being funny, I think.

W. Rideout: Not anymore, no.

S. Furstenau: I noticed a bit of a theme running through your presentation. No matter how much drugs you seize, it’s not enough. This isn’t going to be solved…. I think in here, the line is: “We can’t arrest our way out of this. The scope is so large.”

You’ve touched on safe supply. I was asking about this, this morning as well. There’s an economic aspect to this. There’s an economy that exists outside of our legal economy that is driven by the distribution, the sale and the demand for illicit drug supply.

We’ve been hearing a lot on the safe supply aspect of this, in terms of reducing death, really — that the illicit supply is so toxic. Can you speak to the role that a regulated safe supply would have in reducing criminal activity?

W. Rideout: That’s an excellent question.

I approach it more…. I think it’s the humanitarian approach to have a safe supply, to have that option. I fear that there will always be those that will seek the illegal supply, given the potency of the illegal supply compared to the safe supply, but the idea that we, as a humane society, can provide people who need these drugs a safe supply, to me, I think, is critically important.

Organized crime will always exist, and they’ll always traffic in drugs and money and guns. We’re not going to put them out of business by providing a safe supply. It will just be a competing market.

S. Furstenau: In this conversation, of course…. The war on drugs….

We know that the disproportionate harms of these policies and enforcement are to racialized people and racialized communities. When you talk about school liaison officers, of course, there is an aspect in that…. There are people in communities for whom interactions with a police officer won’t feel safe, especially for youth. I think it’s just really important to recognize that this isn’t a crisis that affects people equally, nor is the enforcement affecting people equally.

When you say there’s always going to be an illegal market in this, I would compare it…. As I asked this morning as well. What has the legalization of cannabis done in terms of the illegal market in cannabis? I am curious about it being…. The largest amount of seizures of drugs is cannabis, by a wide margin. Also, when you look at historically, the prohibition of alcohol and the resulting, I would describe it, sort of collapse of that market….

If you could just speak to what has happened post legalization of cannabis and maybe explain that figure a little bit, as to why it’s so high.

W. Rideout: Well, I can do the best…. Again, I would encourage you to hear from the police themselves.

The legalization of cannabis has not destroyed the illegal organized crime production of cannabis, nor the supply. It is also a competitive market.

[2:50 p.m.]

The challenge we have with hard statistic is…. Because it is now legal, we don’t have the data as much on and we’re not doing a lot of work on organized crime activity around cannabis. We focus most of our efforts on things like fentanyl and some of those others.

The seizures you’re seeing are these operations I talked about around the collective, where you’re going after organized crime groups, say a drug house or a group, and they come upon cannabis that’s being sold as part of the drug-trafficking ring.

In my view, there is still a significant illegal cannabis industry in Canada, and organized crime still traffics in cannabis and competes with the legal market.

S. Bond (Deputy Chair): I appreciate the presentation and the comments. I’ll do two questions, as the Chair has indicated.

There seems to be a somewhat different view of the impacts of border closures during COVID. In a report that was released by the Canadian Centre on Substance Use and Addiction, they talk about the fact that drugs were interrupted. The supply was less available. In fact, they say: “People are adjusting their behaviour as a consequence of drug shortages.” Not my words, but the report’s words. Yet, in your report, it talks about the fact that we have enough drug production going on in British Columbia with a way for that to continue. They’re creative about how they do that.

Can you just perhaps…? We hear, when we talk about the surging cases during COVID, and when you look at the numbers that have happened in terms of deaths…. COVID is often used as: “Well, COVID changed things.” Well, of course, it did, because people couldn’t get to the services where they were provided with support. We went to the extent of delivering things that people needed to them. But I’m interested in that concept of the border closures and the “drug shortages.”

What’s your perception about that?

W. Rideout: I think I have limited knowledge. It’s more instincts from the collective information.

The transport trucks never stopped coming across the border when we needed them desperately for supply, and it would be naive to think that organized crime doesn’t use those routes to move drugs and precursors. What I had said earlier in the presentation was that the literature and the intelligence the police provided suggest that there was greater disruption to the supply during COVID. My point was that it didn’t make any demonstrable difference to the deaths, because there was still plenty that existed, and people were still dying at virtually the same rate, if not even greater, during the last year or two.

It is the biggest border in the world, I believe. And it’s very challenging to interdict any kind of supply, both from Mexico and from America. We also have become a bit of a source country ourselves. You know, drugs are distributed through the Port of Vancouver and elsewhere to Australia and to Asia and back and forth.

If you go down to the ports and you see these massive piles of containers and look at the movement of goods that are in and out of this city and Prince Rupert and up and down the coast, it’s literally impossible to control enough of this, in my view.

S. Bond (Deputy Chair): You certainly reference that we should have a conversation directly with police, and I think that’s on our list, in terms of hearing from people.

I’m not sure if you can answer this question. I’ll keep my other one for the next round, but I’m not sure if you can answer this question. Early in the response to the opioid crisis…. It was in Stopping the Harm where they pointed out that the role of law enforcement, in terms of the response, was different for police.

[2:55 p.m.]

Police did not respond to 911 calls when it was an overdose intervention unless they were the only first responder that was available. It was an attempt to look at it from a health perspective instead of actually causing additional anxiety when people would think: “Maybe I’ll be somehow impacted by that law enforcement contact.” Does that remain the practice today, where a police officer, a law enforcement officer, isn’t the first responder when it’s related to overdose intervention?

W. Rideout: My understanding of that response was mostly in the Downtown Eastside, in the Vancouver centre. That was a desire by the community, exactly as you suggested — the idea that it would prevent people from calling for help, because they didn’t want the police present. I don’t think that was universally adopted across the province, because I think that in many communities, the police have a very positive relationship. It wasn’t really as significant of an issue.

I don’t think I can answer your question as to the current state, because I believe what’s happened over time is that the call volume is so great that there’s simply no choice anymore.

S. Bond (Deputy Chair): I just want to…. I think that’s really an important piece, because it really speaks to the whole issue of this being a health issue and the desire to shape the response from a health perspective. I just thought that was interesting. It’ll be worth pursuing, I think, when we actually have law enforcement. Was it more broadly adopted? Was it the Downtown Eastside, or was there a sense that this is one way to try to emphasize the health side of it rather than the criminal side? So thank you for that.

W. Rideout: If I could just add a little bit. We see this issue as broader than just the toxic drug supply and deaths from fentanyl overdose and others — the convergence of mental health, mental health and addictions, homelessness and the police response. Much of the work of the special committee and some of the work that’s flowing from that is a desire not to have the police anywhere near the front part of that response and only there in the most extreme cases. That’s where we should be.

The police chiefs are very supportive of that idea, because they’re spending all their time doing that and not doing other work that is engaging the public. So there’s no pushback from the police on that at all. The challenge is that we don’t have those other resources at this point, so there’s nobody else.

P. Alexis: This morning we heard, again, the data around who’s impacted. I just wonder if the data makes a difference to your approach with respect to criminality, with respect to how we’re going to combat this. You are obviously privy to the same data, but for some of us, it was the first time to hear from social development, for example, on the large number of people as clients — that kind of thing. Does that change the way you approach this?

W. Rideout: I think the branch and the police are always open to analyzing data to better form an approach. But in this particular case, when it comes to possession or simple possession that would maybe have, historically, been categorized as possession for the purpose of trafficking — in other words, just enough to traffic a little bit — they’re convinced. They’re not interested in doing enforcement action at that level.

So the enforcement pieces that they’re focusing on now are mid- to high-level, and I don’t know that the data — that particular data — is particularly useful in those. They’re using criminal intelligence. They’re using source information. They’re using a variety of sources from foreign and international partners to target that. That said, they may see some value in that.

Holistically, our branch sees value in using that data to try to form some of the other approaches around situation tables and prevention. The more data, the better. We want to be evidence-driven. We’re evolving the police and the RCMP to be not just evidence-led but to be performance- and outcome-based. We’re not looking anymore to just know. You heard my piece about the 129 guns. It used to be that they seized 129 guns and that was the number. What we’re interested in now is: what difference did that make? What was the social-economic return on investment? That’s why we’re trying to apply those metrics to all the things that police do.

[3:00 p.m.]

R. Leonard: Interesting you say that, because that was my question this morning. It was: how do you measure what didn’t happen because of certain things that have been done? So I think that’s really valuable.

It was kind of distressing to hear — with the cannabis, particularly, as an example — that organized crime continues. There is an illegal market because of the desire for…. I don’t know how…. Anyway, the notion that if we decriminalize the drugs that we’re talking about here that cause overdose, there will still be that criminal element of seeking higher levels of drugs.

Then I’m combining that with what you’re saying about not having data with the cannabis now, because you’re not pursuing things — the impact of not having data. It sounds like it creates a void. Knowing impacts, has that come up in a conversation about: if you don’t have that stream of data flowing, and the impact on policing?

W. Rideout: It’s a very interesting question. The way criminal intelligence is generated in this country is based on what we’re looking at, so when we’re not looking at something anymore, we tend to get an imbalanced view.

When you talk about the toxic drug supply, I think by default there was an approach around cannabis that saw it as a less evil — less consequence, if you will — commodity. I don’t believe you’ll see the same approach when it comes to some of the toxic drugs that we’re speaking about here — heroin, cocaine, fentanyl, MDMA, Ecstasy. I think that there’s a recognition that we will always be fighting organized crime, gangs, gang violence and drug traffickers. There will always be a focus on them and the commodities and the manner in which they make illicit profit.

We do have to admit we have limited visibility on the illegal cannabis market at this time, so it’s a concern.

R. Leonard: Just following that, when we came back into town, we drove the Downtown Eastside. Just in that few blocks, you see some interactions. I think you referred to them as low-level dealers. You have people who are dealing to support their drug habit.

I’m curious about where that plays in with the whole notion of organized crime. In communities, you don’t see this sense of organized crime involved in a lot of the activity that you see on the street.

W. Rideout: Well, Chief Palmer and his team will be able to give you more specifics, but it’d be my view that every bit of it is controlled by organized crime in one manner or another. The local dealers will get some of those packages that I showed you, and they may resupply others — maybe for a profit; maybe just to help each other out on the streets — but it all comes from organized crime.

It comes down through people that are violent, horrible and will exploit others. They’ll hurt others, will do terrible things to others. Those will control the streets of the Downtown Eastside as they control every community in this province with respect to the drug supply.

Many of the murders you see, much of the violence you see that flows, are attached to that in one way or another.

N. Sharma (Chair): I have a couple of questions that are in line with what you’re talking about with this idea of exploitation and what we’re hearing from a lot of people before us. This is that there should be a more medical or humane response to people with this addiction, and organized crime being part of the predatory side of it in terms of taking advantage.

[3:05 p.m.]

I guess I have two questions related to what you’ve provided. The first one is…. When it comes to racialized groups, one of the things we learned and we’ve heard a lot of concern about was this idea that — that whole debate on how much the threshold would be for personalized use — if there was an element of too much subjectivity in a response, it would disproportionately impact people of colour or Indigenous people that are on the street that are facing that enforcement. That’s why that whole discussion was there.

I know that you’re not…. You have your speciality and your role in the whole system. I guess my question is more based on…. Can you, where you’re situated with the legislation that supports your role, set some kind of standards of how that stuff is enforced and put into place that would protect those communities from harm that could be associated with a path of decriminalization that doesn’t meet whatever…? There’s debate on the threshold, but there’s a subjective component.

That’s my first question.

W. Rideout: Yes and no is the answer. The current legislation allows me to make standards around training related to those matters, so I can create and ensure training across all police agencies that meets, if you will, a policy on it. I don’t have the ability under the current legislation to make a standard on the issue itself.

Again, when we open up the Police Act, it’s one of the many things we’ll be looking to include. I’m confident that when we arrive at a provincial policy, a provincial threshold and a plan, we can ensure alignment of police board, police policy and the RCMP in a way that will…. There will always be a little flex without some standard, but I’m confident that we can ensure alignment amongst the various police agencies in the province on how we deal with that challenging issue that you’ve described.

N. Sharma (Chair): It’s not really a question, just a comment. I’m curious about the work on carding and that, and how that might feed into….

Anyway, the second question I have was just…. If you could kind of indulge me for a second and just break down what the situation table does and the humanitarian response you’re talking about. Where does it start? Is a person charged with possession and then goes through it? How does that individualized response show up for a person that’s inside this system?

W. Rideout: Sure. I’ll let…. My colleague will jump in.

I think, essentially, the idea is that the police chief, the representative from the city, any number of officials in the community, people who will identify an issue of concern — perhaps a neighbourhood, perhaps an individual who is being identified to the police on a disproportionate number of occurrences and perhaps has mental health and addictions problems…. There’s a recognition that there’s a better way to help this individual than just arresting them and sending them through court.

Brian can maybe speak to the process a little bit as to how it flows from there.

B. Sims: Thanks, Wayne.

That’s right. It’s a recognition that a holistic, wraparound approach to services is what’s required to, hopefully, intervene in a successful way in an individual’s life. It could be police that bring an individual to the table. It could be a social service agency. But the whole idea is to intervene before they expose themselves to further risk, and some of the risk factors associated deal with addictions or deal with mental health or substance abuse–criminality kind of behaviour.

What the province does is provide standardized training for communities and money to fund that training. It’s been a very successful way to bring together agencies in communities to intervene in the most serious of cases. We see it as playing a role here in addition to some of the other intervention and prevention methods that we’ve been developing.

N. Sharma (Chair): Right. So it’s separate from the criminal justice system and diversion and that kind of thing?

W. Rideout: That is correct.

N. Sharma (Chair): All right. I think we are going to a second round here. We have MLAs Halford, Chant and then Bond.

Oh, did you have a question? Go ahead.

D. Routley: I could go into the list. That’s fine.

N. Sharma (Chair): No, you haven’t had a question yet.

D. Routley: Okay, thanks.

Welcome, and thank you very much for this presentation.

When I visited the gang task force unit, I was really surprised to learn that there are simple public policy issues that make some of the enforcement very, very difficult, such as that drug precursors are illegal but gun precursors are not illegal — importing barrels. You wouldn’t even need a licence of any kind.

[3:10 p.m.]

That seems like a fairly simple public policy change to make to interrupt that — at least make it more difficult for them and easier for you to enforce. Are there similar public policy issues that police encounter that make it difficult for you to separate out your treatment of the dealer versus the unfortunate user? Is there any simple public policy out there that people trip on, that you could identify?

W. Rideout: I think where it gets complicated for police is…. I talked a little bit about the liability concerns. Well, if I leave the drugs in his possession and the person dies…. Coroner’s inquest. IO investigation. There’s that. I think we can navigate that.

I think where it gets a little bit more complicated is that we’ve seen some of these videos and news pieces where some of the violence that we’re seeing on the street…. I think where the police are challenged a little bit is if somebody is in simple possession or possession within whatever the prescribed limit will be but they’re also engaged in all kinds of other criminal activity that’s causing a real problem to our communities and our societies. Some of it is survival crime.

But we hear the people on the news saying: “We’re not safe on our streets. We can’t run our businesses. We can’t be in our homes.” And the whole blossoming issue of prolific offender management. Well, they actually may converge into the same issue. We may see, through the data, that a lot of the prolific offender management is in fact these types of people that are actually engaged in a survival crime or survival crime plus.

Then it’s going to get really challenging, because there are going to be significant demands from the community to stop this problem we’re having in our communities. At the same time, we’re trying to be sympathetic and humanitarian to people with these legitimate problems. Trying to find that balance is going to be tricky, though. That’s not an answer. That’s more illustrating the problem than the answer.

I think, like so many things, everything is case-specific and fact-specific. Where we’ve got to go on this is, if we’re going to have a humanitarian approach to try to keep people as safe as possible and recognize that this is a health issue, trying to find where that threshold is around — yes, it’s a health issue, but the facts, in this case, demonstrate that it’s more than just the health issue. You’re also engaged in some significant criminal activity that’s causing problems for the rest of society. We’re going to have to find a little space there.

I worry about the emphasis that we’ve put on gangs and gang violence in this community. If a police officer stops a car and sees 45 of those packages on the dash, if that turned out to be what the decriminalization threshold was, that would be grounds for a police officer to search that car, which may lead to all kinds of other criminal activity, including guns and all. We won’t be able to do that when that threshold exists. It’s almost the opposite to your answer, which is that it causes some other public safety and enforcement implications that we’ve got to think about.

They’re not easy solutions, and I know that that only almost takes you farther away from the answer you were looking for.

D. Routley: No, it’s an example of where these things collide: public policy and the reality on the ground.

Price of the drugs. The illegal cannabis is about a third of the legal cannabis at this point. The drugs that you showed a picture of — the presumption is that they would not be free, so that there wouldn’t be, then, a source of something that could be sold. But where would that balance be? Because we’d want to discourage somebody from getting the free supply and going out and selling it somehow, and at the same time encourage them to use the free supply, not turn to the illegal, potentially toxic supply. How would you judge that balance, if it were you?

W. Rideout: I think there’s another consideration in there. It’s the price, that’s for sure, and the ability to access it and resupply. People with much more experience in this area than myself are probably better suited. But I worry about the potency of what we will provide legally as opposed to what is available illegally as well. So there’s that consideration as well.

[3:15 p.m.]

There are always limits to, I think, what we can supply in a legal form. Then people may still seek out something that’s stronger.

But I think your point is a valid one: if you can purchase it cheaper. My hope would be that if it’s a pathway for humanitarian reasons and we’re trying to keep people healthy, that we would find some way that it would be no cost. That’s the best way it would be competitive, it would seem to me.

D. Routley: Thank you.

N. Sharma (Chair): We have about 15 minutes left. We’re going to go through the next round. I have three people with questions: MLAs Halford, Chant and Bond.

T. Halford: Just a comment and then a question. You know, we dealt with it last fall. It’s just on the naloxone funding. In your bullet here it says that in September 2021 funding was reinstated through the PSB existing budget. We kind of went through this. I think it was last September. I guess my question would be….

I should have asked this earlier. If I would have seen this bullet earlier, when the Ministry of Health was here…. For a ministry that has a $25 billion spend in budget, and I see the last bullet, “long-term funding arrangements are in discussion with PSSG and Ministry of Health,” I think that speaks to the problem. We’ve already gone through a budget cycle. Why isn’t that done?

I’m not asking you to comment on that. It’s just, on an issue like that…. I don’t understand. We’ve gone through a budget. We have dealt with this. We knew it was an issue. For a ministry that size, I don’t know how much this would cost, but I can’t imagine it’s astronomical. I think that, to me, is a glaring statement that speaks to a larger disconnect, right? I won’t ask you to comment on that.

The other thing. When we talk about a humanitarian approach, I agree with all that, but it only works if the resources are there and if they’re available in real time and if they’re actually operational and staffed, right? You probably haven’t seen it, but we’ve got this chart here, building a substance use of care, that’s got a lot of great things in it. I’m sure a lot of officers would like to know that if they’re dealing with somebody on the street or at their home, this is the next step. This is where they’re going to go to.

That’s all great in theory. Again, that is a great tool for law enforcement to have, a humanitarian tool. That only works if it’s not on a piece of paper but if it’s actually up and running and operational. I think a lot of law enforcement have said: “We don’t know where to go. Oftentimes, we have to go to the hospital, or we have to put them in incarceration until they come down.” But then what? Right? We have to think of that humanitarian side for law enforcement, as well, because they want the same outcomes we do. But these tools have to exist.

W. Rideout: Well, I can confirm that they do want the same as we do. I mean, they want it from a humanitarian perspective. They don’t want to see people dying needlessly.

I can tell you from a broader policing and public safety perspective, a lot of our police officers…. Policing is very expensive, as you know, as you heard, very expensive and getting more expensive all the time, and the challenges are greater all the time. They spend a vast amount of their time engaged in these issues that…. We could make our communities safer if there were others doing some of the work.

T. Halford: They become social workers.

W. Rideout: Very much.

They do a very good job at it despite some of the…. There are always the stories, and there are always the bad things that do happen. But when you look at, in this province, some 9,000 or 10,000 police officers doing this day in and day out….

N. Sharma (Chair): Okay. MLA Chant, just try to keep….

S. Chant: Thank you. Just on sort of the same topic, you spoke about three pilots in three communities where the police are looking at being able to move somebody to somewhere else that, perhaps, is a supportive environment for them.

[3:20 p.m.]

I had also heard, when we were talking to the B.C. Police Association, that there is a drug court in the Downtown Eastside where folks that are found to have broken the law are able to go. If it’s a drug-based offence, they can go straight to the drug court. With the communities that you’ve had in place for the treatments and stuff, that seems to be working, yes? Have we had any data out of that?

W. Rideout: Abbotsford, Vernon and Vancouver. So in Vancouver, you’ve heard of the drug court and some of the approaches there. That’s that Pathways Vernon feedback we were getting from Vernon. It’s still being assessed.

Abbotsford is engaged in a process. The chief of the Abbots­ford police, Chief Mike Serr, is somebody you may wish to directly hear from. He has been very much engaged in this issue from the beginning. His community is heavily invested in this approach and some corresponding pieces.

I don’t know that I’m well positioned, given what the current state of that is — how successful it is. It’s something that’s still ongoing. But the fact that it is still going, I suppose, is a testament that it’s demonstrating some success.

The others don’t have a pathway, I suppose, so any pathway is better than not having one at all. Taking somebody to Vancouver General Hospital or Surrey Memorial in the middle of the night is just…. It doesn’t work, unless somebody is in a true medical crisis. But for the long-term problem, it’s a revolving door.

S. Chant: They just roll back out the door.

S. Bond (Deputy Chair): I’ll try to be succinct. Obviously, working across government, we heard today from a group of ministries. I’m interested in the intersection between Public Safety and Solicitor General, particularly with your relationship with law enforcement.

When you look at what the B.C. Association of Chiefs of Police said about decriminalization — these are the tough conversations we have to have — they actually said that the effect of decriminalization of possession of personal amounts of illicit drugs was achieved — was achieved; not will be — by the Public Prosecution Service of Canada when they adjusted the possession guidelines.

In fact, they only support…. At least, this is as recently as December 2021. They only support one gram. So you can imagine that the federal government finds itself in an interesting place, when you have the Health side of the government of British Columbia saying 4.5, and you have police chiefs saying one — and, in fact, that decriminalization has been achieved.

Are those the kinds of conversations…? Your role in the Ministry of Solicitor General…. We obviously are going to talk to police chiefs about that. What is the dialogue like when we see the government make application for 4.5 knowing full well that police chiefs have said one gram?

W. Rideout: Well, we were part of those conversations since the beginning. The police chiefs were present and were consulted with numerous times — lots and lots of communication with the Ministry of Mental Health and Addictions, police and different groups of interest. As you point out, wide positions on what the threshold might be.

I spent much of my life in policing. I’ve come to a place that we want to hear from policing. But we don’t want to be led by the police’s position, because it is also sometimes the subject of tunnel vision.

It’s difficult to spend a lifetime — I’m speaking for myself now — enforcing. If I had, as a younger police officer, come across a vehicle that had the quantity of drugs in it that I showed you in the slide, I would have thought I had a big drug bust. But the world has evolved, and we have changed. We have realized that the war on drugs is not successful.

I think that we must consider police, police leaders’ positions, but we also must look at the other areas as well. It has been robust conversations and consultations along the way. But I feel confident that all the parties have been heard. I think that the idea now would be, if we get to a threshold, to try to implement it in a way that further addresses some of the nuances of what this means.

[3:25 p.m.]

Some of the things I’ve described here today — it’s not always just about personal use. How do we differentiate between what somebody has for personal use and using that threshold as a camouflage for other criminal activity? That’s going to be where the next body of work lies.

N. Sharma (Chair): Okay. Any other questions, committee members? No questions.

On behalf of the committee, I just want to thank you so much for coming and presenting to us today and answering all of our questions. I think it was a really good discussion, and we were able to dig deeper into some topics. I appreciate your time.

W. Rideout: Thanks for having us.

Presentation Topic Areas and
Committee Meeting Schedule

N. Sharma (Chair): Committee members, I just had a couple of things to go over with you about the operations of the committee before we adjourn for today.

The first one: just to talk to you a little bit about what we see going forward. Of course, tomorrow we have the health authorities coming in. The subcommittee met a couple of weeks ago and just talked about the next phase that we see of the work.

So that all of you know the way it’s being organized, Artour and his team of really great people are hard at work trying to organize those panels that we’ll see in June. The idea would be to divide the panels into certain topic areas, and I’m going to read them off here so people know what they are. It would be community support, Indigenous organizations, addiction support, treatment and recovery, prevention, advocates and lived experience, and harm reduction.

The idea would be that we would have a panel of people that present from different locations, or a different topic manager, different array of opinions, and then have them each present. That would be the processing in June. First responders would be one of them, industry, trade, professional associations, academics, legal and federal organizations. Those are the topics we’re thinking of breaking it down in.

We’ll have more of a chance, I think, for the subcommittee to do the work of figuring out who they are and present to the larger committee once we get there. But that’s the general agreement that we saw, so if there are any questions about that, I’m happy to answer them.

I think the next thing that I wanted to talk to everybody about, which is a favourite topic, is scheduling. It’s always really difficult to do with people that are so busy. Right now you will have seen in your calendar blocked-off times for June 14, 15 and 16; June 20, 21 and 22. All of those are confirmed in Vancouver and, now, this location right here. So that’s the next one.

Artour and his team are looking at scheduling in July as well. And July will be, I think, a continuation of those panels that we’re going to be going through. Look for your…. I guess he’s been reaching out to all of your offices to figure out when we can block off that time and get those into people’s calendars as quickly as possible.

So those are just logistical things I wanted to talk to everybody about, if there are any questions or comments about that.

S. Bond (Deputy Chair): I just wanted to thank Artour and whoever organized today, because it gave us a chance to have a conversation, you know, and have more than one question. I realize that time is of the essence when we’re in the Legislature, as Madam Chair pointed out to us. But I think if we’re really going to understand what we’re…. This is a big task. We do need that back-and-forth.

I just wanted to say thank you for the format today, to the Chair and Artour. I think it was really…. It lends itself to more questions and thinking and coming to grips with what the issues are. So I just wanted to say thank you for the format today. I think it was really helpful.

N. Sharma (Chair): I appreciate the feedback. Any other thoughts?

Great. Well, I have to say thank you all for your really thoughtful questions and digging into the topics. We’ll have a lot more interesting questions and lots more to learn, I’m sure.

S. Furstenau: Just on the scheduling, I’m fine with the July. I think, as that list is very long, we have a lot of work to do. I’m not sure where the rest of the committee is at, but I’ve booked one stretch of the summer, the second half of August, to be with family, and I’m hoping that we have some consensus on that little time period. But absolutely, July is all hands on deck — and even the first half of August, if we’re so inclined.

N. Sharma (Chair): We’re really trying not to book in August, because everybody needs a little bit of a break, because I know you’re all very busy. We’re really trying to.

[3:30 p.m.]

If you can make sure that your July is as free as it can be, it’ll help us do that. And then Artour needs a break too, at some point.

S. Chant: This is the first time I’ve been exposed to committees to this degree. Since 2020, all the committees that I have been part of have met during sittings, and that was pretty much it.

I know I’m going to get the look. However, when do we do constituency work? We’ve got stuff planned, all through the summer, of stuff to do within our constituency, people to meet and things to deal with. That includes trying to set up a situation table, quite frankly, which is going to take, actually, quite a lot of work, I think, because our riding is interesting.

We get all these dates. I had stuff booked as of January. Then we get these dates now, and we’re getting more dates. I’m just concerned about that.

N. Sharma (Chair): Maybe we could take the discussion offline. I think that there was a general consensus that this was an urgent matter and that we needed to schedule…. So we’ll just….

S. Chant: I come from that world. I’m just a little worried about my constituency — that’s all — as, I suppose, everybody is.

N. Sharma (Chair): We’ll endeavour to try to get as many blocks in your calendar. We’re also trying to schedule days at a time, so you can schedule around it. If we can do three days or two days — some people have to travel — then it helps to arrange things around it. That’s the way we’re going to do it.

S. Chant: Fair enough. Thank you.

D. Routley: We’ve got at least one member with children, small children, too.

You’ve probably got plans, eh?

T. Halford: Yeah. I know. But this is…. I’m here for them, right? We’ve got to figure out and make this work.

N. Sharma (Chair): Definitely. I wanted to give everybody an update about where we’re at on all that. The subcommittee will find a time to work sometime soon and figure out how we populate those panels and get that all going.

S. Bond (Deputy Chair): Just in terms of location, I think it’s also appropriate to consider alternating so that some of the meetings are in Victoria. Those of us who have to travel, travel anyway, and we try to do that in the most responsible way possible.

There is also a large number of Island members. So I think it would also be…. In July, I think it would be good to consider a week or so of meetings in Victoria as well. If we can think about panels, which might be more efficient for us to have there, I think that would be helpful as well.

If we have to travel, we have to get on one plane. It’s a matter of one or two. It doesn’t change.

N. Sharma (Chair): Yeah. Good point. I think one of the assessments that probably we’ll take into account is how many people have to travel, including the people that are visiting us. If the panellists are…. If it’s better located on the Island or better…. We’ll think about all that when we do it.

Another thing that I forgot to mention was this idea, which, I think, was raised in a regular committee, that actually going to places to see things in person would be a good thing to do, as we process all of this work. There was, originally, kind of top-level thinking…. I’m going to have to report out fully after the subcommittee talks about it further. Maybe a visit to each health authority during the course of our work — not scheduled yet or not thinking about when that would be — would be a way to have one on site. But we can talk about that later. I just wanted to let you know.

All right. I think that’s everybody. I don’t see any other hands up.

A motion to adjourn for today.

Sonia.

Seconder. Okay.

We’ll see everybody tomorrow.

The committee adjourned at 3:33 p.m.