The committee met at 9:01 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Hello. Good morning, everybody. We have a full room here. Welcome, on behalf of our committee.

I’m going to introduce everybody from our side in a second.

First, I want to start by acknowledging that we’re all gathering on the traditional territories of the Coast Salish people, the Musqueam, Squamish and Tsleil-Waututh.

My name is Niki Sharma. I’m the Chair of this committee. Nice to see you all.

I’m going to go through all of us. We can introduce ourselves. Go ahead.

M. Starchuk: Mike Starchuk, Surrey-Cloverdale.

R. Leonard: Ronna-Rae Leonard, Courtenay-Comox.

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

P. Alexis: Pam Alexis, Abbotsford-Mission.

N. Sharma (Chair): And our vice-Chair.

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

D. Davies: Good morning. Dan Davies, MLA for Peace River North.

S. Furstenau: Sonia Furstenau, Cowichan Valley.

N. Sharma (Chair): Excellent. Just a couple of housekeeping issues. You see the timer in front of you. It’s just out there in the front. You can see it. It’s got three lights on it. You’ll see it turn yellow when you’re getting close and then red, of course, when you’re out of time.

Each health authority here…. We have Island Health Authority, Northern Health Authority, First Nations Health Authority and Interior Health Authority, just for the Hansard record.

Each of you will get about 20 minutes, so just know that the committee has seen, now, quite a few presentations that talked about a lot of the general stats about the issue. I think it’s really key and would be really helpful for us if you focused on the specifics of your health authority and the unique things that you’re seeing on the ground or programs that you’re dealing with.

After 20 minutes each in the presentation, we’re going to take a ten-minute break, and then we’ll come back with questions and answers, and the committee here will lead that question-and-answer period. Please introduce yourself when you start speaking, and your team, when I go to you for the health authorities, so everybody that’s listening can know who’s here.

I’m going to start on this side, with Island Health Authority, and pass it over to you. Please go ahead. Introduce yourself, and go ahead. I think we have all the presentations here too.

Briefings on
Drug Toxicity and Overdoses
Panel 1 – Health Authorities

ISLAND HEALTH

K. MacNeil: Thank you, and good morning, Madam Chair and committee members. I’m Kathy MacNeil, and I’m privileged to serve as the president and CEO of Island Health.

I’m very grateful to be joining you here today on the traditional, unceded ancestral homelands of Coast Salish peoples, the Squamish, Tsleil-Waututh and Musqueam Nations.

I’m pleased to be joined today by my colleagues, Dr. Sandra Allison, who is our medical health officer, and Keva Glynn, who is the executive director for mental health and substance use, both of whom have extensive experience in this field.

We are honoured to do our work on the ancestral territories of the Coast Salish, Nuu-chah-nulth and Kwakwa̱ka̱ʼwakw peoples, and it’s with humility that we recognize our privilege to live, work and play on their homelands.

We appreciate the opportunity to meet with you to discuss some of the work that Island Health has undertaken to address the toxic drug crisis as well as our plans for future work. As the coroner noted in her most recent report, 9,400 people have lost their lives to illicit drug toxicity since the public health emergency was declared. If we held a minute of silence for each person, we’d be silent for almost six and a half days.

More important than numbers is remembering that these are sons, daughters, mothers, fathers, brothers and sisters, and their deaths create devastating impacts for friends, families and communities.

Keva and Dr. Allison will be speaking to the specific impact on Island Health communities.

I’d also like to acknowledge the dedicated health care providers who’ve also been impacted by this crisis and who continue to do their very best to provide compassionate care despite their own experiences of loss, when the people they care about and for die in this tragic way. We know from the coroner’s report that many people who die from illicit drug toxicity engage with health services in the year before their death.

[9:05 a.m.]

Island Health is working hard to reduce stigma, so we are ready and able to help people who seek our care. Providing safe and supportive interactions across our system and building trust with the people we serve are critical components to addressing the needs of those who receive our care.

Now I’d like to turn the presentation over to Dr. Allison.

S. Allison: Thank you, Kathy.

Thank you, committee members for providing this opportunity for reflection on this urgent, persistent toxic drug crisis. As a medical health officer involved in this emergency, I’m very grateful for the attention of this all-party committee, and it is my privilege to be here today.

The declaration of the public health emergency in early 2016 signalled a distressing trend in drug poisoning deaths that continues to this day. Despite ongoing commitment and investment in Island Health, in 2021, the number of deaths attributed to the toxic drug supply surpassed the highest number of drug poisoning deaths ever for us, with 326 people, mostly men, dying of drug poisoning. This is 2½ times the number of deaths attributed to COVID in Island Health in 2021.

We all hope that there are lessons learned from our pandemic response to help us realign resources to respond to the toxic drug supply in our communities in new ways. As shown in the figure on the right of the slide that reads “Events and deaths,” while we see the drug toxicity deaths in 2021 at the highest ever since 2016, these startling statistics are proportional to the larger, more invisible burden of drug poisoning events in communities attended by B.C. emergency health services. This is demonstrated in the left-hand figure.

Non-fatal drug poisonings result in disability and impacts to quality of life, anoxic brain injury and other circulatory impacts to major organ systems. The resultant trauma and stigma and disconnection are other ongoing consequences of a non-fatal drug poisoning. A non-fatal drug poisoning is also one risk factor for a drug poisoning death.

The populations and people most impacted are men. Men account for 80 percent of the drug poisoning deaths in our region. While Indigenous people represent only 4 percent of the overall population of our region, Indigenous people are overrepresented in the drug poisoning death data, as they represent 15 percent of the drug poisoning deaths in the Island Health region.

In 2021, nearly 80 percent of the drug poisoning deaths within the Island Health region occurred in ages 25 to 64, with a dramatic increase in fatalities in ages 45 to 64. Across Island Health, the predominance of deaths is occurring in people’s homes, private and other residences. The South Island, and Victoria specifically, has persistently high toxic drug death statistics. In 2021, Victoria had 127 toxic drug poisoning deaths, the third-highest in B.C. Victoria has tragically been among the top three communities for deaths across the province during the emergency.

Data from the coroners service shows that unregulated substance consumption patterns have markedly shifted over the past years to a predominance of inhalation and insufflation rather than an injection. With regard to fatalities, only one in five deaths were attributed to injection of a toxic drug. I’m going to repeat that the people most at risk in our region are men inhaling, insufflating, smoking or snorting unregulated substances in their own homes, alone.

With regard to our response during COVID laid upon the toxic drug crisis, this remarkable and disproportionate impact of COVID on individuals who are underserved in Island Health communities required innovative approaches to meet the basic needs for health and care, particularly on the serious background of the existing toxic drug crisis and the growing concerns of homelessness in many of our communities. Island Health teams worked quickly to implement and adapt to increase access to services, including overdose prevention, naloxone and opioid agonist treatment.

As others have reported to you, our efforts in these three areas were making an impact in the times ahead of the pandemic. We needed to innovate how we maximized this access to these services during the pandemic restrictions. The pandemic measures, while effective in addressing the early risks of COVID, impacted access to services for mental health and substance use. New service models were developed in Island Health to address harm reduction, outreach, access to opioid agonist therapy and witnessed consumption.

[9:10 a.m.]

Island Health teams worked locally to support sheltering providers in collaboration with mental health, public health, community health services, primary care and other community organizations to provide wraparound primary care and social supports through innovative, locally designed solutions. While we worked to meet the basic needs for individuals who were unable to isolate successfully during the pandemic, new innovations are needed, going forward, to address poverty and unstable housing in communities, which will offer stability in the important determinants of health that our communities provide.

Looking back, part of our work was evaluated in the health and housing initiative in South Island Services, where health care providers are readily accessible through partnerships with housing providers. In these models, 54 percent of clients were prescribed OAT. Patients experienced improved care for chronic diseases, with an average of six visits per month with GPs and nurses, each visit addressing multiple concerns, including chronic conditions. This model provided consistent and timely access to care, with 88 percent of patients or residents receiving care on site and over 24 percent of clients prescribed psychiatric medication.

The new relationships developed in this sector during the pandemic have led to improvements in shelter staff competence and confidence in managing communicable diseases. It has reinforced our communication processes and pathways and improved quality of services, and it provides promising examples for future work.

These new and collaborative partnerships with B.C. Housing and other partners, which have developed over the pandemic, will continue to serve the residents of our region in future initiatives as we become clearer and more coordinated in our response to future challenges. Our demonstrated success in mobilizing a variety of community responses across the Island region shows that we can work together in new ways when we need to make it happen.

The next slide speaks to data informing our interventions. Within Island Health, we are continually examining the data available to us. Our ability to tailor services depends upon timely access to data, and I know Dr. Gustafson mentioned that.

Using the data to focus our efforts on those most at risk…. It is through these analyses that we have determined our pressing need to focus on specific areas, including men, especially those in the trades, men who use alone, people who live in supportive housing settings, youth at risk — and supporting peers to design overdose prevention services that best meet their needs.

We continue to assess the data to build approaches to prevention, strengthening our partnerships to address the pressures on youth in our communities, seeking to innovate solutions for those individuals who continue to use unregulated substances in their private residences.

It is not clear why people continue to use unknown, unsafe, unregulated substances at home alone. Our region-specific Using Alone survey let us know that some people are still not seeking care because they don’t feel they need access to services or they fear the stigma related to substance use disorder when they speak with friends, family and the health system.

Our focus on the data has enabled innovative, local, regional initiatives to address the unique pressures we find in the data, working closely with housing providers to strengthen housing-based harm reduction and health services, operationalizing inhalation OPSs across the Island Health region in partnership with service providers and, in the process, building hubs for access in our communities, normalizing this, intentionally destigmatizing services in the long term.

In Island Health, we valued the collaborative work with the Ministry of Education through the pandemic. We hope that, within Island Health, we will bridge our work from responding to COVID in schools to supporting youth across the region to stay healthy and build healthy relationships, preventing maladaptive coping behaviours early.

Island Health leadership also values the important contribution of communities to healthy families and early childhood development. Regarding prevention, the importance of nurturing a supportive childhood within families and a healthy community cannot be overstated.

I will now hand it over to my colleague Keva to share some of the good work across the region.

K. Glynn: Thanks, Dr. Allison.

Good morning. Dr. Allison spoke to the trajectory of the tragedy and how that has impacted the Island’s population. The following slides are going to put that in a bigger picture. We have a substance use continuum of care that we’re going to speak to, and we’re going to highlight and pull out some of the more successful interventions that we’ve had along that continuum and then look forward, in terms of our action plan, on how we’re going to accelerate our actions over the coming number of months.

When you look at that substance use continuum of care, you’ll see that there’s a continuum from prevention, early intervention and treatment through to recovery. Part of this is focusing on working in collaboration with our partners. We couldn’t do any of this without our partners.

[9:15 a.m.]

Turning to the next slide, our cross-sectoral partnerships. The toxic drug crisis is a complex problem, as you know, with deep socioeconomic and structural roots. While, by some, it may be interpreted as an individual health issue, addiction, as we know, has deeper roots and reflects historical, social and economic challenges. As such, making gains to reverse the trajectory of the toxic drug crisis requires partnerships across sectors to address those roots.

It’s through partnerships that we’re able to support people’s journeys from initial engagement with the health care system through to treatment and recovery. As we speak to our successes in the upcoming slides, we’d really like to acknowledge and honour the role of our partners. You’ll see some of them here, and we’ll speak to them in more detail in the coming slides.

On this slide, we highlight our successes in the areas of prevention. Since 2016, we’ve invested considerable resources to achieve a strong platform of preventive services across the Island, most notably eight overdose prevention sites — you’ll see those on the map, where they are on the Island — and five inhalation sites, including an indoor inhalation site in Victoria.

Over the last two years, with the confluence of COVID and the toxic drug crisis on the south Island, we also developed 13 low-barrier overdose prevention sites that are situated within the supportive housing sites. That’s been really successful. The sites have been and continue to be really well utilized by our residents.

I’d also like to pull out, on this slide, the success that we’ve had with advancing drug-checking services on the Island. You’re likely familiar…. There are a number of ways to check the toxicity of drugs. On the Island, we’ve partnered with the University of Victoria and a peer-based organization called SOLID to expand our options to check drugs.

Some examples of these are fentanyl strips and benzo test strips, mail-in packages, the FTIR machines — they are usually fixed sites, but we’re working to make them also available so that we can virtually test drugs — and then paper spray mass spectrometry. It’s a new drug-checking tool that we’re using.

Our focus here is on how we can use these methods to distribute drug-checking models across the Island. It doesn’t just have to be at point of care. People can submit their drugs at point of care, but then they can be analyzed virtually.

From 2020 to 2021, our drug-checking numbers increased by 98 percent. Based on our data up to March 2022, we’re on track for a similar increase this year. It’s really seeing great uptake.

This slide highlights the work in the areas of early intervention and treatment. I’m going to pull out two pieces here. One is around addictions medicine consult services, and the other is our partnership with AIDS Vancouver Island and the SAFER project.

Starting with addictions medicine. Our addictions medicine consult services support physicians and patients on our in-patient units at seven sites across the Island. Consultations are available for the patients and for physicians for any suspected substance use disorder, but the focus has been on opioid and alcohol use disorder.

The physicians provide assessments and diagnoses and initiate opioid agonist therapy in hospital. They also serve to connect patients with community resources. Many of them work in in-patient and in community. That provides a nice connection and a continuity of care for our patients. In the last five years, we’ve doubled the number of addictions medicine consults provided at in-patient units, and that continues to rise.

On this slide, I just want to briefly mention the Cowichan Wellness and Recovery Centre and the success that we’re seeing there. It’s early days. It opened in November 2021. It’s situated in downtown Duncan, and what it’s done is brought together harm reduction, primary care service and then specialized mental health and substance use services all in one place. We’ve also, more recently, been able to expand the safe supply there through a grant from Health Canada to provide tablet hydromorphone.

I’ll keep going. I want to give you a chance to just see where we’re headed.

Looking ahead at the future, we have four areas of focus. One is increasing access to treatment. Another is stopping drug poisonings before they happen, reducing stigma and then equitable access to services. Within each of these, you’ll see underneath a number of tactics.

[9:20 a.m.]

I’ll very briefly just describe one, because it has to do with youth and the rising risk that we’re seeing with youth. We’ve implemented Y-STAR teams. They are youth short-term assessment and recovery teams, and they’re connected with the emergency departments. So if a youth comes in with an overdose, those teams are there and supporting the individuals, the youth, in the emerg and connecting them and providing support in community.

All right. The final slide before I hand it over to Dr. Allison to close. This is our action plan over the spring, summer and the fall. You’ll see here that this isn’t intended to be an all-encompassing plan. It doesn’t reflect all of the pieces that we’ve spoken to here, but it does reflect where our priorities lie in the next 30, 60, 90 days. I think you can see, there, the detail, and if there are questions on that after, we’d be happy to answer them.

Now I will turn it over to Dr. Allison.

S. Allison: Thank you so much, Keva. I’m heartened by these concrete plans and the commitments, particularly as we try to recover from the pandemic. I’m also thankful for this committee’s attention.

Substance use is a predictable outcome of extraordinary stress on a population, and we are seeing rates of various coping behaviours increase similarly. Cannabis use, alcohol use, Internet use are all increased in our latest COVID SPEAK surveys.

Unregulated substance use is only one of a number of coping behaviours people in our communities are adopting, but it certainly is the most worrisome. Unregulated substance use is dangerous and fatal. But people are just not talking openly about their substance use. They’re not.

The Island Health senior leadership team will soon adopt our regional harm reduction policy. This will signal a change for the region as our leadership teams begin to implement through careful education, change management and leadership modelling.

Our regional teams provide care for people who use all types of substances, and Island Health services need to be welcoming and safe to build the trust for people we serve. It is through initiatives like these that we can change minds and hearts in the workforce and spread these sentiments from our health facilities into communities. These changes where we live, work and play encourage us to become more trauma-informed and less trauma-inducing, reducing harms, increasing understanding and being less stigmatizing and othering for those who are coping the best they can. These are really hard times for people.

To reiterate a point from Bonnie, we do need to start asking “what happened to you” rather than “what’s wrong with you.” There is a seemingly insurmountable culture change needed related to substance use and other differences in our communities. But we can get there together. Connection is the opposite of addiction, as Dr. Henry said.

As a medical health officer, I’m eagerly waiting the chance to strengthen safer communities where our municipal and provincial partners invest differently in community to help us build back a better future after the effects of the pandemic, prioritizing efforts to rebuild healthy connection and community and addressing the growing inequities in the social determinants of health.

Connection is the vaccination for this emergency of disconnection, isolation and stigma. Trauma-informed communities and leaders can understand the role of communities in providing safe, inclusive, connecting initiatives and spaces, equitable policies for determinants of health and intentional engagement of people with lived and living experiences. Facilitating intersectoral collaboration is essential to de-escalate this public health emergency.

Good examples in our region include the leadership in the Cowichan Valley. While they don’t always agree, they seem to always do the right thing. The community cohesiveness demonstrated by their community action team, the community health network, Our Cowichan and other brave leadership tables have paved the way to highly functional community systems that can respond to local issues constructively.

We all need to be courageous at this time and become the leaders that our communities need to get us through this unrelenting crisis. We, as passionate leaders from within the health system, will continue to lead as best we can. But it is time to acknowledge that investment in community may be pivotal to make the gains that we need now.

We’ll be looking toward proven models, like our partners in Cowichan, seeking to understand how the community ownership and effective collaboration towards locally generated solutions through collaborative leadership…. Investment in community development that addresses the determinants of health and abates the urgent and growing health inequities could never be more important than at this time.

Our regional experience with our pandemic response has some things in common with our ongoing work with the toxic drug crisis, but some things are very different.

[9:25 a.m.]

The pathways for COVID response were very clear, and our clients and residents were very receptive to our interventions. People spoke openly about their experience with COVID. There was openness about how the community was all in this together.

That is the response that would change the outcomes for the toxic drug crisis. We need to fully understand the drivers that arise in early life and how they influence behaviours so many years later. While the toxic drug crisis has touched nearly every life, many people are still reluctant to mention that they themselves have been impacted for the shame of it all. We really need to speak up about how this awful, unrelenting emergency is affecting all of us.

I met a friend at a local pub on my usual walk about the community of Nanaimo. I live in downtown Nanaimo. He’s a young adult male who I know uses opioids and stimulants, and we speak openly about it. When I asked him, “Why do you use alone?” he said he uses alone at home because of the comfort, of the need to disengage from the world and the difficulties in his life for a while, alone in his own home. He also talks to me about the friend he lost during the drug poisoning in most recent weeks. I reported that statistic, and it was very difficult for me.

I worry about him every day. He won’t seek care, because he doesn’t think he has a substance use problem. I think my connection with him may have saved him that day. I’m glad he trusted me, to speak with me about his substance use, because I accept him. But that’s not the case everywhere.

Thank you for this time to address this important issue. I’m honoured and privileged to share this message with you today. Thanks for letting me go over.

N. Sharma (Chair): Thank you, Island Health Authority, and your team for coming here.

I’m now going to pass it over to the Northern Health Authority.

We’ll start your 20 minutes. Introduce yourself at the beginning. Over to you.

NORTHERN HEALTH

C. Ulrich: Thank you very much. I’m Cathy Ulrich. I’m the president and CEO for Northern Health. I’d just like to introduce my colleague here, Dr. Jong Kim, who’s our chief medical health officer, and Kelly Gunn, our vice-president of primary and community care.

I would like to also acknowledge that we’re speaking here today on the traditional territories of the Musqueam, Squamish and Tsleil-Waututh peoples. I also want to acknowledge the 55 First Nations and territories that we have the privilege in the North of working on.

We’ve given you a slide deck that has a lot of information in it. We’re not going to go through all of the detail. You may have questions later that we can respond to. I’m going to do a couple of introductory remarks and then ask Dr. Kim to give you an overview on some of the health promotion, prevention and harm reduction work. Then I’ll take over on the treatment and recovery side.

I think you all know that the North has a huge geography. It has a sparse population. The geography is the size of France, with many rural remote communities. It has all the challenges that come with the northern geography. We’re going to point out some of those challenges as we go through this over the course of the next 20 minutes.

I do want to highlight something that we worked on during COVID with our partners in the First Nations Health Authority, First Nations communities, B.C. emergency health services and the Rural Coordination Centre of B.C. — a northern, rural remote and First Nations framework. There are things in that framework that have applicability to this crisis, particularly as it relates to care pathways for people who live in rural remote communities, transportation issues and access to higher levels of care when those are needed.

On the next slide, if you can go to slide 3, I do want to highlight a few things about how we’ve structured ourselves. Some of this pre-dated COVID and did fall apart during COVID, and we’re in the process of putting a lot of these structures back in place.

I’m going to start with the regional toxic drug crisis response team that we have at the regional level. There is First Nations representation from the First Nations Health Authority on that response team as well as members from our mental health and substance use team within Northern Health.

I do need to acknowledge Dr. Gerrard Prigmore, who is our medical lead for addictions medicine. He’s not with us today because he’s in clinic, but he’s an exceptional leader in addictions medicine in the North.

[9:30 a.m.]

This response team is led out by…. The executive sponsors are Dr. Kim, Kelly Gunn and also Tanis Hampe, who’s our vice-president of population and public health. That response team is accountable to the executive team. We have, at least once a month, a session on this toxic drug crisis at that table. And then at every board cycle, we bring this topic, in terms of accountability, to the quality committee of the board and then through to the board.

As well, we have a partnership committee, a working group, with the First Nations Health Authority on mental health and substance use. Through that team, we report in to the Northern First Nations Health Partnership table, which meets on an every-three-months basis in the North.

This crisis response team also has set up similar response teams in each of the health service delivery areas: the northwest, northern Interior and northeast. Those response teams are re-establishing themselves over the last couple of months as COVID has abated somewhat. We also have local implementation teams at the local level.

The focus of the response team has been on the following areas. Harm reduction, the expansion of harm reduction and access to harm reduction. The expansion, also, of opioid agonist therapy. We’ll talk a little bit more about that later. We do have a champion in each of the health service delivery areas that is working with the regional lead on that area.

Prescribed safer supply. In this area, we’ve had a short-term working group that has been developing a framework for the North related to implementation of a prescribed safer supply. We have a slide on that later. Then restarting our stigma reduction working group. This is a significant issue in the North. I would also add into that the importance of trauma-informed care, as well as cultural safety and anti-racism.

The other thing in the structure that I wanted to talk about is that in terms of delivery services in a northern, rural geography, what happens at the local level is extremely important. So embedding this work in the primary care home is critical, and having that primary care home supported by a team. We’ve been structuring these teams across the North, populated with nursing staff, life skills workers, social work and a mental health clinician on each of those teams. We’ve been working to expand that as we’re able with some of the health human resource challenges that we experience in the North.

Those teams are supported by a specialized mental health and substance use team in each of the health service delivery areas. We’ve tried as much as possible to have that as a distributed model, where there is a presence of some of those specialized services in each of our major communities. And then those teams need access, at-the-elbow support from experts that may not reside in the North. So the RACE service, rapid access to consultative expertise; the Compass program at B.C. Children’s; and the B.C. Centre on Substance Use 24-7 line have been absolutely critical.

I think I’ll leave that part there and turn it over to Dr. Kim. Then I’ll come back to some of the challenges.

J. Kim: Thank you very much.

On the next slide, slide 4, it shows the death rate per 100,000 per each health authority. It demonstrates that the North has been having the higher burden of that death-related toxicity of illicit drugs. Also, it shows that there was significant impact from the COVID pandemic. COVID impacted the toxicity of the drug supplies, and it also impacted…. Drug toxicity is a complex issue requiring alliances and partner response, and the pandemic impacted the availability and capacity of those partners to respond to the drug crisis.

There are also additional unique challenges the northern residents are facing, including vast distances between the communities, small service centres, harsher climate with poorer transportation systems, remote needs, isolation and potentially limited social, education or employment opportunities.

[9:35 a.m.]

The next slide is the review panel’s Indigenous information from the First Nations Health Authority. It just underlines that the Indigenous community, including those in isolated northern communities, are disproportionately impacted by illicit drug toxicity injuries and deaths. Northern B.C. has the highest proportion of Indigenous people and communities in the province.

In the next slide, slide 6, we also organized our service presentation according to the continuum of services. Just a quick comment is that we are thinking about the services in a continuum, that one of the works we are doing is actually better understanding about how individual families travel through this continuum of care, because it’s not one direction. It’s not point to point. So a better understanding is one of the tasks that we are working on.

We are starting with health promotion and prevention. In part of a continuum of care, supporting the people wherever the people are is an important part of Northern Health’s response. Part of our response is starting with the prevention and promotion.

Prevention starts always in childhood and in the family. In addition to the work that we mentioned on the slide, we are also restarting in schools. There is also focus on promoting healthy families in a primary care home and an inter-professional team. This includes identifying vulnerable families and providing the support of connecting the resources and also providing trauma-informed care and providing education for the providers.

Continuing on the promotion and prevention. Continuum of care starting with individual families also expands to the communities. Northern Health supports many grants that either directly or indirectly focus on mental wellness and community resilience, supporting the community and empowering the community to promote health.

The slide shows some of the examples of what our grants have been supporting and the successful applicants.

We put some information about peer engagement and stigma reduction. It’s been mentioned multiple times that stigma is an important barrier that can lead to poorer patient care and also decrease use of appropriate health care services. This contributes to people dying alone, without having sufficient interaction or intervention by the health care systems.

Similar reduction training and a program has been developed in the North to address these needs. We provided a link there. You can actually check the videos made as part of this campaign.

We are moving on to the harm reduction part. This has been significant work to expand the reach of these services. We have experienced success in this expansion. However, access to these services continues to vary in its consistency and visibility across the region, particularly in more remote areas of the region.

The community action team has been a really important part of our toxic drug crisis response. It has been important building the relationship between the local community leaderships, including service providers and people with the lived experience. It has helped community people implementing local solutions. It has been, unfortunately, also the area that has been significantly impacted by the pandemic. We mentioned that the pandemic impacted availability and capacity as well as for gathering in person for the different parts of a community — to get out of silo and get together and build that kind of connection.

This is also the area that we are reinvigorating as we are getting out of the pandemic and starting to restart and refresh our toxic drug crisis, re-energizing these community tables and the community solutions.

In harm reduction, harm reduction supplies are distributed across the region, as well as drug-checking services. The data we provide on this slide is 2021 information. In 2022, there has been an increase. For example, on the harm reduction side, it has increased from 28 to 43 sites for the harm reduction, with the majority of increase in the northeast. This also means that the harm reduction is available in every community in the North.

[9:40 a.m.]

Just continuing the harm reduction and focusing on the take-home-naloxone program. It’s also kind of underlining that the numbers in 2022 improved from 2021. Now in 2022, we have 198 sites for taking naloxone and also the facility overdose response box program. There are 45 sites for that program.

Now on slide 14, we’re moving on to the overdose prevention services. Overdose prevention services support the safe consumption of the drugs. That includes supervised consumption as well as the drug checking, sterilized supplies and other services. In the North, we have 24 sites designated for overdose prevention services and 14 sites for providing drug checking and other services, as well as the supervised consumption services. The next three slides outline these 14 sites. There are ten other sites that are providing the drug checking and a safe place for using.

Moving onto slide 15, those are the overdose prevention services with the supervised consumption in the northeast. There are three in the northeast.

The next slide is for the northern Interior. There are six in the northern Interior. In terms of the utilization, the example is the Prince George overdose prevention site, which on average sees close to 60 people per week utilizing this site for safe consumption.

The next slide, slide 17, shows the overdose prevention service with supervised consumption in the northwest, many of them led by Northern Health there.

The next slide is on harm reduction, just mentioning about safe inhalation services. Inhalation has become the main route of admission. It has been an important part to provide safe inhalation at the overdose prevention sites across the North and to make this service also available indoors, not just outdoors, given our climates. The challenges of developing this service include the climate challenge we are having.

Also, safe inhalation is a more visible part of overdose prevention services. That leads to varying degrees of support and assistance with community members and local governments. Northern Health is working closely with the local governments and community groups to make safe inhalation more available across the region.

I’ll pass you back to Cathy.

C. Ulrich: Thanks, Dr. Kim.

I’ll just highlight a few things on treatment and support. Before we go into this section, I do want to highlight some of the challenges and some of the opportunities that we see in this space.

In terms of some of the challenges, I think that for our northern geography, access is a significant issue in treatment and support — and also timeliness of that access, so that when people are ready for that service, it’s available for them. Those are challenges that we have not overcome in the North.

Transportation issues are huge for people who are needing to access services and also for service providers doing outreach as well as for moving products, like pharmaceuticals, around the health authority. Access to pharmacies is an issue in the North, and the hours of service for pharmacies are also a challenge in many of the communities. Some of our communities do not have pharmacies, so they are dependent on a neighbouring community that may be many miles away. Cultural safety of the options that are available is also a really important consideration.

I would say that in terms of treatment, we do not have full coverage of our northern communities. We have really good services in places, but they’re spotty in terms of coverage of the entire geography. The other issue that I think everyone is aware of is health human resources and recruiting to the positions that we have created in the North.

I think, in terms of solutions, they’ve been talked about by both Island Health and in some of what Jong has said. It’s about the partnership and collaboration with others — school districts, B.C. Housing, local government, friendship centres, other non-profit organizations, the First Nations Health Authority and First Nations communities.

[9:45 a.m.]

I think those partnerships are the only way that we’ll be able to address these issues using service extenders, such as virtual care. We’ve done a lot of work on this in the North, and we’ve done a lot of work on this in partnership with First Nations Health Authority. Also, building out from the primary care home — building the capacity in that local primary care home is really critical in making sure that people have at-the-elbow support.

Education of providers — I think you’ve heard this previously at this panel. There has been some creative work done in the North with our medical lead of addictions medicine. It is now compulsory in the North for all physicians who are doing their family practice residency in the North to do a two-week rotation in addictions medicine. It’s also compulsory for psychiatrists who are doing their residencies in the North to do a four-week rotation in addictions medicine, and we are talking with the university about how we expand this to the nursing program.

If we go to slide 20, the opioid agonist treatment is listed there. I’m not going to go through that in detail — given I have 33 seconds left — other than to say that we have doubled the number of prescribers that are providing OAT treatment in the North since we started that service.

On slide 21, in terms of RN and RPN prescribing, as of yesterday, we now have seven RNs who’ve completed their coursework. We have ten in progress and four that are just starting.

On page 22, I do want to indulge you and just take a little bit of extra time here around access to treatment and support and prescribed safer supply. This has been a real area of what I would say is moral dilemma for our service providers in the North — the primary care physicians that are involved in this work as well as our addictions medicine specialists.

To this end, and Kelly can talk to you a little bit more about this, we’ve done some intensive work over the last six months in bringing people together to talk about this and to work through some of the ethical dilemmas that they are experiencing and develop a framework for the North in relation to prescribed safer supply.

But as our addictions medicine lead has said to us — just as of yesterday, at our executive table — it’s going to be really challenging to prescribe our way out of this crisis. Moving to a non-prescribed safer supply is going to be critical and challenging in a northern geography. It’s something that we are just starting to think about, and we’re looking forward to learning more as things unfold in the Lower Mainland.

I’ll just leave the next slide in terms of our partnership with the First Nations Health Authority, because I have talked about this. We do have a crosswalk plan there with the regional office of the First Nations Health Authority.

On slide 24 is an outline of our virtual services. During COVID, we developed a virtual primary and community care clinic, and at the same time, we developed a virtual substance use clinic that ran once a week. We have expanded that now to a daily service with on-call on the weekends and merged those two together within the last month and a half. At this point, they’re seeing about five to ten people a day in that mental health and substance use service.

On page 25 through 27 are the opioid agonist therapy services that are available in the North, and I’ll leave that for your consideration.

On page 28 is an outline of some of the treatment services that are available in the North. Adult withdrawal management — formally, we have 16 beds, but we do generally have an expansion of that to 20 beds at the Nechako centre on the UHNBC campus. Then we’ve listed out the other services. But as you can see from that list, they’re remote for many parts of the region, and timeliness of access is a challenge.

The next slide talks about supportive recovery and what is available in the North. The comment I want to make on this slide is that we have established a day treatment program that Northern Health operates in the northern Interior and the northwest. We’re setting that up in the northeast. These supportive recovery beds are critical so that people have a safe place to stay during the time of the day treatment services.

[9:50 a.m.]

The next slide gives you an update on where Foundry is at in the north, and slide 31 gives you an update on where the integrated child and youth team development is in the north. And then on slide 32, we have listed out our mobile support teams that we’ve created in partnership with the First Nations Health Authority and First Nations communities across the north.

Each one of these has a partnership advisory committee that guides how those services are delivered and linked to the rest of the services. And then on slide 33, some emerging opportunities in terms of development of additional treatment capacity in the north. We’re anticipating that some of these will come to fruition in 2023.

I will leave that there. Thank you very much for the opportunity to describe our situation in the north.

N. Sharma (Chair): Thank you so much to the Northern Health Authority for your presentation.

I’m now going to pass over to the First Nations Health Authority. Please introduce yourselves. I think we have your slides here.

FIRST NATIONS HEALTH AUTHORITY

R. Jock: Thank you, Madam Chair. I’d like to introduce myself. I’m Richard Jock, member of the Mohawks of Akwesahsne, and I’m pleased to be serving as the CEO for the First Nations Health Authority. I’m joined by our chief medical officer, Dr. Shannon McDonald.

Thanks for the opportunity to speak to the committee today. A few weeks ago you heard from our deputy chief medical officer, Dr. Nel Wieman, on the scope of the challenge and the toxic drugs’ disproportionate impact on First Nations people. Today we will focus more on the specific items that we recommend be put in motion.

Our First Nations response, developed at the outset of the announcement of the drug crisis, was developed in terms of a four-pillar response, which we have entitled “A Framework for Action,” which has guided our response since 2016 and outlines the various treatment and aftercare options, a range of harm reduction services, and culture-based healing and wraparound supports.

Many of our initiatives are delivered in partnership with the regional health authorities but also with communities and nations, who really remain deeply impacted by the disproportionate effect of the drug crisis on their people. Last year there were 334 dear friends and family members that were lost, and this really outstrips all of the lives that have been lost due to COVID.

However, it’s fair to say that the toxic drug crisis has not received the same level of attention, community support and resourcing, and it very clearly shows that there are differences and that we’re not in this all together at the same level and at the same sense of urgency.

We’ve been to four regional caucuses already, and we’re going to Fraser this week. We’ve heard very clearly that the toxic drug crisis and its impact on individuals and in communities is really a cry for immediate action and attention.

As pointed out, First Nations people are heavily impacted by the crisis, dying at a rate of 5.4 times the rate of other residents, and this is really hard, especially in small communities where it’s really clearly seen that many of these lives lost are preventable. Therefore, looking at this, going forward, looking at a similar approach that we used in COVID may be an important lesson learned and a roadmap for some of these actions.

We remain affected, in a sense, by some of the jurisdictional divides that really are there and have been particularly present in the past. FNHA and First Nations were involved in and benefit from the Ministry of Mental Health and Addictions Pathway to Hope, which is really unique in Canada and really provides first-time access to such innovations as on-the-land treatment and opioid drug effects.

[9:55 a.m.]

Nevertheless, these are really still reflecting in this legacy of jurisdictional divide in that First Nations have not been able to fully access all of the services in spite of our best efforts to date.

One of the things that we are suggesting is that we use an approach similar to what the federal government and others have characterized as Jordan’s principle, which is that the care and treatment are provided, and then we figure out the source of payment afterwards. This would eliminate some of the deliberations over who’s the provider of last or first resort and would speed up access to necessary services. This could really result in some access to services that are needed and are complicated but also really save lives.

There are remaining treatment gaps, and I would say that significant gaps remain in terms of access to timely and culturally appropriate treatment. As our northern colleagues pointed out, there are still not enough treatment beds or detox and daytox programs to support access to those programs. Access to opioid agonist therapy is limited and, as has been pointed out, is spotty and not available across the province.

The long waiting periods between detox and treatment and also limited access to aftercare are important elements, and I would say that FNHA is also recognizing the need to focus on capacity building within communities to provide support through our community-based services in terms of how to access services and to support people going into treatment and coming out of treatment. As has been pointed out, that access is particularly challenging in rural and remote parts of B.C.

The other point we would like to make about access to beds is that having direct access to beds commensurate with the inequity of harm should really be a principle. In other words, having access which really reflects the level of need, as has been demonstrated and articulated, is really important. For example, there are private treatment beds that are accessible through the province and are then accessible through the regional health authorities. However, FNHA does not have direct access to those private treatment resources, and the complications of applying for those really are diminishing that important access.

One of the other aspects of that is that some communities are using their own source revenues to pay for private treatment as a last resort, if you would. In some cases, these amount to $29,000, to higher levels in communities that are already disproportionately impacted by high levels of poverty. So looking at access to beds for First Nations people and for clearer ways to access those would be really important.

Aftercare. Again, we’ve pointed out this is an impor­tant element, and I would say that there is not, for First Nations people, an appropriate aftercare program. We would look for ways to engage and develop such an aftercare program as well as to look at the capacity building that I mentioned, so that we can support harm reduction and use of other groups, such as SMART or Wellbriety, as ways to support individuals in their healing journey.

I’ll now turn to Shannon for the harm reduction conversation.

S. McDonald: Thank you.

My name is Shannon McDonald. I’m Métis-Anishinabe, originally from Manitoba, and have been part of the First Nations Health Authority since its infancy, first off as a member of the Ministry of Health and then transitioned over. I went home.

[10:00 a.m.]

Harm reduction remains a critical component to our response, and we’ve developed a range of harm reduction initiatives. An important one was the provision of nasal naloxone, as opposed to injectable, for our populations. There was significant resistance to injectable, and we have found it to be expensive but very successful to make nasal naloxone available.

We have done our best to increase access to opioid agonist therapies and drug-testing services but have not been completely successful in serving all 203 communities. We absolutely understand the increased need for services, especially in our rural and remote communities — from our community leadership — but more investment is needed. We just don’t have the ability to go down that road just yet.

As seen in the B.C. health system, there is research evidence and reports of barriers to harm reduction services specific to First Nations people. Are those services culturally safe? Are people facing systemic racism when they attempt to enter into those services? And uneven geographic access is huge. The In Plain Sight report was very clear on low rates of utilization.

There are large gaps in access to opioid agonist therapies in rural and remote communities, and we’re working very hard to improve the access to nurse-prescribed services, but at this point, we have one individual who is actually fully functioning in that. We have others that have gone through the training, but every time things try to get set up, access to the medications and other issues have really prevented that from happening.

We need to implement regulatory and financial support for the transportation of OAT by unregulated care providers. At this point, we are struggling with only pharmacists and physicians being able to do that, and we’re looking for expeditious approval of nurse prescribing to certified practice. We have remote certified nurses. We’d like to be able to combine those training programs so that there are more people.

We need pan-provincial electronic medical records. We are always struggling with information and independent access to PharmaNet, which is not universally available to our community nurses.

We continue to struggle with the College of Pharmacists and their current pharmacy-based guidelines for access to OAT that do not meet the needs of First Nations people living in rural and remote areas. Specifically, the guidelines do not recognize that nurse-led programs are a standard of care for providing OAT. So we want to be able to improve medication management at community health facilities — storage, security and nurse administration. But that will require changes to the College of Pharmacists B.C. guidelines to align with section 56 of Canada’s Controlled Drugs and Substances Act.

Prescribed safer supply is simply unavailable in nearly all rural and remote parts of the province, and it is often difficult for people to access even in urban centres. There is significant reluctance to prescribe, as was described. Many care providers are burnt out and beleaguered from the pandemic and just unable to take on more training or extra work. So this simple lack of prescribers in these areas makes it extremely challenging.

It would be wonderful — dreams of commercial production or centralized compounding of safer supply formulations that could be transitioned to smaller communities through new processes, remembering that drug dealers deliver. I’m just saying that. Transportation is a major barrier to harm reduction services, especially OAT and prescribed safer supply but also in accessing overdose prevention sites.

[10:05 a.m.]

First Nations people living in rural and remote areas often have limited or no real access to these services. The need to travel daily over potentially long distances with limited reliable transportation in difficult weather conditions is not reasonable for the majority of residents in remote locations. And the drug dealers deliver.

Many of the province’s initiatives face unique challenges when trying to implement in rural remote and isolated communities, and First Nations risk being left behind. I want to acknowledge our regional health authority partners who have worked so significantly with us through COVID and on these issues through rural and remote initiatives. Without them, we would be nowhere near close to where we are now. But we’re not close enough.

I will pass back to Richard.

R. Jock: Thank you. I also would reflect that I was just at the Tk’emlúps community this weekend, where there was an anniversary of the discovery of the 215 graves. I would say that that, for us, has been a particularly important development. It really reflects the need for us to focus on trauma-based services, rather than trauma-informed services, as really a clear pathway forward.

In doing so, part of what we think will be important is to look at mental health and wellness programs as supported by our innovative arrangement, the tripartite memorandum of understanding, which permits a nation-based development of models to respond to the overall mental health and wellness needs.

This has also supported the replacement of six treatment centre facilities and building two new facilities. So we will have 60 new beds, which will be put in place, but this will take some time to implement. Also, the development of healing lodges or healing modalities, as called for in the Truth and Reconciliation Commission, in terms of a response to what is clearly community-based trauma — part of that is residential schools; part of it is toxic drugs — but also the mental health crisis emerging out of COVID.

As has been said, the rural and remote First Nations and Indigenous COVID-19 response framework is a clear and excellent example of how to focus on some of the rural and remote items. I would say that we would like to use that as a way of guiding our work forward and that we look at how we can provide additional virtual services. We have a virtual doctor of the day and virtual psychiatry programs, but now these are facing three-week wait times, which, of course, creates additional barriers. So sustainable resources for those will be important going forward.

The timely transportation, I think, has really been an important conversation. But we are looking at how to support infrastructure like helipads and other emergency transportation options. I think these will be important improvements, not only with COVID-19 but other aspects of access to services.

Then I would like to conclude by saying that it would be really important for us to leverage additional federal response. The province of B.C. has stepped up and expanded services. However, I would say that this also needs to be accompanied by greater contributions from the federal government for First Nations people specifically and that we look at really addressing these issues in a timely way in order to address the call from communities, which is to address these issues on an urgent and priority basis.

With that, we look forward to the questions, and we’ll give you a minute back of your time.

[10:10 a.m.]

N. Sharma (Chair): Thank you. Very impressive. I appreciate that. Thanks for your very succinct and detailed presentation.

I’m going to pass it over to the Interior Health Authority. You can introduce yourselves. I think we have your materials as well.

INTERIOR HEALTH

S. Brown: Good morning and thank you. I’d just like to introduce myself and the team.

I’m Susan Brown. I’m the president and CEO for Interior Health. I’ve got Dr. Sue Pollock, who’s our interim chief medical health officer; Dr. Paul Carey, who’s our executive lead for our mental health and substance use network; and Diane Shendruk, who’s one of our vice-presidents for operations.

Before we get started, I’d like to recognize and acknowledge that we’re collectively gathered on the traditional, ancestral and unceded territories of the Musqueam, Squamish and Tsleil-Waututh Nations. It’s with humility that we continue to strengthen our relationships with First Nations, Métis and Inuit peoples across British Columbia.

Today you will hear me discuss our First Nation, Métis and Inuit population as Aboriginal, and that’s at the request of our partners.

It’s really a great opportunity for us to listen to the other presentations that have been made this morning. There’s always an opportunity for us to learn from what others are doing, so I really appreciate that we got to do this together.

Interior Health also has very rural geography as well. We have 60 municipalities that we serve and 54 First Nations communities that we work with over a large geography as well.

In slide No. 3, much like the provincial pattern, you can see that Interior Health also saw a doubling of toxic drug deaths, from 140 in 2019 to 288 in 2020 and then a further rise to 372 in 2021. Much of what I’m going to tell you today is that there’s been much effort and an urgency to address this. However, 2022 numbers for Interior Health do not look much different from 2021.

Drugs toxicity is the third-leading cause of potential years of lost life in the Interior, reflecting on the toxic drugs in younger age groups. Additionally, this has disproportionately affected our First Nations population, which is overrepresented at approximately ten times the provincial rate.

In slide 4, you can see the Interior Health substance use framework. This was developed last year and aligns with the Pathway to Hope roadmap. This is really to guide our transformation, and this document promotes a shared understanding of the system of substance use care and how the programs and portfolios fit within that system. The framework has enabled us to both be nimble and responsive when requests for services come in, ensuring that new resources and programming fit within the system and the longer-term vision. We also have a rural and remote Indigenous framework, which enables a number of aspects of this plan to come alive.

Slide No. 6, our governance for this work. We established a substance use steering committee in 2021, which provides oversight and governance on the execution of the substance use framework. Additionally, we have a toxic drug supply task force, which brings together a number of stakeholders: clinical operations, population health, our First Nations partners and peer representatives, who are people with lived experience. They identify and recommend actions to respond to the toxic drug supply by monitoring epidemiology and reviewing evidence and best practice from other jurisdictions. The task force supports operational implementation of the plans and monitors ongoing activities.

Slide No. 7 talks about the structure we have in place and how we partner with our Aboriginal partners, both from the First Nations Health Authority and Métis Nation B.C. They help the strategic planning and also, where we’ve got funding coming, where that’s best utilized for our geography. The First Nations Health Authority and Métis Nation B.C. are also represented at the toxic drug supply task force. They meet bimonthly to help steer that work.

[10:15 a.m.]

We know that an important part of the continuum of care requires upstream focus to prevent the development of substance use orders. On slide 9, it speaks about a program we’ve had in place for a few years now, PreVenture. This is an evidence-based prevention program that uses personality-targeted interventions to promote mental health and delay substance use among youth. This is typically a strategy that’s deployed when children are around the age of grade 8. We’ve been successful in partnering with six local school districts in our region, and we have a total of 1,050 students enrolled in this program to date.

The results are quite compelling on this work and show that alcohol and drug use is reduced by 30 to 80 percent amongst participants. It reduces the odds of binge drinking by 50 percent. Additionally, there’s delayed onset of the first consumption of substances as well as delayed onset of depression, anxiety and other issues. So this has been a very successful program for us.

Additionally, many of the stories that we’ve heard from individuals coming forward to speak to our board have been mothers, fathers, grandparents of children who’ve had injuries, whether it be from construction or car accidents. Their ongoing struggle with pain control has been a challenge, and it’s actually, maybe, how they were even introduced to drugs, opioids, to support their pain management in the first place.

In 2018, Interior Health implemented a hub-and-spoke model for the delivery of pain services. We partnered with the Bill Nelems Pain and Research Centre in Kelowna. Bill Nelems was quite an interesting, progressive thoracic surgeon from our region who unfortunately passed away in 2017. But his legacy lives on, and we are a proud partner with them to deliver pain services in this type of model.

It really allows us to have a broader reach, and we now have pain services in Penticton, Vernon, Salmon Arm, Revelstoke, Trail and Kamloops, with more to come. This service supports more than 27,000 patients annually and provides an interdisciplinary approach to this, not only with interventions from physicians but a whole interdisciplinary team who provide psychology, diet interventions and a number of different group classes around self-management for pain.

I’ll also now provide an overview of the treatment services in our region. Much like many of the people who have already spoken, connections to care are absolutely critical. We’ve developed one phone number for the health authority, 310-MHSU, which has been successful in taking away the navigation of services from people and, actually, us doing that work in the background. So when somebody calls that number, staff will determine the best service for that individual and have them connected to it as quickly as possible.

Nurse prescribers, on page 13. We have 16 nurses in 11 communities — we were the first health authority to have a nurse prescriber — and now they require additional education to do even further work with regards to newer drugs that are coming out. I think we were the first, in Vernon, to have a nurse prescribe slow-release oral morphine. So really endeavouring in that space, because we think it’s great to have that outreach for rural.

But I do need to highlight that when we have nurse or physician prescribers in this space, they use higher use of drugs than what you would typically see, which can result in audits into their practice because of that high volume of drug. This becomes a bit of a stressor for those prescribers, so working really closely with our College of Physicians and Surgeons, Colleges of Pharmacists and Nursing, will be critical to us to being successful in this area.

On slide 14, we also have introduced Suboxone into our emergency departments with a to-go kit. We have 20 emergency departments which give individuals a 72-hour Suboxone to-go pack. Then they quickly get urgent referrals into our opioid agonist treatment programs.

[10:20 a.m.]

We will continue to roll that out until September, where all our emergency departments will have this in place. To date, we have 114 patients who have received the kits, and the majority have stayed with the opioid agonist treatment program since they’ve been connected.

On slide 15, new investments — these investments are critical and are quite exciting to see come alive. We recently did an announcement in Kelowna and got to walk through a new withdrawal management facility that was purpose-built. To see these things purpose-built is absolutely wonderful. And then, of course, they’ve got little individual suites that allow people to get back on their feet and integrate into society after they’ve gone through withdrawal. We also, historically, have had some withdrawal management beds, where we’ve partnered with a First Nation community, Skatin, and also contracted for a number of years in Round Lake, where they provide services that are appropriate for our Indigenous clients.

These new investments will really help us with adults as well as youth. We’ve got new youth intensive case management teams and intensive day treatment programs for youth as well, and also parent and elder-in-residence positions.

On slide 16, we’re expanding our hours related to addiction medicine consult services. We have them currently at Kelowna General Hospital and Royal Inland Hospital and are expanding to other sites.

Recently I was just at the ten-year anniversary of the southern medical program, where we train medical students locally. We’re seeing some of those graduates actually now going into the field of addictions medicine, which is very exciting, because it allows us to grow our services locally. We also have done quite a bit of work with virtual care in this area. Of course, the pandemic resulted in a lot of people going into self-isolation, so coming up with innovative ways to not only support…. There were drugs required but also managed alcohol in those areas.

Slide 17 gets into a bit more detail around the specifics of iOAT and TiOAT, which is in Kamloops. We’re expanding these services where possible and looking to also now pilot and add fentanyl patches to a number of different areas. You’ll see some detail on that slide.

I’ll move to slide 19, where we talk about injectable opioid agonist treatment, which is our highest-intensity treatment option for people with severe opioid use disorder who inject and who have also been unsuccessful in reducing or stopping their opioid use with trials of oral medication. So having this available is an important part of the trajectory for some people, and we’ve co-located this with supervised consumption and primary care in Kelowna.

Next I will speak around our harm reduction services within the Interior. These are an important part of the continuum for individuals who are engaged in care but continue to use, and this can be a lifesaving approach for people who are not currently engaged in treatment.

We do, like many others, have drug checking services, and we currently have five machines throughout the region, which provide drop-in services for ten communities. And we have 21 additional distributed drug checking sites, which increase our access into rural and remote areas. We have broad access to fentanyl drug checking strips via harm reduction and mental health substance use locations.

[10:25 a.m.]

Slide 23. We have four supervised Interior-funded and -supported supervised consumption and overdose prevention sites: Kelowna, Kamloops, Vernon and Nelson. We also do episodic overdose prevention services, available in 100 Mile House, Cranbrook, Elk Valley, Lillooet and Penticton. These are an on-call service, where somebody may want to use and they call a service provider to go and be with them. That may be in a variety of settings, whether it be if they’re in housing sites, a social service setting or a community health setting. Additionally, when that provider goes out, they can speak of harm reduction supplies, educate about safter injection techniques, and provide linkages to health services.

On slide 24, it speaks to our addressing stigma. We have definitely put together a toolkit to try and really get at some of the root challenges there, because — as many others have spoken about — the stigma can really prevent people from coming forward. We’ve also partnered with Addiction Matters Kamloops on the Every Word Matters and the Pledge to end stigma campaigns. This has been quite successful and far-reaching for us.

On slide 25, it speaks of peer inclusion and engagement. Our regional peer coordinator has been leading our peer inclusion and engagement project, which aims to increase and improve Interior Health’s ability to meaningfully engage peers in the planning and delivery of substance use services. Developing and implementing tools and structure to a best-practice approach and engagement is followed. We have 28 active peer volunteers, working in six communities, and a peer advisory group, compiled of 33 members who help provide consultation and engagement for us on substance use services.

Looking forward, slide 27 outlines, of course, the B.C. coroners death review panel work. This is the call to action for us to help coordinate the local, provincial and regulatory requirements, and of course, now this select standing committee will further drive this work forward as we look to new, innovative ways to try and overcome the loss of life.

I’m moving to slide 29, just reflecting on how complex this work is and on a number of the intersections that need to align, including our regulatory and legislative issues, some of which we’ve touched on today. Our collaboration and partnership with the provincial stakeholders and the ministry to respond to the coroners report will provide the best opportunity for us to save lives and, indeed, try and turn the tide.

N. Sharma (Chair): Thank you very much for your presentation. We also saved a couple of minutes there, too, but it was very informative.

We’re going to take a ten-minute break and then come back, I’d say, at 10:40, just to let everybody gather their thoughts. Then we’ll go to the question-and-answer period. Thank you, everybody.

The committee recessed from 10:28 a.m. to 10:42 a.m.

[N. Sharma in the chair.]

DISCUSSION

N. Sharma (Chair): Okay. We’ll get started. I think people will trickle in.

I’m just going to take a list. We’ll ask committee members to maybe ask two questions and then get yourself back on the list if you have more than that. We’ll try to get through as many questions as we can.

Do we have anybody that wants to start?

S. Furstenau: Thanks so much for the presentations. I really appreciate this.

One of the things, just off the start here, is inequities. Quite a contrast between health authorities — what is available, what’s not available. And then, of course, the First Nations Health Authority, I think, very compellingly describing enormous inequities for the most impacted population.

My first question, really, is high level, and I’ll just throw it at all of you. It is: what are the steps necessary to start making access to care, when it comes to this drug poisoning crisis, more equitable across the province? So in Northern Health…. You hear from Island Health about the access to services and the wellness centre opening, and then I hear that you’ve got a real problem with even the willingness to write prescriptions. How do we bridge these gaps happening across the province?

A Voice: Who’s going to address this?

N. Sharma (Chair): Maybe we’ll go through each one, and you can say maybe 30 seconds of what your answer is. I think it would be interesting to hear from everybody.

Why don’t we start with Island Health?

K. MacNeil: Maybe I’ll start from my vantage point, and then I’d ask Keva to comment from an operational standpoint.

I think, in terms of…. What you’re speaking to, Sonia, is really the crux of our challenges when it comes to population health writ large. That is: how do we assess the needs of a population through an equity lens and align the resources that we have available and that we need to acquire to best meet that population’s specific needs?

[10:45 a.m.]

I think, for us on the Island, the key to that calculation, for lack of a better word, is the partnerships, the pre-existing conditions in a community. So being able to know who’s in the community and have the relationships with them so that we can have some synergies and add to each other’s resource pool so that we’re not competing. We’re not having redundancy in terms of offering services.

What you heard from all of us, really, is the importance we put on partnerships and collaboration for our First Nations populations and our communities. For example, for us in the north, north Island — we call it the north, north Island — how important it is for us to work with the First Nations Health Authority and with the First Nations communities themselves and start where they are, as a starting point, and then move from there and not assume that everybody’s at the same starting point.

Keva, I don’t know if you’d like to add anything operational to that.

K. Glynn: I would say…. Two things come to mind. One is that physician champions, in the connections and the relationships between physicians, have been absolutely critical, especially in the addictions medicine world.

The other is, I think, what Kathy was saying. It’s the social capital and the relationships with our municipalities and with B.C. Housing and with police, and so forth that have really helped us expand our services.

That’s where I would leave it.

N. Sharma (Chair): Okay. We’ll pass it over to Northern Health Authority.

C. Ulrich: I mean, this is our challenge in the North, what you’re describing. I would say it’s not just a regional challenge. It’s a provincial challenge, in terms of how resources are distributed in the province.

I think there’s a buildout from the local. I talked about the primary care. There is a lot of strength in what exists in a local community in terms of the relationships between service providers and primary care.

How do you build their capacity? To do that, you need, in the larger centres, where you have an ability to have in place some of the more specialized services…. You need those specialized services to understand their responsibility. It’s not just about serving Prince George or Fort St. John or Terrace. It’s about what they can also do to build out the capacity at the local level.

I think the other thing is about listening to the teams and the people, the peers, others, at the local level about what will work in their context. There are lots of regulatory barriers that prevent those solutions from being actioned. But I think if we listen to what those solutions are and then try to move forward, in terms of removing the barriers….That’s why a governance structure in the health authority is so important — to listen to what those barriers are and then work hard to try to remove them.

There’s a provincial obligation there as well.

N. Sharma (Chair): Okay. We’ll pass it along to the First Nations Health Authority.

R. Jock: I’ll make a couple of comments. Shannon may want to jump in.

I would say, first of all, that streamlining access points for treatment would be really important. I think that we have a complex system. The First Nations Health Authority operates 11 centres currently, which are largely cultural and social and healing in nature, with some mental health supports. Then there are other services offered by PHSA and Providence and other treatment programs offered by the health authorities. There are also private treatment programs, and then there are subsidized access to treatment programs.

When you’re an individual or a community trying to access this, it could take weeks. I think that we need to have some interim approaches for that but also look tactically at how to streamline this. I think it comes from a different time, alcohol and drugs. We’re now in a different environment, and time is of the essence.

[10:50 a.m.]

I would say the access issues…. I think those need to be built, and I think those include various aspects of transportation. Again, they’re going to be different for the toxic drug crisis. Then there are some regulatory and procedural elements that we’ve talked about that are real barriers. I think we need to look at creative, and sometimes more legislative or legal, solutions to those.

S. McDonald: Yeah. Just to add a couple of things. One is the need for skilled capacity at the community level. Communities have NNADAP or addictions workers in the community, but they are not highly skilled or highly trained. They are expected to provide the same service that highly qualified therapists may do in other places, so we need to support those folks, because we burn them out at a furious rate.

I just want to very briefly tell the story of the MOUHSS, and some of you may know about the MOUHSS. It is an RV in Campbell River. You’ve seen the film. An amazing group of people said: “No. We have to go to where people are, where the people who have needs are.” Part of that is substance use treatment specifically, but some of it is, “You need a warm sweater. You need a blanket. You haven’t had a meal today,” and developing those relationships. That has made an enormous difference to the unstably housed population in Campbell River.

S. Brown: I don’t disagree with anything that’s been said to date. Thinking about how we make this part of our system in a normalized way, I would agree that bringing this closer to primary care is essential, on top of all the specialized services we’ve got.

Just this week, we announced that we’re going to have a mental health and substance use network aligned with primary care under one leader. The leader who’s been leading our primary care over the last six years sees a lot of synergies between those files and how we get people working together on those aspects.

Then, just the one thing that got said this morning that’s really replaying in my head is Dr. McDonald’s account of drug dealers delivering and making that so easy for people to get to. Through the pandemic, through our vaccination strategies, we put mobile vax clinics out there. Sort of building on some of the ideas I’ve heard this morning, maybe there is something different that we should be thinking about there.

Dr. Pollock, if you want to speak to equity.

S. Pollock: Sure. Thank you.

Good morning, everybody. Just wanted to highlight some work that we’ve done in Interior Health, which is a chart review conducted for 2017 to 2019. This was 270 people who died from the toxic drug supply during that time period and had also accessed health care services within IH in the year before their death.

Some of the findings really highlighted the health in­equities of people who use substances. In particular, there are, of course, intersecting reasons: trauma; mental health diagnosis; pain, whether that be psychological or physiological; homelessness; unemployment or type of employment; and barriers to care. Those are things that we need to address on a population level, as a whole of society, whole of community, not just by Health but by multiple levels of government and by all of our communities.

P. Carey: Good morning, Madam Chair. I’m Paul Carey.

A couple of specifics around equity that I think we could certainly be exploring. Partnerships with local governments and how we continue to foster the development of services locally that are championed locally, I think is an ongoing and challenging issue but certainly something we need to work on.

From a prescriber perspective, we have recently de­veloped a community of practice for prescribers and potential prescribers that are distributed across the health authority. So that’s developing a conversation that, along with regulatory challenges — which we will get into a little later, I’m sure, in a bit more detail — I think will certainly reduce those barriers, particularly in our rural and remote communities.

[10:55 a.m.]

The launch of virtual addictions services from our larger centres to provide consultative services, both directly to patients as well as to prescribers, I think, is an essential way in which we can address some of the human resource challenges that are not going away anytime soon.

The partnerships with community pharmacies that are not under health authority control, so to speak, are both enlightening and encouraging in some centres and very challenging in others. Again, I think regulatory frameworks, the development of certain standardized protocols around how to support prescribers and distributors of regulated substances, will go a long way, in addition to the distribution networks that we might be able to set up to be more nimble to respond to needs on the ground.

Finally, the Suboxone to-go packages that we are rolling out across all our urgent and emergency care centres across the health authority that will be completed, I think, in the second or third quarter of this year, is a way to distribute that widely across the health authority. Again, not into very small communities, but certainly into all our acute care sites.

N. Sharma (Chair): I think we have to go on, because that was 15 minutes for one question. So we’re going to try to get as many questions in from members as we can.

P. Alexis: First question. One person can answer. How often do you get together and listen to each other and best practices and all of that? How often are you getting together?

A Voice: The health authorities?

P. Alexis: Yes, the health authorities. Somebody can just give one answer.

C. Ulrich: We typically have had two-day CEO meetings with the deputy minister. That has been interrupted due to COVID. That’s just getting restarted again.

During COVID, we were sometimes together every single day for various reasons. But that’s typically it — at least once a month for two days.

N. Sharma (Chair): Thank you. Does anybody have anything different to add?

S. Brown: I know that underneath the Ministry of Mental Health and Addictions, there’s a new group being developed that will allow the vice-presidents involved in this type of work to come together to speak exactly as we have today around what strategies you’re using, what’s working, how we spread out.

P. Alexis: Good. Thank you.

Am I allowed a second question because that one was so brief?

N. Sharma (Chair): Go ahead.

Oh, sorry.

S. McDonald: Really quickly. The Ministry of Mental Health and Addictions has a higher-level steering committee that meets monthly. Then there’s a more operational committee under that that works together as well. It’s not us, specifically, but there are representatives.

K. Gunn: Just to also say that that’s echoed throughout the system. The VP table is newly established. Then the executive director levels also meet. That’s really important because you move from the strategic — what it is that we’re trying to achieve — right down to how it is going at the core phase in terms of implementation.

N. Sharma (Chair): Got it. Understood.

Anybody else?

P. Alexis: Okay, I just have a question. You’re all different. Geographically, you’re serving different populations. So how are you different in trying to reduce stigma? You’re doing a lot of work on reducing stigma. The paper that you’ve released — I think there’s quite a bit. Can I just hear from each of you — very succinctly, if possible, because we’re short of time — about stigma. Does that make a difference as to where you are?

K. Glynn: I would say we have three approaches. One is with youth. We have a specific anti-stigma campaign that is youth focused and through youth social media platforms.

We have a second one that is targeted to men who use alone, and men specifically who work in construction. That’s a partnership with the Vancouver Island Construction Association.

Third, within our organization, we’ve developed a harm reduction policy, which I know other health authorities have as well, which is in the process of being approved.

That will, we anticipate, change the experience, or it’s intended to change the experience, of people who come to our sites, especially our acute care sites, with a substance use issue.

[11:00 a.m.]

J. Kim: I can start, and just ask for some additions. So in Northern Health, we work at different levels too. At the provider level, as we discussed, we are working on that trauma-informed kind of care. At the organizational level, there are stigma campaigns, videos and information and conversations started. At the community level, it’s important work at the stigma or stress like that existing at the community level.

We’ve been mainly working, supporting inclusion of people with lived experience in that community table and decisions and planning. Now having more people with lived experience, including the community table…. As you heard, we are supporting that. That inclusion is a meaningful inclusion, leading to some changes and differences.

K. Gunn: I’ll just add something about the way we can all be different in our everyday life, because I think most of us, in our circle, have been touched by addictions in some way. One of the things is really recognizing the import of the relationship between a primary care provider and a person. I recognize not everybody is attached, so there’s a different strategy for those that are not attached.

Doing a universal, through conversation, assessment and screening, to Dr. Allison’s point, that takes the lens of what happened to you…. There might be nothing. But you might find that a person is dealing with chronic pain. You might find, if you did what’s called an ACE assessment — an early adverse events in childhood assessment — that there’s been early trauma, etc.

It allows you to continue a conversation with the person and be ready for that time when they might be able to disclose that these are the things that are going on for them, because they most certainly are at heightened risk. You create a confidence and a comfort and trust in the relationship by doing that, and I mean with everybody. Every patient gets asked the same questions.

The other thing is, and I had the opportunity to talk to MLA Bond about this on a different occasion, just as an everyday citizen, we know people are overdosing all the time. You can go to your pharmacy and pick up a naloxone kit — and I confirmed that, MLA Bond — just as a citizen, to recognize that this could happen to anybody. This is something that we’re all responsible for, the well-being of our neighbours and our community members. I think really making an emphasis on the everyday things that we can do differently today is something that’s different. It’s a little bit outside of our traditional anti-stigma campaigns. Both are important.

S. McDonald: At a community level, when we did naloxone training — I’ve poked a lot of oranges over the last couple of years — we gave out stickers that people could put on their doors that said: “I have naloxone, and I know how to use it.” I keep giving mine away. People ask; they get a naloxone kit.

Our communications team has actually won an international award on…. I don’t know if you’ve seen the posters that are on bus stops and things. But from a cultural safety and humility point of view, the connection between Indigenous people and addictions is so ingrained in the minds of our population that this is something that we really work on all the time.

Many of our complaints that come in are associated with assumptions about substance use when people present in emergency rooms. We’re working very, very hard, and our team has been working with the Canadian Standards Association on standards of practice in cultural safety, humility and anti-racism at the cold front, because that’s going to make a big difference.

N. Sharma (Chair): Okay. Thank you.

Go ahead, Interior.

S. Pollock: Great. Thank you. We did highlight some of the mechanisms we have in Interior Health to address stigma. In particular, we have the toolkit that is available and includes resources, videos and shared stories. We do have a harm reduction policy, health authority–wide, that is working its way up to senior leadership for approval. That will be specific for staff and providers.

I wanted to note — it’s not on the slide — that we also have funding for two and a little bit youth harm reduction coordinators who will be working with our school districts and our schools. Part of what they’ll do is to help address stigma in the earlier age groups.

[11:05 a.m.]

P. Alexis: Thank you so much. Really interesting.

R. Leonard: I have so many questions. I don’t know how to quite gather them all in, to corral them. I’m thinking, with all of you sitting here, that every health authority has its own personality. You have different issues around geography, communities, all of the things that you guys are individually addressing, but there’s this common thread about how you are approaching it.

We’ve heard what you do, and we know what the numbers are. So there’s a bit of a disconnect in my mind between what sounds like real successes, but on the ground, there are still some challenges. I’m hearing very specifically…. I want to congratulate the First Nations Health Authority for really honing in on what some of the solutions are.

I guess the overarching question is around how we overcome the health human resource issue, because that does seem to be a common theme, and how we address the other resources that are needed. I heard some solutions, like day programs. If you don’t have the residential treatment programs…. I’m curious about that piece of it and what you see as some of the solutions to get us to move forward in a more successful way.

N. Sharma (Chair): Maybe we’ll go this way this time.

Go ahead, Interior Health.

S. Brown: Maybe I’ll start. Much like other people, some of the people that are passing away are people who don’t want others to know they’re using. So they’re using alone, using in their private residence, which I think Island Health identified.

Making it appropriate that people can come forward, that they know their information will be held private — there are a number of ways that we’re endeavouring to do that. If somebody is going to use in their private residence — that there is an on-call type of service that can support them in that. Then those that want to do withdrawal — supporting them. We’ve got an on-call service and virtual addiction medicine available that can allow them to do withdrawal management within their own home versus coming in to a facility. So making it so that people feel their privacy is maintained throughout all of this will be critical, I think.

Employers in other areas outside of health need to understand the stigma that comes with that and what that means for their work and things. I think engaging other industries into what is maybe quite commonly understood in health now, which is less commonly understood in other places….

Paul, I don’t know if you want to add a bit.

P. Carey: I have a couple of comments. I think, most compellingly, although we’ve seen increases in substance use disorders over the last number of years, we would not be sitting here if the drug supply wasn’t as toxic as it is, I would hazard a guess. So the issue is not just the broad challenges of substance use in the context of mental health challenges, but it’s the toxicity.

These evidence-based efforts that we’re putting in place work for sure. There’s no question about it. There is good evidence for almost everything you’ve heard today, but it’s not turning the tide because of the toxicity issues. That’s the challenge. How do we, as a society, deal with that issue?

Human resource. The Portuguese experience in decriminalization, and so on, with which most of the folk here will be familiar, is helpful and informative in some ways, but it was a different issue. We’re going to have to be bold about how we think about decriminalization. Even the use of the word “illicit” in this context is continuing to stigmatize these issues. So we all have a responsibility to do that.

Prescribers. Speaking as a prescriber, we are so embedded in a regulatory system that continues to create the framework from which I practise as a physician, and the evidence base is massive for the role we’ve played in creating opioid use disorder, so to speak. That burden wears very heavily on physicians.

[11:10 a.m.]

With that in mind, I personally do not think that it continues to be acceptable for our regulatory colleges to be sympathetic and understanding of the needs. We need to stand firmly alongside government and other agencies, community partners, to say: “We need to do better.”

Physicians, nurse prescribers, nurse practitioners don’t feel supported to be able to respond, which is what creates some of this moral dilemma that we heard about earlier. We’ve raised this issue a number of times with the colleges, pharmacy, nurses, physicians, the ministry. These are challenging issues. There’s no question. But short of those changes and short of a framework that enables prescribers to do what they’ve been asked to do, it’s not going to move the needle particularly substantially on this.

As far as the HR issue…. I think you raised that. I think that by making some of these changes, you will access human resources that are already in the system to work more effectively. Unquestionably, we are very much under-resourced, but I’m not sure that the framework has enabled us to use the existing human resources adequately to address this issue.

R. Jock: I would say that looking at ways to engage a different group of potential players would be an important way to look at some of the HR capacity. I would say that there are some interesting detox innovations. As a good example of where…. Potentially, not relying solely on a medical model associated with a hospital has some merit, and there have been some interesting mobile approaches to those that I think are similarly important — and, as well, social detox for certain types of individuals.

I would think that looking at how those models could be expanded and more exposed would be really important. I think the MOST program is an example of an innovative approach for providing services. I think, similarly, we would benefit from a look at aftercare. Some of the evolution with respect to virtual care may be really helpful — but looking at a different set of individuals that can be part of aftercare solutions.

I guess I would just say that…. I don’t want to say conference, but some knowledge exchange avenues, so that these kinds of models can be more widely exposed and then possibly emulated would be really important. Then, I think, taking advantage of other folks like B.C. Housing for some of the infrastructure needs and possibilities would be interesting, going forward. Just a couple of thoughts.

I do think that there’s some innovation out there. I think, as we’ve seen from today, we’re not all aware of all of our own developments, and it would be really good to put a focus on that.

C. Ulrich: I agree with what the speakers before me have said. The things that I would add are on the HHR issues. Some of this work has a pretty significant administrative burden, and if we could lighten that load, it would release time to care. I think expanding those that are involved in this work, including paraprofessionals, with the appropriate supports….

Then, virtual care. I think we’ve come a long way on those potential solutions, and I think they can be expanded. Mobile services is another approach, and we’ve used that quite extensively in the northwest with good success. I absolutely agree with Richard on collaboration. I think that the partnerships with others is how you extend what each of us has — the sum being greater than the parts.

K. MacNeil: I think our colleagues have pretty much covered all the topics.

[11:15 a.m.]

One thing I did want to contribute, I think, from this survey that we conducted of people who use…. First of all, this is not a health issue from their perspective. They do not believe accessing the health system is the door for them. What they did comment on was 44 percent said they would access community-based counselling. That’s not covered, right now, by our medical coverage.

Even in the health system, our employees have a maximum of $500 of counselling services per year. To the point others have made, broadening the circle of who might be part of the team may be quite timely at this point in time.

I just want to echo a point Richard made. We need to make it simple. There are so many doors, sometimes, that people can go through when they’re ready that it gets very complicated. That energy actually diverts from the energy they need to actually walk through.

Finally, I’ll just say…. I think Dr. Carey said it very well. There’s a lot of risk to disclose that you use. There are risks to disclose to your employer that you use. Despite the efforts that we’re making around stigma reduction, accessing services where people work, where they’re close to work, it’s still pretty scary to admit that you use a substance and go to work every day.

S. McDonald: We have more women affected than anybody else. One of the biggest fears that women have if they access care is that child and family services are going to come knocking at the door. We need to find ways to support those moms so that they don’t lose their kids, but they still get the care they need.

N. Sharma (Chair): Thank you for that.

Next up is MLA Chant.

S. Chant: How many questions am I allowed?

N. Sharma (Chair): If you have a big one, just do one.

S. Chant: Mine are very big.

My first one is…. One thing I haven’t heard from anybody, so I’m hoping it’s not an issue, is connectivity. I hear about virtual programs. I hear about various things that we’re doing. However, I also am aware that in the community I normally work with — I’m a community nurse by trade — a lot of the seniors, for instance, maybe don’t even use a lot of this stuff.

The regional issues…. Connectivity has been an issue in other realms. I’m just wondering, here, what degree it is.

That’s my first. My second is directed to Richard. Can I get you to expand a little bit on trauma? You said something that caught my attention: trauma-based versus trauma-informed. I’d really like to hear that piece. It’s new to me, and I’d like to explore it a bit.

N. Sharma (Chair): Connectivity. Does anybody want to talk about…?

Okay, go ahead, Interior Health.

S. Brown: We partnered with Telus extensively to get probably about nine communities within the Interior. I think that went the whole way out to Northern Health, where additional communities got connected. Typically, this has really helped the health centres within the First Nations communities be connected, but that broadband does not go to individual homes in the First Nations communities.

There are some other communities outside of First Nations communities that are exceptionally rural, and there are health authorities that still are not connected. We’re continuing to work with Telus on some other highways, like Highway 8, which goes out through Lytton, etc., on assisting with broadband there.

However, in saying that, what some of the work we’ve been doing…. Most children do have access to cell phones, smartphones, of some description. We also have partnered with Telus so that if there are communities where children don’t, they can do much reduced fees on supporting that if children need it. They can then look at apps and different things to assist with mental health and also substance use. There are some apps out there that counselling can be done through.

Exploring that as a health system and partnering with those individuals that have those apps will be important, if they’re good solutions for children.

S. Chant: For children.

S. Brown: And adults. I think the paramedics actually use this as well. They’ve done a bit of a pilot.

N. Sharma (Chair): Any comments on connectivity?

Go ahead, Richard. We have a second question too.

[11:20 a.m.]

R. Jock: I would say, without a doubt, First Nations people still have connectivity issues. I would think that this will be either a major impediment or an opportunity to sort of leapfrog forward. I would say connectivity is an issue.

I would say connectivity is an issue, and I would say it’s not isolated to isolated communities. Some of the folks in the urban context also do not have real access. Part of what we had done throughout early parts of the pandemic was to make laptops and iPads available and also to make sure that Elders were able to have access to iPads through the health centres. I would say that those are pretty well interim, stopgap measures and that access is something we really need to focus on. I just wanted to comment on that and to say that I think it’s a real opportunity to go further faster.

If I could, then, talk about the trauma-based services. One of the things that was really striking coming out of Kamloops and also other communities like Penelakut — I don’t know if you’ve seen the recent podcast on that — is that entire populations really suffer from all of those collective historic traumas. So part of what our thinking has been is: how do we really say that people need to have trauma-based services as a core service?

Part of what we have looked at is a healing lodge or a healing modalities model. The other part of addictions, frankly, is that people tend to suffer multiple traumas. That’s why I would say that looking at developing these new models and accentuating some of our current ones is part of our path forward. It really will take looking at it from a collective point of view but also reorganizing what we’re doing into a trauma-based model.

For example, we have on-the-land treatment. This could be very naturally part of an overall trauma program and really help people, at the same time, address some of the cultural aspects that are also part of trauma. Part of what has been systematically attacked has been cultural and language knowledge, and these are ways and means of addressing some of those.

Also, each nation has kind of a different set of interests. Some of those may be related to on-the-land food collection, but others might be related to horse culture and other elements. So that’s why looking at nation-based models that are unique and developed within each nation is part of how we’re seeking to approach this.

I would say this is going to take a lot of push with both the provincial government, which is exploring that with us, but also the federal government. A lot of what we see is…. When there’s a crisis, people rush in, and they provide interim resources on a short term. That clearly doesn’t work and, in some cases, creates additional trauma.

The other aspect, I would say, is that COVID has been a source of trauma. People have not been able to grieve in their cultural practices or community practices. This is leading to accumulated trauma. That’s why I, and almost everybody I’ve talked to, really fundamentally believe that having a program based on those forms of trauma and cultural ways to address it is really the path forward.

K. Gunn: I wonder if I could just speak to the connectivity issue in two regards.

One is that with the advent of launching satellites, etc., connectivity is really improving across the world. There still, certainly, are issues. What we do find, through our virtual clinic, and we’ve seen in excess of 106,000 people through our clinics since COVID started, is that we are reaching our really rural communities. We track, on a daily basis, where the calls are coming from.

[11:25 a.m.]

Also, in terms of seniors, seniors are accessing the virtual services. So a really strong percentage of people ages 59 to 69. I hope I don’t offend anybody when I say that. So that’s one piece about connectivity.

Another piece, though, around enabling care, which I really would like to stress, is around the use of technology — in particular, electronic medical records that speak to one another and allow for information-sharing. To deal with a complexity issue and how complex our systems are, it is really important that, through the care continuum, we have an ability to follow people and know where they are in their care journey, that we don’t disrupt care and that we use that information to coordinate care and make sure that care is sustained right through, ideally, to recovery. The last thing related to that is the technology, and having those electronic medical records speak to one another is a critical component.

Then there’s the legislation, FOIPPA for health authorities, PIPA for private physicians. I believe FNHA is under PIPA as well. It’s hard to get to the root of whether or not the legislation really does prohibit information-sharing. Some will say that it doesn’t, but there are specific instruments that one must use to protect privacy and appropriately share information for the purposes of delivering care. Regardless as to whether or not that legislation is enabling or not, it is inordinately complex, and it does prevent us from using technology in a way that is really optimal and really does simplify the care journey for people and make sure that they get good care.

M. Starchuk: Thank you for your presentations. I still will not get out of my head, for the rest of the session: “They deliver.” That will never leave my head.

Dr. Carey, I like the fact that you bring up the Portugal model and how it applies. So many times we hear about it, and they say: “Just follow that model.” They don’t take into consideration, sometimes, the incarceration part of it and stuff like that and why it was developed. Your other comment was that it’s going to take a bold change to be able to do it.

Dr. Allison, you said something at the beginning about…. It’s going to be a significant cultural challenge as well. With that in mind, one of my nuances is around recovery coaching and how it seems to be well received in certain parts of the world, specifically the northeast of the U.S., where it’s embedded in emergency wards.

It was Keva…. You just struck my interest instantaneously when you talked about the youth program that’s there, I believe, in Interior Health. You kind of had a concierge system that was inside of there. I really think that the concierge system really works so that you’re not re-explaining to the next person why you’re here and furthering the stigma that goes around it. “Now I have to tell another person why I’m here.”

I’d like to hear from whoever’s here, if you have that concierge service, as I know that you do with youth, how successful that is. The little-known fact is…. On my SkyTrain train in here today, I talked to a person for a whole hour about this exact same thing and how their daughter didn’t have the concierge service. Every single step of the way, she had to retell her story, and it just furthered that whole stigma.

N. Sharma (Chair): Who wants to respond to this? I’m not sure if every health authority does.

Concierge service. Go ahead, Keva.

K. Glynn: I like the term. I’ll start there.

I’ll speak a bit more about the youth program. It’s new. It’s as of the fall of last year. We are evaluating it, but I don’t have data to share with you right now. What I can say is that the connection with youth and then their families or whoever they’re identifying as family has made a really significant difference in terms of their experience in the emergency department and then their experience when they’re going back to community.

It has also helped us rethink and re-imagine how our partnerships work across the Ministry of Children and Family Development and their crisis teams. We are bringing together the MCFD crisis teams with our Y-STAR teams so that we can have a seamless connection and so that that story doesn’t have to be retold time and again.

[11:30 a.m.]

The other connection that is being made differently, as well, is with our Foundries. We have two on the Island right now, and soon we’ll have two more. It’s with the Foundries as well. They are connected with MCFD, with our Y-STAR team and then with the emergency department so that there is more of a seamless loop. In our experience, anyway, on the Island, it’s the Foundries that have a lot of the credibility with youth, with families and with their parents and residents. So that’s where I’d start.

K. Gunn: In the North, to echo some of what Keva has said, in part, I’ll talk about two ways that we do this.

Using our virtual primary and community care clinic, if a child, or somebody from a Foundry who has a child in front of them, calls in for service, the virtual clinic does a few things. They take that history, either from the child or youth themselves or from the referring agency. They provide any direct care that’s needed.

Then they spend a lot of time care coordinating, understanding: what community does that child come from? What are the assets in that community? Are those assets palatable and acceptable to the child, etc.? Is the family involved? Those sorts of things.

We also connect with the Foundries. We have them in Prince George, Terrace, Burns Lake and one emerging in the northeast.

The other thing — I think it’s a universal experience across this province: we’re seeing an extraordinary number of presentations, in our EDs, of young people. That has required some unique solutions, and this is where partnership also really comes into play.

I’ll use the northeast as an example. We’ve talked a lot, in our presentation, about the importance of the primary care home. That’s a physician’s or nurse practitioner’s office. Those primary care homes are supported by a group of interprofessionals that can respond to a lot of non-medical concerns that the child might have. That is really important.

It wasn’t enough, however, in the northeast, so we established, through partnerships, clarity on our relationship with MCFD. I’ll just stress that MCFD, the Ministry of Children and Family Development, delivers child mental health services. That falls outside of the jurisdiction of health authorities. Then the health authorities come to the table with the more clinical substance use–type supports, etc.

We did an analysis of what MCFD can do in the presence of scare resources, what the health authority can do in the presence of scare resources and what other assets we have available to us. One, in Fort St. John, was to contract with a youth provider called Pickles and Honey. I know; it makes me smile every time I say it.

That group of providers just adds strength to the team. They do two things: they provide direct service provision for those kids, youth and families, and they also build capacity in our own providers. They teach what they know, and it’s that collective, mutually reinforcing contribution to the child’s care that makes the difference. Similarly, in Dawson Creek, we engaged a company called Harvest. It’s the same model there.

I really appreciate your question and how it struck you that we really need to get upstream here, really understand what creates healthy pregnancies for people and what creates a really good, healthy start in the perinatal period of time. How do we strengthen families? You’ll probably see, if you ever go out for dinner, that families are all on their phones. There’s a disconnection in parenting, etc. How do we not shame people for that but just draw attention to it and develop strategies that cause an awareness and, perhaps, different behaviours, etc.?

There was a question — I’m sorry for stealing the microphone — about the gap between what we’re doing, what we’ve all described here today, and actually what we’re seeing in outcomes for people. I just wanted to stress that this is a multisectoral problem. I’ve described, in detail, the health response to that problem, but it is a societal problem, and it’s also a societal opportunity.

That means, really, working with those that have their hands on the levers for the social determinants of health, those that are responsible for education and creating safe learning spaces, early literacy programs, physical literacy, the parenting classes, affordable housing — those sorts of things. It’s the constellation of all of those things that contribute to the problem.

[11:35 a.m.]

I share your concern that we’re all talking about very good work. It isn’t enough, because it isn’t enough. It’s not just the health response; it has to be multisectoral.

S. Bond (Deputy Chair): I’m actually struggling to find a way to frame this question, because we’ve been all around the issues. For weeks now, we’ve listened to the core issues over and over again. We are six years into a crisis, and as we speak, six people a day continue to die in our province.

I find, as I listen to you talk with one another as much as with us, in terms of you learning and sharing experiences with each other, the fact that there is a table somewhere where people talk to each other and that there are certain level tables and this group is now being started with Mental Health and Addictions…. This is a provincial problem. And while each of our regions are different, the issue is the same. We’ve listened to the statistics over and over again about who’s dying, why they’re dying. We’ve seen geographic disparity.

My concern is this: we finally get this committee up and running, but where are we identifying to government what the gaps are? There are gaps. When I listen to the First Nations Health Authority say to me and us that they still don’t have access to electronic health records…. There are regulatory burdens, yet, First Nations people are dying at 5.4 times the rate of other British Columbians. Something is not working here.

Perhaps someone can tell me how we are identifying gaps. We hear that we need more recovery beds. We need detox beds. Drug testing is not available everywhere in British Columbia. Yesterday we heard: “Well, machines cost money.” Well, yes, they do, but people are dying. We hear that affordable housing matters.

So where is the interconnection — first of all, between all of you? It is inspiring to hear what you are doing. But we’ve just come through a pandemic where, as Cathy said…. And I am very lucky. I have a health authority that I get to talk to and respond, and I appreciate that. But Cathy said that you met virtually every day on COVID. We can’t get a briefing in between death reports that come out once a month.

Please explain to us. Where are the venues where you share ideas, identify the specific gaps and the needs, from a provincial perspective, and pass them up?

S. Brown: The one thing…. Not to respond to your last question, but this has not been the same over the last six years. This is an evolving challenge, where it feels like we’re chasing some of the issues that were brought before us.

Of course, a few years ago needles and how to support people who were injecting drugs was one of the main things that we were trying to do. Now, of course, that’s shifted to inhalation. I think who’s using has changed, and some of the dynamics that happen provincially, I think, have created a worse burden on the population.

We’ve talked about COVID. What we haven’t talked about is wildfire activity, flooding and different things, where I heard others talk about how people become isolated and disconnected has further caused the issue. All of those things, provincially, have further created disconnection for people who have been relocated out of their community.

[11:40 a.m.]

For Lytton, it’s permanently right now until that community’s rebuilt. In the Interior, we have seen displacement of not only residents in communities for months at a time but also for our own staff. That causes stress and burden — on families, staff, everybody — that is beyond what we may have seen six or seven years ago.

I think that we’re hopefully getting to more of a state where we can be predictive now, because the wildfire activity…. We’re getting things in place that will support better, but some of those dynamics, I think, have made it very, very challenging for teams to identify gaps that didn’t exist maybe just even two years prior to that.

S. McDonald: The sense of urgency around the deaths due to illicit drugs is not universal. The sense of urgency around COVID was universal. Every single person in the province felt at risk. Something could happen to them that they had limited control over. “What are you going to do to decrease that risk to me?”

There is a sense of othering among drug users that we do not acknowledge. The media does this every time, and it drives me nuts. When they talk about overdose, they always show a Downtown Eastside alley, somebody down on the ground with the mighty paramedic standing over them. People don’t see themselves in that, and they are always, consistently, surprised when the suburban — sorry — white kid who’s a jock dies of an overdose. How did that happen? What are you doing about it?

Well, we’ve been trying to do something about it consistently, but because of who has been dying — men, Indigenous people, people in poverty, homeless people, the person that you pass by on the street and don’t want to make eye contact with on your way to lunch…. Because people don’t identify themselves at risk, they’re not as politically excited to make something of it.

COVID — top, front, centre. Throw money at it. Do it. Fix it. We have not seen that in the last six years about this. Despite some really committed, very intelligent, passionate people doing this work, it’s not enough, and those gaps that we’ve talked about are front and centre and not changing.

N. Sharma (Chair): Okay?

S. McDonald: Okay. No more soapboxing.

S. Bond (Deputy Chair): It needed to be said.

C. Ulrich: I think Shannon said that really well.

Just a couple of things I might add. I think the comment earlier about the toxicity of the drug supply has had an impact. We were on a journey. We were taking action. We were successful in making some changes, and then the toxicity really made us have to rethink how we’ve been approaching that. So I’ll make that comment.

Secondly — I think you made this comment in one of the other sessions, Shirley — it’s about bringing the public along with us. I do think that’s really important.

I won’t give you an indication of which community, but we have, for the last two years, had monthly, sometimes weekly, discussions about COVID with local government, and we’ve always talked about this crisis at the same time that we’ve talked about COVID. In a sidebar, with one of the communities, the comment was: “We’re not sure we want you to add more mental health and addiction services to our community, because it will attract a problem to our community.”

So we have work to do in terms of the public’s understanding of this issue and the complexity of the issue and the different kinds of approaches that we’re trying to implement. Sometimes those approaches are seen as bad things, wrong things to do in a community. They’re uncomfortable for people to see. I think we…. It’s more of an education. We have to engage people’s hearts and minds in what the issue is and how we have to work collectively to resolve it.

[11:45 a.m.]

In terms of gaps, I’ll just speak personally. I do have — and I think everybody does, all the CEOs — a monthly meeting with the deputy of the Ministry of Mental Health and Addictions, and I do raise the gaps with her whenever I am talking with her. She’s been receptive to that. I do think that there’s an opportunity with the ministry and their impact on other ministries and the ability to bring things together collectively, so I’m hopeful in that regard.

S. Allison: Thank you very much, MLA Bond, for the question. I really appreciate it.

I really want to echo Shannon’s comment. The idea that we shift society and that culture is that they have to see themselves in it. Until it’s impacted them, because it’s so close to their family…. Several of your members have mentioned that it has impacted their families. Then it becomes real to them. I mentioned in my comments that people are very comfortable to compare their COVID stories, but we do not talk about the opioid impacts to our families. That’s the culture we have to change in our communities.

The communities that I serve echo what Cathy said: “Please put those services somewhere else, and we’ll take the people back when they’re better.”

K. Glynn: I wanted to respond to what Susan said or to add that the crisis, I think, has shifted over time. As we began, the focus has been on addressing the underserved and the most marginalized, and the funding envelopes and tactics from the ministry reflect that. So what we see, at least within our health authority, is that there are some very highly resourced or large funding envelopes for initiatives that don’t have much uptake because — well, for a range of reasons. But injectable OAT, for example, and tablet iOAT has struggled, I think, across the province, really, in terms of uptake.

As we look at the populations that are most at risk — and to Shannon’s point about suburban white kids and others, men who are employed — I think we have an opportunity to shift some of our funding to support in a different way. Cathy made the point about counselling and access to counselling. That is the number one issue that we found, through our surveys, that people need. So could we have a bit more flexibility around how those funding lines are spent, from the ministry?

D. Davies: So many questions, just not enough time. Hearing so many of these stories just reaffirms, obviously, the gaps. Coming from a small, northern community, struggling with access to detox, the supports, the networks that are required, one thing I hear constantly is: “It’s a complex system to work through.” I think it was Interior Health that has a 310 number. Hopefully it’s a point, and I think that’s a good start.

I have a lot of questions, but I am just going to ask a simple one, and it is of Interior Health, on your prevention program that you touched on very lightly. Obviously, we have the issue at hand, but I really think we cannot lose focus on the prevention, the youth, trying to get in front of this while we obviously need to work on this.

Could you just take a minute? You just scooted over it. I’d like to hear a little bit more about that program that you have with the youth and what you’re doing to engage to get those results.

S. Brown: Unfortunately, I scooted over a lot.

P. Carey: I’m not directly involved in the program, but I can certainly tell you that the partnership with the local school districts has been phenomenal. It’s an evidence-based program that has been developed nationally and really takes the opportunity in the schools, at a young age — so the 12-, 13-, 14-year-old grade 8s, typically; some grade 9s in some schools — and runs screening questionnaires for particular personality dynamics and potential risky behaviours and identifies children who are then interested in participating. There’s a consent process that happens.

It’s a group-based intervention that develops a conversation with young people, so it’s destigmatizing. It’s safe. It’s confidential. It’s connected with school counsellors. It gives opportunities for further service access.

[11:50 a.m.]

Certainly, the feedback we get is that the safety that’s created within learning spaces to have these conversations is profoundly helpful. The outcomes really do speak for themselves.

We have presented this work at the provincial mental health and substance use working group, and there is certainly receptiveness around the region, the province, to continue to grow this. So we could certainly continue to move that forward provincially.

D. Davies: With that said, just a quick follow-up. Could you share the information that you have on that program specifically with us?

P. Carey: Absolutely. I’ll speak to our lead on this and get back to you.

N. Sharma (Chair): Okay. I have a question. It just has been really interesting, hearing about the work that you’re doing but also the gaps that you’re all seeing and the commonalities that I hear but also the differences. It really strikes me that you are people with your teams that have been struck by a pandemic and an opioid crisis and really been looking at how to solve this issue for the communities that you serve on the ground, and I just wanted to acknowledge that challenging time that you’ve all been through and the work that you’ve had to do in the last two years.

What we’re learning a lot about is the intensity of the toxicity of the drugs that are on the street right now and these kinds of devastating graphs that show the spike that’s happened over the last two years. We talked about the connections that were disrupted, the toxicity and the different ways people are…. They’re inhaling now, and they weren’t before, and that’s causing all these increases in deaths.

I really, really want to dig deeper into this space of harm reduction and getting people to the services that they need to get to. I know that that’s mixed in with prescribers and non-prescribers and regulated and not regulated and what the success stories are when it comes to separating people from the toxic drug supply that you see on the ground.

I know that’s a big question, but I really feel like that’s where we’re focused on in terms of the deaths that we’re seeing and the toll that we’re having. So if each health authority could say: what are the best practices or pilots that you’ve seen that have worked just to meet the toxicity, and what are the challenges there? We mentioned some with the College of Physicians and the issues with getting the different types that we need. I’d love to dig deeper into that a little bit more.

I actually had one small, specific question. Please, Interior Health, if you could add this. One of the things that we’re learning a lot about is this connection between people seeking medical treatment the year before they may have died and that kind of interface being super critical to figuring out how we get supports.

I thought it was really interesting that you have a program — or maybe others do, but the one that I heard that actually gets people, when they’re in emergency, connected with harm reduction. I don’t know if that’s happening anywhere else, but I think we’ve learned that that seems to be important. Is that actually resulting in a decrease in deaths? I think it was Vernon that you mentioned, in that area. Is that data there?

So maybe that’s the area I’d like to explore. If you want to start, go ahead.

S. Brown: We’ve got Suboxone, which is a to-go pack. It’s for 72 hours, and 20 of our emergency departments enrol in that to ensure they’re all covered. We’ve got 114 people that have taken those packs and have stayed with the referral that they’ve had to the broader system, which is good news. Broadening that and making sure that’s available is a key piece.

I don’t know, Paul, if you want to speak to the piece where I was talking about, where MLA Bond spoke about the gaps. The toxicity piece that you mentioned is so important because it’s changing. It evolves. So that’s what I mean. We’re chasing the toxicity piece because it keeps changing. I don’t know if you want to speak to any of that.

P. Carey: I think when it comes to harm reduction, the provincial data is pretty clear that harm reduction services are not yet being prescribed to the majority of people who have diagnosable opioid use disorders. There are a variety of complex reasons. Many of them don’t see themselves in that category. So I don’t think 100 percent is necessarily the goal.

[11:55 a.m.]

Of the harm reduction services that are being provided, the challenge with chasing this proverbial increasing toxicity dragon, so to speak, is that the OAT — and I’m sure you’ve heard this before — that we currently have really isn’t meeting the treatment needs for people. The standardized, protocol-driven treatment models are really no longer sufficient to meet those tolerance needs for many — not all, but many — users.

The ED piece that we’re doing around the Suboxone induction does a couple of things. Firstly, it’s highlighting for front-line folks in our emergency departments that something can be done, and that produces some hope. The other thing is that it’s only for three days. We drive the downstream services to be providing those connections. We have in-reach clinicians who make those telephone follow-ups and make sure that they’re connected with services for ongoing prescription within 72 hours.

Those are things that are important. In terms of access to harm reduction, I think it’s pretty clear across the health authorities that that has increased significantly over the five years of the emergency. There’s certainly a long way to go.

D. Shendruk: I’m going to add something. I would just like to add…. I think that as important as having a single door of access is, our processes are equally as important. We are very strongly trying to roll out a process where people accessing emergency departments have a standardized screening process where we can provide brief intervention to treatment and referral. With that standardized process, it becomes much more normalized for people to be able to access the treatment that they require.

I think it is equally as important that our processes do become standardized no matter what door you access, so that that ease to having that brief intervention…. It even goes further, to screen for those signs or behaviours where somebody may not be disclosing that they have a substance use disorder. But you can actually assess that and do your very best to link people in a timely way.

R. Jock: If I can just make a couple of comments, and then I’ll invite Shannon.

Just a couple of things. One is that although the crisis is changing, one of the things I wanted to reflect on is that we were making progress before COVID. We had reduced to about 50 percent. I think it’s important to reflect on that.

The other part is that I would say that, through COVID, one of the things we’re seeing with First Nations communities and particular individuals is that there’s a growing reluctance to access the services. Some of it relates to thoughts and perceptions about racism. But it is a factor. One of the things that I would also observe is that one of the areas where we see a lot of complaints is about the perceptions of people in the emergency rooms who are thought to be using alcohol or drugs. I use the word “thought” for a reason, because many times, that is actually not an accurate perception.

I would say that having somebody in the emergency room, and then a diagnosis…. I would say it may be missing part of the issues. There are folks who are escorted out of emergency rooms but are also, again, thought to be using, which generates sort of a wrong response.

The other thing I just want to say is that we see a number of communities calling for a state of emergency with regards to their own drug crisis. I would say we — I include FNHA in this — don’t have a standard response and a way to help them to figure out what they do with that.

[12:00 p.m.]

I would think there are two elements I just wanted to reflect on. There are some that say we have a problem, but I would say there’s not a playbook or whatever to support communities in a systematic way. I would say that that’s something that we should think about in terms of a standard way of responding and not leaving it. I think part of how we respond effectively is access to data. But I’ll turn to Shannon.

S. McDonald: So I took some risks — I’ve been known to do that — early on in the discussion with people with lived and living experience; in the discussion around safe supply, illicit or non-illicit or prescribed or non-prescribed; and spent some time with individuals who had created compassion clubs. They were adamant that they had expensive testing equipment equivalent to or better than what was available locally. They had what they considered a safe supply. They were still getting heroin when nobody else could get heroin. It was coming in. They were testing it. They were distributing it to their members, and they were monitoring the response.

They got busted, right? And they lost their machine. They lost their ability to do that, and a significant portion of the people they were serving with their compassion club have died. It’s tragic. They had the opportunity to be engaged with us in how we move forward on this work, and we lost that opportunity with that particular group. I didn’t meet everyone, obviously. I did go and speak to some of the people with lived and living experience in social situations. But I didn’t have a way forward for them, and I think that that’s something we need to talk about more.

The users are the people that know. There’s a humility involved here. I’m a physician. I’m a public health physician, but I don’t know. I’m not even a big drinker. This kind of stuff doesn’t happen. I smoked when I was a kid. So I don’t have that life experience, and the only way I’m going to get that information about how to support people is to ask.

C. Ulrich: I was going to say that that engagement with peers, I think, is a really important part of understanding how to protect people and help them make decisions that will ensure that they live.

Just on the emergency departments, I think Richard is absolutely right. It is one of the places where we need to focus in terms of the In Plain Sight recommendations. It is our priority in the north. Dr. Patrick Rowe, who’s our medical lead for emergency and trauma services, and his counterpart are doing a lot of work in that space. If there’s any place where we need to work on cultural safety and anti-racism, it’s in the emergency department.

I think, also, what we’ve tried to do in the north is put, in our emergency departments, mental health and substance use nurses, so that they’re situated there and can support the team in the emergency department in their response to people who need support. I know that that happens in many places around the province. But Kelly probably has some other things that you want to add in terms of harm reduction.

K. Gunn: Thanks again. I think I’ll just take this in three pieces. We know from the panel review findings that people who died had had recent contact with the health system. At the risk of harping on this, we really do need to normalize these conversations in primary care. When you go to a primary care provider, you should be screened, assessed and be able to engage in a conversation about a concern just as you would for any other health concern. Really normalizing that is key, I think, to really creating a safe space where people can access harm reduction supplies and potentially even move towards treatment, if there’s a readiness there.

[12:05 p.m.]

Then the other thing is…. I, too, was struck by Dr. McDonald’s comment about just how available the toxic drug supply is for people. We need to make the availability of OAT and other harm reduction manoeuvres equally if not more available for people so that it’s the easy choice.

Prescribed safer supply, notwithstanding the moral and ethical concerns that it can cause for people, is an important harm reduction manoeuvre to keep people separated from that toxic supply until such time as a relationship can be developed, some trust, some knowledge about what next steps might look like for that person, and then readiness, perhaps, to move into the treatment space and, hopefully, also to recovery.

One of the things that I wonder about is who else has used prescribed safer supply. Where is that data? What is the effect of using this particular harm reduction manoeuvre? I think that it is really important that alongside everything that we’ve talked about in terms of rising to the occasion of this terrible health crisis is the importance of actually gathering context-specific data. Are the things that we’re putting in place having the intended effect in the environment within which they are being used? While we really appreciate the provincial data, and it tells us a very important story — I don’t want to discount its importance — evaluation needs to be wrapped around all of these manoeuvres to make sure that we are, in fact, having the intended affects.

I don’t want to speak for prescribers, but what I have heard through the consultation work that we’ve done with our prescribers is that they are not sure that this is going to be helpful, and they are fearful that this manoeuvre might be harmful. One of the ways to reassure them around that is that it’s the thing that we might be able to do now, but we’ll monitor it so closely that we can quickly discontinue it or change the service provision in response to what we’re seeing. That gives some confidence to our providers.

The last thing is to Keva’s point, and this isn’t a critique of any particular ministry. The way we do receive funding is very targeted, and one of the things that is very important in the response right now is the introduction of iOAT, as an example. With iOAT, what I would advocate is for the ability to understand our population, and then use the treatment options that actually fit those circumstances. And iOAT requires a highly motivated individual. It requires seven-days-a-week, 12-hour-a-day service wrapped around it, requires a person to come for injections about three times a day. It’s highly intensive.

It might be the right thing for some people, so I don’t want to discount its importance, but do we have an ability to use the treatment options that actually fit the people that we’re seeing? That’s just another comment, that if we had that flexibility to say, “This is what we’re seeing,” then health authorities need to be accountable. This is why we’re asking for this latitude. I think that that’s really important, too, that then we be given latitude to actually respond to public need.

S. Allison: Thank you so much. Great comments, Kelly.

I just want to speak of downstream and upstream. Regarding what Diane and Kelly both mentioned, the idea about when we have contact with individuals, if we jumped right into “are you using opioids,” that’s a different conversation than “how are you coping, and what are you using to help you cope.” Alcohol is a huge issue for our province and our population, so opening it up like that allows for broader conversations of harm reduction.

Regarding separating people from the toxic drug supply, I know that some people at this point are accustomed to the fentanyl and are fentanyl-seeking. So that exactly goes to Dr. Carey’s point that not everybody is going to be receptive to this.

Very, very far downstream in Island Health as medical health officers, we receive weekly information from the Coroners Service, and we review all of our statistics and communicate that out to community through our community action teams if we have an advisory in place.

I’m working with our local RCMP that if there is a death with substance at the site that I have a small sample tested so I know what was potentially the cause at that site. So, really trying to again bridge those big gaps with the partnerships and really trying innovative ways to get in front of something that’s extremely toxic and causing more deaths.

Really, within our system, it is going to be in manoeuvres like screening every single person and making it normalized that we are all struggling with coping right now. Thank you.

N. Sharma (Chair): We’ve kept you a little bit over time. I just want, on behalf of the committee, to thank you so much for your thoughtfulness, your responsiveness to all of our questions, your great presentations and, more importantly, the work that you’re doing to tackle this crisis and save lives across the province.

There may be…. I think we probably all have more questions. We’ll figure out ways to get them to you so we can get those answered in different ways.

Safe journeys to all of you that have to go back to your regions of the province. Thanks for coming.

We will just take a recess for lunch. We’re going to be coming back at one o’clock.

The committee recessed from 12:10 p.m. to 1:01 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Good afternoon. Thanks, everybody, for coming. We have another full house this afternoon. Just a couple of housekeeping items.

First of all, I want to acknowledge that we’re on the traditional territory — once again, continuing on from this morning — of the Coast Salish peoples: the Squamish, the Musqueam and the Tsleil-Waututh.

My name is Niki Sharma. I’ll be your Chair. You have a timer in front of you right there; you’ll see it. It’ll go from green to yellow when you’re getting close and to red when your time is up. Every health authority will have 20 minutes to present, and then we’re going to leave the rest of the time for questions and answers after that. We’ve had quite a few presentations already, so it would be really great if you focus on, or can provide us insight into, what you are seeing in your health authority and on the ground. It would be very useful for us.

Maybe we’ll go around and introduce ourselves.

M. Starchuk: I’m Mike Starchuk, Surrey-Cloverdale.

R. Leonard: Ronna-Rae Leonard, Courtenay-Comox.

S. Chant: Susie Chant, MLA, North Vancouver–Seymour, also a casual nurse and case manager with Vancouver Coastal Health.

P. Alexis: Pam Alexis, Abbotsford-Mission MLA.

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

S. Furstenau: Sonia Furstenau, MLA for Cowichan Valley.

J. Sandhu: I’m Jat Sandhu. I’m with the BCCDC.

N. Sharma (Chair): You know what? We’re going to have you just introduce yourself when you start presenting, but you’re first, so it’s perfect. That worked out just fine.

Over to you, for the Provincial Health Services Authority.

Briefings on
Drug Toxicity and Overdoses
Panel 2 – Health Authorities

PROVINCIAL HEALTH SERVICES AUTHORITY

D. Byres: Good afternoon, I’m David Byres, president and CEO. I’ll present this morning. I know you’ve got our slide deck in front of you.

I’ll follow MLA Sharma’s lead and acknowledge that we’re here on the traditional, ancestral and unceded territories of the Musqueam, Squamish and Tsleil-Waututh and just acknowledge that they’ve been keeping these beautiful lands and waters around us for all time.

Some quick introductions. I’ll do the presentation of the slides, but then I’ve got a few members of our team here who’ll be happy to participate with any questions the committee may have. Dr. Jat Sandhu is the senior executive director with the B.C. Centre for Disease Control. To my left, Dr. Vijay Seethapathy is the chief medical officer for B.C. Mental Health and Substance Use Services. Next to him is Justine Patterson, executive director for B.C. Mental Health and Substance Use Services.

I’ll just tell you a little bit about PHSA. Then I’ll talk a little bit about the work that we are doing, and then we can get into some of the recommendations or things that we’ve been thinking about for the actual future. For those of you who don’t know, PHSA has been in existence since 2001. We are a provider of provincial specialized care and services in collaboration with the regional health authorities and with the First Nations Health Authority. Our mandate includes a focus on provincial clinical policy, clinical service delivery, digital and information technology, as well as a small amount of commercial services.

On the next slide you’ll just see some examples of that service delivery that we operate, if you weren’t aware: things like B.C. Cancer, B.C. Children’s and Women’s Hospital and Health Centre, B.C. emergency health services. In terms of population and public health, we operate the B.C. Centre for Disease Control, and then we do a number of pieces of work around provincial clinical policy and planning. We have a number of health improvement networks and provincial programs; Cardiac Services B.C. would be just one of those.

Then in the background, as part of our IT mandate, we do a fair amount of work around digital and virtual health platforms. Things that all of you will be quite familiar with — like the health gateway, the vaccine passport, those sorts of things that were developed and used during the course of the pandemic, or the ImmunizeBC portal, where you registered for your vaccine — were developed with our teams in collaboration with the Ministry of Health and, of course, the health authorities as well.

[1:05 p.m.]

I’ll just very briefly touch on the role of the B.C. Centre for Disease Control, because I know Dr. Gustafson has already been here and made a presentation, but just a reminder that their role is really around monitoring the health of the population. And they do that across a number of domains, including around substance use and harms from that. There is a fair amount of work that they lead to address the continuum, look at the data that we have, analyze the data and provide that information.

They do have a BCCDC overdose dashboard report that reports out a number of data elements, trends, local overdose alerts, things that are happening. It’s done in collaboration with the emergency response centre in terms of sharing information. They also oversee…. The distribution of harm reduction supplies and naloxone kits for the entire province is done through the BCCDC. They really work to provide coordination of their surveillance, the monitoring and evaluation of data related to the overdose emergency, and supply that provincially to health authorities and other providers.

A little bit about the continuum of services that we do offer. I give full credit if you’re on the same slide with me, which is slide 10. Vancouver Coastal Health’s regional addictions team have created this framework, but we find it really useful. I’ll talk about the services we have across that actual framework.

In terms of prevention, we do a fair amount of prevention and clinical service delivery, which includes substance use screening, media campaigns. I’ve already mentioned the harm reduction supply. In early prevention, we have a number of specialized services, training, education that happens through B.C. Women’s Hospital, like the Kelty Mental Health Resource Centre. We work, for example, with the Foundry. Foundry uses information from us in terms of what they provide for children and youth. Anything you see on their website comes through our programs at PHSA.

There’s a fair amount that happens in terms of health promotion in schools, and then we have the Compass team that provides consultation to any health care and the provider, if they’re providing care for children and youth, both with mental health or substance issues. The provider can talk directly with experts in our team. Or they can do a telehealth consultation; that is available as well.

Overdose prevention. We have five correctional health community transition teams that support ten correctional sites in terms of people leaving corrections. PHSA provides all the health care that happens in the correctional sites across the province. There is, as I’m sure all of you are aware, an overrepresentation of First Nations and Indigenous people in corrections and a fair amount of focus on substance use and mental health. There is work around expanding the access to opioid agonist therapy as well. We’ve done work around enabling our registered nurses and our registered psychiatric nurses to prescribe.

Then there a number of overdose prevention initiatives that are embedded across all of our outpatient and inpatient services. BCCDC distributes naloxone kits across the province. Now they have I think about 1.3 million kits that have been distributed across B.C. since its inception. Last year alone there were 381,000 kits that were sent out across the province. We have a poison drug alerting system. So if we find any toxic substances within the drug supply, we can send out alerts to users, providers alike so that they are aware. Then we have a number of harm reductions and overdose response practice standards and guidance and education that we provide provincially.

The other thing we have is the Lifeguard App. Right now there are just under 9,000 unique users that have used the app over 100,000 times. If you’re going to use alone, it will send an alert to you once you have injected, and if you don’t respond, it initiates a 911 call. There have been about 130 first responder calls initiated by the app, and there have been 45 lives saved, so we continue to promote an increased use of the app to people who are using alone.

There is paramedic-initiated naloxone. Our paramedics, through BCEHS, also initiate it when they’re out on the scene.

[1:10 p.m.]

Back in 2010, we were averaging, per month, about 37 related overdose calls for BCEHS in a day, the average during the month. Now we are averaging just under 100 overdose calls a day, which BCEHS responds to provincially. That’s slightly down from last year. We were up closer to 116 and now have dropped just below 100. It continues to be a significant amount of the volume that our paramedics are responding to. We also have a mobile response team.

In terms of withdrawal, we have a families in recovery program. We work with both mom and babe and any of their extended family that actually require any kind of support. There are consult teams available. Then we produce a whole number of withdrawal guidelines specific to moms and babies and children, which are available provincially, and some in-room guidelines for managing abstinence syndrome in neonates.

I think maybe what I’m going to do is, unless you want me to go through further examples of what PHSA does…. I’m sure the committee has heard lots of information about what’s available. I might just sum up. I know you will hear it from my colleagues.

There is significant expertise available within the province to draw upon. Maybe, if it’s agreeable to the committee, I could move to what we could do to escalate our response and address some of what we are seeing, rather than go through more examples. Suffice to say, there is sufficient expertise and a lot of really good substance use work that is happening across this province.

I’m going to move ahead, actually, to slide 17, which is: “Escalating the toxic drug response.” I guess the first thing I would say is…. Given where we are, we need a provincial response that is commensurate to the size of the issue we are experiencing. We need a response that is integrated and connecting the work of all the health authorities.

There is a different level of service and expertise available in the Lower Mainland than is available in rural and remote areas of the province. What we don’t have is a system that connects it all, including the transportation and referral pathways. So if a colleague of mine in Prince George, in Shirley’s riding, has a patient that actually requires a really high level of service because of complexity, which may only be available at St. Paul’s, we have no referral pathway, really, to get that individual there, and a transport pathway to get them there, in a quick and respectful manner and that links all of our knowledge and expertise into that kind of network across the province.

We have to do that in a way that is not just a response from the health system. We need a whole multisystem approach. We need to be thinking about involving our colleagues in education or in advanced education.

When we look at what the data tells us about who is using, it’s people who are in their 30s through to just on the other side of my age range, many of them men, many of them who are professionals or working in areas like transportation or other roles, and using alone. The stigma is driving so much use alone. We need to think about how we get at some of that work and create the appropriate policies and guidelines to allow us to provide the right treatment to those individuals.

At the moment, we have some absolutely outstanding research that actually originated with Providence, very much with the support of our colleagues in Coastal and Dr. Daly, which were the SALOME and the NAOMI trials. Those showed the effectiveness for this patient population, especially for people who have used opioids and have been severely addicted, and no other treatment has been effective…. That is the use of diacetylmorphine.

Despite the number of years that has gone by since that research was completed, we still don’t have the ability to offer diacetylmorphine as a treatment option throughout the province. It is available here within Vancouver Coastal. It is available somewhat in Fraser Health but not beyond. So we need the legislation that allows us to provide what we know, our experts tell us, is the right treatment for the patients and in a way that can distribute it across the province.

[1:15 p.m.]

I would say, at the same time…. We would be foolish to think that the only way we will be successful in providing treatment is the use of prescribers. We absolutely need all of our physicians, and we need all of our nurse practitioners who prescribe. We need other models of prescribing as well, whether that is compassion clubs or other ways in which, for some communities like First Nation communities or others…. We can involve them in a different way of managing within their community and distributing the right treatment.

There also is a need to think about how we distribute the work. We have no ability, for example, just to centralize compounding and actually manufacture the drugs and then distribute that across the province. That’s because of some of the regulations that currently exist and how that’s regulated by some of our health regulators and what we, as health authorities, have to follow. If we could simplify that, we probably could distribute drugs and treatment in a much different way.

I know you’ve heard from Dr. Gustafson about the need to ensure we have safe supply to distribute. I know you will have heard from others about the need to decriminalize simple possession.

The other thing I wanted to just speak about is the need to educate health care providers on how to better manage this crisis and ensure that they have the knowledge and expertise to do this work. When people come into the system…. You know from the coroner’s report that the majority of people who died saw a health care provider within three months. They weren’t there because of their substance use. That is probably indicative that we, as a health system, tend to do quite well at addressing physical health, not so well at addressing mental health and quite poor at addressing substance health.

We have to start to think about addressing substance health and making sure our providers know how to do that. When we start to do that, we will start to get at normalizing substance use and eliminating the stigma that’s driving use. It’s not just an addictions issue, of course. It’s also an issue of a toxic drug supply. I think we have to come at both sides of that.

There are a lot of options available through opioid agonist therapy, injectable therapy. I’ve already talked about the need to really integrate the work across the province in a different way — that thinks about the tiers of service and makes sure that any patient, and this comes from our colleagues at province, no matter where they are…. It doesn’t matter where they enter. You end up with a right door, through an integrated system, and we get them to the level of care that’s required.

We do have enough expertise throughout the whole province to actually do that. What we don’t actually have is that whole-system approach like we did with COVID, an actual health system approach that involved everyone. On the government side, it involved more than just Health. We had all the ministries involved for what part they needed to do.

If there’s any point I can emphasize, it’s that we must have a response that is commensurate with the size of the issue. If we continue to do incremental changes, we will not, ultimately, address this issue.

The last just really is…. There are some innovations that are available. Diacetylmorphine, which I talked about, which is not available provincially to all parts of the province, also has new forms that are inhalable that we don’t have access to so aren’t distributing. We could have decentralized models, if we could figure out how to have centralized compounding. We need to have better drug checking for safety, as youth are using, and not everyone has access to those services. Different models of safer supply, whether it’s compassion or co-op models. Really think about substance use health as we move forward.

The last thing I will mention is that in addition to ensuring care is culturally safe and appropriate, we also have to think about a trauma-informed approach, which we do think about. Trauma is underlying a lot of the reason why people are using. What we don’t have is sufficient access to psychological supports across the province, whatever those need to be. You’ll know, from the coroner’s report, that two-thirds of the people who have died also had a mental health presentation. We don’t have access to appropriate psychological supports, and that would need to improve.

[1:20 p.m.]

I see the light is yellow. I think the last thing, maybe, I will just mention is…. We need to change how people think about substance use and begin to normalize it in some way to get to addressing the stigma that is driving so much of people using alone. When you use a toxic drug supply alone, you die.

We don’t have any problem, as society, in understanding that if I want to stop using cigarettes, my physician may prescribe nicotine to help me stop using a cigarette. It is somehow difficult for us to also then comprehend that for me to stop using heroin, I may indeed need to have a medically prescribed form of heroin to help move me along the continuum, stabilize and get healthy. Using something else in order to be stable and function is exactly the same principle.

But we’ve got to get at this stigma that makes society think that substance use is bad and people who use substances are bad, which then prevents them from seeking help. Even those people who came for care three months before their deaths did not do so for their substance use.

I think, then…. Really, the last slide in the package that we’ve provided to you lists all those recommendations. I think I have spoken to all of them from the provision of safe supply, the regulation to enable legal distribution of substances, focus on substance use health, the transport, the integrated service.

Then, really, to leverage our data assets…. So much of the data and available information we have comes too late. Sometimes we get data around use that is two years old by the time it goes through all of the process and analysis it needs to do. By then, it’s too late to act. So in addition to leveraging the data assets, we have to have more timely data.

I think I will stop there.

N. Sharma (Chair): Okay. Thank you very much.

I’m going to now go to Providence Health Care.

F. Dalton: My suggestion — if that’s okay, Madam Chair — is that Vancouver Coastal go first and then me, because we sort of then might fit in with Vancouver Coastal.

N. Sharma (Chair): Sure, okay.

Over to you, Vancouver Coastal Health. Do you want to introduce your team?

VANCOUVER COASTAL HEALTH

P. Daly: Sure. I’m happy to join you today. I’d just like to introduce Vivian Eliopoulos, who’s the president and CEO of Vancouver Coastal Health; Dr. Rupi Brar, who’s our medical director of the regional addiction program; and Miranda Compton, executive director of substance use in priority populations. I’m Patty Daly. I’m the chief medical health officer. We’re happy to be with you.

I just acknowledge that we’re presenting on the traditional territories of the Coast Salish people, the Musqueam, the Squamish and the Tsleil-Waututh, and that VCH has services in 11 other First Nations in our region.

We’re going to talk to you about three things today: first of all, the unique epidemiology of the crisis in Vancouver Coastal Health — which, Madam Chair, you wanted to hear from us; some of our harm reduction and addiction services in VCH; and then our recommendations, as David also presented.

If we turn first to slide 4, this shows, in the lower left-hand corner, the graph that you’ve seen from the coroner. All health authorities have seen terrible deaths since the public health emergency was declared in 2016, but Vancouver Coastal Health has actually had the highest rate of death consistently throughout the crisis, along with Northern Health. We all saw a decline in deaths in 2019. The response to the pandemic led to a significant rise in deaths. You’ve heard about this from others. There were four reasons for that.

The public health recommendations for people to physically distance meant that people did not access overdose prevention sites, which were life-saving. We had 6,000 visits a week to those sites before the pandemic and less than half of that as soon as those recommendations were put in place. Clinical addictions services shut down during the pandemic, as practitioners were advised to only provide virtual care. We know that the closing of borders meant that the toxic drugs, which were coming in from China, became even more toxic and uncontrolled.

But this is really important. We know that more people were using psychoactive substances as a result of the stress of the pandemic. Actually, Dr. Jat Sandhu can answer questions about this from the provincial COVID SPEAK survey. We actually have more people now at risk of death from toxic drugs than we did at the beginning of the crisis, even though 10,000 people have died. So we do need to focus on prevention, and I’ll get to that.

But some of the unique things about Vancouver Coastal Health…. Although we have the highest rate of illicit drug toxicity death, it’s not uniform across our region. We have three health service delivery areas in our health authority: Richmond, Vancouver and our coastal community of care, which is the North Shore, Sea to Sky, Sunshine Coast, Powell River and Central Coast. In fact, if we look at last year, there were only two health service delivery areas in the province that had a rate of death under 25 per 100,000: Richmond and Coastal. They had the lowest rate of death in the province.

[1:25 p.m.]

Conversely, Vancouver had, by far, the highest, and they drove Vancouver Coastal Health to have the overall highest death rate. Vancouver has consistently had the highest rate since the start of this crisis, and if you look within Vancouver, the highest rate of death is in Vancouver’s Downtown Eastside.

Now, you’ve heard others talk about the fact that this is a provincial crisis. It’s not just about the Downtown Eastside. I want to focus on the Downtown Eastside, because these are some of the most vulnerable people who live in our region. They have borne the biggest brunt of this crisis since the beginning, despite the fact that we have many, many services in that community ourselves, in Providence Health Care. In fact, if you have an overdose on the Downtown Eastside, you’re less likely to die than anywhere else in the city.

The concentration of vulnerable people at risk in that community means that they have the highest death rate. We need to ensure that our response meets the needs of those among us who are most vulnerable. This does hide some areas that have higher concerns, as well. Within our rural communities, Powell River has had, consistently, the highest rate of death. They had 17 deaths last year, even though they have only 14,000 people. That would be the second highest within our region.

I want to talk about another unique feature of the population at risk in our region — the socioeconomic status of those who are dying. You’ve heard the coroner talk about poverty being a risk factor for those who are dying in Vancouver Coastal Health. We have seen that among those dying, and this is based on a chart review we did in 2017, only a very small percentage of people were actually working full time. David referred to the risk among people working in the trades. Only 8 percent of people who died were actually working. This is much lower than what was seen in the rest of the province. Seventy-two percent were not working.

If we look at where people died, in most of B.C., people died in greater numbers in private residences. That has not been the case since the start of this crisis in our region, where more people are dying in what the coroner refers to as other residences, which are supportive housing buildings, hotels, motels, the so-called SROs on the Downtown Eastside, rooming houses and shelters. This is an indication of the extreme poverty of the population at risk, but it also presents an opportunity, because those are sites where we can put in overdose prevention services to prevent deaths.

If we then go to the next slide, this is a really important slide that was also based on the chart review we did in 2017. This data was surprising to us. We looked at the pattern of substance use among those who died. What we found is that only 39 percent of those who died were daily users of opioids. These would be people that would have opioid addiction who would be people that we would want to engage in the kinds of treatments that David Byres alluded to, opioid agonist therapy.

That alone will not stem this crisis, because 44 percent of people were daily users of stimulants, alcohol or other drugs and occasional users of opioids that would be contaminated with fentanyl and would result in their death. And 17 percent of people were not daily users.

For this reason, it’s critically important that we don’t just think about prescribed models of either opioid agonist therapy or a safe supply of opioids. We need to think about safer supply for the broader group of people at risk — those who are using stimulants, have severe alcohol use disorder or may only be occasional users of illicit drugs. For these people, prescribed models will not be sufficient.

I’ll turn it over to Rupi.

R. Brar: This next slide speaks to some of the data — more recent and more long-term data — from Vancouver Coastal Health. If you look at the colourful graph to the left, that looks like clients that accessed care within VCH and Providence between January 2020 and December 2021. Over 16,000 people tried to access care for their substance use during that time.

The key takeaway from this graph is that 42 percent of those people actually have a polysubstance use disorder. What this data tells us is the complexity and the severity of substance use is increasing, actually at exponential rates, in fact. We’re seeing higher toxicity, higher complexity. If somebody is using opioids, they now inadvertently may have a benzo use disorder as well. So our services, having a critical look at the services we’re providing that often come from an era quite before this drug toxicity crisis, aren’t able to meet the needs of the complexity of the patients we’re seeing now.

The graph to the right looks at data from 1996 to 2020, so more longer-term data within VCH. It just shows the different prevalence of substance use disorders of people that have tried to access care at Vancouver Coastal Health. This speaks to Dr. Daly’s point about how people that are dying aren’t just people that are using opioids every day. In fact, alcohol use disorder still is the predominant use disorder within our province and within our health authority as well.

The next slide speaks to…. This is early data from Dr. Bohdan Nosyk at SFU and his team. What he looked at was the timing of diagnoses of opiate use disorder compared to mental health. These are people within our province — and also, it’s specifically for us within our region — who have both an opiate use disorder and a mental health diagnosis. What he’s shown is that people are being diagnosed ten to 20 years before their opiate use disorder diagnosis with their mental health diagnosis.

[1:30 p.m.]

We know from data that an opiate use disorder can be diagnosed normally within the age of the mid-20s, so the age of 25 is the mean age. What this tells us, at least preliminarily, is that we’re missing people. So we’re more comfortable, likely, in our system to talk about anxiety and depression, but we’re missing substance use questions. We need to improve our screening assessment and diagnoses, because these are people with concurrent disorders who are getting their opiate use disorder diagnosis ten to 20 years, sometimes, after their mental health diagnosis.

Early intervention is key to help prevent severity and ongoing harms of substance use. This early data just helps outline some of that.

We’ve talked a lot about opiate agonist therapy. You all are familiar with methadone, Suboxone and Kadian. We have decades of data that shows that it prevents harm for those with opiate use disorder but also prevents death. There have been a lot of questions. Is this still what we should be focusing on in the context of our toxic drug supply? This data, published in 2020, from our province, in fact says yes, that OAT still protects against death.

If you look at that yellow line of people not on opiate agonist therapy and then you compare it to the purple line of people on opiate agonist therapy, there’s a significant difference in mortality ratio. So we really still need to consider OAT for those with a diagnosable opiate use disorder. As Dr. Byres and Dr. Daly have mentioned, it’s not enough, because there are many people without an OUD diagnosis that are dying. But in fact, it is something that is protective, and we need to continue to focus on the evidence.

Further to that, when somebody is on OAT, if they fall off in the first one to two weeks — for example, somebody on methadone — their risk of death goes up 83 times than the general population. So what we’re not doing a great job of currently is retaining people on this life-saving medication. It’s pretty shocking data, in fact. This is again from Dr. Bohdan Nosyk and his team. It’s published here. There’s a reference there. You can look up that paper. It’s very interesting.

To know that our retention is poor…. More than half of the people that start on OAT aren’t on OAT within six months. That’s provincial data but also national data. We’re doing not a great job of it throughout the country. It’s something that needs more focus.

Over to you, Miranda.

M. Compton: Thanks, Rupi.

We’re here representing the regional addiction program, which we developed in partnership with Providence as a direct response to the last coroner’s death panel review, which recommended some focused attention at health authorities on the addiction system of care.

Really, what we’re trying to do as a regional program is to develop our early intervention and screening and assessment pathways to get our system of care comfortable in asking about substance use and, therefore, leading to an earlier diagnosis. Also then just building up the capacity across the system to ensure that we’re getting folks to the right service for them, understanding that everyone’s journey through healing and wellness is very different. And also just ensuring that our services are evolving to meet emerging needs.

Rupi spoke to some of the changing dynamics in what we’re seeing in people who use substances in our region. We really need to be constantly evolving our services. Some of the solutions that we had ten years ago…. Certainly the overdose crisis has shone a light on — that that’s not working, because we’re losing people.

On the next slide, you’ve seen various iterations of this. We are really pleased. We developed this framework with Providence, as well, to guide the work that we’re doing. I think that Dr. Réka Gustafson showed a version of it, as well as the province, yesterday. It’s really great to see this sort of provincial alignment around what’s needed as the different components of our system of care.

Really, we were just trying to map out…. I mean, we need all of these components in order to provide a comprehensive response that is responsive to people’s needs. So definitely prevention…. This is an area that needs a lot of building out. We can talk a bit more about that later. Just all the way through to long-term recovery supports to keep people well, knowing that substance use is often a lifelong journey and that there will be different twists and turns in the road, and we want to make sure we’re building a system that can support people over the long term, as well as in their immediate point of need.

We’ll just get into some of our specific services. We’ve talked about our overdose prevention and supervised consumption services. I’m sure you’ve heard about those as being critical to our immediate response, our emergency response. But we just wanted to point out that we did see a significant dip in those visits to our overdose prevention services during the pandemic, and we are seeing them coming up. But what’s interesting about this is that it’s the provision of inhalation spaces. So that again speaks to the changing needs of substance users and how we as a system need to change.

If we hadn’t been able to open those inhalation spaces, our numbers would not be sort of near where they are. We obviously need to get those numbers even up further because of the increase in substance use that we’re seeing.

Interestingly, too, we found it easier to implement inhalation spaces in our rural areas than in our urban settings. I think it’s just the premium price of land here. These need to be outdoor spaces, so that’s a huge challenge for us, particularly in the Downtown Eastside.

Over to you, Rupi.

[1:35 p.m.]

R. Brar: I’ll speak a bit about…. There’s been a lot of discussion about pharmaceutical alternatives and prescribed safe supply. This slide exemplifies the work we’ve been doing at Vancouver Coastal Health in partnership with Providence to implement different strategies.

We’ve led the way in terms of the most risk mitigation prescribing. At BCCDC, evaluation shows that 66 percent of the prescriptions have come from our health authority. We have the expertise in our health authority to be able to develop protocols for fentanyl products, and we’ve been piloting these in our SAFER program. Just to summarize, we have learned a lot. A lot of lessons have been learned in the last couple of years.

One of the main lessons we’ve learned is that our prescriptions cannot keep up with organized crime. You’ve heard about the increasing toxicity of the drugs, the complexity of the drugs. It’s really challenging for a prescriber to prescribe enough opioid or benzos, for example, in the right form that people need and the right quantity to actually separate them from the toxic drug supply. It’s a challenge.

Also, the things that Dr. Daly has spoken about…. People don’t necessarily all have an opiate use disorder. The medical model requires intakes and assessments and reassessments and supervised models. That’s how a medical model works. We miss people because of what Dr. Byres outlined quite well — the stigma in our system. We’re going to miss people who want to use on the weekends. They’re not going to go to their doctor or nurse’s office to get a prescription for something to use.

We miss many people within this medical model. What VCH supports is multiple models of care. One that’s been brought up is the public health approach, legalizing substances and regulating them in a co-op or compassion club type of model to really address it. The medical model, while it’s helpful, and we’re working away at it, isn’t scalable to the degree where we will actually see a discernable decrease in overdose deaths.

M. Compton: The next slide just refers to some of the peer roles. I’m not going to go into great detail. But we just really wanted to highlight that peers need to be integrated at every step of the way in our system, both as leaders and experts in where we need to go as a system of care but also as partners in our front-line service provision.

Slide 15 shows you some of the work we’re doing around these system changes to respond to evolving need. We show some of the cracks in the system in our framework and where we might need to be doing more quality improvements. For people going into detox, they may not need to land in a bed. They may need some more robust outpatient treatment and more on-the-ground supports around them to start on their journey.

We just want to build a system that is able to provide that timely care and then, also, provide lots of support around people as they transition from one service to another.

P. Daly: For the last few minutes — I’m on slide 16 — I want to talk about our recommendations, as David Byres did as well. Really, we’ve got five listed here. I’ll just briefly mention each one.

You’ve heard about our recommendations around a safer supply. I’m a strong believer in the public health approach. Just to give you an analogy, a couple of months ago, my team of environmental health officers were receiving reports of food poisoning from people who had eaten at restaurants in Vancouver. Within days, through the very good public health detective work, they had identified raw oysters as the cause. They had traced them back to the place where they were harvested from on the coast of B.C.

The Canadian Food Inspection Agency, as a result of our work, within days, had those oysters recalled from across Canada — there had been hundreds of illnesses — and replaced with uncontaminated oysters. That was a response — because food is regulated — that occurred within days. We are now six years into this public health emergency, and because these are illegal substances that are not legal and regulated, which is the model I strongly support, we are not able to do that.

We are in favour of all models of safer supply. This is not a one-size-fits-all. It’s similar to what we say about opioid agonist therapy. We need every possible version of opioid agonist therapy. We need all possible models of safer supply, and I need to reach those at risk throughout the entire province.

Next, Miranda has referred to scaling treatment programs to meet demand. We’re very good at doing pilot projects in Canada of 100 to 200 people. We’re not good at scaling up treatment programs to fully meet need for people when they’re ready to access care. I challenge my own team: don’t bring me models of serving 100 to 200 people. We have thousands of people at risk in our region, and we need to be thinking on that scale.

Third, and this is one that’s very important to our health authority leadership, is ensuring that all health care providers screen people for substance use disorder. This is addressing the stigma that we’ve heard about, which exists even amongst health care professionals and connects them to care. This is something that our medical leadership has identified as a priority. Our psychiatrists need to be doing it. Our emergency department staff need to be doing it. Everyone needs to be doing this. The coroner has identified this as well.

The fourth, and I’ll talk about this in a moment, is the importance of prevention programs for youth at risk.

[1:40 p.m.]

The last. We’ve talked about stigma, and this is something really important that this committee can do. Highlight stigma as deadly in the same way that Mary Ellen Turpel-Lafond identifies systemic racism as being critical to the poor health outcomes we see among Indigenous people. Stigma is killing people in this province. We have to be frank that we, as a society, don’t care about people who use substances in the same way we care about people with other health conditions, and we need to change that.

This is not just a government response. In fact, nobody has worked harder during the last couple years of the pandemic at addressing this crisis than Minister Malcolmson and the team in the Ministry of Mental Health and Addictions.

But I was with Minister Malcolmson and Fiona Dalton when, during the pandemic, she announced new funding for this crisis. Very few media attended. Even though we highlighted that more people had died of illicit drug toxicity than the pandemic, that was never even mentioned in the media, and you can see the media demand for daily figures on COVID-19. That’s evidence of the stigma here.

The last slide I want to talk about is around prevention, and I’ve got a list of recommendations that came from a report that I wrote in 2018, the chief medical health officer report, and these are critically important. I’m a prevention physician, so these are very important to me. We need to think about early childhood development, working with Indigenous people, a better system for pain. But the one I want to highlight, the one that frightens me, is that we urgently need to address our at-risk youth.

And you should ask Dr. Jat Sandhu about this in the question-and-answer session. We know that the pandemic response was particularly difficult for young people in this province. We are seeing that now in our health authority. Every week at our senior executive team — and Vivian will confirm this — we hear from our operations lead that they are seeing more and more children with mental health issues at our services, and these are children ten to 14 years of age. We can’t even address the demand.

We need to move upstream, into our schools. We need to implement broad programs for youth who may be vulnerable. We have a good example in our region actually. Vancouver school board has something called the SACY program, supporting and connecting youth. It’s been chronically underfunded. This kind of prevention work is critical, or else I fear that my younger colleagues will be dealing with an even greater crisis as we have another generation of young people at risk in the years to come.

I won’t go through the last couple of slides on some of the work we’ve been doing to support our Indigenous communities. We know that Indigenous people have been more affected by the crisis in our region, as they have elsewhere in the province. You’ve got a list of things that we’ve done there along with the First Nations Health Authority.

The last slide is just asking for your support to help us build a better system of care.

N. Sharma (Chair): Okay, thank you.

Now I will go to Fiona from Providence.

PROVIDENCE HEALTH CARE

F. Dalton: Thank you so much. My name is Fiona. I’m the CEO at Providence Health Care.

It’s a privilege to be here on the land of the Musqueam, Squamish and Tsleil-Waututh peoples.

In terms of Providence’s role, we run St. Paul’s Hospital, Mount St. Joseph, many long-term-care and ambulatory services. Relevant for this work in particular, of course, we run St. Paul’s Hospital, which has got the largest addiction medicine team in North America. We run a couple of clinics in the Downtown Eastside, including Crosstown. We are the host of the B.C. Centre for Substance Use, and we have increasing work around seniors with substance use issues.

What we try to do, driven by the need which we see — which Dr. Daly talked about from the Downtown Eastside, because clearly St. Paul’s is the acute hospital for the Downtown Eastside — is we try to provide the best innovative, evidence-based care. But we also acknowledge that this is an emerging field, and there are areas where there currently yet isn’t evidence, so we try to do the research to create that evidence and to test and pilot models that can be rolled out across the province and indeed across the country and the world.

I just wanted to talk about a few of the things that we’ve done and are doing in those three categories of prevention, harm reduction and treatment.

In terms of prevention…. And I’m conscious you’re hearing the same themes again. Sorry if it’s boring, but it’s also hopefully good because we’re all saying the same thing — that youth mental health is really fundamental. We know that there’s such a big risk factor for developing substance use issues later in life.

Then I also wanted to touch on reducing in-hospital opioid use. Canada is the second-largest per-capita prescriber of opioids, after the United States, in the world. Coming from the U.K., which you might be able to tell from my accent, it’s incredibly striking to me how we have a completely different attitude to opioids in health care from what I was used to.

[1:45 p.m.]

First of all, just talking about proactive youth mental health services, we are proud that Providence is home to the Foundry. It was started in a rented shop on Granville Street, and we’re so grateful to the government for their support. There are now 11, and there will be over 20 across the province.

We have now got support from the federal government and from around the world for that same model. It’s, of course, very low-barrier, proactive mental health support for youth, and what’s pleasing but also distressing is that there have been over 100,000 visits to a Foundry centre so far. We now also have virtual Foundry, so that if you live in a small community you can access it online.

The majority of youth, when we do our intake, indicate that they are in extremely high distress. These are not minor issues in general. The majority of them also indicate that they have not accessed any support and that if Foun­dry hadn’t been there, they would have gone nowhere. They had no alternative. So I think if we can do something to address Dr. Daly’s concern for the future, it’s to create more of this really low-barrier support for our youth.

I wanted to highlight just one of the initiatives, which is the PreVenture project, but I saw from the transcript this morning that I think Susan Brown from the Interior actually talked about that. So that’s great. I don’t need to say any more. I think that’s typical of how we try to work in partnership across the whole province.

Then just a couple of things in terms of prevention, in terms of how we use opioids in health care. We know that one in five Canadians are prescribed long-term opioids. In 2015 we did a survey at St. Paul’s that showed that over 50 percent of the in-patients were prescribed opioids, and that’s when we’d already removed people in ICU, people who were in palliative care and people who were having acute surgery.

Out of that came the opioid stewardship program. They looked at over 1,000 patient encounters per year and made recommendations to change patient management in just over half of those cases. And 93 percent of those recommendations were accepted. A similar program is, I think, now in place at some of the Fraser hospitals and has been rolled out across Vancouver Coastal Health, and it’s really important to reduce the iatrogenic harm that we are creating through such high prescriptions of opioids.

Another, newer initiative that we’re doing around this is when we’re looking at surgical patients. Through our membership with the digital supercluster, we’ve got a project that connects patients pre- and post-surgery. It identifies, pre-surgery, those people who have risk factors for having ongoing issues with their opioid use. And then, post-surgery, through connections with them and connections into PharmaNet, we are able to tell after two or three weeks who is still taking a lot of opioids and filling all of their prescriptions, and we can intervene at that point. Again, that’s really trying to reduce the new number of people who are coming into this epidemic.

Turning to that second group, which is harm reduction, I just wanted to talk about three areas. First of all, at St. Paul’s emergency department, we do see the highest number of overdoses per day, sadly, in the province. About six people per day come into St. Paul’s with opioid overdose.

It’s striking how small that number is compared to the number that Dr. Byres referenced, and of course that’s because the ambulance service, the paramedics, do such a good job at actually resolving lots of those issues in the community. But those six people are really sick who come to the St. Paul’s emergency department. And the range of outcomes for those people ranges from walking out seemingly unscathed to long-term brain damage to ICU admission to death.

I’m really conscious that we always talk about the number of deaths from opioid overdose, and obviously, every one is a tragedy. But we also have a really significant morbidity coming from this, and I’m going to talk a bit later about long-term care in terms of seniors and the long-term brain damage that we have.

It really affected me right at the heart of the COVID pandemic, when we had a large number of COVID patients in ICU, and I saw one of the ICU physicians. I just met him in the corridor, and I said: “I’m so sorry. Your team is under so much stress at the moment with the COVID patients in ICU.” And he said: “Honestly, Fiona, it’s not the biggest stress to us. Our bay of COVID patients — honestly, we’re pretty good at managing them. We know what we’re doing.”

[1:50 p.m.]

The COVID outcomes from people who get to ICU in this province are truly outstanding, not just at St. Paul’s but across the province. He said: “It’s the bay of people we have who have had an opioid overdose.” He said: “They are a lot younger. There’s much less we can do, and the outcomes are really poor.” That conversation has always really stuck with me.

In addition to obviously just providing immediate, life-saving care in emergency, we try to continue to innovate and think of what else we can do. Just a couple of examples. We were the first emergency department in Canada to provide Suboxone on demand. Someone comes in, having had an overdose. Often it’s late in the evening. At that point, they won’t stay. They want to come to the rapid access addiction clinic in the morning. They may want treatment.

But if we just send them home and say, “Great, come back in the morning,” by the morning they may well have used again, and they may well be back in the emergency department with another overdose. So giving Suboxone is a way to tide people over those really critical first few hours. It was really good to…. I know that that’s now being rolled out across the province.

Another, then. Just our latest innovation is that we’ve got a new Cerner system. We’ve got, now, an alert which says that…. We’ve just got it working so that if we have a patient coming in who at any point has had naloxone anywhere in another hospital that has Cerner, it’s able to give the ED people an alert and say: “Have a conversation with them about substance use.” So that’s a really good example of how a computer system can really help.

In terms of harm reduction, our in-hospital OPS. Our original overdose prevention site opened in a car park at the back of St. Paul’s. It was the first in North America. We then subsequently, through COVID, worked with Vancouver Coastal to move it inside for patients.

Vancouver Coastal opened a local, public OPS. That worked well in terms of trying to separate clearly COVID…. Remember, the patients using it were COVID-positive. It also actually separates, to a certain extent, the patients from the dealers, and we have nurses in our internal OPS who are able to support patients with harm reduction supplies and also connect them into care. It’s conveniently right next to the cafeteria, so I think it also does help to reduce stigma.

I’ve just got a little summary of the numbers. As you can see, it’s busy. We have managed 113 overdoses since it opened, and no one’s died. It also has significantly reduced stress on staff and moral distress — because nurses knew that patients were leaving the ward to go and use. Previously to this opening, they knew that they would be going somewhere hidden. Now they’re able to take them down to this unit. It’s made everything a lot safer.

Then I just put a few additional strategies in terms of harm reduction. This is our life, particularly at St. Paul’s, that everyone is trained and alert. Our security staff, who have a really tricky job and don’t always get the kudos that they deserve, as you can see, have actually saved ten lives by being able to give naloxone themselves. Because often they can run faster than anyone else to get to a problem.

Just turning into treatment and recovery, which is the part that we’re trying to really focus on some more, first of all, I wanted to talk about the addictions medicine team at St. Paul’s Hospital. This is our largest physician group. In most hospitals that I’ve worked in, the largest physician group is the anesthetists, sometimes the radiologists, sometimes internal medicine. Not at St. Paul’s. It’s addiction medicine, and we do have the largest group in North America.

That does give us some clinical heft and critical mass. A large number of those people are also researchers at the B.C. Centre on Substance Use. We’re able to provide a lot of training in terms of internships, fellowships, etc., so really support the province and, indeed, the country with training people up in that really big team. As you can see, about one in six of the patients has a history or active substance use disorder, and the team are really busy.

[1:55 p.m.]

They also run the rapid access addiction clinic, which opened six years ago. It’s open seven days a week. It’s either referral or walk-in. A significant proportion of people walk in. It’s for any addiction, so you can come in for your nicotine issue or your alcohol issue, although the majority of people do come in for opioid issues. We’ve tried to make it really trauma-informed, culturally safe for everyone and really low barrier. Thanks to some new money that we recently received, we are in the process of setting up a virtual RAAC. So in the same way every community can’t have an RAAC, we will be able to do that on a virtual basis as well.

Just in terms of the blue squares on treatment and recovery, I’ve just got some numbers there, so you can see how many people are treated there. We’ve now initiated over 5,000 patients on some form of opioid agonist treatment, transitioned more than 3,000 people to a community provider following that. I do think that we will continue to expand that — the virtual model is really important — and to use it as a model, I think, for other communities across the province.

Just turning to Crosstown Clinic, it was the first clinic in North America to provide, we believe, injectable opioid agonist therapy, including injectable heroin. It continues to have really good outcomes. It retains patients at 80 percent. It’s very high touch, and it does wrap care around people. We have patients who need the most support and looking after. We manage to transition about 20 percent of them to oral therapies, and that’s great. That then relieves room, because we always have a waiting list of people needing Crosstown.

One of the things we’ve been doing over the last couple of years is trying to really ensure that we are integrated with Vancouver Coastal Health and other not-for-profits down in the Downtown Eastside to ensure that the people who need the most intensive therapy get to Crosstown. Equally, when Crosstown has stabilized people, and they’re a bit more stable, they can be transitioned out to another facility.

Then I just wanted to talk briefly about the Hope to Health clinic, which is run by the B.C. Centre for Excellence in HIV/AIDS, which we as Providence also host. The concept for the centre, which is on Powell Street, just a little bit further out of the Downtown Eastside, is that it has a supervised consumption site. It provides safer drugs. It also provides primary care and has integrated research. There’s a lab on clinical research.

You can see from the slide that has kind of got the two-ended arrow, from not in care to engaged in care, what we’re really trying to do there…. We have people who have no diagnosis, no connection with any care, and the supervised consumption site is open access. Come in, absolutely; use your street drugs safely here. That room also has people who are using prescribed drugs, so it’s really low barrier to think: “Okay, well, next time I come, instead of doing all the things I have to do to try and get street drugs, what? They all just give it to me for free?” We go: “Yep, absolutely. We can prescribe it for you.” So that just moves people on a little bit.

Then we can say: “By the way, do you have a primary care doctor?” Almost everyone says no. There are about 7,000 unattached people in the Downtown Eastside at the minute, and this clinic is able to say: “Well, here is someone. Come and see them. Can we help you with your HIV or hepatitis or your psychiatric issues?” So it’s a way of kind of bringing people in and moving them from that left-hand side, which is not in care, to the right-hand side, engaged in care.

The little graph right in the middle, for which you can’t see the numbers — what it shows is the retention of people. Just picking up on what Dr. Brown said in terms of that proportion. The green is “Retained,” so you can see that that clinic is good at retaining the highest-risk people. They do that by following up. So we know that if you haven’t come in for your opioid agonist therapy today, and you came in yesterday, you are probably going out to use it somewhere else. So we actually start phoning you and saying: “Right. What can we do to help? Can we come and get you?” That’s the kind of work that we need to do to really get people moving to the right in terms of engaged in care.

In terms of finding treatment and recovery, I want to talk really quickly about two groups, one being the youth and the ways that the Foundry is providing a lot of really specialist opioid agonist therapy and other treatment for the youth.

[2:00 p.m.]

To briefly talk about seniors, we have an increasing group of seniors who are using substances or have many years of using substances, who we have not — I think, as a system — traditionally been able to really look after and have bounced between, often, homeless shelters and the acute sector in a not great way. We’re interested, in Providence, in this group, and we think that we can do better. Our sister organization, Providence Living, is working with and is going to take on Central City Lodge, which is in the Downtown Eastside. I think that together we can really do something that is much better for that really vulnerable group.

I’d say, finally…. I’ve two minutes to just talk about the future priorities. Again, I wanted to echo what’s already been said. We have to increase both capacity and integration across the province so that evidence-based treatment is available when the patient needs it and asks for it. There can’t be a waiting list for that.

I would just ask you to imagine that if you were out for dinner with a friend tonight and, in the middle of dinner, your friend said, “I suddenly seem to have crushing central chest pain,” I think that we would all know what to do — in terms of: we would call an ambulance. Certainly, here in Vancouver, the ambulance would take you straight to the emergency department. The cardiologist would be waiting in the emergency department. They would be whisking you off to the cath lab. But following that acute intervention, there’s a program of follow-up with cardiologists, cardiac rehab, connecting you back to your family doctor.

If instead, in the middle of dinner, your friend said to you, “I have to tell you that I’ve just got this big problem; I’m using street opioids, and I need help,” I would ask all of us here whether we would be able to direct them to a service that had the same response. That’s what we need. That’s what I think we can collectively provide, and that’s when we will know that we have solved this issue of stigma.

N. Sharma (Chair): We’ll pass it over to Fraser Health Authority.

Go ahead.

FRASER HEALTH

I. Tyler: It’s a real privilege to be here with you today and share Fraser Health’s experience with the toxic drug crisis as well as some elements of our response.

My name’s Ingrid Tyler. I’m the executive medical director for population and public health at Fraser, and I am here representing our chief medical health officer, Dr. Elizabeth Brodkin, who was unable to make it today. I’m joined by Norm Peters, our vice-president of regional care integration, and by Christine Mackie, our executive director of overdose response and vulnerable populations.

While we are meeting here today in Vancouver, I would like to acknowledge that Fraser Health provides its services within the traditional, ancestral and unceded territories of the Coast Salish and Nlaka’pamux nations and is home to six Métis chartered communities.

On the third slide now. The crisis of illicit drug toxicity has taken a very significant toll on the population of Fraser Health. Fraser Health sees the largest number of deaths in the province, with 770 in 2021. But given our large underlying population size, we have the third-highest rate of the five provincial health authorities that are currently reported by the coroner’s office.

Our death rate is highest in Fraser East region, which includes the municipalities of Abbotsford and Chilliwack, where 174 deaths occurred in the last year alone. The number of deaths is highest in Fraser South, which includes Surrey. Our overdose crisis in Fraser Health is not concentrated in one area, as is sometimes associated with the Downtown Eastside, but in several visible pockets across the health authority as well as in some less-visible places.

Of all the health authorities, Fraser Health sees the highest incidence of deaths in private residences: 69 percent at the latest coroner’s report, with a much lower number outside and occurring in other residences, like the shelter system, for example. This is a really important consideration in our overall response to the crisis, as the majority of the impact is on what we sometimes refer to as the hidden population — people who are living alone or with their families where they are not sharing their drug use. They may be disconnected to overdose prevention services and are likely to be experiencing stigma or a lack of support from their communities.

[2:05 p.m.]

As you’ve heard previously many times, the deaths are being driven by the illicit drug supply, which is contaminated by fentanyl and other substances. The unregulated drug market continues to change. Benzodiazepines are another class of drug that can cause dependence on their own, and they’re now detected in over 50 percent of deaths. This contamination with benzos has led to overdoses that are more complex to manage. The changing properties of the toxic drug supply is just yet another obstacle in treatment and successful reversal of overdose.

Fraser Health’s response to the toxic drug crisis has five components that we will address today, as you can see on the slide. These have been the pillars of our overdose response since the public health emergency was called in 2016, but back at that time, we were quite limited in the services that we were able to provide. Since 2016, with the provincial investment of $20 million annually for clinical services in Fraser Health, we’ve established an integrated, efficient, effective and accessible prevention response treatment system for our patients and their loved ones, but we do have a long way to go.

We now have six overdose prevention sites, with three more to open in 2022. We’ve seen over 350,000 client visits at these sites by 3,500 clients. We’ve identified and managed 2,800 overdoses at these sites, and these are all potential deaths averted. Through OPS, we’ve connected 522 clients to treatment, 175 clients to housing, 207 clients to detox and 87 clients to residential treatment.

We’ve now established three regional rapid access addictions clinics. We have eight OAT clinics that have a combined visit volume of about 800 visits weekly. We’ve established three regional overdose outreach teams, a virtual health addiction clinic, and at all sites, we strive to provide enhanced wraparound services and intensive case management, as has been described by others.

It’s taken significant effort and partnership across the organization and with the communities that we serve to get here. This hard work and dedication has saved many lives, but as I’ve said and as you’ve heard here, we still have a very long way to go.

Moving through the response components, I’d like to start this slide by acknowledging that substance use is universal. Like all other aspects of our health and well-being, it’s affected by a diverse range of personal, social, economic and environmental factors that determine individual and population health, including income, education, employment, stigma, discrimination, racism and intergenerational trauma. We can support individual resiliency and protective factors and reduce the demand for substances in our population through primordial and primary prevention strategies. This includes promoting health equity, mitigating stigma and mitigating stigma around substance use.

One of the things Fraser Health recently released is our health promotion strategy to prevent adverse childhood experiences and foster resilient children, families and communities. This aims to work with our partners in communities to promote healthy childhood development. ACEs are stressful, potentially traumatizing events that can arise in the household, community or other environments and lead to well-documented health impacts, including an increased risk for substance use. Our strategy aims to prevent, reduce and buffer the impacts of ACEs for children and families by shifting social and cultural norms that drive these ACEs, integrating upstream strategies into our programs and services, and influencing healthy public policy.

Like substance use, ACEs impact all communities, but some are affected more. As such, our priority populations for this strategy include First Nations, Métis and Inuit children, youth asylum seekers, government-assisted refugees and immigrant children, 2SLGBTQ+ children and youth, and young people living with substance abuse and/or experiencing homelessness. This work is going to include ongoing partnerships with our comprehensive school health program, our enhanced family visiting programs and our healthy community partnership teams.

Moving on to the section of this slide titled “Supply Reduction,” Fraser Health supports decriminalization and appropriate regulation of the drug supply for personal possession, as has been spoken to by many others. We would like to see people reducing access to the toxic supply because safe alternatives are available. Decriminalizing personal possession would mitigate the consequences of stigma and discrimination, racialization and the disproportionate burden of the social and health harms of the toxic drug supply.

N. Sharma (Chair): Sorry to interrupt. Could you just refer to which slide you’re looking at right now?

[2:10 p.m.]

I. Tyler: It’s called “Response continuum,” to the right under “Supply reduction,” I think.

I just wanted to note that in this vein of decriminalization and safer supply, we are partnering with BCCSU and VCH in preparing a substance use and addiction program application for the opioid co-op model, to provide a safer supply. As was mentioned by others — the privilege of going last — any reduction in stigma would allow us to reach affected populations with treatment and harm reduction services. We need to actively promote deep listening to the needs and wants of what might be helpful and welcome in the lives of people who use substances, both in our culture overall and in our communities.

Now I’m on the slide titled “Overdose and Harm Reduction Approach.” While the upstream and policy work is critical, the rest of this presentation will focus on direct delivery of services, including harm reduction, clinical prevention and treatment services. This slide summarizes the harm reduction program at Fraser Health in some detail, but I’m going to focus my comments on Mobile OPS and our partnership with Cheam First Nation.

Overdose prevention sites are an essential health service that should be accessible to all citizens who need it. They limit the perpetuation of stigma and stigmatizing encounters by creating a safe, non-judgmental space, along with other health benefits. Note that not all people who use drugs have substance use disorders. However, all people who use drugs could benefit from having access to harm reduction supplies, harm reduction and overdose prevention, response education, naloxone kits and the services that these OPS sites provide.

Unfortunately, a significant gap still remains for universal access to this. Fraser Health currently has six publicly accessible overdose prevention sites operated by community partners, with three more in the planning stage, but the majority of our over 40 OPSs are located in supportive housing and shelters, to support the people who live in this kind of housing. As noted, however, the majority of our overdoses occur elsewhere, in private homes.

Overdose prevention sites don’t necessarily provide the support for these people, which is why we need a continuum of services and multiple access points, continuing to remember that what works for one population of those at risk for overdose deaths does not necessarily work for all of those who are at risk.

Shifting back to overdose prevention sites specifically, in order to be able to provide this essential service in Abbotsford, where no fixed site was found, we’ve implemented a mobile model, with the use of a vehicle and adjacent tent structures. The mobile option works, but it’s an imperfect substitution for a fixed site — which would be our preference — as it limits the number of people who can access the site, and it lacks the ability to provide some basic essentials like washroom facilities and even a climate-controlled environment.

In some communities, like Langley and Chilliwack, we’ve experienced significant municipal opposition to setting up fixed harm reduction services, including direct opposition to locating OPSs in the downtown areas where these would most benefit the clients they’re meant to serve.

Zoning and bylaws have made it very difficult to locate and lease appropriate space in appropriate areas in these communities. In one municipality, a recently enacted specialized medical health services bylaw effectively prohibits OPSs, detox and needle distribution and return facilities outside of hospital property. I believe that much of this opposition actually comes from stigma, which is driven by criminalization, and a number of moralistic arguments that are driven by ongoing misunderstanding of addiction as a chronic, relapsing disease.

Lastly, we don’t currently have publicly accessible OPSs in Maple Ridge, Burnaby or Tri-Cities, and we will be re-engaging these communities soon to look at opportunities there. We’re going to continue to work with all our municipalities to create fixed sites to provide the features that make OPS a safe place for any individual who might want to use, to seek information or services, or to be connected to housing and other supports.

Continuing on the topic of OPS, we are especially honoured to be part of the Cheam-led OPS, in partnership with FNHA and Cheam Nation. As you heard from Dr. Nel Wieman a few days ago, while First Nations people represent 3.3 percent of the provincial population today, in 2021, 15 percent of toxic-drug deaths were amongst First Nations people.

[2:15 p.m.]

But in late April of this year, Fraser Health and the First Nations Health Authority joined the Cheam Chief, Andrew Victor, for a traditional ceremony commemorating the signing of a memorandum of understanding to outline the partnership for a new, first-of-its-kind overdose prevention site in Fraser East. It will sit on Cheam territory.

The overdose prevention site will combine indoor, outdoor and mobile components, all aimed at reducing the harms associated with substance use while embracing an Indigenous strengths-based, people-centred approach. The site will primarily serve Indigenous and non-Indigenous people living in the Cheam Nation but will also be open to people from any area, including Chilliwack, Agassiz, Rosedale, Seabird Island and adjacent communities.

It’s the first such collaboration in Fraser Health and possibly the first one in Canada, and we’re very proud to be a partner in this initiative. It should provide a much-needed service for the residents of Cheam and surrounding communities, and Fraser Health is continuing to engage with FNHA and our other First Nations to see if there is interest in similar partnerships.

With that, I’ll hand it over to my colleague Norm, who will take us through the rest of the presentation.

N. Peters: Great. Thank you, Dr. Tyler.

Before I get into the presentation…. I’m going to talk about the work we’re doing in our vulnerable populations and our substance use program to provide services and programs. A couple of themes, for me, have started to emerge not only as we’ve put this together but listening to the other presentations around how important it is to have a comprehensive, overarching approach to this problem. There isn’t any one single initiative that’s going to be the magic bullet to solving this crisis, which has been ongoing much longer than our pandemic, our COVID-19 crisis.

I think we need to take similar approaches to what we have towards the pandemic, which was that it was an all-hands-on-deck approach, and all communities and all levels of government were leaning in to provide that response. As we’ve seen, that comprehensive response actually got us to the place we are now, and I think a similar response is needed around the overdose crisis.

You’ve heard many people talking about stigma. Stigma is a significant problem. It not only prevents individuals from accessing care. You’ve clearly heard how stigma, though, can also influence policy decisions when people are not in support of the evidence-based approaches that are being supported here today and, I’m sure, that you’ve heard this week.

I’ll touch on the services that we have. Firstly, I’ll touch on our vulnerable populations — so on our outreach slide. While we recognize that a majority of overdose deaths in Fraser Health are occurring in individual residences, we still have a significant number occurring within the unsheltered and homeless population within Fraser Health. So it’s equally as important to continue to provide those services. That’s why we now have an executive director for vulnerable populations.

We’re introducing two programs. The integrated homelessness action response team, or IHART — this team provides a comprehensive, multidisciplinary team that surrounds the individuals living in shelters or unsheltered with various access to care. It includes virtual psychiatry, home health, mental health and substance use workers as well as attaching into our urgent and primary care centres for primary care.

What we have found by providing that kind of comprehensive approach is that we’ve been able to better transition individuals in shelters into more permanent and stable housing and better adjust their ongoing and chronic and complicated medical needs.

We continue to provide an overdose outreach team that reaches out into communities wherever individuals are to help provide them access and support to managing their overdose or substance use issues.

I’m not going to touch on services that have already been highlighted. I’m just going to highlight some of the Fraser Health approaches that we’ve taken that are different than you’ve heard from other presentations.

I’m going to talk about treatment and recovery, again around the comprehensive nature. I’m somewhat envious of Providence’s position on the size of their addictions medicine…. We don’t, unfortunately, have the same addictions medicine access in Fraser Health, so we’ve had to take some unique approaches.

Virtual health has been a significant part of that approach, and that has allowed us to actually extend the reach of our addiction medicine specialists both into acute care settings and out into remote communities, where we wouldn’t otherwise be able to provide substance use services without an addiction medicine specialist. We were forced to do that, in some ways, because of the pandemic, but I think the real learning here is that it has actually been able to increase our reach out into those communities.

We have a comprehensive approach to bed-based treatment and withdrawal management, but we have found that one area of success has been our day, evening and weekend treatment programs.

[2:20 p.m.]

We hear from many of our clients that they’re concerned about giving up their work or their personal lives in order to go into treatment and that if we can provide outpatient ambulatory clinic and services in the daytime, evening or weekend that better meets their schedule, they’re more likely to continue on with their treatment programs.

We’ve grown that extensively. We’ve almost quadrupled the number of patients that are attending our day, evening, weekend treatment programs. We’ve streamlined the access program so people can start that program that day or the next day. They’re able to continue on whatever schedule best meets their needs. Previously, it used to be on an intake process. Like school, you would start at a certain time every year. In fact, now people just join into the program wherever they’re at, and we’re able to continue to provide their needs.

Within the recovery area, on the next slide, again, it’s key and it’s quite critical to have a comprehensive program that focuses on all facets. To highlight a few areas, we’ve heard a little bit about the importance of services for children and youth. We’ve expanded our virtual services for children, youth and parents, including podcasts, webinars, TikTok, Facebook Live, Instagram and Snap­chat, trying to use the social media that young people use now to get messages, and we’ve been able to communicate much more effectively.

We’ve expanded services for our low-risk withdrawal management. It’s quite critical that people that have low-grade substance use disorders get access to care in a timely way. That prevents that from becoming a crisis situation.

Another service that we’re quite proud of is our urgent care response centre in Surrey. This provides access to medical management of substance use outside our normal rapid access addiction clinic hours. In fact, actually, it was just recognized nationally by the Canadian College of Health Leaders for a leading practice of mental health services.

We offer a full continuum of bed-based treatment services, from stabilization beds, intensive treatment beds and transitional beds. We’re working towards having a single point of access so that people can navigate the system. A complaint that we often receive, and it’s not just unique to this service, is the challenges of navigating in a complicated health care system, so having a single point of contact is quite critical for people accessing the care.

What would the presentation be without just highlighting a few challenges on the next slide? I’m sure you’ve heard about it already. We’re experiencing a health human resource challenge across all health services, and it’s felt in this area around addictions medicine specialists, psychiatric nurses. They only graduate 40-some in the province every year. We have open applications for more than that. We could take every grad into Fraser Health and still have vacancies. We, obviously, recognize everyone has got a need for nursing.

We need to provide a full continuum of treatment options. Yes, while in-treatment options may be appropriate for some, it’s not necessarily for everyone. To be able to meet their needs in a variety of locations, we need to have a full continuum.

There are some policy issues that need to be looked at. How do we get greater engagement of pharmacies to be involved in things like safer supply?

User fees. It may be unique to Fraser Health. This is a carryover from a previous billing issue with physicians. In clinics outside of our clinics, the rapid access addiction clinic…. They are charging a user fee to clients in order to access their service. For those that are on income assistance, it’s covered under changes to income assistance. But people are paying $60 to $100 a month to be able to access OAT treatment programs in clinics. I’m concerned about it continuing to be, basically, a user fee for people accessing a subsidized health care service.

On the next slide, I just wanted to highlight that we’re very focused on using data to inform action. This is our daily dashboard that we have now at Fraser Health. I know the print is a little small, but it does show where we experienced overdose events in the last 24 hours. It highlights the age and demographics and allows us to provide a much more comprehensive response, where we know where overdoses are starting to occur.

In the time that I have left, I just wanted to highlight…. As part of our response to the death panel review, we’ve implemented a number of initiatives. You’ve already heard about some of those today. I just wanted to highlight that we now have a dedicated lead for our overdose and vulnerable populations response. We’re focused on expanding and optimizing our OAT services, continuing to remove barriers and improving access to services. As we’ve heard, it’s not universal across all of Fraser Health. We will continue to focus on using our virtual health as much as possible to expand our reach.

I’ll give you back a couple of minutes.

N. Sharma (Chair): Okay. Thank you.

I think we should take a few minutes for a break. Everybody can get up and stretch their legs. Then we’ll go to questions and answers. Why don’t we come back at 2:35.

The committee recessed from 2:25 p.m. to 2:35 p.m.

[N. Sharma in the chair.]

DISCUSSION

N. Sharma (Chair): I think we should try to use as much of our remaining time for discussion and questions and answers. We always learn a lot from that. I have a list going here, and we’ll just ask the members to put their hand up if they want to be added to the list.

S. Bond (Deputy Chair): Thank you very much for your presentations. We appreciate them. As you can imagine, we’ve received a lot of information already, and there’s still a lot more work to be done. But we recognize there are some common themes across British Columbia. Part of the challenge is that there’s more to be done.

I really appreciated Dr. Daly’s comments about the Downtown Eastside. I think it’s an important perspective for us to remember, because we are hearing about the demographic of who is dying. I found that very helpful.

I have two questions. I know the Chair is going to allow me to break the rules because I do have to have a flight home shortly. I was relieved to hear a lot of discussion about prevention, because in some of our earlier presentations, that hasn’t necessarily been the highest priority. But it’s really important that there’s a spectrum here that runs from prevention to treatment. And yes, we have to deal with the here and now.

I’m concerned, though, about the issue related to youth mental health and the supports available. I’ll give you both questions. I’m wondering if that is a similar experience across all of your institutions, your agencies, to what Dr. Daly expressed. That caused me a lot of concern. Relieved that it’s being raised, but obviously we need to make sure there are supports in place.

I guess a number of you, not specifically necessarily, were engaged in the death review panel. I appreciated seeing that there’s been a response, obviously, at Fraser Health. But I’m wondering what the corporate approach is going to be, the cumulative approach to the death review panel, because there were some very specific recommendations. Many of you were a part of creating that roadmap.

So what happens now, when we look at the urgency that was outlined in that report? Is it everyone for themselves? They’re all responding independently or…? I’d just really like a response to that, considering that many of you were engaged in that panel work.

N. Sharma (Chair): Okay. I guess what we were doing…. It worked well this morning. I’ll just go to each health authority, maybe, or service authority for the provincial side. Then you can have your response. We’ll make sure everybody gets an answer. So why don’t we start with the Provincial Health Services Authority.

D. Byres: There were a number of questions in there, Shirley. Maybe I’ll start first with the questions about youth, and then we can go to the coroners report.

Jat, I don’t know if you want to speak to anything about the survey.

Then Vijay, specifically just around services.

Then we can talk about the organization-wide response.

J. Sandhu: Sure. Why don’t I start by just putting into context the burden that we’re seeing with regards to youth.

The COVID SPEAK survey that was conducted twice during the pandemic, first of all in May 2020 and then secondly in May 2021, really highlighted for us the disproportionate impact of the pandemic on the mental health and well-being of not just the general population but also youth and young adults in particular.

Whilst the survey was targeted at 18 plus, we did capture information on households with children. What we noticed from that was that many of the households experienced stress amongst their children. They had significant concerns around learning deficits, as well, that were as a result of the school closures.

I think there’s a spectrum of mental health and well-being issues that were identified through the survey, as well as many of the resiliency measures that, typically, B.C. does very well on. They had significantly deteriorated as well.

As a consequence of that, there was a young adult task force that was established to review the evidence, not only from the COVID SPEAK survey but other data sources as well.

[2:40 p.m.]

It came up with a number of recommendations back in the summer of 2021. I think some of those recommendations really relate to the fact that young adults, in particular, have had many of their life goals delayed and sometime even abandoned. The consequences of that are things that we still need to continue to monitor. That’s the burden aspect.

V. Seethapathy: Primarily, at BCMHSUS, we are pro­viding services for the adult-aged population. We did provide a service for the youth-in-transition age called Ashnola at Keremeos. During COVID, we couldn’t keep it running, unfortunately, and we had to shut it down due to the infection prevention and control measures. It couldn’t be enacted on that site, particularly with the rural and remote nature of the work.

Currently we’re working on revamping the service, looking at the model of care and looking out for proponents to take that work and keep it running. That’s an in-patient provincial for concurrent disorders, primarily focused on addiction but also the mental health, for up to three months or even longer.

That’s work that we do at the local level of services. In addition to that, the children and adolescent mental health team within Children’s Hospital has been pretty active in expanding the service and trying to work through this transition age and see how we can match the services with what they’re getting at the age of 18. But everything stops in terms of funding and a lot of the staff there.

That transition has been a bit of a challenge. There’s a lot of work being done currently by the CNA group, along with BCMHSUS, with the health authorities, to try and figure out what we can do with the transition age population.

What I’ve also noticed, and what we have noticed at the PHSA, is that the age group keeps coming down and down in terms of overdose and risk and overdose events. We’ve seen children at the age of 13 dying of overdoses, which is really disheartening. There’s a lot of upstream work that needs to be done. I’m really glad about the prevention, really glad about the youth mental health, the discussion around it.

The key thing is to look at all age groups. Sometimes people do address those things with youth, at the young adult age, but sometimes people don’t address these things for a very long time. We have a continuum, a stream of population, where they never had the support — like I was hearing from Fiona earlier on — to say: “What happens if somebody with addiction issues or mental health issues…? If they want help, where do they go?”

It doesn’t matter what age they are. We don’t have services that are equitable, that are available all across our province, all across our regions, whereas people with acute medical care or chronic medical care have the means to go and address and approach it. Beyond stigma, the lack of availability of services is really disheartening.

Youth are an important area. We are working through those things in the service model to try and see and map that transition age population, but more has to be done. The integration of mental health and addiction has to happen at that level. We can’t be subtle in that approach. More work needs to be coming in that way.

D. Byres: To your second question, Shirley, just in terms of PHSA, what I would say is…. While traditionally and historically, there had been work happening at each site, there hadn’t really been, to the point we’ve all been making around that integration and whole-system response, that across PHSA.

In response to the coroner’s recommendations, there now is…. All of the agencies and groups have come together. It’s being led by myself and Dr. Gustafson, and we are developing work and actions based in response to what the coroner is recommending. That will be for PHSA itself.

In addition, the CEOs of the health authorities have also begun discussions around what we can do collectively, in terms of sharing what we’re doing and helping to advance that idea around that integrated system and really building off the expertise that exists in pockets around the province and how we create the right kind of pathways and connections. What do we need to do? Of course, we will need to do that in collaboration with our colleagues in both ministries.

F. Dalton: Briefly, in terms of the question about youth mental health, we agree. My colleagues from the Foundry say…. Across the province, they think that rates of anxiety and depression in youth have gone up 30 to 40 percent through the pandemic. That’s a big number.

In terms of the death review, yes, there is a formalized process. We’re doing that in partnership with VCH.

[2:45 p.m.]

I wanted to just reiterate what David said. I think the really important thing is…. Our CEOs are all saying: “We need a provincial system here.”

To follow on, on my kind of cardiac thing, at points in COVID, when the Lower Mainland was really under pressure on ICU, we moved some cardiac patients over to Victoria, on the Island. When Prince George gets into trouble, they send to St. Paul’s. We’re always happy to help.

We need to have the same in terms of addiction services. Wherever you are in the province, if you say: “I’ve got a substance use issue. I need help….” Whether you need out-patient or in-patient help, whether you need detox, recovery, anything, we need to be able to say: “Yes, we’re ready.” Saying, “Well, yes, that’s fine, but there’s a waiting list. Come back in six months,” doesn’t work. It’s not acceptable.

P. Daly: Thank you for your questions.

Just to address the first one, around youth and speaking about prevention…. I’m a prevention physician, so this is critically important to me. We know we have over 100,000 people at very high risk of death from illicit drug toxicity. These are people with severe substance use disorder in our province. The thing we need to do for those people, of course — the most important thing — is the safer supply initiatives, improving treatment.

We’re standing at the bottom of a waterfall, and it keeps getting bigger. If we don’t focus on prevention…. As I said, no matter what we do — and we’ve responded somewhat incrementally — that number is growing.

The data that Dr. Jat Sandhu talked about…. The impact of the pandemic on young people, in particular, could create a whole generation of people that are going to be at higher risk for substance use disorder, in addition to the data that he didn’t mention. More and more people were using psychoactive substances during the pandemic because of the stress of the pandemic.

Now, when I speak about youth…. We have seen…. Vivian knows this, because we talk about this at our senior team every week. We’re getting more visits from young people. These are people that are in crisis with mental health issues, as young as ten to 14 years of age. I’m talking about moving more upstream.

We’re not actually seeing a lot of young people dying of overdoses. Of course, it’s concentrated in the young adult age, the 30- to 59-year age group, with an average age of death of 44. But we know that things that happen in early childhood, at a time when the brain is developing — and Dr. Tyler referred to this — amongst young adults can put them at risk for both mental illness and substance use later on.

Early childhood development is probably the vaccine against mental illness and addictions. Of course, that would take a generation to reduce the risks.

The reason why I talk about the urgent need to focus on young adults is…. We’re already seeing these young people coming into our mental health services. We can’t cope with it, even in the Lower Mainland, where we have access to the Children’s Hospital and other resources. I’m sure it’s an even bigger problem in other parts of the province.

I want us to have programs that engage youth, not just those coming into those services but youth in the school setting, so we can identify…. There are experts in our schools — we’ve underfunded these programs, historically, even though we know that they’re very skilled — who identify youth who may be vulnerable to problematic substance use and work with not only youth but with parents, with teachers, with the school system.

The program that the Vancouver school board has had for many years is called SACY, supporting and connecting youth. You can go to their website to see the great work that they do. I think they have a program that leads the nation in many ways, but it’s always been on very soft money. It’s not well funded.

These programs need to be in all of our schools. Young people are starting to go back to school and engage. Given the last two years, I don’t think we can predict the impact that will have on young people. As we talk about the importance of those currently at risk…. We can’t forget about those people. Much of what you’ve today is about addictions care, safer supply. We need to have an equal focus on supporting these young people, building their resiliency so that they don’t develop problematic substance use.

Now, in terms of the coroners death review panel…. Actually, looking around the room, I think I’m the only person here who was part of the coroners death review panel. I will say…. I know that the coroner has presented to you. I think there is a frustration on the part of the coroner. We’ve had two public health emergencies — one declared in 2016 and one in 2020. The response to the COVID-19 pandemic has been very different than the illicit drug toxicity crisis.

I don’t think we can blame government for that. As I’ve said before, there is a stigma associated with substance use — people have talked about this very eloquently — that prevents us from viewing it as the same problem for all of us as it might be for those who are at risk.

We, in Vancouver Coastal Health, took the first coroners death review panel very seriously. That’s why we established our regional addictions program, as Miranda Compton mentioned. We recognize a lot of…. Addiction medicine, as Fiona Dalton has alluded to, is a relatively new speciality. We’re very fortunate to have amazing expertise in this province. Rupi Brar is one of those experts, the B.C. Centre on Substance Use.

[2:50 p.m.]

Historically it was part of a mental health and substance use program which was primarily run by psychiatrists. You’ve heard Dr. Nel Wieman, who’s a psychiatrist, talk about it. Psychiatrists haven’t received training in addiction medicine. That’s not Rupi Brar’s background. Most addiction medicine is provided by primary care doctors who have got some expertise now in addiction medicine. It’s a relatively new area.

I think we have to…. These are not the same crises, and I’ve talked to the ministry about this. I’ve been involved in the pandemic response for two years. While the coroner wants us to replicate the pandemic response in some ways, I would argue that the illicit drug toxicity crisis is much more complex than a pandemic.

I’m a public health doctor. We know how to manage communicable disease outbreaks. One of the greatest miracles in the history of medicine, the development of a vaccine within one year of identification of a new virus, was the solution. If I had a vaccine that could prevent addiction, we would be focusing all our energy into that. We know how viruses are transmitted. This behaved like other viruses. We know the cause. A single cause. It was a virus. We developed the vaccine in response.

Think about the illicit drug toxicity crisis. Think about the groups of people who are at risk. It ranges from Indigenous people with their intergenerational trauma from colonialism to people who may have had early childhood trauma. Many have faced sexual abuse or other early childhood trauma, if you speak to the physicians who have these patients in their practices.

You think about the people who may have started on opioids, as Fiona Dalton mentioned, because they were responding to a workplace injury, for those who work in the trades. It’s a very multifaceted problem. The drugs, now, are becoming much more complicated. It’s not one drug. It’s not just opioids. We can’t just replace the illegal opioids with prescription opioids. We have people using stimulants. We have severe alcohol use disorder. Benzodiazepines contaminating the system.

This is a much more complex problem. I do think…. The CEOs now have said: “We are going to respond to this together.” I’ve heard the same direction from Vivian. She can speak to it. As both David and Fiona have mentioned, the two ministries — the Ministry of Mental Health and Addictions and the Ministry of Health — have a joint position who’s now coordinating the response to the coroners death review panel.

We are in the process, just in the last couple of weeks, of putting together a response, and there’s going to be a working group — I’ll be sitting on that working group — that will help ensure that this response is coordinated. I think that’s a really big step forward. I’d like to thank the CEOs of the health authorities and the deputy ministers of the two ministries for putting that response in place.

You may want to address that, Vivian.

V. Eliopoulos: No, I’m good.

N. Sharma (Chair): Did you want to jump in here, Fraser Health Authority?

N. Peters: I think I would just echo what everyone else has said. I think we are, as well, seeing an increased need for services for children, youth and young adults. I think for Fraser Health, it’s a combination of a rapidly growing population…. We have a very young population in Fraser Health. There are more children under the age of 18 than all of the population of Vancouver Island that live in Fraser Health. That’s one of the challenges we have: just the young population, compounded with, I think, the impacts of the pandemic. We’re starting to experience that.

I think any continued investment in this area….

[Interruption.]

Am I over time?

N. Sharma (Chair): No, I’m not sure what…. Go ahead.

N. Peters: We’re pleased to see the introduction of a Foundry in places like Abbotsford and Surrey, and it’s been a pretty critical part of the service. I know the Pathway to Hope has got additional funding and resources, and we welcome any investment in helping youth and young adults in our community.

In terms of the coroners death panel review, I would support, as everyone said here, having a provincial strategy and approach. I think collectively, just like we did during the pandemic, would be ideal.

S. Furstenau: Woof, there’s a lot, as usual. Stigma has come up a lot in all of the conversations we’ve had, all of the presentations we’ve had. Talking about drug use on a continuum, talking about drug use being, at one end, a substance use disorder, and at another end, recreational, and that people are using a variety of drugs. Some of them….

Many of us might go home on the weekend, or even tonight, and have a glass of wine. Nobody’s going to tell me that I need to go seek medical help for that.

We’re talking about the impact of stigma, the harm of stigma, yet we keep coming back to fixing people, to treatment, recovery. I recognize that that is an essential component, but I’m also concerned that we’re reinforcing a kind of stigma here, that there is this….

[2:55 p.m.]

Of course, we’ve mostly heard from medical professionals and medical agencies so far. But the orientation has been very medicalized. For a lot of people, we’ve also heard that accessing the medical system is going to reinforce experience of trauma that they’ve had in that system.

So there’s a complexity here in even how we’re hearing about this issue writ large. I think it tends to funnel towards this point of: “We have to treat people. They have to recover. They have to be cured.” But we hear other input as well.

How do we navigate that? I’ve heard from several of you today and from other presenters…. We’ve heard decriminalization. We’ve heard legalization today. How do we walk this line of not reinforcing the stigma that is there in the work that you’re doing and in the work that we’re trying to do — recognizing, of course, that there’s no one-size-fits-all approach to this? I don’t know if you can comment. I’m just really struggling with: are we reinforcing stigma right now?

I. Tyler: I’m happy to provide a few thoughts. Really, just reflecting on your question, which I think is an excellent one, I struggle with this myself all the time. I struggled with trying to find just the right language for my presentation today to try and sort of ensure that we weren’t being stigmatizing in the language that we used.

I think all the things you brought up are real issues that we all struggle with. The treatment component will always need to be there in one way, shape or form. But I know that in my day-to-day interactions going back to my role as a medical health officer working with municipalities in trying to promote the health of the population in my municipalities, the vast majority of what I hear is relatively outdated thinking around addiction and mental health in general — that people did it to themselves, need to get over it or shouldn’t have been dumb enough to use drugs in the first place.

I honestly believe that it’s that level of culture change that I try to allude to, which is one of the first steps. I think we need more and more people to lead by example in terms of being able to turn that around and understand the issue as a chronic, relapsing disease.

I hear what you say about medicalization, and that’s going to happen because a lot of us have “doctor” in front of our names. It may be one step in the right direction away from that very old-school attitude around this idea that it’s a moral failing.

Maybe, once we’ve actually moved everybody past that kind of thinking, then we’ll be able to demedicalize and normalize in yet another way. But that prevailing attitude around moral failing is very disruptive, very difficult, and, as I said, actually prevents us from delivering the next step, which is some of these medical and prevention treatments that we would like to be able to do in our communities.

P. Daly: This is an excellent question, and I think ad­dressing stigma will be an important, hopefully, outcome of the work that you’re doing. I think there is…. First of all, I will say…. This is kind of an odd habit, but I look at the obituaries every day in the newspaper. You’ll see that when someone dies of cancer, they battled cancer. It’s heroic. People aren’t blamed for getting cancer.

I look at the people who died who are young adults. “Died suddenly.” Almost never do people even acknowledge that their child has died of illicit drug toxicity. Even there, there’s shame in the deaths. We have to stop that. That shows you the level of stigma that exists in our society. You’ve acknowledged that almost all humans use psychoactive substances in some form. You, carrying a bottle of wine, will not get arrested for possessing that on the street. This is a consequence of prohibition, which is really at the heart of a lot of the illicit drug toxicity crisis, which we do need to address.

[3:00 p.m.]

I don’t know that the federal government, at least this federal government, will address it, but right now you can be arrested for even very tiny amounts of a number of substances that we know contribute to illicit drug toxicity deaths. I’m in favour of decriminalization because it can help address stigma. We’ve been fighting over it for years. I recommended this in the chief MHO report in 2018. The provincial health officer recommended decriminalization in 2019. We’re years later, and the amount that you can possess without risk of being arrested right now is still zero.

I know drug users would like for the amount to cover everyone who might be possessing it for personal use, but police have some concerns. My advice: start with whatever the government will agree to, even if it’s low. Evaluate it. Show that it doesn’t lead to harms. I know Dr. Gustafson talked about this. We can do that; that’s what we did with Insite. Then we can bring people on board. We can increase it, but we need to start.

Decrim is important. It won’t change the toxicity, the underlying illicit drug supply, but it’s to address stigma. Stigma is a much broader issue. We even have it within the health care system, as you alluded to. Dr. Brar talked about doctors that try and wean people off their opioid agonist therapy because they think they shouldn’t be on opioids. If these people have an addiction, it’s a chronic relapsing condition.

I didn’t used to like the term “recovery” for the same reason that you’ve questioned it. It implies there’s a cure for this and that we should be able to get off these substances at some point. You’re at highest risk of death if someone weans you off your opioid agonist therapy. David alluded to this. You can even be on heroin and live a stable life. So we need to get past that and recognize that this is a chronic relapsing condition. That’s part of the stigma that we need to address, but it’s complicated.

I don’t know, Rupi, if you want to speak with it, because you deal with this on a daily basis.

R. Brar: Sure. If I could just add a comment on what you mentioned about people that just want to use substances. It’s centuries old; people use substances. We’re drinking caffeine right now, like you pointed out. So to say, with this drug toxicity crisis, now if you change the lens…. Even physicians and other health care providers are saying: what about those people too? It never used to be such high rates of death, and now we’re worried about everybody, even those that use maybe once every six months. So that’s why this non-medical safe supply piece of the continuum that all my colleagues have spoken about is critical.

Then that treatment piece, low barrier, is also important. Like Dr. Tyler said, we need to have treatment. It always needs to be there for those that develop problematic substance use. When their use starts to affect their work, their family, their lives, they would want to enter into treatment that is evidence-based and holistic.

That’s what we need to keep working on as a health authority, but we need government. We need drug policy change and elimination of prohibition with good regulation. We don’t want opioids at the street corners, but we want to be able to provide it to people that need it, along with prevention.

That actually may even address that whole piece — that we are looking at those who want to use cocaine once every six months, or that mom whose children are away for the weekend and decides she wants to use a substance that isn’t regulated but can get a safe supply of it and still be able to care wonderfully for her children. That’s the society we live in, and we have to accept that.

Then just destigmatizing…. The literature talks extensively about stigma, and one of the key pieces they recommend is the education. We need to start talking about people who use drugs as normal people who provide for society. Right now we talk about people who use drugs as those that are in and out of jail, living on the street, severe mental health problems, and share concurrent disorders to a high degree. But many people who use drugs don’t have a mental health problem, so it’s unmet trauma needs and different things.

P. Daly: Yeah. I think one of your challenges will be for young people, because a lot of what we’ve talked about is adults who use substances. What about the young person who is going to experiment?

One of the things we have to acknowledge is that young people are going to experiment. I’ve spent my whole career trying to reduce psychoactive substance use among young people and, for the legal substances that were not regulated strongly enough 25, 30 years ago — alcohol and tobacco — to try and increase the regulation around those. I’ve been to city councils where I am opposing some of their proposals to make alcohol more readily available, while at the same time supporting legalization of cannabis. I wanted to understand the differences there.

So I’m aware of the fact that we have to get this right. I don’t want to see, with a model that provides a safer supply, that more young people begin to use psychoactive substances in a harmful way. But we have to acknowledge they’re going to do it. I’m the parent of three children. If they are going to use substances, I don’t want it to be a substance that’s illicit that may be highly toxic. You hear about these deaths as well.

[3:05 p.m.]

But that’s going to be one of the challenges you will have. We have to get it right. Even if we talk about co-op clubs and compassion clubs, we’re not going to say: “Young adults: first time you want to use, come here.” We’re talking about people there who have problematic substance use. So we have to keep this in mind, and that’s where we need to also focus initiatives on young people and ensure they make good choices, recognizing that they may experiment, but we want to reduce the harms associated with substance use.

F. Dalton: I completely agree. I’m reminded of when we decided, as a hospital, that it was the right thing to do to have an OPS on site. That was a difficult, important decision, and I think we’re still the only Catholic hospital in the world that has one of those. There were members of the board who were concerned that this might encourage more substance use, and the analogy was made that, well, if there was a bar in your apartment block, you might drop in and have a few more drinks. I could see that that could be me for sure.

We actually went and spent some time and had the board talking to people in the OPS. What was really clear was that there was no joy here. These were people who we were providing an essential service for and were absolutely seeking treatment and wanting to be looked after and treated.

I absolutely recognize that there are a group of people who don’t want to be treated, and we should absolutely respect that and create a safe environment for them. But there are definitely a group of people who are saying: “This is absolutely disrupting my life, my family life, my work. Please help.” That’s, to my mind, also a real priority — that we need to be able to say: “Yes, we can help.”

J. Patterson: I guess I’ll keep my remarks pretty simple, but I completely agree with your question. I think we need to disentangle substance use and the paradigm shift around substance use as being normal versus substance use equalling addiction or substance use equalling a health issue. I think we need to target public campaigns that really speak to this and recognize that we all use substances and that we’re going to continue to use substances.

V. Seethapathy: Just a quick comment. I think it’s a very complex question. That’s what I would have to acknowledge. The most important thing I would say is…. I don’t want to kind of bore with the same answers that have been given, but I just want to add a couple of points to it.

One important thing, as a physician myself, it’s not about medicalizing the problem. There are people who use substances, including nicotine, alcohol, other substances. There are people who have been using substances for centuries, like other people were saying.

In the medical world, the way we look at a disorder or a problem or an illness is when they have a global impact on the functioning, on their ability to kind of take care of themselves and function themselves well. So people could have a low mood; that’s not classed as depression. People could have a stress; that’s not classed as an adjustment disorder. The disorder kicks into play when the global functioning is affected all around. That’s where the substance use, the problem, kicks in.

People are using recreationally, and they don’t lead into any major issues, no impact in functioning. That’s been happening for years. Once it starts to have an impact, once we see people dying, six or seven people, and we talk about 100 overdose events happening every day and BCEHS calls coming through, you see a large impact that’s happening. That needs to call for a different shift in how we look at things.

The stigma is not going to be just brought in by medicalizing the problem. I think it’s a larger and a complex issue. Like we’re saying, this has been happening in mental health, too. People don’t want to listen to the mental health issues, leave along addiction for a minute. So this is a complex issue, and we all have to work together in a multi-pronged way to see how we address the stigma.

Medicalization…. I wouldn’t use the term at all — first of all, kind of move it away and say that this is a large impact we’re having. We are in a crisis, and we have to do some action. We have to take a multi-pronged approach, including the medical model and treatment that’s available.

D. Davies: Sorry I was late. My name is Dan Davies. I’m the MLA for Peace River North out of Fort St. John.

One of the things we heard this morning, as well, from the presenters and loud and clear now — and it really scares me — is the impact of the pandemic on the youth. You know, I’m hearing the trajectory for many of those youth. There are concerns raised.

[3:10 p.m.]

We talked about the SACY program. It was just mentioned — something here that’s helping. Interior Health mentioned they have the PreVenture program, which is another one. But this is a problem that’s in Fort St. John, in Burns Lake, in Terrace. So my concern is that this is going to be an issue that’s emerging.

If you had the magic wand, what is something that government can critically do right now to help head this off? Again, we’ve heard Foundry. But Foundry’s only in a handful of communities. SACY is here. PreVenture is only in a few areas. What is something that government can immediately do to help redirect these youth at risk? That comes from me as a former educator as well as a dad. It worries me a lot.

I don’t know. Whoever.

N. Sharma (Chair): Okay. Why don’t we start…?

Go ahead. Why don’t you start, Dr. Daly.

P. Daly: I do think that focusing on schools is what I would recommend. I mean, we deliver immunization programs in schools, and we get incredibly high coverage, because you have youth…. You’ve got a captive population there. The SACY program and the Interior Health program — these are not expensive programs. There’s expertise there, with funding.

I think working with the Ministry of Education to develop modules that could be delivered across all school boards with the expertise that we have in the province in a number of areas is something that could happen relatively quickly, so I would definitely…. This is not medicalizing the problem. This is working with the educational sector. It’s working with parents and families and other organizations as well. So I strongly recommend that we…. And we start at a young age.

The McCreary society is a society that we’re working with in Vancouver Coastal Health as well. They do a survey of youth in schools, and we’ve used that data for a long time to track substance use, for example, among young people, among other things. So there are a number of organizations out there who could be brought together, and this could happen relatively quickly. What we haven’t had is funding that we’ve been able to direct towards these services, either through the Ministry of Education or through the health system. Because we collaborate on this.

So I do think — and others may have thoughts on this; Ingrid, you may have thoughts on this — that these kinds of programs would not take long to implement and put in place. What we would then do is be able to be upstream and build that resiliency among young people, especially now, at a time that’s so critical, because they’re so vulnerable coming out of the pandemic.

V. Eliopoulos: I was going to say, it’s such a great question, because when I think about acute care services or operational services, I always ask the question: “It’s Christmas Eve. It’s 3 in the morning, and you need to access some assistance. What do you do? Who do you speak to? Is there a service in your community?” I think that so often, we forget about our rural and remote communities and our Indigenous communities, where access to care can be difficult, whether it’s acute care, whether it’s community care, whether it’s prevention services, etc.

I think the thing to think about is: where do you have broadest access to services across the province? How can you utilize the infrastructures that are already in your community to provide services or create access to information so that youth etc. can actually find those services? The suggestion of schools is a good example. We have schools in most communities. I think that we need to…. We often talk about our large urban centres, and we don’t think about our rural and remote communities, where we have youth and adults who are really looking for services.

I also think, through the pandemic, we really understood how to use technology to push out information, in particular to youth, when we were talking about immunizations, access to information, etc. So I would also suggest using different types of social media to communicate with our youth to make information accessible and make those connections accessible for them.

N. Sharma (Chair): Fraser Health Authority, did you want to jump in?

Go ahead.

I. Tyler: Yeah, thank you. I think I’m probably just going to say exactly what Vivian said, but maybe in slightly different language. I do think we need to support — be able to have people seek help that they need early and understand that it’s okay to seek help if you’re feeling anxious or if you have a low mood, because I think that that’s when kids, especially, need to be able to seek help.

I know from personal experience that to get a private counselling appointment, the wait-list is about eight months. Public services — you’re not going to be able to get them until you’re in crisis, basically; that’s what I’ve experienced. So I do think that that’s something that…. I don’t know if it’s a quick fix, but I think that that’s an important part of the issue.

[3:15 p.m.]

But with that needs to come a lot of that information and education that people know what to look for. Support for parenting services. Support to parents on how to manage the mental health issues that might come up with their kids and how to escalate those appropriately and then have those services available if escalation is needed, even really early escalation for that kind of support. I do think people are left to themselves to handle their mental health for far too long, and that is a probable contributor.

D. Byres: I was just going to add, in terms of your question on what you could help us with, at the beginning, I think every presentation highlighted the need for a multisystem approach. You’ve heard the need to have not just Health involved but Education and other ministries, other parts of the sectors working together to be effective.

We can then leverage what a lot of us have in terms of virtual health and digital health platforms if we also have the ability to access additional psychological supports. So it doesn’t matter whether you’re in Burns Lake or wherever you are. Through virtual health or other mechanisms, we have the experts. We can distribute them, virtually, all over the province, to be accessed in schools or otherwise. But to Dr. Daly’s comment, we haven’t had the funding to be able to do that or the ability to pull those people together and then create a platform to make them accessible across the province.

So we do, I think…. Underscoring all of these comments is that we need a multisystem, multiministry approach, working together to be successful.

V. Seethapathy: I want to just quickly emphasize the point that David was saying. I think the psychological and the behavioral therapies are such a key thing to support early, particularly when we’re talking about prevention and early intervention in relation to all of the interventions that we can use. It has been clearly highlighted that we don’t have that currently available to our system of care.

We have medications covered. We have other hospital services covered. But if you look at most of the illnesses or most of the problems or most of the issues that come up, a simple behavioral intervention — a brief intervention is what we call it — is, first and foremost, really the key, and we don’t have that coverage right now that is available. So I think that’s a key thing. We need to be really looking at how we do that.

Also, just one more thing I want to add on is that it’s extremely difficult to put an emphasis on just one thing as a magic wand, like you’re going to fix the problem. We have to, first of all, recognize that this is a complex issue. We have to do a multipronged approach and a multisystem-level approach, like David was saying. We need to have a larger oversight and governance to do this work. If we don’t do that — if we’re going to just do the band-aids and quick fixes — we’re not going to really solve the problems, going forward.

The last thing I want to emphasize is that we really need to work on a target or benchmarking. I’m a big fan of benchmarking. If you look at cardiac care, orthopedic or surgical care, we always have benchmarking for all of them to say: “Within so many hours, within so many things, this is our target.” But if you look at addiction care — access, the timeliness — we don’t have benchmarking. We need to have benchmarking. We need to really, regionally and provincially, have that equitable access all across, for all our interventions that we’re doing. If we don’t have a target or benchmarking, we’re just really shooting blind.

N. Sharma (Chair): Okay. Thank you.

MLA Chant, go ahead.

S. Chant: Thank you. I think my question is probably just way too simple for this group, but that’s okay.

Dr. Sandhu, you spoke, when you did the COVID surveys, of resiliency measures that you were looking at. Can you dive a little deeper into what those community resiliency measures looked like? Maybe give me some help in thinking about how we can look towards developing those in schools, in all sorts of different ways. I think everybody’s got a different idea of what resiliency is right now, because we’ve been using it so much. So perhaps you could help me there, please.

J. Sandhu: Sure. Thank you. That’s a good question.

I think, within the COVID SPEAK survey, we really looked at resiliency in a number of different ways. I mean, the self-reported mental health and well-being…. There are aspects around stress, feelings of stress. There are also aspects around your sense of belonging to community. And sense of belonging to community…. It’s a really powerful measure of how engaged you are within society, within your immediate social network, and it’s been shown to be a very good proxy for those…. A higher sense of community belonging is shown to be associated with more positive lifestyle behaviours.

[3:20 p.m.]

Those are the kinds of things we look at in the survey, including your social connectedness to family and friends. As you can imagine, during the pandemic, all of these deteriorated significantly. Then we also look at the financial security, the food insecurity that exists, as well, within households with children. Again, all of those measures deteriorated.

I think, going back to the previous question, there’s a really great opportunity to invest in children and adolescent supports at the school level. It is a captive audience, and I think that’s the opportunity. Children and adolescents are going through a critical period of social, emotional and physical development during those years, and having the adequate supports in place to make sure that they can thrive, together with their families being partners in that, I think is really the avenue that we should be looking at as one of the approaches.

R. Leonard: Thank you all very much. Your presentations have been a little bit different in their nuance compared to this morning, when we heard from the more rural and remote communities. As MLA Starchuk just said, those are in close proximity to each other, so you probably have a little bit of synergy at this table.

I really appreciate the comments around this crisis being different than COVID, because in my mind, it has been an apples-and-oranges kind of comparison. The one thing that’s the same is the sense of urgency.

I want to marry that issue around timing with the common thread we’re hearing about needing timely data. So I want to know what kind of data it is that you’re looking for. What are the barriers to getting it, and what are the consequences, with respect to protection of privacy and the impact on engagement with people in the system?

N. Sharma (Chair): Okay. That sounds like a full-panel-response kind of thing. So why don’t we start over here.

J. Sandhu: Sure. I can start.

I think one of the issues that we all recognize is that each health jurisdiction holds data assets, and to a certain extent, some of these data assets can be integrated at the provincial level, just the way the data flows together. But there are certain data assets that are held more in silos, and I think part of our data gaps is the integration of all the data assets. That’s one thing.

Secondly, it’s a timeliness issue. The timeliness really relates to…. There may be natural lags in the way that the data is collated and made available — for example, the coroner’s data. We’re still looking at the current crisis using 2020 overdose deaths. They haven’t been integrated with all the broader health administrative data that’s available.

That is a timeliness issue that comes from just a natural lag in getting the data but also just from the fact that in the past two years we haven’t had the same focus on this. We’ve invested a lot in the infrastructure for COVID-integrated data across the continuum of care, but we haven’t necessarily done that in the same complete way, in the timely way, for overdose. So I think there’s an opportunity there.

The other aspect — and I can invite my regional colleagues to speak to that as well — is that if we think about the continuum of care, we have different information systems that capture different aspects of that continuum of care. What is held provincially can be more easily integrated, but what may be held regionally that provides us with the perspective — the perspective that resulted in the chart reviews that gave us valuable insight into what was going on — is information that isn’t as easy to integrate, because we have different information systems at regional levels across all the health authorities.

F. Dalton: I think it’s a big question, because there’s so much data that would be useful. Just a couple of things I would suggest. I think a fully population-based cascade of care…. We need to know the complete number of people who are using opioids, people who are connected into care, people who we have on opioid agonist therapy, people who we had but now have lost contact with, etc. That helps us know where the gaps are. Where should we be really focusing our effort?

[3:25 p.m.]

Then one of the things I thought was really helpful for COVID — and I completely agree that they’re not the same thing, but there are some parallels — was really real-time information. We knew what was going on and what was happening on the North Shore and how that might be different from Richmond and different from Prince George, or the same. You could move around. I think if we know in real time, we should know where capacity is. So if someone needs detox capacity, where is the detox capacity currently in B.C.?

In the same way as we know where the empty ICU bed is, we should know that. We need to be able to coordinate across the whole province on that. Then we also need to know when we’re losing people, like in the anecdote I had earlier. If someone is on opioid agonist therapy, and they don’t come and get their prescription — they haven’t shown up — someone needs to be going to find them. I think near-real-time information would make a massive difference in this situation.

P. Daly: Well, I have a bit of a different response. First of all, I meet with my colleagues across the country. We have better data in this province around this crisis than any other province. There are some provinces….

I want to give credit to the coroner. On the coroner’s website, there are reports that come out now, up till the end of March, with very detailed data, down to quite a small geographic level. No other province has this. Many of my colleagues across the country are two years behind, even in terms of their coroners’ data, the quality of the data that we get from Lisa Lapointe and her team. I want to acknowledge that.

I want to acknowledge the B.C. Centre for Disease Control and the dashboard that they have put together, with real-time data. That includes the coroner’s data. It includes the EHS data, the ambulance data. It includes the number of people who are on opioid agonist therapy, by region. It includes the number of prescribers. So we have better data than any other province.

We also have real-time data, by the way — to your point, Fiona. In addition to what the coroner has, which goes up till the end of March, we — now, this doesn’t exist all across the province — have relationships with our local police force. They report likely overdose deaths to us, on a weekly basis. We don’t have to wait a few months for the coroner. This correlates very well to what the coroner eventually finds. The Vancouver police department attends deaths, and they classify them as likely illicit-drug toxicity or overdose deaths. They report those to us.

We have local data from the fire department that identified, for example, when they respond to overdoses, that you’re more likely to survive in the Downtown Eastside, despite the high death rate there, because there are more services. We have real-time data, and we have a very good cascade of care here in this province. We alluded to this quickly. It was put together by Dr. Bohdan Nosyk, who works at the B.C. Centre for Excellence and also at Simon Fraser University.

Using a lot of government data — he was given access through the provincial government to incredibly detailed data — I have a cascade of care for people at risk or who have opioid use disorder, not only for my whole region but by each of our health service delivery areas. It shows the number of people, how many have actually been diagnosed, how many are on treatment, how many have been retained for three months, six months or a year. We have great data.

The area where we’re lacking — I’ve heard others talk to this as I listened to some of your previous presentations: we don’t follow people well across the continuum of care. Some of this is due to the information systems that Fiona mentioned. I know you’ve talked to the coroner about the different options for treatment for people.

It’s not just in the health authorities. Think about recovery homes or places that offer recovery services — many of which grew up organically. They’re often run by private citizens. We have no idea of what the outcomes are with some of these programs. They may know how people are when they are discharged from their two weeks’ stay or three months’ stay, but we don’t know what happens to them in the long term. Given that substance use disorder is a chronic, relapsing condition, we need to be able to track people across that continuum of care.

By the way, Fiona mentioned the B.C. Centre for Excellence. This is something that they have done very well. It has allowed us to be probably the world leader in reducing the rates of HIV through a system of care. They have a cascade-of-care model, but they also track the people who are on antiviral treatment for their HIV. If they fall off their treatment, the health authorities go and find them and bring them back into care. They do that for their whole life, because this is a lifelong condition.

We need to have systems in place that can track people across that care continuum. There are many, many really good things we’ve done with data, but that would be what I would identify. I don’t know if you have any other comments.

D. Byres: The only thing I might add, Patty, too, is that the data is part of it, and then it’s how you interpret and use the data. To your earlier comment about needing a public health approach to this, which I absolutely support, we also need our public health experts to help interpret that data so that we are providing the right intervention. Sometimes it’s not always the data, but we don’t avail ourselves of the experts to interpret what we should be doing with the data for the right intervention.

P. Daly: I think that’s exactly right.

N. Sharma (Chair): Did you want to add something?

[3:30 p.m.]

I. Tyler: I was actually going to make the same point David just made, which he did very eloquently. The only other note I have here that hasn’t already been covered is around…. We mentioned different types of data. Data is not one thing. There has been some allusion to the evaluation and research data. We have a lot of data. We don’t necessarily follow it through well. We don’t always analyze it.

I think that if we’re going to invest anywhere, we do need a lot more investment in the appropriate analysis of data, so we draw the right conclusions and take the appropriate next steps and, as part of that, ensure that we have the evaluation and the research on both ends of the spectrum.

Somebody earlier today mentioned that we do a lot of pilot projects. I think that’s great. But we need the implementation science and the upscale part, all of which…. I hear all of that when I hear data, not necessarily just the performance monitoring or benchmarking, which was another excellent point, that we need that too.

M. Starchuk: Thank you for your presentation. I just want to make a comment because it was said this morning with the other authorities. You had said it here — single-point access. I refer to it as a concierge program. It also touched on the issue of stigma. You simply get into the system. You tell your story once. You don’t have to tell your story seven times and be traumatized every time you tell your story. I really hope something like that comes out of the system.

My question is relatively simple. It came out with Fraser Health’s presentation, and I guess it applies to everybody else. It was the issue around a user fee and how that becomes a stumbling block to somebody that may be seeking treatment in some way, shape or form.

N. Sharma (Chair): Who wants to start?

N. Peters: Maybe, though, just to your first comment. I think it’s an important one as well. I’d say that generally we need to do a better job in that area of central points of contact in many services, not just in this area. I think one of the biggest complaints we get from seniors is trying to access care in a timely way and a coordinated way, so anything that we can do to improve the experience of people trying to access services is critically important to us.

To touch briefly on the user fee, I think those present real barriers, especially for people in low income, from getting treatment. We don’t want to put up more barriers than necessary, especially when dealing with something like this.

R. Brar: I was eager to answer the user fee question because I see those barriers every single day. It’s not just in Fraser Health. We have it in our health authority and, I think, across the province. In fact, I recently had a patient from the Island who was actually not using anymore on a dose of Suboxone and couldn’t afford, on their low income, to continue to pay their virtual doctor on the Island. That actually goes against our Medicare health act, in fact, to charge for a medically-covered service.

It continues to happen. It’s sort of this historical process. The way that user fee is happening legally is that they’re claiming they’re also going to provide counselling services within their OAT clinic. Often people don’t want that service. Whether or not it exists, I can’t speak to that. But I can speak to the fact that people are falling off of their opiate agonist therapy and encountering a high risk of death because of these user fees, and they continue to happen throughout this province, and it shouldn’t be happening.

At the rapid access addictions clinic in the Downtown Eastside, the Connections Clinic, we see people every day who detach from their provider because, that month, they can’t pay the $30 to $90.

V. Seethapathy: Just a quick comment about the single point of access. I just wanted to comment on that very quickly. There’s a model which I’ve come across in New Zealand where they call it the first line of defence for mental health and addiction. They also did this big work in COVID. The New Zealand telehealth service is a nationally run service. They have a final annual report which has shown fantastic results.

I think, in a way, that we need to have a single point of access for many of the services we have. We should be really, really focusing on that quite heavily. Having a single point of access without having data points and the data about where is what available is just going to be not very prudent. So I think having the data to support a single point of access would be the way to go forward, and connecting people at the right time, in a timely fashion, when they’re actually asking for help, would be the key thing to do.

We do have crisis lines. We do have access lines and access centres.

[3:35 p.m.]

I can give you a quick example. It’s so sad. I’ve seen clients as a psychiatrist in ER. I want to connect them to addiction services. The only way they have to do it…. They have to go the next morning to the rapid access, or they have to call — when they don’t have any phone — the access line to get into addiction care.

It’s a no-brainer to understand the guy who has just taken an overdose and is walking out of the door having to call, the next day morning, an addiction service all by himself without having any phone or any services. That referral should go from anywhere, from anybody. It doesn’t have to be a self-referral. Again, coming back to the stigma, coming back to why the person is using. Is it self-medication, or is it recreational?

Like, in those questions and actions, we should, over all the service, not just have a single point of access. The referral should go from everywhere, from anywhere, and the patient should be able to get the help.

P. Daly: I think we alluded briefly…. I think Ingrid talked about this. We have overdose outreach teams. We do not rely, now, on people to call or seek care. In fact, we actually, early in the crisis, in Vancouver Coastal, ordered our emergency departments to report anyone who came in with an overdose to our team. This is run by Miranda Compton. We outreach those people. We don’t rely on them having to phone or go somewhere, and we connect them to care.

But I wanted to tell you about…. I think any door should be the way in. Absolutely, without a doubt. The health authorities are too complex for many services, as you’ve heard, and we need to make it simpler. Some of these services then rely on people coming to a hospital or an emergency department.

One of the programs that has really been, that we’re very proud of, in Vancouver Coastal…. We’ve worked with Vancouver fire department, who attend a lot of overdoses in the Downtown Eastside. Now you’ve heard — I think you heard this from Fiona — that most people who overdose don’t ever come to a hospital anymore. They’re reversed with naloxone, but how do we then access them and link them to a system of care?

We started a program with Vancouver fire department where they track the overdoses that they treat that don’t go to hospital. With a member of Miranda Compton’s team, the firefighter and a member of our team go and visit those people in their homes to try and connect them to care. You might want to talk about this, Miranda. People are overwhelmed.

This addresses stigma too. This firefighter cares about them enough to follow up, to try and connect them to care.

M. Compton: It’s quite a wonderful partnership because, of course, the firefighter will go and just offer: “I have someone with Health here with me today. We treated you for overdose yesterday. Would you like to talk with them?” The vast majority of the time, people have willingly and eagerly accepted that extra support.

I think it goes back to that. If we’re really wanting to get to an “every door is the right door….” It’s getting to a place of comfort across our service continuum, of giving people the message that their lives matter, that we want to know about their substance use. Whatever support that looks like, they define it. We’re here to provide it.

We did this work in the HIV sector years ago. A lot of the work was about getting people to a place of comfort across our services at every point of care, to ask people about their sexual health in a culturally safe and client-centred way. Now the work is how we talk about substance use with people in a culturally safe and client-centred way.

D. Byres: I just want to add one comment. I don’t disagree with Patty at all, but I don’t want to lose Vijay’s point. I’m speaking now not on behalf of PHSA. I’m speaking as a researcher who’s a co-PI on some research and has been asked to have some involvement with some hospitals or health facilities across the province.

We still have places that are discharging people if, while they’re admitted, they use. There are policies in a number of facilities across the province that don’t support delivering appropriate care to people who have a substance issue, that, to your point, further exacerbate….

We, as health care providers and institutions, exacerbate the stigma that it’s driving. There is excellent work that is happening across this province. I don’t want you to think that there also isn’t huge room for improvement at many of our sites across the province. We are not implementing best practice.

P. Alexis: I think you’re all rock stars. Don’t ever forget that. You guys are just amazing.

I just want to go back to the youth thing. I get parents coming to me whose kids age out. Technically, they become adults. They get cut out of the process. They’re so lost. It’s a very difficult transition for parents, in particular, because they no longer have access to their child’s file or they don’t really know what’s going on.

How do you recommend we move forward with this? This has been an issue for awhile. I do get parents coming to me with this specific issue.

[3:40 p.m.]

D. Byres: My immediate comment, and I’ll ask my colleagues to jump in, is: I share your concern. It is incredibly challenging for our health care providers as well, especially when we are dealing with children and youth — more on the youth side — who are competent to make decisions around their own health. They don’t want their parents or guardians or families to be aware.

The legislation compels us not to do that, not to release that information. We do everything we can to make sure that a youth is making an informed decision, provide the options. But you are undeniably correct that there are tragic outcomes.

I wonder. If we were able to share…. It goes back to: an individual has a right to make decisions around their own health, even if that might put them at risk. We might not make the same decision, but they make the decision for themselves. We have to follow through with what, legally, we are required to do, which is doing everything we can to inform that adolescent of all the options and the risk and doing what we can to inform their parents of what we’re allowed to share. It is a very, very challenging issue that our clinicians face every day.

I don’t know if Justine or Vijay have anything to add.

V. Seethapathy: One other thing I have to say is that in the real clinical world, when we see clients…. I’ve actually had clients that come over to me not just from…. Like comorbid mental health and substance use problems and also mental health issues. There are the system-level challenges and policy-level challenges and the funding stream — how things work up until they’re 18. Then, when they’re just 18, everything is done.

I heard people who had two or three support workers supporting them up until 18. Then they became 18 plus one day, and everything stopped. There is no way we can provide the same level of care, and there is no funding model that’s available.

I think the funding has to support the level of care that the client needs. If they’re 18-plus, that has to follow through. We need a policy chance and a system change for that. We don’t have the ability to do that right now, at the current stage.

That needs interministerial work and policy changes to kind of support the individual to the right level of care, what they need, with the right funding model. It has to follow the client, whether 18 or beyond, plus the other health-related information-sharing and everything else, like what we’re talking about.

D. Byres: It also depends on the clinical area of focus. With our health authority partners, with Providence, we do have programs that span the age continuum. I think of eating disorders, for example. For children and adolescents, we’re providing the service. But to Vijay’s point, once they enter into that more adult age range, then we work with Providence Health Care, and we have a process to transition the care.

There’s no hard-and-fast deadline, like once you’re this age…. We assess their developmental characteristics and where they’re at and their ability to do so. Sometimes that might happen at 16. Sometimes it might not happen till 18. But we work with them, then, to transfer them on to the health authorities.

We don’t, however, have the ability to do that, as Vijay said, in every area. In many instances, they’re lost. Once they hit that magic age, we have nowhere for, then, the care to continue.

N. Sharma (Chair): Anybody else want to jump in on that?

P. Daly: I would say, and I thought David was going to address this, that certainly in the Lower Mainland, where children receive a lot of care at B.C. Children’s Hospital, the age cutoff is 17. That’s a problem for us, because you think about a youth with, let’s say, a mental health crisis — I’ve had families like this — who is maybe one day past that birthday. Do they have to go onto an adult ward in an acute care hospital? It can be a very frightening place.

There are also children aging out of supports they receive from MCFD and others. I do think we need to…. I know that in Vancouver Coastal, when we look at our youth services, we’ve tried to say that youth is anyone under 25. We don’t want it to be such a young age group. I do think that you’ve hit on an area where we need to do better.

Those transitions of people…. That can be challenging, even arranging between health authorities to transition care. But you may want to talk about this, Vivian, because we’ve had it for other things, too.

D. Byres: I would absolutely agree with that. It’s an absolute…. We’re starting or trying to shift, as I was saying, not to look at, boom, “You’re this age, and now you’re out.” It’s really to assess a whole number of characteristics and when it is appropriate to actually do that transfer.

But of course, on the other end, we have hospitals all over the province trying to send children and youth to us and a finite amount of beds. If we keep somebody longer, it just means that referral in Prince George or Kelowna is waiting until they can get to our expert clinicians.

N. Sharma (Chair): I have a question. We’ve had a really interesting day. We’ve spoken to health authorities from across the province, the Provincial Health Services Authority here.

[3:45 p.m.]

What really strikes me, first of all, I have to say, is the level of compassion, commitment and expertise that, clearly, we have in B.C. when it comes to responding to, it seems to be, a very complicated crisis that’s getting worse with the toxicity, with the tragic death toll.

We’re learning a lot about very specific programs. I was very intrigued by Providence, your health care, your program where you have a continuum of care, safer supply, all the treatment at one site. It really seems like there’s a disparity in how these services or programs are showing up on the ground across the province. Also, sometimes a need for a different approach, because it’s more rural remote, if there’s different….

On the other hand, I also see a lot of expertise and cutting-edge, leading programs that are happening in different pockets of the province. I’ve often asked: “What other jurisdictions can we look to?” That’s part of our job, as this committee — to see what else is out there that we could often replicate. More than once, the person has told me: “Well, the expertise is in B.C.” We have this knowledge base and experts that are doing addictions medicine, that are doing cutting-edge programs like the co-op model that we’re learning about for compassionate care and things like that.

Yet there’s still this kind of need to figure out how…. I don’t know if it’s to get it to every corner of the province or adapt it or share information or coordinate. That word also seems to be coming up a lot — coordination, working together, figuring out how to get these to every corner, sharing expertise.

With you in front of me, I would love to just ask you that. What is the way that we better work together to amplify this expertise that we have to address this crisis? What are the tables that we do that at? What are the ways that we get the expertise to the corner of the province, or programs like you talked about in Providence and the research that you’re doing to different parts? How do we fill those gaps, then, I guess — it’s really what I’m thinking right now — to address the crisis that we have? Kind of a big question, but I wonder what your thoughts would be on that.

D. Byres: I guess for me…. At the beginning, I talked about the potential to apply a level-of-service model. What I meant by that is that each of those elements, you would then need to define…. If you define levels of service, what are the requirements in each of those levels? If you have a top level, regardless of what that is, you probably only need that in one location in the province. But then every community might need what’s in the lower level.

You have to start to build that and then integrate them and create the pathways for people, when they need the highest level of care to access it, and be working, I think, with communities or public health experts and means of public health approach. We need to be involving people with lived and living experience so we make sure we’re actually meeting the needs.

I could go into a lot more detail, but in a nutshell, to do that work, you have to have a whole-system response that involves more than health and then leverage the amazing data we have to drive what that is and base it on the evidence.

N. Sharma (Chair): One thing that I also forgot to add to my question, to go back to it, was this beautiful diagram that we’ve seen about the system of care. I feel like it’s a very kind of visionary approach to…. Well, there you go. I have the person. Miranda may be in front of it.

But this idea of creating a system of care that needs to be built up over time seems like a really beautiful made-in-B.C. approach that could leverage all the expertise. I just wanted to add that in there — that it sounds like a….

I don’t want to interrupt, if people want to…. Although I already did.

Go ahead.

M. Compton: I think we were trying…. That’s a framework that we can measure ourselves against. We’ve used that tool to look at our entire region, so to speak, because we do have rural and remote areas of our region. We’re sort of figuring out…. We use it as a tool to identify the gaps, so we have it all laid out. Some, of course, is resourcing. Some of it is reorganizing the way we do things in some of the ways that David is suggesting.

I was just in Powell River last week, and they were amazing in that they had the same continuum that Fiona described. They’re doing…. They have a wonderful overdose prevention site, including inhalation site. They have injectable OAT, one of our only rural programs. They also have some great supportive housing. We were there to talk about a new complex care housing project.

But it’s all in Powell River, and the geographic area that they’re trying to reach is so broad. There are huge transportation issues, and there are very real issues around how people can’t take carries of these medications that they’re relying upon every day, and they’re having to figure out transportation in, every day, to these sites. It can feel overwhelming.

[3:50 p.m.]

I think a provincial mechanism to really break through some of these policy and regulatory barriers, which are really stopping our innovations in their tracks…. That’s everything from some of those compassion club models, which we’re talking about, but also some of the practical everyday — user fees — and just some of the regulations around the substances.

P. Daly: Maybe I’ll just add, from our health authority…. We recently presented to our board. They’ve challenged us. “What are the big things that you could do that will have the biggest bang for the buck?”

You’ve heard that we do a lot of pilots. We have different sources of funding. Even the Hope to Health clinic, which Fiona talked about, came from SAFER funding from the federal government. It was a fairly significant amount of funding, but we’re not going to be able to get that to every corner of the province.

I must give credit to our provincial government, who continue to make investments, even in the face of the pandemic, into this crisis. Our job, those of us delivering care, is to figure out how to maximize those investments to address the biggest cracks in that. Miranda really wanted to have the slide that showed there are some cracks.

This is our vision for what this could be. Where are the areas where we can invest the next bit of funding in the most effective way? I think that’s the challenge for us, and I challenge my team all the time. Don’t give me a program that’s going to cost $5 million for 100 to 200 people. We need to figure out something that could reach thousands of people.

For rural areas, how can we do this in a different way? Powell River is a great example. We’ll reach a smaller number of people in need. They can’t open a Hope to Health clinic. It wouldn’t make sense there.

It’s a big challenge. I am encouraged by the CEOs having us come together to respond to the latest coroners death review panel.

I would agree with your point. In Canada, there is no province that has greater expertise. It’s about doing everything we can to build the system of care, from providing the metrics…. Your point is a good one. We’re all working towards using virtual care. It’s going to look different in different parts of the province, because it’s not a single crisis. There’s rural…. There are urban issues. It’s about leveraging what we have in the best way possible.

We have all now, I think, agreed on where we want to go for a model and on identifying those big, big challenges ahead. Having said that, I want to acknowledge that I’m in a health authority…. I listened to Ingrid Tyler, and even in the Lower Mainland, we have municipalities that won’t even allow harm reduction services. We don’t have that in our health authority. We’re very fortunate in Vancouver Coastal. Not every part of the province is ready for this yet.

We need to make sure that people can do the good work that’s needed.

N. Peters: Yeah. I’m just thinking a little bit more about David’s comment around a broad sector response. It takes me back to the floods we had this summer.

For many parts of the province, we weren’t necessarily impacted, but in Fraser Health, we certainly were. Health had a key role, but it wasn’t the only partner at the table. In fact, actually, probably one of the biggest ministries involved was the ministry of highways. There was an incredibly important transportation route through the Lower Mainland cut off from the rest of Canada.

Every organization had to lean in to be able to effectively respond during the flooding situation in Abbotsford. I think that’s the level of response that’s needed, recognizing that there are many ministries that have a role to play in our response. Yes, there are some real key ones that need to be involved. I think, in many ways, there are others that need to be at the table involved in these conversations.

Just recently, this week, we started having an executive-level conversation between the Ministry of Mental Health and Addictions and the Ministry of Health to ensure we’re pulling together a coordinated response. I think that needs to broaden and expand into other areas, and it needs to be structured, with clear accountabilities and a clear purpose.

I. Tyler: If you don’t mind, I’ll just add one more thing. It’s going back to stigma and municipalities and why you may see such a different response.

It struck me, during this afternoon…. When we were dealing with COVID, we all fundamentally had the same goal in mind. I mean, I agree with Patty. It was a relatively simple problem, in the grand scheme of things, and we all had relatively the same goal. We had some heated discussions with a few partners, but for the most part, we got there.

This is very, very different. I spoke to some of this earlier. Going back to my experience as an MHO working with communities at the community action tables, which still exist…. They’re still going strong in many communities. It looks very different in every community in terms of the work that they do and the participation they have around the table, and there are two sides to that story.

[3:55 p.m.]

Picking up on David’s point that not all hospitals are doing best practices, I think a lot of municipalities, with their CAT tables…. They may have different people around the table, very appropriately. But in other communities, it’s impossible to engage with fire or police or the municipality or the business improvement association or other key partners in that community.

We know that if we had the engagement, we could do a lot of things around data, around response and many others, but we’re not all on the same page here like we were with COVID. Generally with COVID, if you asked, people were willing to help. Here — and it drives all the way back to the stigma discussions we had — we’re not there yet. I do think we need to get the province to where we can all be actually responding to this crisis from, effectively, the same playbook.

F. Dalton: I completely agree in terms of the coordination across the province, not just within health. We need one system.

Building on the COVID analogy, when we needed more capacity in COVID, we built it. We created it. It was not acceptable for people to wait. We have to create the capacity so that if someone says, “I would like treatment,” regardless if that’s out-patient, in-patient, detox, recovery…. We can’t be saying: “Yeah, come back in three months.” We have to have the capacity to say: “Yes, we can look after you now.”

V. Seethapathy: I was going to touch on a similar basis there, just to follow up on the point and also the discussion that we’re having. A couple of comments from my end would be….

I’m hearing from Mike around how the conversations were different this morning to what we’re hearing this afternoon. My assumptions there would be…. I worked in rural remote areas and did some clinics myself. The needs there and the interventions that they have are very different to the interventions and the needs in some areas, particularly the Lower Mainland.

We’ve invested a lot in terms of treatment and interventions. Now we’re talking about prevention, so we’re going to go upstream quite a bit now.

In rural and remote areas, I’ve seen that they don’t have some basic interventions that are available — no treatment options available, no substitute treatment readily available. I think they’re not really looking at prevention. They’re looking at the crisis point. “What can we do, here and now, to solve the problems?”

The system of care is a good example, what you mentioned. If you look at the system of care and the competent system of care…. We need to really shift our mindset to say, “Okay, what’s our approach in the next five years?” rather than say: “Okay, what’s our approach in 30, 60 or 90 days?” That’s good to have, but beyond that, we should say: “You know what? In five years, down the line, what does the system of care look like in every neighbourhood, in every region across our health care?” In particular, address addiction and mental health in combination. What are the needs, what are the gaps, and what is the baseline that everybody should have?

That’s going back to targets. If we don’t have a target to say: “Okay, they all have to have access….” Like Fiona was saying, they need access now. They need to get access in 24 hours. We need to be transparent about it. That should be reflected in our data and our metrics and our dashboard. We should be looking at the intervention- and outcome-based dashboard system. We’re going to see that openly and transparently and fairly across our neighbourhoods.

We don’t see that in other health care either. We don’t know how many people are waiting for hip surgery in one area and how many people are waiting for gastroscopy in one area. We don’t see that, so we don’t have that fairness right now represented in other areas. It’s not fair to us — that we’re going to do that here. But we should really start to become more fair and transparent in having the data and metrics, which are intervention-and-outcome-based metrics, available in addition to the demographics and what we’re seeing in the dashboard.

N. Sharma (Chair): I don’t see any others. We’re definitely coming up on time. It’s four o’clock now.

On behalf of the committee, thank you, all, for joining us here today. Thank you for the work that you do every day for the province and for the people that you serve. Thank you for your ideas and your vision and everything about how we address this. It was really appreciated.

D. Byres: Thank you for the work you’re doing on behalf of the province and on our collective behalf. Thanks to all of you.

N. Sharma (Chair): Take care.

We need a motion to adjourn.

Okay. MLA Davies.

Motion approved.

The committee adjourned at 3:59 p.m.