The committee met at 9:03 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): I want to welcome everybody to our second day this week of the Health Committee.

We are on the traditional territory of the Squamish, Musqueam and Tsleil-Waututh people, and we invite everybody to think about that as we conduct our work and the difference we can make through reconciliation, especially today, National Indigenous Peoples Day.

I want to welcome our first guest, who is Daniel Remedios from Richmond Addiction Services Society.

Welcome, Daniel.

We’ll just do a quick go-around of the room and see who’s there and who’s on the phone.

My name is Niki Sharma. I’m the MLA and the Chair, and I’ll go to the Deputy Chair, Shirley Bond.

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

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

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

D. Routley: Doug Routley. I’m Nanaimo–North Cowichan.

R. Leonard: I’m Ronna-Rae Leonard, MLA for Courtenay-Comox.

N. Sharma (Chair): And Pam and then Trevor, on the phone.

[9:05 a.m.]

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

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

N. Sharma (Chair): Okay, Daniel. We have about 15 minutes for your presentation. We all have your presentation slides on our various screens available to us. Then we’ll have 45 minutes for discussion afterwards.

Over to you.

Briefings on
Drug Toxicity and Overdoses

RICHMOND ADDICTION SERVICES SOCIETY

D. Remedios: Thank you. Good morning, hon. members of parliament. My name is Dan Remedios. I’m the executive director of Richmond Addiction Services Society. We’re a small non-profit located in the city of Richmond.

Our building itself is located on the Musqueam, Tsawwassen and Kwantlen Nation lands.

I want to start today by showing my appreciation for inviting me to speak. I work at a grassroots organization, and it’s appreciated to share our voice at the larger table, because we try to do just as much good work in our community.

On a personal side, I’m an immigrant. I moved here around 20 years ago. My family and I, every day we’ve been here, have been reinforced about our decision to be here and be part of this country. Personally, for my family today, this is a momentous occasion where we were invited to be at the table. I just would like to extend my gratitude and acknowledgment of that, so thank you.

Slide 2 has a bit of an itinerary of today. I don’t want to…. I know all the members at the table are well-versed in the current epidemic within the pandemic of COVID, so I’ll just be briefly touching on some points. Then I was hoping to actually make a few suggestions about how to address the toxic overdose deaths specifically in the community of Richmond. I’ll go into why I believe it’s a bit of a microcosm within the province.

To give some history about our non-profit, Richmond Addiction Services Society has been working within the Richmond community for almost 50 years. We focus on the prevention of harms of substance and behavioural addictions in our population. We primarily serve youth and their families through focused programming groups, education events and limited counselling as needed. At our core, we believe that healthy connection to ourselves, each other and our community is what can help sustain people through their challenges with addiction.

For some insight on the city of Richmond, we’re a municipality that consists of approximately 209,000 individuals, 75 percent of whom are a visible minority. And 60 percent of our total population are immigrants. This is taken from the 2016 StatsCan survey, so we do believe that those percentages would be a little bit higher now. This makes Richmond its own little city within the province and, like I said at the start, it’s why I believe the provincial response has to take in this key metric of immigrant and visible minority — majority — population when we’re addressing this crisis.

One of the most prevalent themes that you’ll find when it comes to addressing substance use or mental illness is, unfortunately, one of stigma and stigmatization. Richmond tends to be traditionally conservative and has a lot of concern — and there has been a lot of resistance — around the topics of mental illness, subsidized housing, legalization and, recently, the decriminalization of small amounts of substances by the province. It’s woven into our cultural fabric.

Stigma itself, for a lot of the individuals I’ve spoken to, comes either internal or external, even societal and familial. I was speaking to the executive director of Richmond Mental Health Consumer and Friends Society. It’s actually a non-profit that employs individuals with lived experience. He told me that in Richmond…. Here’s a quote: “Stigma is worth dying over to some people.” I do believe that it’s this sense of stigma that has taken our illicit toxic drug deaths from literally one, ten years ago, to 32 in 2021.

Now, I know the sheer numbers of it might be small when you’re comparing it to the Downtown Eastside or Surrey, but for a community as small as ours, it represents a 30-fold increase in the number of people dying. When I spoke to our medical health officer, she informed me that we’re probably on the same pace this year as we were last year. The primary cause, I’m sure all of you know, is the growing toxicity and unpredictability of street-supply drugs.

Unfortunately, many of these deaths are preventable, though I do have to note that, much like the official reported numbers, they’re only the ones that actually get reported in. There has been a note that likely not all are related or labelled as overdose deaths, but they possibly could be.

[9:10 a.m.]

What can we do to address this crisis of health in Richmond? We believe that our response has to be multifaceted. There is no one solution but, rather, multiple forms of intervention and actions that need to be taken to reduce and hopefully stop unnecessary death.

We have to address the immediate problem, but we can’t ignore the future. We have to treat the people now, but we have to also inoculate and prevent the same deaths reoccurring later on.

The lens that we use at Richmond Addictions is the levels of prevention, and it aligns with the tiers of prevention graphic that will be on your PowerPoint. Just very simply, it goes primary, secondary and tertiary. The primary should focus on protective factors and reducing needs for addictive substances. The secondary focuses on diagnosing and treating addictions and substance use disorders. And tertiary is support for individuals with chronic or severe addiction disorders.

The coroners death review panel put forth three key recommendations earlier this year. It was a safer drug supply; a coordinated, goal-driven strategy; and a comprehensive, continuous substance use care. All three of these actually fall within the three levels of prevention.

For the tertiary, the most urgent priority is to increase access to safe supply — offer non-toxic drugs. If safer supply of drugs is available and easily accessible, we believe that it will have an immediate impact on the number of individuals dying due to toxic drugs.

Another recommendation is to have a safe consumption site in Richmond. I’m sure there are a lot of statistics talking about Insite, the sanctioned, supervised drug injection site in Vancouver. It’s been operating since 2003 and has had about 3.6 million individuals walk through its doors. It reports that there hasn’t been a single death due to overdose at the site.

For Richmond, specifically, safe supply is difficult — literally — because one of the main testing sites is actually in a place that is not accessible by transit. Addiction workers in the field have mentioned users would rather use than make a lengthy trip to test their substances. There have been calls for a more accessible bus route that stops outside of the facility, but it has been years, and it has yet to materialize. So specifically, that’s how it affects Richmond.

Another long-term goal that we have at Richmond Addictions is to have a safe injection site in our city, but the inherent resistance of the population to an initiative like a safe consumption site is a significant barrier. That second barrier also lines up with our second level of prevention, which is secondary prevention.

One of the main topics that we continually work on is the topic of stigma. I’m glad the province has recognized that it should be treated as a health problem rather than someone lacking will or being incapable of not using. It creates societal barriers and individual barriers around services and people obtaining those services. It’s one of our core causes at Richmond Addictions — to destigmatize use and inoculate the population.

An interesting parallel between Vancouver and Richmond is the inclusion of youth peer voices in the conversation around deaths. Like I said earlier, the Richmond Mental Health Consumer and Friends’ Society is a non-profit that has had quite some success in Richmond. It encourages participation of people who are users in recovery and who have experience in the mental health system. Studies have shown that by including peer voices and feedback, we can actually increase the uptake on our targeted population, as well as increase the uptake on the programming itself.

A comparison here would be, in the last decade, VANDU, the Vancouver Area Network of Drug Users, which did have some positive steps towards reducing the amount of deaths in the past. And then, of course, the community champions that are out there.

In the province, the focus, generally, is on secondary and tertiary prevention, but I believe that primary prevention should also be placed in the same regard. In 2010, the office of the provincial health officer put out a special report titled Investing in Prevention: Improving Health and Creating Sustainability. This report spoke to the importance of prevention in health promotion.

There is significant evidence in there that there are a number of prevention interventions that can be cost saving and cost-effective. We know now that the likelihood of an overdose increases fourfold when a mental illness is present, particularly in youths and young adults.

[9:15 a.m.]

The current toxic drug crisis highlights the need for upstream prevention. Primary prevention takes the form of trying to prevent adverse childhood experiences, building resilience, promotion of mental wellness and delaying first use.

For us, we focus a lot on our school district. Recently we actually had to create a program called constructive alternative to teen suspension in response to one of our school district policies. We found that when a youth got caught violating the substance use policy at their school, they were suspended for three days. Ironically, we found that the youth then would go home and proceed to use the exact same substances they got suspended for.

We reached a bit of an agreement with the different schools in Richmond that instead of suspending them, they would come in for about 12 hours — three to four hours per day — and actually just talk to the prevention specialist there. What we do instead is that we can explore some of the reasons why they use, give them tools to cope as well as connect them to other assets present in the community, so more really focus on prevention rather than punishment.

The space that we see is safe, non-judgmental, and it’s a great first step in destigmatizing youth. The program has seen a reduction in chronic use as well as people expressing a better sense of connection and support — very similar to the SACY program, the supporting and connecting youth program, in Vancouver schools.

We can’t focus on a singular tier in our response to this epidemic. We have to focus on all three at the same time, and therein lies the challenge. But I believe there have been some steps taken by the province that are positive, and it’s the right way to go — the decriminalization of small quantities of substances being one of them. I have been seeing many more advertisements of users being individuals, just like mothers, fathers, doctors and teachers. I believe that all these steps are actually in the right direction, provincewide.

But I do feel like we have to make and take many more steps before we are through these challenging times, though the first few have been significant. I think we can take the rest together through a provincial strategy, and then, as a whole, that’ll help address addictions on a continuum. I believe that me being part of this conversation is a first step, and together I believe that all of us can.

N. Sharma (Chair): Daniel, maybe I’ll just start off with a quick question and then go around. I was really wondering. You know when you broke down the demographics of who’s dying in Richmond, and it’s higher. Do you have any more information about who they are? Do they fit the demographics that we’re learning about across the province — of men between, I think, 20 to 50 and alone — that’s growing? A little bit more about that would be….

D. Remedios: Yeah, that’s correct. Demographics-wise, it is reflecting the provincial average. And you’re right. Generally, larger incidences of death due to toxic overdose are happening because people are using alone. Interestingly enough, we did start noticing it more when we started looking into it. Some of the recent coroners reports as well as some of the StatsCan should support that.

R. Leonard: I’ll just take that one a little bit further. First of all, thank you very much for coming in this morning and presenting. That was very helpful. It’s really good to hear the perspective of a single community that has its own unique profile.

One of the things we’re hearing is around stigma and using alone. You mentioned that the number of deaths is quite high. Have you got anything more to add in terms of that link between addressing stigma? You talked about the prevalence of it and the entrenched values against using. I’m just curious if you have something very concrete to add to this.

D. Remedios: Yeah. We have been seeing that. In Richmond, it’s…. Because of the immigrant population, we are seeing that. You know, “We don’t air our dirty laundry in public. We try to solve this at home” — a lot of that. We’ve had to activate a lot of community champions, so a lot of the leaders at different churches or different religious organizations that actually have to go out and talk to people, speaking about that it’s okay.

[9:20 a.m.]

Unfortunately, right before COVID happened, the province did put some funding into creating community action teams in response to what they saw was the opioid epidemic starting. There was a lot of movement.

Interestingly enough, in our numbers, once we started a…. It was a year-long process, and we actually had a lot of community engagement and community discussions. We involved business leaders, individuals that wanted to speak. We actually saw a slight dip in…. We saw a reduction in the amount of deaths. There was some genuine progress happening. Unfortunately, because of COVID, everything stopped.

We do know what works, particularly for Richmond. It’s actually bringing people to the table. A lot of people have voiced the fact that they weren’t…. A lot of them come with the feeling that they haven’t been involved. Quite literally, setting up tables and chairs and bringing the community together, we know, has had an impact on reducing the amount of deaths of people.

D. Routley: You spoke about safe supply as being an immediate step to be taken to reduce deaths. It seems obvious that the toxic drug supply is responsible.

How do you think you could expand safe supply in Richmond? One of our terms of reference is to expand that. How would you communicate the benefits of that to people?

D. Remedios: Excellent question. Richmond is a unique community. We actually are extremely collaborative in our nature. We work really closely with Vancouver Coastal Health, our health authority. We work really closely with our health board. Our city itself funds a lot of health promotion, like preventative behavioural funding.

At least for Richmond, we have the scaffolding set up to actually slowly push out messaging as well as slowly push out initiatives on safe supply. But this is primarily for the city of Richmond. I do know that this already exists.

Even for this conversation here…. Those are the people I reached out to. I reached out to our city’s public health officer. I reached out to the director of mental health and substance use in our Health Ministry as well as the other non-profit EDs. We wanted to share a joint voice at this table. A lot of what I said today isn’t just mine. It’s ours. I believe that that’s how, for Richmond itself, we can address the start of opening up safe supply for individuals.

D. Davies: Doug kind of took my question on that.

Really, what I was interested in…. I really like this presentation — the upstream, midstream. I like the whole continuum, which is really important. It’s also recognizing that the issue right now is the emergency crisis that’s facing us. That’s the six deaths a day, the toxicity issues.

You had mentioned…. I’m going to rephrase. I hope you can go a little deeper on Doug’s question. As a conservative, you said more area…. Traditionally, Richmond is…. Of course, many areas in the province are as well. There is this natural push-back against safe supply and these things.

You touched on it briefly. I hope you can go a little deeper on how you work with the community on the ground, at that ground level, to say: “This is the best way to get to where we need to go.” How are you doing that with your association?

D. Remedios: That’s an excellent question. Quite honestly, that’s something that we struggle with every day.

The more conservative populations are quite resistant and quite vocal. Some recent examples would be when we tried to open up a subsidized housing system for people that are struggling with mental health and use. It took months upon months to actually get it passed. There were protests on both sides — some for and some against.

Realistically, it’s a long-haul question. It’s not something that we can immediately address and put forward tomorrow. There will be instant resistance. I know this. It has to be something…. It’s a slow boil. I feel like we just turn on the heat, little by little, and slowly, hopefully, people see the light.

[9:25 a.m.]

The interesting thing about Richmond is…. What we’re seeing now is…. We have a very vocal and very strong youth voice coming through. We are actually forming a lot of youth advisories. Interestingly, it works the other way, where the youth are then informing and putting some internal pressure on their parents that this is okay.

It’s our youth that are more open to speaking out about counselling and to reaching out. They’re very open with what their counsellor told them at session last week. We are finding that that’s definitely helping. That youth voice…. The parents, while they could ignore the policies that are put out…. They can choose not to hear what we’re saying. We’re finding, from inside the families, that championing by those youth and so much happening through those youth is really helpful.

S. Bond (Deputy Chair): Thank you very much for being here today and, also, for contributing to our province. So many families like yours came and make a difference. We’re really appreciative of that.

I’m really grateful that you actually raised this issue. It’s not just Richmond. There are people across British Columbia…. Whether they would consider themselves conservative or not, the idea related to safer supply — no safe supply, safer supply — is hard for people to grasp. One of the things this committee needs to do is recognize…. While there’s a crisis, we also need to bring British Columbians with us. I think that you’ve expressed that really well today.

I am really interested in your connection with schools and families. There does need to be a full spectrum of consideration here, starting with prevention and going right through to treatment. Do you have connections in the schools? How does that work, and how does that look in terms of your organization?

D. Remedios: Thank you, MLA Bond. Yes, we do have connections in the schools. We work side by side with the school district. What that looks like is…. We focus more on the secondary destigmatization and then the tertiary treatment and support for youth.

Our prevention specialists and prevention workers are well versed in prevention knowledge and concepts. That’s what we try to share at the grades 8, 9 and 10 level. They’ll go in, and they’ll spend months with a single class, talking to them.

What we try to do is…. In the past, it’s been a lot of: “Oh, don’t use. This is bad.” We try to focus on the reasons why they use. Youth, even though they’re 12, 13, 14, can be quite insightful on what’s troubling them. They’re very candid about why they use.

Now, naturally, they’re in the time of experimentation and exploration. You will get a certain percentage that, no matter what, will seek out substances to use just because they want to. But you will get some subsets that are very honest about what else is going on. In that case, what we, then, do is…. We connect them to a counsellor, or we connect them to outside programming at RASS. It’s called Supporting Youth and Supporting Families.

One of the things that we have found in the past is…. We would notice something wrong. We would go in, and we’d, say, give them two counselling sessions. Then we’d stop, because that’s what they’re mandated for. Again, like we said, in that continuum, we hope…. We build those relationships, and we’re there. The youth don’t have to be a client file in our counsellor’s cupboard. They can call and go in.

That’s been helpful, with VCH Foundry coming in, which is open to just drop-in counselling, short-term drop-in. It’s really helped when we can literally go to our partners and be like: “Hey, we’ve been in the school. These three or four youth have been really showing some symptoms. Definitely, this one needs to be spoken to.” They’ll come in, and we’ll connect. That helps because we have a shared electronic medical record, the EMR. It really helps reduce some of those barriers we had in the past.

S. Furstenau: Thank you so much for the presentation. I really appreciate this information and the approach, which is community-oriented and community-building.

Are you finding…? Just hearing you talk about how you respond to youth…. Are there sufficient resources right now? Where are the gaps in the resources to approach it in the way that you’re approaching it?

[9:30 a.m.]

D. Remedios: That’s a great question. As a non-profit, we are very dependent on grants. There have been some generous grants in the past from the provincial, the federal, the city of Richmond itself as well as our Health Ministry.

Right now one of the issues is one of sustainability. What we’re finding is…. Grants aren’t long term. They’re, rather, one-, two- or maybe three-year cycles, if we get lucky. But the reality is that it takes about one or two years to build a program up and build those connections. It always feels like we’re building up the scaffolding, and then we’re quickly pivoting and trying to find funds to continue building. That seems to be the largest challenge.

I feel like the funding is there, and there are sources for it. It just feels like that sustainability of funding is what really…. It’s always in the back of peoples’ minds. We absolutely can build it and put programming in, but there’s always that concern of: when is the funding going to stop or run out, and then when do we have to restart all over again?

N. Sharma (Chair): I’m going to the second round, but first we’ve got Pam, with her first question.

Go ahead, Pam.

P. Alexis: Thank you so much.

A fascinating presentation. Thank you, Daniel.

A question regarding COVID. We noticed that our numbers of kids that were really feeling troubled escalated through COVID, and we couldn’t keep up with the number of counsellors, etc.

On the heels of MLA Furstenau’s question, how did you manage through COVID? Did you see any differences, and were you able to keep up with respect to the volume, if there was an increase?

D. Remedios: We did see an increase in…. Well, naturally, there were more incidences of youth and young adults reporting more concerning mental illness and mental health–related issues during the COVID time.

We specifically focus on prevention. We don’t necessarily have counsellors that are attached to, very specifically, mental health at RASS. From the partner agencies and from VCH, they did…. We absolutely do have an increased wait-list, even now, in Richmond for youth seeking out mental health support. A lot of the primary questions, the screening questions, do relate to the fact of just being tired, fatigued. A majority of it we do know relates back to COVID.

Unfortunately, MLA, I can’t specifically answer that question on the connection between mental health and COVID because that’s not specifically our mandate. I apologize.

P. Alexis: Not at all. Thank you for clarifying. I just thought that maybe it would go hand in hand. If you saw kids that were suffering, would they be turning to drugs as a solution kind of thing? That’s where I was thinking there might have been a connection.

D. Remedios: Yeah. The reason we do…. I can answer just a smidgen of that question. It was seen as more of an escape. A lot of use, we found, was kids just wanting to, for a few moments or a few minutes, not feel or be who they were. Even a lot of our older adults and adults that use, use it as an escape or because they’re just done.

D. Routley: I really appreciate your use of the metaphor of scaffolding. I think it applies generally to this situation where we have the first level being this immediate response. A lot of the acceptance will be, perhaps, built by assurance and showing people that the rest of the scaffold is there as well — the housing, the treatment and the other things that support that.

The simple, urgent measure of safe supply by itself isn’t the scaffolding. Along with those other measures, such as housing for people who are active users and that sort of thing, as difficult as that is, like you found in Richmond….

[9:35 a.m.]

I guess my question is around that. When you use the language that you’re using, do you see any kind of change in people’s understanding? Do you perceive that they come around at some point, once you’ve assured that scaffolding is there?

D. Remedios: Thank you. That’s a good question. We can only hope. I can’t for sure say that, yes, when we use that language, it does help. But what we did find was that, once the housing unit was built, all the protests stopped. I think a lot of it was fear-based, which a lot of the concerns are. A lot of questions, when we were building, when RainCity was coming in to put up the housing unit, were: “What if I find needles on the ground?” or “Will there be security?” Or some quite fascinating ones like: “Where will I walk my dog if you build it on this park?”

A lot of what we found was just reiterating what we were saying, so almost that joint answer to show that VCH, RASS, RainCity, the school district, the city…. It doesn’t matter who you’re going to. You’re going to get a similar response. We knew what we were going to say, and we knew the reasons why we were doing it, and we repeated it. We tried to assure individuals that had concerns, in the best way that we could, that it would be okay.

D. Routley: Can I follow up just very briefly? We have a similar issue in Nanaimo, and, of course, everywhere in the province, around acceptance of projects like that. We’ve found that telling the success stories afterwards has helped as well. But if they weren’t there — if you weren’t actually able to point to “These are the services” — then it would be a vapid kind of response.

D. Remedios: Yeah. Richmond is fortunate in that we have had some success in a lot of these endeavours, so we can point to: “Well, it’s worked now, and there haven’t been any incidents or there haven’t been any issues.” So we are fortunate in that sense.

S. Bond (Deputy Chair): I agree with Doug. The word “scaffolding” was very interesting. It’s the first time we’ve heard that description, so I think that’s really important. It sort of describes a bit of precariousness, too, when you see scaffolding and you think about what it’s intended to do.

We’ve listened carefully to others as well, and I’m interested in your comments about the schools and the fact that so many not-for-profit or grassroots organizations are working closely with schools. One of the things that I’ve written down as a potential recommendation is more specialized counselling in schools. You talk about: “Well, maybe you could provide two counselling sessions.” School counsellors are critical and important and they do a great job, but to add mental health and addictions counselling to their workload….

How would you react to a systemic approach to looking at additional resources in the schools that are specialized counselling resources? That may be where young people feel most comfortable talking to someone. I have that on my list. What would be your reaction to that?

D. Remedios: I would love it, MLA Bond. Any support for Richmond that moves us in those positive steps, I would be for.

You’re absolutely right. I feel that exactly what you said has been experienced by a lot of our counsellors, as well as workers in the field. They’re getting more training, but their bandwidth is already maxed out. So to add on more training for mental health and substance use support on counsellors that are already working quite hard and over and above…. I appreciate the fact that you added the fact of adding more individuals in there. I do believe that adding more counsellors and more supports in schools will absolutely help with what the youth are currently going through.

S. Bond (Deputy Chair): To be crystal-clear…. I appreciate the way you shared that back to me, because it is not at all critical of school counsellors or teachers or anybody else. They’re up to their max here, so how do we provide additional, regular, sustainable funding to make sure that kids get help where they need it at the front end of these issues? I was thinking about schools, so I totally agree with you. I think that so many non-profits are working so hard to be supportive. But you fundraise, I would imagine. Do you?

D. Remedios: A certain portion, yes, but a lot of it is grants by the Health Ministry and the city.

[9:40 a.m.]

S. Bond (Deputy Chair): Well, that’s great to know.

Thanks for that answer. I appreciate it.

R. Leonard: In my mind, I was wanting to find out just a little bit more about the structure of your service and how many people you serve, that sort of thing. But I want to take what Shirley has asked just a little bit further.

I know that in my community, we’ve started…. There’s a pilot going on with an integrated mental health team, which incorporates all of the services like yours that are operating now within the school system, to try and integrate everything together. It is a challenge to make it happen. Then we’ve also heard, in the Interior, about a program called PreVenture that is also about training counsellors.

It just clicked in my head. Do we have a network in place where all of these great ideas that are happening throughout the province — where there can be that sharing and building of best practices? So I actually had two questions.

D. Remedios: Okay, just so I can answer you a bit better, one of your questions is: is there a current provincial network of different organizations and structures that seem to be addressing the same issues in their different communities? I don’t think so.

R. Leonard: Okay. Yeah. I think that’s what we need.

D. Remedios: I do know that there are individual…. I know Foundry is provincewide, and I know that they do have implementation meetings and substance use coordinator meetings. I’m sure of that. I’m sure PreVenture also has their own. But for, I guess, cross-talk, I am not aware of it, MLA. I’m sorry.

R. Leonard: No, no. This is important to note. Thanks.

And just asked about your organization and the numbers — how many people you serve, who’s on your team.

D. Remedios: The Richmond Addictions Services Society has about 14 individuals that work for us. Seven are full-time, and six are part-time. All of them, actually…. Well, 90 percent of them actually live in Richmond, and quite a few of our prevention workers and prevention specialists actually grew up in Richmond, so we’re having a lot of success of having those people that are born and bred in our city that know the challenges.

We really focus a lot on lived experience as well. So we do have members on staff that have actually grown up as teenagers through the mental health system, as well, so they understand. They can empathize with what youth are going through now, because they are quite literally peer support. We find that working really well.

Unfortunately, again, we would…. In the past, a few years ago, we did offer a continuum of services, all the way from prevention to tertiary as well as counselling. But again, like I said before, we’re very funding-dependent. About a few years ago we actually had to…. Our funding got repatriated, so we actually now focus primarily on primary and secondary prevention, because we have very limited counselling. We have one counsellor instead of, previously, six.

We have had to change our mandate and our mission and our vision and switch scope. But we’ve always banged on the prevention drum in the past, so it was just a full buy-in into what we believe.

R. Leonard: Thank you very much. I really appreciate that you bring a very broad lens to the whole challenge that we’re facing.

N. Sharma (Chair): Before we go to the third round, I have a couple of questions. The first one is about decrim. You said something that really struck me. That was: stigma was worth dying over, in some areas. B.C. stepped into this leadership role of being the first province to step into the decrim space, and the whole goal, what we heard from experts, is that it’s going to help with the stigma in communities.

I’m really curious. How is that going to show up for you in your programs once we get there, and how do you think you could maybe, I guess, adjust in the implementation of it to help this get to the stigma that you think is so devastating in a lot of the communities? That’s my first question.

The second one is that we’ve been learning a lot about just the devastation of the drug supply right now, in terms of how heavily addictive it is so quickly and how toxic it can be in small amounts.

[9:45 a.m.]

I just really want to know who is showing up, getting your services right now. Is it people that are on fentanyl? Has that taken over some of your addiction services? Who shows up at the door, and how are you treating people that come there based on the terrible drugs that are out there? Those are my two questions.

D. Remedios: To address the decriminalization aspect of it, or from the province…. Anecdotally, a lot of what we’ve heard is that a lot of resistance to, say, even cannabis or substances was: “It’s illegal, and that’s why we don’t do it.” I can speak personally, as well. In my conversations with my grandmother and my parents, even during our conversations around the time in 2018 when cannabis was being legalized, a large driving force with them on why we don’t use is because it’s illegal.

I think the concept of decriminalization offers a different talking piece on why they believe that it’s…. They don’t use because of illegality. Well, now it’s been decriminalized. It just gives us another talking point to readdress that conversation and speak to why it’s important and to tie it to facts.

A lot of it is disassociating a lot of deep-seated feelings and concerns that a lot of parents and families have about use. Realistically, in the past, a lot of it has been fear-based. If you use, bad things will happen, or if you use, you will have…. Like my grandma said, if you use, you’ll die.

I think decriminalizing it just gives us another node of conversation to speak on it. I believe that in topics such as these that are so close and near and dear to people, the more times you can come to the table and speak about it, it just gives us more options to slowly make those inroads into the acceptance of policy and procedure that we have.

N. Sharma (Chair): The second question was on the types of people that you’re helping and the substances they’re using and if that’s changed, from your perspective.

D. Remedios: Chairperson Sharma, I can’t speak personally to what’s coming in the door or the types of people, because primarily, RASS focuses on youth and families. So I don’t really have those statistics on the tertiary types that Anne Vogel would have, which is the testing site in Richmond.

N. Sharma (Chair): I guess just showing up with the youth and families, is there an intersection you’re seeing with this toxic drug supply, or are your services kind of at a different stage in people’s lives?

D. Remedios: We have seen an uptick in concerned calls from parents. Generally when the youth are coming in, because we’re focused on the primary and secondary tiers of prevention, they’re not really disclosing what substance they use. We don’t ask them to divulge that information until they’re really comfortable or if they really want to, so even any stats that I had would be skewed. So I can’t properly answer that one.

N. Sharma (Chair): Sorry, this is another follow-up. Do you have educational services to those youth about the harmfulness of the drugs? So you do it that way?

D. Remedios: Yeah, absolutely. That’s what we focus on in our constructive alternative to teen suspension program. One of the main sessions is on dependence and harms associated with use. We don’t prescribe that: “Oh, you can use. You’ll be completely fine.” There’s always a counterbalance with responsible use, because there’s a good chance that if you go into chronic use, there will be some harms associated to it. You’re right. It’s never safe use but, rather, smart use.

D. Routley: There’s a lot of great language in your presentation. Thank you for that. I think that illegality equals immorality in people’s minds, and decriminalization and regulation takes away some of the potential of a moral judgment. It’s something that needs to be controlled and managed carefully and all of that. I think it gives us a chance — as you say, different language that lets us step past that.

[9:50 a.m.]

Another piece of language you used was “delay first use.” That is really a positive way of addressing that whole long step between a simple, “No, no. Must not. Just say no,” to…. People are going to say yes, and we’ll cope with that. That, I think, also feeds into softening the acceptance of safe supply.

I think it’s more of a comment, but I just wanted to share, more or less, my impression with other members, because I really like the way you phrased it. I think if we show that we’re integrating supports, along with those measures…. I’m hoping that you can say for sure that people are more accepting, once you’ve used that sort of language. It sure gives me hope that they will be. Basically, just thanks for the language.

D. Remedios: Thank you.

N. Sharma (Chair): Okay, I think those are everybody’s questions.

On behalf of the committee, I just want to thank you very much, not only for the work that you do in your community but also for being here today and helping us learn from your perspective. It has been really valuable, and we wish you all the best.

D. Remedios: Thank you, MLAs. Thank you very much for having me.

N. Sharma (Chair): Okay. Our next presentation is at 10:30.

The committee recessed from 9:51 a.m. to 10:30 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Okay, I want to welcome our next presenters.

Welcome. Thank you for your time and for presenting to this Health Committee.

We have, coming up next, Dr. Christina Basedow from Edgewood Treatment Centre; Geoffrey Ingram, Edgewood Treatment Centre; Jessica Cooksey, Last Door alcohol and drug addiction treatment program; and Lorinda Strang, Orchard Recovery Center.

On behalf of the committee, I welcome you. We have about 15 minutes, I think, for each organization, and then we’ll leave the rest of the time for questions and answers. There is usually lots of discussion afterwards. We have your presentations in front of us on our SharePoint here, so we’ll be able to follow along that way.

I don’t know who wants to go first. How about Edgewood?

Would you like to go first? Okay. Over to you.

Briefings on
Drug Toxicity and Overdoses
Panel 1 – Community
Outreach and Services

EDGEWOOD TREATMENT CENTRE

C. Basedow: Thank you so much for having us this morning.

I think we’re going to start off with just a little bit of an introduction, maybe on slide 3, for those following along. We really wanted to just start off by talking about who we are.

Edgewood Health Network is a collection of treatment providers across Canada. We engage in a lot of residential treatment services, in-patient treatment services. Then we have a very rich out-patient program, as well, where we deliver a lot of different levels of care.

The idea for us, what we subscribe to, is really national best-practice care when it comes to not only addictions treatment but addictions medicine. And really looking at that from a research-based perspective, really pushing through outcomes research, as part of our programming, and making sure that that’s part of it — when we say that we’re doing what we say we’re doing, we’re actually doing it, which is super important for us — and then, of course, the cross-country profile. We provide that at all different levels across Canada.

When it comes to British Columbia, which I know is our point of focus, we have, of course, Edgewood Treatment Centre located in beautiful Nanaimo, B.C. We have 111 beds at that facility.

We’re also currently in talks — well actually, we’re close to closing — with Interior Health region on a centre in that area and a commitment to provincially funded beds at that centre as well. That’s an exciting movement forward for us, not officially made public yet but public enough. So that’s coming as well.

A Voice: Now it is.

C. Basedow: I know it is, public enough. Exactly, right?

I know that we only have a short amount of time, so I wanted to just focus on some key pieces, why I think we’re here to talk today and what makes us unique.

For us, when it comes to using best-practice care — whether you want to follow along, we’re going through slides 5 to 7 now — it really is not only about ensuring that we treat what we say we’re treating. It’s not only abstinence-based. It’s a range of services. We’re looking at everything from harm reduction services to abstinence-as-a-choice services and then, also, out-patient pieces.

Something that I think is important to note is…. We often look at: how can we know that we’re getting what we say we’re getting? We are not only licensed. We also are CARF accredited. Whether it’s Accreditation Canada or CARF accreditation, there are licensing bodies and accreditation bodies that actually do the work for you, for us, to ensure that, when we are starting off centres, we know that they are assigning quality of service to those centres, which is really important for us as well.

Again, important, I guess, for us is the medicalized piece, as well, the importance of access to psychiatry. We have full on-site psychiatrists and, obviously, MDs specializing in addictions medicine, in addition to the clinical counselling and psychological care that’s required for that piece. I think many of us are aware of how impactful the concurrent side of this is. Also, with drug potency, drug supply, we see more comorbid issues and more mental health challenges as a result of not only drug use but of just needing that treatment in general.

Jumping on to slide 7, what we treat. I think that’s a big one for us. It’s not focused on one specific thing. I understand the opiate crisis has, obviously, gotten a lot of attention. Very important. I don’t want to negate that. I also want to say that there’s a range of other issues affecting British Columbians. What that looks like is substance use disorders, both alcohol and drug use. We also have problem gambling. We have gaming challenges, gaming use disorders, obsessive-compulsive disorders, a variety of trauma.

[10:35 a.m.]

Something that COVID has shone a light on is not only concurrent mental health challenges, like rises in depression and anxiety, but a huge amount of trauma responses, not only within the first-responder population but within, really, the general population.

When we say we have trauma programming, we also have separate trauma programming in our sites, as well, catered to first-responder populations but also catered, potentially, to non-first-responder populations looking at mood and anxiety programs. This also means we treat mental health only, not just substance use in combination with mental health programming. Then, of course, eating disorders in some of our facilities, additionally.

I won’t drag out too much here. I think slides 8 through 10 really highlight the treatment overviews that we have. I really wanted to focus on not only the fact that we have services for abstinence-focused. We also have harm reduction measures in place using, of course, best-practice MAT or OAT therapies and really looking at overdose prevention, etc., for all of the individuals coming into treatment, both in-patient and out-patient.

New to us, as well, would be, really, our culturally driven programming. We took really seriously where we were lacking and where we needed to expand and evolve, looking at the different treatment programs offered. Indigenous healing circles — many different staff now are actually doing that programming for us, which is amazing, because we feel a lot more culturally informed — and a variety of programming that help there as well. That would be moved on from slide 10.

I’m really trying to get to the meat of the good stuff, Geoff, here.

G. Ingram: No, it’s good.

One thing I do want to bring up is the importance of aftercare. This is on slide 13. One of the programs that we really focus on is making sure that we stay in contact with our patients after they complete treatment. We do aftercare programming. That is group therapy and monitoring for up to a year afterwards, which really helps us keep track of who’s successful. Also, one of the things we find out is when people maybe relapse, in terms of getting them back on track. We have a really good track record with that.

On slide 14, we talk a bit about treatment costs and outcomes.

C. Basedow: Yeah. I think our main piece there is…. We, obviously, have some publicly funded beds. Then we have private beds at a variety of price points.

I think the importance here is really just saying…. We have the ability and the expertise to treat mental health and addiction disorders and, also, mental health on its own in a cost-effective model. It’s really the point of those slides, in the sense that there is the opportunity…. Whether it’s through a partnership or through collaboration, there is a way to say: “That is our area of our expertise.”

We are private treatment hospitals across the country. It is something…. We’ve been able to operationalize efficiencies in a different capacity that maybe isn’t as easy to do in a public health system. That’s really how we like to balance that out. Finding a continuum of care from both public and private blending together in those capacities, as well, is something that I really think is important to highlight. Us all working together, to me, is the only way through not only the opiate crisis but continuing on for mental health for British Columbians provincewide. That’s how I would look at that.

G. Ingram: Down to slide 17 now, outcomes and psychometric testing. This is one of my projects that I am very passionate about. We do psychometric testing with our patients at the beginning, middle and end of their treatment to look at: is the treatment actually working? Is the treatment actually helping patients with symptoms?

We see statistically significant improvements across the board in all of our metrics. We have multiple data samples from over 500 patients in the last few years, especially looking at COVID — things like functional impairment, PTSD, emotional regulation, anxiety, depression, substance dependence and substance cravings.

C. Basedow: I do want to say, too, that the measures we use…. I think it can get confusing, right? People say: “We do outcomes measures. We do marketing research. We do whatever.” I think it’s really important…. Obviously, Jess is very involved in this too.

The psychometrics we pick are all best practice–validated instruments that are used across psychological research. It’s not saying: “We’ve developed this tool.” Or we’re pulling it out of thin air. Or we’re asking people: “Are you still sober?” They are really rooted in: does symptomology change? Do we see a change in recovery capital? Do we see a change in mental health challenges and conditions?

G. Ingram: The other thing I’d like to highlight is…. Our opioid use disorder patients made up about 10 percent of our patient population in the last three years, so we separated out their results from our main patient population.

[10:40 a.m.]

While there are slight differences, there’s no statistically significant difference in their results. There’s also no common directionality in them. In some measures, they do a little bit better; in some measures, they do a little bit worse. But it’s all kind of within the same margin of error as our general patient population. For example, in the last three years, we’ve had roughly 1,800 patients since 2019. So around 10 percent of those are opioid use disorder patients.

Next, on slide 18, we do our ongoing outcome research. Like I talked about, we do follow-ups. We do follow-up phone calls, checking in: “Are you still sober? Has the quality of your life improved? Are you attending recovery meetings? Are you staying in touch with us by coming to…?” We do a lot of alumni events.

That has been some really interesting data for us, as well, in that we’ve made almost 3,000 calls since January of 2020, and we’ve connected with about 30 percent of our alumni on those calls. Of that 30 percent, 95 percent of them indicate that they’re still sober. I mean, that’s just a really good number for us. Then 83 percent of those who indicated that they have relapsed end up coming back and getting sober again.

I like to talk…. When we have patients who maybe do relapse, it’s not about relapsing. It’s about: “Are you willing to keep coming back and keep trying to….?”

C. Basedow: …engage in services?

G. Ingram: Yeah.

One of the other pieces that I’m really proud about is on slide 19. We asked our patients: “If a friend were in need of similar help, would you recommend these services?” Over 90 percent of our patients strongly agree that they would recommend us.

Now, I want to talk quickly — I was speaking with Shirley about this before — about a U.S. national recovery study that came out a few weeks ago. I included the source of that study in our slides. They looked at a few hundred thousand people who are in some form of recovery, whether it’s harm reduction or abstinence.

What they found was that 54 percent of adults in recovery from substance use disorder in the U.S. do some sort of continuous abstinence, while about 46 percent do some sort of harm reduction. Abstinence was associated with greater recovery capital, self-esteem, happiness and quality of life, as well as less psychological distress. Harm reduction itself was associated with a younger population — which, I think, makes a lot of sense — and a greater number of psychiatric diagnoses.

I do want to put the caveat in there that while abstinence was associated with greater well-being and harm reduction was associated with greater distress, it’s possible that people who are in greater distress use harm reduction as a way of coping. It’s not that that is necessarily a causality.

That being said, I think, as someone in recovery, when I look at this, this makes a lot of sense. This is probably what we would have expected, but the fact that the U.S. survey has gone out and done this legwork and found these results really kind of reinforces what we thought was there and puts it there.

The other thing they really did a good job on was that they weighted the study in terms of demographics and ethnicities. You don’t always have that ability to do that in a lot of research settings. They really did a good job.

We talked about a lot of B.C. government beds. We have five continuous beds at Edgewood in Nanaimo, and we have a three-year wait-list for those beds.

C. Basedow: Yeah, I think that’s something for us. I think, as we look into our expansion in the Interior — and we’re looking for more beds there — it’s also about how we continue to grow accessibility for service and grow a partnership for service with per-diem price points that work for the level of care.

For us, it’s sad to see a 2½- to three-year wait-list. We’re doing our best to engage people on the wait-list, and we’re doing our best to even implement right now, which I think is important for us, some research measures for the wait-list, actually, to see how people are doing on their wait-list and if they’re willing to engage in sort of a pre-treatment interaction to help with accessing recovery capital, accessing harm reduction services, accessing pieces that may be more publicly accessible before they come into treatment.

It really does speak to the importance of it. There are people waiting for beds, and waiting for a significant amount of time. We know that on those wait-lists, outcomes are not, typically, better. They typically, over time, get worse.

G. Ingram: We run those beds at a loss, because we want to do our part, to give back and be good B.C. citizens, but again, it’s important that we have that space there.

[10:45 a.m.]

C. Basedow: Yeah, from another…. We have slide 23. Just to highlight other government perspectives, we do, from the Yukon Territory, have six continuous beds for Indigenous patients only, and the Northwest Territories actually have unlimited funding currently — unlimited as far as how many people they can send, with very few restrictions.

What we’re recognizing, too, is that many patients who come from those areas are also engaged, then, in continuous services in Nanaimo or in the treatment centre that they attend. That’s something that has been useful, as well, from a recovery capital prospectus, prior to sending home. The ability to engage in some longer-term care is also an important piece.

G. Ingram: It’s very common for people from the territories to end up in and stay in British Columbia. Then they become very active and healthy members of our community in Nanaimo. It’s really nice to see.

C. Basedow: I think the final pull, which is slide 24 — I made it through in time — is really just comparing…. Many of you may or may not be familiar with the OPOC tool. It’s called the Ontario perception of care tool. It’s actually very hard to find an outcomes tool that is both accredited and free, selected-research-wise. We use the OPOC not because we’re in Ontario, but because it’s the only one that’s available.

Public health approval rating — when we look at what’s best practice, it’s at 90 percent from a patient outcome perspective. We do this with every patient that goes through, and we are at 96 percent, which we think is just sort of a plug to say that we actually do what we say we do, and we exceed what the outcomes would be from a public health perspective and allow that to sort of be an average satisfaction score as well.

N. Sharma (Chair): Thank you.

Lorinda, did you want to go next?

ORCHARD RECOVERY CENTER

L. Strang: My name’s Lorinda and I’m the executive director of the Orchard Recovery Center. I’m also a person in long-term recovery. I’ve also lost a family member to accidental drug overdose in 1984, so going long back before fentanyl was ever around. So I come at this from many perspectives.

I’ll just open my slide show now. I didn’t do a big presentation on the Orchard itself, but I will tell you a little. We are a private drug and alcohol treatment centre. We were the second private drug and alcohol treatment centre to open after Edgewood. We only have 25 people, so we’re a very small centre. We did used to have an extended care house and some continuing care residential options, and after the pandemic, we shut down to just primary care.

In my slides, I do speak to the fact of things that are needed, which include that ability to refer out for things. I’m going to start with…. We are also CARF accredited and licensed by Vancouver Coastal Health.

I would also like to say that we respectfully acknowledge that the Orchard Recovery Center operates on Nex­̱wlélex̱m, Bowen Island, which is the unceded territory of the Squamish people.

I wanted to say, as well, and I heard you speaking earlier, that you’ve been talking to a lot of people that are providing services for the Downtown Eastside. Clearly, at the Orchard and Edgewood, somewhat, we do have people that have been through or been down there.

One of the young fellows that I was just speaking with…. I was like: “How are you on the Downtown Eastside?” He’s not out physically on the street, a 22-year-old young man. He is in behind, in the SROs. He said they are filled with hundreds of people. He said: “When I’m in there, people are relapsing all around me. At that point, I don’t care if I live or die.”

He’d been to treatment previously. He ended up at the Orchard. He had one relapse. How he got out of there…. He called an alumni, and the alumni got him, and we brought him back. He’s now in sober living in Victoria after going through treatment.

Those are the kids from the suburbs that you don’t think are going to be down there, but they are. It’s also how you keep them out of there. It’s obviously a death trap.

[10:50 a.m.]

I wanted to just start by saying that we work with people who want to get better. The people that come to the Orchard are typically through workplace intervention. They may have had an interaction with law enforcement, with drug impairment, divorce proceedings, child custody issues. Family members have pressured them, given them ultimatums, or they personally have just crossed their own moral boundary of their own values and morals. It can be as simple as: “I’m sick and tired of being sick and tired.” And they make that call themselves.

I think one of the things with private treatment centres is that the barriers to entry are not so difficult. The family member can make the phone call. We can talk to the family member all the way through. The person in their active addiction is not in their right mind, and they are not always capable of making that phone call. So if they’re willing to come in, and they stay, then that’s willingness. They’ve said goodbye to their family at the gate. The families leave, and they stay. Then it’s our job to get them inspired and to want to stay and to enter into recovery.

As drug use becomes…. This is a fear of mine — that drug use becomes normalized. I would say that it is already. I mean, alcohol certainly is. But with decrim and safe supply, and with some of the messaging that’s going out, it’s becoming normalized. I feel like it’s going to create additional challenges for people that are in recovery or people that are asking for help.

It is critical for people choosing to recover from drug addiction to be provided equal consideration for their safety and ongoing care needs. I think possible unintended consequences for some of the policies and messaging that’s going out right now are that people that are in recovery that have to go live in the world, where alcohol is celebrated, where cannabis is now celebrated and becoming normal…. As we keep adding more and more to that, it’s more challenging for them to live a life drug- and alcohol-free.

Drug trends at the Orchard. We’ve been taking statistics of the drug trends. When people enter treatment, we ask them: “What are your three drugs of concern?” This is self-directed from the patient, not from us. One of the questions was about the pandemic. From 2020 to 2022, there has been a spike in alcohol and stimulants. For the people that identify opioids as their number one drug of concern, there has been a decline. That falls a little in line with what you were saying. It’s less of our population, but we’ve actually seen a decrease.

Cannabis use. People that have come in, and their number one drug of concern identified by them that is cannabis — we saw a spike between 2020 and 2021, with a slight decline this year.

Meanwhile, the death rate from toxic drug use is rising. The death rate is not…. I mean, we’re getting these statistics from the fentanyl overdose crisis, but there are people that are dying from alcohol misuse as well.

With decrim and safe supply comes great responsibility. I say that with the utmost respect and seriousness. This is a grave impact — implementing these policies if we don’t address the underlying topics. For me, those top three are: mixed messaging…. Our words matter, and we really have to get clear as this message rolls out and as safer supply becomes more readily available. I’m not opposed. I just feel that we have to be really careful what the message is that we’re sending.

I’m going to do this. I have three grandchildren. I look at their eyes, and I think about when they become teenagers in the next ten years. I think about myself and what I was like in West Vancouver growing up, as a not-very-well-behaved child and teenager, and I think about what I heard and what I would think if I put myself back in my shoes when I was 18 years old or 17 years old.

[10:55 a.m.]

I’ve talked to a lot of our alumni, and I put to you that as these things go forward, if there’s ever a time where you want to test any of your ad campaigns — or Health Canada does — send them to all of us. We can give you some feedback. We can test, through our client base and our alumni base, the people that are in recovery. What do they think, and what would they have thought when they were trying to get help?

Health care over handcuffs — I think it was Mayor Kennedy who may have said that. I believe in that 100 percent. But my fear is that we’re not ready. I don’t know that we have the system in place to handle if we actually believe that we want to provide health care for every person who wants help. There’s a lot of work to be done on that, and we’d love to be part of it.

Systemic barriers. We need to make it easier for people to ask for help, normalize asking for help and help them when they ask for help. You can’t do one without the other. Decriminalization and safe supply alone cannot stop drug overdoses. Therefore, we must invest in recovery-oriented systems of care. If we don’t, my belief is we are giving up on people. Every person deserves that dignity and respect. I know so many people. I could tell you story after story of seemingly hopeless situations.

One of them — I’ll say Kenny — was in and out of jail. Bus ticket back to the Downtown Eastside. Circled through many different treatment centres, every supportive recovery house. Finally got clean and sober. He’s now, I think, 15 years clean and sober, and he works at The Cabin in Chang Mai as a support worker in a drug and alcohol treatment centre. It’s a miracle.

You can’t give up. Every person has the opportunity to get well and should be provided that opportunity. It has been seen in places that have tried decrim or are currently using the decrim model and safe supply. Without balancing recovery options, a larger health care crisis, I’m going to say, was and could be created.

I look to the recent headlines from Salem, Oregon, where they were not prepared. The headlines are sensational, but if you dig deeper into the articles, a lot of what they’re saying is: “We weren’t prepared.” They want more time. I think we need to look to that to make sure that we are prepared. We haven’t done it, but we’re doing it.

Our hospital system. I won’t go on about this, but I think it’s really important to note…. This was in, I think, one of the newspapers on Vancouver Island — that 27 total overdoses in 2020 survive and present with psychosis in hospital and require admissions under 48 hours to stabilize. So we have 27,000 overdoses where people are admitted to the hospital in psychosis. You get psychosis from cocaine, crack cocaine and stimulants.

I feel like those people that present like that, if they’re in active psychosis, are not stable enough to come into treatment, but once they’ve been stabilized in the hospital, they need to be referred to treatment. Some will say yes, and some will say no, but the more they’re readmitted, the chance is that one day they’re going to say yes. Then what that does is stop the cycle of in and out of the hospital.

Yeah, they may go to treatment more than once. But as Geoff and Christina just said, when people have relapsed after leaving treatment, they ask to come back. They may get five years. They may get a month. They may get a day. They may not need to come back after treatment. They may have the resources and the tools.

But 90 percent of them fight to get back their recovery, because we have instilled in them the knowledge that they can get well. They like the feeling of feeling well, and they realize that they can do it. I think that’s one of the biggest gifts that treatment centres give to people.

[11:00 a.m.]

Our messaging is a big thing for me. What does our current messaging say to the next generation? As we move forward in this, it’s got to be top of mind. We have to be thinking about that. Current media messaging: safe supply versus safer supply. I never want to hear anyone say safe supply. It’s safer. Drugs are not safe. They cause untold destruction in families and to the person themselves.

Warning labels. Advertising guidelines. Prevention. Education. What are we going to do about impaired driving? We already have significant challenges with cannabis, because you can’t drug test. It stays in your system. We have clients whose cannabis stays in their system for six to eight weeks.

I name these things because this is what is coming at us in the media right now. It’s alcohol, cannabis, microdosing magic mushrooms, decrim, safe supply. So it’s like all of these things that we’re getting hit with.

I wrote letters against it, but in West Vancouver, we have cannabis stores popping up. One of the only restrictions is that they can’t be within certain metres of a high school. It’s something that we need to look at and we need to be thinking about.

Then I think that there is a lack of investment in recovery messaging. I’ve put the definition of recovery from the B.C. Addiction Recovery Association in here, and I’ll leave it to you. I don’t want to…. I’ve got no more time left.

There are ad campaigns that work. I’m going to stick to that for my final…. It’s drunk driving, Mothers Against Drunk Driving, smoking. You see a decrease in these things. These campaigns work, and we need to be thinking about that as we introduce this next level of legislation.

I’m going to close with the words of Barack Obama:

“The tragedy of how we’ve been dealing with the war on drugs generally over the last 30 years is that we haven’t emphasized treatment, recovery. We treat it as a public health problem but have often thought of it as a criminal problem and a throw-folks-in-jail problem. That not only ruins the child’s life, but it is hugely expensive for society, and we end up being penny-wise and pound-foolish.

“The good news is that awareness is starting to rise, starting to recognize that generally how we have dealt with the reduction of addiction and drugs has oftentimes been counterproductive and that we need to shift a lot more resources into treatment.”

I recommend everybody watch Prescription for Change: Ending America’s Opioid Crisis.

N. Sharma (Chair): Thank you.

Okay. Over to you, Jessica.

LAST DOOR RECOVERY SOCIETY

J. Cooksey: I’m Jessica, and I would like to thank you for the invitation to present to this committee. I’ve written down what I would like to provide a snapshot of, because I can be very chatty.

I do want to acknowledge that we are situated on the unceded, traditional territories of the Musqueam, Squamish and Tsleil-Waututh Nations. Last Door Recovery Society is situated on the unceded territories of the Qayqayt First Nation, as well as all Coast Salish people.

If you are unfamiliar with Qayqayt First Nation, I encourage you to watch A Tribe of One, and that can give you a context of the land on which our services are provided.

We ask that you also continue to join us in reviewing and actioning the Truth and Reconciliation Commission calls to action and the calls to justice for the national inquiry into missing and murdered Indigenous women and girls.

I also want to express my humble gratitude to all the past and present residents, families and colleagues who have generously shared their recovery experiences with each of us.

Resolving substance use issues is not just a matter of abstinence or symptom reduction but also improvements in functioning, psychological well-being and quality of life.

Last Door Recovery Society is an accredited, community care–licensed, registered Canadian charity providing health authority–funded and direct-pay bed-based services to trans folks, men and youth. We provide family enhancement programming that is funded through awarded grants, corporate and personal donations.

Despite what our colleague at the B.C. Centre on Substance Use presented last month, Last Door’s recovery-oriented services are provided by certified addiction counsellors with the support of a medical team within the network of publicly available Fraser Health substance use and mental health services.

We experience systemic discrimination for providing abstinence-supported, people-centred services and Recovering Out Loud. Last Door will be actively participating in the Clean Sober and Proud Pride float and also at Recovery Day, and everyone is welcome at those events.

[11:05 a.m.]

The presentation slides — which I won’t go through, but you can see there are a ton of references — provide a quick snapshot of what recovery-oriented systems of care can look like, just a high-pace overview of the key messages that I would like you to consider in responding to the poisoned drug supply. One of the key takeaways is that recovery is situated and embedded in overall health indicators.

The social and community are essential and intrinsic parts of the recovery process. Recovery is interdependent with the communities in which it occurs.

I’d like to take a moment to acknowledge the profound lives prematurely ended in ways that have left a profound loss for so many of us.

The causes flagged by many of the other presenters that I’ve had the opportunity to listen in on…. Thank you for making those so readily available in your meeting minutes. I really appreciate that.

The term “access deaths” really lands in a personal way for our family. We are blocks away from where my brother died. I’m sorry. I’m trying to keep it together, but I may sound a bit clipped. It’s still a very visceral reaction, being in this area. He died as a result of what has been described as an access death.

We need new ways to triage and respond. Recent experiences of only the sickest of the sick being triaged to access acute-based services are perpetuating deficits in the services necessary to respond to the crises we are experiencing. I would like to echo the calls to action for health condition–specific responses for complex social, mental health and addiction issues.

I acknowledge that we have strategy fatigue. There are hundreds of recommendations upon our tables, and they call for more resiliency and adaptation than we’ve ever needed before. At Last Door, all of us remain committed to working with stakeholders, despite the overt discrimination and weaponizing of grief and trauma.

We need parity of funding and the resources necessary to respond in meaningful, holistic ways to the needs of our communities. I want to acknowledge that the private sector is subsidizing public beds, and I want to extend our appreciation for the warm handoffs and the commitment to door-to-door service when we need to transition people between our services. It’s something that we need more of.

We need to realize the full continuum of decriminalization, adapted and contextualized to British Columbia. So far what’s being portrayed in the media does not meet the calls to action. Reacting to the proximal cause is the bare minimum, and people continue to die.

Data indicate that acute-based medicalized responses are insufficient. I could parrot the data and the research, but I believe that you have been presented out on that data, and it’s readily available to you. It leaves one question in my heart and many families’ hearts: when did a breath of life become an ordinary metric for the value of our lives?

There are five spheres of influence on health behaviours and outcomes that we can influence: the individual lifestyles, the individual detriments, the social detriments, the human-moderated environment and the natural environment. The Elder spoke of going through the urban settings and connecting with people and bringing them back to the land to have a cultural experience different than they’ve had in the past. These are things that we can actively be engaged in.

The World Health Organization defines quality of life. I echo what Edgewood and Orchard have said. We look at metrics that we can measure more than whether they’re abstinent, more than whether there’s something…. We look at the quality-of-life indicators. Those are the identified goals of the families and individuals that we provide services to. We look at their perception of their position in life in the context of their cultural and value systems in which they live, in relation to their goals, expectations, standards and concerns.

Recently there have been a lot of life and recovery surveys across the world. One in Canada reported that over 50 percent sustained recovery without a single relapse. I’ll use the word “relapse” because it’s in their presented items. I personally like the term “relationship with substances.” As has been presented out, our recovery journeys ebb and flow. Our relationships with substances ebb and flow as well.

There are dramatic improvements in life quality. They use a mean of six support services to sustain their recovery. The commonest barriers to recovery initiation are a lack of knowledge and stigma. The biggest motivators to initiate recovery are relationships, so that connection piece, wanting a quality of life; and then improvement of health, so that existence of pain in the presence of hope.

[11:10 a.m.]

Recovery is transmitted through supportive social networks and dedicated recovery groups. This has been researched. This has been published. This is not just an altruistic opinion. This has been shown.

When we look at recovery capital, Last Door started looking at how we could measure quality of life indicators specific to people’s recovery journeys, and the term “recovery capital,” from the social capitalists and psychologists, really hits home for us. We’ve partnered with a United States organization to provide My Recovery Plan, partnered with the government of Alberta to roll that out, and we’ve rolled it out in our own organization.

We’ve provided a couple draft graphs. Granted, we rolled this out during COVID, where our residents were on lockdown, as they call it — they call themselves the COVID crew — for 2½ months out of 12 months. We have staggered intakes, but that’s a chunk of time to stay on site, left to your own devices. I wouldn’t say that these results are able to be standardized, but we decided to hit the ground running with My Recovery Plan, because we all need to start somewhere.

Really, what it measures is quality of life and satisfaction. It flags the barriers to recovery. It looks at our service involvement and needs, their personal recovery readiness, their social recovery capital, their relationships, their recovery group participations, other supports and then a commitment to ongoing recovery. There are a bunch of different recovery capital domains that I will park. If you want to learn more about them, by all means, we’re available.

What we did…. What was recently published was a description of a recovery-ready ecosystem model, which I included in the slides, just to kind of look at how there are multiple entry points and support points necessary for ongoing recovery and to address people’s relationships with their substances and how there’s interplay between the individual, community, institutional and policy levels.

Oftentimes the terms “evidence” and “success rates” are rolled around. In our recent accreditation survey with Accreditation Canada, one of the surveyors brought to mind the community economic development — the research approach of looking at social model programming in a community base and really looking at how to research that in more meaningful and effective ways. So that’s something that we’re looking at for the future, because health care is tied to funding, unfortunately, but it’s the way of the world.

It calls for social innovations by policy-makers and acknowledges that the solutions are uncertain and that stakeholders were often in conflict and we often have a variety of different ideas of how best to proceed. When we look at a developmental evaluation, we look at that systems thinking model, where it challenges even the continuum of substance use. It’s a matrix. It’s the benefit. It’s the payoff matrix or the payoff grid rather than experimental down to dependency. To us, from feedback from our residents, it’s an outdated perception of what substance use looks like.

But looking at developmental evaluation, it’s really looking at the situation, how we can respond and how we can adapt. A recent example outside of Last Door Recovery Society is…. I attended the SFU Horizons: Crisis and Social Transformation in Community-Engaged Research conference. Unlocking the Gates Services Society — I don’t know if any of you are familiar with that, but they’ve been in operation since 2011. They started out as a pilot project, like many of our programs do in British Columbia. I know that we get teased about being the pilot project province, but I think we’ve made leaps and bounds on that.

But they started out as a pilot project by people with lived experience, and they wanted to address the barriers for women upon immediate release during incarceration, specifically for the Alouette corrections facility for women. Unlocking the Gates has grown since 2011, and they serve individuals incarcerated at both men’s and women’s provincial and federal facilities across the province of B.C. They have ongoing support and funding from the First Nations Health Authority alongside research grants and private donors.

When we look at how to reduce the risk of overdose deaths or people dropping off from engagement with services, they have some profound but very operational recommendations that they have been practising in community for quite some time. I encourage you to [audio interrupted] as an example of how to connect with some of the vulnerable populations that we know are dying as a result of the toxic drug supply.

[11:15 a.m.]

We’re in an era of practice-based research. The times of…. Evidence-based practices absolutely have a role to play in addressing the toxic drug supply and providing meaningful, quality services for people with substance use issues. But we don’t have scientific studies for the recommendations and innovative practices that are on your table for recommendations. We don’t have the evidence yet.

Working in community-based, recovery-oriented services for going on, oh, since 1996…. We have been criticized for not having evidence for quite some time, because we have been too busy keeping food on our tables, too busy surviving off of scraps of funding, pilot projects, interim funding to even be able to embark on program evaluation. I want to thank Edgewood and Orchard for having the capacity to continue to supply evidence and track metrics and teach us how to do that as well in the public system.

You’ve seen the recent SFU reports. You’ve heard their presentations. You’ve heard the calls to action. But if Last Door were to ask for one thing, it’s not a four-year cycle. It’s more of a 20-year cycle. It’s that we have a comprehensive, cross-government response, including prevention, harm reduction, treatment and broader supports to address the drivers of the social detriments and to increase the quality of life.

So that’s what I have. I know it’s a lot. We have a lot to say about recovery. We really do, and I think that the B.C. Addiction Recovery Association…. We’ve all shown that we can all come together, and we’ve been able to connect with each other. We all want to express an invitation. If you ever want to see any of our services, come on by, have a meal, meet some of our families.

I think I’ve said as much as I can. Thank you.

N. Sharma (Chair): Thank you, Jessica.

Now we’ll turn to discussion. I had Trevor with a question, and then I’ll just take a queue here.

Go ahead, Trevor.

T. Halford: Thanks so much, Jessica. Good to hear your voice. I wish I was there to see you in person.

You mentioned a stat that stood out to me, and it was three years — a three-year waiting list. I think we can all agree that addiction should not wait three days, three months, let alone three years. This is kind of a loaded question, but in order to get that wait time down, what is the number one thing that we can do or can help people? I know it’s not as simple as more money or anything like that, but what is the one tool that you see government having that could help you bring that number down?

C. Basedow: You know, it’s funny. I was just joking with Geoff. I looked at Geoff, and I was like: “Funding, money.”

I don’t want to say it’s as simple as that, but I do think there are some simple pieces. If there were the ability to more competitively fund…. Edgewood, across Canada, across British Columbia, is very open to opening up beds because we’re not at 100 percent capacity. We typically operate at around 85 percent to 90 percent capacity, so we always have those additional 15, 20 beds available at any given time. But when we’re operating under a deficit, it’s a really hard way to push people, so we push people in. We give discounts. We try to do what we can.

I don’t want to say it’s as simple as funding. I think in some ways it is. It’s an open partnership between government and private to really be able to operationalize the ability to treat as many British Columbians that want treatment as possible and to increase access. For us, it is that simple.

I don’t know if you wanted to add anything, Geoff.

G. Ingram: Vancouver Island Health had an excess of funding this year, so they created two new spaces, but that was one-time funding for two individuals. So while we have these five continuous beds, there was a point earlier this year where we weren’t sure if they were going to get renewed. So on top of having funding, having that commitment and knowing that we need to keep those beds aside is something that’s good for us.

One of the other things is that we have something like a 97 percent utilization rate of those beds. A lot of those CMHA beds come in…. Our traditional program runs for about 50 days, and then we also do an extended care program if needed, where we help them transition back out into the community. So some of those individuals are in for up to four months. When you have a three-year wait-list, but patients are probably in for anywhere from 70 to 90 days, it is more difficult for us to cut into that wait-list as quickly.

[11:20 a.m.]

Then there are barriers when they get out of treatment that we don’t necessarily face with some of our other patients and clients. There’s a story from last summer with a patient that I spent a lot of time with that spent four months in treatment and then had to go back to living in their car because they weren’t able to transition into appropriate housing. There was no housing available for them.

As much as we want to say that our beds are a catch-all solution, it’s really tough if there isn’t something that we can also transition them into when they complete. If they’re back to living in their car, their chances of success are small.

S. Chant: You mentioned the OPOC assessment tool. First of all, can you tell me what OPOC means? Then can you tell me…? Is it applicable to opioid use, and does it look at longitudinal assessment?

C. Basedow: The OPOC tool…. It stands for the Ontario perception of care tool. Basically, what it does is…. It allows a patient, in any form of service, to fill out a survey as to how their services were. Did we meet their needs? Did they feel they were cared for? Did they access trauma-informed services? Were they culturally competent? On and on it goes.

The idea is that everyone, upon discharge, completes that. So it’s not specific to opiate use disorder. It’s specific to any care experience in any public or private health care setting. The reason we use it…. It’s the only validated one, and we want to use a validated instrument.

Yes. That’s what that stands for.

The other pieces that we use, from a psychometric perspective, look more at the addiction rates, recovery rates, recovery capital.

G. Ingram: I think a big piece for us is finding the gaps in our own service and then making sure that we address them. This work started off as a way of doing program evaluation and then kind of grew into more outcomes research. We’ve been really pleasantly surprised with the results we’ve seen so far. We’ve only been doing this for three or four years, and we have a lot more work to do. We want to make this a continuous part of our program.

L. Strang: Can I jump in and add something about reducing wait-list times?

Right now I think the top tier level that the government will pay — I could be wrong because we don’t have any government-funded beds — is $350 per day. We have a lot of different unions, like the Nurses Union. They send their B.C. residents to Homewood in Ontario. A teachers union. We often get people that come in and opt out of that because they don’t want to get on a plane. They don’t want to fly somewhere. They want to be somewhere local, and they’ll pay out of pocket to come to the Orchard.

I would suggest that a system get put into place where the government has a per-diem rate that a person can utilize and put that as a credit towards any licensed and CARF accredited or Canada accredited…. All you need to know is that we have accreditation. If we have accreditation by Accreditation Canada or CARF accreditation, that is a…. It is not something you can even do in your first couple of years of opening. It’s an exhaustive, on-site, every three years standard of care that you have to actually be able to afford to even be able to implement and have in your centre.

There should be a way, I believe, where…. There’s a large number of people that are paying out of pocket.

They’ve changed the system. We used to be able to provide a tax credit for your health care. We had to break it down. It was like: what was your counselling fee? What was this? They’ve since changed it. You can submit your entire treatment fee, and I believe you get 30 percent back from that.

There’s a lot of working people or families that are paying, and they don’t go through the government-funded system. I feel like it’s the middle class that gets left out of everything all the time. I think that needs to be looked at and explored.

[11:25 a.m.]

We have a small amount of beds. The last time we did a government application, in conjunction with Edgewood and Cedars, it was only awarded to Cedars. They wanted us to give them 20 beds. Well, we can’t do that.

There are ways to look at that. We welcome you to come and see our treatment centre.

I think that every single not-for-profit also has government-funded beds, because they cannot operate on the funding that is provided. So the level of care that you provide…. There’s an increase in cost.

We have psychiatrists that are distinguished fellows of the Society of Addiction Medicine as well as being addiction medicine specialists. Our doctors are addiction medicine specialists. That comes with a price tag. That just is something, I think, that could be considered.

Alberta is moving in that direction. I don’t know what their cost per diem is.

R. Leonard: First of all, thank you for coming and presenting and enduring the temperature in this place.

C. Basedow: It keeps you alert.

R. Leonard: I guess, yeah. There you go.

I want to share that in my world…. I recently had a young woman, not even a grownup, overdose at home, a recreational first-time user. I’ve had alcohol addictions in the family. Abstinence programs work to change lives. So I want to appreciate that. I also know about ongoing addictions and the need for safe supply. I’m not throwing any babies out with the bathwater here.

My husband was an alcohol and drug addictions counsellor for his career. That’s how I met him. I was a volunteer. So I understand a lot about the non-profit world and the challenges that come with that. He also moved into working in government service.

I have a sense of it all, and I appreciate all of it. I want that on the record.

I know that there have been challenges around what you provide within the continuum of care. I want to get a better understanding of that, the discrepancies that we’re hearing — as you, Jessica, pointed out — the issue around being able to do evaluations.

One of my first meetings was with a father who lost his son three weeks before. He had been in Last Door, came out and used on a construction site, and is no longer with him. His father and his family advocate for legalization. I guess, for me, the trigger question that I have is: what do you know about what we have heard around people who go to treatment, come out, are more at risk and die? We’re hearing a little bit around what your successes are, and I don’t deny that at all. I’m just curious about the challenges around….

J. Cooksey: I could speak to that.

From a publicly funded point of view…. Many of our residents have complex health care needs — physical, mental, spiritual, emotional — and those assertive linkages to mental health supports sometimes are delayed until their benefits plans kick in. Even then, that can be a challenge, because there’s a limited number of counselling sessions available. Having their medications adjusted based on their coping skills or the side effects that they’re experiencing, when it comes to men’s health, all impact their functioning post treatment or post program participation.

I don’t know of any bed-based service that doesn’t have continuing care services that are funded outside of the public system to keep people engaged. When people are experiencing losses in their life, whether it’s as a result of an overdose death, another life stress, the death of a family member, a child, they generally come back to Last Door for support.

[11:30 a.m.]

We have an open door policy for a reason. If someone has overdosed and died in the community, it’s likely that everyone who was in treatment with that person is going to connect with us, because we have a rapport. When we’re looking at how to address continuing care post-bed-based services, we still need those mental health supports.

There are secondary issues that, once a foundation of recovery is initiated or reinitiated, and they have coping and their basic needs met…. The men and trans folks have other core issues or core things that are now safe to unpack, and they need those mental health supports.

It’s very challenging to get access to mental health supports, currently, for the public health system. The parity of funding, the full funding of certain resources…. We know that there’s a staff shortage. We know that there’s online availability for counselling. There are resources. But that public messaging is not readily available.

The other part is when people are re-entering the workforce. The men, especially, have to be brave and raise the conversations about first aid naloxone training, especially in the trades. This should be a part of everyone’s first aid policies at every work site. It’s first aid. Simply put, it’s first aid. Anyone that’s public facing should have access to naloxone training. We should have naloxone on every work site, from my point of view.

Many of our alumni have used naloxone on the public. This isn’t just a person-who-uses-substance issue.

A Voice: They’re not the ones using it on themselves.

J. Cooksey: When we’re looking at people exiting our services, we’re seeing an increase of emerging adults with anxiety. I would say that they’re using substances to cope, that their medication…. It’s a long-term adjustment period and stabilization, and it ebbs and flows as their coping skills ebb and flow, as stressors show up — when they return to school, when they resume work, when they have a roommate fight, when they gain and lose weight. All of that needs to be continued to be evaluated and monitored, and our system isn’t set up in a way that’s responsive to that.

I’m in recovery. I’ve been diagnosed with a mental health issue. My GP does not have access to my mental health records at this point. I would have to go and get them and give them to my GP. I have the capacity to do that. I don’t know very many people who would do that.

G. Ingram: If I may as well. One of the things we know is that after spending 50 days or more in treatment, people have a reduced tolerance. It’s very common.

For our patients — not a lot, but enough — it’s a common thing where patients make a decision that they’re going to relapse while they’re still in treatment. Then they put on a mask. They pretend that they’re doing the work, but they don’t really do the work. Then they get out, and they use the same amount that they used to before. But because they’ve been sober, they have a decreased tolerance, and they end up overdosing. That’s just the way the science works.

We work hard in that we have monitoring, both drug monitoring and alcohol monitoring, after treatment. It can be for a year. It can be for three years. It can be for a different amount. But that comes at a cost.

It’s also not uncommon for us to monitor somebody for a year, and then the day the monitoring ends, they go out and relapse. Now, like I said before, with some of our other research, we see that most people who do relapse come back.

C. Basedow: To your point, I think you’re right. To be so bold as to say that it’s not a completely fixable issue…. I think that there will be people who will leave treatment and who will overdose. We will have those incidents occur no matter all of the safeguards we put in place.

I also want to say that there are people who will function in the way they would like to function on safer supply. There are people who will continue to take opioid replacement therapies or MAT therapies continuously, potentially for their lifetime. I think that’s really the continuum of care piece.

As much as we say that we are recovery-based services, recovery looks different for a host of different people. Also, maintenance, etc., for people of different…. Right? I don’t want to say that we only support one way. It’s really about targeting those messages.

Yes, everyone who leaves treatment gets a naloxone kit. Yes, everyone learns how to use it. Yes, everyone gets access, I mean, similar to the points you guys were making. But I also want to say that that will exist. How do we set up people who are showing, in treatment, truthfully, many of the behaviours that put them at risk for a potential relapse and being open about the fact that they may not want to stop using? Then it’s really on us, from an evidence-based perspective, research-based perspective, to help them connect with the care that is in line with what they currently value, choose, want to continue doing.

[11:35 a.m.]

I think that can be an expectation of a service provider. It’s definitely an expectation I hold for us as a service provider — to help individuals make the choice and then have access to what is safe for them.

J. Cooksey: I’ll speak a little bit further down the line. When people…. I have a friend who wanted to complete their Methadose and become pregnant, and they experienced withdrawal symptoms while playing sports with myself. Their prescribing physician, I think, could benefit from having discussions about plans to resume substance use in less risky ways, living at risk, rather than calling them weekly to ask them if they wanted to resume their medication.

When people are completing mental health medication or other medication-assisted treatment — whether it’s blood thinners, insulin or whatever have you — we’re talking about health-promotion conversations. It’s not just people leaving treatment. It’s other people who are completing mental health, physical, OAT, what have you. Those conversations about health promotion and plans to resume substance use need to start happening more often than they are, more often in bed-based services, more often with people who are already engaged in front-line services.

L. Strang: I want to say that all of us…. You cannot work in this field without having had alumni that have passed away. It’s devastating.

Now, I think it’s really important, though. If you look at the gun situation in America, they say: “Well, you can’t take away the guns, because there are always going to be gun deaths. There are always going to be people who have guns, blah, blah, blah. Therefore, we’re going to do nothing.” There are always going to be people that die from drug overdoses. Does that mean that we don’t try to help anyone? No. That doesn’t make any sense. We have to continue to help.

I have a mother that came to me. Her daughter had been through Orchard. She then went on…. We sent her off to supportive recovery somewhere else. She was on Suboxone. So she was on an opioid replacement therapy. She went out, told her mom: “I’m not…. Don’t take me.” She was given permission to go to meet, as it happened to be, one of our alumni. She was going to get this. The mother was supposed to drive her out there. The daughter said, “No, you need to trust me,” and the mom said: “Okay.”

This is not what the supportive recovery house had agreed to. She had been in treatment for almost five months now. The mother let her go on her own. She went to the SkyTrain station, and someone sold her some drugs. She got out to where our alumnus was. Thank God he was an alcoholic. Otherwise, he would have probably been implicated in this or considered part of the problem.

He thought she was acting strangely. She hadn’t used yet. She didn’t want to go to the movies, which is what they were going to do. He drove her back to the recovery house. She went back in. They did what you do when somebody comes back from an overnight pass. You know, that’s not primary care. She had it hidden in the back of her phone. She went back into her room, she used the drugs, and she died.

That mother has said: “What are you going to do differently?” I said: “Well, we’re not going to give up trying.” She was like: “If there were safe supply, she could have gone and got that.” I just said to her: “But would she have?” It was a moment of availability — that split second in your head where you went: “Okay, I’m going to do this.” She was 18.

We can’t control every life circumstance that got her to the point where she’d already been through several treatment programs before she got to there. These things are going to happen.

This is what we teach them in treatment, though. When they leave, they sign a piece of paper. It’s very strongly worded: “You are at higher risk.” So they’re clean and sober, they have the knowledge, and life happens when they leave. This is what I’m saying: availability creates greater risk for the person who’s trying to not use drugs and alcohol in a society that says you’re different and weird.

[11:40 a.m.]

We have to provide…. One of the things I’m asking for is: how do you…? We have some of the best treatment programs in North America, hands down. I have clients that have been to Promises, Hazelden Betty Ford, all of the best top treatment centres in the United Sates, and they’re with us, and they’ve relapsed. This guy is an alcoholic.

We have great treatment here. We need to strengthen what we already have. We need to be able to refer to the supportive recovery houses. We need sober living. In the United States, they have 3,200 Oxford Houses. In Canada, we have two. Why don’t we have more sober living houses?

Why don’t I open up a sober living house? I’m not opening one up — zoning, not in my back yard, prohibitive licensing requirements that don’t fit our sector, and liability. They’re the people that are most at risk and the most…. They’re out in the community, so they’re at bigger risk. They’re at last risk when they’re in a primary care treatment centre.

Our insurance. I just redid our insurance policy. It’s $115,000 a year. You have to have the funds and the means and the energy and the staff to be able to run these places.

Where would I like to see them? I’d like to see them in North Van and West Van. Turning Point is trying to open up a place in Squamish. They’ve been trying for I don’t know how many years, and they have not gotten that passed. I’d be referring to them all the time. They do primary and extended. We do acute care, and we refer all the time on to the next phase. Our clients need to see psychiatrists.

N. Sharma (Chair): Sorry to interrupt. I just want to make sure we get through as many questions as we can, because I’m sure we’ll dive into lots of topics.

S. Furstenau: Thanks to you all for your presentations. It’s really informative and really helpful for rounding out. I think what we’re seeing is there’s triage happening everywhere, and you’re part of that triage. I go back to the presentation we heard this morning. There’s an upstream, midstream, downstream aspect to this.

Your point, Jessica, about mental health care, I think is really well taken. People can exit from programs and recovery but then don’t have mental health care available to them in any really substantive way. We know that in our own communities.

I just want to ask — I’ll start with maybe Edgewood — about the model. I’m sorry I missed the first couple of minutes. Industry-leading mental health trauma addiction treatment facilities. I think when we hear about industry, this evokes: “Okay, we’re building an industry here.” Maybe if each of you could just talk about the model. Is it private? Are they all private except for you, Jessica — public?

Is it for-profit, not-for-profit? Do you have a board of directors? Can you just give us a little bit more insight into the structure of your organizations?

C. Basedow: Absolutely. I think for us, we’re slightly different because we’re Canada-wide, so there’s a bit of a difference there. We are a private treatment centre. We are a for-profit treatment centre. Then we operate publicly funded beds within that structure, in a variety of different areas across the country.

We do have a board of directors that, obviously, sits in Toronto. Maybe not so obvious that it sits in Toronto. I myself am responsible for all of western Canada, so any facilities that we build in western Canada, from Manitoba west. Then there’s a counterpart of mine that operates in the east. We report directly to the CEO of the board of directors. That’s the business strategy.

When you asked…. Do you want more about what the industry means? I think, for us, ascribing to sort of the accreditation piece, the best…. We can say “evidence-based care, best practice.” It gets thrown around a lot.

[11:45 a.m.]

What that means to us is that it’s heavily rooted in continuous education and continuous research on what’s best practice, not staying with what was best practice five, ten years ago. This field evolves at a rate where I don’t think any of us, regardless of sector, can keep up 100 percent of the time, and I’m very aware that that is a deficit for everybody.

I will say we do take some guidance from the United States. Typically, whether it’s just technology-wise or otherwise, we’ve seen them move ahead in a pace of about five to ten years advancement based on, I think, even just access to population credentials, university research, etc. For example, in our trauma program, we used to do a full CBT circuit, and we did EMDR, and then the States was doing a lot of accelerated resolution therapies, so we bring that in.

We really try and keep up with what our industry leaders in the United States are doing that we haven’t seen come across the border with the same intensity as before. Then, for us, a key indicator for our success is: are we also publishable? I say that, like, to a peer-reviewed journal. Not publishable to Global News or a media outlet or anything else that’s exciting, or a magazine. But the treatment that we do, the outcomes that we have — can I take that research, the demographics, put them in a peer-reviewed journal, and then can I get it published? Then I think we’re at a level of care that is excellent, and that’s in combination with accreditation.

Does that answer? Do you want more?

S. Furstenau: No, that’s good.

L. Strang: I am an owner of the Orchard Recovery Center. We are different from Edgewood in the fact that we are just one small — would consider ourselves a boutique-style — treatment program. We are CARF accredited. You can’t be CARF accredited without being licensed, so it’s redundant to say both. But we do still have to follow the Vancouver Coastal Health licensing. The licensing is not for our sector.

I would say sector versus industry. We are private. I do find the words not-for-profit distasteful. I would say we are self-supporting through our own contributions, which comes from the 12-step program.

I am an administrator at the Orchard. I came to it from a heart perspective of my family history. What I’ve done is hire well. Dr. Chodkiewicz is our psychiatrist. He was department head at St. Paul’s.

On to VGH right now, as I said, distinguished fellows of the addictions society of medicine. Dr. Durnin is our medical director. She’s a West Van resident, and Dr. Chodkiewicz is a West Van resident. Due to our location, we are able to hire off-Island. I mean, things are changing. This is a separate subject of hiring staff that can’t afford to live in your demographic area. Bowen Island is becoming outpriced as well.

We don’t have the resources to do all the research. We do, do our own surveys and research. One of the things that I find is: would you recommend us to a friend or family member? And 93 to 95 percent of our clients would recommend us to a friend or family member. I think, really…. They’re the ones that have been through treatment. We have family programs, and we do continuing care programs. We do that all through…. All of our family programming and continuing care programs are upfront in the cost.

J. Cooksey: With Last Door Recovery Society’s programs, we’ve had a youth program since 1996. We have four funded intensive residential treatment beds, and we have 26 support and transitional living beds. It used to be called support recovery. The terms change depending on the heath authorities. I would say that many of the longer-term, stellar funded programs meet the requirements of mid-level treatment services.

[11:50 a.m.]

A note on the licensed care. In order to have a community care licence, we need a contract with the health authority. When we talk about direct pay or self-supporting, our funded beds have a means assessment that Fraser Health conducts. Some citizens do direct pay the $45 a day directly to us, so we’re collecting funds for a public bed in addition to whatever our four different per diems with our contract look like. That I can’t speak to. You’d have to talk to Fraser Health. A contract is a contract, and that’s theirs. They own the files and the data with those.

We are a social model program, which is an offshoot of a therapeutic community model, with professionalized staff. We evolved out of the sober living of the early ’80s. Last Door started in the mid-’80s before….

I started working there in 1996. I was with the youth program since day one. I’ve seen the funding pilots and the evolution and the interim funding ebb and flow through, back when we had regions instead of health authorities, and the amalgamations and the shifts between having substance use and mental health combined. Then it pulled apart. I’ve seen all of that.

When we look at community care licences…. I applaud the creation of the assisted living registry. The licensing officers who are approving community care licences have no experience or training when it comes to substance use and mental health. I’m wondering if there have been any new community care licences issued since the creation of assisted…. And that’s an unintended consequence. There are some issues there, which I won’t get into.

For our model, we tend to employ people with lived and living experience. We do onboard training. Based on what we’re able to fund, we put them through school. We require that they are certified addiction counsellors through the CACCF. That’s voluntary. Anyone in B.C. could call themselves a counsellor and open up shop.

We have raised funds to become accredited through Accreditation Canada as a form of standard and as a form of education for the public. If you are accessing bed-based services, there are some key ingredients that are necessary to ensure quality.

Way back, all of our programs were required to be CARF’d. The publicly funded…. That stopped. I don’t know why. I was new in my career. CARF, in accreditation, is a regulating body, and it’s evidence that there are standards in place and that we do follow them. We have 400 individual points for our community care licence inspections. We are monitored. There is a form of quality assurance that’s happening in the public system, despite the false narrative that there is none.

We’ve continued on with the social model. We’ve been able to have a roster of a medical team that’s funded outside of the health authority’s funding. That includes an addictions physician, access to a psychiatrist, psychologist, registered clinical counsellors and what have you. Again, that depends on what we’re able to raise outside…. We’re a registered charity. So we have accountability through CRA, in addition to being a B.C. non-profit.

There are a lot of different oversight bodies that are happening for many of our bed-based services in our health authorities.

N. Sharma (Chair): Okay. I have four more people that want to ask questions. I realize we’re coming up on time at 12, so I’m wondering if people can stay a little bit later. I think we’d probably prefer to get through the questions. Am I right, everybody? Okay. We have Shirley, Doug, Dan and then myself.

Go ahead, Shirley.

S. Bond (Deputy Chair): Thank you to all of you for presenting. Obviously, there is a lot packed into what was presented today.

It is really important that we hear this component piece of responding to the opioid crisis. Our terms of reference do talk about prevention and recovery. It is one thing to deal with the here and now of harm reduction, but we also need to think about the bigger spectrum.

I have a ton of questions. I’m just going to limit it to two.

First of all, I really want to say thank you to Jessica for talking about gender. I’m very interested in the work, and I’m going to see if we could, perhaps, hear from them at some point in this process.

You reference the Centre of Excellence for Women’s Health. One of the things that is so critical is…. When we look at who is dying, First Nations women, in particular, stand out in a tragic sort of way. So I just wanted to thank you for talking about gender when we actually look at this issue.

I wanted to say that. Hopefully, we can have…. I assume it would be worthwhile having a conversation about gender and addiction. Obviously, we’re seeing two groups — men between 20 and 50 and then women, particularly First Nations women. Maybe just a brief comment on that.

[11:55 a.m.]

I also wanted to reflect on your comment. I think one of the inherent issues here…. You described it as scraps of funding and a pilot project mentality. That is a huge issue. It was an issue with our government. It continues to be an issue. I think we have to grapple with: what does core funding look like? How do we allow people to do the work that they are trained to do without worrying every other Tuesday about filling out some form for a grant? So those things.

My last…. By the way, if we need to fund more treatment beds, it’s okay to say that. There was a lot of discussion at the beginning. “Oh, is it this or that?” I don’t think there’s a person at this table who doesn’t think we need more treatment beds. We actually need people to identify that as a to-do item. Anyway, I just wanted to say that.

Edgewood says that they operate beds at a loss. We need to understand that. We need beds, but we don’t expect it to be based on someone’s benevolence. We actually need to have more beds, and they need to be fully funded.

If I could just have those two issues.

I want to thank you all. There’s just so much in there — celebrating recovery, making sure people understand recovery is a possibility. Words do matter, the messages that we send. I really so much appreciated a jam-packed panel today.

I know we all have many more questions. I’ll leave it there. The Chair is going to cut off my microphone momentarily.

N. Sharma (Chair): I haven’t done that yet.

S. Bond (Deputy Chair): She has not done that yet.

J. Cooksey: I think that we…. I mean, technically our contract does indicate “male.” We have long since been providing services to folks who prefer, whether a female-based or a male-based and what have you…. That’s a learning in progress. The health authority has not been: “No, stay in this box.”

I would say that all of us subsidize the public system, one way or another, when it comes to beds. We ethically cannot provide services at a lower tier because of the funding. That’s just a matter of course. I know that funding is very limited for mental health and addictions.

Jonny, from the CMHA, mentioned a percentage. I really liked his…. He’s very well spoken.

I think that in a male-dominant organization, it’s important to raise awareness about women’s health and the disparities that we all experience. Everyone has a mother, whether they’re present or not in their lives. We have a duty to model that in our programs.

G. Ingram: I was just going to say…. We are limited at the moment to five publicly, Health-funded beds, because that’s what we can afford to run at a loss.

C. Basedow: To break it down…. Very frankly, we get $233 a day for those beds. We will not treat the individuals in those beds any differently than the individuals in any private-pay bed at $695 a day or $950 a day, depending….

When I say they operate at a loss…. In order to have the addictions medicine, the psychiatric, the concurrent treatment, the registered clinicians, the rich amount of programming, regardless, and the individualized programming and care…. We choose to operate those because we want to still be engaged with the public system. We see so much success come from those beds. I wish it were more.

In some of the talks with…. The process of accessing funding…. Most recently, in speaking about some of the work I’ve been doing with Interior Health…. It is challenging to advocate for what it really costs. We’re trying to show the outcomes perspective. This is what it could look like, though, if it were funded, and this is what it targets. Actually, this is where this level of funding takes away from the burden on the medical system here.

It’s a combination of a lack of funding and, maybe, a lack of awareness of the fact…. With the right amount of funding, we actually are taking the pressure off the public system in a different capacity. Being able to really be honest about that conversation can be really helpful.

We have beds. I was being in jest and not in jest with the first question. The answer is money. We could fill the beds, and we want to fill the beds.

We don’t expect to turn a profit on the public beds. I need that, also, to be a very clear statement. Of course, it can’t be a loss, to that point. It is really about having that conversation and us being able to break down per diems in a different capacity and then, also, us being able to take a higher acuity patient.

That’s another piece. How do we tier the access? We can take someone directly out of psychosis, out of a hospital. We can take someone with active suicidality, as long as they’re under watch. We have the ability, due to the level of care, to take a different type of patient.

[12:00 p.m.]

If we could tier that, I actually think we could do a world of good in tiering where people go. We’re not a remote location. We’re access to…. Like, all these little pieces and these nuances. We can take someone different, and we can take someone who is really struggling in a different capacity.

J. Cooksey: Upselling that to the board of directors is probably no small…. We all have a board of directors that represents the interests of our patients. So in addition to talking about efficiencies and whatnot to the public, we also have boards of directors that we are accountable to — that have to sign off on: “Can you do it for a cost? What’s the benefit?”

L. Strang: I can make the decision in our treatment centre. I don’t have to go to anybody else. I want to say that we don’t have government-funded beds. But at least five to six beds a year we do pro bono. We just do that because….

I’ve got somebody calling me right now who went through five years ago, an Indigenous woman, who doesn’t want her band to know that she’s coming back into treatment. She wants to come anonymously. She wants to come to us. Suddenly her family member died. She had five years of sobriety. She’s filled with shame. She doesn’t want to be honest about it. She’s like: “Can you help me?” I’m like: “Yeah. Give me a call in August. I’ll help you.”

We do that all the time. But we’re not getting any money from the government for it.

N. Sharma (Chair): Just cognizant of time here.

L. Strang: We also have eight beds that we shut down, and we’re not full all the time. So there are beds available.

G. Ingram: Just quickly on the gender piece. Prior to COVID, we were in talks with government to open up…. We have a daycare facility on site, so we were looking at creating a program for single mothers to come in and have their children in daycare while they participate in programming.

COVID kind of put a stop to that, but we’re finally at a place where we’re starting to have those discussions with the ministry again, and hopefully, we can get that going soon.

N. Sharma (Chair): All right. I have Doug, Dan and myself. We’ll see if we…. I’m hoping we can just go for another ten minutes, and that’s it.

Maybe if each person can just say something once, and then we’ll try to get the full answer.

D. Routley: Shirley and I have a long history across tables, and I think we’re both somewhat alarmed at how often we agree. I think it’s generally around really immediate issues of problems and challenges that demand people surrender dogma and just address things in the most practical way possible, immediately.

I look at the spectrum of different approaches to this — abstinence, harm reduction. All of these things have their value, and all of these things — that spectrum of offerings — have to be there. I’d ask around the language, the importance of language when it comes to safer supply. Given that that appears to be the way we’re headed to address the immediacy of the problem, how can we mitigate the consequences by employing language that would support people, including those who are in recovery in the community?

Then maybe I should have asked later. But if we were to expand in partnership with existing facilities like yours, how much capacity could you add? Where would that break even be for you, without surrendering….

A Voice: Too much confidential information?

D. Routley: Yes.

A Voice: You can go ahead.

L. Strang: Okay. First of all, with the messaging. I think we should never say “safe supply.” That’s number one. We need to say “safer.”

Each drug has a different consequence. So a lot of this is around the opioid addiction. You know, typically, you need to look at what are the symptoms that you have when you’re using opioids. Then what are the symptoms that you have when you’re using crack cocaine — cocaine and stimulants. It’s very, very different.

There just needs to be a general understanding and education first. We’d be happy to be on board with any further conversations around this and utilizing our networks. But I think…. You know, impaired driving. We need to look at that.

We also need to look at this idea of normalizing drug use so that people feel that it’s okay to ask for help. Obviously, I understand that. I want people to feel welcome and not feel shame, to ask for help. However, we cannot be saying that drug use is good. In the words of Susan Hogarth — she got so upset — “Drug use is bad.”

[12:05 p.m.]

J. Cooksey: Look at the language. I think the B.C. Centre on Substance Use and the B.C. Centre for Disease Control, the prescribed and non-prescribed…. We prescribe alcohol in managed alcohol programs. We prescribe THC for a variety of medical…. Then there’s the non-prescribed.

When people who are resuming substance use, who have accessed our services, that’s generally the question, for myself, as a professional, that I land on: are you seeking prescribed or non-prescribed access to substances?

When we attach terms like “diverted….” Let’s look at the barriers that the system has created in order to why that’s being…. Let’s look at the actual social detriments of health. I don’t think that “diverted” is an appropriate term. I don’t have another…. I look at prescribed and non-prescribed from a point of view of: “Are you using this substance for whatever reason? Do you want prescribed or unprescribed? Those are the choices. If you want a prescription, here’s how you can get it. For non-prescription, here are some choices.”

G. Ingram: I think around the language, too, is this idea that drug use is normal. It isn’t necessarily normal. Alcohol use may be. I did an admission with a patient last year who was talking about their meth use. I’m like: “Well, how much meth did you use?” “I don’t know. A normal amount.” The reality is that normal people don’t do meth.

When we talk about a safe supply or a safer supply, it almost normalizes drug use. While there is a subsection of the population who do use drugs and we want to destigmatize it, we also don’t want to go so far as to normalize it. It’s a coping mechanism, and it’s a sign of a bigger issue that we want to try and heal.

C. Basedow: I’ll answer, quickly, on the point of funding. I’ll just talk about Edgewood, and even our Interior kind of thing there.

If we’re looking at just the gamut of services for a higher-needs patient, a break-even point would be anywhere between $450 and $550 a day in a per-diem setting. I can make those decisions, which is good. We could take anywhere from ten to 25 more beds as of right now.

I also want to say…. I have the ability to also, if there was an opportunity to do so…. There is the ability for us, as a larger company, to have the capacity to actually take over different treatment centre options, which we’ve looked at, with a 50 to 70 bed capacity, and have it roll out as a complete potential option for public funding and then reduce the cost, etc. If we were able to access that funding now, I mean, the beds would be there, and we’d be able to do so.

I’ll just leave it there. More conversation at any time, yeah.

D. Routley: Thank you.

D. Davies: Oh my goodness. I don’t even know where to start. So much here that we’ve heard today. I want to thank all of you, of course, for the work that you do in your different organizations. It’s a fascinating discussion, the questions.

The words matter. I know many of us have said that. That’s really valuable for me to hear that. The normalization of drug use — is that the unintended consequence of what we hear today? Good to hear all that and hear about the silos and the patchwork of different things that are happening. B.C. is not the only guilty one here. This is across everywhere, which we really need to look at in our recommendations on how we can improve a better system for everyone.

The presentations we’ve heard from all of you today have also been counter to what we have heard from others, which I think goes to show the complexity of this issue. We’ve had some folks here just recently. One profound comment was…. People often go into detox or into recovery not to get off drugs but to use less or to feel better in the interim. Again, it’s something that I hadn’t really thought much about until I heard that.

My question for one or all of you is: are your organizations open to someone who is on a fentanyl patch? They are that in an addiction. That’s what they need to be maintained. Is there an ability for them in your recovery programs, when they’re at that level?

I have 50 other questions. I’m going to have to get your business card and reach out.

[12:10 p.m.]

C. Basedow: The short answer is yes. What I want to say is that as much as we have abstinence-based options, we offer a full continuum of care, including out-patient, in-patient…. I really do believe there is a place, for specific people, for moderation management — for people with chronic pain issues, for people who want to maintain pain management, for people who want to access safer supply.

I truly believe there is a real access for everyone, and I believe, within our network, we can provide recovery-oriented services to meet the patient where they’re at and to meet them where…. There’s no expectation on abstinence. They would be then placed in specific programming that would work for their needs and align also with them having that success within that program.

Short answer: yes, absolutely.

L. Strang: For us, we have patients that are coming in now on very high doses of hydromorphine — so a safer supply. They want to come off of it, so they’re coming in to us to help them. They’re not going to come in and just cold-turkey off of that. What we would do…. The doctors would typically…. It’s going to be between the person and the doctor, first and foremost, but typically, what would happen is the drug would probably be switched. Hydromorphine would go to either methadone or Suboxone, something that’s less harmful to the person, less addictive.

Our patients often leave on…. Methadone or Suboxone would be the typical ones. And then it would be less often that there might be someone leaving on a continued use of benzodiazepines or a continued use of certain medications that can be addictive to the person.

So it depends on the doctor. And no, not everybody comes in and then completely leaves abstinent. Different medications are used.

J. Cooksey: I guess my question would be: what else have they been using, either intended or unintended? In our social model programming, there’s a fair amount of activity, so having a patch…. The means of administration may need to change for the fentanyl because of the sweat. And, first and foremost, what are their identified recovery goals? Without that information, the medication that they’re currently prescribed…. There’s so much more complexity to that. And why are they prescribed fentanyl above anything else?

Those are key points. If it was a funded Stellar bed, they would automatically be referred to more intensive services and likely wouldn’t land in our queue. With our youth program, the family would be contacted, and then they’d funnel through a funded bed.

So it depends on what their identified goals are and if we can meet those identified goals in the extended period of time that they would like. But it’s never enough.

N. Sharma (Chair): Okay. Thanks. I have a couple of questions. I’ll keep them as short…. Although none of the questions have been short, or the answers, because there’s so much we need to learn.

There were a couple of things that haven’t been answered already that I was curious about. One was…. Lorinda, you talked about this. We’ve learned from some earlier experts that there’s this connection with the health care system. People come in for either something related or non-related to their substance use, and they’re in a situation where they could, at that point, be given resources. You talked about referrals or getting to them — that intervention point. I think it was Interior Health that was looking into this or had a program like that.

I guess my question is…. I heard you say this more than once. I think everybody said it: that treating it like a medical issue, a health care issue, rather than a criminal issue is an important kind of way to look at how we evolve our thinking about the war on drugs and all the things you talked about.

I just was curious if you’ve seen any examples of that working — that referral program, that connection between primary care that we see people go to before they end up being in the coroner’s report. It seems like there’s a connection there. That was one of the questions.

The other one that I had was that…. We were learning from some of the treating doctors that are on front lines of safer supply that there’s this point of addiction where, especially with the harshness of the street-level drugs and the relentless drive to get the illicit supply to be the most potent they can in the smallest amount and how that’s killing people…. That there’s this chase for not going into withdrawal because withdrawal is just so brutal.

[12:15 p.m.]

So to come to help with a safer supply in that situation, where it stabilizes them so they don’t need to chase that withdrawal cycle, is actually helping them save lives and get in there at that critical moment.

On the continuum of care that you’re talking about, up to this point of recovery or the choice of recovery, how do you view that intervention? I’m just really curious about that idea. Those are the two.

A Voice: The intervention of…

L. Strang: …a safe supply.

N. Sharma (Chair): The safer supply at that point of just….

We were hearing that when people are on these brutal drugs, they’re chasing the drug so they don’t go through withdrawal — that point of withdrawal being so painful that it keeps them on the cycle of the street supply that’s very toxic. That intervention point of being able to stabilize somebody with a safer supply that’s prescribed, in the case of the doctors, that gets them to the point of not chasing withdrawal is an important intervention point that can prevent death.

I just was curious, from all your perspectives, what you thought about that in our continuum of care that we might provide.

L. Strang: I think that to be used correctly, that’s the perfect time to use it. The person is trying to withdraw. They want to come off drugs, either asking for help…. They have to get from point A to point B. So if you can check into a treatment centre, we’re going to do that with you and for you.

When somebody goes on Suboxone, they have to be in precipitative withdrawal before they take the medication. To do that on your own…. They have to get into withdrawal. They give up before they get to the point where they’re going to take the Suboxone.

Some of the other medications that are being used right now, such as hydromorphine, even fentanyl…. Leaving it to the person is unrealistic. That’s one of the benefits of being in treatment in a hospital. They’re not using their own self will to get to the point where, then, they can take that medication.

It also can be dangerous. Alcohol is another one that it’s dangerous to withdraw from on your own without medical assistance. In an outpatient setting, where the person’s going into a clinic — they’re seeing a doctor, and they’re being monitored — that can work.

An unintended consequence from some of this is: “If I can just take hydromorphine, then that’s what I’m going to do.” I have a letter written here that I won’t read out but would like to. It’s from somebody who said that if they were offered safe supply or treatment…. This person is now 2½ years in recovery and on OAT therapy. She said: “I would have taken the drugs, and I wouldn’t have gotten into recovery.”

J. Cooksey: Some of my favourite people have accessed prescribed medications, and they’ve been life-saving. My brother’s life could have been saved, had he been treated appropriately for his diabetes. So when I look at life-saving prescriptions, we are very far from providing those globally.

When I think about prescribing medications to reduce the urgency of avoiding withdrawal management, we don’t have the resources readily available to people to provide stabilization and the transition between services. So if we are going to prescribe medications to reduce the functional drive to avoid withdrawal management, there needs to be something else offered in addition to that. Otherwise, we are leaving people in squalor, as we continue to do.

I want to make a really important note that access to a less toxic drug supply should not only be available to people who meet the qualifications of substance use disorder. We have youth dying at alarming rates. We have rural populations dying at alarming rates. I know that may not be popular to some of my colleagues or Last Door as a whole, but I do want to…. That experimentation or curiosity should not result in death.

When we’re looking at prescribing, we also need to look at the other resources available to help people have an improved quality of life. Reducing the withdrawal management and then what? Then what?

[12:20 p.m.]

That’s what they’re faced with: the reality of life with no additional supports. How long will they be able to hang on and be resilient without those additional supports?

C. Basedow: I’ll just chime in. I heard your question a little bit differently, so maybe I’ll answer it differently, if that’s okay too.

I actually think there is a place for it. I’ll explain why. I think that for someone to…. You’re describing the drive to access street supply, and street supply fentanyl has a much higher intensity when it comes to usage than a hydromorphone prescription, etc. I truly believe that when someone is seeking that type of illicit substance and seeking a high that is of that intensity, they absolutely are not capable of thinking through their recovery options at that time.

I think it has a great place. I think it serves as an opportunity for someone to stop that obsessive cycle to some capacity and decide what, maybe, it looks like for them, have the ability to have a different level of thinking around access to recovery services in the community. Not everyone’s path will be abstinence-based. That’s completely okay. Nor should it be.

I’m of the opinion that I actually think that’s a useful strategy if it allows someone to take the time to think through different options. If that’s something that they stay on for an ongoing period of time, under doctor supervision, I also don’t see that as a bad thing, on a continuum of care for services accessed in British Columbia.

So I heard it slightly differently, and I think you guys have some different points.

L. Strang: I didn’t say that I disagreed with you.

C. Basedow: No, no. I know. I didn’t say that. I just think we’re slightly different.

N. Sharma (Chair): I just want to thank you so much for the really rich conversation that we had today and how much I think we all learned. We understood your perspectives. I think that was really powerful.

I know you all shared some very personal stories, sometimes, about people that you’ve either helped or seen, and then losses. I just want to acknowledge that. We’re sorry for those losses.

Thank you for your time and the work that you do.

L. Strang: Can I say just one thing? We get calls three times a week for youth. Decrim starts at 18. We have to get a special exemption to take an 18-year-old. But the calls that are coming in — 14 years old. So Last Door and Westminster House have a youth program…

J. Cooksey: And Traverse.

L. Strang: …and there’s Peak House. There are very, very limited resources for youth.

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

The committee recessed from 12:22 p.m. to 1:05 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): We’re resuming for our afternoon session.

On behalf of the committee, I just want to really welcome Deb Bailey from Moms Stop the Harm. We really appreciate you coming here today.

We’ll do a quick intro of people that you see before you so that you know who you’re talking to, and the people on the phone. Then it’ll be 15 minutes for your presentation, and the rest of the time we’ll have for discussion.

My name is Niki Sharma. I’m the MLA for Vancouver-Hastings, and I’m the Chair of the committee.

D. Davies: Good afternoon. I’m Dan Davies. I’m the MLA for Peace River North — in Fort St. John, I live.

S. Furstenau: I’m Sonia Furstenau, MLA for Cowichan Valley.

D. Routley: I’m Doug Routley, from Nanaimo–North Cowichan.

S. Chant: I’m Susie Chant, MLA, North Vancouver–​Seymour.

R. Leonard: I’m Ronna-Rae Leonard. I’m the MLA for Courtenay-Comox.

N. Sharma (Chair): And we have some people on the phone.

P. Alexis: Good afternoon. I’m Pam Alexis, Abbotsford-Mission MLA.

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

Briefings on
Drug Toxicity and Overdoses

MOMS STOP THE HARM

D. Bailey: Usually, when we give talks, we project pictures of our kids, our loved ones. Since I think there’s no projection capacity here or something, I’m going to pass this around. You can always find this on Moms Stop the Harm, under our gallery, just so that you get a look at some of the faces.

Thanks for including Moms Stop the Harm, which came into being when three moms lost their sons due to overdose. Sadly, I can say that from the beginning of those three, Moms is now approaching over 3,000 members across Canada. Although the name says “Moms,” we have lots of dads, grandparents, friends, aunties and uncles. We provide support for those who have lost a loved one or for those who currently have someone dealing with problematic substance use. Of course, we are big advocates for changes that could stop the senseless deaths from toxic drugs.

In my pre-Moms life, before my daughter died, I was a counsellor, a teacher, a social justice manager and a prof at a local grad school. Mostly, though, I had enjoyed really being Ola’s mom. Ola was a lively, effervescent little gal that we adopted when she was three.

Since she died, I’ve been active in advocacy. I’m on the BOOST committee about opioid agonist treatment for the B.C. Centre for Excellence and the BCCSU family engagement committee on the Vancouver Community Action team. I process all of the new joins to Moms Stop the Harm — or most of them now. I just do B.C., because there are so many.

For reasons that I’m going to point out later, I’m just going to tell you a little bit of my daughter Ola’s story. One December 21, Ola left and never came back. She said she was going Christmas shopping on Robson. She had been struggling with drug use for the past two years, but that day she seemed good, upbeat and looking forward to our big Christmas family gathering. She loved seeing her aunties and uncles and cousins.

She was supposed to meet me at 7 p.m., but she didn’t show. Later that night she didn’t make it to meet up with her boyfriend. We thought, “Uh-oh,” and, with a sinking feeling, we wondered if she had been pulled into drugs yet again. For us, it was serious business. Ola had overdosed already, four times. Each time, she had been taken by first responders to the same hospital emergency, and each time released the very same day with no follow-up. We only found out because her boyfriend, who did not use hard drugs, told us.

My husband came back late that night, and he said he’d heard on the news that four people had overdosed in the Downtown Eastside. One of them was a woman who was 25 to 26. We knew Ola was afraid of going into the Downtown Eastside, but still, we wondered. I called the police, and they actually gave me another number. That was the coroner’s number. So I called, and they said: “Oh, no, there’s no one here like you’re describing.”

[1:10 p.m.]

This flood of relief washed over me and then annoyance, because drug use had cost our family so much and created so much angst, chaos and despair, and it had cost Ola everything. She was once a great hockey player. She was a high-ranking cadet, a horse rider and jumper. She earned a black belt in martial arts, and she played the bagpipes. Now she did none of those things. She had lost her job. She had lost all her dreams. But she always told me: “Mom, it won’t always be like this. Don’t sell my goalie gear. Hockey is my life.”

An hour later I saw two young policemen walking up to my front door, and I knew before they rang the bell. They came to tell me that she had been the young lady that had overdosed in the Downtown Eastside, and that Ola was deceased.

She had been found, alone, in a third-floor stairwell of an SRO on Abbott, not that far from here. Her ID, her purse and her phone had all been taken. The police said they wondered what she was doing there, because she didn’t look like a Downtown Eastside person. But I knew why she was there, why she could overcome her fear of the Downtown Eastside. She was looking to score some drugs over the holiday season. That’s the pull of addiction.

It was Christmas Eve, and we were in the morgue identifying her positively. The coroner said to me — she’s a very nice lady: “She will be cold.” But I stood there waiting for the door to open, still hoping they were wrong. You know, like it would be on TV. It wouldn’t be Ola. But the door opened, and there she was, looking as though she was sleeping.

I mean, I just couldn’t breathe. I held her hand, and I wished I could warm her back up to life. The top of her hand, around here, had needle marks by each knuckle. I knew what she had been trying to do. She knew about fentanyl. She had OD’d four times. So to try to make sure that this was safe stuff, she had given herself multiple small injections.

Ola was just 21 years old, and it was December of 2015. You know, it’s a sad story, and I’ve only shared a bit of it, but I tell her story to point out two things. Since I do so many of the membership applications at Moms Stop the Harm, I can tell you that there are thousands of sad stories just like this one.

Most shocking of all, it’s been six years since my daughter died. We knew very quickly what was killing people. The drugs were polluted with fentanyl. People were literally getting poisoned. They bought what they thought was heroin but got this other deadly mixture.

Six years on and we still haven’t managed to curb the deaths. The numbers tell the story. They’re on my shirt, actually. People are still dying, in increasingly horrifying numbers, and the main cause of death — toxic drugs — has not been touched by any interventions to date. That inaction, I can tell you, has left many of us deeply discouraged, disappointed and angry.

In 2016, not that long after Ola died, I went to a talk given by Dr. Keith Ahamad. He’s an addiction doc out of St. Paul’s. He was talking about the crisis that we were having, and he said to me something that has always stuck with me. He said: “No one needs to die from addiction, but they are.”

I think one, huge obstacle — and you’ve probably heard this multiple times — is stigma. Our own attitudes about people who use drugs and misperception of why people use drugs, stigma against the drugs themselves and even families of the loved ones. People are disconnected, insulted, rejected and generally shunned. It’s no wonder that addiction still lives in the shadows. If you’re addicted, would you want anybody to know? Would you want anybody at work to find out?

People are going to continue to use alone and hide the use of drugs. I think maybe stigma impacts those who have the power to make tough, tough decisions needed to halt the crisis. Government is cautious about the stand they take. Likely, they don’t want to become unpopular with many of the people who vote for them, but they’re the only ones who can make a change.

One of the previous speakers — Cheyenne, I think it was — pointed out how long it can take new knowledge to replace current thinking. Something like 17 years. So many people in the public are just not up to speed the way we all are. Are those old attitudes blocking necessary actions that we need to keep people alive?

Carl Hart, in his book Drug Use for Grown-Ups, talks about ideological rigidity — our rigid belief about the drugs. We need to get a grip on our stigma, emotions and prejudices about the drugs people are using. We can get most of them already by prescription. People are not dying because of prescription drugs; people are dying because they can’t get a prescription for the drugs they use. So the drugs they buy have unknown strength and contents, and they get a toxic amount.

Heroin is a prescribed substance, used in the U.K. and in the United States and other countries. I have to tell you something that sometimes shocks people. Ola was a heroin user. When she was on heroin, she wasn’t on too much, which makes people nod off. She wasn’t coming down, which makes them try and get more. But when she was on the right amount, she, who had mental health difficulties — she had bipolar — was very calm and very nice and very happy.

I thought to myself then: “Gee, I wonder if there’s something to this drug.” We tried lots because of her bipolar. This worked quite well, but I didn’t tell her that.

[1:15 p.m.]

We’re really fortunate to live in B.C., and we are well ahead of other provinces, but our progress towards keeping people alive isn’t really enviable. I think we have to ask: are we going in the right direction? Are we asking the right questions? A lot of people want to know: “Well, what do we do about addiction?” Well, the answer is complex. There are many ideas and opinions, and often treatment is brought up. That’s great, but that’s not going to stop the deaths.

Then we say: “Well, what do we do about the opioid crisis?” We tried policing, naloxone, safe injection sites, treatment programs, safety apps, the foundation Rapid Access programs. They’re all great ideas, but still the number of deaths climbs.

If we ask ourselves a different question and operate on that — “How do we stop people from dying?” — the answer becomes much more clear. For those who are addicted or dealing with substance use disorder, an available supply of regulated drugs of known content and strength could replace the drugs that dealers are selling now, and they’ll continue.

We have studies done in Vancouver that show what will likely happen if a safe supply is available to people. There’s increased stability. There’s less crime in the area. There’s a decrease in homelessness, and some people would begin to work again.

We might be able to make a dent in safe supply if we make it available, but we need to provide it through many channels — medical areas, compassion clubs, special centres, mobile units, telehealth. We need to look at how we can do that. We have to be very careful when we do that that we don’t create barriers with guidelines, which is something that we really seem to like to do.

One is mental health. I don’t know how many of the moms have been told, “Sorry, but we can’t accept you because you have an addiction” — if you were trying to kick them out — or, “Sorry, we can’t accept you, because we’re not equipped to deal with mental health issues” and sometimes even: “Sorry. There’s a place over there, but we don’t transfer across health authorities.” Goofy rules.

Another one is daily witness ingestion. You have to go to the pharmacy every day, take your meds on site and then open your mouth to show that you have done so. Usually, you do this in plain view of everyone there. People have been dropping out of OAT programs. Is it any wonder? Who else do we treat like that?

Ola’s methadone story is interesting too. She went to get methadone. She tried to get help many times. As she walked down the stairs with the worker, the worker was saying to her quite cheerily: “Now, don’t forget. It won’t be instant. It could take about two weeks.” I’m thinking: “Two weeks? Who has two weeks when your kid has OD’d four times?” Near the end of her life and before she actually entered the hospital, she was actually buying methadone off of the street in an effort not to use. Crazy, eh?

We need to decide if this is a medical condition, and if it is, we should treat it like it is. Decriminalization is an important position to take. But has the health care model really wrapped itself around the idea of addiction as a health care condition?

We heard from Adrian Dix, the Minister of Health, many times regarding COVID but rarely over overdose. He’s the Minister of Health. What’s his plan? Sheila Malcolmson seems like a really nice lady, but by far and away, she’s no expert on drugs. That’ll come up later.

What are our expectations of physicians? We think: “Oh, physicians can now dispense safe supply and Suboxone.” The thing is that they don’t. It’s not working. Many docs don’t want to deal with this. They don’t want to prescribe safe supply.

I read what the college said when they talked to you, but I’m here to tell you that many doctors tell us: “I don’t want to get the college…. I don’t want to deal with the college.” They grab us by our arms and say: “I don’t want to deal with the college. I don’t want to get sanctioned.” So yeah, I think they’re out of touch.

Then we need to do some long-range planning, and I think that’s where the government can come in so nicely. How do we get a long-range plan? How do we get a continuum of care?

I’ve seen in some of the readings that lots of people have mentioned Portugal. I’ve been to Portugal, and I’ve talked to the people there. I have my own interesting take on it. First, Portugal and Vancouver are different, so what they implemented there we can’t necessarily implement here, nor should we.

The architect of the program told me something really important. He said: “Don’t follow our program. Follow our process.” That was to have experts come together and make recommendations that the government then implemented. It was beautiful, he said, because if it didn’t work, the government could say: “Well, the experts told us what to do.”

So the government could really help by setting that team, implementing it, funding in a long-range, overseeing plan. I don’t think people in government should be the ones determining what is needed. We need to let the experts guide.

[1:20 p.m.]

We saw what happened when we did that during COVID. We let medical experts tell us what to do, and the government backed them up. Governments hold the power, and they can make substantive changes. It might not be popular decisions, but it would be good. People will not continue to die.

Bill C-216, which didn’t pass in parliament, was a real disappointment to us. It was a good bill, and it had a lot of good ideas. We were shocked, really, to see the list of people that voted no for it. I thought: “How can you vote no for it and go to sleep at night?” I really don’t know.

I think Ola’s little legacy is…. She was the face of the change to delinking Suboxone and methadone. Sarah Blyth and I went to see Jody Wilson-Raybould shortly after Ola died, and we talked to her about Suboxone. She said: “I’ll do something about it.” At the time, methadone and Suboxone were linked. There’s no need for that. Suboxone is not methadone. Suboxone, in many other countries, is just given in a take-home form.

About four or five months later, her aide called me and said: “Listen to the radio. There’s going to be an announcement.” That was when Suboxone and methadone were delinked, and doctors could start to prescribe it on their own. It didn’t have to be addiction doctors. So I really think it can be done.

I always say that it’s dangerous to give moms a microphone. We could talk for hours, but I won’t. I’m just going to end with a Chinese proverb. It says: “The best time to plant a tree was 20 years ago. The second-best time is now.” Six years. We need to do something. Quickly.

Moms Stop the Harm, I have to tell you, is willing. Give us the money. We’ll implement a program for you. Yes, we all say that it would be good to get to that kind of thing. We know all the experts. We’ll just get them together in a room. Anyway, I know it’s a hard job. If you see the faces of those kids and loved ones over there, it’s what we have to do.

I made it, with 35 seconds to spare.

N. Sharma (Chair): Thank you, Deb. Thanks for your powerful presentation.

D. Bailey: I have two-thirds more. I won’t….

N. Sharma (Chair): Well, we have lots of time for discussion now, which is great.

I’ll start to take any questions that any of the members might have.

S. Furstenau: Thank you, Deb. I really appreciate Moms Stop the Harm. I appreciate the kind of no-nonsense approach. I’ve met with Leslie many times and attended a session with some of the moms and really found it to be so effective at centring this around people and children. Thank you for that. Thank you for your presentation.

D. Bailey: It’s not a club we want anybody to join. We’re doing a good job, I think.

S. Furstenau: No. I think every mom, myself included…. We live in fear of joining this club.

D. Bailey: People often say: “I can’t imagine.” We say: “No you can’t, and nor do we want you to.”

S. Furstenau: I’m so sorry for your loss.

D. Bailey: Thank you.

S. Furstenau: Creating the expert team. I looked across the table here at one of my colleagues, Shirley. I think this is the first time we’ve heard this as a piece of advice or a recommendation. I’d like you to delve into that a little bit more for us.

Also, the comment from Portugal: “Don’t follow our program. Follow our process.” This is really fascinating to me. So if you could give us some more on that.

D. Bailey: Yes. I mean, they did what they did for different reasons than we’re doing. They don’t have a fentanyl problem. They don’t have the same reasons, but they had a lot of drug use on the streets.

A high percentage of people were using heroin. They decided they needed to do something. They got together a group of experts, mostly all from Portugal but some from outside of Portugal. You can get a list of who those people were.

The government asked them: “Put together a program that’s going to work. What can we do?” They put together a multifaceted program. They have some mobile units. They have some rules about…. If they catch you doing heroin on the street, this is what’s going to happen to you. All different kinds of things, things that wouldn’t maybe work here.

We have so many experts here — you probably heard a lot of them — that could put a program together, that could do this really brilliantly. Better than I could and, I know, better than you could. You’ve got tons of stuff on your plate already. I feel like these people could do it if we got them….

[1:25 p.m.]

Then, if they do it, the government has to say: “Okay. We’ll back you up.” What he said, I think, makes a lot of sense. The government said: “Well, work for us.” If it didn’t work, people wouldn’t blame us for it. It would be the experts that screwed up.

That’s what they did. I found it fascinating, too, that whole idea of: who’s going to do this?

Did you ask me another part? Yeah, okay.

P. Alexis: Thank you so much. I am grateful for your presentation, in particular, because you’ve put a face to this for us. I’m very upset and very moved by your words. I just want to say thank you for sharing and just being so impactful.

I have a question for you. You talked about stigma. How would you recommend that we go about reducing further stigma?

D. Bailey: Well, I think we need to name it, of course. I think we need to realize and recognize that it’s there, and I think we need to train for it. Stigma operates even amongst the police, even amongst health care workers — I’ve had experience with stigma with those folks — and certainly amongst the general public.

I think we need to help people understand what addiction is. It’s not what they think it is. If you’ve lived with it, you know what it is, but many people don’t. So I think we have to have a big campaign, not just [audio interrupted] now. I think it’s good.

I think we need to do a lot more explaining. People don’t understand that addiction…. You know, something’s going on in the brain there for a vulnerable set of the population. Not everybody will become addicted if they use drugs. I think we really need to think long and hard about what we can do.

I think what helps sometimes is…. People who have power and people who have a face talking about it, I think, changes people’s minds. I actually went down to a Ryan Reynolds…. When he was filming…. I don’t know what it was, Daredevil or something. I couldn’t get in to see him, but I gave him a packet of information — not him but the PAs — just to see if he would think about taking us on. When they do…. I think that could change….

It’s a huge barrier. I mean, people get all wigged out even about heroin. It’s just a drug like any other one. It doesn’t have an ugly face. We just need to wrap our heads around it and grow up a bit.

N. Sharma (Chair): I have a couple of questions.

First of all, I just want to say that I’m really sorry for the loss of Ola. I’m sure that was very painful and continues to be.

I was curious about your discussion of the OAT program and how it doesn’t work for people or people don’t seem to stay on it when they’re….

D. Bailey: The B.C. centre for excellence…. The BOOST committee was charged with forming committees provincewide to help increase the number of people that stayed on OAT. They found that after six months, only three out of ten people were on the program. I was the family voice there. They did an excellent job of meeting with people across the province. They’re now specifically meeting up in Kelowna.

What they were trying to do was increase that number from three out of ten to seven out of ten. So we were….

I think the biggest thing that they found out was just the connection that people need. For example, once when Ola didn’t show up to get her Suboxone for a while…. She was actually out using drugs someplace. When she went to the addiction doctor, he went: “Oh, hi. I thought you went to somebody else.” Nobody phoned her. Nobody said: “What are you doing? You’re a week off Suboxone.” So they’ve started to phone now, in some provinces.

I put to them the question…. There’s no team here. These people need a support team. Maybe you do need to find a way, with their permission, to wrap their family in so that they can support them, so that they can understand them. We get all wigged out about confidentiality here. It’s true. We need it. But is confidentiality sometimes getting in the way?

We need to figure that out. So they did. Many of them have been starting to include teams. It doesn’t necessarily have to be family. But who are their supports to do that?

They started to measure…. Cole Stanley has this…. He’s quite amazing with the mathematics. He has this way of measuring their success in what they do.

[1:30 p.m.]

They started to meet with each other and give each other ideas about how to do that. They were pretty successful at it, at boosting their numbers up to seven out of ten.

But if you’re on a methadone program — this is the stuff we hear — in some areas and you miss three days…. We had a gal. She missed three days. It was Christmas, and she missed three days. So she went back in on the fourth day, and they said: “Well, you missed three days. Somebody else has your spot. You’ll have to get another interview.” “When’s the other interview?” “It’s about a week from now.” Does that make sense?

When Ola was on Suboxone, I had a lot of trouble with the doctor. She was prescribed Suboxone from a hospital doctor who was very good, and we were given carries, as her parents. When that stopped, she stopped, because she didn’t want to do daily witnessed ingestion. I went in to see the doctor and find out what was going on. He did give us carries again, but what he did was he made Ola’s dad and I go to the drug store every day to pick it up, and we’re like….

Interjection.

D. Bailey: Yeah. This is kind of kooky.

In Portugal, I asked the pharmacist: “When people there use Suboxone, what do you do?” She said: “Oh, we give them seven week’s supply.” Here we’re given a day.

I think there are all kinds of barriers that we really need to look at. Let’s be careful not to put barriers in place for that.

N. Sharma (Chair): Thank you.

Shirley, go ahead.

S. Bond (Deputy Chair): Well, thank you very much. It’s really hard to hear. That’s important. It is important we hear it, because I’m sure there’s a sense of: what’s it going to take to get somebody to do something?

D. Bailey: Yeah. We recognize the difficulty, but yeah.

S. Bond (Deputy Chair): I’m thinking about Portugal. I think it’s about 20 years, or something like that, since the beginning of their most recent efforts on the plan. I really appreciated what you said about how they went about it. I think that’s really important.

I want to ask you this question. Are there supports and care for families? You lost Ola. We just saw the photographs of many young men and women. Who cares for the families that go through the incredible grief? You also helped Ola along the way, going to doctors and then…. Is there care?

D. Bailey: When you’re in that trying to get things organized, nobody helps the family. I’m a very resourceful person. I knew lots of resources. So I was always scrambling, making a new plan and getting new resources in place to see if she’d go. But it’s all on you. You don’t really get a lot of help from anybody.

The police throw their hands up in the air. They don’t have any resources. The Ministry of Children and Families doesn’t really know what to do either. So nobody really helps you.

When your kid dies, nobody really helps you either. I mean, victim services came over and handed me a brown envelope full of stuff about funerals. That wasn’t too helpful. But Moms Stop the Harm fills that gap, so that’s okay.

Before that happened, in the tumult of this horrible roller-coaster that you’re on of your kid on drugs, which is terrible to see…. Ola was loaded for bear. Both of her parents were addicts. She had the genetic email for it. But I really needed help, and you really couldn’t get it. It’s all piecemeal. You could get this person…. I mean, her addiction doctor didn’t even call her psychiatrist to talk about bipolar, that kind of stuff.

S. Bond (Deputy Chair): I guess I just think that one of the things…. Our job is to look at, as you say, to stop the deaths, but I think it’s also to look at the other impacts of the opioid crisis. One of those impacts is on moms like you — and dads and sisters and brothers.

I think we need to make sure that not only when you’re on the journey…. We need to try and stop and mitigate some of those deaths. But certainly to goodness, all of us who’ve lost anyone we care about, even from more natural, that happens when they…. But to go through what you did and many, many families do…. I think that all of us need to hear you today on another level — not just about what we do about the opioid crisis now but what we do to care for people who are deeply, deeply impacted.

I just want to express my gratitude for you sharing. I think you’re amazing to be here today. You’ve been moved from protecting and working with your daughter to now becoming her ongoing advocate. That’s hard work.

[1:35 p.m.]

D. Bailey: Yeah. Not everybody can do this in Moms Stop the Harm, but those of us that can say: “Don’t worry about it. We’ll do it for you.”

I mean, our kids are with us all the time. She’s always with me. It’s not just that she was when she was present. I think that’s interesting. Yeah. It’s painful, but I think it’s a little bit of a legacy.

I didn’t finish this story. Ola was on national TV shortly after. That seemed to push the tide over for Suboxone to become delinked. So that’s what we hope now.

Yeah. I mean, it’s horrible for any reason, if you lose your kid. It doesn’t matter what the reason is. It was just as horrible in a different way before. I mean, I went places to get her that the police were afraid to go. I used to walk around in places with wasp spray. You can’t have a gun, so I put wasp spray in the back of my pants. I never had to use it, but I had a reputation. You just become fearless when it’s your kid.

No, nobody was there to help. I mean, what can the police do, really? They tried. They felt terrible about it. I’d send them to where she was. That’s a whole other story. They’d say: “We really wish we could help, but there’s nothing we can do.” The ministry doesn’t want to help, even when they’re 18 or 19, because they’re 18 or 19.

S. Chant: There are a number of moms and dads in the room. We all feel. Thank you.

Thank you, also, for the work that you do to advocate for and support a group of people that have gotten to a point where they don’t feel there’s anybody there for them. Thank you so much for that work.

When I look at the pictures — I think I have a bit of OCD — about three-quarters of them are male. In your terms, do you think there’s a difference in how to approach and how to make things available and accessible and very free…? Is there a difference in approaches between boys and girls and men and women?

D. Bailey: I think so, but I don’t know that it’s gender-based. I think when we start…. If we could do safe supply, we need to think about what groups we are trying to get to, and we need to process those groups.

But there’s something going on with the genders. What I’ve noticed is…. I thought I discovered it, and then I found out: oh, there’s a bunch of work on it.

Here’s the pattern. At 14 or 15, the kids start to experiment. There’s genetic email in their background somewhere about addiction. They have some soft neurological signs too, like ADHD, anxiety, depression, OCD, whatever. These things seem to combine to make them part of the 10 percent of vulnerable people. If you look at it across a biopsychosocial spectrum, you go: “Oh, way more boys have those characteristics than girls. I think three-quarters, at least.”

Ola herself was diagnosed with ADHD. She had mental health problems. They just seem to be the vulnerable ones. So when we talk about prevention, I think we need to look at that and the gender thing. Is there another way to work with boys? I think it’s important to think about.

S. Chant: Thank you.

N. Sharma (Chair): I have another question. I think that one of the really powerful things about yourself and so many parents with lived experience is your way of viewing, potentially, what the interventions might have been that might have made a difference. I think that’s really important for us to hear.

What I heard you saying during your…. I just want to make sure that I got it right. It’s that if there was access to some kind of safer supply for your daughter that had less barriers to access, then that might have helped. Is that…?

D. Bailey: I often say to people that if Ola had come home and said to me, “Hey, Mom, I’m going on a safe heroin program,” I would not have been thrilled. That wasn’t what I wanted for her, and that wasn’t what she wanted for herself. But I would have been relieved, because it could keep her alive. Then I’d have more time and she’d have more time to get into treatment.

Treatment is a possibility, something that’s important. That’s what she wanted too. Many, many of them do, but they don’t talk about it. Treatment is a whole other mess that we have going on here.

[1:40 p.m.]

I also think…. The first week Ola did heroin she told me. I went: “Ola, what are you doing? Blah, blah, blah.” I wish that I’d been able to get her in some place right then, you know, before the crisis came. Maybe I could have, but I wish it had been more accessible, almost like we have for early psychosis prevention, where at the first sign of psychosis prevention, you can call up the team, and they’ll come.

It depends where you are. Very true. That’s very good if there is a team. That’s the other thing. What do you do with outlying areas? How do you provide support? I think we’ve all learned something during COVID, and that was about how we can use our technology in a better way.

T. Halford: I just want to thank you for carrying your daughter’s legacy forward today and every day. I can hear it in your voice. I want to thank you for that.

We talked about support for the people that are experiencing addiction. I’m pretty familiar with your group. I’ve met with you guys in Victoria and in other places. Just in terms of the support that you guys are getting individually…. I mean that through…. Once a family’s going through this, the whole family is obviously involved, whether it’s parents, whether it’s siblings. They’re all a part of it.

Do you guys have access to support in terms of going through that? What’s that like?

D. Bailey: Actually, no. We made it, though. Now Moms Stop the Harm has started two groups called Holding Hope and Healing Hearts. Healing Hearts is for those people that have lost someone, and Holding Hope is groups for people who haven’t. These groups meet in person or sometimes on Zoom. There are grief groups, like From Grief to Action, Compassionate Friends. There are those kinds of folks as well.

But I think we saw the need for support, because there’s still stigma. I talked about Ola right from the very beginning. You wouldn’t believe some of the comments I got. Some people don’t feel safe to go outside of the group that really knows what they’ve experienced.

So I think we’re doing it. We did get a SUAP grant. Then, in B.C., we were given some money, very nicely, to organize these groups, and they are going. That’s a really good thing.

We’re just starting one, myself and another worker, in the Downtown Eastside, so we’ll see how that goes. That will be interesting.

N. Sharma (Chair): Did I miss anybody’s hand? I have another question then.

You mentioned B.C.’s step into decrim and the idea that we’ve heard from a lot of people, that treating it as a medical response rather than a criminal response…. I just was curious, from your perspective, about how that might play a role in how we move forward.

D. Bailey: One of the groups that we’ve met with often…. We’ve met with people like VANDU, people who use drugs. They have taught us a fair bit. [Audio interrupted] some people who don’t want to stop using. They use. They don’t see it as a medical condition. Okay. But they don’t still want to get poisoned drugs.

But for some, for people like my daughter, it was a medical condition. She had mental health problems. That’s where she needs to land. For those other folks, they might have done well with a compassion club.

In Portugal, what they do is they have clinics. People come in and get interviewed by special doctors. Then that doctor sends the prescription to the family doctor, who then prescribes it — that kind of thing.

I think we need to just look at various ways of doing it. But it doesn’t belong in the criminal field, for sure. I mean, the people who have addiction now, we know, are in this vulnerable 10 to 20 percent of the population. I had both my knees replaced. I’ve been on OxyContin and Percocet. It didn’t do a thing. I didn’t become addicted. Most people don’t. Millions of people have taken that. But some people….

I had a very lovely masters student who came to me, and she said: “I have to go to treatment again. I’m falling off the wagon.” I talked to her a little bit. I was talking about how it happened. She said: “You know, for me, the first time I did cocaine, I was done. That was it. One time.” It’s just part of this vulnerable population.

[1:45 p.m.]

D. Davies: I’d just thank you very much for sharing your personal story. I’m sorry for your loss.

We’ve heard lots, obviously, around stigma. There hasn’t been anybody in those seats that hasn’t mentioned that. Trevor just asked about the funding and how that goes.

One thing we heard from a presentation a couple of weeks back…. Where someone dies of a heart attack, it’s in the eulogy: “Please support the Heart and Stroke Foundation or the cancer….” But if someone dies of an overdose related to it, they just pass away, and suddenly. It’s interesting. To change the current thinking takes 17 years. I’m sure that plays a role, but there obviously is a lot of work ahead of society to move into understanding and being more understanding of the challenges.

I had a question, and it just kind of floated away as I started my little preamble. Oh, darn.

D. Bailey: I know how that happens.

There is a lot of work ahead of us, but I think we do need to, right now, answer the question: “How do we stop people from dying?” Then we can’t stop there, though. We have to keep going and find this whole continuum of care. I mean, sometimes people get treatment, and then they get released. They’re fine, but they go back to where they used to live, with everybody else using. They don’t have a job, and they have no purpose.

We really need to look at how we do the whole thing. It probably would cost a lot less than what we’re doing now with all the policing and the ambulance as well. There are a lot of people shooting each other on the streets these days, and that’s all drug turf stuff, right? It might even impact that.

Did you remember your question?

D. Davies: No, I didn’t. I wrote everything else down but the question.

N. Sharma (Chair): When you remember — it’s okay — get back to me.

R. Leonard: Thank you. We hear lots of statistics and lots of stuff. It’s really good to get grounded in the reality of people’s lived experiences. Thank you for sharing that.

D. Bailey: Any time.

R. Leonard: Multiple times — 17 years’ worth, apparently.

I know that a lot of obituaries say, “Sudden death,” or whatever. It’s the bravery of the families who step up and say, in the obituaries, why they died. Earlier this morning, I mentioned my first meeting, when I was elected, with a father who had just lost his son. They did that — very outspoken — and that’s what you’re bringing to the table. I think that’s part of this and what’s going to move us forward.

D. Bailey: It is part of the stigma — that we feel that we can’t say that. We often say now, “Poisoned, a drug poisoning,” or something like that.

Yeah, it is interesting. We don’t want people to think less of our kids, and we’re worried that they will if we say: “Died of a drug overdose.”

R. Leonard: Yeah. There’s so much to addressing stigma. I think what you have brought is help to overcome that.

D. Bailey: I think people think that…. One of the things that they used to say or that you hear, as well, is: “Well, you know, they just want to get high. Why should I spend my tax money if they just want to get high?” It isn’t like that. They just don’t want to be sick. After a while, the drug…. It’s an incredible pull.

I used to phone Ola and ask her for coffee. I could hear it. If she was using, I could hear her going: “Tick, tick, tick. Well, you know, at three I’m going to have to call the dealer, and then I’ll be getting sick then. So, no, I can’t go at five.” “How about at seven?” “Yeah, I can go then.” It drives everything they do.

I only saw the change when she started to use Suboxone. I thought: “This kid is…. All of a sudden, she can see the future.” It was just too bad that she had such difficulty getting it at that time.

S. Furstenau: I’ve got this note here: “We have a kind of systemic failure, but the burden and responsibility falls on individuals.” We’ve heard a lot about, from others as well, things like undiagnosed ADHD, mental health….

[1:50 p.m.]

D. Bailey: Diagnosed or undiagnosed, it doesn’t make any difference.

S. Furstenau: Right. When Ola got diagnoses for her mental health issues — you said bipolar — what kind of support was there, and what burden was on you and her to find that support?

D. Bailey: Well, I had a great psychiatrist in White Rock. It was a really great guy. But I really think that Ola could have used a youth care worker whose contract wasn’t going to end in six weeks. I tried to get that — even pay for it myself. I think a worker would have been really good, because when they’re teenagers, you know, their parents, who were once wonderful, are not so wonderful anymore. But they really gravitate towards peers. So I think we need to have something kind of like that. Some kind of program like that.

I can honestly say that even though Ola was loaded for bear, I didn’t expect her to go the drug route, because she had so many other activities that she chose — we didn’t push her into any of them — and she loved. I thought, I hoped, that that would really provide her with some resiliency towards that, but it didn’t.

I think, if we’re going to do any prevention programs, we just have to be honest and say: “These are the groups of kids that are impacted.” It’s easy to teach the other 80 percent. They’re not impacted. But these kids could surely be, and if they are, then we need to look at: “Oh. This is what happened, and now we need to move in again — quick.”

I wish there had been more resources. I think we’re just learning to…. Ola was lucky, because I provided a lot of the resources. She went to a great elementary school, which she loved. Her problems started…. I know the day when bipolar came to visit her. Really, a lot of her problems started then.

Then, certainly after that, probably 13…. Then at 14 and 15, there’s this experimenting with drugs, even though at first she didn’t want to, but she did anyway. They do anyway, because their peers are doing it. It’s hard.

D. Routley: Thank you very much. I really appreciate you sharing your story with us. I have a daughter who struggles with mental illness, and a few times the police have been involved. Once she disappeared, and they came up the driveway. Just like you said. I fully expected…. I dropped to knees in tears. Fortunately, for me, it wasn’t that. But she’s lost a couple of friends. She doesn’t use…. She uses softer drugs.

I live in total fear of it. One of her friends who was lost was a young equipment operator. A really sweet kid. We took him to Alberta with us. My partner is from Alberta. I didn’t realize that he had that problem. But I was wondering: like why does he drive such a poor vehicle when he’s making good money? I should have known. I feel really badly, because I probably had an opportunity to have some kind of influence on him. But maybe that’s not actually the case.

When I look at these faces and realize that every single one of them is preventable — and could have been prevented, if they’d been reached in the right way — it’s so tragic.

D. Bailey: A lot of them were in the trades. They have money. They usually have a place or a vehicle.

D. Routley: His was a back injury and OxyContin.

D. Bailey: Yeah. We find a lot of kids actually did get addicted in that way.

D. Routley: I know there’s this immediate need to address the toxic drug crisis and save people from that — immediately — but it’s reaching them, in terms of the trauma that they’ve had in their lives and all of that.

There’s a contention between prevention and safer supply and treatment. I, personally, think the full spectrum is what we need. I don’t know. Could you describe your own feeling about safer supply?

[1:55 p.m.]

D. Bailey: I don’t think it’s a place to stay, for most people. I think it’s to keep them alive. That’s what we’re doing. Really, once they are on safer supply, it gives us an opportunity to reach out to them like you wanted to do or to talk to them and to build a relationship with them.

Ola tried many times to go get help. She was open to it. Maybe she just needed more time. So I don’t think we want to live in safer supply, but right now, we just want to stop people from dying so that we can get them someplace else. Then we get into the whole treatment conundrum, but….

I think the research shows that actually, most people get better from addiction. It runs its course. At some point or other, they do get better. I think safer supply is just one way to…. I’m just really clear on it. That’s how we keep them alive. Then we can’t stop there. We need opportunities for treatment.

I’m connected with OPS, Sarah Blyth. I was talking to Trey one time, and he said: “They come in here, and sometimes when they’re ready…. They come in here, and they’ve been using.” He goes: “When they’re ready, they say, ‘Can you help me?’” And he says: “I have 20 minutes. I have 20 minutes to find a place for them to do something before they go, ‘Ah, you know, it’s not worth the hassle.’” I went: “Oh.” You know, it’s hard. It’s a short amount of time. It’s hard.

I think we need to do smarter things, too. Like, if you have had a back operation, and we start to ask you: “Does anybody in your family have addiction? Were you ADHD when you were a kid? Depressed?” Maybe you should never be on opioids. Maybe we could catch some people that way. We just have to think smarter. I know it’s a big job, but if we break it down — decrim, then safe supply — maybe we can do it.

I hope all the best for your daughter. I know it’s tough.

N. Sharma (Chair): On behalf of the committee, Deb, I just want to really thank you for coming here today. I know we all learned a lot and really appreciated your perspective and your depth of knowledge on the issue and the way that you’ve…. It sounds like…. You said you’re very resourceful and have really connected a lot of dots, I think, from that. Sorry for your loss.

D. Bailey: Yeah. Well, I’d like to thank you for your hard work and for your interest. I know not everybody is interested in it. I know it’s hard to sit here and listen to what you’ve had to do. We really appreciate it too — just that people still care. You’re the people who can do something, right? I hope you do.

We’ll help you. If any of you ever want to talk to Moms Stop the Harm or have Moms Stop the Harm come out and talk to your constituents, just phone us.

Thanks very much. Good luck with everything.

N. Sharma (Chair): We have about a couple of minutes if people want to…. It’s very tight, though.

The committee recessed from 1:58 p.m. to 2:01 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Our next presenter is Dr. Kate Salters from the B.C. Centre of Excellence in HIV/AIDS.

I want to welcome you on behalf of the committee.

I’m Niki Sharma, the MLA for Vancouver-Hastings. I’m the Chair of the committee.

We’ll do a quick intro here.

Go ahead, Deputy Chair.

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

D. Davies: I’m Dan Davies. I’m the MLA for Peace River North.

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

D. Routley: I’m Doug Routley from Nanaimo–North Cowichan.

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

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

N. Sharma (Chair): We have two on the phone. Go ahead, Pam and Trevor.

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

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

N. Sharma (Chair): Dr. Salters, you have about 15 minutes for the presentation, and then we’ll have the rest of the time, till three, for discussion. I’ll pass it over to you.

K. Salters: I provided some slides.

N. Sharma (Chair): We have them.

KATE SALTERS

K. Salters: I’ll refer to them as we go along.

I like to say that I’m a fringe academic. I’m affiliated with Simon Fraser University, but I don’t hang out at the university all that often. Most of my work is in the Downtown Eastside. I’m located at 625 Powell Street. For those that are familiar with the Downtown Eastside neighbourhood, it’s right near Oppenheimer Park. That’s where most of my work is done.

I come from a background of epidemiology and health services research. Like most folks, I think, that ended up in this line of work, I stumbled upon it because it does…. I think what I’ll allude to is that it naturally intersects with a lot of other health crises, which highlights some foundational underpinnings that are driving this crisis.

I’ll acknowledge that I come from an academic lens, but I very much partner closely with clinicians and people with lived experience. Where possible, I have tried to bring that in, as well as research that I conduct in my role as the senior research scientist.

I also recognize that as somebody who is not somebody with lived experience but greatly invested in the community, I want to acknowledge those that have died and those members of our community that we’ve lost.

I’d also like to acknowledge, with gratitude, that I work, and my research is done, often in partnership with Indigenous peoples. I recognize that I’m an uninvited settler on this land, and I think today, if not any day, I’d like to recognize that, as this is National Indigenous Peoples Day.

I’ll highlight on page 3 of my slide show that these are data that were released in January 2022, looking at the observed and projected opioid-related deaths. These were released with expectations of what was going to happen in 2022. Unfortunately, we know that it has actually gotten far worse. Even within reports where we thought that the fentanyl crisis would continue — that perhaps we would have access to the same, if not increasing or improving, harm reduction services — it has continued to surpass all of our expectations.

I’ll also notice, because I see that the committee has explored this as well, what the impact has been since the COVID-19 pandemic. Some of my research, in particular, has looked into how this is changing both drug habits but also quality of drugs.

[2:05 p.m.]

We have seen across the board that clients of ours have noticed the poorer quality, and that has impacted how they’re able to source drugs. That has had one of the impacts in this increasing toxic drug supply as well.

I’d also like to acknowledge…. My peers that I work with, with lived experience really wanted me to highlight the fact that isolation and loneliness are something that have not really been a focus of the impact of this crisis and that the devastation to communities and the re-traumatization of communities are leaving them feeling extremely isolated and alone.

I’ll highlight, on page 4…. I’ve looked through, and I know you’ve received a lot of data from a lot of different, very wonderful people. So I won’t drive home facts that I’m sure have already been presented to you.

What I do want to highlight is, in the slide details…. There have been around 95 emergency responses each day to suspected opioid-related overdoses. We know that it’s far beyond this. I work at a supervised consumption site. I do a lot of the research and evaluation related to that supervised consumption site and safe supply program. About 10 percent of all overdoses go on to either a hospital or to an EMS. That gives us just a sense of the scale of things. These are really an underreported number.

I also what to highlight…. What I think this slide highlights is the role of fentanyl in the overdose crisis but also just polysubstance use in general. Fifty-nine percent of the deaths in Canada, from these data, as of January 2022, had a stimulant involved as well. This isn’t just an overdose crisis related to opioids. It really is a poisoning of the entire drug supply. So I want to highlight that as well.

On slide 5, what I really wanted to highlight is…. As most of you know, B.C. really is disproportionately impacted by the crisis. Of course, within the province itself, we recognize that there are certain regional disparities in terms of what services are being offered. I’ll speak to that as well.

I’ll skip slide 6 because I think you’ve seen this. I saw most of your presentations. So to spare a little bit of time.

On slide 7. One of the questions that was asked was: “What is making the ongoing crisis even worse?”

We have a cohort of people who are now intentionally using fentanyl. I think we have to recognize that a lot of the policies, a lot of the clinical approaches that we have now are responding to the heroin crisis from ten years ago or longer. We also know, as I mentioned, that more than half of accidental opioid toxicity deaths also had a stimulant reflecting polysubstance use in this population and that 86 percent of these apparent toxicity deaths were also involving an opioid as well. I highlighted here a figure that I think well illustrates the differences in the potency between heroin, fentanyl and carfentanil as well.

Lastly, the increase in smoking drugs, which is a fatal method of using drugs, has increased. The coroner has provided a great explanation of what the impact of that is.

I manage a cohort of people who have been recently treated for hepatitis C, and we follow their outcomes over time. You’ll see me go back and forth between hep C and HIV a little bit because that’s the nature of the work. In this cohort of people living with hep C, we track, every three months, what types of drugs they’re using. We ask them about their harm reduction services. Fentanyl is the only drug that we’ve actually seen increase since 2017.

The proportions of drugs among people actually haven’t changed. The toxicity of those drugs has been changing. I think that’s important to highlight. It often gets pushed back on to people who use drugs, saying: “Well, the types of drugs people are using may be changing, and that’s why.” But actually, the types of drugs people are using aren’t changing that much. The market is changing, and people are using as they intend to use.

On slide 8, I have just an illustration of the illicit drug toxicity deaths by mode of consumption. This was provided by the Ministry of Public Safety. Of course, we see that a large proportion of folks are smoking, and that is leading to fatal overdoses.

[2:10 p.m.]

Now, I think everybody is probably fairly aware of the problems. What I want to talk about, with my remaining time, are some of the solutions that we’re trying to move forward and generate some research and data around.

One is…. As I said, coming from HIV and hep C, there’s a reason why the same populations that were dying of HIV and are the same populations that are impacted by hep C are the same populations that are dying now from overdoses. That is ongoing structural racism, violence and systemic oppression resulting in poverty.

Some concrete steps that I think are necessary are…. We have some — not a lot, but we have some — really effective interventions to support people, in particular, who use opioids. Things like OAT, or opioid agonist therapy. We also now, thankfully, have options for risk mitigation with the new guidelines, as well as safer supply options. However, we don’t have any way to alert physicians or care providers when people stop those medications.

With HIV, we’ve found that to be, actually, a life-saving tool. We’ve centralized a system in B.C. with HIV drugs, and that’s been something that’s gone through the minister’s office, has gone through policy experts, and it has been solidified. So now if somebody is HIV-positive and stops taking their treatment, you don’t come down on them and say it in a punitive or a shameful way, but you reach out.

It launches an alert that goes to a health provider or a nurse, and they go and support that person to re-engage. Oftentimes it’s: “I lost housing” or “I have this life event that has interrupted or led to the interruption of my HIV treatment.” The folks that I work with, the partners that I work with, just think that could be such an easy step to implement in order to reduce overdoses.

We’ve shared — and I’ve shared, in these slides, as well — how, when people stop their OAT, they are more than three times more likely to have a fatal overdose than when they’re maintained on opioid agonist therapy. Certainly, that’s not going to work for everybody. We know that opioid agonist therapy isn’t the right fit for everybody, but for those that it does [audio interrupted], if we’re able to sustain them on treatment through those alerts, that would be a life-saving measure.

We also can ensure 100 percent linkage to care after non-fatal overdose events through better outreach measures. We have great teams in Vancouver Coastal. We have the overdose response team. They’re really fantastic at reaching out and connecting people to care. But care facilities are increasingly getting full. They’re at capacity, and people don’t know how to pass off folks when they’re discharged from hospital after an overdose event.

I’ll say this as a researcher: having a centralized monitoring and evaluation plan embedded within clinical practice is something that’s actually really rare. I work in research, in a rare circumstance, or a rare situation, where our research and evaluation is embedded into our clinical practice. There isn’t enough infrastructure or support for a lot of clinical teams that are doing really great, really innovative work to actually rigorously monitor what they’re doing.

That’s why, almost two years after the risk mitigation guidelines have been published and released, we don’t have really great data on what the impacts of things like hydromorphine and safer supply alternatives are. It’s not because people don’t want to publish it; it’s just because they aren’t set up with the infrastructure. So being able to party or support collaborations with clinicians and researchers would be a really great step as well.

Another one is day-of dispensing for OAT, as well as safer supply. I’ll give an example. We have a new diacetylmorphine program running out of our Hope to Health clinic, which is fantastic and far superior, in the eyes of clients, than the tablet hydromorphine program. We also have a fentanyl patch program, which is working exceptionally well. The feedback from clients is: “I can finally sleep again. I feel like I finally have my day back.” It’s been wonderful to see the implementation of that service.

However, one thing that I’ll note that is that with our iOAT or diacetylmorphine program, we have so many issues accessing those drugs that it actually takes us two days to get them, from the time that we want to start somebody…. If we want to start somebody on those medications on Monday, we actually have to get the medication dispensed from Crosstown Clinic. They have to dispense it to us. We have to move it over.

If we had the opportunity to have daily onsite dispensing, we would be able to start people and actually start to titrate them the day of, which would be an incredible advantage for maintaining and supporting people on these alternative risk mitigations.

[2:15 p.m.]

I see that I have about 12 more slides and two minutes left. I put decriminalization at the bottom of this — “Opportunities for a centralized health systems response” — on slide 9, because I think it goes without saying that decriminalization is the path forward to address these but not the only path forward. I think what I really want to, hopefully, convey is that the situation that we’re in right now is a legacy of the war on drugs, and our responsibility to the clients that I serve and that I work with is to try and find a new way forward.

I’m really happy to be working for an organization — I’d be very pleased to answer some questions about how our model of care is working — where we have a really rare model. We have research evaluation, a safer drug supply program, a supervised consumption site and a primary care clinic all co-located together. I think that’s why we’re seeing different rates of retention in our program — up to about 85 percent retention on things like OAT and risk mitigation compared to other settings where we’re seeing retention of about one-third of the population and even further after a one-year period.

I hope that I can use my time to maybe answer some of those questions. I’d be very happy to speak about both our research, our research findings, as well as the clinical programs that we’re offering.

S. Chant: I have a really quick first question. First off, thank you so much (a) for the work you’re doing and (b) for your presentation. It is truly appreciated.

Secondly, on slide 9, can you tell me what syndemic means? It’s not a word I am familiar with.

K. Salters: Syndemic is a way to think about multiple, intersecting epidemics.

S. Chant: Oh, epidemics.

K. Salters: Epidemics, yeah. It’s another term for multiple, intersecting epidemics that often mutually aggravate or make each other worse.

When I think about the overdose crisis, I see it naturally intersecting with an epidemic of homelessness, HIV, hep C. That’s why somebody like me, who came from infectious disease, ended up doing substance use and addiction research.

S. Chant: Okay. The other piece to this is that when I look at the slide related to the supervised usage sites…. I’m going to call them that. What would it take to move those over so that you can use whatever way you need to — i.e., smoke it, which is apparently killing a lot of people right now. To switch those over — what is the barrier to that?

K. Salters: There are physical barriers, and we have, at our….

S. Chant: Psychosocial.

K. Salters: Yeah. I mean, our physical barriers are quite pragmatic. We need a way to have negative air pressure in a room where people can use inside. Most of the smoking facilities are outdoors, as folks have probably mentioned already. We want to try and find ways that people can use inside.

I think I have here on slide 11 that there really is this sliding scale of folks that are not engaged in care, and we want to get them to a place where we’re addressing whatever their needs are, letting them set their goals. But at the supervised consumption site or overdose prevention site, a lot of them don’t have that connection. So bringing those inhalation sites or smoking sites inside I think would be a really great step.

We are trying to fundraise for three booths, and it’s going to cost us about $1 million.

S. Chant: For three booths.

K. Salters: For three booths. That’s the reality of having enough ventilation to upgrade the system so that we can actually have ventilation be sufficient enough for WorkSafeBC. We obviously have a lot of safety measures that need to be in place for people to be using illicit substances in a booth if we need to do a medical response or anything. It’s physical and monetary.

N. Sharma (Chair): I have a question for clarification on slide 3. I just don’t understand the side colour. You have a purple line and a dashed green line and red and a dashed….

K. Salters: Oh, yeah.

N. Sharma (Chair): That whole section — I’m curious about that.

K. Salters: I’m going to do this as best I can. You can see mine are black and white.

N. Sharma (Chair): The top one is purple for me.

[2:20 p.m.]

K. Salters: The top one is just saying that if harm reduction services stayed the same but fentanyl supply or the fentanyl toxicity increased, these would be our levels. It’s saying that if fentanyl got worse but harm reduction stayed the same, then it would continue. If harm reduction stayed the same and fentanyl stayed the same, this is where it would be. Then the last is if harm reduction increased but the fentanyl increased subsequently, that’s where we would end up. Then if harm reduction increased but if fentanyl stayed the same, that’s where it would end up.

It’s trying to kind of measure some projections or model some projections as to what would happen if our harm reduction services changed or the fentanyl toxicity changed in the illicit market.

R. Leonard: I’m sorry. My document trying to load just kept trying to load, so I really concentrated on what you said. I had no pretty pictures to follow.

I really was interested in the comment that you made within your solutions around the opportunity if there was a system in place where there was some sharing of information. We’re hearing a little bit about that from a little different perspectives, around that information sharing and the issues around privacy and confidentiality.

Do you see that as a barrier, or do you think that there’s a way forward, like if people are willing to sign off on that sharing of information? I know there is some information-sharing possible.

K. Salters: I think everybody was really, rightfully so, cautious with HIV. Our organization really takes charge of the HIV registry in the province, and we are very protective over that, naturally. We don’t share data. The ministry and the CDC are the partners that we’ll share data with, and that’s exclusive. Even that is deidentified data.

Being able to send alerts to public health nurses is something that was a long and arduous process. But I think the fact that there’s been proof of concept with HIV…. That is something that we never thought that we’d see, and we’ve seen that there’s great benefit. Not only that, but we’ve seen that clients have really appreciated that.

I’m leading a CIHR-funded study that’s evaluating that right now, and I’m happy to follow up and share some of our exciting results. We’re asking providers and patients what their experience with it has been. Overwhelmingly, it’s been exceedingly positive.

I think the proof of concept with HIV really shows that you could do that with OAT or safe supply, anybody who’s engaged in care for supporting active addiction.

N. Sharma (Chair): One of the things we’ve been learning is that — I think you mentioned it — the safer supply models that we have for heroin are kind of outdated now when it comes to the drugs that people are using on the street.

You also mentioned how…. You said fentanyl patches, and then you said diacetylmorphine. There’s a two-day wait. Can you explain that? Help us understand what the steps are to getting it.

K. Salters: It took us two and a half years to actually get that. Our first application went in almost three years ago for diacetylmorphine, and we have been going back and forth. I luckily stay out of those negotiations. We have a lawyer who is much better at handling those things than I am. But the kind of back and forth has been that VCH has allowed us to have a certain amount of diacetylmorphine, but actually getting our hands on the medication has been the thing that has been hard.

PharmaCare has been great. They’ve supported us. The Ministry of Health has supported us. But getting the release of those drugs has been the difficult thing. I don’t know why it’s so difficult. I wish I had a good explanation for why it’s so difficult. The two-day waiting period or the two-day delay is just because we don’t have any dispensing on hand. For the fentanyl patch or when we had hydromorphone or when we did injectable hydromorphone, we had pre-filled syringes, and we would keep that on site for folks.

That’s not possible with diacetylmorphine, in the same way, for clients. You can’t predict. With the fentanyl patch, we could just say that we anticipate that 30 clients might be interested in our fentanyl patch, and we’ll have a certain reserve in a locked box, and it’s all Health Canada approved.

[2:25 p.m.]

We can’t do that with diacetylmorphine. They’re very strict about…. Somebody has to formally enrol in the program. You have to send that. It needs to get dispensed from Crosstown Clinic. Crosstown is the only clinic, their pharmacy, to release diacetylmorphine, and then we get it two days later, after the approvals go through. It’s kind of an administrative barrier.

N. Sharma (Chair): Just a little bit of a follow-up. We were also learning about how the body’s response to fentanyl means increasing the dose that is required to get, I guess, that level of withdrawal. Some doctors were just seeing a very high amount of a daily use that was there to replace the no-withdrawal symptom.

I’m just…. Are you seeing that too? Is the diacetylmorphine something that helps with that, or the fentanyl patches? What’s the…?

K. Salters: Yeah. I think we try and leave it up, as much as possible, to what the client’s asking for, because they know better than we do. We have a whole bunch of doctors that are trying to figure out what the difference between a rock and a gram is. We’re all just trying to figure out what the clients need.

I have two things, I guess, to answer. One is that we have three different types of safer supply risk mitigation programs. We’ve had the tablet hydromorphone, which was not really acceptable to clients. Eight milligrams of hydromorphone didn’t do anything for people that were taking one gram of fentanyl a day. It just didn’t even scratch the surface. It wasn’t acceptable. The generic form — they didn’t like how, even though you got a tablet, it wouldn’t dissolve nicely for injection. So it just wasn’t appropriate or relevant for the user.

The fentanyl patch program — people really liked it. There are some issues with how it’s administered. You keep it, and it ramps up, and then, usually, a day later, you’ll hit the therapeutic dose. So waiting to get to that, sometimes clients don’t love it. Some people really love it. Some people think it’s been a game-changer for them. It’s also a response that if you’re using fentanyl, it’s fentanyl in response, and that’s one thing that clients really like.

The diacetylmorphine — some people really, also, love it. We’ve had 13 people start on it in the last month, and we’ve had two people stop because they’ve just said: “It doesn’t touch what I need for heroin. It doesn’t have the same hit that I’m looking for.”

The diacetylmorphine, I think, for the other clients that have been retained on this, they’re just really happy to have substance that isn’t going to kill them, to be honest. That’s how it lands with them most of the time, and it’s something that frees up their time. They don’t have to source for six, eight hours a day. So the appropriateness of it, I think, is married with…. It’s more relevant for their needs than the hydromorphone, at least.

N. Sharma (Chair): Any other questions?

Go ahead, Susie.

S. Chant: Where did the hydromorphone idea come from? No, the tablet.

K. Salters: Yeah, the Dilaudid.

S. Chant: Dilaudid. Sorry.

K. Salters: I’m not sure, actually. I’m not sure where it came from. I think, with most things, maybe the hydromorphone was a solution…. I mean, Dilaudid is still an opioid. It could be, I think, most easily prescribed. It was probably on the…. It made more sense for PharmaCare, probably, to start releasing it.

I’m not…. I don’t want to speculate. Sorry.

S. Chant: No, no. Thank you.

P. Alexis: Thank you so much. I really find this interesting, because you’re providing us with possible solutions. You talk about systems. I know that that question was asked about centralizing a system. Are we capable, at this moment, of providing a centralized system for the crisis? If we are, that’s great. If not, what are the next steps that would need to be taken?

K. Salters: That’s a good question. I’ll speak for the B.C. Centre for Excellence in HIV/AIDS.

One of the things that we’re trying to pilot, or push forward as our next steps, is actually developing a mini-registry, actually doing this and developing some proof of concept within our own clientele. We don’t have to go through the same public health and privacy issues, because it would be our clients, and we would have outreach nurses that would help us identify folks that we see discontinuing.

[2:30 p.m.]

That registry or that alert system — we’re taking steps to actually try and develop that, because if we can do it at the community level then maybe we can galvanize this at a larger level. Whether that’s by health authority…. If we were able to even do it by health authority that would be an incredible place to get to.

I think one of the pieces with that is having the dispensing not at a private dispensing pharmacy. That’s one of the struggles. One of the things we’re also trying to do, in addition to trying to get money for the inhalation rooms, is set up a dispensing pharmacy in partnership with VCH.

If we were able to, especially in a place like the Downtown Eastside…. You can think of Nanaimo, or you can think of Victoria. Places like that, where you may have a few different clinics working together. If you had one pharmacy actually dispensing the hydromorphone, the OAT, the diacetylmorphine to those clinics, the clinics could act as almost a group, and then the alert system would go out to that clinic group in partnership.

That may be one thing to start, in terms of a proof of concept.

R. Leonard: Suddenly a second question came up in my head. The first one was…. I’ve thought about this often. I just haven’t asked the question. So I’ll ask you.

What changed that suddenly the preferred method was smoking? Is there a sense that it might be safer than injecting, or did we just come upon a new generation of users who don’t like needles? What’s going on with that?

K. Salters: I think there’s probably a lot to tease out in that. I’m not actually sure that smoking has increased. It’s just that the fatality of smoking has increased.

In the coroner’s report, there’s the graph, slide 8. This is the illicit drug toxicity deaths by mode of consumption. It’s showing which are injections, smoking, internasal, oral or unknown.

We’ve tried to look at it within our data. We actually don’t see that smoking itself is increasing. The method where people are having fatal overdoses may be disproportionately changing to smoking.

There are a few things that I’m not sure of and that I think are worth inquiry. This is where data and collaboration are something that I think is really needed.

There could be an impact of supervised consumption sites. You have more people…. You have spaces where…. People who inject or consume or ingest can use those sites, but you don’t really have a lot of sites for people that are smoking.

People who are also using polysubstances may be smoking and injecting. What we’re seeing is…. With the rise in fentanyl, this complicates things even further. But with the rise in fentanyl and carfentanil….

The opioids are so strong that people are using side a lot more. Side is just like meth or another amphetamine that people are using alongside it. It is used oftentimes as a harm reduction tool. It’s like…. The opioids are so strong, and they’re going to suppress my system so gravely that I need to use meth or I need to use something to keep me up a little bit. Because the fentanyl is so strong….

It could be a multitude of things. It could be that maybe people are smoking more. It could be the fact that supervised consumption sites are very effective at their job, and they’re keeping people who are injecting safer. It could be that people may be smoking side and injecting down, but when they’re smoking, everything is still tainted.

Even in the coroner’s report…. It’s not just fentanyl — we often think of fentanyl, carfentanil — but benzodiazepines. There are other ways that people are tainting, and that could be why we see more stimulants being involved in fatal overdoses now.

R. Leonard: Boy, I’m glad I asked that question.

K. Salters: I don’t have a clear answer. It’s probably all of those things, if I’m to guess.

S. Bond (Deputy Chair): Thanks for your presentation today and the work that you do. Just two quick things, hopefully.

One, is there a role for drug testing, and is that utilized currently in the work that you do? We’ve certainly heard about the limited availability of that.

[2:35 p.m.]

Secondly, when you talk about opportunities for a centralized health system response, one of the things that you note is to make sure that there’s a linkage to care after a non-fatal overdose. When you look further in your presentation, a lot of people don’t have a primary care provider. So how do we do both of those things? If they need follow-up, who on earth is going to do that if they don’t have a primary care provider? The number is quite high, in terms of the sample that you’ve provided there.

It’s not only that. The other thing that’s really interesting in the stats you’ve provided is the fact that a vast majority of people have been incarcerated before. I think, again, that’s another focus of some of the work we’ve heard.

So drug testing, and then what happens? Who looks after them if they’ve had a non-fatal overdose and they need care?

K. Salters: Yeah. Those are great questions. We opened our supervised consumption site in October 2020. We’ve offered drug checking since day one, and we have a handful of people that use it every month, of the 9,000 visits that we’ve had so far.

S. Bond (Deputy Chair): So people just don’t use it.

K. Salters: I think if we had more sophisticated analysis…. We might be able to get some samples from people, but a lot of people don’t want to offer it up. We have fentanyl strips and benzo strips, so people can know. So many people are intentionally using fentanyl that it’s redundant. We offer it, but we don’t find that it’s used.

What we’re trying to do a little bit more are some pharmacokinetic studies. We’re trying to see if we can ask people for samples — more of a safety check on a few samples every once in a while — to just get a random selection of what people are using, and try and compensate them for it. Obviously, when they’re coming into a supervised consumption site, they don’t really want to give up what they’re using, understandably. We’re trying to figure out a thoughtful and ethical way to start looking at that.

For the primary care provider…. I mean, that’s an excellent question. That’s actually something that I’ve been trying to grapple with for myself.

On slide 14, there’s a table that says…. Table 1 is a sample of clients at our Hope to Health supervised consumption site. I have a cohort of 125 individuals. We’re starting to grow it. It’s actually for a hepatitis C initiative that we’re trying to do to eliminate and try to tackle hep C and gaps in care. Inadvertently, this is actually a cohort of people who use the supervised consumption site. We’re growing this cohort, but there are 125 people in it.

We asked them about their primary care provider, and 28.8 percent said they have not seen a primary care provider in the last 12 months. That, obviously, like you, stuck out for us. That is not only a lack of an opportunity to address things like wound care, like mental health, like OAT opportunities but also iOAT, fent patch, DAM — all of these interventions — not to push it on them but to actually ask them: “Do you have any interest in using safer supply? If so, we’re going to be here. We have a primary care clinic directly next door.”

Through this initiative, we’re trying to actually address some of those gaps. There is, I think, this misconception that the Downtown Eastside has this abundance of services. When we started and launched our clinic in the Downtown Eastside…. VCH is doing a wonderful job. Everybody, I have to say, is doing a wonderful job. This is not a criticism. DCHC, which is the Downtown Community Health Centre, which is directly beside us, can’t take any more clients. They were at full capacity the day that we opened. The Pender clinic didn’t have the capacity to take on new clients.

When we opened…. We didn’t launch, largely, but we were getting phone calls from people that were saying: “We hear that you’re open and that you may be able to take clients. I have a patient that’s getting released. Could you please see them?” That’s how we grew to 1,400 clients since 2019. It just shows that connection. I think that may be a larger discussion about the health system, primary care networks, community health centres and what’s happening there. I think that, in and of itself, is probably its own crisis.

[2:40 p.m.]

I’ll speak to what we’re seeing at the Hope to Health clinic. We see clients. One of the big differences that we’re seeing is…. We ask them to goal-set: “What’s important to you? Let us figure out what we’re going to do that’s going to work for you. The idea is that you are not going to stay here forever. Maybe you will. Hopefully, this is for a period of time, and we get you to achieve your goals.”

That should mean moving out of the community health centre system, eventually. Maybe that takes ten years. Maybe that takes a year. But I think that there is a lot of cycling through different systems in that community health care kind of crisis. We’re trying to move away from crisis management, where people are coming in, and coming with their most urgent issues, and we’re trying to ask them about safer supply, OAT, hep C, HIV — all of these things that we think should be front of mind but unfortunately are reflexive later on.

S. Bond (Deputy Chair): If I might, one of the interesting things, when you stop and think about the groups of people…. When we look at some of the data that we’ve received, we see that some of the people who have died have actually had ten or more visits to health care within the last three months of their death. So we have people that are overrepresented in the health care system all over the place. And then we have, in the case of your cohort, almost 30 percent of them who don’t have a primary care provider. We have to sort out what’s going on there, as well, as part of the context.

So I really appreciate your insight. I’m grappling with: how on earth do we have people making multiple contacts, and on the other hand, don’t have a primary care provider in 30 percent of that particular cohort? So thank you. I really appreciate that very thoughtful presentation. I appreciate it.

S. Furstenau: You talked about time a little bit. In our last presentation, we heard about a mom trying to organize coffee with her daughter. Accessing substance meant that that calculation had to be made. You just mentioned the amount of time. Can you go into this a little bit more for us? What does that time factor look like? Then what does access to safe supply do when it comes to time?

K. Salters: What we’re doing with the fentanyl patch program and the diacetylmorphine program is rapid evaluations. So myself and my research team ask people what their experiences are: what’s working, what’s not working — everything. We make sure it’s not the clinicians, because there are obviously a lot of reasons for not having your clinicians ask you about how your care is.

One of the things that we ask is: “What are your goals in this? Independent of your clinician, what do you hope? What is your motivation for this? What are you noticing right away?” In the diacetylmorphine evaluation, as well as the fentanyl patch program, the first thing people say…. Well, I’ll say their goals are — and I’m glad you said that — to, often, reconnect with their family. It’s not to get clean. It’s not to buy a house. It’s usually to have some stability so that they can reconnect with their kids or their parents or their siblings. When we ask them what the first thing they notice is, it’s that “I have all this time on my hands.”

I think that, to us, is…. In addition to the sleep quality, which when you are not having to wake up with withdrawal, and you’re not shaking, and you’re not having stomach pain and all of these things — the amount of quality of life…. I think we all know what a good night’s sleep will do for our attitude and our demeanour, but then on top of that, to not wake up in the morning and have the first thought you have be “where am I going to source my drugs so that I can prevent withdrawal?” is a massive win or an advantage for folks that are going through the safer supply program.

The fentanyl patch, in particular, because it lasts for a while…. You don’t have to apply it every eight hours. It will last for a few days. People have remarked and said: “I immediately, as soon as I started this program, woke up in the morning and realized I had eight hours in front of me that I didn’t know what to do with, so I’ve started thinking about going back to school” or “I’ve started thinking about getting into trades” or “I’ve started to think about other things that I can start doing with my time.”

There are certainly a lot of people who still are embedded in the community. That’s where they have support. That’s where they have connections. They’re still, likely, within some sort of the same social environment. But the freedom of them to be able to dictate what their day looks like is something that I think doesn’t come through in a lot of the clinical research showing that it’s reducing overdoses — that people are retained on it. All of those are really important, but those quality-of-life measures, I think, are some of the most impactful.

N. Sharma (Chair): Any other questions, Members? No.

On behalf of the committee, I just want to really thank you for coming in and helping us learn from you and your experience very much on the front lines of figuring this out with people. I think we all learned a lot, and I also want to just thank you for the work that you do every day.

K. Salters: I really appreciate what you’re all doing, and I really appreciate the time that I got to sit and chat with you all.

The committee recessed from 2:45 p.m. to 3:29 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): On behalf of the committee, I just want to welcome you. We have Dr. Mark Tyndall from the University of British Columbia here today from the School of Population and Public Health.

We’ll do a little bit of an introduction, and then I’ll pass it to you.

My name is Niki Sharma. I’m the MLA for Vancouver-Hastings and the Chair of the Health Committee.

I’ll pass it to the Deputy Chair.

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

D. Davies: Good afternoon. Dan Davies. I’m the MLA for Peace River North.

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

[3:30 p.m.]

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

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

R. Leonard: I’m Ronna-Rae Leonard. I’m the MLA for Courtenay-Comox.

N. Sharma (Chair): On the phone, we have Pam and Trevor.

Go ahead.

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

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

N. Sharma (Chair): Dr. Tyndall, we’re really looking forward to learning from you today. We have all the materials that you sent on our various screens. You have 15 minutes for the presentation and the 45 minutes that we have left — whatever time we have left — for discussion after that.

I’ll pass it over to you.

MARK TYNDALL

M. Tyndall: Okay. Thank you for inviting me to speak here today. I’ve been at this for quite some time. I most recently was the director of the BCCDC. I was the associate deputy provincial health officer, and I’ve worked at the B.C. Centre for Excellence for about 15 years, doing HIV work. So I’m fairly familiar with this area. I prepared my statement to read, so I’ll basically just read what I wrote.

As I said, I very much appreciate the opportunity to present to the Select Committee on Health. I think your work is extremely important, and I’m pleased that the provincial government recognizes that there is a crisis going on and that something needs to be done about it. But having presented at similar political committees and having spoken with countless federal, provincial and municipal politicians over the years, I am not optimistic that any significant change will happen.

The way that we use the criminal justice system to reduce the drug supply must change. Our current approach of shaming, isolating and punishing people for using drugs is the exact opposite to what is needed as we are trying to reduce drug use. Our abstinence-only approach must be rejected.

Our own version of this war on drugs has been playing out in British Columbia for decades, although everyone knows that it is unwinnable, expensive and destructive. We have been unable to pivot from the criminal policies and punishing environment that people are living in. This is despite international headlines around the high rates of HIV in the 1990s, the disappearance and murder of over 50 women at the Pickton farm, and now in response to the drug poisoning crisis. At this point, I do not see the general public, law enforcement, public health leaders or politicians willing to take the necessary steps to challenge the status quo.

I have been working in the world of drugs and health for a long time. I arrived in Vancouver in March of 1999 after spending four years doing HIV prevention research in Nairobi, Kenya. I went from one HIV crisis to another — one crisis where HIV transmission was rampant among sexually active young people, and the other where HIV was rampant among people using drugs and sharing needles.

The political response was entirely inadequate in both places. In Nairobi, it was because we couldn’t respond. In Vancouver, it was because we wouldn’t respond. This same type of inertia plays out with every new emergency, including the current overdose crisis.

There have been some incremental changes. Supportive housing has become a thing, needle and syringe programs have evolved, some specialized medical clinics appeared, a small prescription heroin program was established, and Insite was opened in 2003, almost 20 years ago. Much of this progress has been initiated by community activists, drug user groups like VANDU, and NGOs like the former version of the Portland Hotel Society. These initiatives are largely confined to the Downtown Eastside of Vancouver, and the rest of the province, at least until very recently, has refused to offer these harm reduction services.

When the issue of drug use does come up, mainly around election time, most of the promises revolve around doing more of the same — more police to enforce the drug laws, more shelter beds to act as temporary housing, more residential treatment beds and more gentrification of the neighbourhoods to squeeze people out. Rarely mentioned is the need for less police presence, decriminalization of drug possession, more community supports, living wages, real housing and a regulated drug supply to replace the illegal market.

The devastating and unrelenting drug poisoning crisis in the province has forced the public and politicians to keep looking for solutions. When the public health emergency was declared in April of 2016 by Perry Kendall, I was the associate provincial medical health officer, along with Dr. Bonnie Henry. It seemed that there was a window of opportunity for some real change, but that evaporated quickly.

[3:35 p.m.]

In 2015, it would have been unfathomable to think that seven years later, things would actually be worse and that the poisonings would go far beyond the Downtown Eastside and become a provincial and national crisis. Over 25,000 people in Canada and over 10,000 British Columbians have died in the last six years.

This new reality is the predictable culmination of prohibition, criminalization of drug use and societal indifference towards those who are dying. Our failed response to illicit drug use has implications that stretch far beyond the overdose deaths. Under the false and arbitrary pretense of illegal drugs, homelessness, severe poverty, community crime, HIV and hepatitis C transmission and mass incarceration are accepted as intractable problems.

At the extreme, we have created an underclass of people who spend their days hustling for drugs, scrounging for food, searching for shelter and avoiding the police. This scene is played out in communities across British Columbia and is largely preventable.

The criminalization of people who use drugs creates violence, destroys communities and ruins people’s lives, often for good. Criminalization puts the responsibility and blame for drug use firmly on the backs of individuals most at risk. While physicians and other health care professionals are keenly aware of the social and economic injustices that perpetuate poor health outcomes, we have been relatively silent on the call for decriminalization of drug use, even though it is so clear that most of our medical interventions are severely limited by our drug policies.

The medical community is focused on expanding opportunities for addiction treatment and care by increasing the options to receive substitution therapy. But clearly, these initiatives are not enough to stop people from dying of drug overdose. Most physicians are not willing to step outside of their rigid medical practice to accommodate people who do not adhere to the rules of practice. Most physicians do not think that addiction should even be part of their practices at all.

For a profession that prides itself in scientific evidence, prohibition and criminalization have no standing. The basic justification for this approach appears to be founded on the belief that punishing people for their drug use will act as a deterrent to further use and to provide a strong disincentive for people to try drugs in the first place. This approach has been an unmitigated disaster, as illicit drug use has continued to rise, the illegal market becomes more violent and unpredictable, and more people end up in the criminal justice system for drug-related offences.

The criminalization of drug users has stripped us of our empathy and concern for those who most need it. When people are engaged in criminal activities, it is much easier to be dismissive and unaccountable. In fact, criminalization gives permission to overlook the racism, mental illness and the tragic life events that people have endured. After all, why should we care about people who choose to break the law by engaging in dangerous behaviours, especially when the medical system is already overstretched caring for people who are law abiding?

Arguably, the most damaging and direct consequence of criminalization is that it reinforces the powerlessness, hopelessness and lack of self worth felt by most people who use drugs. This is the antithesis to the self worth, personal agency and hope for the future that is critical to a person’s recovery. In fact, the trauma associated with arrests and involvement in the criminal justice system mirror the trauma and violence that may have led to drug use in the first place. While there are many ways that people can emerge from their world of pain, addiction and despair, no one recovers without hope.

In our system, you go from a troubled teenager, an Indigenous person dealing with generational trauma, a person with untreated mental illness or a victim of a road accident directly to a criminal by a decision to self-medicate with drugs. You go from a person that we want to help to a person who is in the criminal justice system. This makes no sense.

Decriminalization of simple possession is a critical first step to improve the lives of people who use drugs, but there is a very long way to go to address the damage that has been inflicted on our most vulnerable citizens by decades of unchallenged, reckless and radical drug policies. We must be willing to prioritize support and engagement over punishment and exclusion and a commitment to ending the disastrous impact of drug criminalization.

Let me say a few words about safe supply. This was not on the list of harm reduction interventions even five years ago. I provided the committee a commentary that I had published in the Canadian Medical Association Journal in January 2018 entitled “An Emergency Response to the Opioid Overdose Crisis in Canada: A Regulated Opioid Distribution Program.” This was one of the first articles to argue that a public health approach to the crisis, using a regulated safe supply of drugs, was necessary.

[3:40 p.m.]

In 2017, while I was the director of the BCCDC, I secured a Health Canada grant for $1.4 million to distribute hydromorphone pills at a supervised injection site. Not one pill was ever distributed, as barriers were put up by the provincial government, health authorities, addiction care doctors, the College of Physicians and the College of Pharmacists.

The idea of giving out opioid tablets to people was thought to be a ridiculous idea, when physicians were busy cutting people off of their opioid prescriptions. The popular narrative at that time was that unscrupulous doctor prescribing had caused the problem in the first place.

In 2019, I received another Health Canada grant, this time for $3.4 million, to trial the MySafe program, which dispenses hydromorphone pills through a biometric machine. Learning from my previous experience with safe supply, I didn’t ask anyone for permission. I was legally allowed to prescribe hydromorphone, called Dilaudid pills. I followed the pharmacy requirements for dispensing narcotics, and I set up a society to accept the funds from Health Canada so I didn’t have to involve academic institutions or health authorities, which I knew would create barriers.

So far, no one has tried to shut the project down, but MySafe remains a bit of an orphan program with no support, financial or otherwise, from the province or the health authorities. The funding runs out in March 2023, and I’m not sure what will happen. We have three machines currently running in Vancouver, all in the Downtown Eastside, and one in Victoria. There are around 100 active participants using these four machines.

While we have partnered with the BCCSU, who are conducting a comprehensive evaluation, there are a number of positive outcomes that I can share with you today.

Like other safe supply programs, participants are able to reduce or even eliminate the purchase of street drugs. In self-reported surveys, 100 percent of the participants say that they are purchasing less street drugs, and about 30 percent have eliminated street purchasing altogether.

There are three major benefits to this. Firstly, it greatly reduces the chance of overdose by ensuring exposure to drugs with a known potency and purity. No one in MySafe has died of an overdose after over 10,000 dispensing transactions. Secondly, it decreases participation in the informal economy and reduces the chances of arrest and jail time. Thirdly, perhaps most importantly, it gives people an opportunity to access other services: housing, health care, employment, family connections, etc.

Other important observations include…. Hydromorphone pills appear to be an acceptable alternative to street fentanyl and heroin for most people if the dose provided is adequate. While other drugs are used in addition to hydromorphone, including cocaine, crystal meth and benzodiazepines, the reported use of these other drugs is also down significantly.

The biometrics used to identify the participants are fast, accurate and dependable. Participants are not spooked by the technology. The machine provides real-time dispensing records through a secure website, and automated daily reports are manufactured which are superior to the pharmacy records.

One rather unexpected observation is that many people are swallowing the pills instead of crushing them for injection. A move away from the use of needles is a trend in the community overall. Dilaudid tablets provide people that option, as opposed to distributing powder, which is used only for injection.

Participants have been very consistent in picking up their prescriptions. There are people who have left the program, almost always because they have moved out of the area, got employment or no longer need daily dispensing.

While the current focus is on the poisoned drug supply, the increased isolation due to COVID, the rise of mental illness among young people and the lack of treatment beds…. These are all distractions from the bigger issues of prohibition, criminality, violence and intense poverty. We have created this through our drug policies and an upside down view of addiction, where people can only get help if they agree to stop using drugs. From my experience, I know that people will only stop using drugs when they find something better.

N. Sharma (Chair): Thank you, Dr. Tyndall.

Okay, committee members. Questions?

Go ahead, Susie.

S. Chant: First off, is it possible that we can actually get a copy of that statement sent to us, please?

M. Tyndall: Sure. Yeah, we can send a copy.

Interjection.

S. Chant: Oh, it will be on Hansard. That’s true. But if you wouldn’t mind, I would appreciate that.

M. Tyndall: I’d be happy to, yeah.

S. Chant: Thank you.

MySafe, which is what I heard you talking about, has been useful to a group of people. But you never had…. From what I’m understanding from what you’re saying, you did it completely under your own jurisdiction, without going through the various hoops and barriers to get it established.

[3:45 p.m.]

M. Tyndall: Yeah. I say that a little tongue in cheek. Everybody knew I was doing it. The colleges all saw it and demonstrated it. So everybody was quite aware of it.

S. Chant: They were aware, but you weren’t applying to the college, saying: “I’m going to do this. Can you…?”

M. Tyndall: “Please give me a letter to….”

S. Chant: “Can you give me your…?”

Yeah. Okay. Thank you. I appreciate that.

D. Davies: Thank you for that.

We’ve heard a lot about these barriers and silos and the patchwork of different things. We’ve heard about almost a near inability to get methadone or people not wanting to access it because of the rules laid out.

If you had a recommendation for us to get these treatment options to individuals the easiest, what would that be? What needs to happen? Is it the pharmacies that are blocking this? Like I say, what policies do we need to be really zeroed in on right now to make this easier?

M. Tyndall: We use the term “low barrier” or try to set up situations where people can easily access things. What I’ve tried to test out is using a machine to do it, where people don’t have to go to a pharmacy. It’s open 24-7. They can get it. Two of these machines are in supportive housing units, so the machine is for the people living there. They just go down to the lobby and get it when they want. That’s one model.

But we’re so restrictive, and the safe supply programs that have been rolled out really are following the methadone recipe, where it’s quite restrictive who gets on it. If you miss a couple of days, you have to get back to see your doctor for another prescription, and they’ll reduce your dose. You work back….

In my 20 years of experience with methadone, the biggest reason people don’t continue is because of the program, the pharmacies. For any of us, you can imagine if your expectation was that every day, you have to go line up and get your methadone. I mean, over years, that kind of wears off. There are going to be times when you clearly can’t do it, and if the penalty for missing a day is that you don’t get it the next day until you see your doctor, people just give up.

That kind of very punitive, top-down approach really sends a message to people that they’re not in control, like: “We’re doing you a massive favour by allowing you to have our methadone program. Here are the rules to follow, and if you can’t follow our rules, then you’re off.” That never made any sense.

People are using methadone, for example, to help themselves. They’re trying to reduce their reliance on other drugs by having something. The idea that people can’t have carries and all this never made any sense. You’d be much better off giving people a week or a month…. Keep it in the refrigerator. If you decided to drink it all at once, you’d kill yourself. But people don’t do that, generally. They could kill themselves other ways if they wanted to do that.

Anyways, we need to rethink the whole program — that this can’t be medicalized and punitive. We need to look through the eyes of the person that we’re trying to help. How would you want your methadone? Nobody would say: “Oh, I want to line up at the pharmacy every day to get my methadone.”

The technology that I’m using for the hydromorphone would be perfect for methadone, too, where people were keeping track of things and it’s in a secure place. But it’s like a safe lockbox for people to keep their own prescriptions, and they can go get them as they need them. Those kind of low-barrier technologies are what we need. So more carries, or give people much more autonomy with it, or have it in safe places, like these machines, where you can just go get it, I think.

D. Davies: You were talking about these, and I think the old Ramada on Granville has one of those machines in it.

M. Tyndall: Yes.

D. Davies: I did see it there. They explained it to me. It’s amazing.

M. Tyndall: It’s called the Lugaat now, or something.

I mean, it’s not the only thing. But those kinds of low barriers and giving people control over their own treatment, I think, is critical.

S. Bond (Deputy Chair): Thank you very much, Dr. Tyndall. I guess I’m not surprised by the sort of tone of your comments, because there is a lot of skepticism and, I think, a lot of history around….

[3:50 p.m.]

You used the word “inertia.” Not to be defensive at all, but you speak to where the general public is, where politicians are. I can just tell you — and I can speak very personally about this — that as we speak, I am on a learning journey here. This is not a world that is necessarily overfamiliar to me. So the information that we’re receiving will hopefully drive where we….

I can say that after two decades as a provincially elected official, I haven’t wilfully decided that I don’t think we should help people, but I don’t have lived experience. So part of this process that I think brings benefit is that we do need to bring British Columbians with us. Frankly, we need to bring colleagues and other people with us.

Your comments are appreciated from that perspective. While perhaps I feel a bit uncomfortable hearing those, it’s important to feel that way in order to make change, to move…. I’ve been very honest with my colleagues here. I’m on a journey. I’m learning about this. I just want to set that context. I’m no expert, and I don’t have lived experience, so all of this information is important.

Maybe you could help me by backing up a step here. You’ve talked about the need for low-barrier access, and we’ve heard a lot about that. When you say to me that there are three machines available, I assume that that means dispensaries, in essence, so that people can come. But machines don’t decide the dosage. They don’t provide…. Perhaps, walk us through….

The machine is the ultimate innovation in that people don’t have to go to a pharmacy. I can assure you we’ve had panels from VANDU and many other drug-user groups who have said those very things — that it’s humiliating beyond belief to have to go and open your mouth and go to a pharmacy every day, all of those things. I personally am learning about that.

Maybe explain to me what it takes to get to the machine, who’s behind that, how that works. Is that work funded from the grants that you’ve received? The people that make the machine operational.

M. Tyndall: Yeah, thank you. I didn’t want to dominate it with my little MySafe project.

S. Bond (Deputy Chair): It’s important, though. I’d like to know of that.

M. Tyndall: I’m happy to do that. The entry to get into the machine is if you’re buying street fentanyl. The eligibility criteria is pretty straightforward. So most of the people in the building are interested in hydromorphone or that.

I have a team. Well, I have a nurse and a community worker who identify people who are interested in it. We put a little advertisement up in the hotel: “Hydromorphone is going to be available.” They do a quick screening on people, and then I’m the prescriber.

I either go down there for a day and see a bunch of people, or a lot of the consults are on FaceTime. So I just see them quickly and introduce myself. I have to know them. Then I just write a regular prescription. It goes into the pharmacy. We pick it up and load the machine. It’s pretty straightforward that way. Then we have…. We follow people along, but in a very supportive way, not a punitive way. If they miss a couple days, we just ask them why.

One of the funnest parts of enrolling people is that I ask them how much they need. They’re always surprised that the doctor is not telling them: “This is what we’re going to start you on.” I say: “How much fentanyl are you using, and what would you need?” Many doctors giving out hydromorphone limit it to six or eight pills a day, which lasts people like two hours. Usually people want 16 to 20 Dilaudid eighths a day. I agree. I work with them on what dose they need.

Then there’s a biometric part of the machine. It’s pretty straightforward. They just have to get their hand scanned, and we load it in. Once they’re registered and their pills are in the machine, they just go once a day. The machine is all programmed, so you can only go once a day. It times out. If you go too early, it will say, “Next dose is available in six hours,” or something, if they go too soon. Then they get it, and then every night I get a printout on the web of who got it, what time they got it, and we track people that way. It’s very straightforward.

Now the technology. Right now there are 48 rows in each machine, so it’s limited to 48 people per machine. That’s only because the pharmacy regulations require you to pre-label each package that goes in the machine with the participant’s name and my name and the dose. Everything has to be prelabelled so only that person can get it.

[3:55 p.m.]

Technically, these machines could be networked so you could go to any machine. If you lived in Vancouver and you’re going to Victoria for the weekend, you could get your pills there. We’d be able to track it just the same way, but the machines, then, would just be loaded with certain doses of drugs. On the way out of the machine, then we’d record who got it and what time they got it, all the same information. The college of pharmacy is not ready for that yet, but you could technically put this kind of technology out there and network it across the province.

It’s very regulated, so people can’t just go and get as much as they want. We know exactly how much they’re getting and when they’re getting it. That’s basically how it works.

There’s one called the Carl Rooms on Princess Street, in the Downtown Eastside. There’s one at Lugaat, on Granville. There’s one at the OPS, the overdose prevention site, also on Hastings. Then there’s one in Victoria now. We’re starting one in Winnipeg and, hopefully, one in Prince George. Somebody is from….

S. Bond (Deputy Chair): I am.

M. Tyndall: Sorry, yeah. There’s a community group and a doctor there that I’ve been in touch with, and we’re hoping to get something in Prince George.

S. Bond (Deputy Chair): I ask that not because I want…. I mean, I understand your sort of not wanting to talk about the machine, but I think it’s an example of how…. Your comments earlier on were that governments basically are people — generally just want to keep doing more of the same. This is an example of how a technology, in this case, a different mindset is allowing there to be some degree of change. So that’s why I wanted to hear more explicitly how the machine works.

I have some others, but I’ll let others go ahead, Chair.

M. Tyndall: If you’d just make the vision of somebody we expect now to go to an alley, to some stranger, and buy an unidentifiable package of drugs and take it home versus going to a machine that you know what’s in it, and you get it…. I mean to me, in this environment, with all this poisoned drug, it’s so obvious that should be the image we’re trying to promote.

If it wasn’t illegal drugs, if there was any other kind of widespread poisoning like this, we’d just put these machines out there, and anybody could use them instead. “Wait, wait, wait. Don’t buy your drugs there. Just go to the machine because you won’t die when you do that, and then we can help you later.”

The idea that somebody gets up in the morning feeling dope sick or withdrawing, and they’re immediately thrust into this crisis that they have to find money and drugs right away…. Versus if you wake up at Lugaat, you go down some stairs, you go get…. Your day is quite a bit different once you know that you’re not going to be sick all day, you’re not going to be desperate all day. It’s very effective for people.

S. Furstenau: I think hitting home the point that all these barriers that exist to safe supply don’t exist to the illicit supply…. Right? It’s not hard to access the illicit and very toxic drug supply. It’s barrier-free. Not that I’m recommending…. But I think that that’s really something to hit home, right? It’s not that these barriers prevent use of drugs that aren’t going to kill people and create more need for, as you say…. I think it’s really important to hit that home.

In our presentation earlier today from Moms Stop the Harm, Deb talked about, akin to the COVID response, a panel of experts driving the response to this. So when you talk about the problem with political will, the problem with the challenge for politicians and elected people to move beyond status quo, to — as Shirley points out — push the kind of level of knowledge and understanding, what do you think of the idea of…? I mean, it’s been declared a health emergency, yet the decision-making seems largely to remain in the hands of politicians and elected representatives.

[4:00 p.m.]

There are some examples where there can be a health order that says that we’re putting in an overdose prevention site in this community, and that circumvents whatever efforts a municipality might put up, although we heard that there are challenges with that as well. Do you have thoughts on that recommendation and what that could possibly look like?

M. Tyndall: Perry Kendall was kind of an expert in this area too, right? He was on the inside, and he worked with Terry Lake at that time. I was in on a bunch of those meetings. That’s when I was a bit optimistic that people really listened to Perry. There was a group of people around Perry. He had a lot of contacts, and things would happen.

The one thing that did happen fairly quickly was the supervised injection sites. The Liberal government at that time decided: “Yes, go ahead and get them going.” So that happened quickly. But then things kind of ground to a halt when it came to the criminalization and all the other things that we were talking about.

But in answering, I think that, yeah, it seems so obvious to me that you would have a group of experts who are doing this. To Shirley’s point, I mean, it’s really like 1 percent of the…. It’s a massive issue for the people, and that’s all I think about and do. But in the whole scheme of things, it’s a pretty small segment of our population, and people can’t be expected to really understand it.

I think it would be great if the government gave some of that — maybe the final say could be government, but some decision-making or recommendation table; let’s go for this kind of thing — to people that are more on the ground and knowledgeable about this thing, for sure.

I said in my statement, when I first came to Vancouver, all the innovation was done, really, through the Portland Hotel Society. They were pushing the envelope. Some of it was civil disobedience. They just did stuff. Those things — whether it was needle distribution or the supervised injection site or supportive house programs — basically all started out as kind of against the rules, and they just did it. All those things, in retrospect, are now kind of just accepted.

We need some aggressive steps that people can do. We’re dealing with a very conservative college thing too. The College of Physicians has taken no responsibility for this. They’re still sending out messages to stop prescribing opioids, which is so crazy. The College of Pharmacists has such entrenched rules with how they deal with narcotics. They haven’t moved an inch from that. So it’s not just the…. The whole infrastructure….

As I stated, a lot of doctors don’t want anything to do with this. Even if we get the green light to start prescribing, I would say 95 percent of physicians will go: “Oh, it’s not my thing.” They might even say: “I don’t know anything about this either.” That’s not their reality. They don’t think they should be dealing with illegal drugs.

There are a lot of barriers there. If you had a group that could challenge some of those…. Even a “let’s just try this” kind of thing and not make the College of Pharmacists change all their bylaws but just say: “Okay, for this year, this is the way we’re going to try and do it, and we’ll evaluate it and see what happens.” But right now if we have to ask permission for it, nothing can ever happen.

Then I didn’t talk about the police very much. Clearly, that’s a huge elephant in the room too. They have so much vested interest, and so much of their budget and time goes into this. I heard Minister Malcolmson say that even with our safe supply announcement, or the decriminalization announcement, now we can focus more on the dealers. Well, that’s still the war on drugs. That is not….

We don’t want the police just increasing their RCMP presence and trying to bust people, because every bust they do creates chaos in the whole…. It goes to somebody else. It’s a Whac-a-Mole type of thing. Again, focusing all our attention on the dealer or the drug lab is just never going to turn out well.

[4:05 p.m.]

R. Leonard: I’ll just echo what Shirley was saying, noting your cynicism from a lifetime of experience coming up against a wall. It sounds like not just here but across the world — some places that couldn’t and some places that wouldn’t. That’s what I think you said. I understand that when you don’t ever see the final solutions coming forward, it’s hard to see light at the end of the tunnel.

I’m a bit more hopeful. I got into this game, and I live by the motto that I believe in evolution, not the revolution. We have to bring people along. I think Shirley mentioned that too — that drug use and stigma against drug use has existed since the dawn of man and the use of drugs.

We’re here today to try and find a way to kick-start ourselves into a better place, and so much of what you’re saying is stuff that we have heard from many, many experts. I appreciate you reinforcing all of those sentiments about how we should move forward.

I wanted…. It’s not a silly question. It marries my interest in the machine with your comments around policing. I need to go to that machine, just because it’s such a novel way of dealing with some of the conservative constraints that we’ve been hearing about.

Now, I’m not sure if I understood that you’re doing it without seeking permission or you just didn’t seek approval in the…. I still don’t quite get that. I wanted to know that.

I wanted to know: is there a cost to people who are getting their drug supplies? Is there a problem with policing, hanging around the machines to then strip people of their drugs? Are there issues around carrying ID? That’s one of the things that we heard. If you don’t have your ID, you can’t say: “This is my drug.” So they get confiscated.

Then on the criminalization and the decriminalization, if…. We had asked for a larger amount for the decriminalization exemption. We didn’t get it. It’s for three years, and then, presumably, we’ll be looking at it some more. Is that the path we should be going on? Do you see that as the way?

There are quite a few questions in there, but they all revolve around the machine.

M. Tyndall: Yeah. Well, the policing part…. Actually, Bill Spearn was the main VPD person, and he tragically died a couple of months ago of a brain tumour. Bill was a huge advocate and a friend of mine. He was raising money from the police for the machine.

The one letter of support and recommendation was from the VPD. That’s my prized letter from the VPD — that they’re totally supportive of this way to do things. From that perspective, the police have been very supportive of the work I’m doing. At least the VPD is quite supportive of safe supply. They want people getting prescription drugs and things, so that’s a plus.

For the machine, the two big questions about the machine are: do people just hang out and wait for people to get it and mug them? That’s never happened — zero times. At least in the Downtown Eastside environment, there are drugs everywhere. If you’re going to mug somebody, with pretty much anybody, you could do that. The machine is not a target for that.

The other thing is people diverting their drugs. They get their 30 pills, and they run out in the street and just sell them. We can’t say, 100 percent, that that doesn’t happen. We asked people about diversion, and about 20 percent occasionally divert, they say, but that’s almost always to friends or the partners who are drug sick. To me, that’s just a nice thing to do when you…. It’s not a huge problem. The idea that you’re running to a public school and handing them over the fence to children or something…. That — zero — never happens. It stays within the community.

[4:10 p.m.]

If people are on the program, they want to reduce their reliance on street [audio interrupted], so there’s really no reason for them to go and trade their good drugs for bad drugs. I think there are occasions where people might trade their opioids for some cocaine, if they really need it. I can’t say that no drugs are diverted, but the vast majority are not diverted.

As far as the permission thing goes, I mean, this is totally…. Obviously, it’s for everybody to see, and I’ve had countless meetings with the College of Pharmacists, the College of Physicians and doctors groups and things. But just getting them to sign a letter saying they support this has been…. They don’t want to say it. They say: “We’ll let you know when we see the results of your study.” So they’ve agreed to just let it happen, but they’re not bending over and trying to support it for me.

That’s what I mean by not asking for permission. It’s totally aboveboard. I’m not doing anything illegal.

R. Leonard: Thank you. That’s what I wanted you to say.

M. Tyndall: Yeah. I’m a doctor. I can write a hydromorphone prescription, and I go through the PharmaNet.

The province is paying for it. So that’s another conversation I had with the PharmaCare people in the ministry. They came and looked at the machine too. There was some concern that they wouldn’t want to pay for the drugs, and it would have to come out of the grant. But I did have a conversation, and they agreed to pay for them. An eight milligram Dilaudid pill is 32 cents in the pharmacy, so a day’s supply is $4 or $5. It’s not that much.

S. Chant: That’s nothing.

M. Tyndall: The participants don’t pay for their drugs.

R. Leonard: Can I just say one thing? I wanted to say thank you for using the word “hope.” When I hear that, I’m seeing that in so many of the things that people are saying. Without hope, we’re not going to get to a place where people are not dying.

For me, that’s just really driving me now to be looking at where…. What road we go down has to include hope. It has to be the basis of it.

You talked about personal agency and that dignity, and all of that. It all relates to recognizing the human value in every person that you’re dealing with. Thank you for your work.

D. Routley: Thanks, Dan.

He just sent us a picture of your machine.

D. Davies: It was really interesting. I was with the police, and they actually said: “This is really cool.”

N. Sharma (Chair): Go ahead, Doug.

D. Routley: I’m okay, thanks. My question was asked.

N. Sharma (Chair): Okay. I have a couple. The first one I have is that it sounds like this way of distributing through the machine is associated with housing or some kind of housing. Is that right?

M. Tyndall: It can be. Three out of the four machines right now are associated with housing.

N. Sharma (Chair): Three of the four — okay.

I was wondering about…. Two things came to mind while you were talking. One is the complex care model of housing — people that need the wraparound supports in housing units. It’s the thing that was launched by the ministry recently. Do you see a role for this type of…? Do you see the housing being a successful tie-in with this type of, I guess, safer supply? Is that something that could expand with housing — like the housing that’s going in with complex…?

M. Tyndall: Yeah. I’ve had conversations with people from B.C. Housing. I mean, if you’re setting up a supportive housing environment for people using drugs and you don’t put any drugs in it, then those services aren’t going to be used very much.

Before I even had the machine, before I even thought about a machine, I was working in Surrey on the 135A strip, where there were like 400 people living in tents, and there’s an RCMP set-up there. It was basically like an outside jail for people.

Then they got all this modular housing. So they moved. I think 75 to 80 percent of the people who were on the street all of a sudden got housing. They put them up fairly quickly, and they had supports in there. I followed this as it happened, because I had some patients I was looking after in the clinic that went there.

[4:15 p.m.]

I’d go there at nine o’clock in the morning, and it would be pretty deserted. These modular housing…. Like 80 people, 90 people lived here, and there were like three or four people hanging around. Everybody has left, because they have to go get drugs. So they cleared that street. Most of them ended up on the SkyTrain going to the Downtown Eastside to get drugs. It seemed so ridiculous.

It was great. They had this housing, and most people had a place to sleep at night, at least, but they were pretty much empty. All these ideas, that we could offer all these services to people on site and things, just evaporated because they weren’t there.

I argued initially to have a…. At that time, I didn’t have a machine, but at least had a safe supply program in the building so that people don’t have to go searching for drugs, because that’s what’s really hurting them. I think every B.C. Housing unit, if they’re catering to the people who are using drugs, should have a safe supply program there. The machine is the easiest way to get that up and running.

N. Sharma (Chair): Yes. My next question is a little bit related. I want to know your position or your views on the prescribed safer supply and the medical role in that — which it sounds like you’re squarely in. Some people that present to us say that it should be different models that are not administered in that way. I’m really curious where you land on that.

M. Tyndall: Well, it’s not going to happen if it’s just up to doctors like me, because there’s not enough of me around to want to do this. Even if you have some guidelines that sort of protect doctors, if you tell someone who needs safe supply, “Well, go ask your doctor,” most times you’d come away with not what you need or what you want.

I do think there needs to be a non-medicalized model. Now, there could be a general prescriber. I mean, it’s nothing to write a hydromorphone scrip. Certainly, nurse practitioners but, I even think, trained nurses — under some kind of supervised thing — could write these prescriptions and get the medical doctors out of it. There’s no real billing way for them to do it, so some of this is financing. I’m prescribing to 100 people, and I’m not billing for it up to this, kind of, under the grant….

It’s kind of a unique position I’m in. For other doctors that I’m trying to get to prescribe, the way they have to bill, they have to see people to bill for them. All I’m doing is letting the nurses kind of follow people, and every eight weeks I write a new scrip. That’s not really a billable, sustainable way. There actually needs to be a model where those prescriptions come out of a central agency and are dispensed somewhere else.

I do think that if we’re serious about scaling this up, in direct response to allowing people not to buy drugs that are killing them, it’s also our attempt to undermine the illegal market and try to come up with a regulated way that people can get these drugs — which, I think, is the way that we have to go.

If you had a provincial-wide way, people would have to qualify for the program. You’d probably do a urine test, and you’d see them, and you’d know that only people who need it are on it. Then, once you qualify for the program, it’s kind of like a designated scrip. The government or somebody sponsors it, and now you’re eligible to get this particular drug in different ways.

N. Sharma (Chair): Thanks for that. We’ll have a second round going around.

S. Chant: To follow up on Niki’s question, the Compassion Club model for a safer supply — that says that it’s outside of the physicians’ realm. I just wonder how you stand on that one.

Also, and this is just a clarity-for-me question, we heard from VANDU that at one point…. I think they said that in 2014, methadone went to Methadose. Apparently, for some people, that was a very difficult transition, if it worked at all. Can you explain to me the difference between methadone and Methadose? I’m a nurse by trade; I haven’t a clue.

M. Tyndall: Sure. That has never been corrected, and people now are getting back some access to methadone. But most people are still on…. The default is Methadose, and that’s what doctors write.

S. Chant: So what is Methadose, versus…?

[4:20 p.m.]

M. Tyndall: It’s supposed to be…. It was advertised, when they made the switch, as having exactly the same pharmacology, so you won’t notice any difference. It’s much more concentrated, so you get a littler dose. The pharmacology, if you ask the manufacturers, should be the same. But so many people say: “It just doesn’t do it for me. It’s not as good as methadone as far as how long it lasts and how it makes me feel.”

That was a great example. It was a top-down, economic decision, and the government just switched it.

S. Chant: It was a formulary…

M. Tyndall: Yeah. It’s cheaper.

S. Chant: …change over to generic, like we did for so many other things.

M. Tyndall: Exactly. They didn’t ask anybody. People, all of a sudden, came into the pharmacy, after getting their methadone for years, and then got this little red thing. “Well, what’s this?”

S. Chant: It didn’t work.

M. Tyndall: “Oh, it’s not good.” That was a huge problem, and a lot of people fell off the methadone bandwagon and went back to using drugs. So that was a terrible decision by whoever makes that decision in PharmaCare.

S. Chant: It has never been turned around.

M. Tyndall: Not enough. I mean, people now can…. If they’re really wanting to get methadone, they can. But that’s a huge problem.

Then your first question was….

S. Chant: I was just wondering about the compassion club model and where you stood on that.

M. Tyndall: Yeah. I mean, people need all kinds of opportunities. I think the people that I’m dealing with in my program probably couldn’t function very well in a…. These are….

It’s really how much agency you have. I can see people arguing for a compassion club who have it together and just want to get a safe supply. They could get a bunch of their friends or community together. They could purchase it, find it.

The people that you generally see pushing shopping carts around…. I don’t know how well they’d do in a compassion club model, if they had to pay into it and things.

I’m not against it, and it would be a non-medicalized way to get it out. They talk about how, under current restrictions, you get your shipment of cocaine and crystal methamphetamine. It’s pretty complicated, I think. At least with opioids, we have pharmaceutical equivalents we can give people, whether it’s fentanyl or hydromorphone. When you get into stimulant drugs, there are still huge international barriers for that. You and I can’t order cocaine very easily, and I don’t see that’s going to change in a hurry.

I’m not against the model.

N. Sharma (Chair): Okay, the final question.

Shirley, go ahead.

S. Bond (Deputy Chair): I just wondered about…. In the case of the people who you care for in your practice in this way, with the machines, who cares for the rest of their primary care needs? How do they intersect with the primary care health system? We know that some don’t have primary care physicians, and some have constant contact, apparently.

How does your practice intersect with primary care?

M. Tyndall: That’s a great question. Part of the push-back, on the machine, from my addiction colleagues is that it doesn’t provide the primary care that’s necessary. My argument for that is: well, that’s not what the objective of this is right now. It’s to get people a safe supply of drugs. My experience is that people then have time to find their primary care.

Again, I don’t want to limit the conversation to the Downtown Eastside, but there is no shortage of primary care. There are four clinics down there with a lot of doctors, and people just don’t go.

I do not believe…. I think it’s probably better that the safe supply is separated from the primary care. People, when they go to a doctor and ask for safe supply, don’t want to get their blood pressure checked or their sugars checked. That’s not what they’re there for. I, on purpose, don’t offer any primary care. I’m an infectious disease doctor, so I wouldn’t be very good at it, anyways. If they got AIDS, I’d be great.

The philosophy of safe supply shouldn’t be that it’s all this wraparound primary care. We want to give people the option not to use street drugs, and then they have time to work on other things. So the nurses and the people that I have in the program are always referring people to other clinics and stuff. To get a doctor and stuff is great, but I think it should not be associated with this.

[4:25 p.m.]

A lot of the problem with primary care and addiction is that people stop going because they feel they’ve let their doctor down. There are a lot of people on methadone who kind of fall off the wagon, get back into drugs. They’re reluctant to go see their doctor because they wanted to do all this other primary care stuff. “I feel like I let them down. I don’t want to do it.”

My own philosophy is that it should be totally separate. We should have, obviously, referrals for people to get primary care help, but it should not be connected with safe supply.

R. Leonard: Still back to the machine. The question I have is around…. We’ve heard about how people who use fentanyl need more and more and more. The amounts they need are so great. With this model…. You write a prescription. It’s for this amount. Do you find that you have people coming back asking for increased dosages?

M. Tyndall: That’s a great question. To a certain amount, I leave it open. We check in after a week: “How’s it going?” “Well, it’s pretty good, but if I had four more pills, it would be better.” Then we give them four more pills.

Almost everybody…. The average number is about 20 Dilaudid aids a day, which is much less in morphine equivalents than they would be getting with fentanyl.

There’s a bit of a myth around this idea that this whole community now has been exposed to fentanyl. Their tolerance is off the map, and they’re never coming back. Tolerance is a very fluid and elastic thing. People will adapt to what they get.

People who have had huge experience with opioids over the years know that for themselves. There are some days they take more. If you’re a poor drug user in Vancouver, at welfare day, you take a lot. By the end of the month, you’re not getting much at all. It’s a fluid process for people.

The Dilaudid that I’m giving people…. I’m generous with them, compared to other physicians who are maybe levelling off at eight or ten a day, but it’s enough to keep people not needing to supplement with street drugs.

N. Sharma (Chair): Those are all the questions.

I want to thank you, on behalf of the committee, for coming here and for the great materials you provided for us to read and for all the work you’ve done for a long time on this issue. It was very clear — your passion and your expertise and your creativity in figuring out what’s needed on the ground.

We really appreciated that.

M. Tyndall: Thank you for asking me.

I can forward you my notes, if that would be helpful, and you could give them to people.

N. Sharma (Chair): That would be great.

Committee, we need a motion to adjourn.

Okay. We’ve got Sonia and then Dan.

The committee adjourned at 4:28 p.m.