The committee met at 9 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Good morning, everybody. I’d like to welcome our guests.

I’ll start by acknowledging that we are on the traditional territory of the Lək̓ʷəŋin̓əŋ-speaking people, the Songhees and Esquimalt First Nations. I would invite all the members to think about how that shows up in the work that we do.

I want to welcome…. Today we have, starting us off, the Office of the Representative for Children and Youth — Dr. Jennifer Charlesworth, the Representative for Children and Youth of B.C.; Samantha Cocker, deputy representative; and Pippa Rowcliffe, deputy representative.

Welcome. We’re so looking forward to learning from you. You have about 20 minutes for your presentation and 40 minutes for discussion. You’ll see the time there.

I’m just going to do a round of introductions so you know who everybody is.

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

I’ll just go to our Deputy Chair over there.

Shirley, go ahead.

S. Bond (Deputy Chair): I’m very happy to see the Chair this morning. All of you, as a matter of fact. It’s chaos in airports across the province.

I’m Shirley Bond. I’m the MLA for Prince George–​Valemount.

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

D. Davies: Dan Davies, the MLA for Peace River North.

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

M. Starchuk: Mike Starchuk, MLA for Surrey-Cloverdale.

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

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

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

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

N. Sharma (Chair): Okay. I’ll let you know, also, that we have your presentation on our screens.

Over to you.

Briefings on
Drug Toxicity and Overdoses

OFFICE OF THE REPRESENTATIVE
FOR CHILDREN AND YOUTH

J. Charlesworth: Wonderful. Thank you so much. We are so pleased to be here, so thank you very much to Artour for receiving my plea to be able to come before you. You’re doing critical work, and it’s work that we have an intense interest in, in my office.

I’d like to start in a good way by acknowledging whose lands we’re on — and thank you for starting us in that way, Chair — the traditional unceded lands of the Lək̓ʷəŋin̓əŋ people, the Songhees and Esquimalt First Nations.

You’ve met Samantha and Pippa. I will be doing the presentation. Then we’ll move into the questions, and we will be a team responding to that. I’ve also encouraged them to break into the presentation should that be necessary because I’m missing something important.

I can also tell you that I’m really excited, and there’s so much I want to share, so we will do this presentation, and then we will also do a written submission, because I know we won’t have time to cover everything that we want to bring forward.

Since April of 2016, when the province first declared the public health emergency, the devastating effects of the toxic drug supply on British Columbians have grown more apparent by the month. I’m grateful to each of you for stepping into this very complex and vexing challenge, to understand the phenomenon, the drivers, impacts and possible responses.

I’ve reviewed all the proceedings brought forward to this committee to date and will do my best today to build on the many informed presentations and add new knowledge and perspective to that mix, particularly that of the impact of the toxic drug crisis on children, youth, young adults and their families. The tentacles of the toxic drug crisis are far-reaching, and young people are not immune. It’s an enormous and persistent issue that we see come up repeatedly in my office every day.

There are three key points I’m going to address in my remarks. The first is that the harms associated with the toxic drug crisis are not restricted to adults. Children and youth are both directly and indirectly affected to a degree that many are unaware.

Second is that we do not have a robust array of voluntary services and supports available for children, youth, young adults and families throughout the province. Some progress has been made, and I’m grateful for that. However, we are a long way from where we could and should be, and the journey to access services is often full of closed doors and impassible obstacles.

The third area I’ll speak to is harm reduction. Harm reduction with and for children and youth is critically important. It’s an uncomfortable topic, and I get that, but we have to blow up the myth that harm reduction is somehow encouraging or condoning substance use. Substances often serve a purpose in a young person’s life — for example, a coping mechanism to deal with unresolved trauma and grief — and harm reduction, especially safe supply, can be the bridge to addressing other issues and pain while keeping children alive.

I’ll start with the data, then move into several stories and journeys, and then speak to what could make a difference.

[9:05 a.m.]

In your slide… The first slide is the number of youth deaths due to toxic drug supply. According to the coroner’s service, in 2021, 30 people in B.C. under the age of 19 died due to toxic drug poisoning. Most of those became known to us. This is the highest total on record, and it’s 2½ times the number in 2016.

In addition, a record 324 people between 19 and 29…. We consider that the youth and young adult population, so really very closely tied to the under-19 population that we are primarily responsible for. These young people died from toxic drug poisoning in the last year. That’s a 59 percent increase over 2016.

Of course, I realize that the majority of deaths we see in B.C. from the toxic drug crisis are amongst people older than this, but nonetheless, these are significant numbers for our province’s youngest and most vulnerable population. I want to emphasize that those numbers come nowhere near close to telling the whole story of the way that the toxic drug crisis is impacting children and youth.

I’m going to explain a little bit. A number of you know the way in which our office has worked, but just in case, to bring others up to date, as an independent office of the Legislature, we receive a reportable whenever a child or youth who is in care or receiving certain public services — reviewable services — dies or experiences a critical injury. Every month we analyze those reportables to determine trends. The damage being inflicted on children and youth by the toxic drug crisis is a trend we cannot ignore.

The next slide is the number of youth deaths due to substance use that we have reviewed. Of the 99 deaths reported to our office in 2021, 21 percent were substance-related. In 2020, there were 13 substance-related deaths among children and youth receiving reviewable services. When it comes to the individual deaths on which RCY has conducted full investigations in recent years, all have involved substance use and the lack of adequate services as significant factors. I should say that even when the primary area that we’re taking a look at is something other than substance use, substance use is a factor in that child’s well-being or in that family’s well-being, as we’ll see a little bit later.

Moving to the next slide is to talk about critical injury. We want to look beyond deaths, because deaths is one measure of harm, but critical injuries is another. In 2021, we received 2,227 in-mandate critical injury reports. A critical injury means an injury that may result in the child’s death or cause serious or long-term harm to the child. Of those 2,227, there were 184 reports of drug poisonings for children and youth who were in receipt of reviewable services. That’s about 8 percent of the total number of reports, but that is a vast underrepresentation of the number of children and youth experiencing significant overdose events.

We don’t receive reportables yet from health authorities, even though they are required by law to do so, so we’re missing those that might present in emergency rooms, for example. Many young people experience overdoses, but that does not come to the awareness of the parents or the people that are responsible for their care.

It’s also important to note that some of these overdose events result in catastrophic brain injuries. There are a number of children right now who are in hospitals that have not been able to be released for many, many months because of the catastrophic brain injuries associated with overdoses. It’s also important to note that substance use was a prominent factor in many other injuries included in the incident categories of sexual assault and exploitation, for example.

Let’s talk about something that I think is particularly underappreciated. That goes to the next slide. Within the same time frame, our office received 158 reports of emotional harm injuries experienced by children and youth as a result of the substance-related death of a loved one. Let that sink in for a moment. This is evidence of the indirect effect that the toxic drug supply is having on B.C. children and youth who receive reviewable services.

The death of a parent or caregiver or any family member or person who is close to the child causes deep and lasting emotional harm. In addition to that, it can also result in significant change and trauma for a young person. For example, in some cases, it may mean having to come into government care, losing contact with friends and family, changing work or schools and having to relocate to a different community. The story I’ll share with you is an example of that.

[9:10 a.m.]

Our data further show that First Nations and Métis children experience the most emotional harm injuries from the loss of a loved one due to substance use. Further, there’s an upward trend to these types of emotional harm injuries. The negative impact of these experiences on young people should not be underestimated.

There’s another slide that says: “Lifetime issues of interest associated within mandate critical injuries.” Let me explain that slide a little bit. It puts these young people’s stories in the context of their familial and social conditions. For every mandated reportable, the team tracks what we call lifetime issues — what’s been going on for this young person in their life thus far. You will see from this graph that documents the last quarter — this is just one quarter in fiscal year ’21-22 — that parental substance use, family violence, poverty and familial mental health concerns are commonly occurring concerns that are affecting the young person.

What’s important about that is to understand the intersection of many different conditions. It’s never just one thing that we’re dealing with for a child. This helps us understand that the ripple effects of substance use concerns and drug toxicity amongst the adult population have a significant impact upon children and youth.

That’s some of our data, but I want to tell you a few stories. As I’m doing this, it’s important to remember that the children that I am going to speak about are so much more than their complex needs. They have dreams, aspirations, many beautiful characteristics, etc. So I’ll try and highlight some of those things as well as the disappointments, hurt, pain and disconnections.

As you know, in the RCY, we have the honour of walking alongside young people, both in our advocacy work and then also through our reviews and investigations work, understanding the journey that young people are on. I’m going to bring forward several composite stories to respect confidentiality and privacy, but every element of these stories is seen dozens of times every year for us. These are our recurring patterns and issues.

One of the things to understand is that there are significant life events in almost every child’s story around substance use, that there’s something that’s happened to them that has affected the way in which they see the world and they see themselves in the world. It’s traumatic, and it could be things like bullying at school, sexual assault, family breakdown, loss of someone or something very important to them, whether it’s a parent or a pet, home and stability, etc.

For many, these events catalyze a cascading array of adverse experiences. Please bear this in mind as I’m telling a story of Tony, and think of yourselves as systems designers, too, and think of those moments as I’m telling the story in which a different trajectory might have been possible with interventions.

When Tony was 11, they loved animals, math, Marvel Comics and playing soccer. They were quiet and a bit shy but kind and loving towards their young sister, who lived in the same foster home, and their foster parents. Tony had a few very special friends whose families enjoyed having Tony around. Tony’s biological parents struggled with substance use, mental health concerns and domestic violence, but they cared about their children, and when they were more stable, they engaged with Tony and their sister and were supported by the foster caregivers to do so in a beautiful way. Tony was described as a wise old soul and was able to see that their parents struggled, but they were trying to stay connected.

Tony felt safe and secure with these long-term foster parents, who were like both parents and grandparents to them. They were older. Catastrophically, in the space of two months, Tony’s world collapsed. Their biological mom died of a suspected overdose, and one of their foster parents died unexpectedly and suddenly. The surviving caregiver was overwhelmed with grief, and, before long, they could no longer care for Tony.

Tony’s younger sister was able to move to the adult daughter of the foster parents, but they were unable to take Tony as their house was deemed too small and their lives too full for two extra children. Tony was told that the separation from their sister was just for a little while until they could live together again in a new family, but things continued to unravel.

This was a significant time of loss for all of them. But despite the extended foster family’s request that they be able to stay actively involved, Tony was moved to a new community due to shortages of local caregivers. This new community was some distance away from family members, including their father, sister, foster parent and their cultural community, and Tony had to leave those friends, school routines, meaningful activities and important connections.

Tony was dealing with unaddressed grief and loss, and the new caregivers were ill-prepared to meet their needs. Mental health concerns built. Tony felt overwhelmed, disconnected and unsafe. Self-harming began, as did substance use, as a way to cope.

[9:15 a.m.]

By the time Tony was 13, they were struggling at school. Substance use had gone from experimentation with cannabis and alcohol to use of a variety of substances. New foster parents demanded that Tony be moved, as they had younger children and didn’t want Tony around because Tony uses — another loss, another move, another layer of stigma and shame.

Tony was temporarily placed in a staffed resource with a revolving door of other young people and staff. They bounced around a bit more. Mental health concerns escalated, and by the time Tony was 14, they had four diagnostic labels, including generalized anxiety disorder, PTSD and oppositional defiant disorder.

By 15, this quiet, shy and gentle child who, a few short years ago, loved animals, their sister, school and soccer, among other things, was now described as having complex needs, which made them difficult to place. They are sad and angry, and substances increasingly become a way to cope.

How does Tony make sense of all that’s going on? First, they feel unloved and not worthy. They are sad most of the time but also angry at what has happened to them. They sometimes act on that anger in ways that scare other people. But Tony describes this as trying to get people to pay attention, as they don’t feel heard.

They know the risks of polysubstance use. They know about fentanyl. They’re quite well informed about toxicity, but increasingly, they don’t care about the risks, So harm reduction for this 15-year-old in a smaller community with few resources has consisted of being supplied with a naloxone kit, surreptitiously getting some testing strips, and an urging not to use alone.

They’ve overdosed two times in the past three months. On one occasion, they were taken to the local emergency department by ambulance after they were found barely conscious in a park by a passerby who was fortunately able to administer the first dose of naloxone. The overwhelmed emergency department discharged in a few hours after they were stabilized, and they were transported by cab back to their staff placements.

A few times, Tony has thought about detox, but they are fearful of what lies on the other side. Regardless, the wait times for any detox resource close to them is significant, and they aren’t sure if this is right for them anyway. There’s too much else going on that they are struggling with. Tony is disconnected from school, on their third guardianship social worker and, in the last 18 months, hasn’t connected in person with the latest one even after the ODs.

There isn’t a Foundry in their community, and although they tried virtual counselling, it didn’t work for them, as they are quiet and shy. They were also referred to child and youth mental health services, but as they didn’t show up to several appointments, their file was closed.

Let me add one more thing to this story. Tony’s biological dad, whom they have not seen since being moved away from the community in which they were raised, has just passed away from a suspected overdose. The worker is planning to meet with Tony to let them know both parents are now gone, and I can tell you that there are many children in this province that have lost both parents to overdoses.

Tony’s story is hundreds of young people’s stories in this province, and let’s briefly unpack their journey and their experiences: parental exposure, substance use, brought into care at a young age, few supports provided to those parents to support reunification, multiple losses, moving to another community, separated from their sibling, unresolved grief and loss, completely disoriented, etc.

Foster caregivers are not able to meet that child’s needs. There’s a poor fit. They don’t feel like they belong, self-harming, substance use, coping with pain, mental health deteriorations, few supports available in their small community, very limited harm reduction, deemed difficult to place and, as we call it, unbelonged at home, school and community.

Now, there were lots of things that Tony had in their favour, but unfortunately, there were not the opportunities to build on those strengths and those capacities in order to shift the trajectory of this child’s story. There were critical crossroads moments, as I’m sure you can understand from hearing that story, when a different response may have resulted in a better outcome. While detox or bed-based treatment might be helpful now, their story reveals that it just isn’t that simple, and a developmental, whole-of-system response is called for.

I have another story, but I don’t have time to share that, so we’ll see if that comes up in the context of the questions. Really, through our stories, common themes — intergenerational trauma, unaddressed and unresolved grief and loss, lack of supports — lack of timely supports, particularly — inequitable access to those services.

[9:20 a.m.]

Concurrent mental health and substance use, and even beyond that mental health and substance use, sexual assault or exploitation are very common — and an inability to deal with that complexity and an incomplete harm reduction response.

Just a few moments…. I’ll just highlight some of the things that I think are important.

Nearly four years ago we released a report called Time to Listen: Youth Voices on Substance Use. It made five key recommendations to improve the services.

One has been implemented, several have been partially implemented, but we are still a long way from the main one. That is for Mental Health and Addictions and the Ministry of Health, with other relevant partners, to lead the development of and ensure funding of a comprehensive system of substance use services capable of consistently meeting the diverse needs of all youth, with specific attention given to the development of culturally relevant and culturally safe services and supports for First Nations, Indigenous, Métis and Inuit youth and their families. While I am grateful for progress that has been made, we’ve got a long ways to go.

That was in 2018. It was the first report I released after I was appointed. And it’s interesting. Over the journey that I’ve been on as the representative, I’ve realized…. While I stand by those recommendations, what I realize is that we need to take a whole systems approach. It’s not simply a response of Mental Health and Addictions or the Ministry of Health or the Ministry of Children and Family Development. Tony’s story illustrates all those different points at which the system needs to come together, and the collaboration is simply not there. As I say, it’s simply not simple.

A couple of things to bear in mind, and then we’ll move into the questions.

I feel very strongly about the area of harm reduction. While we want to do upstream work — and I think that’s critically important — we also have to recognize that there are many young people who are using, and we have a very critically dangerous supply of drugs.

When I talk about harm reduction, I’m also talking about safe supply and youth safe spaces to use. It’s completely inappropriate for us to be asking young people to continue to go in the alleys or in the unattended backyards or in somebody’s home, where no one is watching. When we have those available for adults, why would we not make those available for young people? And I don’t want to see young people in those adult facilities. That’s a critical piece.

Being able to have opioid agonist therapies or other things that are available to that young person that are prescribed and safer for them is critically important. I know that’s controversial, but it’s also very important that, in addition to harm reduction, we think about how to prevent the trajectory for that young person in the first place. So we are working on what we call keeping families safely together, which is to support the parents in those early years, especially when they are struggling, and also to ensure that the families have access to information when they have those early signs that something is not going well for their child. We’ve seen too many missed opportunities for families to access the health, social, emotional and cultural supports that they need.

I’m going to stop there, in the interest of time, but know that this is actually a number one area for us, one of our top three areas. We’ve got some wonderful research partnerships that are underway and will continue to be building this up over this next year, in particular, and also to take a look at the broader system’s response that is necessary.

At this point, I will stop there and welcome your questions and your comments.

N. Sharma (Chair): Thank you. We have a list here.

Go ahead, Trevor.

T. Halford: Thank you, all of you, for the work that you do every day. I’ve got a few questions. I’ll ask one and then maybe get an opportunity, in a second pass, to ask the others.

I do agree, when you talk about harm reduction. I’ve often said before that is…. I talked about prevention. We’ve got a lot going on right now, in terms of…. One of the issues is…. We’ve got decriminalization, but that’s not legalization. You and I talked. I’ve got a 13- and a 14-year-old somewhere in Victoria right now — making sure I’ve had those conversations so they understand the difference between legalization and decriminalization.

How do you view the issue of prevention, particularly for our youth? Are we doing enough? I would assume the answer is no. What more should we be doing, and how should we be doing it?

J. Charlesworth: It’s a beautiful question. Thank you.

[9:25 a.m.]

Of course, prevention and early intervention are critically important. That’s why we say a robust array of voluntary services is critically important. I know, from reading transcripts, that you’re all very interested in those upstream interventions.

I think there are a couple of things. One is…. Tony’s story illustrates that those upstream…. It’s not simply about substance use but also about considering the trauma or the issues that that young person is experiencing and that unresolved grief and loss. We don’t do grief and loss very well in our society.

I think that when we think about prevention and early intervention, we also have to understand the child in the context of what’s going on in their families and to support families — they are the primary resource for children and youth — to enable them to have the important conversations, much as you have with your children, Trevor, so that parents have other parents that they can go to, to say, “I’m struggling with this,” and not feel the shame and stigma that is so often directed towards parents when their children use.

So put the early intervention and prevention in the context of overall child well-being, not just children who use. I think that’s a critical piece.

Then, absolutely, schools are important, but also, so too, are community recreation centres, the places that children participate in, in their day to day to day. Those kinds of protective factors are important as well — having some things that are prosocial for young people.

You should note that poverty is a huge issue that comes up over and over again in children’s lives, so being able to understand how it is that those young people, from a prevention point of view, have more access to the resources that they need.

D. Routley: Thanks very much. You referred to a broader system response that you might speak to in a written submission and that the collaboration is not there. Earlier you mentioned that you are not receiving health authority notifications of incidents. That seems like a very obvious failing of collaboration.

I wonder if you could speak a little bit to the kind of collaboration that you would like to see, how it could be achieved and whether there is potentially a predictive and preventative element in seeing the crises that people are in and addressing that.

J. Charlesworth: Let me start with the last one first. There was some research done in Victoria and Vancouver, actually, by one of the people that has presented to you, Dr. Brittany Barker, with a colleague of ours, Vicki Sure. One of the things that they noted and we’ve been paying attention to, as well, is that there are often significant life events in that space of age between eight and 11. It’s a very critical developmental age, as we know.

Oftentimes, as Tony’s story illustrated, something traumatic has happened. Then that sets things up in motion that have the long-term impacts around numbing emotional pain, which is what young people tell us over and over again they use substances for. So thinking about those critical events and what is our intervention at those important developmental times, and also thinking about how critical that eight, nine, ten, 11, 12 age is.

We often are just horrified if we think: “A child is using? That can’t be.” But children are doing what children have always done, which is that they’re trying to figure out who they are and what their place in the world is and what their identity is. Experimentation happens. But if there are things that are going on that increase the risk of problematic use because we are not addressing some of those issues, then you can start to see the trajectory. It’s proven to be the case over and over and over again.

If we understand that, then the collaboration needs to start at when things are going sideways for a child or a family and there are multiple things going on. What needs to happen, for example, in terms of income security, housing security or food security? Those become important when a child is going through a difficult time.

What about access to mental health? If there are co-occurring mental health and substance use concerns, I can tell you that there are more doors closed than open in this province. We aren’t very good at co-occurring conditions. So what’s the opportunity for mental health and substance use services to be collaborating more effectively?

Then also education. That’s where many of these kids are, especially in that eight-to-11 range, before we lose them. What are the kinds of services and supports that are being brought into the education and coordinating with children and families — for example, children and youth mental health?

[9:30 a.m.]

We have lots of barriers to even information-sharing around kids and what’s happening, and that gets in the way of collaboration.

I’m looking to Sam and Pippa, if you wanted to add anything.

S. Cocker: I can’t think of anything right now to add. I think it was good, Jennifer.

J. Charlesworth: I hope that answers the question.

S. Chant: Thanks, as always, for the presentation. Can you tell me, with the stuff that has been done…?

There has been some work towards better support for youth in general, exclusive of these being youth that are specifically in care that we’re talking about right now, or governmental services. What has been done that is working that we can build on? Are there models in other provinces that we’ve seen that might prove functional? How is B.C. doing, in general, relative to other provinces?

J. Charlesworth: Okay, great question. As some of you will know, I sit on the Canadian Council of Child and Youth Advocates. In every province and territory, with the exception of the Northwest Territories, there is somebody like me. This is a topic that we were just addressing earlier in the month of June, when we got together.

I would say that B.C. is better than most other provinces. There’s no question about that. In many other provinces, there is a high level of denial of the concerns. Also, we are ground zero in terms of the toxicity in this country. So what we are seeing….

I was saying to my colleagues a couple of years ago: “Be careful. Watch out. It’s going to come.” They were saying: “No, it’s just not an issue for us. We don’t have fentanyl. We don’t have those analogs in our drug supply.” It is going across the country now. So even if you’re in P.E.I. or Nova Scotia or New Brunswick…. They’re finding the toxicity is escalating.

We should be ahead. It hit us first, it hit us hard, and it continues to hit us hard. Having said that, some of the things that I think are important…. There’s some good movement.

Foundries are helpful, for sure, but Foundries are not in many of the communities. Foundries, also, again, have a beautiful model. I love that they bring in the physical and medical care as well as counselling and peer support and the range of services. For many young people, though, that does not feel like the space that they want to go to if they’re deeply into their substance use.

We have to think…. It should never be a one-size-fits-all, nor does Foundry think that they should be a one-size-fits-all.

Many are not open in the evenings or on the weekends. For many young people, those are the times that they are at critical risk. Last night I was speaking with a street nurse. I strongly encourage this committee to listen to people that are working on the ground with young people. The street nurse here in Victoria was speaking about the fact that there’s no place for kids to go in the evenings that’s safe for them as youth.

Foundry is doing some wonderful things. I’ve been there in the early evenings, and it’s bustling. But they, too, are feeling overwhelmed, especially around those co-occurring conditions. Foundry is good but not the only resource.

The movement towards doing more in the schools — strong, important. Absolutely agree with that. As you can see, many of the young people are disconnected from school and wouldn’t actually have positive experiences, so they wouldn’t present in those integrated child and youth teams. And those are just fledgling. There’s just one or two of them, I think, that are underway now. It’s going to take some time to roll out.

There’s creative work being done, often below the threshold of observation, where people are saying: “We have to do something.” I’ve heard some very creative and innovative partnerships between, for example, pharmacists and people working on the street. It’s often below the radar, and there’s a great deal of anxiety associated with it.

I’m giving you kind of both versions. Good progress in some areas. But we’ve got a long ways to go.

[9:35 a.m.]

The other thing, at the other end of the spectrum, is…. There is a commitment to increasing the number of bed-based residential care options for treatment, which is great. But there are, I would say…. What we see often is very limited aftercare, time and time again. It’s true for adults as well. Young people will go through a detox or treatment, and then there isn’t a good handoff back into the community. So they relapse.

I would say that the aftercare…. Again, great that they’re bringing online more of these treatment resources, but the aftercare is a consideration.

I’m going to turn to you, if you want to add…. I can tell you want to add.

I think the other thing is…. Oftentimes, in order to access that bed-based, you have to go a long way from home, and we know how important belonging and connection are. When you’re separated from your family and your community, it makes it very, very difficult to have a good, warm handoff, welcoming back, and that aftercare that’s necessary.

As I say, progress and more work to be done. I hope that’s helpful.

S. Cocker: That was the other piece I wanted to add. So often kids have to be disconnected from community to access programs.

You mentioned the Foundry, Jennifer.

I would also like to mention the reconnect programs that are through friendship centres, which also have lots of workers that are really connected into kids at all hours of the day and night and any day of the week. I think it is a good philosophical program that they have.

The one other thing that I was going to say is…. There are really good government programs for kids to go to treatment. I don’t think there are enough of them, and they’re not long enough. Twenty-eight days is just scratching the surface and opening the wounds, and then we let kids go, adults as well. There need to be longer government-funded programs that are available for families and for kids.

J. Charlesworth: Maybe I’ll add to that too.

We have had situations in which parents have asked to be able to go to treatment with their young children. We think there’s a tremendous amount of value in that. What we do see is intergenerational trauma, and there’s an opportunity, in those kinds of family-based treatments, that can make a huge difference. We’re very, very limited in that, and there’s a tremendous amount of stigma and shame attached to that. The attitude that we have towards parents who use is problematic.

That’s a whole other conversation. Happy to chat about that too.

S. Furstenau: In the many weeks that we’ve been meeting, we’ve heard from a lot of people with lived experience, a lot of organizations, a lot of different groups. Many of them have raised with us the harms being done by children and family services in this province.

I’m a little surprised, quite frankly, that that wasn’t, really, a focused topic of your presentation this morning. We’re hearing that from all these other organizations and people, but from the watchdog agency of MCFD…. It’s as though that system is just a natural part of our world, and we’re going to talk over here about these outcomes.

We look at 2,227 critical injuries reported in one year with — what? — 6,000, 7,000 kids in care. That is not a ratio that any of us should be okay with.

The things we’ve heard on this committee have been harrowing. Getting around birth alerts by apprehending a baby after the parents leave the hospital is happening in this province.

I’m, as you can tell, a little agitated by a lack of a sense of urgency around holding this government body to account for the harms that are being perpetuated by the child welfare system in this province. It’s not that toxic drugs are somehow leading to…. Obviously, there are a lot of harms coming to children in care. But how much of that time in care is actually leading to substance use? When we’ve asked that question of other people, the answer is a lot.

I’d like to hear about…. What guidance should be given to this committee around looking at the harms that are being wrought by a government-funded body, which your organization is tasked with the oversight of?

[9:40 a.m.]

This was a little surprising, for example. Doug brought this up. We don’t receive reportables from the health authorities, even though they’re required by law to do so.

What are the next steps? How are you going to make sure they’re following the law? There was a report four years ago. One out of five recommendations has been implemented. And what? We have this disconnect that seems to be happening here around these harms happening in government care and what we’re hearing right now.

I’d really like to hear from you about how you see your role in terms of this perpetuating of harm that’s happening in government care.

J. Charlesworth: I appreciate the question. I want to be clear that I had 20 minutes, and I chose to do things that you have not heard before in the presentations.

You’ve had some excellent presentations that have spoken to the harms. In fact, the second story that I was going to share speaks to that. But I think it’s also important that Tony’s story speaks to that. There were many points in which the child was doing well, and then the decisions that were made created more challenge and trauma for the child. I’m hoping that you can think about that story as well.

Having taken a look at the circumstances with the ministry…. First of all, just to put in context, the 2,227 is for kids in care and for children who are receiving services, not just the 6,000 children in care. But you’re right. It’s a staggering number.

When we take a look at the experience that many families have, one of the things that we have been talking about is how important it is to back up the bus. Our keeping families safely together initiative is about that. For families who are struggling when their children are little — when they’re dealing with their own vulnerabilities, intergenerational trauma, poverty, instability, all of those kinds of things — what are the ways in which a system would wrap around that family rather than create fracture and disconnection? It’s critically important that we take a look at that.

That’s why I said that I stand by the recommendations of 2018. But in this job, I’ve seen how much more important it is that we address the broader systemic issues, starting with families in those early years. It’s a myth that parents who use cannot parent. It’s absolutely a myth.

There are many situations, having said that, where children are not safe when their parents are using. There has to be some important discernment, because there are situations, and we see them, in which children are harmed. However, the kind of categorical, “If you use as a parent, you’re not able to parent,” is a myth that we have to bust. We have to address that and understand what might be driving parental substance use and what the supports are that would be available to them.

Trauma is a thing for parents as well. Grief and loss are things for parents as well. I can tell you that many times, the loss of a child into the in-care system exacerbates the grief and exacerbates the use. It’s particularly so if the parent is young and in care themselves. When they lose their child into the care system, then we do see an escalation of substance use. The coroner has addressed that on a number of occasions.

I’m not shying away from the challenges that the system has in order to see the bigger picture. We could go on for quite some time. I do have some notes with respect to parental…. For example, when you heard from Hawkfeather Peterson and West Coast LEAF, they did an excellent job at speaking about the shame and stigma and the implications of the child welfare system in the lives of many parents.

If you want me to talk some more about that, we’re happy to do that. But I’m not denying for a moment that there are harms caused. There’s a reason for a child protection system as well, so trying to find that nuance and recognizing that there are some situations in which protection intervention is critically important. Then there are other times in which family intervention is what is necessary rather than removals and disconnections.

[9:45 a.m.]

P. Rowcliffe: If I could add to that, you asked a very specific question related to health authorities. I just wanted to address that for you.

It has been a really difficult road to run over the last four years, but we’re very close now to being in the final stages of working with the Ministry of Health to ensure that they are reporting. We’ve only been able to move as fast as the ministry will move with us, but the framework is pretty well in place at the moment. We’ll be piloting it in a couple of places and then able to report out on what’s going on in certain aspects of the health care system as well.

The question that you asked around recommendations and the degree to which they are being enacted, followed up on. We also are very aware that we need to do a better job on understanding the impact of the recommendations that we make. Certainly, when Jennifer started, we really weren’t tracking recommendations — the implementation of them. We’ve done a lot of work on that over the last three years and will be coming back to our select standing committee in the next short while with a whole new model around how we actually really track and hold all of us accountable to the kinds of recommendations that we’re making.

Work is underway, and we’re very aware of the kinds of things that you’re raising and are doing a lot of work under the scenes to be able to make sure that we can come back with better reports, or at least more concrete, transparent reports around how our ministries — all ministries, not just MCFD — are doing in addressing the recommendations that we make.

R. Leonard: Thank you very much for coming and presenting today and seeking to be able to present. It’s an important piece of the work that we do, especially around substance use, as a government. I appreciate the work that you do, because it is the thing that gives people trust. I assume that it very much gives trust to youth when they come to you and seek solutions and seek support. So I just want to honour that.

I read another…. I think it’s another presentation that we’re getting. It was talking about that issue of trust with youth and how they don’t want to seek medicalized treatment. They don’t want information-sharing, because that’s an issue of: “How do you know that?” Right? Something that works for us institutionally and systemically may actually have some other unintended consequences. So I’m wondering if you can speak to that.

I also wanted just to ask a question around the written report that you presented, but I’ll wait and ask that one after.

J. Charlesworth: Just so that I understand, you’re curious about the information-sharing and how that affects the level of trust that a young person has in terms of accessing care or treatment? Okay.

It’s quite interesting. We’re actually doing a separate piece of work now, on consent and capacity to provide informed consent and the rights of children and youth to have to determine who has any access to the information about them, including their health care, their substance use, etc., and their circumstances, because it’s a bit of a dog’s breakfast right now. You’ve got different acts that have different considerations around capacity and consent.

But nonetheless, a child over the age of 16, under the Mental Health Act, is able to make a determination as to who has access to the information about their circumstances. As you know, the Mental Health Act is often used in order to deal with young people who are dealing with co-occurring substance use and mental health concerns. They have the right to determine who has access to information and who does not, including their parents. I think that’s a consideration.

For younger children, it very much depends on the worker, really, as to what information gets shared with parents or with other caregivers. There’s quite a bit of concern about that if we’re planning for a child, should not everybody have access to information?

[9:50 a.m.]

We have to balance that with the child’s rights, as well, to be held safe. In many cases, that safety is a consideration around who has access to information and who doesn’t. That’s one thing.

The other thing is: what’s the level of engagement and relational practice that a young person has without somebody who is consistently engaging with them so that trust gets built? Trust is a relational act. It’s not something that just because I have a position of authority that you’re going to trust me. You have to earn trust. We all do. So that’s a consideration as well.

To get back to your comment, Sonia, one of the things that’s important is to recognize how many people are coming into the lives of children and how much turnover there is. Therefore, there isn’t that opportunity to have those kinds of relationships build towards trust, so that you have a better understanding of what’s really going on for a child and what it is they need and that their voice gets heard. We’re actually working on a report right now with respect to a child’s right to be heard and how often children are not able or encouraged to express the things that are important to them and to be a part of their own care planning.

I don’t know if…. That’s kind of….

R. Leonard: Yeah. No. I just wanted to accent that issue around trust and consent and just being aware of that. If I can…?

N. Sharma (Chair): We have four more people that want to ask and a few moments left, so I’m going to keep going.

M. Starchuk: Thank you, Chair, and thank you for your presentation. I have a page of questions, but I’ll go to the top one that’s here.

Through the last couple of years of COVID-19…. You’ve used the words “disconnected” and “disconnected from school.” I take a look at the critical injuries that we have there that show that there’s a cycle that’s there. Can you explain or maybe define if COVID has accentuated…?

We all know that family violence — that there was a greater increase to what was there. But the disconnect factor that’s there…. My concern is that there have been so many youth that have spent two years of not being in school, doing it from a distance. They get disconnected from everything else. What’s the predictability that substance use became a part of their life? Now they’re going out into the open. What is it that they’re seeing?

J. Charlesworth: Yeah. Such a great question. This gets to the co-occurrence of mental health and substance use concerns as well, and the impact of loss. The loss of your routines, the loss of connections, the loss of being able to celebrate milestones in your life — that’s a loss for a young person, especially when you take a look at it from a developmental point of view.

Mental health concerns — there are no questions. That has significantly increased, and we’ll be coming out with a report that we’re doing with the Children’s Health Policy Centre. We predicted that it was going to increase, and now we have the data to say that we’ve seen, in some cases, a very dramatic increase, particularly in depression, anxiety and behavioural challenges. Those are the three areas where we’re seeing a significant increase.

As you can appreciate, that becomes a vicious cycle. You’ve got mental health concerns. There are very few resources readily available to address them. The young person is struggling, and then that enhances the experience of unbelonging. Their behavioural challenges increase, or their depression increases. They don’t attend school, or they’re not welcome in school — further disconnection and unbelonging, as we speak of it.

Then again, if we understand that substance use is an experience of numbing the emotional pain, when you’re dealing with mental health concerns or you’re dealing with family violence or you’re dealing with loss, then substance use also escalates. So we are definitely seeing an increase in the number of overdose injuries. That’s related to the increase in the use of substances at a younger age, as well, but it’s co-occurring, in many cases, with mental health concerns. We need to do a lot of work in that area.

The other thing is that we saw young people using alone, and as we know, that’s a huge risk factor as well right now. I was speaking with a street nurse, and she said: “You know, the good thing is” — to get to your question, Susie — “kids know how to use naloxone.” They are carrying naloxone kits, and they are using it. As the nurse said: “With their eyes closed, they can use naloxone.” Great. But if you’re not in the presence of a friend who’s watching out for you, then you are at greater risk.

It’s those factors, I think — the disconnection, the separation from meaningful life events, the increased mental health concerns and, again, using substances to address the pain.

[9:55 a.m.]

N. Sharma (Chair): Okay. I think I’m going to try to get through the next three questions, so let’s try to keep it succinct, so everybody can get a chance to ask.

D. Davies: Thanks, Chair. My question actually was already kind of covered. It’s around the accountability.

I’m just going through your website here, and I look at the reports and the constant recommendations being made to multiple government bodies and just having that accountable. I think people have talked briefly about it. We do need to do better on holding police bodies accountable. So my question has already been kind of covered.

S. Bond (Deputy Chair): I think we may need to…. This might be a repeat visit. A lot of us have questions, and when we have children in government care…. I really appreciate Sonia’s questions. There is a level of accountability. If we can’t assume that children are safe there and that there isn’t interconnection between ministries and agencies….

I think the thing that I find most discouraging about the conversations we’ve heard is the constant reference to the fact that ministries, agencies and departments are not talking to one another. We have an opioid crisis where people are dying every single day, and people somehow are still being territorial about the work they do. If that doesn’t get to the heart of what the problem is, I don’t know what does.

I can tell you that my blood pressure has risen today too, because we hear, over and over again, that it is a stovepipe mentality. That has to change if we’re ever going to make a difference here.

My question is about catastrophic brain injury. We are talking about the people who die every day — six, at last count, in our province — but we have heard constant reference to: “That’s not the only injury.” Who cares for young people who have a catastrophic brain injury?

We look, in our communities, for the services for adults who are on the older end of the spectrum. If they have a brain injury that requires additional support, where do they go? They end up, often, in seniors care, in long-term care. For people who have catastrophic brain injury as a result of this, and you’ve said the numbers are very high, who cares for them, and where do they go, and what services are there?

J. Charlesworth: First of all, thank you for lifting up the importance of that collaboration and how critically necessary that is. It really gets to the understanding that this is a complex phenomenon that we’re dealing with and that needs a whole different way of working.

With respect to catastrophic brain injury, what we’re seeing are young people that are staying in hospital for many months or at places like G.F. Strong for rehabilitation. Then in some cases, depending on the circumstances, they might find themselves in Community Living B.C. as they move into adulthood, or they are in situations where they are….

I’m thinking of one young person who assisted us in one of our reports — was doing so well, relapsed, had a catastrophic brain injury, was in physical rehab for over a year and then is basically in supportive housing right now. Virtually nothing to help them continue on their trajectory. Despite their very great desire to continue to work on their rehabilitation, they’re in supportive housing. That’s as much as there is available to them.

I’m happy to inquire into that further, and I would love to be able to come back and address some of these other questions.

P. Alexis: Years ago when I was a school trustee, we looked at the readiness for kindergarten children and realized that in my community, anyway, there were about a third that were not, for a number of reasons. This has been something that we’ve been concerned over for decades — and the importance of the investment, as a young child.

My question, although I have many as well, is regarding Tony’s story. What single thing could have been different that would have changed the ending of the story?

J. Charlesworth: Well, we probably all have some perspectives on that. By the way, Pippa was the leader in the human early learning partnership that speaks to the school readiness. She has a very strong bent towards those early years.

[10:00 a.m.]

I’m going to actually choose two. One is: when Tony was born — this gets to your comment, Sonia — what would have happened if, instead of the children being removed, there had been supports wrapped around that family so that they could continue their own healing journey and be the best that they could be and as most involved as they could be? Even if their children couldn’t live with them, what would be the opportunity to wrap around that family?

I think there are opportunities in those very early months as a family in figuring out how they’re going to raise up their children. What would have been possible in their extended family and community? What would have happened if there were investments to stabilize their housing and to ensure that they had access to treatment or to be able to go to family treatment with their infant, for example? That’s one.

The other thing is at the same kind of juncture: 11 years old, foster parent tragically dies. I can tell you this happens quite a bit. We’ve got an older constellation of foster parents. What would have happened if there had been wrapping around that family, because they were actually doing a really good job of staying connected with all the other family members?

What would have happened if, recognizing the tremendous grief for the surviving foster parent, there was a lot of respite care — or, when the adult daughter came in, we said, “What do we need to do in order for you to continue the relationship with these children,” so that that second family was not blown apart? Those would be two times that I think are important.

Anything you want to add, Sam?

S. Cocker: No. Those are the things I was thinking of too.

N. Sharma (Chair): Okay. On behalf of the committee, I just want to thank you so much not only for the work that you do every day, but also just letting us learn from you and your perspectives on this crisis. Thanks for your time. If you want to forward all the other written submissions or things that you want us to learn from you about….

I just want to acknowledge, also, that the committee members had a lot of questions, so we’ll figure out a way to manage that, maybe, after this.

All right. We have our next presentation. Maybe we’ll just give everybody a three-minute break and start at 10:05.

The committee recessed from 10:02 a.m. to 10:07 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): We’re back. It’s my pleasure to welcome our next guest from the Our Place Society — Julian Daly, chief executive officer.

Welcome.

My name is Niki Sharma. I’m the Chair of the committee and the MLA for Vancouver-Hastings. We’ll do a quick go-around.

Go ahead — our Deputy Chair.

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

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

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

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

M. Starchuk: Mike Starchuk, MLA, Surrey-Cloverdale.

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

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

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

N. Sharma (Chair): Okay. We’re looking forward to your presentation. You have about 15 minutes to present, and then the rest of the time we’ll have for discussion and questions

Over to you.

OUR PLACE SOCIETY

J. Daly: Good morning, and thank you very much for inviting me here this morning. My name is Julian Daly, and I’m the CEO at Our Place Society here in Victoria.

We do many things, but one of the things that we do is work with people who are homeless, people living in poverty, and many people who are affected by mental health and addictions.

We’re, in many ways, really, very much on the front line of this crisis. Also, I think, we’re on the front line of providing services to try and abate this crisis too, whether that’s the paramedics that work at our centre on Pandora Avenue here in Victoria — who reverse thousands, literally thousands, of overdoses every year — or our New Roads therapeutic recovery community in View Royal. This is a centre where men can come and spend nine to 24 months getting sober and sustaining their sobriety in a therapeutic community. So we’re very involved in this in lots of different ways.

I’m not an expert in drug toxicity, so I’m not going to speak to that. I’d really like to focus more on some of what I believe are the tangible solutions to the overdose crisis, which is in itself, I think, part of an addictions crisis too. I think it’s worth saying that, because I think sometimes that sort of gets missed.

[10:10 a.m.]

Before I make my comments, I would like to acknowledge all that this government has done in terms of the opioid crisis and the overdose crisis and drug toxicity. I think B.C. has done more to address it than probably any other province, and I think it’s remarkable what has been tried here. So I just wanted to acknowledge that.

As I said, great work has been done, but I don’t believe that we have — and we absolutely do need it — an evenly resourced and complete continuum of addiction services. We need that, I believe, if we are to make further inroads in the current crisis. A continuum that would include harm reduction, then to detox, then to recovery and treatment and then post-treatment and recovery support.

I’m a great advocate for harm reduction. Indeed, when I worked in Edmonton, in Alberta, I opened the first safe consumption service in Alberta, in Edmonton. I am a firm and long-standing advocate of harm reduction, but I do feel that, in B. C, we have focused our attention, perhaps unduly, and resources on harm reduction as being the primary response to and primary solution to the opioid crisis. This has, I think, sometimes been done to the detriment of other services, potentially services that could be life-saving for folk.

Harm reduction saves lives. I want to be really clear. There are thousands and thousands and thousands of people who are alive today in British Columbia because of the harm reduction services that exist. To me, it’s only part of the solution. It’s not the only solution.

One thing that struck me, at our service in Edmonton, was how many people who came to our supervised consumption service wanted to give up…. They wanted to stop their addiction and stop their using, and we had little or no paths for them there. I think that’s quite a similar experience here. We need a continuum of care for those people who want to give up, a path out of their addiction that they can access where and when they need it. I really believe that would save more lives.

That continuum…. I’d like to just unpack a little bit what I think its component parts should be, could be, at a minimum. The first part, the entry point, if you want, is the harm reduction services. I think we do really well in that respect, by and large, here. We have a whole range of those.

The second is accessible detox. I don’t know what the situation is in many of your constituencies, but I know, in Victoria right now, there are 150 to 200 people waiting to get into detox. That can represent several months of wait for folk. The day someone wants to give up should be the day that they get access to detox. If people want to give up and they can’t get that access, the moment is often lost. Not always, but often it’s lost. That very person who might want to give up, if they had detox and could have got into it, might, the very next day, go and use again and die or overdose.

Once folk access detox, the next stage in the continuum, I believe, is effective and accessible treatment and recovery options. It’s not easy to access treatment. If you’re a woman, for example, on the south Island, of Vancouver Island, you can’t access treatment at all. You have to go to the mainland, unless you can afford the $20,000 or $30,000 a month it costs for private treatment.

Also, the treatment programs that we have, which are typically 30 to 60 days, we believe have been shown to be largely ineffective. It’s simply not enough time for someone, especially someone with pretty profound addictions, to begin to address the causes of their addictions and to achieve sustained sobriety.

Indeed, they can be quite dangerous. If someone can go in for 30 days and get sober and clean and then come out…. Because the deep work hasn’t been done, they start using again. Because they have been clean for a month or longer, their resistance is down. They actually can sometimes overdose because of that and die. I know that’s not an intentional danger to treatment, but it is one that exists, nonetheless.

[10:15 a.m.]

I would also share with you a model that I think really does work. Many of you may not be aware of it. Our Place Society operates a program called New Roads therapeutic community in View Royal, just outside Victoria. That’s a place where men — unfortunately, it’s only for men at the moment — can come and spend nine months to two years, understanding what is driving their addiction and working on that. Actually working as well. We have a workers therapy program.

We’ve had extraordinary outcomes because of the length of stay and, also, because it’s done in community. These men have a leadership model and a hierarchy. They support each other because they’ve all been through this themselves. That combination of community and the length of time has transformed the lives of those men. Many of them will tell you how it has literally saved their lives.

I can’t stress enough the length of time — how important that is. One man said to me…. I was amazed. “Julian,” he said, “I’ve been severely addicted half of my life. I’ve been to these 30-day programs. They don’t do anything for you. How can I undo that in 30 days? It took me nine months to begin to understand why I was using drugs the way I was. Now I’m really on the path to true and sustained recovery.”

Our graduates there have about a 90 percent success rate in terms of maintaining their sobriety. Even if they fall off the wagon, they are always welcome back to us as well. We keep that connection with them. There’s nowhere else like that on this Island, and there are only a few in B.C.

It isn’t cheap. It costs about $75,000 a year for someone to go through the New Roads facility. But keeping a man in jail — and half of the people who are at that centre were incarcerated — costs $100,000 a year. Keeping someone homeless — and several of the people there are also homeless — can cost, as we know, up to $120,000 a year.

We can choose how we spend our money. We can choose to spend $100,000 a year keeping someone in jail for offences related to drug addiction, or we can spend $75,000 a year and help them transform their lives and achieve sustainable sobriety.

The final part is what I call post-treatment and recovery support. This is really important for people to have successful re-entry back into society after they’ve been through treatment and recovery and sustained sobriety. When people leave, there are a lot of temptations. They can feel quite isolated and disconnected and tempted back into old ways of being.

What we do at New Roads, for example…. Every man who graduates from our program has a home to go to. In fact, some very generous folk donated a house where the men live, in second-stage housing, as part of their re-entry into community. Six of them live together, and we find other housing for the men who there’s no space in that house for.

Every man who graduates from our program is either in employment — already, we’ve found them a job — or in education and, in many instances, both. They have a really structured environment to go back into, and a supportive one. They keep in touch with us as well. They come back to monthly alumni meetings and have that connection. I think that’s a really important part of the continuum, which we currently don’t have.

We have seen at Our Place how, by providing this kind of continuum, you can change the trajectory of people’s lives and literally save their lives, in some instances. I think there are too many gaps and not enough capacity in the continuum that we currently have. If we were to take, I think, a more balanced approach and fund the different parts of that continuum adequately and make them truly accessible to men and women, I think we can have a greater impact on this crisis.

I see this, and I think everyone in this room does — the opioid crisis, the overdose crisis, the drug toxicity — as a health emergency. It’s been declared as such. I think folk need to be able to access what you might call the ER of the opioid crisis — so harm reduction services, detox, treatment and recovery programs — like we can all access ER for physical health emergencies, quickly and effectively and when they need it, not when it happens to become available.

[10:20 a.m.]

I think if we do that, we would save lives. I have no doubt. It’s not the total solution to what we’re facing, but I think it is certainly a partial solution and will have a significant impact if we can get that continuum together in a way that I don’t think we currently are.

So thank you for listening to me. I would also, in parting, invite anyone here who would like to come and see our New Roads facility to come. I personally would be happy to tour you. I think it’s a real beacon in our province, and it’s kind of hidden away. I think a lot of people don’t even know…. I bet many of you in the room have never even heard of it, yet it’s transforming people’s lives every day and is a real model, I think, for how to do this work.

You’d be more than welcome to come, and I’ll put that invitation out there. I don’t know how…. You can get my email. I’m sure there’s a way. If you would like to come, I’d be happy to show you.

N. Sharma (Chair): Thank you so much for the invitation.

Comments, questions?

P. Alexis: The New Roads facility — what kind of programs, or what happens in a given day at that facility? What’s different about it? I’ve toured a few, so I’m curious.

J. Daly: It’s very structured. There are activities all day, everything from physical exercise to group work to one-on-one work for the men. There is…. Every man there has a job within the community. It is very much a community. So some of the men…. We call that part of our work as therapy program. So there are men working in the kitchens. There are people doing the garden. There are folk tending to all the plants and vegetables and things that we’re growing. There’s a team of men who are cleaning the facility and maintaining it.

There are, obviously, NA meetings and AA meetings as well. The men prepare presentations for each other. They also…. For the first month or so — for a few months, really — they’re not allowed out of the facility. Once they are, then there are trips and visits to other places, and then, as people progress, there’s opportunity to get employment offsite. They get jobs, and they go to those each day, as well, and then come back.

It’s a pretty full day. We feel that’s really important. The men…. I think what’s different, too, is that it is a community, and there’s a hierarchy. There are community leaders, whom the men elect themselves. They hold each other accountable and support each other as well. It’s really…. It’s lovely to watch it and to see that in action, that support and that accountability-holding.

D. Davies: Thanks for that. I was just looking at your website here. It’s impressive, some impressive numbers. Speaking of numbers: success rate. Is that something measurable that you have, and if so, what is it?

J. Daly: As I said, of the men who graduate — they pretty much all keep in contact with us — over 90 percent of them have maintained their sobriety. Not all men make it through to two years. Some leave earlier. On average, men spend about five months with us, which I think is a success metric, because by that time, people will have made a lot of progress. For some, actually, that’s enough time to not only get sober but to maintain it when they leave, because people are quite individual in that way.

I think other success measures for us are men getting employment, sometimes for the first time in a long time, if ever; men getting into education, completing high school, for quite a few of them; finding their housing. I don’t know. It would be interesting to ask them. I’ve been to some of their celebrations. They have a monthly celebration where the men talk about what’s been happening for them.

I was struck by how many of the men spoke so openly and intimately about each other and their care for each other and also how many of them talked about how their lives had literally been transformed and saved.

[10:25 a.m.]

One man, just three weeks ago, graduated from that program — not only graduated but graduated into a home where he was able to get his kids back for the first time, to have his kids come and live with him for the first time since he had the kids, because his addictions were so bad that children’s services had taken them from him, rightly. He was able to get them back.

Those are measures, I think, of success as well. I mean, they’re a bit more intangible, but I think someone feeling their life has been saved and transformed is a pretty big measure of success.

D. Davies: Along the same line…. How long do you keep in touch with your clients afterwards?

J. Daly: As long as they want.

D. Davies: It’s up to them to….

J. Daly: Yep. There are people who are still in touch with us who started it three years ago. They’re always welcome to come back for NA and AA meetings but, also, this monthly celebration that we have. Also, if things fall apart for them, which it does for some — it’s not a perfect process — we welcome them back into the community.

D. Davies: A final question, Chair, if I might.

What is your funding? Do you have provincial funding? I see lots of “donate now” and “generous support of the community” and such. What does your funding look like?

J. Daly: Our funding is, frankly, very precarious right now. We do have some…. It was initially set up by the province. They had a starter, a large contribution to that. Then we have some money from the Mental Health and Addictions Ministry and from Island Health each year.

We have to sustain it, increasingly, largely, by donations. This year we’re putting in $800,000 of donations for it. By 2026, we would have to be putting in $1.5 million of donations to keep it going, which, frankly, for our organization, is unsustainable. The funding from government is going down, down, down each year.

That was the original arrangement, in fairness to the government. When it was started, my predecessor said that it would be financially independent within five to seven years and wouldn’t require any government funding. It would be totally funded by donors. That turned out to be very unrealistic and certainly unachievable. We’re struggling with donations just generally. They’re already down this year.

The idea that we could sustain what I think is a key health service with donations from individuals in greater Victoria is, I think, unrealistic. I don’t want to be too alarmist, but we can’t sustain it unless we get further funding. I don’t know what would happen, but it certainly couldn’t be sustained by us.

S. Chant: Thank you for your presentation. It sounds like a comprehensive program, to say the least. What does your clinical staffing look like?

J. Daly: At our Pandora site, we have paramedics.

In terms of the opioid crisis or at New Roads?

S. Chant: Sorry. Let’s look at New Roads.

J. Daly: At New Roads, we have some doctor hours each week, about 20 doctor hours or thereabouts. At the moment, we have one nurse, and we have three counsellors. I think two of them are psychologists. I can’t remember their exact qualifications, but they’re all qualified counsellors and therapists. Those are our clinical staff.

We also have an Elder, an Indigenous Elder on site, providing a different approach to healing as well.

S. Chant: If I may…. How many beds do you have?

J. Daly: At the moment, we have 33 men there. We have capacity to, in our mind, go up to about 40.

S. Chant: Okay. Of that, publicly funded…. Are any of the beds publicly funded per se?

J. Daly: All of them. Well, all partially publicly funded in there. Our funding is a mix of government and donations.

S. Chant: Okay. I’ll ask another question in a bit so that I can….

Interjection.

S. Chant: Oh, okay.

If I’m a male and in need of…. How much am I paying? Do I pay anything?

J. Daly: Yeah. Through their benefits, most of the men are eligible for that. There’s about $300 or $400, I believe, in that region, a month that will come through for rent.

S. Chant: All right. Thank you so much.

N. Sharma (Chair): Okay, thanks.

I have a question for you. It sounds like you have a very long history of working in the area that you do in different provinces. You said something at the beginning about setting up the first harm reduction in Edmonton.

[10:30 a.m.]

You make the point that it’s also about addictions and treatment and harm reduction and all the work that you’re doing. One of the things we’re learning is that it can be really hard sometimes to set up harm reduction in different places depending on municipal bylaws or the general feeling that people have about those services being in their neighbourhood. When you mentioned that you set the first one up, I was just curious about your experience on that and how you see that — how you overcome some of those difficulties of setting up those services in parts that some jurisdictions just don’t want them in their area.

The other question I had is how does that harm reduction…. You said you believe in harm reduction as part of the service. How does it show up when people are accessing your services, and what does that look like in terms of the continuum of care that you see that’s necessary?

J. Daly: To your first question, there’s a sad ending to that, because it was the first supervised consumption service in Edmonton. It also was the first supervised consumption service closed by the Kenney government in Edmonton, as a result of local pressure. That, sadly, is the answer to your question.

There were those in the community that were vehemently against it, even though all the crime figures and everything in that area — everything went down. All the negative indicators went down as a result of us opening it, every single one. Even the police were supporting it because of that, yet folk just didn’t want it there. So unfortunately, the folk that were using it have now returned to where they were before, which is in the alleyways and outside, where they were using.

I’m not sure I have anything to bring from that experience in terms of how you win folk over. That just happened recently, since I left Edmonton. But there’s no doubt…. We have that here in Victoria, because next to Our Place is The Harbour, which is a supervised consumption service, which a lot of people think Our Place runs, but we don’t, actually. It’s run by Lookout. Again, there’s a lot of local resistance to that, and unease with it.

The role of harm reduction — I think it’s crucial. Folk can’t get sober or get to detox or get to treatment and recovery if they’re dead. It’s as simple as that. Harm reduction keeps folk alive. It saves lives. I know some people who use don’t want to give up, and that’s fine. I certainly support that. But there are a number who do want to, so I think harm reduction provides a great opportunity to have those discussions with folk, and to provide them with paths out of their addiction if they choose that.

I certainly see the role of paramedics too. For example, at our organization, we don’t provide supervised consumption services at Our Place, but we do have paramedics. They have been instrumental, I think, in saving a lot of folks lives.

I think harm reduction should be a starting point, not an end in itself. That’s just my view.

N. Sharma (Chair): Thanks for that.

M. Starchuk: A couple of quick ones. With regards to funding…. You said right now you’ve got 33 beds that are being used, and a capacity of 40 beds. Has any of the government’s per-diem funding come for those beds?

J. Daly: Yes, we do get some per diem as well.

M. Starchuk: Secondly, back to harm reduction services. You’d said that there were no paths that were there for people that wanted to end their use that’s there. Do the men that enter your system…? Can they enter into your system on OAT therapy, and then continue on?

J. Daly: There are paths. They’re just very hard, and sometimes, they’re inaccessible. Sometimes, they don’t exist, particularly for women. I mean, women are particularly ill-served in this area.

Yes, the men coming into our recovery centre have to have been in detox. The detox folk here, in fairness, do prioritize their entry into detox so that they can then get into treatment. That’s another way we do harm reduction, as well — people who are on opioid replacement treatments and therapies can continue that at New Roads.

[10:35 a.m.]

Many of the men are. Not all, but a good number are. They’re allowed to continue that under medical supervision.

M. Starchuk: Okay.

S. Bond (Deputy Chair): Thanks for your presentation today. You’ve referenced a lot about the support for men. Your society obviously does a number of things. It has transitional beds. It has all of those kinds of things. Do you provide services that serve the needs of men and women?

J. Daly: Oh, absolutely. In every other service we have — our transitional housing, our permanent housing, our drop-ins, our employment services, our food services. Absolutely, women are…. It’s equal access.

S. Bond (Deputy Chair): Okay, so it’s the….

J. Daly: It’s just the therapeutic recovery community, because that was set up for men only. That tends to be the model. They tend to be gender-specific.

S. Bond (Deputy Chair): Okay. I appreciate that clarification.

Did you say that you have empty beds at the moment?

J. Daly: We have we have capacity for more. Yeah, we could have up to about 40. That’s our sense of the optimum number.

S. Bond (Deputy Chair): Is funding the issue?

J. Daly: No, it’s…. Well, COVID was a challenge, I have to say. Although, we did increase our numbers. We doubled our numbers during COVID, which was great.

What we find is that we want to introduce the men gradually, because if you bring too many people in at once, it can be very disruptive to a community environment. But also, a lot of the men who apply and want to come in fall away even in that process, and they don’t make it make it there too. The men that actually make it in are actually a reasonably small number of the people who initially apply. So that’s another reason why it’s not full. But yeah, I would welcome if we could have more people.

It’s open to anyone. That’s the other thing. I think a lot of people think that it’s only just for folk coming out of jail, but it’s not. People come out of the health system, and indeed, anyone could apply to come to our society. We have some people who are just from the wider community, and I would welcome them in as well.

S. Bond (Deputy Chair): So there’s a screening process. People make application, and then they are successful through the screening process. Then they are provided with the services that you offer.

J. Daly: Yeah. We have an intake process which is pretty thorough, because we have to make sure that people really want to be there and that they’re not there because they’re mandated to be there or because family or peer pressure or such — that they’re just doing it to keep family away or at bay. People really need to want to be there, voluntarily.

On our website, there is information for that. We haven’t publicized that widely, because at the moment, for example, we’ve got about seven empty beds. If we put that out, I think the need is so great that we could be inundated with that. It would be hard to manage that. But it is there.

S. Bond (Deputy Chair): Yeah. That was just my point — that we hear everyday day that we’re in committee about the shortage of beds and the shortage of opportunity. So to know that there is a place where people are being helped…. I’m sure there are different models that work for different people, but seven beds are seven different lives. That could be….

I was curious about that. So thank you for your information.

S. Furstenau: Thanks for the presentation. On your website: “Priority…given to individuals with high to medium interaction with the criminal justice system, a history of homelessness.”

I toured, I think, under the previous director. At that point, it was an option. If somebody was interacting with the criminal justice system, rather than a prison sentence, this was an option. Is that still the case, and is it operating that way?

J. Daly: Yes, it is. That’s an area…. We have to be particularly mindful of people’s motivation for coming, because clearly it would be…. If and when any of you visit, you’ll see it’s a very nice environment, obviously nicer than being in jail. So we have to be really clear.

We work really well with the prison service, and we’ve got a good relationship with them now. They help us identify people who are, in their minds, really genuinely committed to this process.

[10:40 a.m.]

I think in the early days, we had more folk whose, perhaps, motivation wasn’t as you’d want it to be. That’s quite rare now, actually. It still happens occasionally but rare.

S. Furstenau: To follow up on that, as you pointed out, the funding to keep somebody in prison is $100,000 a year. Does funding follow the people?

J. Daly: No, it doesn’t. Actually, it’s interesting. We get no resourcing from that service, which would make a lot of sense actually, and it would solve a lot of our funding challenges if we did.

S. Furstenau: That’s fascinating.

R. Leonard: It occurs to me that this might be a question for you, because you have residential treatment as well as working out in community. My husband worked in addictions counselling but as an out-patient counsellor.

We’ve heard about the lack of treatment beds, but we haven’t heard a lot about what happens out in community, and I’m wondering if…. I’m not talking about New Roads but your other services. What kind of services are you able to provide to people living in community?

J. Daly: At our Pandora site, very little. We don’t have any. We have one specific addiction worker for the whole site.

At our hotel sites and transitional housing sites, there are addiction and also mental health services provided — some by Island Health, but also by Umbrella, a local organization. I know SOLID and a few other organizations also provide those. So we don’t do that directly.

Our capacity outside of New Roads to provide those kinds of services in community is extremely limited. Again, I think it would be useful if we could, because there are so many people coming to us and, also, on the pavement outside our building, who could avail of those services. But we have no resources to do that.

R. Leonard: If I can quickly follow up, do you refer people from Pandora Street to your New Roads treatment?

J. Daly: Absolutely. Yeah.

R. Leonard: In what kind of proportion would you say of the people who end up living in…?

J. Daly: We’ve been increasing that. I would say probably a small…. Most folk come either through the health service or the prison service. I’d say, at any given time, there are probably about four or five out of 35 who would come directly from Pandora.

R. Leonard: Where their motivation is high enough to make it.

J. Daly: Yeah. Sometimes people are really motivated, and then when it comes to the intake process, they kind of fall away, or they lose their motivation. I see, I think…. A lot of the folk that are in and around our centre and Pandora — they’re called pre-contemplation. They’re not really at the space quite yet to go to somewhere like New Roads.

R. Leonard: Okay, thank you.

S. Chant: There’s a bit of a disconnect here that I’m feeling or hearing. We’ve heard from a number of different presenters, yourself included, that when people say it’s time — “I’ve had enough of this; I’ve got to break this cycle” — we need to find them somewhere right away. Yet I hear that there’s an intake process that people fall off.

How do we bridge that gap better for the folks that are saying, “I need it,” but perhaps are not able to make it through that intake process, sometimes through chaos in their lives, and sometimes through chaos in their heads? How do we make a better transition for those folks, if that’s a possible thought? Thank you.

J. Daly: The disconnect…. You’re right. That’s a question I ask myself too. The disconnect is at the detox point, because to get into treatment or recovery — the New Roads facility or any facility — you have to have been through detox. And with the huge waiting lists, it’s hard, in the moment, for folk to get into detox.

If someone turns up and says, “I want to get in. I’m done. I’m fed up” — we can’t. They can’t. We can support them to go on a waiting list, but we can’t get them in that day…

S. Chant: We can’t. Very good.

[10:45 a.m.]

J. Daly: …or very soon — like within 24 hours or so — which is, I think, what you need with folk. You need to have it ready for them when they need it, not just when it becomes available, because then they may not need it or want it at that stage.

S. Chant: Very good. Thank you.

M. Starchuk: What is your annual budget?

J. Daly: As an organization? This year it’s in the region of $20 million. It’s mostly made up of housing — transitional and permanent housing contracts.

M. Starchuk: Secondly, you’ve got some of your beds that are funded through the assisted living registry. At one time, there was talk, much to Shirley’s comment, about seven seats being open. At one time, there was talk that when you went to the website, it would show how many beds were funded and how many were available. Did that ever get off the ground?

J. Daly: Well, we have reports that we provide to Island Health and the ministry on a quarterly basis — and also a large annual one — which will show you the month-by-month occupancy rates. I’m not sure that’s on our website. It might be, but I wouldn’t want to say it is, because it might not be. But it’s certainly a document that is publicly available.

N. Sharma (Chair): Okay. This is, I think, your final question.

My question is…. I was curious to see what types of substances the people that are coming to access your services are suffering from addictions with. Has that changed over time? That kind of viewpoint about that.

J. Daly: Yeah, definitely. I’ve seen that not just here but also in the work in Edmonton. It’s interesting. You hardly ever see anyone drinking or drunk anymore. When I started in this work 14 years ago, I’d say most of the folk were drinking pretty heavily — also using other substances, but that was often the primary drug, if you want. That’s really fallen away.

We’ve certainly seen an increase in the strength of drugs and the toxicity. There’s no doubt from everyone who’s in the field that that has affected behaviours and changed the scene, if you want — the streetscape and also within our organization over the years. Some of those drugs — as I said at the beginning, I’m not an expert in that particular area — make it very difficult to connect with people and to work with them because of the impact they have on them.

Certainly, more people are dying, and they’re definitely more dangerous. There’s no doubt about that. But it’s kind of striking how quickly it moved from more alcohol and cannabis use to these other drugs almost exclusively now, it seems.

N. Sharma (Chair): Okay. On behalf of the committee, I just want to thank you not only for your expertise and years of experience and the work you do but for coming today, helping us learn from you and your perspective. It’s been really interesting.

Thanks for the invite to visit your facilities. We appreciate that. I’m sure, if schedules permit, we’ll probably find some time to do that. We appreciate your time.

J. Daly: Thank you very much, everyone.

N. Sharma (Chair): We will go into recess until 11.

The committee recessed from 10:48 a.m. to 11:01 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): It’s my pleasure to invite our next guests, the Cool Aid Society. We have Kathy Stinson, chief executive officer; Nikki Page, manager, housing and shelters; and Dr. Chris Fraser, medical doctor at Cool Aid Community Health Centre.

Thank you so much for coming here today. We have your materials on the screens in front of us. Thanks for sending them this way.

My name’s Niki Sharma. I’m the MLA for Vancouver-Hastings and the Chair of the committee. We’ll just go around and do some introductions before you get started.

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

S. Chant: My name is Susie Chant. I’m the MLA for North Vancouver–Seymour.

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

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

M. Starchuk: Mike Starchuk, MLA, Surrey-Cloverdale.

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

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

N. Sharma (Chair): Great. We have our co-Chair, Shirley Bond, joining us in a quick minute, and Dan Davies over there. He will be here shortly.

Over to you now. You have about 15 minutes for your presentation, and we’ll have the rest of the time, 45 minutes, for discussion and questions.

Go ahead.

COOL AID SOCIETY

K. Stinson: Thank you so much for inviting us. We really appreciate the opportunity to share our experience with you and, hopefully, some ideas on how to move forward together.

I want to acknowledge that Cool Aid has the privilege of providing our programs and services on the unceded territories of the Lək̓ʷəŋin̓əŋ people, known today as the Esquimalt and Songhees Nations.

I’m really pleased that Chris and Nikki are here to join me, because it’s really about what happens on the ground that makes a difference.

We’re going to tell you a little bit about who we are, what we do and how we deliver and adapt our services. Chris is going to do a bit of a deeper dive into our health services and some of the issues that they face on the ground. Nikki is going to do a bit of a deeper dive into things in our housing and shelters program, particularly our overdose prevention unit at Rock Bay Landing. Then I’ll just provide some closing remarks and we’ll open it up to you for questions.

Cool Aid envisions a community where no one is forced to sleep on the street or go hungry and where everyone has the dignity that comes with home, health and connection. We have some principles that guide our work. Certainly, meeting clients where they’re at is kind of front and centre in our harm reduction approach. We have a commitment to anti-racism, decolonization and cultural humility. We approach each client with empathy and compassion. We practise integrity and mutual respect in all our relationships, and we advocate for those we serve.

Working with our partners in the capital region, Cool Aid offers life-changing services to people who are impacted by poverty, colonization, stigma and homelessness. Since 1968, we have provided an integration of housing and health services and now serve more than 12,000 people each year in the capital region. We operate 20 different sites and have three sites in development.

We offer a continuum of housing options. We have three emergency shelters, including Sandy Merriman House for women and women-identified, and Rock Bay Landing, where our overdose prevention unit is located. We have 14 supportive housing buildings, including four that are for seniors, and we have one assisted-living building.

Many of those buildings have food services programs inside. We have a very large food services program, offering meals at many of our buildings. We just started offering some affordable housing as well, and that will be expanding when our new locations open.

[11:05 a.m.]

Then on our health and support services side, we have our community health centre on Johnson Street, which includes a dental clinic, a dispensary, counselling and primary care outreach, and a lot of new services that Chris is going to talk to. Our support services include our downtown community centre, our casual labour pool, counselling and outreach as well.

Cool Aid has always taken a client-centred, trauma-informed, harm reduction and housing-first approach to our service delivery. With the onset of the overdose drug poisoning crisis, followed by COVID, we’ve had to continually and rapidly adapt to these ever-changing challenges. We’ve been on the front lines of the overdose drug poisoning crisis since before it was declared an emergency.

We certainly introduced, very early on, staff training to deliver naloxone and have been offering that at all of our sites. We introduced, with the support of Island Health, the overdose prevention services at Rock Bay Landing, including an inhalation tent. Nikki is going to speak a lot more to that. We really scaled up our engagement of peer support workers to help with that work.

Then there was our COVID rapid response, where we were really asked to provide primary health care in all of the temporary sheltering sites that opened up across Victoria and really doubled our services there. Chris will talk a bit more about that as well.

I’m going to turn it over to Chris now.

C. Fraser: Thank you, Kathy, and thank you very much to the committee for this opportunity to be with you today.

Certainly, the opioid crisis is a pressing one. It affects all your communities, wherever you’re representing in B.C. Nowhere in B.C. are we where we want to be in terms of our response. So I think it’s very exciting that this committee will be able to come forward with some practical options and interventions that can meet the need.

I’ve been a physician working in this field for a quarter century. Fentanyl and the arrival of these lethal drugs has really changed the landscape and made us adapt to provide new services. But we’re not yet where we need to be.

You’re going to hear this word a lot in the media and amongst this committee — about toxic drug supply. I really like to refer to lethal drug supply. The issue is that the drugs being used — cocaine, stimulants, heroin — even at a pure level, have toxicities to the human being. In an ideal sense, we’re trying to prevent people from starting that path at all, and I’ll speak to that in a bit. But the thing that’s really changed in my career is the lethality of what is present on the streets.

We have been trying to meet the demands, and I think we’re doing a fairly good job responding and building services. We have an inner-city health centre here in Victoria, serving nearly 6,000 folks, providing an array of services, as Kathy described. We’ve got very strong accomplishments in overdose prevention, treating HIV, treating hepatitis C, providing integrated approaches to mental health and substance use.

The challenge has been that with the severity and urgency of the opioid crisis, some of the other care we need to provide has been hard to provide as well as the need of providing life-saving therapies. We have really scaled up our opioid agonist therapy, which I’m sure you’ve heard about from other presenters, and various forms of therapy that are available to us as clinicians.

Then with COVID and with the issuance of the risk mitigation guidelines from the B.C. Centre on Substance Use, we’ve had the chance, as providers, to provide pharmaceutical safer supply alternatives, with varying degrees of success and engagement of key clients. We’ve been able to, with good support from Island Health, provide creative outlets for these types of services and sheltering sites. We’re learning that we have to go much more to where people are at and, as per the previous presenter, provide mobile outreach services, van-based services and things that really can help provide people services where they’re at.

Similar to Our Place, I would certainly invite the committee to come along and see some of these services as they’re being provided, to see what the limits are and what the successes are. I think it’s going to be really important for you to take away from those visits what is working. How can we grow? What’s working around the province in all the settings that you represent?

It’s been really successful, over the last six months, with these mobile outreach services. We’ve been able to provide 10,000 services to different client groups in different places.

The issue comes down to how we are going to try and help people stabilize once they’re into the lethal drug supply, as I like to call it. It really comes down to safer options, and we’re not where we need to be. So we need leadership from this committee and from the provincial government to provide access to people in the community to newer forms of therapies — fentanyl analogues, things which have not been available yet. There are different types of routes of ingestion of these. There’s oral, inhalation and injection.

[11:10 a.m.]

I think having supply streams available across all of these will make better engagement and better outcomes. We need to also be able to have more flexible points of access to these services and really understand what’s working well.

One key thing we’ve learned during COVID…. We have been limited to a prescriber-based response to this — so through a physician, through a nurse. With all the limitations of primary care health workers, I think we need to really, strongly consider — and I would encourage the committee to look at this — non-prescriber-based alternatives. So community groups, harm-reduction organizations, through public health, could be authorized to issue safer supply alternatives and reserve the access to physicians and nurses to provide clinical services related to when people are ready to engage in addiction care, ready to engage in effective mental health care — that that’s where that can occur.

Physicians and nurses are always going to be regulated to a certain standard of practice by our colleges. So whether it’s the College of Physicians or College of Nurses, when we’re providing intervention to a client, we’re evaluated on the safety, efficacy, the evidence basis of what we’re providing. What we need to do now with some of these interventions is be pioneering and try and lead the way. Using community-based groups, I think, would be a very effective way to rapidly scale.

Clearly, along the way here, you’re going to look at decriminalization and legalization alternatives. From my perspective as a physician, anything that happens in those two areas is a positive. The criminal justice system for non-violent, small-level drug users is a real tragedy for disrupting relationships and setting people back, whether it’s mental health, whether it’s engagement and overall health concerns. The less my clients have to deal with criminal justice and the complications of that, the better, when they’re not doing anything which is violent or disruptive to the community. That’s certainly a lot of the folks we deal with.

In terms of another stream that I would really look to this committee to issue some strong, practical guidance on, we really need to look at prevention and early intervention. Hopefully, I think, we’re having very good success accessing people with low-barrier, harm-reduction-based services, but we’re not doing a good enough job with youth and people who are just starting to have issues engaging with the substance use issues. I think some robust, new programs in that space will be very important across the kind of continuum of care that’s needed, and continuing to fund the kind of options we’re doing with our population.

A missing piece in terms of the low-barrier harm-reduction services we do…. When people are ready to make a change and move on from a very harm-reduction-based lifestyle, ready to cut back on their drug use, ready to be in safer housing, we need to make sure those types of streams are more accessible.

New funding initiatives there, new supportive housing with folks who are willing to transition and make progress and recovery are essential, because we’re not offering people those options quickly enough now. We’re keeping them in a low-barrier, very harm-reduction environment. If they raise their hands and say, “I want to move on,” that takes time. I think the previous presentation alluded to that as well.

I think the final piece I would conclude on is just the training and support for folks. Trauma-informed and responsive care should be mandatory for any people working in this space. Very simple programs for outreach workers right through to nurses and doctors should be required, I think. Then also really leaning into the regulatory bodies to say that your job is to be more nimble in authorizing practitioners to evolve their care in this space and not use outdated models, outdated regulatory capacity.

Just to say…. A quick example of that would be that one of my colleagues who was doing safer supply work in this space had to answer for why they acted in certain ways from the college as a regulatory body, and wasted ten hours of their time corresponding to the college about why they had done this service which was actually helping their clients. That’s just one small example I could cite.

I look forward to more questions and discussion, and I’m happy to hand over to Nikki at this point.

N. Page: Thanks, Chris.

I’d like to echo Chris and Kathy in saying thank you for allowing us to come and share our stories with you.

As mentioned, I’m the manager of Rock Bay Landing, and we do have an overdose prevention unit on site, not to be confused with Insite — similar services. Our overdose prevention units opened in early 2017, and I’ve been lucky enough to be working at Rock Bay since before it was built in there. In the last six months, we’ve seen over 2,500 visits from people coming to use injectables and over 8,000 visits by people coming to smoke their substances. So that really speaks to a need for more safe inhalation spaces.

The staff have responded to a minimum of 77 overdoses involving naloxone being required to bring somebody back. We’ve also created a job opportunity for people with lived experience to come in and be peer support to our folks who are accessing services and share their stories and safer practice uses — things that are beneficial for the community.

[11:15 a.m.]

We’ve also seen a new model, the housing outreach peer prevention services, known as HOPPS, and that’s offered in more of the housing settings, not so much the shelter setting. It’s delivered by community peer-based organizations. Within Cool Aid, we have two sites benefitting from this, both Queens Manor and the Tally Ho.

When we look at issues on the ground, a lot of things come down to comorbidities. We know it’s not just one factor. We know that people have a lack of appropriate housing, mental health concerns, suffer from substance use disorders or a lack of access to harm reduction supplies. There’s also a lack of a continuum of care. Recently, I had a client who was turned away from hospital services because they determined it was a drug-induced psychosis, despite knowing that there was a history of mental health and mental health supports in another community.

Staffing challenges continue to be a big problem affecting this sector, and certainly part of this is around grief and trauma. Staff are continuously experiencing grief and trauma and have the same responses that we would have to those.

The secondary challenge to that is finding and retaining staff. I can only speak to Victoria, but the cost of living in this city is astronomical, and it’s hard for people to continue to live here while they’re working for what would be a livable wage, but the cost of living here is a little bit higher. We also see that lack of proper follow-up and support for staff when they are experiencing trauma episodes.

What we need to happen, and what we would like to see from the committee, is an increase to access. We need access to quick, easy and non-stigmatizing care. We need to normalize people seeking that support. Chris from Our Place certainly demonstrated that need. We need to see all parts of the recovery continuum ready to go when we need it. That’s the detox beds. That’s treatment beds. That’s the ability to access the supports that are needed when they are needed, when the person who accesses them deems it’s needed.

We need more trauma counselling, not just for our staff but for our clients as well, counselling that’s not related to trauma. We all have our own lives. Our staff are no exception. This isn’t limited to Victoria. This needs to be seen across the province and, really, across the country at some level.

We also need to see non-siloed interventions and consider the entire person. That’s their physical well-being, their mental health well-being, their socioeconomic well-being, food access, and they need to be able to access those services with dignity.

I will turn it back to Kathy.

K. Stinson: I think the fact that this committee is struck is really important, because I think everybody realizes that we can’t afford to play catch-up anymore. Too many lives are being lost. We know that we had a record-breaking 722 deaths just between January and April this year. So we need to recognize and address the role of systemic issues like colonization, racism and poverty that underlie this and the trauma that results that needs to be addressed.

We need a continuum of care that starts in childhood and includes public and private partners, service providers, people with lived and living experience, law enforcement, education. We just need that full range of options available when they’re needed. I mean, that is the most important part. There are these gaps in the system. When people are ready to make change, they just don’t have the access to that support they need to make that change.

Thank you so much for the work you’re doing. We really appreciate the opportunity to share with you today.

N. Sharma (Chair): Great. Thanks for the presentation. We’ll switch over to questions and answers.

Sonia, go ahead.

S. Furstenau: Thanks for the presentation.

Dr. Fraser, you mentioned — I’ve heard from all three of you, and we’ve heard this a lot — trauma-informed care, which clearly is essential, but we are in an environment in B.C. where we have a lack of regulation for counselling and therapy. How do you see being able to achieve trauma-informed care across the spectrum? What are the barriers and steps that are going to need to be taken to get there?

C. Fraser: Trauma-informed care is a great term. It’s an aspirational goal. We talked also about trauma-responsive practice, which is a way of working with people in terms of meeting them where they’re at. It’s a style of practice, and it’s a way of engaging people. One common phrase along those lines is: “No wrong door into care.”

[11:20 a.m.]

Traditionally, in health care, if you had addiction and you presented to addiction, like Nikki’s case, with a mental health crisis, they would have said: “Oh no, you came to the wrong place. Go somewhere else.” You’re retraumatizing someone in the course of supposedly responding to their needs.

Really, to think of trauma-informed care, I think, is to set out a map of providing skills — where no provider says, “Oh, I can’t deal with this,” but every provider says: “I have a few tools to help with some brief counselling. I have a few tools to help with linking you to other services. I work in partnership with other providers.” So I’m networked into a system — whether it’s out-patient, in-patient — and then we can promulgate, through that, evidence-based practices for a variety of mental health and trauma-informed issues.

One of the things which is really good is the training of all our staff so that the cultural competency…. The PHSA has really done great leadership in making that pretty much standard. And that’s across all our teams and providers. We have that type of practice.

T. Halford: Thank you for the presentation. When you talked about staffing challenges, you talked about grief and trauma and the challenge to find and retain staff. On that grief and trauma, can you maybe expand on that? Then just expand on the challenges, in terms of recruitment or retaining the staff that you’ve had or lost.

N. Page: I can say — as a person who has worked in this field for a little while and responded to a number of overdoses — that it can take a toll on whether you want to come back. Having quick and immediate access to grief services, to a counsellor…. We have a contracted counsellor within Cool Aid for our folks, but that’s really one agency supporting one agency’s worth of staff.

On a greater picture, to not have access to that may mean people not coming back because they’ve experienced such a traumatic overdose. So coming back to work every day, they’re kind of re-traumatizing themselves. They’re coming back to the same environment, the same clientele, the same kind of day-to-day pace.

We’ve seen interventions, early interventions. MRT, the mobile response team, has a great intervention, but even trying to get them to your site in the moment when it’s happening — or, really, shortly after — is not always doable. It’s not always feasible to get them there within 24 hours. That’s their goal, and they strive for that. But if I have a staff member who is experiencing a trauma, I need to be there to respond and be prepared to support them, and there need to be better wraparound services.

I’m not a counsellor. I can’t do what a clinical counsellor can do. I can’t do a clinical debrief with somebody. So for them to have that ability and know that they’re well taken care of, that they can come back to work and that they’re working on that resiliency-building piece — that’s key for me.

P. Alexis: From all the health authorities, we heard and learned that inhalation is certainly the preferred method now. Many cited issues with respect to infrastructure and how they weren’t ready for this method, necessarily. Can you talk to us about how that happened with you, what kind of infrastructure you put in place, or anything at all? That seems to be the preferred option now.

K. Stinson: Well, I can speak a little bit, and then Nikki can add…. Certainly, we knew early on that smoking was one of the preferred methods. We’re fortunate that at Rock Bay Landing, we have a large outdoor courtyard. Our overdose prevention unit, which is located inside, overlooks the inhalation tent, which is outside. That’s where, primarily, the peer workers are — the ones who are supporting that inhalation tent and responding when there’s a crisis in there, because they have good sightlines indoors. That’s what has been helpful.

Nikki, do you want to add more to that?

N. Page: Yeah, absolutely. Certainly, for a period when we first saw this crisis become declared a crisis, we definitely did see that there was a higher number of people overdosing from smoking than from injecting at our site. The introduction of the inhalation tent has resulted in great successes. We also are incredibly lucky that we have a larger staff pool to use at that site. So we rely on our harm reduction worker in our overdose prevention unit.

[11:25 a.m.]

We also rely on our front-line team to be secondaries and be third responders, and to be there offering the external supports that you need in an overdose response in a setting where there are so many people around. They get busy, it can get chaotic, and having more people is huge. We’re incredibly lucky to have that, but certainly, sites that wanted to expand and have inhalation services would need a staffing model that would allow for that to be safe.

The other piece becomes around what’s safe for staff to respond in. Can they be going into this space where someone’s been smoking substances? We’re very lucky that we have a physical structure. People can go in. It’s not sided off. We have a decent amount of ventilation, and we can respond safely and quickly. That’s something that would have to be factored in as well.

P. Alexis: That, maybe, doesn’t transfer well in other communities in British Columbia because of the mild climate. I get it. Okay. Thank you so much.

C. Fraser: It’s been a challenge overall. The dogma used to be that the inhalation of drugs could be effective harm reduction. It could be less dangerous for people to overdose. It could be less likely to acquire hepatitis C or HIV. This has really not been borne out with fentanyl.

That’s part of the shifting that we’re doing. It is a challenge, though, if you map out — and this will be something for the community to wrestle with — how much money should go into the infrastructure renovations and the incredible expense to create those spaces versus human services. That’s a real challenge. Promulgating the lowest-cost best practices in this area is one good thing the committee could look at and find, if we’re looking at a provincewide approach.

M. Starchuk: Thank you for your presentation. I find it…. When we learn something new….

I’m just very surprised, Dr. Fraser, that there’s a higher rate of overdose with inhalation rather than injection. I’ll wrap my head around that. Doctor, you had mentioned that there were varying degrees of success with safer supply. Could you just touch on what that would mean, varying degrees of success?

C. Fraser: Sure. One of the challenges of safer supply…. We would really, as clinicians, like to provide folks with a safer supply. We know that the safer supply we have prescribed or issued is used by the person in the moment for themselves when they need it. The challenge has been accessing and providing it in the moment to people.

We’re trying a few various alternatives. We’re cooperating with the MySafe Society to try and use a biometric machine, where, when people feel they have to use something, they can go touch a screen and get that delivered to them. So we’re evaluating that approach.

What we’ve had to do, in the interim — COVID isolation and other factors — is give people a daily supply, say, of opioids that they then use across the day. The challenge to that is…. We don’t really know how much of those opioids they use themselves. If they have multiple addictions going on, stimulants and alcohol use disorder or other things, we can’t really ensure that it’s being given to that person in the way we intend.

It becomes an issue of the provider-patient…. How good is that communication? How good is that relationship? Observing them clinically, talking to housing staff, and seeing how it all unfolds. This is why I think using a more nimble, broadspread approach of administering safer supply with community groups and on-demand access at various supply points would be much more effective. We’ve had reports that some of the safer supply we’ve tried to use has not ended up in the hands of those we really want to use it due to the many factors that occur.

Again, at the end of the day, it comes from the decriminalized drug market. People have an incentive to become involved in this to make money or pay off debts or those types of things, which are far beyond the patient-provider relationship domain.

One point of clarity on the inhalation. I certainly didn’t want to imply that inhalation is a higher risk of overdose than injection. We hoped it would be much less of a risk. That was the dogma pre-fentanyl, but now all bets are off. I couldn’t say it’s higher, but it may be approaching equality to an injection drug with the wrong person, the wrong drug, at the wrong time.

M. Starchuk: Thank you.

R. Leonard: Thank you for the work you do. Thank you for coming to speak with us today.

Something you said…. I’ve been trying to contemplate why the change to inhalation from injection. I’m afraid of needles, so to me, it would be a no-brainer, if I was bent that way. But what you have said makes sense — that there’s a sense that it was a safer way. If it becomes known in the community that it’s not….

[11:30 a.m.]

Is there a reason that it’s become so prevalent, knowing that it isn’t safer? Is there a chance that if we spend millions and millions of dollars on creating safe inhalation sites, something else will come along, a different way of administering the drug? Is it that precarious, the type of use?

C. Fraser: It very much can be, depending on the client. I’m sure Nikki would have some comments as well.

The challenge is…. To use a safe inhalation site, people have to come and get there, to the site. Can you ever have enough sites to meet those needs? That’s the concern about putting so much money into that versus, perhaps, more cost-effective dispersed models. That’s the challenge there. That’s where pilot projects with robust evaluation can really help a lot. You can see how something works.

If we’ve got the best site in the world at Rock Bay, and there’s someone over on the Gorge smoking fentanyl in the park — not talking to anyone, not accessing care — and there are not enough outreach workers out there, we’re not reaching the right person at the right place at the right time.

R. Leonard: Right.

N. Page: I would say there has been an increase partially because of what Chris mentioned — that people had this idea that they could smoke and they were less likely to overdose.

There’s a lot more to it, I think, when you factor in ease of getting supplies — getting syringes and getting safe injectable supplies versus potentially being able to use what’s in your kitchen, in the form of a straw and some aluminum foil. I think there’s also the stigma around needle use and people wanting to be more discreet with their substance use and being afraid of being judged.

I think there’s a piece around being able to continually use IV drugs. People’s veins collapse, and they start using different areas of their body. When it becomes less and less effective for them or it’s more time-consuming, and they’re just still unwell from the symptoms of withdrawal, then they’re kind of at a point where: “I could smoke this. I might need to buy more to smoke it to get the desired feeling, but I’ll get that desired feeling. I don’t have to fight my own body to get it.”

N. Sharma (Chair): Okay, thanks. I have a couple of questions that are tied together.

First of all, we had a presentation from the colleges that just talked about their perspective and their viewpoint on offering safe supply — the doctors or health care providers that are in that space.

The question I have is…. First of all, I’d love to know a little bit more, from your perspective, about the rub between that, between what you see with health care providers doing the work and the colleges, and what that looks like, from your perspective.

The other thing is…. Is there any way, for people like yourselves, who are on the front line, of figuring out how a safer supply works to get people stabilized, as you mentioned it? Is there any way that there’s a forum or working group or somewhere that you’re feeding in, through the colleges and the B.C. Centre on Substance Use, what you’re seeing and what’s working on the ground with what they’re doing as regulators or people setting the rules? Do you have some kind of space where that happens rather than one-offs?

Then the second question was the comment about non-prescriber models and what that looks like to you and what you think is successful in that area or could be successful.

C. Fraser: Great questions.

To speak to the colleges…. I think that the colleges are very much there to regulate. Technically, if you look at the colleges’ websites, they are there to make sure the public stays safe from the interventions of physicians and/or nurses and that our practice is always safe, evidence-based and effective.

When you’re dealing with an area with uncertainty, like how to respond to fentanyl…. I’m an evidence-based practitioner. I like to go by what’s been proven to work. There’s very little data on fentanyl. So when the college evaluates how I’m doing my job, they don’t have much leg to stand on. They are very much a problem in this area. You can anticipate that they will always stifle innovation, react negatively to things that work. Very much to your point, we have gone offside to create working groups, provider-to-provider informal communication.

The B.C. Centre on Substance Use is a much more useful body to lead this kind of dialogue. They have to, probably, bring the colleges to the table and say: “Hey, this is the way it’s going to be. You have to agree that if providers are following this guidance, you’re not going to come at them and say they’re misprescribing or they’re doing something which could harm the public.”

[11:35 a.m.]

There’s always that sense of scrutiny by the college. Historically the college…. They’re doing a lot of catch-up now. They have very much been on the side of an abstinence-based approach to addiction medicine, which has been very slow to embrace harm reduction.

I go back to when I first started doing a methadone practice in the Downtown Eastside. Some of my initial patients were young women who continued to use cocaine after three or four months on methadone. The college said: “You must stop their methadone.” That was college dogma in the late ’90s. Some of those women, tragically, went on to be associated with Mr. Pickton.

The college, in a way, broke my relationship with my patients, because they were so abstinence-based. They’re going to come to you and say: “We’re really on side with this.” But they are very much slow to the game.

Providers have taken that to the point…. We’re going to have to be innovators and work with ourselves and present the best case and show evidence. So we go to conferences like the Canadian Society of Addiction Medicine and the International Society of Addiction Medicine.

My group and I will be going to the International Network on Health and Hepatitis in Substance Users to present data on what’s happening. The paper, which I think is part of your package, that we assembled on our work with this risk-mitigating guidance work is part of that.

What was your second point again?

N. Sharma (Chair): It was on the role of non-prescriber models. What do you think that looks like, and what would you see as a good path for that?

C. Fraser: That’s where I think the real promise of this group is — to create something really new, which really can make a difference. It’s to have provincial consensus guidance, perhaps crafted through a partnership with the B.C. Centre on Substance Use: “These are the approved opioid analogues which can be used in B.C. by harm reduction community-based groups. These are the amounts that can be distributed on a daily basis through these sites.”

Then not having the bottleneck of accessing physicians and nurses…. We’re in short supply, as you all know, from your communities. If our time is being taken up by that kind of service, we cannot, then, deal with infections such as HIV, common addiction-related issues, mental health issues. Our patients get much worse and then have to seek hospital-based care, and we get into that whole cascade. If we have more time to do primary care, ongoing longitudinal primary care, particularly with COVID, making sure COVID vaccination gets to our population effectively, that will really create space.

I think that would be a key recommendation from my side — that there’s some process coordinating the B.C. Centre on Substance Use and public health. These are going to be the approved new fentanyl analogues that can be given in powdered form for usage at sites and distributed in that way.

D. Routley: You mentioned the peer support workers. I’m wondering how you manage their participation, if they’re compensated and how they’re compensated. Also, do they have a role in the design and evaluation of programming and how you introduce things?

N. Page: Our peers are paid in honorariums. They do get paid for their services. Then, absolutely, maybe on a less formal level, they’re involved. They had been involved on a formal level previously, but COVID has certainly put a damper on that. On an informal level, we’re talking with our peers every day, because we see them every day.

I go to work at Rock Bay Landing, and I get to interact with the peers and the people receiving services. It’s the same. They work in tandem with a harm reduction worker. So they’re constantly having that ability to have a conversation, which then comes back, through the harm reduction worker, through our meetings, where we talk about this really great idea that’s come up or this really great idea.

Our peer volunteers are part of the group who started us doing outreach on a different level. They’re involved in cleaning harm reduction supplies on the street, in front of us, or going out and cleaning our entire courtyard as a means of being a face that’s present and connecting and engaging with clients.

Does that answer your question?

D. Routley: Thanks.

S. Chant: Is there anywhere else in Canada or elsewhere where the equivalent of the College of Physicians and Surgeons is more supportive of this work?

C. Fraser: I would have to double-check with my colleagues across the country. I think, generally, we would perceive that Ontario is a bit further ahead, but I haven’t really done a detailed check in with colleagues there. I think Quebec, not so much. I think Maritime Canada, not so much. Potentially, Alberta has had some innovations. But whether that’s driven by the college, again, or by more physicians saying: “Hey, no, we’re just going to do this….”

[11:40 a.m.]

Certainly, we’ve never looked to the college side — nor, I think, is it part of their mandate — to say that this really has to happen for public safety.

S. Chant: Thank you.

S. Bond (Deputy Chair): Thank you for your presentation. On one of your slides, you talk about non-siloed interventions. We’ve heard a lot about that today and in past days.

Can you talk about what the barriers are to people working across agencies, ministries? What does it take to fix that? You have it as: “What needs to happen.” So can you talk a little bit about how we consider the whole person?

K. Stinson: Yeah. I mean, I think it’s about…. There are just simply not enough services across the whole spectrum. I think that’s why you end up with these siloed systems and the fact that when people are ready to move from one thing to another, that thing is just not there for them at that time.

Certainly, we are fortunate, in Cool Aid, that our health and housing services are integrated. We’re trying very hard to make sure that our mobile health services are available across the community. We’re working very closely with partners at our place, at PHS, at Pacifica, taking our mobile services where they’re needed and trying to be as responsive as we can. Part of the challenge is just staffing shortages across the board, which also interferes with that ability to be there when you’re needed.

I’m sure that Nikki has some additional thoughts on that one as well.

N. Page: I do. I absolutely agree that staffing challenges are part of this problem, where we can’t dedicate more time to our clients. We can’t engage them in meaningful ways. We really are just at that very bottom level of Maslow’s hierarchy, right? We’re just getting people food, water — and shelter when we can. That doesn’t account for the hundreds of the population that are still outside.

I mean, in the context of this, we’re very narrow-visioned into people who need low-barrier services. We’re also not looking at the people who have great Monday-to-Friday jobs and who used to access the Harbour before it really became a low-barrier community around the space. We haven’t factored in people who could be working class like us. We haven’t factored in how we’re getting those services to people who aren’t accessing our services.

Talking about food equity, how are we getting food to the people? We can now get health care to them, but we don’t always have the ability to get food — which is a basic human need — or clean water or bathrooms. How a person feels when they can’t access a bathroom and how we feel, as staff, when we’re saying, “Sorry, you can’t enter this facility right now,” because we’re controlled by COVID, or because we have staffing challenges and we can’t bring extra people in….

We’re stripping away that humanity that makes a person a person, so we really have to get back to a place where we look at every piece of who a person is and how we meet those needs.

C. Fraser: I think that’s a great question about silos. I think the committee could do a lot of good work on silo-busting.

I would think of it in terms of contracts. Contracts get issued, and services are flowing through certain channels. I’m very lucky to do my health practice through Cool Aid, because there is integration. But what about redoing a lot of contracts — that if you want to be a housing provider, you have to have a partnership with the health agency, or there’s no contract? What about if you are running a residential recovery program, and you have to have on-site mental health services or no contract?

I think if you come back to that level, that’s a good way to break up the silos, because I agree that’s a huge problem. Money just keeps flowing. It’s not necessarily results-based. It’s not driven by what works or leads to better outcomes. So that would be one thought there.

S. Bond (Deputy Chair): Do you have touchpoints with health authorities, with the government? How do you talk to one another about what’s working, what isn’t working? Is there an ongoing dialogue, a place for innovation, accountability? Where is that space?

C. Fraser: Not enough of it, still, so we can do better there.

B.C. Centre on Substance Use leads a lot of good dialogues, but it comes down to within your health authority. We’ve had some good managers within our health authority.

[11:45 a.m.]

I think COVID has taught us…. Again, this is Kathy’s point, building on some successes of COVID that say…. In Victoria, we’ve talked about: what if we have an integrated inner-city contract for health and housing services, and integrate under one big tent, in a sense? It’s really somewhat random that the health authority managers are not required, say, if it’s Island Health or Coastal, to go out and meet with folks and then find out what’s really working well.

I think Coastal, in my opinion, would be one of the better health authorities overall. Island Health is now catching up and doing a better job, but promoting those dialogues is going to have to be really fundamental.

Again, I think one quick way to do that is contracts. If it’s required in a contract, they’re going to do the dialogue.

S. Bond (Deputy Chair): I just really appreciate the conversation, because…. So money flows to programs, to organizations to provide services, yet there isn’t an overarching sense of how that money is…. I’m not suggesting that there isn’t accountability for the physical dollars, but it’s what people are doing with those dollars, who has the best ideas and how we bring those ideas together to innovate, to adapt, to actually…. So there is not that level of discourse.

K. Stinson: I think recently, in our community, there has definitely tried to be that level, certainly with the coming together of health and housing at the provincial-municipal level. We had B.C. Housing and Island Health working very closely together through COVID to bring on the temporary sites and to make sure primary health care services and harm reduction services were available at all of those sites, so a real recognition that health and housing have to be integrated in order for these challenges to be fully met. I think that there are definitely lessons learned here in Victoria that could be spread elsewhere around that.

I think it’s still challenging. I mean, we come together. We have representatives from B.C. Housing, from health authority and from various community organizations, and we meet regularly, and we have these conversations and dialogues. But I’m not sure how it flows back up.

S. Bond (Deputy Chair): Is a simple summary, a way of looking of at this…? COVID forced people to do things differently and find ways to work together. Perhaps the opioid crisis should have a similar response and approach so that there is a sense of urgency and innovation and collaboration that we saw during COVID. We need to see that same energy, focus and drive on the opioid side, and that same sense of we’re all in this together.

K. Stinson: Absolutely.

C. Fraser: Very much. If I could introduce one term for the committee to lean on in any reports or guidance, it would be “task shifting.” How do you shift from doctors and nurses to peers and get more robust peer networks? How do you shift some of the tasks of engagement to harm reduction agencies and train them to have some capacity? So “No, I can’t help you” to “Yes, I can help you to this point. Then I’m connecting you to something more definitive that will be helpful.”

R. Leonard: Just springing off the previous line of questioning. In my community, we have, and I’m pretty sure they’re throughout the province, a community action team. I just attended one of their monthly meetings recently. That was a place of dialogue. There’s been a lot of coalescing around creating a like-mindedness and drive in community.

I’m wondering if that is happening in the Victoria region and if you see that as that incubation place for new ideas.

K. Stinson: Certainly, there is a community action team. There’s a meeting that I’m going to this afternoon of our community action team.

I don’t think it’s been very front and centre around this. I think, certainly, some good work has been done through there, and some kind of on-the-ground work. Very much, that’s kind of the grassroots, in terms of getting some funding out to peer organizations and to groups like Moms Stop the Harm — making sure that that is happening. Certainly, it’s a place where ideas are shared. I’m not sure how much of that translates back into actually creating policy, though.

R. Leonard: Okay. Just getting, then, back to what Dr. Fraser said earlier about the non-prescriber model, I just wanted to follow up a little bit on that.

[11:50 a.m.]

You suggested that regulations could be created — for which drugs, how much is a maximum — and then to give, to a non-prescriber, to be able to go to those limits, maximum. But then you said: “To be consumed on site.” I immediately thought of what you had just said about inhalation sites and how not everybody is there. I’m wondering how successful that would be. I’m challenging you here.

C. Fraser: Yeah, great question. No, you’d need to flesh it out, and you’d need to look at different models, for sure. One group we’re not doing a good job of reaching is construction workers, for example. Those are those folks who are…. They can’t fess up that they’re using. There’s no engagement. There’s no connection. A mobile team would go to them and give them some amount when they’re not ready to do formal addiction medicine care yet.

Other folks who are very much enmeshed and are very street active and doing ten drug deals a day — if we can get them consuming what we give them immediately, that’s going to have a better yield for that person and the community.

I think you could have four different streams. There could be a per-dose distribution. There could be half a day distribution, twice a day. There could be once a day. Then in rural areas, it could be less. I think you could come up with some algorithms that would be approved. As long as the workers are following, say, the four streams of approved algorithm, it would be within a scope of practice that could be defined.

R. Leonard: This is something that the B.C. Centre for Substance Use could provide the expertise to say what the parameters are.

C. Fraser: Sure. Yeah.

R. Leonard: Thank you very much.

S. Chant: It occurs to me that there must have been some work that’s been done, through COVID, forced by COVID, that’s actually turned out to be groundbreaking and working. Can you…? Are there a couple of things there that you can say?

We’ve heard from other people — and I think, probably, in your world as well — that they’ve found a couple of things. COVID hasn’t been great, but there have been a few things that have worked and have been able to be trialled in this unique environment that may well take us to a place that may be more productive.

C. Fraser: I think marked enhancement of mobile outreach, going to where people are, linking health and housing in our sheltering sites…. Many of my colleagues across Canada, during COVID, saw many fewer patients. We enrolled up to 800 new patients in our roster because of good planning and innovative services. Then the other thing that I think would be really important there is to link up to good evaluation so you can make sure that that’s working.

The other thing is that safer supply, with the papers included in your package, for some folks really dramatically cuts down their amount of use. For the low-barrier person, overdose rates reductions. People who’d been to EHS or emergency with four overdoses in the previous month — no more need of that. Still using a lot, but not overdosing. Huge harm-reduction gains and safety gains.

An overdose prevented is really someone stabilized and given a chance, when they’re ready, to enter into recovery. Recurring overdoses lead to worsening brain function, and that person has less of a chance to realize their full potential when they do decide to engage in addiction care.

N. Page: If I can jump on that, as well, I just think it’s important to note that COVID has also given us a lot of outreach groups and a lot more teams doing the work that we didn’t have pre-COVID. So the ability to get to somebody….

It’s a give-and-take. We’ve lost staffing and our ability to maybe have big, robust teams that we’d like to have on-site, but we do have this supplementary opportunity for people to be seen where they are by somebody who’s not a clinical doctor or a nurse, who’s just an outreach worker who genuinely wants what’s best for the person, as they determine it, if it’s safe, and getting to them and meeting those needs. The ability there has increased, and that’s a huge thing that we’ve gained from COVID.

S. Chant: Great. Thank you.

N. Sharma (Chair): On behalf of this committee, I just want to thank you not only for the work that you’re doing every day but for helping us learn from your perspective and giving some really practical and innovative recommendations. We’ve really appreciated that.

Chris, Kathy and Nikki, thanks for coming. Take care.

Okay, committee, we’re going to go into recess until one o’clock. Enjoy your lunch.

The committee recessed from 11:54 a.m. to 1:03 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): I just want to welcome everybody back after our recess.

On behalf of the committee, it’s my pleasure to welcome our next guest, Council of Construction Associations, which is joining us virtually. We have Dr. Dave Baspaly, the president, and Grant McMillan, the strategic adviser.

I just want to welcome you, and we’ll do a quick round of introductions. My name’s Niki Sharma. I’m the MLA for Vancouver-Hastings and the Chair of this committee. I’ll pass it over to our Deputy Chair.

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

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

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

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

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

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

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

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

N. Sharma (Chair): We’re very eager to learn from you today. You have about 15 minutes for your presentations and then, the rest of the time, 45 for discussion and questions afterwards.

I’ll pass it over to you.

[1:05 p.m.]

COUNCIL OF
CONSTRUCTION ASSOCIATIONS

D. Baspaly: Thank you. Maybe I’ll start, Grant, if it’s okay, and we’ll go through.

I just want to thank you for the opportunity, Madam Chair, and also to all the members that are here today, to explore this important issue.

Without a doubt, in our sector, this is an issue that has, unfortunately, been kind of buried in our COVID experience over the last little while. It’s certainly a crisis that happens every day across B.C. In our sector, because of the demographic that we represent — 18-to-54-year-olds, predominantly male, working in our industry — we tend to have a disproportionate amount of opiate users. Of course, then we get the challenges that come with it.

What we’re going to do today a little bit is tell you a few things that I think the committee would want to hear from B.C. construction. First, I’ll give you a little bit about what COCA is so you know who you’re talking about, what our unique role is. Then we want to get into a little bit about the problem, as we see it, in construction. Then, finally, what we’re actively trying to pursue to deal with it as a sector, and in partnership with the health authorities, to try to remedy the situation and support the workforce.

It’s good to see many of you friends again.

What COCA is, is the Council of Construction Associations. We’re an organization that spans all 20 associations within construction. The only other organization that does that is the B.C. Construction Safety Alliance, which is sort of a health and safety organization.

We are really the organization that works with WorkSafe, Technical Safety B.C. and the provincial government to make sure that…. Effectively, two major test questions, the first being: make sure our workforce goes home safe every day, in every respect. We want to make sure we support all of the regulations and policies that are out there, and we try to make sure that they’re going to make sure that happens.

The second major test question that our organization champions is making sure the economic conditions of our industry aren’t unduly affected by regulation, policies and changes. So we’re a really good one to come and talk to you today.

The opioid crisis…. We were approached to participate with a cadre of other stakeholders within our sector, including the labour side, to discuss how we could come together to address the issue. The first thing was…. I think we had a number of round-table sessions where we sat down and dialogued about: why us? Why construction? What is it that makes us unique and those circumstances? Again, I think, in those round-table circumstances, we came up with a couple of key features.

One is, obviously, the demographic nature of it — the fact that it draws in a male-predominant workforce. The younger side of it tends to be more likely to experiment — a work-hard, play-hard sort of ethos. They’re out there among the individuals there. I mean, these are also the same individuals that are incredibly proud about building the buildings and the houses and everything that’s there.

They also struggle with when they go out and try to let loose and participate or even handle the stresses and deal with pain, because we have another situation. We have chronic pain and a lot of soft tissue issues and things that happen from people participating in these works. Unfortunately, males of that particular age tend to want to manage it themselves. It can be from the opioid they’re prescribed by their family doctors to deal with the chronic pain, or it might be the fact that that leads them down the road into more drugs that can deal with it.

Then there’s the recreational side, which is also another track that we found that would lead people into that space that’s unhealthy behaviour, and that’s where we end up.

The one nice thing that came out of that process that we did with this consortium of stakeholders was that we had the health authority representatives there, as well, talking about how they could assist. There are a number of things that are really impactful in construction, that work really well. So we started to do a lot of whiteboarding about what kinds of strategies and activities we could do to make a difference.

The funny thing about our sector is that you have a lot of individuals that are really fiercely protective of their privacy, fiercely protective of their rights and don’t want to necessarily put themselves in the spotlight when it comes to things that are illicit or considered to be stigmatizing. That makes it a very tough situation. Just putting out information isn’t necessarily the best countermeasure for people that are going down that track.

[1:10 p.m.]

We did tap into something. We talked a little bit about helping the brother or sister next to you. In other words, make sure that everybody…. It’s easier to say, “I want to help a brother or sister,” than it is to take it on yourself and to believe that you have a problem and that you need to manage yourself. If you created a culture around that, we thought, by the information, and we circulated enough resources and information — naloxone kits were within arm’s reach — what we could do is we could create a system by which everybody helped everybody else, a safety net around how we would do that.

The dialogues here were…. We obviously needed a portal or a resource think tank. The B.C. Construction Safety Alliance, which is sort of a constructions house, where they go to get some of these resources…. The trades, of course, have another portal where the workers come to get resources, and so on. These would be primary areas where we would locate and put most of the materials so they were at easy arm’s reach for anybody that wanted to do that.

Then we would push it out to industry in tailgate toolbox talks and these kinds of things, to just socialize the fact that…. It’s not stigmatizing. This is a real situation in society. Here’s where you go for help, not judging. Try to get people to the right place. From there, there was…. We had a long conversation. I think you’ve heard this from others that may have approached this committee and had conversations.

If we could do one thing that made a difference, what would it be? One thing. This is a complex problem. You’re going to need a lot of things happening in harmony to actually make a major difference. But if we could do one move, as construction…. What could we do to stand up and try to make a difference against this epidemic?

What we landed on was a naloxone kit in every hand. What we thought is…. From a construction standpoint, with our 20 associations and the trades and the apprenticeships and the B.C. Fed, we could work as a team, as distribution, and make sure that we saturated our sector with naloxone kits and the education and information on how to use those kits properly.

What that would do, if you just stand in the background for a moment, is put a kit in every truck on every site. So every party that was going on, where people were gathering…. Every time somebody was at home, they’d have it in their truck, just in the driveway. There would just be enough of these kits floating around that they would never be out of arm’s reach for somebody that was put in harm’s way or felt themselves in danger. There would always be….

That buddy program we talked about would be the second stage of that. Make sure everybody knew you were taking these kits to support somebody beside you if they ever ran into trouble.

We approached the ministry of addiction services and made a proposal and a presentation. We were hopeful to try to work…. We felt that the construction sector would be the natural logistical arm for moving these kits out and making sure they actually made it out to the rank and file of all the companies and everything that was out there.

I stand here before you today to say that proposal is still live. We’re still working to see if we can get enough of the kits. We argued that we could even do a bit of an empirical study about it. Our baseline in this area would really be the trajectory of statistics that’s happening on a daily basis, these tragedies that are happening to the families and workers. Then we would be able to bend that curve down by simply making sure…. We know when we start the program where the kits are saturated and what we could do.

Vis-à-vis that initiative and that intervention…. We really do believe, if we did that for three to six months of a really intensive push in this space, we’d really start to see a difference in the numbers, and we would be saving lives. We’re not going to cure the addiction. We’re not going to make it go away. That is a different trajectory that we work on over a longer curve. This would be something that we did as an immediate triage to make sure that anyone that’s caught in this cycle of addiction actually has a chance to survive if they run into harm’s way.

That is our thinking. I’m just going to stop there, probably — I know we’ve got six minutes or so left — and maybe turn it over to my colleague here to say a few things from his perspective. Then we’ll entertain any questions you guys have.

Again, we’ve come here prepared to help in any way we can. We recognize it’s a problem, and we want to get this right.

Grant, over to you, maybe, for a few words.

G. McMillan: Thanks, Dave.

I just wanted to add a caveat. I don’t know the full range of what the committee has done or what they plan to do.

[1:15 p.m.]

I come at it from the point of view of process. Having run a number of projects like this, including an addiction project back in the ’80s, which was a while ago, I think the important things are, first of all, to define the scope of the problem that you’re trying to solve, if you haven’t already done so. Put as many numbers to the problem as you can. That is, use data to help yourselves understand what the problem is and also understand how you can measure the success of your initiatives.

Second, I would recommend that you research what’s being done in other jurisdictions, if you have not already done so. I think you should look at what has worked and what has not worked within other jurisdictions. By that, I mean, if you haven’t already done it, travel to the jurisdictions. Do it in person, not over the phone or virtually, because I believe you’ll get far more accurate and open information by going to the jurisdictions. Telephone conversations and online discussions for this kind of research…. I think you’d get much better results person to person.

You can also evaluate what has been done in other places, from the point of view of what may or may not work in B.C., given whatever conditions may be different between British Columbia and the other jurisdictions.

I’m not sure, again, what you’ve done. But I would establish criteria for measuring the effectiveness of the program that you’re undertaking — before, during and after a span of two to five years. Other jurisdictions may also have criteria that could be used.

I recommend using impartial researchers — not people or organizations that have a vested interest in what you’re doing. Some people work within the industry and see it as an ongoing event, and I think you’re better off working with more impartial research resources.

Finally, I’d suggest, if you don’t already have it, to put in place a project management system similar to the Gantt chart that lets you track time and events. Otherwise, in my experience, projects tend to dissipate, and you tend to lose initiative and momentum. I don’t think you want to do that. Again, those are general ideas.

One final idea is…. I would recommend that whatever you’re doing and whatever the outcomes might be, one of them should be a campaign that explicitly shows the dangers of using street drugs. It should be as explicit as possible, because media research has shown that of those media projects — television, film and even radio — the ones that show the harmful impacts most graphically are the ones that are most effective. So I would recommend you think of that down the road, once you have one or more of your programs in place.

That’s what I have. I can expand, if you wish, on questions. But those are the basics. I may be telling you things you already know, but just in case.

N. Sharma (Chair): Okay, I’ll just manage the…. You have two more minutes left. Is there anything else that either of you wanted to say?

D. Baspaly: I think we can turn it over to questions. You’ll probably pick up some of our responses in our answers.

N. Sharma (Chair): Okay.

Go ahead, Susie.

S. Chant: Thank you for your presentation. You’re right. We have had other folks talking to us about the concerns in the construction industry.

I’ve got two questions. One is very straightforward, which is: what are the components of a Gantt chart? It’s something I should probably look up, but I’m just going to be bad and ask.

Secondly, one of the things that was said to me by somebody in the construction industry was that — I’m way out of my league here, so bear with me — various employers do testing for cannabis specifically, urine tests, etc. The impact of that, the unexpected result of that is that people are going to things outside of cannabis which you can’t test for in urine tests.

What would happen if we took testing out of the equation?

D. Baspaly: Well, let’s start with the Gantt chart, Grant. Why don’t you explain that, and then I’ll go into the other piece.

G. McMillan: Basically, it’s a project management system that was developed decades ago and is still probably, in my opinion, one of the best. What it does is it gives a time frame for the entire project.

[1:20 p.m.]

It breaks it down into deliverable results within other, shorter time frames so that as you’re tracking your project with maybe two or three or a dozen researchers or initiatives, you can look at that chart and get a sense of whether you’re achieving what you were expecting to achieve by, say, November of 2022 and whether or not you are then in a position to achieve the next milestone within the Gantt chart. That’s a very simplified version of it.

Actually, Wikipedia has some excellent descriptions of Gantt charts, and you can also download some of these charts from there.

S. Chant: Thank you so much. I think I have been exposed to them. I just don’t think I knew their name.

D. Baspaly: The one asset this committee has…. If you decide to make a recommendation where construction would be the logical partners, we are the best at logistics. We do this for a living. We can put up bridges that cross rivers, skyscrapers that reach the skies. So when you talk about even a crisis like an opioid crisis, distribution of kits or distribution of information, we’re a special sector to use. We just don’t have…. We need the partnership with the health side and the addictions side to really have the resources in hand to really use the logistical networks that we have to do that.

Grant is giving you some of the things that we do on a daily basis to make sure we hit targets and timelines, etc. Social issues are more challenging, obviously, because they have a lot of variables to them. But if we knew what we were trying to do specifically…. You’re talking about the best in the world for execution of getting this stuff out and doing it right. There’s probably nobody better that can do that. So I just want to leave you with that piece.

Your second question about testing is a tough one, because it’s…. There are the civil liberties in this situation. We have good experiences from camps. We’ve got experience from circumstances around testing, as well, where it’s gone well. It can cause an unintended consequence sometimes. When you’re trying to test for one thing, you bump people into another experience.

But the other side of it, too, is even if we did testing perfectly and made it mandatory for all our workforce, we’d still end up with a problem of people using between their cycles out of camps, using recreationally on the weekend. These are smart people who, if they have the problem, can manage their addiction. What that means is, over a weekend, they know that it’s out of their bloodstream by Monday, when they go back to work, so they’re going to get away with using.

Our position as a sector on this is that we just want to get people out of that cycle. We don’t want them using recreationally. We had developed kind of a hierarchy where it was about triage first. Let’s have no more of our young people dying, our workforce dying. Let’s make that number one. Then let’s work on medium- and long-term solutions from there about what we can do to actually change the circumstances around why people are using and what the issues are. Those become far more complex.

I mentioned pain management. This is a workforce that’s very tactile with picking up lumber, walking it across steel I-beams and stuff like this. Soft-tissue injuries happen all the time. You know, a 55-year-old doing the same repetitive jobs around a worksite and working is going to end up with these issues. They want to manage that, and their doctors will give them painkillers, typically, as the circumstances…. Most of the…. Unfortunately, it is the solution. They very rarely get rehab or breaks for long periods of time to rest those muscles. So you end up with a circumstance where people start to self-manage.

When we start down that road, it’s all for the right reasons. But what ends up happening is that we get into impairment, which is dangerous on worksites in any form, where people are actually trying to manage pain but trying to still go to work. The second thing is that we start the pathway down to addiction of a very addictive substance that…. Nobody is a hero in this world. If you start down that road, you’re going to end up in that space.

Lastly, I’ll say that this topic was raised at Whistler, when there was a symposium about that. They did something different with the symposium. They asked everybody, on their phones, to type in what the top three things were that they were facing from this pandemic that they’ve been through. It was anonymized. It was just pushed up on the screen so everybody could see it.

In the room of colleagues that you would think would be professional managers, workers, CEOs, everything else, a good one-third of that room had things in there about drugs and alcohol and problems they’d had throughout COVID. It was actually shocking to see that we cope with these once-in-a-lifetime circumstances and other situations sometimes by doing things like self-medicating or trying to distract ourselves from those things that are pushing on us. So it’s a real issue.

I don’t have an answer for you around testing. It’s so nuanced in how it could be effective or work that it would have to be contextual to what we’re trying to solve.

[1:25 p.m.]

As Grant said, we really need to be clear with a complex issue like this. What are our goals? What are we fighting for? I’m sure this committee would agree that number one is keeping people alive and then starting a longer-term process of getting people away from opioids and making better choices.

R. Leonard: I hope you’re not boiling in that car.

D. Baspaly: The irony is that I’ve got about six construction sites around me. You can hear saws and jackhammers all around us right now, because this has been a crazy time for construction right now from an economic perspective. But over to you.

R. Leonard: Your organization represents the construction industry from the employer side, if I’ve got that right. I’m curious about the relationship you have with the trades in that conversation.

I also wanted to ask…. We’ve heard a lot from people who use substances who can function. The question was raised about the fear that if you’re known to be using drugs, then you’re off the work site — and the ability to perhaps change the culture so that it is more about testing the impairment, if they’re able to function safely. As you say, it’s all about safety.

I’m just wondering where the conversation has gone with your industry on that.

D. Baspaly: We’re going to come at it from a couple of points here. The first is that…. You asked about the relationship with the trades and the labour side of the issue. Yes, we do represent the employer side, but we feel, on the employer side, that our workers are our strongest asset in any of our companies now, so we are integrated. We believe in it being one thing.

With our labour colleagues, we will be on the side of certain issues where we talk about different things. But on issues of asbestos, opioids or any kind of safety issues, we almost invariably are all united in trying to solve it together. That should give you comfort as a committee. Without even knowing what labour has said before you, I’m sure that some of that’s starting to line up with what we’re talking about.

We also are pragmatic as an industry. I think that when we look at putting people in harm’s way, we recognize very much that harm reduction is a situation we want to do. We don’t want anybody to be stigmatized, go underground and then end up with a statistic. An unfortunate devastation is it’s not just the one individual. We learned from some of the testimonials that this actually rips through a community in most cases. One death can just be horrific to a work crew, to the families impacted and everything else. This is not just a statistic on a piece of paper. This is actually horrendous for B.C. — period.

The other piece that I will make is about some form of tolerance to allowing people to function while they may be using substances. Labour and ourselves — we recognize the pragmatic side, but we also have to take a zero-tolerance on that, because the nature of our industry is very dangerous. I mean, the one thing that we do inherently is we build very complex structures and buildings, where there is an inherent form of danger in almost every turn. We need people to be on the top of their game when they walk on those work sites.

That’s where the abstinence model comes from. It’s not for any other reason. If we know that somebody’s even taking prescription medication, in that circumstance, that causes some form of poor judgment or just interferes with their instincts, we could be putting that individual in tremendous harm’s way. That’s why the sector — and I believe it’s top to bottom — would argue that we don’t want that mixed with anyone out in the field, because we really are just finding a different way to maybe hurt somebody in that environment.

That doesn’t mean we can’t be compassionate as industry and try different things that we know work in other areas. We talked about interventions that take place in the Downtown Eastside or in other sectors. We know the harm reduction model works. We do want to make sure that people are set up for success. We know that when people are using, they’re not making great judgments and they’re not really looking for support.

As a sector, one of the studies we looked at was actually the U.S. Army and addiction in the armed forces. It was quite interesting. The same theory that was involved in it about “protect your brother or sister….” People, especially young males, tend to existentialize their risk. “It never happened to me. I’ll always be fine. It’ll be somebody else that gets hurt.”

Where the pivot point is, is the campaigns that were successful there — “make sure everybody goes home safe around you.” What that allowed, in the armed forces, people to do…. People were now vigilant, as a responsibility that they needed to take to make sure that their brother or sister….

[1:30 p.m.]

If they were off site, on site, at work or off work, they always had a responsibility to make sure everybody was safe. It created a culture, and the culture did result in a reduction of incidents that were taken…. More often than not, that person didn’t walk out of the restaurant or the party and go to their car or sneak around to some private place. Somebody would walk out with them and make sure that they were okay.

If we can create something in our construction sector where the same bravado is brought out, where you don’t need rugged individuals that are hiding this, where we know we’re working as a team, we’re working to make sure everybody is safe, and we’re recognizing this social ill, not a stigmatizing problem that somebody can be pinned to the wall for, we’re going to end up with solutions that are, I think, working in the right space here.

The employer’s responsibility in this, in my mind, is to do everything possible to remove all the barriers. So when we talk about access to information, it should be effortless. It shouldn’t be ten clicks on a website to find it. It should be pushed into the space. We talk about posters and things that I know seem archaic now in the COVID world, but they really did work on the shop floor. It did work when you knew that you could just phone one number and talk to somebody if you’re having problems and you’re running into issues.

We know addiction isn’t one thing. It usually is a whole series of things that have culminated into a circumstance, and people need mental health treatment and other forms of support in that situation. So those kinds of strategies really do work. But the other thing is really maybe tapping into this colleague-supporting-colleague team approach to making sure everybody is safe on and off the worksite. I think it really goes a long way to doing it.

Then the last thing I would say, to Grant’s point about process, is: let’s handle this like it was a project. That’s where the construction sector really wants to take its A game and participate in such a way: it’s to make sure that the fail-safes, like the naloxone kits, are only a hand’s reach away, that they’re not sitting in some warehouse somewhere, gathering dust, when they could be out and actually making a difference in saving lives.

That’s where we really think that there would be a value: saturate our sector, and watch the statistics fall. At least people will be trained on those kits and know how to use them. Inevitably, our hypothesis is that you’re going to drop those numbers dramatically, because the solution will be in the hands of people that can help.

P. Alexis: A comment first, and then a question. We have learned, because we’ve been at this for weeks now, that young people, in particular, are not afraid of the drug, and that we have to come up with something else other than…. I think it was Gary that talked about showing them what could happen. That’s a really tricky one, because that’s not working, necessarily. We’re really hearing that they are fearless, so that’s frightening. I just wanted to put that in.

A question for you. I have 40 percent of the workforce that I represent that are in the trades, so this is a huge deal for us. It has hit every cultural community as well. What are you doing to reach people from different cultures in construction who…? I hear from friends and colleagues that sometimes it’s almost normalized, the use to complete the workday. “Equated to caffeine,” I’ve heard in some cases.

Can you tell me a little bit about that?

D. Baspaly: Another couple of good things. First of all, these individuals at the low end of that demographic spectrum are invincible. You’re not going to convince them otherwise. They really do…. They’re the ones that will…. They’re like our firefighters and our first responders. They’re the first in, the first to pick up a big load, try anything they can. There are things we like about that, but in addiction, it backfires. It’s become something where they don’t know what they’re really getting into, and no amount of education and telling them, necessarily, is going to change that.

What we have found works is strategies of support, of proper information before they find it on the streets from people that are giving them the bad information. Alternate pathways. In other words, if you have pain or you’re struggling, ways to channel that into the medical system as opposed to onto the streets.

Again, it’s a form of pragmatics to how we actually work through that to get to the right answer there, because there are so many different experiences of their journey, how they get there. But again, the Scared Straight program is another example that everybody held up that if we just scare the hell out of them, they won’t do it. Well, that’s been proven wrong when we look at the follow-up studies on that years later. People just would walk through those tours, would be aghast, and then they would turn back, and they would go: “Oh, it’s not me. It would never happen to me. I’d never do it that way.”

[1:35 p.m.]

We’ve got a similar effect here. We’ve got to find different ways to get at people and pull them in different ways, as opposed to telling them they’re not who they think they are.

Here’s a model that actually could be quite helpful. In the old days, in the trades, we used to have what we called the senior tradesmen and women. They would stand up, and they were revered as the sort of knowledge-keepers, experts in this industry. If you were good enough, you would know it, because you would be told by these individuals that you’d made it. It was a big deal. It was sort of like your university degree in the trades.

Those individuals carry tremendous influence on a worksite. They were also sometimes the worst gateways into the bad behaviour. But we worked really hard to try to make sure we changed this over time, so pushing into the space of getting our most experienced hands on deck telling the young ones: “This is how what road you’re going down — where the danger is.”

Nobody is going to…. I’ve been at events where we’ve all cried. I’ve watched these guys cry, because they bleed for their crews. They bleed for the new journeymen — the trades and apprentices that are there that they see as the future of the industry. There’s a proud industry in B.C. So when we see that happening, we could really tap into that and get people to support.

This is a very human issue. This is not something that…. If we force it into the shadows, it will get worse. If we bring it into the light and we let people that are well respected on our jobsites intervene, that’s where we start to bend and make a difference.

Our employers have a responsibility to help create the form around that. We can have what I would consider to be…. Create spaces where…. Before work starts, a toolbox talk. Let’s take an extra 20 minutes to have a conversation about anybody. Close the door, and let the workers talk to themselves about this stuff.

That’s how the employer can be a supporter here. Let’s make sure and listen to the joint health and safety committees and some of the other ones, which may be able to tap into some of this information to go to the right place.

I believe that…. You know, I can see your heads moving up and down. This is where we get intuitive about how to make this solution. It’s just not going to be more information pushed out. It’s not going to be scare tactics. It’s going to have to be everybody recognizing that this is a health issue that’s gotten….

It’s probably worse in the death toll now than the COVID crisis, given how it’s been sort of happening across the province, in all demographics, in all sectors, in places we never thought we’d ever see it. So we have a responsibility to bring it into our sector and actually take it as a team approach from all places in there. That’s what I would say on that.

I look forward to…. Actually, I don’t even look forward to it. I think we are doing it already — the trades, the Fed, the employers. Given some support by government to do a few moves here…. And this is where it would take government, because I don’t think the sector itself has the access to the naloxone kits. Maybe even the political will to really aggressively work this space and say, “We are not going to tolerate one more worker dying in construction,” and make it more than a campaign — make it, actually, a seismic shift.

I think we can actually not only move the needle down but really make a remarkable difference here. But what we’ve been mired in — and I want to put this to the committee, so that you’re aware of it — is that when we’ve made asks, we’ve put it in a proposal. When we submitted the proposal, the proposal has sat and hasn’t gone anywhere. Every day our sector watches the tally of individuals that don’t make it to see the next day. We know, again, what that means. So does everybody else.

We’ve got to get the red tape and the bureaucracy out of here and really get to a place where we’re actually doing some of these solutions. Like I said, you’re never going to get it perfect. Pick two or three things we can do together, that you can make a recommendation on, and you’ve got construction as a willing partner at all levels that’s going to be willing to support the solution-making and inevitably, hopefully, change the circumstances.

S. Bond (Deputy Chair): Thank you very much. I appreciate the comments and the work that’s been done to date.

We do know a few things. We know that…. You know, people characterize the opioid crisis in certain ways, and many people think that it’s the Downtown Eastside, or it’s other communities with downtowns, those kinds of things. We know the majority of people dying, or many of them, are men in a particular age category that use alone. As you said, very correctly, you have a workforce that fits that demographic.

We also know that we’ve heard from others that have presented that people are afraid to admit that they’re using because they may lose their jobs. So they use alone, which leads to the ultimate issue.

[1:40 p.m.]

You’ve had a symposium. We’ve heard from a variety of groups. What are the next steps for this sector to step it up and together, look at what best practice is? This is a target group, and while we, as a committee, have work to do to work with government and they’ve called the committee, in my humble opinion, there needs to be an industry-led approach to this. You can’t mandate that from on high in government.

Is there an ongoing initiative that says: “We have a problem on our hands. We need to figure out how to deal with this in our industry”? Are there best practices in other jurisdictions that construction is looking at? I guess I just…. I’m hoping that there is some sort of ongoing, focused, targeted effort by the construction industry.

I know that, for example, some regional groups have hired people to come and be advisers and work regionally and those kinds of things. But this is a cross-sectoral issue. So can you just give us some sense of confidence that there is a recognition of the magnitude of the problem that the demographic fits, tragically — some of the worst outcomes? What specifically is the industry doing together to address the concerns?

D. Baspaly: Those are really good words. It’s good to see you again, personally. I haven’t seen you since one of our ICBA events.

S. Bond (Deputy Chair): There we go. I hope you’re going to…. You’re starting to get a sheen on your face, so just make sure you open the window soon.

D. Baspaly: It does get us passionate, I tell you.

You’ve got a good command of the issue. I think the committee understands it well. The only other thing that I would add in from a demographic standpoint, before I get to your question, is that we’re also a small…. Construction seems mammoth — billions of dollars changing hands and all of these skyscrapers you see on a daily basis and bridges and tunnels we build. But what you need to see also is the small crews in a van. Microcosms, small businesses — most of our sector is small. That’s how these things get further fragmented down, smaller and smaller, until it’s one person using alone in an alley or at home.

So that’s the other side. We have an inherent nature of small cohorts of groups. Whether they be your drywallers that come in twos and threes, your framers, working on a crew of four…. If you get my sense, that’s one piece I would add to your demographics that makes us a little bit different than your general society out there.

Now, do we get the magnitude of it? I would say: “Hell yes.” You know what is staggering? I’ve been to so many events, virtually and in person, where people have broken down over this issue. Like, these are strong people who don’t like to share their feelings broken right down to their knees on how sad and traumatic this is to everybody that works there — the individual, the family, the friendships, the community that these people live in. It’s just it’s ripping through everything, and it spills far beyond our sector in terms of its devastation to B.C. society and to our economy. I mean this is just a nightmare altogether. So we get it.

I’d say we get it at all levels. Owners of companies understand they have a responsibility here, right down to the foremen, shop foremen that are on the floors and the people who are heading crews. Even the workers know that there’s a sense of what’s acceptable, what’s not acceptable.

A greater recognition, universally, is that this is a social disease. This is not a stigmatized circumstance. Maybe 20 years ago, we looked at people who were doing drugs as: “You’ve got a problem.” Now we’re talking about, “We need to help you find solutions,” because this has happened to people outside of all walks of life now these days.

What we’re doing about it was the last part of your question. When the associations came together with the trades, and we had conversations about what we could do together, this conversation happened very similarly to what your process is today. We tried to…. First of all, you come in hand with what you think would be simple answers to complex questions, and then, very shortly after that, you’ve filled an entire wall of solutions and really dug into this problem. It’s highly complex.

Everybody’s journey to addiction is different, and understanding that you’re not just going to get a silver bullet and fix it is the other thing. So we need to be working at all levels in different ways to actually get things done.

The construction sector is also, as I said before, very good at handling very complex things. So if we have…. We’ve put these recommendations, I should say, into a report. Vicki from Fraser Health, I think, had that information, and we put it into a proposal — what we thought the first step would be — to the Ministry of Addictions.

[1:45 p.m.]

The idea was: let’s start with stopping the bleed — the people that were dying in this crisis. Stop that, and then work the longer-term solutions through everybody working to provide information exchanges, buddy programs, different exposure and different tactics.

Where the sticking point is — if I was asked, Shirley — in this circumstance is the fact that we all started at once. So you had some regional efforts that were taking place. You had some major associations like the B.C. Construction Safety Alliance. ICBA, actually, has been pretty good. B.C. Construction has been good. All starting small programs, because the inertia of it being a big, coordinated initiative was stalled, mainly because the first step that we wanted to take as a sector was to get the naloxone kits in place.

We saw, in our minds, pallets of naloxone kits arriving at the various associations and trades and using those as hubs to dispense them out to all workers so that we actually flooded the system with them. Then we would run, concurrently, a study beside it to see if we actually dropped the number of fatalities that were connected with it. We really, strongly believed, all of us, that that would be a good first step.

Since that didn’t happen, people went to their own solutions within these various things, so it’s very fragmented right now. One of the recommendations that the committee could make that I think would be very empowering is to say that the recommendations the construction sector has, lined up with the ministry and lined up with, maybe, the health authorities, coming together and being told to play nice and to implement the recommendations, not just talk about them…. I think we would actually see something within a very short period of time, because people are ready to act.

Again, the last thing I’ll leave you with is the construction sector is about action. We just want to…. Give us the nail; we’ll hit it with a hammer. I mean, we want to get in there and start actually doing some things to make a difference. Information and portals and these kinds of things are great, but hived off into their isolation, they’re not as effective as a coordinated full, all-hands-on-deck approach, as you can imagine, with the whole sector, health authorities and ministries working in the same place.

D. Routley: Thanks very much. I’m really, super encouraged by you and the message that you’re bringing. I think it’s really what needs to be heard in the industry.

My own experience with joint health and safety committees in industrial sites is that they’re a really excellent mechanism because they’re outside of the usual push-pull of union or labour and management. Even during labour disputes, they continue to function in a positive way. So I really would like us to somehow find a way to duplicate that for unorganized workers.

You referred to this fragmented nature of the sector. “I work for framers, and I work for an electrician uncle, and I work for….” All these different people — painters and all these different crews — some qualified a lot more than others, but still doing contract work and bigger jobs and coming into those bigger settings without any of those kinds of supports.

How do you…? You’ve addressed it somewhat already, but how do you see extending that form, that structure of support to the smaller contractors, some of whom, the employers themselves, have the same exact problem.

D. Baspaly: Well, first let me acknowledge that suit you’re wearing. That is fantastic.

D. Routley: Thank you.

D. Baspaly: I’ve never seen anything like that. It’s very Canadian. I like it.

I’m going to go first, and then I’ll let Grant maybe colour in the lines here too.

How we extend what we’re doing to this fragmentation, is the question. Well, we have a lot of the infrastructure in place to do that already.

Because it’s handy, Independent Contractors and Business Association represents the independents. So does B.C. Construction, to a degree. They have reach through their programming down to these man-in-a-van circumstances where you have the small crews and these kinds of things.

A lot of the programming is gold standard. We run health and safety programs in all of our associations, from the road builders to the home builders to these big associations, that reach into those organizations. I can’t forget the trades. They do fantastic training and support too. So we’re getting in through all of those things.

The question is: how do you marshal it all at once? What I would argue is that that’s where we have to have the vision that’s beyond the individual association. We need to work as a sector. We need to work beyond the sector with the health authority and the government to say: “This is no longer acceptable. We are going to get this solved.” It’s going to have be like our moonshot.

[1:50 p.m.]

We believe it’s that way. You already have the infrastructure to do it within our side, as long as we can we can get the knowledge and expertise from the health authorities and the addiction specialists. Social services, too, would be involved in there. I think you’d also be bringing in mental health, for sure. We have issues, I think, across society right now from the pandemic, predominantly in those same demographics.

Then, of course, government, to really set the stage and make the expectation that government’s here to support, normally with safety initiatives and things, sometimes with some investment and some leadership to make sure that we actually go somewhere and do something.

That’s how I feel it needs to happen. I really do believe that you’ve got…. You’ve primed the pump. Everybody wants to act. The question is: who goes first? I hate those situations, because every day somebody dies. We don’t need that anymore, as this committee already knows.

Grant, over to you, maybe, for some thoughts.

G. McMillan: I understand the challenge before the committee. I just have a question for someone within the committee. That is whether your end result would be a report that recommends various ministries do various things or whether your report would turn it back to industry and recommend that industry do certain things. I’m just not clear on the relationship between where you’re headed and where industry is currently.

N. Sharma (Chair): Maybe I can take a stab at answering that.

We are a committee of the Legislature that’s cross-party. We have terms of reference that were set out by the Legislature itself. They set out different areas that we’re meant to explore and to learn from people like you about how we can address the deaths and the toxic supply of drugs.

At some point, we’ll be issuing a report with recommendations. At this stage, it’s up to the committee how broadly we want…. Obviously, our tools are to recommend to government, but we may comment on how we see recommendations to other sectors that are not directly in our purview as a government.

We are at the stage right now where we’re listening to and learning from as many people as we can, and that’s been a really broad range of front-line workers to specific industries. At some stage, we will have those recommendations come out.

Does that help with the question?

G. McMillan: I really would encourage you to look at what’s being done elsewhere and how successful it is. I think looking outward and talking with people directly will give you a lot more information than what you currently have.

I think the outreach you’ve done to industry here with construction and others is excellent. I also think there are other jurisdictions within Canada and within the United States that are facing the same issues. You read about it every day in the paper. Some of them may be more successful than others in solving the range of problems here.

It’s not just one step. It’s the drugs themselves, how they’re managed, how they’re distributed or sold or given away, how the treatment process works or what other tools are in place. All of those things…. Many of them have been tried in other jurisdictions, some of them successfully, some not.

I’d encourage you to actively look outward and actively meet people. Send one or two people from your team to identify jurisdictions in, maybe, Ontario, Quebec and Nova Scotia. Look at what’s going on in California. Look at what’s going on in other major states. Try and figure out how you can really learn from other people’s successes as well as their mistakes. That’s my major recommendation to where you could go from here.

N. Sharma (Chair): Yeah, thanks for that. We will be doing that. We’ve been reaching out to other jurisdictions to learn as well.

M. Starchuk: Grant and Dave, thank you for your presentation.

Dave, I really like the fact that you’re talking about something that’s a lot more simple than 12 clicks to find out where the information is that’s there — and actually having it up on a wall, where it’s easily accessible. I make the assumption that it’s up on a wall in areas where people might be alone, in certain places. If there’s any way to contemplate it, it’s at their fingertips.

My question is a lot simpler. When and if you get a naloxone kit in everyone’s hands, is there some documentation that goes to the address to let everybody else in the household know that this is coming home and it’s going to be in the household?

[1:55 p.m.]

D. Baspaly: Thanks for that question, first of all.

Here’s what I think around the naloxone kits. You have to understand…. Many of you, early in your careers, may have had some exposure to the construction sector too. You know what it’s like. It’s a beer after work on a Friday. It’s a culture, a family affair, in most cases. That’s where you get the situations.

Indeed, yes, posters up on walls, ways to do it. The naloxone kits go further than that. We’ve had a number of actual examples of where people weren’t even trained on the kits and saved lives. I’ve got two or three examples I could share with the committee right now, but we’d be here for 20 minutes if I told stories out of school.

One of the particular stories was…. A guy was off work. He still had his hardhat with him. He was in the back alley of the guy’s house. He’s a senior member…. He used to be, actually, a board member for WorkSafe.

He ran out with his naloxone kit. He’d happened to have attended a session two days before and had just brought it home and left it on the counter. He grabbed that kit and, without even reading it, even though the instructions are fairly clear on the box, no real training around it, just stabbed the individual. There’s probably a better way to say it than “stabbed.” He put the needle into the individual and saved his life. When the medics came, they were like: “If you hadn’t put it in, he was certain to die. It doesn’t matter. You didn’t do it perfectly, but you did it well enough.”

As a construction sector…. If you think about the idea of saturating the sector with these kits so that they’re only an arm’s length away, in a truck, in a van, at home, in an apartment…. They’re just around, and they’re familiar enough to people that they’re no longer stigmatized to see the kit, number one. So people go: “What’s that? Why is that here?” “Oh, we all got them at work.”

Number two, we all want to protect each other. We want to make sure we’re doing this. We’re going to party together. We’re going to work hard together. We’re going to do all this stuff. That kit is always right there. Somebody is going to have it in hand, close enough to get it into the arm of somebody if they need to actually protect them.

We started to talk about this. We workshopped it with some of the actual users that were former…. They were anonymized, and they were telling us their stories. They said: “You know what? That’s the problem. When we would use, we wouldn’t be close enough to naloxone kits to physically get to them when we needed them in those circumstances.”

We thought, from a triage point of view, if we want to stop just the sheer death toll that’s happening right now…. If it costs a couple of million dollars to put these kits into every hand….

Now, they last a year and a half to two years before they need to be replaced. So there are some complexities on the back end — to make sure that kits are, for example, restocked. We do need to do some education. You don’t want them going out there…. From a systemwide perspective, if we did an all-hands-on-deck toolbox talk, where everywhere they were, they were being used on that….

It also removes the stigma of the kits themselves because they know everybody just got them. It wouldn’t be foreign to see one in a truck or at a party or these things. What you’ve done is effectively taken your best mitigating measure and put it right at ground zero where the issue is happening.

Again, that’s our hypothesis here. I can’t tell you that it has been done like that in any other sectors, but I can tell you, from all of the feedback we’ve gotten from people, that if we were able to do it at that quantum, you would see a precipitous drop in the deaths. There’d be interventions all over the system, in all kinds of different contexts. At least, that’s the hypothesis.

That doesn’t mean the work stops there, guys. This isn’t the silver bullet. This is just stopping the time of the death. The rest of the initiatives this committee is picking up on are going to have be implemented in concert — and Grant’s ideas about reaching out to other sectors to see how they’re doing in the long game and the medium-term game. Just a sheer stop to the death toll…. That’s what we’re suggesting as a sector — to work as a team to just get that so that we can actually work on the longer-term problems.

I hope I answered your question on that one.

N. Sharma (Chair): Okay. So I get the final question here. I just wanted to start by saying thank you for coming here and talking about how important you see this issue as in your sector.

Certainly, I speak for myself — and, maybe, my colleagues. When we heard the presentation of the statistics in the construction sector, it was very shocking and very sad — the number of not only deaths but also of the people that are using and are experiencing mental health challenges or pain. I can certainly see that that’s something you need to be pretty tasked with, in terms of the people that work in the sector.

I had a question about if you’ve heard of the Lifeguard App and the fact that it…. I can see that the naloxone kit is part of the strategy, and you’ve articulated it. The idea of using alone and the idea that the Lifeguard App might be able to save a life…. Is that something that you’re able to promote to people in your workforce now and that is available to, potentially, save lives? I guess that’s the one question.

[2:00 p.m.]

The other is, in a sense…. If it’s a bigger one, we won’t have time to get into it. But I was just really curious about your thoughts on harm reduction and how it shows up in the workforce, just because keeping people alive is what we’ve heard — to actually get them to get the treatment and all those things.

We were learning from…. I can’t remember the full name of the organization, but the one on the trade side that actually supports workers that need mental health support or pain support and all those things and how amazingly under-resourced they are to face the challenges that they face. So I just was curious about a comment on that as well.

D. Baspaly: Well, I’ll start, Grant. Maybe you can finish it up.

I understand that the committee’s time is precious. I’ll say a few things. The Lifeguard App is fantastic. It’s a good app. Implemented correctly and introduced correctly, it is going to save lives. Let’s underscore that. I really wanted to harp on the naloxone kits, because I really do believe that as a consensus of that symposium we talked about, we really came away with that being an intervention we felt would slow the death rate down. That’s basically…. The Lifeguard App will do the same.

It’s already being implemented. It’s being pushed out regionally and through the major associations and through the trades. It’s already starting to hit the ground in different places, so I look forward to seeing what that actually does. Again, we should be concurrently running some research beside this, even if it’s just action-oriented research, to get a sense of what’s working and we know it works.

I think we can make two different things from that from the committee’s point of view. One, we’ll be able to learn what works and what doesn’t work, where our investments should go, but also where we should put our political will and leadership into what’s going to actually make a difference. So research is going to be critical as we implement some of these things and put them out there. I know the construction sector is looking at doing some of these things in tracking some of the use of it — anonymized, of course — to try to find out how it’s affecting the population and making a difference.

The second thing I want to say is that I just want to…. As a word to the committee itself, you guys are at the right time in the right place right now to do something remarkable, which is give a recommendation to our industry that shows government support for the outcomes.

Complexity won’t work. If we get 450 things we need to implement, I can tell you we won’t do a very good job of it. If you get three or four big objectives or stage them, we will get the job done, and we’ll do it right. That’s a big thing to know, because sometimes these reports are so obtuse that they can’t be actioned.

Right now in the circumstances, we need more than talk, and you’ve heard this from everybody who has come to talk to you. We actually need simple things to do that are going to make an immediate impact on those numbers. We can worry about the other pieces concurrently and over time, but people are dying every day. So the faster the committee can come up with its recommendations and say, “We want to do this, that and this other thing,” the faster we can get that to ground and the faster we’ll actually start seeing the difference in B.C.

That’s the heavy responsibility and burden the committee has, because at the sector level, we can only do what we can do about raising awareness of the resources within our sphere of influence that can do it. It needs to be bigger than that. That’s the one thing we learned when we came together, and that’s why labour and the employer have come together on this issue. We believe it’s a shared responsibility and how we find the answer. I think you’re the natural next piece that basically reminds everybody that this has got to be bigger than that.

Those will be my closing remarks. I just want to really thank the committee for doing this important work, because it’s the quiet disaster that’s taking place around us. We’ve been through floods, COVID, every other disaster, but this one has always been with us, and it’s become so neutralized out there that people don’t think of it as something. They just….

If you haven’t been down to the Downtown Eastside, I would suggest you drive through there now, because a lot of the individuals that have been not served well during this pandemic have all ended up in a real visible place like that, where you can see the net effect of addiction when it goes its full course. They’ve taken all over the streets down there, which just goes to show that we’ve got so much work to do. But we’ve got to start somewhere and make a difference.

So I just, again, applaud the committee for getting into this space. I really hope that you come to an answer quickly and recommendations so that we can actually implement something and save some lives.

Grant, over to you.

G. McMillan: Well, basically, I’m echoing what you said, Dave.

I think it’s critical that the study, the research, be comprehensive, that it understand the complexities of the problem, but that at the end, out of the funnel, comes three or four solutions that people can understand and implement, because too often royal commissions and commission reports can come out as complex as they went in, and people don’t have anything that they need to do or must do.

It’s a big responsibility, but I’d urge you to take the time to be concise when you’re finishing that report. Thanks for your time.

D. Baspaly: We’ve got to add, too, that we’re your partner. Help us help…. Whatever the recommendations that come out — we’ll be with you. Thanks again for the time.

Back to you, Madam Chair.

N. Sharma (Chair): Well, on behalf of the committee, I want to thank you for your time and coming here today and helping us learn from your perspective. It has been really informative. We appreciate it. Take care.

We’ll take maybe a couple of minutes before we get our next speaker, a two-minute recess.

The committee recessed from 2:05 p.m. to 2:09 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): It’s my pleasure to welcome our next speaker here today. We have Dr. Danya Fast, research scientist from the B.C. Centre on Substance Use.

Welcome. We can all see you up on our screens here today. We’re going to do a quick round of introductions before I pass it to you. My name is Niki Sharma. I’m the MLA for Vancouver-Hastings and the Chair.

I’ll just pass it to our Deputy Chair, Shirley.

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

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

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

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

M. Starchuk: Mike Starchuk, MLA, Surrey-Cloverdale.

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

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

[2:10 p.m.]

N. Sharma (Chair): Okay. Danya, you have 15 minutes, and then we’ll have the rest of the time for discussion.

If you can hear us and see us okay, over to you.

B.C. CENTRE ON SUBSTANCE USE

D. Fast: Thank you so much for having me. Good afternoon.

I want to start, of course, by acknowledging that I’m joining you today from the unceded and occupied territories of the Coast Salish people, including the Squamish, Musqueam and Tsleil-Waututh people.

I’ll start by introducing myself beyond my institutional affiliation. I should say…. You can probably hear from my voice that I’m recovering from a pretty nasty cold. So I apologize for my scratchy voice. I’ll take a cough drop, if needed. But let me try to get through. I am a medical anthropologist by training, and I’ve been doing work with young people who use drugs in the context of unstable housing and homelessness in greater Vancouver since late 2007.

What is a medical anthropologist, you might ask? What that means is…. The kind of research that I do with young people across greater Vancouver tends to be very longitudinal and immersive in nature. I’ve done a great deal of work, what we call field work, in the places where young people are living, working, sleeping, socializing and, also, accessing services and systems.

Towards the beginning of my research career, I really focused on young people’s substance use trajectory, really tracing transitions between different substances and also modes of use among young people experiencing unstable housing and homelessness in greater Vancouver. However, since around 2016, which, of course, is the year that the overdose emergency was declared in British Columbia, my research has really shifted to focus on young people’s substance use treatment and care trajectories, again across greater Vancouver and, also, to a point, across the province.

I’ve really been closely tracking, across time and across place, young people’s movements between places like residential treatment centres, looking at how they get on to and sometimes fall off of opioid agonist therapies such as methadone and Suboxone, looking at their movements in and out of recovery houses and then, of course, also tracing their movements to all of those places that they spend time when they’re not engaging with treatment and care or when they’re actively disengaging with treatment and care. I’ve spent a lot of time in these various places doing fieldwork and speaking with, actually, hundreds of young people since late 2007.

Since 2018, my work has included a community-based participatory approach. Since that time, I’ve been working with a group of around ten to 12 young people with lived and living experience of substance use and mental health challenges in the context of unstable housing and homelessness. That youth advisory council, as they’re called, currently meets weekly and collaborates on all aspects of my research.

The two knowledge translation documents that I shared with you prior to our meeting today were authored by and with this youth advisory council. I’m really here presenting this work on behalf of my team, which includes a large number of young people with lived and living experience.

I just want to pause here to say that when I’m using that term “young people,” I’m actually referring to quite a broad age range. I’m referring to those within that age range of 14 to 18 as well as those from that age range of 19 to around 24. As my work is so longitudinal in nature, of course, I follow young people actually up into their early 30s, in some cases. So I work with a population that has a wide age range. I had, in my goals, some good representation from among those different age groups, which, of course, we know are institutionally important to look at.

Let me turn, firstly, to the report that you were sent. This is a draft report, the youth voices on treatment report, but I wanted to share it with you because I just think this is an incredible opportunity to share this work. But please note that it is a draft. We’ll be finalizing it by the end of this month, and I can redistribute it at that time if people are finding it useful.

This report emerged from my long-term research conducted across greater Vancouver, as I said. It also emerged out of shorter-term work that we did with young people who use drugs in Kelowna and Prince George.

[2:15 p.m.]

We did some focus groups with young people who use drugs in the context of unstable housing and homelessness in Kelowna and Prince George. A publication drawing on that work, the focus groups in Kelowna and Prince George, as well as my work in Vancouver, is forthcoming in the middle of this month, July 15. Again, I will pass that along, because I think that paper is just so relevant to the work of this committee.

We also held a youth-led summit in 2019. This was entirely planned by our youth advisory council and led by them, with the researchers only there as supports. The findings from that summit, which focused on responses to the overdose crisis across the province, also informed this report.

I don’t have a lot of time, and I know that you received a copy of the report. But I just want to direct everyone’s attention to the summary of recommendations, which you’ll find close to the end of the report. I think it’s the third-to-last page, or the second-to-last page in terms of the layout of the report that you received in the PDF.

The main point that I want to drive home here is that we have heard from so many young people over so many studies and over so many years that they experience a sense of ambivalence, suspicion or outright aversion towards highly medicalized models of care — whether those are being implemented in a hospital setting, in a residential treatment setting, in a recovery house or in a community health clinic. By highly medicalized models of care…. What I mean by that and the way that young people themselves characterize that is models of care that are focused first and foremost on treatment, pharmacotherapies and the sort of monitoring that goes along with those things.

Young people did not respond to those models of care in the way that we might expect but rather expressed anything ranging from ambivalence to suspicion or outright aversion towards those. The result when they were drawn into those very highly medicalized models of care was often disengagement from care — very actively avoiding care and avoiding different kinds of care teams. That includes even some of our most low-barrier and low-threshold services and teams.

Again, I don’t have a lot of time. But let me just switch from the negative to the positive and provide a brief summary of what young people were asking for. They were asking for care that centres on relationship-building, self-determination and safety. They were asking for approaches that present pharmacotherapies, such as methadone and Suboxone, and also psychopharmaceuticals, as one piece of a whole that includes housing, employment, income, social and cultural supports.

They were asking for approaches that do not privilege monitoring and surveillance, which can signal danger to young people and lead them to disengage with care, as I just said. They wanted providers to seek permission before sharing information about them with other providers. They wanted their care to focus on the present and not the past. Related to that, young people did not want to be reduced to their files and what was written there, which could often be highly negative.

Youth need to be involved as partners in developing plans and timelines for opioid agonist treatment and psychotropic medications, including pathways to tapers. I can talk about this more during the question period if there’s interest. But we have heard overwhelmingly from young people of their desire to taper off of opioid agonist therapies as well as psychotropic medications, regardless of what guidelines say.

Therefore, it is so important that providers are working with young people on this. The alternative is, as we heard from so many young people, they decide to just do it on their own, often with disastrous consequences. So this is an area where they urgently need support.

We need to provide youth who want treatment with access to the full range of opioid agonist therapies and not just Suboxone or buprenorphine-naloxone. We need to provide them with methadone as well as Kadian,or slow-release oral morphine, if that’s what they desire and that’s what works best for them, and we need to recognize that many young people prefer treatment modalities that give them more control and subject them to less surveillance.

Related to that, we have heard from so many young people over the years and across studies that they prefer, often, to use cannabis as a treatment and harm reduction strategy rather than engage with opioid agonist therapies and different psychotropic medications.

[2:20 p.m.]

Okay, so I don’t have much time. I’ve got five minutes left, so let me turn now to the second document that I distributed, which is the harm reduction calls to action.

These calls to action emerged from my community-based participatory research focused on substance use and health. This was a project, really, where university researchers were supporting the youth advisory council that I mentioned earlier as they collaborated with young drug-user activists and allies from Vancouver, as well as from Portugal and Pittsburgh, to generate these calls to action.

Let me use my remaining time to highlight a few of these. These are not all the calls, but these are the calls that I would like to highlight for the committee. I am going to read them out in young people’s words, so I’m going to use that language of “we.” But keep in mind that these are really coming from young people themselves.

“We oppose approaches to preventing drug-related harms among young people, including very young people, that are premised on abstinence. We want accurate information about the risks and benefits of different drugs and how to practise different kinds of harm reduction in our schools and communities.

“Young people’s engagement with harm reduction programs and sites should be kept confidential in order to encourage relationship- and trust-building and enduring connections to care.

“We demand investment in low-barrier, youth-dedicated and youth-led harm reduction programs and spaces, including safer consumption, drug checking, shelter and housing sites. Ideally, youth-oriented safer consumption sites should have a non-clinical or non-medical relaxed feel to them and include a welcoming drop-in space alongside private spaces for safer consumption.

“These should be places where young people who use drugs can access harm reduction supplies and information, as well as food and other basic necessities. They should be staffed by a mix of peers — that is, young people who use drugs — and providers with experience providing non-judgmental care, support and camaraderie to young people who use drugs. The focus” — again, this is a common theme — “should be on relationship-, trust- and future-building, not on damage, deficits and the past.

“Youth-oriented safer consumption, drug checking, shelter and housing programs and spaces must account for the needs of youth who use stimulants and polysubstance-using youth.”

As we know, there’s been a great deal of focus on youth who use opioids in the context of the current crisis, but the young people involved in this project really wanted to direct our attention more widely.

“They must also account for the needs of BIPOC youth, gender-diverse and queer youth, and self-identified young women.”

Here’s the next call that I would like to highlight.

“Stop pathologizing young people who use drugs and trying to save or fix us. Recognize that we have the human right to make decisions for ourselves and keep ourselves safe. We demand an end to compulsory or involuntary abstinence-based treatment programs. Instead, we want to be listened to regarding what drugs do for us socially, physically, mentally and emotionally in our daily lives.

“Youth-dedicated drop-in centres and service hubs should centre relationship- and trust-building and harm reduction, with treatments such as opioid agonist therapies easily available to those who indicate they want these. Comprehensive sexual and reproductive health services should also be available.

“When it comes to any kind of treatment, young people who use drugs should be empowered with decision-making power regarding plans and timelines.”

Again, you can see that connection to the previous report as well.

“We add our voices to those strongly cautioning against the involuntary detainment of young people who use drugs, including following an overdose event. While we recognize that those providing care to young people who use drugs are often desperate to forcibly intervene, our research and experience demonstrate that involuntary approaches can push some young people further away from life-saving care, including during those moments when they are most vulnerable.

“For example, we know of instances when a young person hesitated to call emergency services while witnessing a friend overdosing or attempted to escape from an ambulance in order to avoid detention in hospital and other kinds of repercussions.”

I’ve got one minute, so let me read this last call.

“The services and systems that young people who use drugs traverse must be redesigned to foster youths’ self-determination in relation to their drug use, harm reduction, care and families. Young people who use drugs should be represented, engaged with and empowered as citizens capable of making their own decisions.

“In our opinion, this is at the heart of what it means to practice trauma-informed and culturally safe care. Young people who use drugs who are in government care must be able to access harm reduction services without fear of discipline and repercussions, including being placed in psychiatric wards, youth detention centres and certain kinds of housing environments by social workers and teams as a last-resort attempt to fix their substance use.

[2:25 p.m.]

“These approaches are often isolating and traumatizing, leading young people to begin evading care altogether and putting them at greater risk for overdose and death.”

Thank you very much.

N. Sharma (Chair): Thank you.

Okay, we’ll go to questions.

S. Chant: I’m not sure how to phrase this without sounding my age. I am a parent. Where in this equation do parents fit? We’ve had various times that we understand that parents try to help and are not able to because of various constraints. Other times, where parents want to help and the kids want their parents to help, constraints hit in anyway. You talk about the kids being able to….

I am a parent, and I’ve been through a number of opportunities. I just wonder where parents play into this exercise, because I think we’ve had some real challenges in that area about parents wanting this for their kids, the kids having no want for that, etc., etc.

I’d just like your thoughts, please.

D. Fast: Absolutely. It’s a great question.

The first thing that I want to say is that when it comes to empowering young people with self-determination in relation to their care, if young people are saying that they want parents involved — as well as other kinds of caregivers, and there are many — they should absolutely…. That connection should be facilitated. If we’re following a young person’s lead, we should absolutely be involving and supporting parents and other kinds of caregivers when that’s something that young people are asking for. When it’s not something that young people are asking for, that is, arguably, much more difficult.

The first thing I want to say is that I work with a very specific population of young people. The young people I work with tend to be coming from very unstable and unsafe family environments, by and large, so let me start by saying that these calls are coming from that population, right? It’s a population of young people who don’t feel safe, necessarily, or comfortable involving family members — or maybe specifically parents, because that’s what your question is about.

In the case of the population that I work with, many of the parents of these young people are themselves struggling with substance use and mental health challenges. So I just want to highlight that, firstly — that these calls to action may be quite specific to this population, and we may need to think differently about young people who are in stable and secure home environments that they can return to after hospitalization, after treatment.

With this population, a question that young people are raising repeatedly is: “Okay. I go to treatment. I go on treatment. What’s next? Where do I go next?” And often for this group, it’s back to unstable housing and homelessness. So let me just present that as a caveat, because I don’t think that these calls can necessarily be applied to all young people.

But let me offer some thoughts as someone who has a sibling who has been in the situation that you described, where my family is wanting to protect my sibling and is hoping, on some level, for them to be hospitalized for a number of days so that we can recuperate and they can recuperate to sort of figure out where to come forward. Let me speak from that perspective for a moment.

My experience — and I do also work with some young people who do have supportive family and caregivers who they can return to — is that when we work against youth in these settings, whether it’s in a hospital setting or a treatment setting, and we forcibly implement some kind of a treatment plan, the result is so often that young people run away, whether that’s physically running away or that they finish the treatment program, and then they enact all of these different kinds of strategies in order to evade care and make sure that they never again end up in the ambulance, that they never again end up in treatment.

So I think that if what we want to do is connect young people with care in an enduring, lasting way, that’s where we really do have to privilege that relationship- and trust-building and really put the young person’s voice, perspectives, needs and priorities first in the context of that relationship-building. And then maybe work with the parents alongside, so that we can eventually, perhaps, come to a situation that everyone is happy with.

[2:30 p.m.]

But I worry that when we force young people to do things that their parents want them to do but they are not at all comfortable with, that ultimately what happens is that they learn, very skilfully, how to evade care, how to avoid interactions with our health care system. That, as you know, can be incredibly deadly in the current context.

We can, of course, force young people to be in hospital following an overdose event, but that’s a two-week period. If they then leave that and run away, the results can be even more devastating.

R. Leonard: Thanks for taking the time today, especially if you’re not feeling well. It’s a beautiful day, and hopefully, it’s a healing time for you.

I read the report that you referenced, the youth voices one. In there, I read that youth want a future not defined by substance use and mental health crises. I think I might have read it wrong. I’m interested in hearing what was meant by that.

In my mind, it was youth imagining a future where there was hope and aspiration and not being weighed down by substance use and mental health crises. Not having a whole lot of life lived to be able to begin to go down that path in their mind — there’s just so much yet to open up in their lives.

I’m curious about what that means and where it might lead, in terms of what they’re looking for.

D. Fast: Yeah. Thank you so much for that question. This is something that has come out, really, over the entire duration of my research, even since my earliest work in 2007, 2008 — young people talking about what many describe as these normal lives that they’re reaching for, that they’re hoping for.

The relevance of it to our discussion here today is that what many of the young people who have participated in my studies seem to be asking for and saying is that rather than focusing on mental health and substance use treatment first and then that opening up these other kinds of futures, they often see it the other way. They talk about employment and housing and different kinds of building of social relationships. They talk about all of that as coming first, and then possibly opening up possibilities for treatment.

That’s a shift in a lot of our thinking, right? We often think: “Let’s get them into the hospital first. Let’s stabilize them. Let’s get them onto opioid agonist therapy. Let’s get them onto psychotropic medications for mental health issues. Let’s do that first, and then we can open up these other possibilities.”

Young people are telling us: “I’m not going to treatment until I’ve got a job and I’ve got some money saved up, because I’ll get out of treatment, and what’s next?” Again, it’s that question: what’s next? “I won’t have money. I won’t have a place to live. I won’t have social relationships that fulfil me. I won’t have the ability to engage in leisure time.”

I really want to highlight the importance of at least working on these things concurrently, if not shifting our thinking a little bit to prioritize things like income supports and training. Of course, we know housing. I don’t think anyone is debating the importance of housing. We know that housing needs to come first, that it’s incredibly difficult to engage in treatment, whether it’s treatment for mental health or for substance use, when you’re homeless or very unstably housed. Going beyond housing, also looking at things like income supports, training, supports with schooling, supports with apprenticeships.

The other thing we heard is that young people don’t want to be on social assistance. They may be on social assistance. Many of them are. Many of them are on youth agreements. Many of them have financial support coming in. Yet what they want is employment, education, training, those kinds of things. So it’s building that into our understanding of how to address this crisis and, really, how we approach treatment and care.

[2:35 p.m.]

Again, what I will say — just to come back to the very real consequences of this — is young people told us: “I’m not going to treatment. I’m not staying at treatment until I have a job, until I have money in the bank, until I have housing that I like.”

We can open up all the beds we want, and we can facilitate tremendous access to things like opioid agonist therapies. Yet many young people are making the decision to defer treatment until they’ve met those other needs. The sorts of things that they’re reaching for that are part of what they’ve often lost is that normal life.

S. Furstenau: Thanks for the presentation and the energy. It’s great. We’ve heard a lot over the course of our meetings about drug use. It’s something that’s existed forever in societies. You’re making a very impassioned case for being honest and realistic about the landscape, especially for youth.

I’m interested. In all of your research, do you have a sense of the amount of drug use? Right now, what we’ve got — the term this morning, I think, was a really good one — is a lethal, illicit drug supply. Do we have a higher amount of drug use happening among youth now than we had in previous decades or generations, or is the main problem we’re looking at just that lethal supply?

D. Fast: Thank you for that question. I will say, because I’m a medical anthropologist and my research…. It’s added up to a lot of young people. I’ve talked to hundreds of young people within the last 15 or so years. That being said, I’m not an epidemiologist, so I don’t have those numbers that you would be looking for there.

I would agree with the characterization that it’s not necessarily that more young people are using more drugs — that the drug supply is just so incredibly toxic and lethal. That’s the reason that we’re in the crisis now.

Let me just tag onto what I said previously, in my answer to the previous question. We do know that as socioeconomic inequality deepens, issues like substance use and mental health challenges increase. That’s as I understand it, from the research, and again, I’m not an expert in the numbers. I’m much more of an expert in the stories than the numbers.

When we think about things like the COVID-19 pandemic, when we think about growing inequality in Canadian society and here in B.C., I think it’s very reasonable to assume that things have become worse for a lot of young people. Here’s what I’ll offer from more of a story perspective, which is what I do. I collect stories from young people.

When I started my work, like I was just saying, I heard, I would say, more of those narratives of that normal life that young people were reaching for. I would say that I also heard more optimism about achieving that. It seemed to me, during the first, let’s say, five or six years of my research, that young people really, genuinely believed that they would get that job, that they would get that housing, that they would get that relationship and start a family and have a dog and go hiking on the North Shore Mountains on the weekends. They really did believe that they would get that.

What I’ve noticed more recently, let’s say from 2016 onward — talking, again, to much younger folks in treatment settings and talking also to the staff in those settings — is that while young people still talk about wanting those normal lives, they are much less optimistic about getting those.

I’m hearing much more talk around: “Why would I stop using drugs?” I’m not going to get that job that I want. I’m not going to be able to have that career that I’m dreaming of. I’m not going to be able to get that housing. That’s shaped by broad, political, economic forces that are operating in society as well as things like the COVID-19 pandemic that we couldn’t have anticipated.

If you even think about the rise of Airbnb rentals…. That has depleted a lot of the housing stock that might have been rented by these young people who are looking for that entry into market rental housing, which is something that all of the young people I work with deeply desire. As the cost of living in Vancouver goes up and Airbnb rentals proliferate around the city, there are even less of these places for these young people to rent.

[2:40 p.m.]

I do hear a lot more of that. “What would I be giving this up for? Why would I give up this drug use which is giving me all of these things in the present? Why would I give that up for a future that I want but I don’t really think that I’m going to be able to achieve?”

T. Halford: I would assume, when you’re looking at youth and drug use, that it’s across the province, but a lot of it is actually, probably, starting in very small communities where youth are then relocating to Surrey, Victoria or Vancouver. So just kind of your comment on that — if you guys are seeing that as well and if it’s kind of…. Maybe there’s not enough help in some of those areas, whether it’s Prince George, Kelowna or way more remote than that.

The second thing is that I think, in previous work that I’ve seen you do, you’ve talked about the role of cannabis. If I could get a brief comment on that at the end, that would be great.

D. Fast: Great. Thank you for that. Absolutely — you’re right. The young people who I work with across greater Vancouver and specifically Surrey, New West, Richmond, to a point, actually, as well as Burnaby and then Vancouver central…. Many of those young people, the vast majority, are coming from elsewhere. They were not originally from Vancouver. And if we look at downtown Vancouver, most of those folks came, at the very least, from different suburbs or surrounding areas of the Lower Mainland but even extending further into the Interior and other parts of B.C.

Absolutely it’s the case that there are less resources in other areas, and that can be one reason why young people relocate. They know that Vancouver and Victoria and, to a lesser extent, Surrey and other places are where there are more resources for them as they’re contending with unstable housing and homelessness and looking to access harm reduction.

Does that answer your question? I feel like I’m basically agreeing with you.

T. Halford: I was just wondering: does it get worse if you relocate to Vancouver? Does it get better? Obviously, there’s probably more access. That’s kind of what I’m getting at. If you’re leaving, let’s just say, Prince George, and you’re travelling to Vancouver, is that compounding the problem, usually, for youth in that case? Or is it…?

D. Fast: Yeah. I will say that young people do often talk about their drug use intensifying when they get to Vancouver. If we think about the kinds of housing environments that are often available to young people, they tend to be places where there is some concentration of drug use and also dealing. So I think it is complicated — that trajectory.

On the one hand, moving to Vancouver can open up new kinds of social networks that can be very protective, new kinds of safety as well as engagement with services and care. We have much more coverage in Vancouver, obviously, than elsewhere. On the one hand, it can be facilitating more access to care and greater safety, and then on the other hand — absolutely — young people do talk about their substance use increasing.

The other thing that’s interesting is that I hear a lot of young people talking about going home as a way to reduce their substance use. Young people do talk about going back to Prince George or the surrounding smaller areas around there or going back to Kelowna and other areas in the Interior as a way to reduce their substance use. So there’s a lot of potential there, I think, as we increase supports across the province to see how we can support young people with their own strategies of sort of a return home as a way to pursue treatment and recovery. I think that’s really interesting.

Now, tying on to that, another one of young people’s own strategies…. Again, I’m talking about a specific population here. I’m talking about young people who are experiencing profound vulnerabilities shaped by settler colonialism, a large proportion of Indigenous young people involved in those studies, as well as other factors like very entrenched socioeconomic disadvantage across their lives.

Among this population of young people for whom unstable housing and homelessness have been a reality across their entire lives, they overwhelmingly identify cannabis as a treatment and recovery strategy as well as a harm reduction tool.

[2:45 p.m.]

I cannot convey how pervasive this is among the young people who I’ve followed over the years — using cannabis to reduce their use of fentanyl or even eliminate it; using cannabis to reduce their use of crystal methamphetamine or even to eliminate it; using cannabis, as I was talking about earlier, to taper off of opioid agonist therapies and replacing that with cannabis as a treatment strategy.

It is incredibly pervasive. Regardless of what our views are on cannabis, we need to be working with young people on this, because we’ve also heard from these young people that their cannabis use can become unmanageable. It’s an area where they want support, but they don’t want an abstinence-focused approach. That is really not going to work with this group of young people, for whom cannabis is a critical aspect of keeping themselves well and keeping themselves safe.

When we’re working with this population of young people who are using cannabis daily to keep themselves well, we need to be having conversations with them about what their use looks like, not about whether or not they should be using the things.

N. Sharma (Chair): Okay, thanks. I have a question.

I don’t think I really, clearly understand what harm reduction strategies are available to young people. We heard a little bit here and there about how at one of the opioid overdose prevention sites, they check if they’re under-age. Then, if they’re under-age, they can’t go there. Then we heard somebody say that we don’t actually want adults and kids at the same spot anyway. We heard that some of the substances or controlled substances exemptions don’t apply to under a certain age group.

Those little tidbits are things that I feel like I have floating around in my brain, but I actually don’t understand what is available to a young person, let’s say, under 18. It sounds like it’s controversial for some people. What’s available to them when it comes to OAT therapy? What do you mean by tapering off — that kind of thing? If you could help me understand all that.

D. Fast: Yes. Keep in mind that I’m not a medical doctor, so I’m by no means an expert on tapering in terms of the nuts and bolts of how that needs to happen medically. Let me just say that.

Tapering, as I’m talking about it, just refers to young people’s desires to get off of opioid agonist treatments by slowly reducing their dose. If young people are doing it themselves, if they’re on Suboxone, they might just completely fall off of it — just stop taking it — because the sort of withdrawal that accompanies that is not severe.

If it’s methadone, where the withdrawal is extremely severe, they, themselves, try to take less and less methadone. That’s kind of hard to do. You have to manipulate the daily witnessed dosing that’s happening at the pharmacy. Or what they do is just stop getting their methadone and say, “Okay. I’m going to use fentanyl, or I’m going to use down” — some form of opioids, whether that’s morphine or anything that they can access on the street. They try, themselves, to use less and less.

What we’re hearing from young people is that they employ these strategies when providers are not willing to talk to them about tapers because, as you may know, the provincial guidelines on the treatment of opioid use disorder strongly discourage tapers. Providers are simply following the guidelines. The approach is really to try to convince young people to stay on opioid agonist therapies long term. And that is, indeed, what the evidence supports. That’s when these therapies work best: when young people stay on them.

What I’ve seen overwhelmingly in my work since 2016 is that young people do not want to stay on these. They do not plan to stay on them. And if they’re not provided with support medically or, at least, conversations about the harms of a taper and how to taper safely, they do it themselves, in those ways that I just described.

That’s why it’s so important, regardless of what the evidence says, for physicians and other prescribers to be opening up conversations with young people about tapers from the outside, because when young people do these tapers, it often ends in disaster, just like the evidence shows. They end up relapsing. They end up overdosing. It’s absolutely disastrous, and young people acknowledge that. Yet they continue to do it again and again, because they do not envision themselves being on these therapies long term.

The point that I want to make with the opioid agonist therapies is that we really want to involve young people much more as partners in decision-making and have conversations with them about: “Okay. Here’s what happens if you’re going to do your own taper. Here’s how I would like to approach a taper. I’m willing to help you to taper, but here’s how I’d like to approach it, at least so that it’s safe.”

Does that clarify things with the opioid agonist therapy?

[2:50 p.m.]

N. Sharma (Chair): Yeah, it does. Thanks.

D. Fast: Okay. Let me turn now to the question around what there is for young people when it comes to harm reduction.

Obviously, this varies greatly across the province. In my experience, young people can access what we think of as harm reduction supplies. So clean syringes, tourniquets and, in some places, glass pipes for smoking. Those kinds of things are available to young people, definitely in Vancouver. Elsewhere across the province, the coverage — we certainly heard from young people in Kelowna and Prince George — is more patchy, but those things exist.

Opioid agonist therapies are sort of the same thing, I would say. By no means am I an expert on the coverage across the province, but let me just go on what we heard from young people in Prince George, Kelowna and then greater Vancouver, extending all the way out to Abbotsford and other areas — so really, beyond.

Opioid agonist therapies are certainly available to young people and even, indeed, pushed on young people quite aggressively in downtown Vancouver and surrounding areas. They become less available across the province but are still reasonably well available, I would say, in Kelowna at least. Young people did talk about being offered those in Prince George as well.

When we go beyond that to things like supervised consumption spaces or overdose prevention sites…. Those are much more inaccessible to young people, even in Vancouver. While a young person might not necessarily be turned away from somewhere like Insite or the other overdose prevention sites, what we heard overwhelmingly from young people is that they do not feel comfortable in those spaces.

They do report being turned away. They report being told: “You’re too young. I don’t see track marks.” “No, we can’t come in here.” So access to overdose prevention sites and safer consumption spaces is limited, at best, for young people in our context.

In the full paper…. I provided the committee with the two-page summary of the harm reduction calls to action. In the academic article that the two-pager is based on — we have a full-length commentary — we include much more detail about why young people need their own overdose prevention site or safer consumption space across settings.

It was quite interesting, actually, to hear young people, many of whom started using hard drugs and even injecting at 12, 13, 14 years of age, talk about how uncomfortable they feel in adult-oriented spaces, including feeling like, in those spaces, they have to pretend that they’ve got it all figured out with their substance use. They can’t ask questions. They’ve got to just go along with whatever is going on in there with older users.

The young people who we worked with on this commentary said: “We want a space where we can go in, use safely but also talk to a nurse or a peer about maybe not wanting to use as much or wanting to transition somehow in our substance use.” Maybe that transition I just talked about, like using more cannabis and less fentanyl or something like that. Young people have really told us that they don’t feel comfortable having those conversations in the adult-oriented spaces.

I would argue that we urgently need youth-dedicated harm reduction spaces across the province, where young people can feel comfortable to go in, ask questions and just build those relationships that I keep talking about, build that trust, build those relationships, with peers, with people with lived experience but also with trusted providers, with nurses and with other folks who will provide that non-judgmental care and support.

I think it’s really important to note that the young people who I work with are not asking to exclusively interact with peers and those with lived and living experience. They want to interact with, I would say, nurses, similar to our street nurses in Vancouver, those who are very skilled at providing that non-judgmental care and building those relationships and really seeing young people and helping them to feel seen and to really feel like they matter and that they have someone who cares about them and who knows who they are.

N. Sharma (Chair): Excellent. On behalf of the committee, I just want to thank you so much for your very detailed and interesting perspective on the research that you’ve done over so many years. It’s certainly a perspective that we haven’t heard yet and I know I, for one, really appreciated. Thanks for the work you do, and thanks for your time.

We have all of your materials in front of us too.

D. Fast: Great. Thank you for allowing me to bombard you with all our work. I will pass along that forthcoming publication, if it’s of interest.

N. Sharma (Chair): We look forward to it. Thanks. All the best.

D. Fast: Thank you for having me today. I appreciate it.

N. Sharma (Chair): All right. Committee, we’re going to go into recess until our next and final speaker at 3:30.

The committee recessed from 2:55 p.m. to 3:16 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): It’s my pleasure to welcome our next guests. We have with us today the Resident Doctors of B.C. represented by Dr. Brandon Yau, chief resident, and Harry Gray, executive director.

Thanks for joining us today.

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

I’ll just pass it off to our Deputy Chair.

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

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

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

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

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

M. Starchuk: Mike Starchuk, MLA, Surrey-Cloverdale.

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

R. Leonard: There’ll be a test later.

Ronna-Rae Leonard, MLA for Courtenay-Comox.

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

N. Sharma (Chair): For all the members, Artour just put their presentation up in your materials. You should find it there.

We’re so glad that you’re here so that we can learn from your perspective on the topic. You have about 15 minutes to present, and then there’ll be 45 minutes for discussion afterwards.

I’ll pass it over to you.

RESIDENT DOCTORS OF B.C.

B. Yau: Great. Thank you.

My name is Brandon Yau. I am a resident physician. My specialty is in public health and preventive medicine. I will also say that I recently graduated from my family medicine training program so a very new to practising family doctor — 11 days ago, 11 days in practice.

I’ll just let Harry introduce himself.

H. Gray: I’m Harry Gray. I’m the executive director of the Resident Doctors of B.C.

B. Yau: I’d just like to start off with a land acknowledgment. We would like to respectfully acknowledge that we’re presenting to this meeting today on the traditional territories of the Lək̓ʷəŋin̓əŋ peoples, known as the Esquimalt and Songhees Nations, as well as the Victoria Métis chartered community.

Just a little bit of an introduction, a bit of gratitude to begin with. We appreciate the invitation to speak to you today. We appreciate the recognition of the work that resident doctors do and the recognition of the work that Resident Doctors of B.C. does.

I want to start off by just introducing who resident doctors are and what role we play in the health care system. Resident doctors are physicians who have completed medical school and are pursuing further medical training in their specialty of interest. Resident Doctors of B.C. is an organization that represents us in our negotiations with the government and looks after our interests, essentially.

[3:20 p.m.]

I think it’s important to situate the role of resident doctors in the health care system because I don’t think that many people understand our role. I think that we also bring a unique perspective and a unique lens to the table. We have a diverse cross-sectional experience of our health care system. We rotate through different clinical settings and clinical rotations monthly, even sometimes, often, more frequently than monthly.

We really have a unique lens into the state of our health care system in some ways. I would say more so than a traditional staff physician might have, because we are constantly doing something new, so we do bring that lens with us.

The four main points that I want to make to this committee today in terms of addressing the opiate crisis…. The first one is just challenges in terms of a targeted strategy in connecting with resident physicians in completing opiate treatment therapy. I’ll go into all of these details further on in the presentation, but I wanted to give you my thesis up front so that you could keep that in mind.

The second issue is in terms of the challenges accessing addictions care in rural and remote communities for patients. That difficulty reflects the challenges in accessing addictions training in these settings as well.

The third issue is about the inconsistencies and how resident physicians are trained to provide care. In particular, what I think is most relevant to treating people who have substance use disorders is low-barrier care, trauma-informed care, harm reduction and cultural humility. So there’s a variation in terms of how we are provided with this level of training in our medical training.

The last piece I wanted to touch on was the expertise on people with lived experiences and with peer workers. I believe that their role in our training can be formalized and can be improved in terms of the training that they can provide to us resident physicians.

I guess part of my disclosure is that my specialty is in public health and preventive medicine. So I’d be remiss if I were to not talk about prevention. I think we often forget that there are preventive measures that we can take to prevent people from becoming addicted to substances as well as from suffering the consequences of this addiction.

If you’re following along on the slide, this is a study that came up from the BCCDC overdose drivers knowledge translation group. That’s a mouthful. They looked into the drivers of the overdose crisis as well as recommendations for prevention, and many of these things I know have already been presented to this committee — but important to keep that framework in mind, because it’s not just about the end use. It’s about the upstream determinants of health and prevention as well.

Some of their findings that I wanted to go through were just that the criminalization of substance use and substance use disorders creates tangible harm for folks. Promoting family well-being and family cohesion is protective against overdose, and overdose is strongly correlated with socioeconomic marginalization, poverty, structural racism and cumulative adversity over the lifetime.

Some of the points that they wanted to make were: decriminalization to reduce the stigma, to strengthen the support for families and for parents and, specifically, screening for adversity early on as well as providing early intervention. Then the last point they wanted to make was in terms of addressing comordibities like mental health and chronic pain, essentially.

The next slide is essentially just a picture from the BCCDC, or a graph from the BCCDC, showing that it’s important that we prevent harm. It’s easier and more cost-effective to prevent disease than address it later on. It’s just keeping that framework in mind from the preventive medicine lens.

Moving on to clinical services, I just wanted to highlight that opiate agonist therapy, or OAT, is the mainstay of treatment for opiate use disorder. Opiate agonist therapy is traditionally known as methadone, Suboxone or buprenorphine-naloxone, and sustained-release oral morphine, things like Kadian.

These are things that family doctors and addiction medicine specialists prescribe to patients with opiate use disorder to help treat it and to help reduce their use of other illicit substances.

We have recent research that shows that retention in this treatment is protective against overdose deaths even in the fentanyl era. So folks who are using substances, who are on OAT, have a lower chance of dying from an overdose death than somebody who is not on this treatment. Again, that’s our mainstay of treatment for people with opiate use disorder.

[3:25 p.m.]

In terms of how we prescribe or how we control the prescription of these opiate agonist therapies, prescribers are required to complete a training course in order to become prescribers. As a resident physician, as a staff physician, one would have to complete this training. It’s run by the B.C. Centre on Substance Use.

The training course is called the provincial opiate addiction treatment support program. This training program includes an online course, a workbook, as well as an in-person preceptorship before we can prescribe and treat opiate use disorder.

One of the gaps that I wanted to highlight to the committee was just the variable training requirements for resident physicians. OAT prescribing, or that provincial opiate treatment program, is an optional training program for family medicine residents and an optional training program for most resident physicians across the province. Additionally, access to addictions training is optional. Exposure to addictions training is optional for residents in family medicine and residents in other specialties other than addictions medicine, primarily.

The last point was just about, again, the rural and remote settings. The further away we get from urban centres, the more challenges there are for folks to access addictions treatment. Equivalently, there are also increasing challenges for us as resident physicians to access addictions training in these settings. It kind of creates a bit of a snowball effect, where we’re not getting trained, and there’s already less access for folks with a substance use disorder.

I just wanted to bring back that last point, that, again, access to OAT, opiate agonist therapy, is known to be life-saving. The connection to care can be life-saving as well. The province of British Columbia has a strategy, as well as the health authorities have a strategy, to increase access to OAT treatment. They’ve expanded the ability to prescribe these medications to nurses as part of their strategy to decrease the barriers to accessing this medication.

I think that’s great. I also think that resident physicians are low-hanging fruit. We are the pool of physicians who will become staff physicians. But to my understanding, there isn’t a formalized strategy to get us trained up, because we are young physicians, and training us is an easy way to get us to prescribe opiate agonist therapy and to become addictions providers in the future. This is kind of the concept that the greater number of prescribers there are in the community, the greater access there will be to addictions treatment and to this life-saving treatment in general.

This is the “what” of what we can do as prescribers. What we can do is prescribe these medications. We can engage folks in care. We can provide this care.

The next part I wanted to talk about was the “how” of how we provide care. I think this is equally if not more important, in terms of how we treat or how we engage folks with substance use disorders. Again, just reading off the slide a little bit, the requirements for resident physicians to get training in trauma-informed care, culture humility, low-barrier care is variable across residency training programs. There’s no consistency, and there’s no requirement that we complete this type of training.

I think what the consequence of that is — and I’m speaking to my own experience as well as some of the experiences of my fellow residents — is that the clinical experience in the community is incredibly variable. Many spaces — and some would argue most spaces — for folks with substance use disorders remain highly problematic and highly unwelcoming.

There’s a quote or a data point from the B.C. Coroner’s Service death review panel in 2022 that noted that there’s a high percentage of people who experienced a drug overdose death that had high and frequent contact with health care professionals.

My question is: how do we leverage that frequent exposure to health care workers and the health care system into a low-barrier and safe and non-stigmatizing way to provide care for people, because the current system…. I don’t want to say that it’s purely the lack of training, but that lack of training creates spaces where folks who have substance use disorders may not feel comfortable engaging in care, essentially.

[3:30 p.m.]

Speaking from my experience in family medicine training, I’ve trained in a low-barrier family medicine clinic, and the characteristics that engage people in care are care that’s longitudinal, care that’s low-barrier, care that we can provide that’s pragmatic and opportunistic, and care that’s stigma-free.

I think this is a part of the bigger picture or the bigger issue of the primary care crisis. I am no expert in that. I know that there are great people working on that issue. I think that’s part of the issue, in terms of accessing addictions care for folks as well.

The next topic, again, was on harm reduction. Similar to the previous things I talked about, harm reduction is kind of the how of how we provide care. We know that spaces and clinics that don’t incorporate the values of harm reduction are challenging for people who use substances to engage in care. Again, the training for resident physicians in providing a harm reduction–informed approach is variable and inconsistent.

Shifting gears a little bit here, in terms of safe inhalation spaces. There’s lots of data showing that there’s an increase in prevalence for folks to use inhalation as a mode of consumption. I appreciate that the Minister of Health and the health authorities have been working towards increasing access to safer inhalation spaces for people who use substances. I support that expanded access. That is a critical resource for folks who use substances.

The next topic I want to talk on is the peer workers, or people with lived experiences. People with lived experiences play a critical role in our clinical training. They’re the experts in their experience, in their specific disease that they may have, and their insight and knowledge can’t really be replicated by textbooks or studying, essentially.

The BCCDC has done a lot of great work in terms of setting up the parameters of how we engage peer workers in our clinical training and in committee work and things like that. I just wanted to reiterate that. I think we should further build on that and remain committed to having them incorporated into our training programs.

In some ways, the other pieces — the pieces about harm reduction, the pieces about trauma-informed care and the piece about peer workers — are how we change hearts and minds. I think engaging with peer workers and people with lived experiences changes their experiences, from what I think of, of somebody who uses substances, and makes them a real human being. I think that helps change the way we frame the care that we provide.

The last topic was just in terms of novel approaches to addressing the overdose crisis. There is a variety of pilot projects and programs being done right now, things like the iOAT, the injectable opioid agonist therapy program; prescribed safe supply; a co-op model; and a compassion club model. These are alternative models to the medicalized model of harm reduction and opiate treatment.

We are calling this a crisis. It is a crisis. I believe that all the options should be on the table. These pilot projects are important for us to gather data on and to develop new kinds of best practices, essentially.

In summary, again, the main takeaways I wanted to speak to the committee about. One, include resident physicians as a low-barrier group in the strategic approach to increasing the number of OAT prescribers. It seems like a fairly…. We’re low-hanging fruit, essentially, for that.

The second one was ensuring access to addictions training, particularly in rural and remote settings. We know that those settings are more challenging for folks to access care.

Develop standards in residency training for trauma-informed care, low-barrier care, cultural humility, harm reduction. This is how we get people to engage with us, meaningfully, in care.

The fourth piece is just about including peer workers and people with lived experiences in our training program, wherever appropriate.

I guess I should also frame what I’m saying in terms of placing where I am. I am an end-user of our medical education system. I don’t have the knowledge, for each system and each structure, of how this came to be. I can only speak to the gaps that I see from my training program. Those are areas that I think can help address the issue that has been presented to us.

N. Sharma (Chair): Okay, thank you so much for your presentation. Congratulations again, on finishing your residency.

We have a lineup of questions here.

S. Chant: Thanks for your presentation. Good work in putting this all together, as well as finishing. Sometimes it doesn’t all work.

[3:35 p.m.]

Some things are optional. Some things are variable. Is there a core syllabus that could be augmented with these things successfully? That’s question one. Is there somewhere — and maybe this is outside of the realm of where you’ve been — across the country that does it better, or is there another model somewhere else that does this work better?

B. Yau: The first piece, in terms of a core group of coursework…. I guess to describe the landscape a little bit, each residency specialty is its own little program. To my understanding, there’s very little that’s required for each program to do. Essentially, that would be the UBC postgraduate medical education that has that greater insight into what’s required and what these programs need to do.

I don’t know if, Harry, you have any….

H. Gray: There are somewhere between 74 and 76 different programs that UBC offers — everything from anaesthesiology in the As, all the way down to vascular surgery in the end of the alphabet and everything in between.

Family practice is really the one that we’ve been addressing today. Family practice is a two-year program, 350 residents in that, so 175 graduates — these are kind of broad numbers — a year. By far the largest program, but when you look at that program and how it’s divided across the province….

Dr. Yau actually went to…. His residency was based out of St. Paul’s in Vancouver. But we have other people that are based out of Victoria, Nanaimo, Penticton, just all the way across the province in family practice rotations. Each one of those goes through a series of month-long rotations. They’ll do a month in psychiatry, a month in obstetrics, a month on, like that. What there isn’t is a month, or even a part of a month, where they do anything that’s related to this topic.

Part of the suggestion is somewhere in there…. If this becomes a priority, you would think that it should be a recommendation that it becomes one of those parts of a rotation. Does that help?

S. Chant: I’m out of my space of knowledge here by quite a long way. But is there any appetite to either inculcate it in the preliminary training that all the docs take before they start branching out or standardizing a component of the residency training? Is there appetite for that? If there is, who waves the magic wand and says “thou shalt”?

H. Gray: I don’t know what the appetite is, and I really can’t comment on that.

When you look at the education system, there’s medical school. That’s where every physician, whether from A to Z, goes. That would be where you would be ensured of getting education for all residents, all physicians being trained.

If you want to make it more specific to those physicians who are likely to be dealing with drug addicts, then you got to put it into the family practice area. Again, there are many of those across the province.

B. Yau: I also think that there is an argument to be made that a lot of this training may be necessary for all physicians. All physicians touch somebody who may have a substance use disorder. I’ve seen it in my family practice in the Downtown Eastside. It’s difficult, sometimes, to get patients specialist care, because it can be challenging to make those spaces safe.

There is also an argument to be made that it’s not specific to addictions physicians, emergency physicians and family medicine physicians. Ultimately all physicians at some point may engage in care — and not just addictions but Indigenous folks, folks facing marginalization. It’s important that we all have this training. That’s an argument that I would make.

T. Halford: Welcome, and congratulations. Let me know if you’re taking patients.

I’m joking. I’m okay.

[3:40 p.m.]

One of the challenges is that we do have a lot of doctors retiring, coming into retirement. When you’re coming out of your residency, are those conversations quite rampant in terms of how we’re talking about harm reduction, safer supply — all those things that I probably would assume weren’t common topics 20, 25 years ago? With your colleagues, your newer colleagues and maybe colleagues that are coming after you….

I’m not trying to put you in a hard spot here. Are you optimistic that those conversations are happening more frequently, from a health point of view, in terms of how we deal with harm reduction, safer supply, recovery options as well? Just your thoughts on that, if this is something that you’re seeing more people come into the field with.

B. Yau: I think I need to recognize a bit of the bubble, in terms of my training — I was trained at St. Paul’s Hospital in Vancouver, which is a known centre of excellence in substance use disorders — and also recognize the bubble I live in, in Vancouver.

I think it’s common within my own sphere. I think it’s variable. I think there is a certain subset of family physicians who say: “Addictions medicine is not within my scope of practice. I don’t want to do this. I’m not interested in harm reduction. I’m not interested in prescribing hydromorphone and things like that.” I think it is variable. I’m hopeful, for my cohort of co-residents that are recent graduates, that the conversation may be shifting.

I think a powerful piece for me is the San’yas training that many of us do. This is a training program that’s run by the health authority for cultural humility. Again, I don’t know if every residency program requires this training. It’s an excellent online training program, and it helps us look at the history of colonization and work towards reconciliation.

I look at that as a model. When we get those conversations started early, it helps shift how we think about the patients that we see. Rather than seeing patients as demanding, challenging, problematic…. It shifts how we think about that because it gives us insight.

If we were to be able to change the discussion about substance use disorder early on…. It creates a new generation of physicians who are willing to engage in that care and to treat people with the understanding of the harms of a criminalized system as well as the history of personal harms that most people with substance use disorders have suffered. That’s why I think that training is so important, in terms of changing that perspective for people.

S. Furstenau: Thanks for the presentation. Congratulations. Great to see you.

I just have to say…. There are a couple of things I really appreciate about your presentation. You take what has often been talked about in terms of individual responsibility, and you lift it up to the social determinants of health. Your slide on prevention, I think, is fantastic. It removes it from, “Here’s the individual failing,” to: “Here’s the societal condition that we need to address.” So I thank you so much for that.

Your recommendations. Again, I feel like these seem so obvious, but you’re the first to put this so succinctly. I turned to my colleague here and said…. We’re six years into a health emergency, and we haven’t really identified the education of health care providers as a priority in this.

I just want to really appreciate what you’ve provided us here, in terms of that really critical lens of: how do we change this conversation? Well, it’s always…. Education is the starting point.

This morning we had a doctor presenting. He talked about trauma-informed care. We’ve heard about trauma-informed care over and over and over again. My question for him…. I’m going to repeat it for you, particularly hearing that this is variable…. We are graduating doctors and residents in British Columbia without an expectation of a consistent level of trauma-informed care.

[3:45 p.m.]

Can you talk to us about what your training around trauma-informed care involved? Do you see that as…? How do you see that as being something that we can ensure is universal for health care providers — not just doctors but health care providers — having that essential component of their education?

B. Yau: I had some challenges creating my thoughts behind this.

I constantly hear: “This is never taught in medical school. This is never taught in residency.” There’s an endless list of things that we could always include, and we would never graduate as physicians. I don’t want to add to that, to say: “These are all the things that we need to be trained on in order for us to be better physicians.” However, I think there are some basics, in terms of how we engage in clinical care, that are important.

I think the actual training, the online courses, the things that we do like that are important. That’s a small baseline. I think for me, personally, what changes my heart and mind is the peer workers, the people with lived experiences, and hearing their stories. We have a lot of coursework. We do a lot of online engagement and things like that. But it really is speaking to people and understanding their stories that humanizes them and that changes our perspective.

There are great modules and coursework that’s done by the health authorities on all of these topics, frankly. The piece about integrating people with experiences and then going out in the community and engaging with patients with those experiences is part of that broader learning experience.

I work in a clinic in the Downtown Eastside. There’s always a moment when I look at somebody’s social history…. We take people’s history. It says: “Residential school survivor.” It makes me stop for a minute and think. If this person is being challenging, it makes me remember why I’m here and what my role is in a way…. If I were in a walk-in clinic and I didn’t know anybody’s history, it would be a different contact.

It’s part of that holistic piece. A part of it is the actual coursework, but I think part of it is that genuine exposure of that human experience. Ultimately, that’s how we change people’s attitudes. There’s only so much a course can do if somebody already has these prejudices. But it’s harder to be prejudiced or develop those prejudices when you really understand the history of patients and the history of trauma. That’s where I come from.

Again, I think it is easier to get us while we’re young, to get us while we’re early in our career, before we’ve developed those, maybe, negative thinking tools or whatever you want to call them. I think it’s easier that way. I think it’s such an apt opportunity for us to get in early, essentially.

S. Bond (Deputy Chair): Thank you very much. Congratulations. I hope that you do continue in family practice. Heaven knows we need you.

I wanted to just focus on two things quickly. You said something that I have been thinking a lot about — in the death review panel, from the coroner — the point that there is, and you quoted, “high and frequent contact with a health care professional.” Then we talk about the need for…. It’s complex, obviously.

I’m wondering if you can see links to the fact that these people have had connection with the health care system, yet it didn’t result in a longitudinal approach, in terms of their care plan, all of those kinds of things. Is there a link between training, compensation? When you think about time-based care, there’s no incentive for that in the current….

Do you understand what I’m saying? What are the links to the fact that these are people who…? Many of them are not infrequent in terms of their contact in the health care system, yet there hasn’t been a permanent connection, a plan, something that’s been a result of that.

[3:50 p.m.]

Is it that it’s complex? Is it that people aren’t trained? Is it that they don’t have the time to do it with the nature of the situation? Why such frequent contact yet the outcome they faced?

B. Yau: Maybe an easy answer, or a cop-out answer, is to say this is a family medicine crisis overall. I think I do see a connection. I do see a connection in terms of the lack of training or the lack of understanding and the reluctance to seek care and reluctance to disclose. Not infrequently, we send people to the emergency department because we think that it’s beyond our capacity as a family doctor to manage, only to have them come right back and say: “I didn’t have a great experience” or “I do not want to go to the emergency department.”

I see a clear link. I don’t know if there’s objective evidence to say there’s a gap here or that there are best practices elsewhere so we have better access to care, but I see a strong link. Just speaking of not even people who use substances, but people who are marginalized. Indigenous peoples. Name your group. You are told to go to a space that you don’t feel comfortable in. You don’t feel welcomed. You just don’t think that the provider or the clinic really understands you or gives you the time of day. You’re not going to want to disclose something that is so stigmatized like a substance use disorder, or so stigmatized like interpersonal violence, or anything like that.

We need to create those spaces. It’s incumbent upon us as primary care physicians to create that space that’s safe for people. It’s an us problem, and it’s a system and it’s a culture problem I see. Yes, no easy fix, but it’s pervasive. It’s pervasive across the health care system. It’s not one clinic. It’s not one emergency department that’s in the news. It’s pervasive. That’s why we have such difficulties. That’s why these people are “frequent fliers,” because they’re not getting appropriate care, so they have to continue to present, to present, to present, until they get the care that’s appropriate and timely and pragmatic for them.

I see a strong connection to that. I think how we set up our system is not friendly towards anybody who doesn’t feel safe in those spaces.

S. Bond (Deputy Chair): I think the whole point…. When you think about longitudinal care and what that means and what assumptions go with that, the fact that if you’re going to care for someone in a meaningful way, you need time-based recognition for that work, and training matters.

But I just want to move on if I could, Chair, just to one other question, because we met with…. I’m trying to think if it was councillors or psychologists or somebody that talked about a warm handoff.

T. Halford: Psychologists.

S. Bond (Deputy Chair): Psychologists. They are looking at a model where, in a practice, for example, there would be a family care physician who would do the initial sort of intake and begin that relationship, but in that model you build in the specialist support of, say, a psychologist, who…. Warm handoff is that they literally can go down the hall and say: “I want you to meet this patient, and together we’re going to serve this patient.”

I just thought that was a really interesting model. Is that something that would benefit family physicians, if we look at the concept of team-based care? But there’s that ability to do the warm handoff. The person is there, physically. It’s part of a team. What’s your reaction to that? I thought their proposal was really interesting.

B. Yau: Again, speaking to my own experience in the clinic that I primarily work in, that is built into our system, where we have an internal medicine specialist. We have an infectious disease specialist. That is helpful. I think part of that is because we recruit physicians who we know will be able to provide that safe care.

Patients coming into our clinic where they know it’s a safe space are already disarmed, because they’re in a space that they know is safe. Part of it is that as well. But I think that model makes sense. That’s a low-barrier model. Rather than saying to you “I’m going to refer you to a psychologist” and you go find out and hopefully they’re nice to you, we have that built in-house. That is, in my mind, an aspect of low-barrier care of, “We’re going to refer you,” and there’s somebody in-house, and you’re familiar with this space. That’s a way that we can engage people in care that’s easy for them and makes sense.

[3:55 p.m.]

I’m sure there are complications in terms of how we compensate and all of that messy stuff, but that is a great model. Having multiple services under one roof is why people come back to family doctors’ offices. That’s why we are able to provide that longitudinal, low-barrier care for folks as well. So that’s another waving of the flag for family doctors.

S. Bond (Deputy Chair): I really appreciate that. Thank you.

N. Sharma (Chair): I have a question. I just want to start by saying I really appreciated your energy and perspective today. It was pretty clear that you’re not only passionate about it, but you have very specific, thoughtful things to say about what we need to do.

But I was curious about your next steps, because it sounds like you’re working in a clinic on the Downtown Eastside. Is that right?

B. Yau: Yeah.

N. Sharma (Chair): I’d love to know about your kind of front-line experience and perspective when it comes to the OAT treatments and the prescribing that’s happening, if you’re working on that — just what your thoughts are on how that’s working in more particular ways and what the balance is and what your take is on the prescriber versus non-prescriber models in that.

B. Yau: Yeah, that’s an interesting question. I will say that prior to medical school, I worked at Insite, so I have a longer experience working in the Downtown Eastside. For me, providing this type of care is the baseline. It’s not the exception. So that is where I’m coming from, and that’s kind of what I’ve always done.

I don’t know if I would be able to speak to the non-prescriber model, to be completely honest with you. But what I’ve seen done well in our clinics and in the care that we provide in the Downtown Eastside are things that I’ve kind of already touched on, like the trauma-informed care, the harm reduction, being welcoming of people and just having an open clinic. We operate amongst a group of family doctors, all of whom have a similar philosophy, all of whom are not stigmatizing. We’re always trying to learn to be better, to make spaces safer for people. I think that’s part of the model.

How we prescribe opiate agonist therapy…. There are challenges for folks to gain access to OAT. There are challenges to people connecting with a primary care physician and regularly having witnessed ingestion of medications and things like that. But again, the evidence shows that it is protective against overdose, which is the worst outcome that we’re trying to protect against. I think models that support the provision of care in that way are important. I think being able to provide that care in that way is important.

I spoke to one of my colleagues in public health who was also recently trained in family medicine. He was telling me that in spite of the crisis…. We’re resident physicians trained in the COVID pandemic and in the opiate overdose pandemic. In spite of that, there was no formal training in addictions medicine in his family medicine training program, and there was no specific training in trauma-informed care in his residency training program.

So that’s a huge gap. That’s a huge issue — for somebody to be able to graduate from family medicine training in B.C. in this time and not get addictions training and not necessarily get any exposure to that. The “how” of how we provide care is troubling to me.

And I don’t want to say that family doctors need to be trained on everything. I think that there is a scope of practice. We can choose whether or not we want to do obstetrics, whether or not we want to do X, Y or Z. But it is troubling in this specific context. I find that very surprising, and I think that you probably find that surprising as well.

N. Sharma (Chair): Specifically, when you’re interfacing with people that are using this very toxic drug supply, what are you finding? Is it methadone? What is the thing that you’re prescribing or that people are prescribing, from your perspective, that’s helping to stabilize or get them off that?

B. Yau: It’s a variety of approaches, honestly. Again, I want to reiterate that my experience in working in addictions medicine is an outlier, I think. The Downtown Eastside community is a very specific community. The experience of the Downtown Eastside does not necessarily translate to other parts of the province, so it can be challenging to generalize.

[4:00 p.m.]

However, the opiate agonist treatments that we’re prescribing include methadone, Suboxone or buprenorphine-naloxone, and the sustained-release oral morphine. That’s things like M-Eslon and Kadian. Those are the traditional forms. Working at the PHS clinic, we prescribe fentanyl patches. There’s a fentanyl powder program, and there’s an injectable opiate agonist therapy program as well.

It kind of runs the gamut, and our patients reflect that. Some folks are stable, in remission, on the traditional treatment, Suboxone. Some folks are on a whole host of things. But our patient population is quite refractory to the traditional treatment — again, not necessarily representative of everyone across the province.

We find what works for patients. For some, we aren’t able to find a model that works for them, but we’re always there and our clinic doors are always open. When people are ready to engage in opiate agonist therapy treatment, we’re there to start it — when you say you want to start it.

It’s similar to smoking cessation. We don’t say, “I’ll speak to you one time a year about smoking cessation,” to a regular patient. We drill it down. We do it every single time you come to our clinic, and when you’re ready, we start it. That’s how we get people to stop smoking. That’s how we get people to change behaviours. So that’s part of how our model works as well.

Just the last piece, in terms of the novel approaches piece. There are great programs that are being run by the BCCSU and other organizations. Those, I know, are being researched. I think those are really important to highlight as non-traditional options for folks who are very refractory to the mainstays of treatment for opioid use disorder.

R. Leonard: Thanks. Everybody is saying congratulations.

B. Yau: I appreciate it.

R. Leonard: You’re a welcome addition.

I guess the question I have is…. You are Resident Doctors of B.C. We’ve heard from the College of Physicians and Surgeons, who said it’s not their job — they’re regulators — that that whole clinical practice is up to Doctors of B.C. Who would we turn to, to seek that change, where it actually becomes a training component for physicians?

Then my second question relating to that is: who would be teaching? I have seen over the decades the evolving practices, and we’re never going to be at the end point where we’ve got the perfect answer. So just: how could it evolve over time too?

H. Gray: Let me explain the landscape. Doctors of B.C. has practising physicians, and there are, in round terms, about 6,000 family physicians in the province. That’s not an exact number, but it’s somewhere in that region. The number of residents that graduate each year is 175.

If you want to get the training into residence, you would go to UBC postgraduate medical education. That would be the entry point.

Certainly one of the things that we’ve done in other aspects of training is where we’ve got training for residents with the specific idea that what’s going to happen is they’re then the next generation of leaders coming into medicine. What they’ll do is bring that message forward and start to deal with their colleagues as they go into the workplace. That would be restricted, though, to the 175 grads a year. Over five years, that becomes a fairly large number of people.

If you want to get the 6,000 that are currently working, appreciate that there’s going to be…. You know, people are about to retire all the way from fresh graduates and, I mean, everything in between. That would be more the Doctors of B.C. territory. The question there is: how do you get those practising physicians to take up that training?

B. Yau: Again, I don’t fully understand the landscape, but I think there may be a role for either the Ministry of Health or the Ministry of Advanced Education.

[4:05 p.m.]

They are the ones that liaise with UBC PGME, postgraduate medical education, in terms of the funding that they provide and what that funding comes attached with. I believe that there is a role in terms of how the government negotiates with medical education funding.

In terms of the question about who would be doing this teaching, there are great physician leaders. How medical education works is that oftentimes we model ourselves off of our preceptors — the people that we’re working with who we look up to. There are a great number of people that I’ve worked with who I look up to and who I learned from in terms of not just the what of medicine, of how we diagnose and treat, but how we do medicine, the softer skills. There’s a lot of that informal mentorship that happens.

I recognize that physicians are…. There’s a limited pool of physicians, and there’s a limited amount of time that they can really devote to this.

I think the piece about peer experts and peer educators is critical. There is capacity. It doesn’t need to be a physician. Anyone can provide low-barrier, compassionate care that is non-stigmatizing. There are experts in nursing. There are experts in allied health, and there are experts with people who have lived experiences. So I think there’s a great opportunity to include that. It doesn’t need to be physicians, because physicians, oftentimes, can be overburdened with tasks already. But there are examples of excellence across the clinical care spectrum, essentially.

N. Sharma (Chair): I didn’t see any more hands up.

We’ve had a really great discussion today, so on behalf of the committee, I just want to thank you for coming here today and sharing with us your perspectives that were very interesting. We learned a lot from you today. We wish you all the best in your future and everything that you do. Thanks for your work.

H. Gray: Thank you for having us.

N. Sharma (Chair): Okay. We just need a motion to adjourn, then, for today.

Trevor, and then Dan.

The committee adjourned at 4:07 p.m.