The committee met at 9 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Welcome, everybody, to our second day of hearings.

We are on the traditional territories of the Lək̓ʷəŋ­in̓əŋ-​speaking people, the Songhees and Esquimalt First Nations. I just want us to all think about how that shows up in the work that we’re doing.

It’s my great pleasure to welcome our first guest this morning, Nola Jeffrey, from the Tsow-Tun Le Lum Society, the executive director.

We just want to welcome you and thank you for coming. We really look forward to learning from you today.

My name is Niki Sharma. I’m the Chair and the MLA for Vancouver-Hastings. We’ll just go around and do a quick intro so you know who we all are.

I’ll pass it over to our Deputy Chair.

Shirley, go ahead.

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

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

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

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

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

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

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

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

N. Sharma (Chair): Excellent.

Nola, you have about 15 minutes, and then we’ll save the rest of the time for a discussion with you.

Over to you.

Briefings on
Drug Toxicity and Overdoses

TSOW-TUN LE LUM SOCIETY

N. Jeffrey: Good morning, everyone. Thank you for welcoming me here and for recognizing the territory that we’re on. I, too, recognize it. I want to recognize the Creator and the ancestors.

My name is Nola Jeffrey. I am Tsimshian and Coast Salish, born and raised in the village of Lax Kw’alaams. Lax Kw’alaams is about 20 miles north of Prince Rupert. I come from the Gitandoh Tribe, out of the house of Ska-gwait. I’m the youngest of nine children.

I have to laugh. I turned 60 in November, and my eldest sister just turned 73. All of us are still on this side.

The Tsimshian people are matrilineal. So we follow our mothers. I am who I am because of my mother and her mother and her mother before that. I know, without a shadow of a doubt, that I come from very strong, powerful people.

My mom’s name was Bobbi Garner, and my father’s name was Fred Dudoward. My maternal grandparents are Mercy Kelly and Robert Garner. It’s from Robert that I have my Coast Salish Stó:lō blood ties. My father’s mother was Frida Dudoward. His father was Frank Gudna. There’s controversy about who my dad’s dad was. He wasn’t in my father’s life. My dad was raised by his aunt and uncle, Annie and Ernie Dudoward.

I grew up in the village till I was 14 years old and had to leave to go out to school. I left at 14, moved to Prince Rupert, with teachers, and went to school there. I met my husband when I was 15, and we’ve been together ever since. So on June 3, it was 45 years that we’ve been together.

Mm-hmm. I know. I deserve a couple of awards. [Laughter.]

We have four children, three that are living. Our youngest daughter is in the spirit world. She left very suddenly, in a car accident, when she was just over 20 months old. It has really shaped who I am today. It has helped me discover my strength, which I didn’t know I had, and it has helped me speak out.

I came to Vancouver Island in 1989 and started working at Tsow-Tun Le Lum in 2000. I don’t know how much you guys know about Tsow-Tun Le Lum. Tsow-Tun Le Lum is a healing house. The word is a Hul’q’umi’num’ word, a Coast Salish word, that means “helping house.”

Back in the ’70s, the three families got together. At that time, alcohol was very, very prevalent in communities. People thought alcohol was the problem, and they wanted somewhere on the Island for their people to go instead of going off to Alberta or Round Lake. They worked with the federal government, they got the money, and we opened our doors in 1988.

[9:05 a.m.]

The foundation of what we do is based on our cultural teachings. The biggest thing that the Elders tell me is…. The biggest thing that we can do is love people, have kindness, care for people and accept people where they’re at.

Also, we’re very much trauma-informed. This has come with a lot of years of experience and working to know…. Alcohol isn’t the problem. It is the symptom. Same with the drugs that our people are using. It’s really, really hard to live with a lot of the atrocities that they’ve experienced. They cope by using alcohol and drugs and gambling and relationships, and on and on it goes.

When we opened our doors, we had…. At that time, we called them two addictions programs, Thuy Na Mut programs. I think they soon realized we needed more than that. We got funding from the Aboriginal Healing Foundation, and we opened a trauma program. I think, for our people, because of our history…. All of us need to do trauma healing because of what we’ve experienced.

I was just talking about COVID here. When COVID hit, all of us got really, really scared. I think, as a whole society, we got scared. For Indigenous, Métis and Inuit people, it hit us at a different level. It was just in the 1800s that smallpox went through here, and it wiped out 90 percent of our people over those years.

When I think about…. It almost blows my mind to imagine my family — I’m a very emotional person too; I need to say that — 11 of us, and there’s really only one left at the end of the day.

What that did to us, as Indigenous people, is…. It put us into a trauma response, even though we didn’t know that, myself included. Even though I have all this education and all this knowing, I went into a trauma response.

That happened to people. What do people do when they’re in a trauma response? They’re no longer in the cognitive part of their brain, where they’re able to rationalize and think and problem solve. They go into that state of fight, flight or freeze. What people usually do is…. They do what they know. They cope the way they know. We saw a rise in the use of alcohol. We saw a rise in the use of drugs, and because the borders weren’t open, we got even more poisonous drugs.

For Indigenous people…. I know you guys know this already. The numbers that we lost because of the opioid poisoning during these last couple of years were astronomical. We’re still losing people, young people, at a high rate. For us, it’s a lot of the females. It’s more females that we’re losing than males. We lose a lot of males too.

Even though you try and get the education out there…. You try to teach people. For a lot of our…. What I’ve found, because of the disconnect for us…. We’ve been disconnected from each other. We’ve been disconnected from the land. We’ve been disconnected from the Creator and the ancestors. We’ve been disconnected from our languages. We’ve been disconnected from our cultural ways, our ceremonies and our teachings, and taken away and raised in strange environments.

A lot of people don’t know who they are. They’re lost. They don’t feel that they have value. They don’t know that they’re important. They actually feel that their lives are not worth living. They really struggle.

There’s tons of sexual abuse in our communities. I would say 100 percent of us have been impacted by sexual abuse, and that is a legacy from residential schools and colonization. If you know what sexual abuse does to you…. I, personally, am a sexual abuse survivor. It makes you feel that your life is worthless. It makes you feel that you’re not important. It makes you feel like you’ve done something wrong and that you’re not valuable. That’s a really hard one to get past, so you need to do healing work.

Back to us getting hit hard. We are healing, but it’s going to…. They talk about it taking seven generations. I don’t know how many generations we’re in. I know that when my parents raised us…. My dad was an alcoholic, and my mom started using too, to cope with life. Things had happened. They didn’t have any healing.

[9:10 a.m.]

I made a decision in my life that I wasn’t going to go that way. I wasn’t going to use substances. I said: “People don’t look at me like I’m a trauma survivor, because I became a workaholic.” I’m still a workaholic.

My goal, my reason for living, my reason for breathing is so I can help others, so that I can help our people be who they really were truly meant to be before all of this stuff happened. I do what I do. I fight for our people, because a lot of people don’t understand, and we know that there’s racism. We know that there’s systematic racism. I talk to grandmothers who are raising their grandchildren and that are afraid to go into the hospitals with their grandkids when they’re sick because they’re scared they’re going to be taken.

Now, if you’re blonde-haired, white-skinned and blue-eyed, you don’t have to worry about that. You don’t have to be afraid of that. There is still so much judgment that’s put on.

Tsow-Tun Le Lum has a support line that the First Nations Health Authority asked us to start during the pandemic, and when they did In Plain Sight, we ended up receiving tons of phone calls. When I say we, I really mean me. Me and my husband were the ones that answered that phone, and I had to talk like a Philadelphia lawyer. That’s what my mother always said. I was a Philadelphia lawyer.

I would be on the phone with psychiatrists, because they didn’t want to put people in the hospital that were very suicidal. The treatment some people have gotten…. I have had to talk to people. And I don’t know why…. Maybe the title “Executive Director” on the phone gives me clout, and then I use the First Nations Health Authority’s name also — whatever I can use to help people get the services they need. I think it’s really important, and I also think things are changing for the better.

I think that with the discovery of the children in Kamloops, it kind of opened everyone’s eyes to what we already knew. And the trauma that that’s brought up, not just for survivors, for intergenerational survivors, is huge. I tell people: “I know it’s hard, but it’s good, because that stuff sits in us, and it sits at a cellular level, and that’s the stuff that makes us sick.” That’s the stuff that makes me pick up a drink because I can’t cope with the pain when it’s sitting there and I don’t know what’s happening. So we need to heal. I think all of us as human beings need to heal. It’s not just Indigenous, Métis and Inuit people. It’s all people.

One of the things that I was afraid of, and I see some of it happening, but I still see people looking…. People started looking away because it was too hard to see what was right in front of them. It was too difficult to look at the fact that there are, in Kamloops, 215 children that are….

I don’t know if any of you have gone to see the site, but I actually was up there for the one-year anniversary, and the lady that’s running it I know very well. So she invited us to go down to the site where the children have been…. I want to say disposed, but I’m going to say buried. I can’t explain to you how emotional that was to see all those little markers. Some of them are almost on top of each other. We know that the graves aren’t very deep, so they believe that children are the ones that dug those graves, because they’re so shallow.

Like I said, I’ve worked at Tsow-Tun Le Lum for lots of years, and I worked in the trauma program. I worked with survivors directly for 7½ years, and I heard the stories about babies being put in the incinerator, about children being buried, about children being disposed in the ocean — many, many horrible stories. So it’s no wonder we cope by using alcohol and drugs and other things. It’s no wonder we even get out of bed in the morning and that we….

[9:15 a.m.]

This is what I see. I saw so many survivors and intergenerational survivors come through our house for healing, and I’m always amazed at their strength. I’m amazed at their courage. I’m amazed at their resiliency. They just amaze me because, really, I don’t know how they do it. I’ve gone through stuff, and mine doesn’t even touch what some of them have gone through. So many horrors. So I’m not surprised that people use alcohol and use drugs and other things to survive.

I need to take a breath. I’m not sure what you guys wanted to hear from me. I was invited to come and share. I don’t know if you guys have questions. I don’t have a presentation.

I always ask the Creator and the ancestors to be with me, to help me speak my truth, to open people’s minds and hearts so that they can listen and they can really hear the suffering that has happened and is still happening.

Our people live in poverty. I’m one of the privileged. Our people live in substandard housing. They live on the streets.

The territory has been taken away. I don’t know how long it’s been that way, acknowledging publicly that we’re on the territory of the people. And then I often wonder. What does that mean? Do we really, really understand what that means? In fact, where we’re sitting right now…. This used to be one of the biggest clam beds for the Lək̓ʷəŋin̓əŋ and Esquimalt people. They filled it in to put what we have here. So taking our resources for food away, taking our ability to live on the land away.

I guess the biggest thing is taking our children away. As a mother whose daughter died when she was 20 months old, I know…. I had a really hard time staying here. I had a really hard time living. I didn’t use alcohol and drugs. I was of a clear state of mind, I guess, but I really wanted to die. The pain of that was so huge.

I think about those villages that were emptied of children. It’s amazing. Some of those parents didn’t live. Some of those grandparents didn’t live, because their purpose for living was gone. Our purpose is our children. Our purpose is the future generations. To have that taken….

It amazes me that I still get to sit here today. I have my ancestors to thank, for their strength, that I get to be here. So, yeah, that’s kind of where I am at this moment.

I’m hoping you guys have questions.

N. Sharma (Chair): Nola, thank you. We’re really grateful that you’re here, too, and to have the opportunity to learn from you.

I’m just going to have questions-and-answers and discussion right now. I have a list right here. So we’ll start with Susie over there.

S. Chant: Thank you so much. Thank you for being you and for all the things that you bring to help us learn and, also, to the people that you have been serving and serve. It’s really, really, greatly appreciated.

Can you tell me a little bit about the program that you do — how people access it, what sorts of resources you utilize, what sorts of resources you would need to make it what you’d like it to be, if it’s not? Can you tell me a little bit about that, please?

N. Jeffrey: Yes, I can. Thank you. We use referral workers. That’s really loose. It doesn’t have to be a counsellor. It could be a doctor. It could be an Elder. It could be a nurse. It could be a social worker. It could be a friend, if it has to. So people need to have a referral. They cannot refer themselves.

For the substance misuse program, which we call Thuy Na Mut, we ask for…. I think it’s two weeks of sobriety before people come in. That doesn’t happen. I don’t even know why we bother, but it was there. Sometimes people show up and….

[9:20 a.m.]

I think it’s really, really scary for people to make that choice to come in. Some people are scared of what they’re giving up. That’s kept them alive, as funny as that seems. Substances have kept them alive, but they’re also really scared of what they’re going to go into and the fact that they’re going to have to face the pain that was caused to them and the pain that they’ve caused, because when you use substances, you hurt people, no matter if you’re trying or not. So they get referred.

I have two intake workers. I have an intake worker for the Thuy Na Mut program, and I have an intake worker for the Kwunatsustul program, which is the trauma program. Pre-pandemic, we were running two Thuy Na Mut programs and one Kwunatsustul program, and we would do a rotating intake. Then, in between, we’d run shorter programs on grief and loss. We’re just finishing up a three-week grief and loss, because there’s so much grief and loss in our communities.

I was going to get sidetracked; I won’t. I’ll stay on track.

At Tsow-Tun Le Lum, we bring them in, in cohorts, so ten people. Ten is our magic number for a group. We had 32 beds. I guess the other thing I need to say, which you guys might not know, is Tsow-Tun Le Lum has been leasing land off of the Snaw-naw-as people for 34 years. Our lease was coming up, and Snaw-naw-as decided not to renew the lease.

The community actually grew up around us. When we first opened there, there were no houses around us, and now there are houses all around us. They don’t have a community gym. They don’t have a kitchen. They need their land back. They want the building, and they want the gym and the kitchen. So we had to find new land.

We did. We found land down in Duncan. Sonia absolutely knows about this, because she came to our…. Last June we did a blessing of the ground. We found land in Duncan, and we’re in the process, right now, of building a new healing house. When we started this project, it was going to be about $12 million, $12½ million. Because of what’s happened due to the prices and COVID, we’re at about $17 million right now, and still 32 beds.

The beautiful thing is, in the house we’re in right now, it wasn’t built for 32 people. It probably was built for 20, and we were always over capacity because of the need. The other thing is because Tsow-Tun Le Lum is so culturally based — we have Elders that live in residence; we have cultural people that come in and do ceremonies and the teachings — many, many of our people want to come there. So we have a very good reputation.

Prior to First Nations Health Authority taking over…. Maybe two years ago they said to me: “You need to only service B.C. residents.” We used to service people right across Canada. Now it’s just B.C. residents and the Yukon. It’s because of the funding dollars. The federal government sends money to First Nations Health Authority. It’s for the province of B.C. Because we were taking people out of province, there weren’t beds for what we call B.C. residents, so they had to ask us to not do that.

First Nations Health Authority funds us for 20 of our beds. We’ve worked with Correctional Service Canada for many, many years. As you know, many of our people are in those institutions. I call them another residential school. So we work with…. We have a community liaison worker that goes into the federal prisons and helps to get people ready to come in. They have to go through a rigorous process, people that are in jail, in the federal jails, to come to Tsow-Tun Le Lum.

I just want to add this little tidbit. I don’t know how many years ago Correctional Service Canada did a study on Tsow-Tun Le Lum, so people would come in. Everyone coming out of the institution has to do our Thuy Na Mut program, even if they haven’t been using substances for a long time. That’s so they can get a really good, solid foundation.

Inside, you have to live a way different life than you do when you come out into society. So it’s to help them to get used to living in community, because we have community people that come in too. We would get them to do two of the Thuy Na Mut programs.

[9:25 a.m.]

The reason, too, is for the first one, they really, probably, weren’t taking in a lot of the content. They were just starting to build trust, to know that we really are who we say we are; that we’re good, caring, loving, kind people, and that our whole purpose is to help them be successful in what they do. Then they would go on and take the trauma program.

I think they looked at 115 people that had come through and done three programs with us. Out of that 115, I think 105 were very successful — had never gone back inside, had never committed another crime. So those are pretty high numbers.

People are always asking me how I measure success. I don’t measure it. I think our people need to measure it. I think they have to say how they did. I think if they can say their quality of life is better than when they walked in the doors, then I think that was successful. That’s what I believe. I think everyone has to take responsibility for their own healing. What we do at Tsow-Tun Le Lum is we are there to support them on that healing journey. I can’t heal anyone, and nobody can heal me, unfortunately. You know, that’s our personal journey.

For resources — we always need resources. What happens when people come in and have been using substances to cope with life? They’re not taking care of themselves, obviously. They’re not taking care of their well-being. How we see human beings…. Well, one of my Elders tells me that we’re spiritual beings having a human experience. But there’s the spiritual part. There’s the physical part. There’s the mental and the emotional part, and that has not been looked after.

When they come in and they start going into sobriety, what we see is a lot of physical ailments come up. Of course, there is spiritual, emotional and mental, but a lot of physical ailments. We have zero medical staff at Tsow-Tun Le Lum, so I’m working to try and get a nurse practitioner or a doctor into the new place so that we can have somebody there with that expertise. We’re not just dealing with people that are using substances. We’re dealing with people that have physical ailments. We’re dealing with people that have different mental diagnoses.

A lot of that, again, I think, is because of the trauma, but there are other things. People have schizophrenia. They have bipolar. I don’t even know what the labels are. But we at Tsow-Tun Le Lum do our best to treat everybody with love and care and kindness. I can’t say exactly the same, because we’re not all exactly the same. Everybody doesn’t fit in one little circle, so we do our best to treat each person respectfully and with kindness to help.

So the programs aren’t based on the steps. I’m finally getting to the programs. Probably the biggest work that we do in the Thuy Na Mut program is around the history of their using — not only their history, but what did they grow up with? What happened to them? How were they hurt by people’s use, and then how did they hurt people? And then what are they hoping for?

We have lots of ceremony around letting go. We have pipe ceremonies. We do something called brushings. Everything in this world is energy. There’s positive and negative energy. Myself, as a human being, I’m made up of positive and negative energy. Some of it comes from the outside. So when you walk into a room and there has been tension and you don’t know that…. Every one of us has the ability to feel that, and that can get stuck on us. It gets stuck on us. Then what happens within our own emotions?

What the medicine is able to do…. It’s like a magnet, and it’s collected with prayer and protocol. It’s returned to creation with prayer and protocol. What it does, with the work of your ancestors and the ancestors of the person doing the brushing, is they’re able to pull that off, and then those messages go up to creation.

I think that’s one of the pieces — that we’ve forgotten our ancestors. Well, I haven’t. But probably before I started doing this work, I had. We’ve forgotten our ancestors. We forgot that our ancestors want to help us, and that’s all of us. That’s all the people that call themselves Canadians, that have come from other lands and other territories. You guys all have ancestors, too, that are waiting for you to call on them to help you. I truly believe that from all that I’ve learned in my 60 years of life.

[9:30 a.m.]

About more money — how do we need more funding? When we were on the land that day…. I do get messages from the ancestors. We’ve always had a residential treatment centre, but we also have a huge cultural support team. It was started through the Indian residential schools settlement, and we have workers called resolution health support workers, and attached to that were cultural support workers. We got funding to hire one or two cultural support workers, but instead, because we had so many cultural workers attached to us, we decided to not hire one or two but do it on an honoraria system.

I probably have between 25 and 30 cultural workers, and we’re able to go out into community in five, six, seven different directions. As we speak today, they started doing the search on the Alberni Residential School. Two of my cultural workers are out there with a resolution health support worker and will be there for the ten days that they’re starting to do the searching.

So my vision was — it wasn’t mine; it was what came to me — that we need another building. We need another building so that people…. People have no place to go sometimes to have the brushings or the cultural work and the ceremony. We bring them into Tsow-Tun Le Lum, but we can’t bring them into the building because we have residents in there, and they need privacy.

We have this beautiful spiritual pond. Spiritual bathing is really, really important to us, especially to the Coast Salish people. We bring them out to this beautiful pond and do the work there. Well, that’s nice. It’s good if it’s…. Well, maybe it’s not even good on a day like today, because it might be way too hot. But if the weather is good, then it’s good.

I want another building where I can bring in individuals, families, community and organizations that will be able to utilize the cultural gifts that we have there — to be able to use the sweat ceremony, to be able to do pipe, to be able to have brushings — but also a place where we could do healing circles or grief and loss work. So I need that, plus I need money to finish the building that I’m working on.

N. Sharma (Chair): Okay. Nola, we have a whole bunch of us that want to be able to ask you questions and get as much as we can from you.

I’ll go on to Pam, and then we have Sonia, Trevor, and then Shirley and myself.

P. Alexis: Thank you so much. It’s been a privilege to be able to hear you speak. I think I’ll probably remember you forever, so thank you for that.

I was wondering if you could speak to the fact that more women are impacted with this horrible opioid crisis than men. Can you tell us a little bit more about that part, please?

N. Jeffrey: Well, I think that’s a good question. Maybe for Indigenous women, because of what’s happened with colonization…. I’m making this up as I go. This is what’s coming to me, so just know that I don’t have a definite answer of why this is happening. But I’m thinking that, with the patriarchal system…. Most of us were matrilineal. Most of us had a voice at one time. Most of us could speak up. Then with the adoption of band councils…. It’s not our system. It’s not the way that we operate. A lot of times the woman’s voice has been silenced.

There’s been lots of violence in our communities — tons and tons of violence. I remember when I was a kid, it was really normal. I don’t know if…. Back in the day, the women used to wear curlers in their hair — it was a thing — with their kerchiefs and black eyes. They’d walk around with black eyes. It was a normal, normal thing. It was just the way it was.

So lots of violence, but people are violent when they don’t feel very good about themselves, when they’ve been pushed down. They’re trying to have some kind of power, and unfortunately, that’s come out in the wrong way. Then you’ve got the trauma and all of that on top of it. So I think a lot of our women are using in isolation, and that’s why they’re dying from it.

S. Furstenau: Lovely to see you, Nola.

N. Jeffrey: Good to see you too.

[9:35 a.m.]

S. Furstenau: A couple of my questions have already been answered, but I want to expand on what Pam has asked about women and the background of residential schools, the Sixties Scoop. Something we’ve heard from a lot of presenters is the ongoing trauma that exists as MCFD continues to take children and babies.

Can you speak to how that, in the current day, is playing out in the work you’re doing and what you’re seeing and what we, as legislators, should be thinking about in terms of that perpetuation of this trauma that’s still happening now?

N. Jeffrey: It’s interesting. MCFD is doing this whole community engagement. I don’t know if you’re aware of it. I almost…. I’m such a…. I can exaggerate. I was going to say I almost fainted. They did a presentation, and they talked about the systematic racism. They talked about their policies, and they want to do better.

I kind of think it goes back to what I said. As Indigenous people, our children are the most important things to us. They are. Maybe this is true of all people. I’m not sure. But very much we look to those seven generations. We look forward, and we look backwards. Our kids are really, really our future.

It goes back to what I was talking about. Imagine somebody coming in and taking your children and your grandchildren, and you have zero power over it. There’s not one thing that you could do. I know myself. They’d have to kill me. Seriously.

But back then — you’ve got to go back — and what happened and how it got perpetuated…. This is my own belief. I’ve gone back to school. I’ve done First Nations studies. I’ve looked at the European and the colonial perspective and our perspective. I think one of the biggest things was the disease that came through and wiped out 90 percent of our population. That in itself devastated us. It had to have brought my ancestors to their knees.

And I go on. How did they go on? I don’t know how they did that. Then let’s put all the policy on top of that. Let’s put reserve systems on top of that. Let’s put getting….

When I was studying, I really looked at my own village, Lax Kw’alaams, and I looked at our hereditary system. Women and men both could be hereditary. I don’t even know if “Chiefs” is the right word, but that’s how they translate it. It was the person that took care of the tribe, the person that looked after the tribe, the person that made sure….

They didn’t do it alone. They did it with the women. The women had huge, strong voices. Even to this day, there are some women that could…. If the man is the one in the seat, they can derobe him if he’s not doing the job that he is supposed to be doing. Women had a lot of power, and their children were important. It was important to the whole community. It wasn’t how we see family now — mom, dad and the kids. We had huge, huge communities and tribes that were responsible.

Because we follow my mom, my uncle was…. He was a hereditary chief. His responsibility wasn’t to his children that he birthed. His responsibility was to his sister’s children. His responsibility was to make sure that we were looked after and that he taught us and raised us in the right way. So a little bit different, right? That was his responsibility. His wife’s children — it would have been her brother’s responsibility to look after those children.

Splitting up families is devastating. I don’t know if you were in here, Sonia, when I said that I have had many, many stories where parents and grandparents are scared to take their kids to the hospital. They’re scared that the kids are going to be apprehended, especially if the kids have had some kind of accident or something has gotten broken. They’re terrified to bring them in there, and honestly, they’re not treated well. That is the absolute truth. They are not treated well.

T. Halford: Thank you for taking the time with us today. I can’t overstate how important it is.

Just to pick up on the last two questions. A theme that we’ve heard quite a bit through the testimony is specifically on Indigenous women, who are disproportionately affected by this. We’re seeing it every month when we get the numbers from the coroner.

[9:40 a.m.]

I think a lot of us would agree that a lot of that, a vast majority, is due to trauma — trauma even with their own children, in terms of the fear. If they try and access support, they may have to do so independently, without their children.

We’ve heard from numerous presenters in terms of how we need to support women who choose to go into recovery with their children, and find ways to make sure that that is not a barrier, that they can access help and know that they can do that with their child or children, so they’re not in fear of when they get out that their reality is so much different than when they went in.

Just your thoughts on that in terms of the recovery process, doing that in partnership with the family, with your children.

N. Jeffrey: It’s funny. We had a three-week grief and loss group, and people came in. One of the mothers had to leave last Thursday because the ministry threatened to take her son. She had left her son in her brother’s care, but I don’t know why they weren’t happy with that situation. So we had to get her out on a plane and home so the ministry didn’t scoop her son. I just want to say, that stuff still…. Here she is, trying to work on healing herself and trying to do better, and she’s threatened with that.

I think family treatment is really important, but I also think individual treatment is really important. I’ve talked a lot with Lisa Robinson. She runs Kackaamin. Kackaamin is a family treatment centre. She feels like people need to come and do their individual work first and then come and do the family work, because they’re still in so much trauma, and then it’s really scary to heal. It’s really hard to heal.

Then, going back to the women, I talked about sexual abuse when I first started, and I said 100 percent of us have been impacted by it. I didn’t say because we were the victims. Sometimes it’s because we’re the perpetrator too. But 100 percent of us, I would say, have been impacted or have witnessed. A lot of women have been really badly sexually abused, and it’s hard to explain what that does to your spirit. It’s really, really hard to explain, and sometimes you have to cope again.

It’s going back to how we cope, and that’s what people are doing: using alcohol and drugs to cope, and other things. There are many other things. Like I told you, I cope by working. Even though I’ve done a lot of healing, I don’t know if that’s the trauma now, or if that’s just my drive to try and support as many people as I can, but I can’t stop. I can’t stop what I’m doing. People are scared I’m going to burn out, but I’m tough. Tough Tsimshian. I don’t know if that answers your question, but….

S. Bond (Deputy Chair): We appreciate meeting you and hearing you speak from your heart. That’s something that’s so important when we’re talking about this issue and others.

I just want to make sure I understand the sort of mechanics of the program. So it’s co-ed. It’s a co-ed program. You have 32 beds that are…. Are those full regularly, or is there a…?

N. Jeffrey: Pre-COVID — full to the rim. Now, for about a year, we did only ten beds, and we went online and did online programs. We have the support line, and then last August I thought: “You know what? Yes, people are dying from COVID, but not as many that are dying from the opioids and alcoholism and other things and accidents, because they’ve been using substances, and on and on.” So I opened up 20 beds. That’s going to stay as it is until….

We’re in our current location. We got an extension until December. We’ll run programs until December, and then we’ll move into the new facility, and hopefully, we’ll have that up and going by March, because it’s going to take us a while to move in and then learn how to operate the house, and then it will be 32 clients.

I didn’t finish saying — with the Kwunatsustul program, people need to be six months in sobriety because of the in-depth work that is done.

[9:45 a.m.]

We hope that they have really good support, whether that’s a counsellor or a psychologist or an Elder or whoever that can support them, because the healing journey…. It’s just one step in their healing, coming to our programs. It really, really is.

It is co-ed, and it is people that are coming from the federal institutions. We have a male and a female side in this place, but we also need those for people that are transgender or non-binary or gay or lesbian.

So in the new house, we did something called a bottom-up lean process. All of the staff, my cultural people and my board designed our house. I’m hoping we haven’t left anything unturned, but I think we haven’t. There are 16 rooms, but the two rooms at the very front of how it is — you guys should come see the new facility; you really should; it’s beautiful — they have their private little entrance. We figured that’s where people who don’t identify as male or female or don’t feel safe being on the male or female side of the house can be, right up in the front. There are four beds, one on each side.

S. Bond (Deputy Chair): My last question is about relationships in terms of the partners that you work with, because we’ve heard a lot about the fact that, you know, organizations tend to work on their own and there’s not a lot of cross-ministry, cross-organizational support.

I gather that you receive some of your funding from the First Nations Health Authority. Maybe just tell us a little bit about the working relationship with the First Nations Health Authority and also the Vancouver Island Health Authority more broadly. Are those positive? Do they honour the work? Are they looking at ways to replicate the kind of culturally embedded work that you’re doing?

N. Jeffrey: Well, I love the First Nations Health Authority. I have a very close working relationship with them. And, you know, they’re new. They’ve only been there since 2013, and they’re growing. And I would say they absolutely appreciate what Tsow-Tun Le Lum brings to community. They call on us to go…. I talked about our cultural team. So our cultural team gets called all the time to go…. Not just on Vancouver Island, but we get called off the Island all the time.

Community calls us in because…. I believe in something called blood memory, and they call it epigenetics. But I think, you know, there’s been lots passed down that is inside each of us. And the cultural work is, I don’t know, like eating dried fish. I don’t know how to explain it. It’s like eating our traditional foods. It just resonates. But you know what? It doesn’t just resonate with Indigenous people. It resonates with so many people that have had the opportunity to experience it.

We got called by FNHA, and they were doing a big conference with the Doctors of B.C., so there were doctors and psychologists — I don’t know; all kinds of people — there. We brought our cultural team, and people were blown away with what they experienced.

What I’ve always said to people is: “You don’t step off the cedar feeling worse than before you stepped on.” You always feel way better. You feel lighter. People have experience of connecting with their ancestors. We’ve had people who don’t speak their traditional language, while they’re getting a brushing, start speaking in their traditional language. Now, that’s blood memory. It has to be.

R. Leonard: Thank you for coming today and presenting. I appreciate you telling your story and really giving a frame of who you are and where you come from, and I think it’s important, probably, for all of us to know what we’re coming into the room with.

You’ve mentioned the two weeks’ requirement for sobriety, which gets waived, I’ll say. But you also mentioned six months’ sobriety to do the trauma work. One of the things that we’re looking at is safe supply, and I’m wondering where that fits into your program, if people are on maintenance programs. And I’m curious, too, because one of the things that we have been hearing about is how people come out of abstinence-based programs and then go back to using and die. I’m just wondering what your experience is with your….

[9:50 a.m.]

N. Jeffrey: That absolutely happens. We are abstinence-based, and that comes from a board level. They do know that there are other programs that support OAT therapy and other things. But people also die when they’re on OAT therapy. I just want to add that — and that they still use other drugs when they’re using methadone or Suboxone or Kadian or whatever it is that they’re using. Then people get stuck on using that. That ends up being it, and they have to go for their supplies. I don’t know if that’s really a fulsome life, but I guess it’s better than death. I’m going to also say that.

But I think there has to be more than that, so that’s what we’re hoping — that when people come to us, they can get connected to their culture. They can get connected to Creator and the ancestors. They can get connected to the land. Most importantly, they can get connected in here — that they know that they have value, that they have worth, that they have something to give, and that they’re able to receive and that they’re loved. I think that is the most important thing.

And, yes, we’ve lost people, but we’ve also had many people…. I have so many staff that walked through the doors as a client that are now working for us. All of us have to be alcohol- and drug- and substance-free to work at Tsow-Tun Le Lum — two years for some positions, three for others. We have to walk our talk. We have to be real. We have to be honest. We speak our truth.

We try to make sure that we’re all on the same playing field. Our analogy is that we’re in a canoe, and we’re all pulling together and that all of us have roles and responsibilities in that canoe. Sometimes it changes, right? Sometimes we take on a different place in that canoe. But if we don’t work together, if we don’t paddle together, we’re not going to go anywhere. That canoe is going to stand still. What we want in life is to be able to move forward so that there’s a better future for our children.

R. Leonard: I just want to acknowledge, too, that you said that out of 115, 105 of your clients have been successful in not going back inside. I think that’s a good number.

N. Jeffrey: I think so too. I’ve never…. I was just told about the…. I don’t even know what it’s called. It’s not a survey, but whatever they did to get those numbers, however they looked at it…. They’ve never given me a copy of the report, but they just told me about it.

R. Leonard: Do you have a follow-up program after people are finished with their residential programs?

N. Jeffrey: We do follow up. We phone call. We also give them the support-line phone number. The support line runs Monday to Friday, 8 a.m. to 8 p.m., and then on the weekends from ten to two, and people can call in, and they can connect with cultural support or counselling support. Ninety-seven….

I’m making up numbers, but my husband and I are the ones that answer the phone. It’s in my purse right now, so I hope it didn’t ring, because it’s on mute. But the majority of the people want cultural support, and many of our cultural support workers were in this field prior so that they have the counselling experience.

Also, all of my cultural workers have had trauma-informed training. They’ve had suicide training. They’ve had crisis debriefing training. Any kind…. The other thing is that when we train, we all train together. So whether you’re cooking, whether you’re cleaning, whether you’re the accountant…. It doesn’t matter what job you do. We all get the same training so that we try to be all on the same page.

N. Sharma (Chair): Okay. Thank you, Nola. I just have the final question from my side.

First, I just want to start by saying that I used to work for ten years with residential school survivors, and I remember that Tsow-Tun Le Lum was the place that a lot would find a lot of connection. There’s something about decolonizing what we think of as treatment and spirituality and a connection with the land that I think you offer that’s very beautiful. I just wanted to acknowledge that.

I was really curious to know where most of your referrals come from. What’s that source? Is it mostly just the Island? And then, also, the other kind of question to that is: are there any things in the rest…? One of our tasks is to think about the whole province and where people might go in northern or more remote parts of the province if they wanted some kind of healing, like your Tsow-Tun Le Lum offers.

[9:55 a.m.]

I’m curious if there’s a network somewhere of other healing centres or what that looks like for the rest of the province.

N. Jeffrey: There are nine healing centres that the First Nations Health Authority funds. There’s one in Kitwanga. There’s Round Lake. There’s Carrier-Sekani. There are three on the Island. There’s Tsow-Tun Le Lum, Kackaamin and ’Na̱mǥis. Who am I missing? I’m missing a few.

There are other healing centres, but there are really very few in the north. So our clients come from everywhere in this province — from the north, from the Interior, from the mainland. All five regions we get. Sometimes people don’t want to heal close to home, because their trust has been broken. There are trust issues, so sometimes they want to travel somewhere else.

Round Lake gets a lot of referrals too, and Round Lake has more beds than Tsow-Tun Le Lum does. They just do the substance misuse, whereas we do…. I think we’re the only ones that do a trauma program — solely a trauma. Others have trauma work mixed in. But I think we’re the only ones that offer a five-week trauma program.

N. Sharma (Chair): Well, I just want to say, on behalf of the committee, thank you for all that you do and all the work that I know that you’re hard at work doing — even on your phone ringing right now, you were saying — and the personal passion and commitment that you bring to that work.

I know we’ve all had a really powerful morning listening to you talk, so thanks for coming in.

N. Jeffrey: Thank you.

N. Sharma (Chair): We’re going to recess for four minutes, or three minutes, and try to start at ten.

The committee recessed from 9:57 a.m. to 10:03 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): It’s my pleasure to welcome our next speaker. We have Dr. Jaime Arredondo Sanchez Lira, who is a scientist at the Canada Research Chair in substance use and health systems. I want to welcome you on behalf of the committee.

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

We’ll just do a quick intro. We’ll go to our Deputy Chair.

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

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

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

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

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

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

D. Davies: Dan Davies, Peace River North. Welcome.

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

N. Sharma (Chair): Wonderful.

We have the materials that you sent in on our screens. You have about 15 minutes for the presentation, and the rest of the time will be for discussion and questions.

Over to you.

CANADA RESEARCH CHAIR IN
SUBSTANCE USE AND HEALTH SYSTEMS

J. Arredondo Sanchez Lira: Thank you so much.

Dear committee members, I want to thank you for the opportunity to talk this morning about an important issue around the overdose crisis and the illicit drug toxicity problem that affects our communities.

To begin with, I want to recognize that we are meeting today on the traditional, unceded territories of the Lək̓ʷəŋin̓əŋ-speaking peoples, including the Songhees, Esquimalt and W̱SÁNEĆ people.

I would also like to acknowledge that while I’m a user of substances, I have never personally experienced the long-lasting consequences of marginalization and discrimination because of the current international drug criminalization system. However, as a Mexican citizen, I have seen firsthand the consequences of the war on drugs while living and doing research in the border area of the United States and Mexico, as well as in Canada.

[10:05 a.m.]

My name is Jaime Arredondo Sanchez Lira. I’m a doctor in public health, and since 2010, I have worked as a researcher and an activist around harm reduction topics in North America. I am currently the Canada Research Chair in substance use and health systems at the Canadian Institute of Substance Use Research, CISUR, at the University of Victoria, and an assistant professor at the School of Public Health and Social Policy.

Due to my previous government work in public safety in Mexico, I have focused part of my research on police and public practice topics, understanding the consequences of decriminalization reforms and providing training for police officers that could help align the goals of public safety and public health. In 2015, I helped implement occupational safety and harm reduction training directed to reduce accidental needle-stick injuries among police officers in the city of Tijuana, Mexico.

A second area of expertise I work in involves the implementation of evidence-based interventions such as community drug checking, safe consumption site services and overdose prevention programs. In 2018, I became one of the members of a team led by the BCCSU that helped implement a drug-checking pilot program centred around the detection of fentanyl using community drug-checking tools, new tools, across the entire province. With the knowledge gained from this experience, I was able to implement the first fentanyl detection program in Mexico, documenting the introduction of the illegal opiate in the street drug supply south of the border.

I’m also a member of the team that has implemented the first safe consumption site in Latin America. It is directed only for women, and it has been using, as a reference, many of the models that have been implemented here in British Columbia.

The increase of toxicity and the overdose epidemic in British Columbia is a complex issue, and many of your previous speakers have already addressed some of what I consider important elements. I would like to emphasize the need for housing as a harm reduction strategy, the implementation of non-medicalized safe supply, the increased availability of smoking facilities in our communities, exploring psychedelic therapy for addressing substance use disorders, and recognizing that more actions are needed to expand services for Indigenous populations in B.C.

For this reason, I would like to focus my testimony on three main topics that I believe need additional clarification. I’m happy to talk about these and other issues during the question-and-answer section of my talk.

To begin with, I would like to address the role that B.C.’s illegal market, of the opioids market, plays on the international political economy of drugs. It was here in B.C. — in particular, in Vancouver — that we first started detecting the adulteration of the drug supply with illicit manufactured fentanyl. This trend has now become the norm along the North American region, as the Mexican drug-trafficking organizations have now modified their illegal supply to satisfy the demand both in Canada and the United States.

Similarly, in early 2019, we started identifying, through the drug-checking programs, benzodiazepines in the street supply in British Columbia, another trend that has now become regular in places like the United States. It will not take long until international drug cartels adapt their products to satisfy this new reality.

These two examples are an indication of how B.C. should be seen as an early warning system for understanding the drug supply trends in North America. Also, it’s an indication that we should collaborate with other regions to create an international toxicity monitoring system using similar technologies and procedures.

This leads me to my second topic, the relevance of funding drug-checking services not only across the province but also sharing our findings and lessons with other places around North America. It was thanks to the funding provided by the federal and provincial governments, and collaborations with the drug analysis services of Health Canada, that we were able to adapt technologies used traditionally for music festivals and nightlife settings into spaces such as overdose consumption sites.

These programs allow not only the empowerment of people who use drugs, but they also provide a vital tool for public health organizations to help implement toxicity monitoring systems and overdose prevention strategies, resulting in the rollout of naloxone or new protocols for addressing overdoses where benzodiazepines are mixed with opiates.

[10:10 a.m.]

The lessons learned from B.C. programs are currently being implemented across the United States and Mexico, with more than a dozen community programs adopting the same infrared technology in their cities. For example, Victoria is home to what I consider now the gold-standard service for community drug checking in the world.

Substance is a program led by the University of Victoria researchers Bruce Wallace and Dennis Hore and offers a unique opportunity for other places to learn from their experience. Its sophisticated technologies might allow for people to dose better, reducing the risk of accidental overdose and understanding the finer details such as the concentration of fentanyl in the local drug supply.

In this sense, the implementation of B.C. drug-checking programs has created an opportunity to generate national and international monetary assistance to prevent future toxicity crises that might still be on the horizon. Helping programs outside Canada is also beneficial for B.C., since drug trends that might be detected south of the border have the potential to reach out to our communities.

Finally, while drug-checking programs have provided an opportunity to learn from other countries, B.C. has a lot to learn from decriminalization stories abroad. While decriminalization is a necessary condition — but not a sufficient condition in itself — for addressing the overdose crisis, we are faced now with the challenge to create a system that takes the best practices from other places while, at the same time, avoiding their mistakes.

For example, in 2009, Mexico tried to adapt the notion of decriminalization from the Portuguese model. However, we can now say that it was a failed reform, as it continued to involve the justice system in the proceeding of people and it introduced extremely low limits for personal possession that, de facto, continued to criminalize personal possession. The magnitude of this failure can be seen by the recent decision by the Mexican Supreme Court that deemed as unconstitutional this orientation table and mandated that each case should consider other circumstances beyond personal possession limits.

As B.C. has expressed the idea of setting the personal limit at around 2.5 grams, maybe we should explore other possibilities like the Portuguese model, where they use the daily amounts only on a ten-day-period basis. So for example, this would result in 25 grams for personal possession in the new B.C. model.

Also, we need to remember that the law on the books does not always translate to the law on the streets, and decriminalization efforts need to be complemented with the training of police officers and other operators of the system. Once again, for example, five years after the Mexican reform, only 8 percent of police officers in the city of Tijuana, Mexico, knew the limits for personal possession.

We need to include funding and programs that help police officers understand the benefits of decriminalization changes, emphasizing the benefits for public safety and their own occupational health but, above all, of the health and well-being of people who use substances in our communities.

I would like to finish my opening remarks with an additional reflection. While the actions that the B.C. assembly might take will directly have impact in our communities on the Island and other areas of the province, all the innovative harm reduction information or efforts applied in B.C. have positive externalities both for provinces in Canada and for places like the United States and Mexico.

We are not three countries apart from each other. We are interconnected through a free trade agreement and cultural connections. Harm reduction practitioners from New York to San Diego and from Mexico City to Tijuana have come to B.C. to learn the best practices to address similar problems in their communities.

I encourage you all to continue expanding funding for this community intervention and to consider ways to expand knowledge exchange between cities that face similar problems. Only through joint efforts could we declare a common end to the war on drugs and help improve the lives of people who use substances in our three countries.

[10:15 a.m.]

With that, I’m thankful for the opportunity to provide my testimony, and I’m happy to answer your questions.

N. Sharma (Chair): Thank you very much. Colleagues, questions?

Okay, maybe I’ll get us going. You said a lot of things that were very interesting, but the thing at the top that I was struck by was not only that people are coming to B.C. to learn about best practices but that B.C. is an early warning system — that we detected the fentanyl, and then it started to be the norm from the illicit suppliers in Mexico.

Why is that? Like, what’s happening between the drug supply that makes B.C. a kind of early warning system?

J. Arredondo Sanchez Lira: Well, I think B.C. and Vancouver have a long history of substance use. I think the place, on the port and on the Pacific Ocean, kind of creates this natural first point of entry for new trends. Obviously, it’s the inability to grow, for example, opium in our communities or to provide it in a safe supply way that has led criminal organizations to find ways to substitute what otherwise might have been heroin with, now, illicit manufactured fentanyl into our street supply.

This was taken notice of by other crime organizations throughout North America. That led the criminal organizations in Mexico to start substituting heroin manufacturing — poppy plantations throughout the south of Mexico — and to now transition more into bringing over, for example, the chemicals to produce fentanyl in laboratories in Mexico and then send it over to both the United States and Canada.

It is also interesting, for example, to see the case of benzodiazepines, because really, this was the first place where we started noticing it. As a personal history, I was part of the team that implemented the drug-checking pilot. I remember well one person who came over to our service.

He came to tell us that he had never used benzodiazepines. However, in their urine drug-testing results, it came out positive, so he was wondering what was happening. When he sent out the sample for our testing and then we were able to do confirmatory testing with the drug analysis laboratory of Health Canada, we were able to say, for the first time, that benzodiazepines were actually being introduced into the streets of British Columbia. Now we’ve seen that same trend appear in some cities in the United States.

So it’s a complex issue, I guess — like I said, part of being in the port and being close to China and India and other places that might bring the chemicals. That is what could be creating this phenomenon of B.C. as the first case of seeing new drug trends that might be replicated in other places.

However, like I mentioned before, it could be also seen in the opposite way. Maybe other drug cartels might be trying to introduce new substances. While they adapted in places of production — in Mexico, for example, in Columbia, with cocaine — we might see them in the future here in B.C.

P. Alexis: Can you go over again what’s happening in Mexico with respect to decrim, with the model in Portugal in mind? Can you just explain that one more time? I’m not exactly sure that I understand all of it. So if you could just go through what exactly is being proposed — a description of the model from Portugal that they’re looking at in Mexico.

J. Arredondo Sanchez Lira: When we talk about decriminalization, most people will refer to Portugal as the perfect example of where we will want to go, even though the Portugal model also has some limitations. Portugal started decriminalization first in 2002. And then in 2005, Mexico tried to experiment with the first decriminalization reform. It was a funny story where the president in that moment sent a law to congress, the congress passed it, and then the United States — in that moment, President George Bush — complained, because media said that drugs were being legalized in Mexico, and the president vetoed the same law.

It moved several years later on into 2009. Then they created this kind of hybrid model, where they set up a table in the general health law including several substances that were decriminalized, using that same model from Portugal.

[10:20 a.m.]

You’ve seen the Portugal law. You have a list of substances and quantities for substances, right? Mexico introduced something similar to that. We introduced one table that decriminalized marijuana, MDMA, opium, heroin, but the limits were set up too low. For example, for heroin possession, it was 0.5 milligrams. For marijuana possession, it was five grams. For MDMA, or methamphetamines, it was one pill. This was really low on the threshold.

The idea that Mexico took with this was because, really, in theory, since the ’80s, personal possession was kind of decriminalized if you were deemed a regular consumer of substances. You would have to go to a judge, and then you would have to go through an entire process, and then you would have to be having a substance use disorder in order not to be sent to jail.

Some people thought that by having these limits, there was now not too much space for corruption because, generally, what would happen is you couldn’t be sent up to the police and then extort your way out, offer someone $100 to say: “Well, he doesn’t have anything. He’s ready to go.” So they thought that by setting up these limits, we could curtail corruption.

The problem is that those limits were really not set up in accordance with the experiences of people who use substances. It was basically done by people in Mexico City — experts such as myself, but not really experts with lived experience, who understood what the needs were for people who really consume day by day.

So what we face now is that the limits are so low that you are de facto criminalizing all possession, because when someone is being stopped by a police officer, really, you have so much more. When you go and are trying to buy from someone, there’s currently no way that you could apply through the process of the law.

Then they also introduced some other examples that probably were taken from the United States. There was the three-strikes rule. They said that according to the law, if you were found under that same circumstance for the third time, being arrested and found with the drugs, then treatment should be mandatory. But there’s nothing in the law stating what kind of treatment or who should be doing that process.

Also, when the Mexican Congress passed this law — this was set up in 2009 — they set out three years for making all the changes to police officers, to the judicial system, to the health system. But as many cases happened with law changes, they didn’t set up any funds in order to implement these changes. This is why, for example, in 2015, we did research with police officers in the city of Tijuana. We interviewed almost 2,000 police officers, close to 95 percent of the police force in the city of Tijuana, and we found that less than 8 percent of them knew exactly the limits around heroin, cocaine, methamphetamines and marijuana.

That’s why I was emphasizing that in any change that might be passed here in B.C., we need to remember that the law itself is not implemented just by goodwill, but we need to set up mechanisms of training that will address these issues. Hopefully, I was able to set it out a little more clearly.

P. Alexis: Thank you. If I could, just as a follow-up. We did have the head of the police chiefs association give us the actual stats about how many people had been charged over the last, say, five years for possession of this amount. We see less and less cases in the last two years in particular, so I think we’re already there. I just wanted to say that if you listen to some of our testimonies that we’ve heard, you’ll hear that as well — that it’s not as big an issue as, perhaps, other people may think. We heard the numbers.

J. Arredondo Sanchez Lira: I was able to read some of the transcripts, and I think I saw one of the testimonies. While people are not getting arrested, they are indeed getting their drugs confiscated on some occasions. This also creates a disruption in the lives of people who use substances.

P. Alexis: Of course.

[10:25 a.m.]

J. Arredondo Sanchez Lira: We’ve seen this example in places where we conduct drug checking, where people might be afraid. They might not be arrested, but if they’re getting their substances confiscated, it still provides a risk for them.

Decriminalization is not only the fact of not sending people to jail but finding ways to disrupt their lives the least possible. In this sense, by confiscating their substances, you are creating a big problem, because they are going to have to try to find some other source of substances. They might be at risk because the substance that they had might have already been tested. Since it got confiscated, they might have to jump out to whatever is next available.

Also, decriminalization might offer a possibility of not having to contact police, for people who use substances. This is one of the big things that we need to address in the Portuguese model. Really, the entire part of decriminalization is being handled by health professionals and not really by the judicial system or the police. It makes the whole difference for a person to have contact with police officers versus social workers or health workers. Those are kind of the final details.

There’s a researcher that says that, really, the devil is in the details. Unfortunately in the case of decriminalization, once you pass a law, I think it’s more difficult to go back and try to change it. These changes in law…. The status quo is not flexible. It will take years before you decide to open up the law again and address the shortcomings.

That’s why I think it’s important to take the time and hear from the people who will be affected — not only from police officers and public health officials but, above all, people with lived experience — to address these issues from the start and not have to revisit the law a couple of years into the future.

M. Starchuk: Thank you for your presentation. I have two questions. I’ll ask the first one, and we’ll wait for the second one. It goes around drug testing. We’ve heard it a number of times — where the user doesn’t want to give up a portion of their drug for the testing. They want it all for themselves, and they want anonymity. That happens with that as well.

Inside of your presentation, you had mentioned large-scale events where you have drug testing that’s there. Can you explain that a little bit further? I think about an event that happened in my community last weekend, where there would have been 20,000 or 30,000 young people entering into there. The ability to test a drug may create a longer lineup, and people just go: “I’m not going.” It just takes too long. Just a little bit on what your experience with that is and the amount of the substance that’s actually having to be given up by the user themselves.

J. Arredondo Sanchez Lira: Sure, thank you for your question. I think it’s really important.

I would like to first try to address the technology that we’re using. Once again, B.C. being a pilot, we first started seeing, with the introduction of fentanyl…. Probably you’ve seen the fentanyl testing strips. These are really easy tools to use. Interestingly enough, it’s a Canadian company, and that company is now selling those fentanyl testing strips along North America. They have become a staple for harm reduction services in the United States, Canada, Mexico and other places even around the world.

You don’t really need, for example, for those testing strips, a lot of the substance. In the research that I have conducted down in Mexico, we use even the paper wrapping that comes around the substance. The sensitivity of the test is so high that we really only need something that has been touching the substance to try to understand if fentanyl was present.

For example, precisely to minimize people not being willing to test their substance because they might be losing something, you can tell them: “I might just test the wrapper that is wrapped around, and that will be enough to understand if it has fentanyl or not.” This is an advantage.

Also, it’s an advantage because…. For example, cocaine might have been in close proximity to fentanyl, and might test false positive for fentanyl in this case, if it was really just touching around, since drug suppliers might not really be keeping their scales clean all of the time. For this reason, we also moved into this pilot drug-checking program, into more advanced technologies. This was done in part with the collaboration of organizations which provide services at electronic music festivals throughout the province.

[10:30 a.m.]

I will be having the opportunity to actually volunteer and do some work on this next week at the festival of Shambhala with ANKORS and other people in Interior Health. We published, just a month ago, a report around the detection of drugs at music festivals in 2019, before the start of the pandemic. The innovation is that we have now implemented a technology, which is infrared spectrometry.

What infrared spectrometry is, is that…. I put it, usually, as like a prism. I don’t know if you remember from school. When you put a crystal through it…. You pass a laser light into it, and in spectrometry, you have the spectra of the substance, so you can see exactly what the main components are of this substance. Also, one big advantage of this is that you can see or approximate the concentration of an active substance. This is what led to a really big quality jump in drug-checking services in B.C.

We use these machines. Probably you have seen them in some places around. They are able to provide results in less than 15 minutes. The really interesting part of it is that you don’t really need to dispose of the substance. You can give the substance back to the person. You only need around the size of a grain of salt, which is really extremely low, compared to what people will have to use for personal consumption.

In my personal experience, and seeing the implementation of this program, both in festival settings and in overdose prevention sites, people are willing to give up just a tiny amount of their substance. Even the technicians who are conducting this test make the most out of the work and try to give back most of the sample to the person.

Perhaps, yes, indeed, there might be a limitation at the festival since you have limited capacity. Some people might be discouraged by seeing a long line before using the service. But this is where providing the service in other community settings — like having it here, for example, at Substance in Victoria or other places in the Interior or getting your drug tested in Vancouver — is where people can plan ahead. If they’re going to use their substances at parties or nightlife, they can go before time to avoid doing the line during the festival.

Actually, we encourage people: if they’re planning to use the substance, then they should test it beforehand to know what they’re using. That’s one of the other technologies that we are using.

Finally, there are sites, like here, at Substance, that are using mass spectrometry, which is usually a technology that you can only find in big laboratories like the drug national laboratory of DAS, of Health Canada. You have the ability to, even with a finer detail, detect really extremely low levels of concentration.

What is interesting with these efforts is that now we can see, for example, in the local opiates, the average concentration of fentanyl. We can see…. Someone comes in. We see that they have a 20 percent concentration of fentanyl. Maybe they know that it’s an extremely high concentration, and then they will be tampering or sharing it with other people. Or maybe the market can now adjust itself to what will be “a safer level” of fentanyl concentration, where we can minimize the overdose rates for people who are using these substances on the streets.

S. Bond (Deputy Chair): Thank you for your work and your presentation. I’m going to ask some questions about drug testing as well. I think that it’s one thing to develop a technology and to pilot that. It’s another thing to move that into, in essence, what is commercialization of that knowledge, that technology.

You commented on the fact that British Columbia has, in your mind, the gold standard service for community drug checking. You referenced a program called Substance. One of the things we’ve heard consistently is that there is no…. Depending upon where you live, drug testing is not available. It is infrequently available. It’s inconsistent.

[10:35 a.m.]

We have knowledge. We have that side of the equation. How do we expand that process so that the average person sitting in Smithers, B.C., has the opportunity to have the same sort of option?

I guess my second question is: you’ve mentioned that other…. Just as a sidebar, I’m assuming you can also detect benzodiazepines when you are using the drug-testing technology, if you could clarify that for me. We were talking about the construction industry, for example, which is an incredibly challenging demographic — mostly young males, who are in the demographic we’re losing in this province: young males using alone.

How do you move from a technology that looks at testing drugs at a music festival to testing drugs when you’re thinking about using at home, in your residence, or when you’re using in a hotel room in Victoria? How do we move the technology, how does it emerge to become more personally available, and how do we deal with current inconsistency in our province in terms of availability of drug testing broadly?

J. Arredondo Sanchez Lira: Thank you so much for your question, an important question itself.

Well, for the first one, it’s interesting. We need to remember that many of these interventions are also, yes, innovations in B.C. and North America, but they have been around for more than 30 years in Europe. For example, these drug-checking interventions started in the ’90s in places like the Netherlands, both Germany and England, and other places where yes, it was geared towards more of a nightlife setting.

For example, if you arrived in Amsterdam — many years ago I had the opportunity — the first time that you got down from the train there was a sign posted by the health ministry of Amsterdam, of the municipality, where it mentioned that they had detected that a batch of cocaine was adulterated with heroin and was causing overdoses. They had public signs reminding people that there were risks, because we had detected this on the streets of Amsterdam.

That technology had been used for, like I said, many decades in this nightlife setting. It had been adapted in places and festivals in B.C. But the innovation that we have done now in British Columbia is precisely how to jump an intervention that was geared towards a particular nightlife setting of youth into more of a street-based substance use kind of population, right? That was kind of the uniqueness of the pilot that we did in B.C., and that’s what is now being replicated in places in the United States.

The idea behind it was to be able to provide these services at safe consumption sites. We started providing it, for example, at Insite, in other places like MOPS overdose prevention and the Overdose Prevention Society.

Then other organizations starting providing it as well — for example, Get Your Drugs Tested, which is a privately financed drug-checking service. But Dana Larsen provides the service in a unique way that maybe helps address some of these shortcomings that you were mentioning. For example, we could let up people to send their substances…. The way they happen right now, they send their substances by mail to Get Your Drugs Tested, and they provide the service. Then they get a number, and they can check what the result was from this testing.

We can also do what they’ve done, for example, in Amsterdam, which is have some places where you can drop the sample in government-authorized sites. Then we send it over to places — that concentrates this capacity-building for drug checking — and provide the results through a text message or, like Substance does today, through a web-based page, where you have a code and then you input it and then you can get your individualized result.

Indeed, we are faced with a capacity constraint, because the technology is only part of the solution. Yes, we can have the best technology, but we need to remember that we need to have the staff that does the correct reading of these machines. It might be also irresponsible to give a tool to a person who has not the proper training to conduct these life-and-death decisions.

[10:40 a.m.]

What we have created in the province, I think, is a unique model for training for people who are conducting drug checking across several cities. We have also created parallel knowledge, opportunities of knowledge exchange between drug checkers from the Interior. They can now, for example, talk to people on the Island, and then if they see a weird reading, they could get in touch through WhatsApp or other means of communication and say: “I have a question. I just came across this sample. I think it looks weird. Could you take a second eye?”

Unfortunately, one thing that we have…. Right now we have the spectrometers. There are, I would say, more than ten spectrometers in the province probably. But we don’t have more sophisticated tools like the mass spectrometry that Substance has or the ability of some organizations in Vancouver to send their samples for confirmatory testing to the drug analysis substance, DAS, laboratory of Health Canada.

We should try to create more connections between these community organizations and the DAS laboratories to send their confirmatory testing, and that can only happen through increased funding so they can process additional samples, but also maybe explore these new technologies and replicate this Substance level in other places — have one, for example, in the Interior, have one in the northern territories and perhaps creating these hubs of more high-tech, concentrated technologies where we can conduct this more in-depth testing that then can allow for the communities to provide these services.

Now, we also need to take into account that testing, like I said, is only one part. It’s also, as in many other harm reduction interventions such as needle exchange or safe consumption sites, just one more tool in the toolbox that will allow us to bring the person in contact with someone that can provide some orientation about other places or other circumstances that might be affecting their lives.

In this sense, for example, drug checking might help out a person to come over to an organization, and in that time at that organization, a social worker or a peer experienced person can say: “How can I help you?” Maybe in that moment of contact, that person can make a life-changing decision and decide that they want to stop using substances, and then they have that contact with the person to provide an orientation into other treatment facilities or opioid substitution alternatives or other opportunities to reduce their substance use disorder if they wish to do so.

Finally, I wanted to address the question on the benzodiazepines. Unfortunately, we’re still struggling to find the best technology to detect them. We do have some testing strips designed specifically for benzodiazepine, but there are several variations of benzodiazepines that are present in our local drug supply. So they might miss some of those benzos in the drug supply.

This is where we need additional technology that maybe an experienced technician might be able to detect with the infrared spectrometry. But, really, with the mass spectrometry, that will be the certainty we will find of knowing that we detected benzodiazepines into their sample. So it’s a combination of both more advanced technology and better training of people to handle these technologies.

D. Routley: Here we have, maybe, pressure from the police to keep the personal limits down. The measures that were taken in Mexico kept them down to keep the limits low in relation to possible corruption. Then there’s the reactionary response from some people in our society to any notion of decriminalization. Are we sort of keeping those opinions tamped down or giving them satisfaction? We’re only allowing this tiny amount.

[10:45 a.m.]

All of those add up to this circumstance that you describe. What would be your recommendation for personal amounts and how to establish them?

J. Arredondo Sanchez Lira: Well, I’ve read many of these transcripts, and I think several people have described, from the BCCSU and other research projects, really higher limits that are more adjusted to what the daily intakes of people who use substances have indicated.

I think that we need to remind police officers that decriminalization can also work in their advantage. One of the ideas behind decriminalization is that then we can dedicate the police force to do other, more important issues — to address issues of violence in the community rather than just prosecuting someone who is really using a substance for their personal consumption.

The limit is never an easy answer. In the way that Portugal…. If you analyzed the law in Portugal, the limits are extremely, extremely low. They’re 0.1 grams, I think, of heroin and 0.2 of methamphetamine. This is why they introduced that as a daily limit. But really, what they understood is how much a person will be carrying with them for a couple of days.

In this sense, perhaps, if we are set in stone on the 2.5 grams, maybe, yes, use that as a metric of how many days does a person need for their personal consumption. So we can still get stuck on this 2.5, but not use it as a one-day metric. Use it, as in the Portuguese model, as a ten-day supply, and this will lead us kind of to the 25 grams that is approximate to what the other researchers have expressed to this committee.

I think that could be, perhaps, a compromise between what is already kind of set in stone and some wiggle room to be decided — to be three days, seven-day supply, five-day supply, ten-day supply. We can start that discussion. So then we have a higher limit than the one that is being set up right now.

But yes, there is no easy answer on the limit question. I’ve asked, on occasions, in Mexico or even in Portugal, and sometimes it’s like a black box where no one really knows where the magic number came from, but it’s set already in the law.

Yes, it is important to focus on that. But perhaps if we are set up on the 2.5, like I mentioned, let’s take it over not only as a one day but as several days. Multiply that by three, five, seven, ten — whatever we decide to. So we give ourselves a little more wiggle room and not set low standards for the decriminalization limits.

D. Routley: Very quickly, is there any place that you know of where the limits are different based on geography? We’ve heard in the North it would be very difficult, as compared to in Vancouver.

J. Arredondo Sanchez Lira: Well, unfortunately, I think that when we are setting laws…. I used to work, for many years…. I was in the Mexican Congress, in my youth, and then during my time in government as well. There’s no easy compromise. When you’re trying to satisfy one region, there will be another one who will always complain.

Then I think that creating geographic differences within the province will create a quagmire, because what if you happen to be in the border between two of the regions? Just by happening from one street, or one kilometre to another, will I be judged differently? I think it creates more complexities than what we really need.

I think that the law and the changes that we set up needs to be clear and easy to be understandable by all the actors in the system, because the more complexity that we introduce, the more difficulties we have to reap up the benefits of passing decriminalization into the province.

N. Sharma (Chair): Jaime, I have three more people that want to ask you questions, and we have maybe about 12-something minutes left. So let’s try to see if we can get them all.

R. Leonard: Thank you for presenting. I really appreciate — I think we all appreciate — your international perspective when bringing this forward.

I’m struggling on the issue around the drug testing, because we’ve heard from folks about who uses the drug testing. In the Downtown Eastside, for instance, 80 percent of drug dealers are survival dealers, and they’re using it to help make sure that their product is more saleable.

[10:50 a.m.]

Then you talk about recreational users. We’ve heard from all sides about either the timing of waiting for a result and that that’s unacceptable, etc. I won’t go any further on that, but what comes to mind is that there’s a…. The question I ask a number of people is: if you had a dollar to spend, would you spend it on drug testing, or would you spend it on safe supply?

J. Arredondo Sanchez Lira: That’s a really good question. If I had a dollar, I would split it in half.

R. Leonard: So it’s equal.

J. Arredondo Sanchez Lira: Well, safe supply is the road to go ahead. If we want to have long-lasting results into addressing the opioid epidemic, we really need to look into ways that address this phenomenon. Once again, for example, let’s remind ourselves — in Europe, a heroin maintenance program has been set up since the 80s. We are just barely talking about here, five, six years ago, even more recently, with examples like DULF or other examples led by the BCCSU or other government institutions.

Unfortunately, it’s one of those cases where safe supply is the final goal. While we get there, we still need these other services, right? Let’s say, for example, that we address safe supply and we tackle issues like methamphetamine, heroin and cocaine. If we can set out, for example, an international agreement now that there’s going to be a leftist government in Colombia…. They’re opening and they have been setting up laws regarding setting up international trade of cocaine. It’s something that is on the foreseeable, possible alternative in Colombia, but while that happens, people are still using substances.

So, unfortunately, we still need those drug-checking services to keep people safe while we achieve that goal. So if you put me into that position, I will have to say that we need them both before we reach the goal that we decide.

S. Furstenau: Thank you very much for the presentation. I want to go a little further into the safe supply question and the international drug market and the illegal aspect of it. If you could provide us some insight into how much safe supply could make a dent in that aspect of the illicit drug trade and the crime and violence that comes along with that.

J. Arredondo Sanchez Lira: That’s a problem that I have also talked about with people who are proposing safe supply initiatives here. It’s to try to see the big picture. For me, as a Mexican, I take particular interest in drug policy, because I’ve seen the effects. My country, in the last three years, has seen around 120,000 people dead. The city of Tijuana, where I conduct my research…. I live partially there. Almost the same amount of deaths — 2,000 homicides, which was close to the people who died of overdose in the province, in British Columbia. So for me, it’s a personal topic when I address this.

How and why should we address this? Well, like I was mentioning, there will be positive externalities of things that we address here. What I mean by positive externalities is the benefits that are additional to what we have here in B.C. from measures that we undertake. A positive externality perhaps could be the reduction of demand of drugs from Canada. If we could set up a safe supply model here that will be less dependent on the international drug trade, that will create less incentives for producing countries and for organized crime to tackle or to provide these substances, and this violence generated by these substances….

So by creating a safe supply model in B.C., but also in Canada and, hopefully, in North America, then we’ll be having less incentives for organized crime to continue doing violence and the production of substances in places like Mexico or Colombia or other places around. Unfortunately, I don’t see an easy answer right now, because the drug crimes organizations have evolved, and it’s not only now a drug trafficking organization. They are involved with human smuggling. They’re involved with racketeering and other illicit activities.

[10:55 a.m.]

We’ll be making one dent into their margins of profits, but not completely cancelling all the other sources of profit that are still benefiting from their crimes right now, their profits right now. We’ll be making a dent. I think that’s something that we need to consider: it is not a silver bullet, and it will not solve all the problems associated with organized crime, but perhaps it will address one part of it.

That’s the way we should go. We should tackle one part at a time, following the harm reduction mantra: let’s take one issue at hand. Let’s take what is the low-hanging fruit, and then we can reap it up and take care of the rest of the tree.

M. Starchuk: Just one quick question with regards to testing and mass spectrometry. We know that some people, when they go into a supervised consumption site, are not going to wait around for 15 minutes. They’re walking in there, and they want to get their substance into their system right away. Has there been any thought with regards to locating one of the machines in a supervised consumption site and testing the product after?

J. Arredondo Sanchez Lira: When we were doing that pilot at Insite, we had exactly that problem, and, particularly, we were able to spend many hours with our technicians in that situation. It comes back to your previous questions, where we have suppliers in the Downtown Eastside who would also want to test their products so that they themselves don’t die or so that the persons that they share them with don’t die as well.

When we are in a safe injection facility or a safe consumption site, time is limited, in the sense that there’s not too much space. There are other, chaotic things happening at the same time — perhaps addressing an overdose. There’s limited space, and with COVID, it became extremely difficult to try to have people inside to wait for these services.

I think the challenge is to be able to provide the services not only there…. If we had the mass spectrometry, yes, it would be beneficial. But providing it in other places where people can then test their substance before using, without having to wait those 15, 20 minutes, it might be able to impact the risk to their lives. It would be a better situation.

Right now, for example, Substance’s setting is around other community services. You have SAFER in there; you have SOLID on the top. It’s a community hub that can then allow people, before they go to an overdose prevention site, to use. When they come over, they can test their samples. But while we would like to see these mass spectrometry tools being set up in overdose prevention sites, I don’t see one particular space that might be able to handle it with the amount of traffic, the high level of demand for the service, that we have.

Right now you have the staff dedicated to many other activities. Then asking them also — while they are safely supervising someone, are responding to an overdose or even directing someone to overdose treatment — to provide this additional service, it gets complicated. Not every site will be able to do it. That’s why I think we need to have them in other places as well.

N. Sharma (Chair): Thanks so much for coming today. On behalf of the committee, I just want to thank you, not only for the presentation that you provided but for the international lens that you put to the whole conversation, with your experience about the other side of the crisis in Tijuana, where you do your research, and what’s happening here. I think that was definitely a different perspective that we hadn’t heard yet, and we really appreciate that.

J. Arredondo Sanchez Lira: Thanks to all of you for your questions. I’m happy to talk more about these and other issues outside of the select committee. Thank you for listening. I think it’s an important topic, and I’m always happy to provide that perspective.

When I first was invited, I felt that maybe I was a little bit out of place after seeing all the amazing people who were joining you. But I realized that trying to understand what is happening not only outside of B.C. but outside of Canada and to play the role that we play in this international drug trade setting is really important, both for the communities in the producing countries and for the country here, for the communities here on the Island and in the province as well. Thank you so much.

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

Committee…. Are we going to recess?

Interjection.

N. Sharma (Chair): Okay. Maybe we’ll give everybody a couple of minutes, and we’ll come back at 11:05. That’s a recess, for the record.

The committee recessed from 11 a.m. to 11:06 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): On behalf of the committee, I’d like to welcome our next speaker, Vancouver Island Construction Association. We have Rory Kulmala, chief executive officer.

Welcome.

My name is Niki Sharma. I’m the Chair of the committee and the MLA for Vancouver-Hastings. We’ll just do a quick go-around so you know who’s here.

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

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

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

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

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

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

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

N. Sharma (Chair): Great.

We have 15 minutes for your presentation and then about 45 minutes for questions and discussion.

Over to you.

VANCOUVER ISLAND
CONSTRUCTION ASSOCIATION

R. Kulmala: Well, I thought I’d start off by thanking you for inviting me to speak today.

I’m really not sure how or where I was going to go with my presentation today, given that, as a construction association, we might be a bit out of place in having this conversation in this room with what we’re doing. I would have been in the same perspective five or six years ago, having just started this job, understanding what the construction sector is and what we need to support it.

About five years ago, when I started this job, I had a colleague that was working at Island Health. They were a harm coordinator, and the statistics were starting to be promoted and published about how the toxic drug supply was affecting our sector. It was subtle at the time. There wasn’t so much promotion to talk about. We knew that 25 percent of the deaths were coming from the construction or the trade sector. What it was about was just quiet conversations that we knew these deaths were happening.

Island Health, at the time, was trying to get in front of people. So over a social engagement, I was asking what she did. She said: “Well, I do harm talks.”

That’s when we first got started in this, in 2017 — to try and create awareness. From that, we — and particularly myself as, I would say, not just the CEO, the chief executive, but the chief advocate for our sector, with the Vancouver Island construction sector — started to express and explore: “What can we do differently, and how can we raise awareness?”

I think the underlying tone that I learnt over the last five years is that this is a significant problem that’s happening in the construction sector. I was asked once: “Does it affect the construction sector?” I would say it doesn’t. We have so many other things that are really causing some grief for us as a sector. What this is affecting is those workers and the people that are in our sector.

So we continued, and we worked with Island Health to develop and promote awareness and training. Again, we were kind of doing it ad hoc, off the sides of our desks. In 2020, we were invited by Island Health to do a more formal approach, to create some campaign.

I trust that the package…. I just prepared a dozen or so slides to kind of outline what we do and how we do the tailgate toolkit. If I might, I thought I’d take a little bit of time to talk a little bit about the tailgate toolkit project, what it is, and how we’re rolling it out and deploying that in B.C. I’ll also close it off with a couple of comments about where some of the gaps are and what we’re learning from the sector.

[11:10 a.m.]

We started this, again, with funding from Island Health. Our pilot was developed with the goal of trying to reach construction workers. Our primary goal was to reduce the stigma, provide education and help with resources for those in our sector that may or may not have a problem with drug use, with illicit drugs. It’s not a heavy-handed approach to talk to people about what they can and can’t do. We were there to create awareness. We wanted to help reduce the stigma that’s associated within our sector, particularly with our colleagues or with our co-workers and our employers.

Last year, we were asked by the province, the Ministry of Mental Health and Addictions, to take our Vancouver Island initiative and roll it out to the rest of the province. That’s what we’ve done. We’ve embedded harm reduction coordinators. They’re all specialists in social work; they’re all trained social workers. In fact, one of my key harm reduction coordinators in Vancouver is actually a recovering addict. His stories are both real and compelling. We’re leveraging that, and we do it in a meaningful way to help in outreach to our sector.

When we think about the challenges that we’ve had, the toxic…. You know, we ask: why is this project needed? Certainly, there’s no doubt — I’m sure all of you at this table are here for that reason — that we have a problem. The latest statistics coming out, by month — I just had it on my phone — are that 260 or so needless deaths that are happening, and we want to associate this to the toxic drug supply. This isn’t an overdose crisis; this is a toxic drug supply crisis. We want to help change the dialogue that’s happening on worksites right across the province.

Why are we talking with the construction sector? I think you know the stats more than anybody else. Eight out of ten people who are dying in this sector are men. We know the age brackets are almost identical to the age brackets aligned with the construction sector. We know that 69 percent who die were dying alone, dying in their own homes — they’re with means; they have residences — and we know that one out of five who die were members of the construction sector. That number has changed from 2018 to 2022 but also has a significant amount of deaths that have happened. So I take that statistic with a bit of a grain of salt.

We all know that we always engage in harm reduction activities in construction. We have fall protection. We have personal protective equipment. We spend a lot of time…. What I like to articulate is we want to spend time on the jobsite about how we get those workers to go home at the end of the day safely. This is different. This is about bringing them back to work the next day.

We ended up working with a stakeholder group that included not only employers, but we brought together a users firsthand experience group. One of our key advocates is a gentleman who has lived experience in this. We were able to digest what he was telling us — how, what and why — so that we could have a better conversation with our members, with those workers in the field, to say: why are you taking drugs? “I just had a bad relationship as a kid. I have pain management. I work hard and play hard.”

All of these analogies are really being associated with an outcome that’s resulting in death because of toxic drug supply. It doesn’t matter the journey. We’re trying to articulate that there’s more of an end problem. That doesn’t mean we’re not trying to effect change at all levels, but for our little program here, we’re trying to do the best we can with the resources that we have to reduce the stigma, create a conversation and have a worker that says: “You know, I might need a little bit of help. Where can I get that?” “Great. We can help you with that.”

We developed a tailgate toolkit project. There’s a link that you can find. This is a comprehensive report that we prepared that really walks through those elements of what causes…. What was on the mind of a person who has addiction issues? It was to talk about pain management. We don’t often think that pain management can result, itself, in death. Ultimately, we’re finding that many construction workers…. As we can appreciate, it’s not an easy job. You go to work sore; you come home more sore. People are often supplementing their abilities by opioids, by pain medication.

I often talk about — and my colleagues, who are really entrenched in this…. You know, we’ve all had that prescription or something: “Do not operate heavy equipment.” What about the person that says: “The only way I can operate that heavy equipment is if I have my medication”?

[11:15 a.m.]

It just becomes a part where the health care system is misprescribing opioids or losing track of where they’re at, and people just kind of go off the rails with it. Those are some of the contexts of why. I did have more conversation, but that’s in this report — about what’s compelling our members and these men and women to pursue those.

When we started with what we’re calling the tailgate toolkit talk on a provincial level, we created these talks. They’re really designed…. For those of you who may not be aware, a tailgate talk is something that happens on a jobsite. It’s mandatory. At the beginning of the day, before all work starts, all workers are required to stand around, typically, a tailgate. They talk about safety. They talk about work. They talk about anything special. They go off, and they do their own things.

We found this was a great opportunity to invite workers to come and listen to a presentation, where they might not otherwise attend. What I mean by that is it says: “We’re having a talk about opioid and drug use after work. Anybody who’s interested, you’re welcome to come out.” Who comes out? Nobody, because they don’t want to be the person that walks in the room and says: “Yeah. I’m the guy with the problem.”

They won’t even walk to their HR advisers to say, “I have a problem,” because the stigma attached is suggesting that if you have a problem, you’re going to lose your job. If you have a drug issue, if you have an addiction issue, it will reflect poorly on you, as it does from your employer as well as your colleagues as well as the people that may not know you have a problem.

I’m being very general. This isn’t scientific, but 90, 95 percent…. Let’s just say a lot of people don’t understand. They don’t know. “I didn’t know that person had a problem.” So we want to reduce that.

We talk about supervisor training. Supervisor training is really designed to create those corporate supports that companies can use to help their workers that have addiction issues. As we know, in today’s economy — we cannot lose a single worker at the best of times — we need everybody. We need all hands on deck. I’m not talking…. I don’t want anybody to die, but I need healthy workers. Our sector needs people that can be reliable and dependable and can help contribute to get the infrastructure we desperately need in this province.

The supervisor training is what we’re working with, with our employers, to give them the tools and the infrastructure, the knowledge, to help them work with their employees. Don’t treat them like criminals; they’re not criminals. You hate the crime; you don’t hate the person. We want to change the language we have so that people can get help in a way that they’re being respected, that they’re being assisted and that their employers are there to support them.

We have a comprehensive print and digital campaign that we’ve developed with this. One of the strategies we’ve had is that within each region we create a resource package that’s specific to that region. There’s a significant amount of work that’s happening in Kitimat. If we’re up in Kitimat, we know that there are, as I call it, concentric rings of support. You have those supports that are immediately available — perhaps more emergency response, quick supports, small support groups — but there’s also the broader context. If you want to get more or more comprehensive help, you have to move out of those communities.

We start at: what’s in Kitimat? What do I move out to the next big region? Maybe it’s Kamloops or Kelowna. Then I go to Vancouver. Maybe it’s something that’s more national. We try to create these rings that say: “You can start here.” The more complex care and the more complex treatments are going to be required more broadly — likely in Vancouver or something. We want to create that awareness.

We have a regional digital ad campaign that’s presented on billboards in all regions, where we’re showing where people can get help. They are bold statements. We’re not trying to sugar-coat this. When I started this — and I still get it — our sector was saying: “Don’t talk about it. We don’t have a problem. The more you talk about it, the less people are going to want to come into construction.” Basically, I call that rubbish. We cannot put our heads in the sand.

I was in the military for nearly 30 years. Every person that says to me: “If you go to the military, you have PTSD….” Rubbish. It doesn’t happen. We’re making bold statements. We’re talking about toxic drug supply and that it will kill you.

Our print and digital resources are a really comprehensive part. We’ve handed out…. In the statistics, I’ll talk a little bit about that as some of the outcomes that we’re really proud of.

[11:20 a.m.]

The final component to that is that we have a support group. It’s non-faith-based; it’s not a 12-step program. What we found, for doing our talk with our advisory committee, was that they just want somebody to talk to.

It’s led by…. We do it with the Umbrella Society here in Victoria. It’s a virtual platform that’s one night a week, Thursday nights from seven to eight. We call it Hammer Time. It’s really an opportunity for…. Anonymously, people can go and listen. I think we’ve had about 25 people participating in that since January. I think that’s one of the elements where…. It’s led by people with lived experience. These are well-educated and learned people within their own right to help have a conversation with somebody with addictions.

The final part I want to talk about — well, almost final part — is our stats. Since we’ve started the toolkit talk, we’ve given the talk over 110 times throughout the province. We’ve presented to over 2,000 men and women in the construction sector. We’ve offered the training supervisor course seven times with 45 participants, both here and in Vancouver. We’ve had Hammer Time meetings. We have them weekly. We’ve had over 50 of those. And our resource packages have been delivered to over 6,500 people in the province. So that’s making some very measurable outreach right across the province.

The final part I’m going to leave you with is just some of what else can be done. One of the strategies when we started this…. When we do, particularly, supervisors training or the toolkit talk, we wanted to leave a naloxone kit with every person we present to. We’ve hit a bit of a hurdle with that. That’s not been possible.

We want to support, certainly, the safe supply and the legalization. I know the province has made steps to minimalize small amounts of opioids. I am not an expert, but I do think that that has to be constantly revisited and tuned to be appropriate to what the lifestyle or the usage is of people with addictions.

Expanded access to treatment. We have some major programs. They’re mostly based out of Vancouver. I think the expanded treatment is very important.

Enhanced drug checking. I know we have safe supply sites, but we don’t have a safe distribution. Having that access where people can bring their drugs to get them checked is probably one of the single most steps that can be done.

Expanded harm reduction resources. VICA is only one part of it. One of my criticisms, when I start this program, is there are a lot of agencies doing this. It’s almost a shotgun approach, but we don’t know where those pebbles land. We should have a much more coordinated approach to harm reduction and how resources can be identified and allocated.

Certainly, an enhanced approach to mental health. I’m sure that’s come up in your conversation. I will leave it there for questions.

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

Susie, go ahead.

S. Chant: Thank you very much for your presentation. It’s really appreciated, and it certainly aligns with other things we have heard, although I’m very pleased to see the outline of what the tailgate toolkit looks like. We heard reference to it before, and you’ve given me a lot more detail to work with.

A couple of things. One of the things that came up was for people who have determined that they’re willing and able to seek help, time off was a problem — getting time off, particularly women with families. I was wondering if there’s been anything worked into that.

My second question is: what is your estimated population in the sector, and do you have a vague idea of the breakdown of males and females?

R. Kulmala: I do, actually. We have…. I brought that just in case you were going to ask.

S. Chant: There we go.

R. Kulmala: There we go. So in the province, we estimate that the number of construction trades in B.C. — and this is trades — is nearing 180,000. You’ll see reports of anywhere from 180,000. It’s probably 220,000. Of that, our female workforce is approximately 6 percent right now.

On the Island…. It’s irrelevant about the regional distribution. We’re probably close to 200,000 in trades, men and women working in the trades, and 6 percent are women.

S. Chant: Okay. Thank you. The other question was around the reluctance to take time off to deal with concerns, or the ability to take time off fiscally, etc.

[11:25 a.m.]

R. Kulmala: Yeah. That was one of the other parts that I glossed over my notes, but…. One of the parts is the legal rights of substance users. I wrote out some notes here that substance use disorder is protected as a disability, and not a lot of companies know that. It’s not promoted. I don’t think it’s something that companies really want to explore.

The reality is that we’re trying to do…. Certainly through our supervisor training, we’re doing that. But when we talk about WorkSafeBC, what is their obligation to identify this as a critical factor no different than…? Certainly, the Ministry of Mental Health and Addictions is doing a lot of work on that front as well. But we’re not conveying what this is as a disability and how people can get…. Legally, what are they entitled to?

S. Chant: A little bit of a follow-up. What I’m hearing from that is that you actually have to have a substance use disorder diagnosis, which doesn’t actually work with our folks that use on a weekend or, you know, recreationally use, who are at desperate risk for toxic experiences.

R. Kulmala: Very true. Without going too far into the legal parts of that definition, I would argue that many people, as I said, do this very privately. They don’t acknowledge these shortcomings with their physician, to say: “I’m using opioids way too much, Doc. What can you do?”

Again, there’s a bigger systems issue that we haven’t really…. It’s a little bit out of our purview to explore. We’re trying to say that if you have a conversation with our social worker and say: “I have….” They would just say that you should talk — give you a path to say: “Here are some resources.” So we want to direct them as opposed to manage or assist or treat them.

S. Chant: Very good. Thank you.

T. Halford: Thank you for the presentation. You just alluded to it a little bit in your answer, but where is WorkSafe?

What I mean is that I look at your toolkit program and your work with the Ministry of Mental Health and Addictions and everything like that, and we see…. The amount of people working in construction in B.C. is unbelievably high, but you don’t hear much about WorkSafe. Do they have a seat at the table? Are they at the table?

R. Kulmala: I would say that indirectly they are. As far as what we do, they’re there to support us. The difference…. WorkSafe is a bit of a grey area in my mind, and where that comes from is that we don’t necessarily have people…. We don’t have this problem on our jobsites.

Now, I have heard that somebody was found that used on a jobsite — that overdosed at lunch or something. I haven’t been able to quantify or qualify or prove that. I only heard it once, only recently. But I also hear that if there was an overdose on a jobsite, WCB would know. If there was a death on a jobsite, both the coroner and the WCB would hear about that, and they would get involved.

WCB’s policy is zero tolerance. Right? They talk about it. They are advocating. Where they fall in is that they try to talk about: if you’re a user, just don’t use on the jobsite, because we have rules around being impaired, and all of our employers will say they will send people home if they are visibly impaired.

But for somebody who is on a pain medication, how do you diagnose that? If you read our report — and these are firsthand stories — you hear: “You know, man, that Bill guy? He worked his tail off all day. He always had good energy. He was polite.” He was this. He was that. You find out he died. You find out that he did have an addiction issue.

Again, it’s very private, and WCB really talks about what they can do on the jobsite. Once a person leaves the jobsite, it’s not their problem. And to some degree, it’s not even the employer’s problem. This is why we’re all trying to come together and say: “We can make it our problem. We can do something that will help our workers come back to work the next day.”

S. Bond (Deputy Chair): Thanks for your presentation. Just a couple of things. You said that when we’ve been looking at numbers….

Your stats talk about how one out of five people who lose their life as the result of an overdose is a construction worker. You said the numbers have changed, and you basically take them with a grain of salt. I just want to be sure that we’re on the same page here. Are you talking about the numbers being higher than one in five?

[11:30 a.m.]

R. Kulmala: In 2018, the report was one in four. In the 2022 update, it was one in five. So it went from 21 percent down to 18 percent. But the numbers in 2020 also went up. So even though it was proportionately fewer deaths, or it was a smaller ratio, there were still more deaths overall, because there was a larger number of people that died.

What I was talking about is…. It’s gone from 22 percent down to 18 percent. Those statistics are still compelling enough — that don’t mean nothing as far as impact.

S. Bond (Deputy Chair): Yeah, that is still an astronomical number of people that are dying — and that they are concentrated in a particular sector and a particular demographic. So that drives the need for programs like the tailgate toolkit.

My follow-up…. I know others have questions, so I’ll just keep it to this one. You talk about that resources are now being…. You have now been asked to take your program and make it provincewide. It is a big province with a lot of people who have needs.

Can you just be a bit more specific about what services are provided regionally in terms of…? Is it two or three people across the entire province who are then…? How do we actually cover the province? It’s a big province with a lot of small companies with organizations. Can you just speak to that?

R. Kulmala: Sure. For us as a construction association, we have regional construction associations. There’s Vancouver Island, Vancouver Regional, Northern Regional and Southern Interior. We’re leveraging that relationship that we have. We have a federation of sorts.

What I’ve done is hired a harm reduction coordinator for each of those regions. We run the program. There are employees, but we embed them in those communities. The reason we’re doing it and leveraging us as construction associations is that we have touchpoints with a significant amount of contractors of the construction communities in those regions.

Where I have a construction coordinator, I have…. And I’ll also supplement that. I have a harm lead, who’s here, who runs our supervisory training. So we have a harm reduction coordinator embedded in each region — Victoria, Vancouver, Kelowna and Prince George — and we work through them to outreach to all of the construction sectors, whether they’re members or not.

That’s the other thing about this tailgate toolkit. We are agnostic. It is not about just doing it for our members. It’s about doing it for anybody. And I’m going to be a little bit candid. I know we’re being recorded, but don’t hold this against me. We’re kind of giving it to a few companies that may not be direct…. They’re a supplier of working on construction sites. So we are giving it to anybody who wants to listen.

We’re also doing this with all of…. So far we’ve got Vancouver Island University, Camosun College, BCIT, both Okanagan and the Interior. We’re actually giving it to the first-year apprentices once a month when they bring in their trades classes. We set that up about three months ago, where that is basically a standing offer where we’re trying to get in front of young people.

The third component to what we do is that we really try to get out to industry partners — so the BCCSA, the B.C. Construction Safety Alliance. They have been a staunch advocate for us. They’ve been a great supporter. They are working on a mental wellness program that is using our component as part of the opioid part. They’re letting us deal with that, and they have a very strong provincial presence.

We’re partnering with the Electrical Contractors Association. So all the people I know in my business…. I’m saying: “We’ve got a program. If you want it, give me a call and we’ll get people out there.”

Minister, the final part was capacity, I think I heard. For instance, Vancouver…. We have a lot of traction in Vancouver right now. We did the BUILDEX show not long ago, and we’re doing probably ten to 12 talks a month in Vancouver. I sent my coordinator from Victoria over for four days last week to help him get outreach to when they need it.

We have that capacity to move our staff around. If Prince George is a bit quiet or is really busy because we’re trying to get in front of LNG Canada — all those major construction sites…. We’re still working at it. That’s the part that is on us — to try and get in front of them. But we’re working. If I need to send people, I’ve got a staff I can send out.

[11:35 a.m.]

S. Furstenau: Thanks for your presentation. Great to see you. We’ve heard from CIRP. We’ve heard from you. We’ve heard from the Council of Construction Associations. There’s a lot of effort going into responding to this crisis.

I’m interested in your thoughts on what the drivers are. Why is the construction industry seeing this overrepresentation? In addition to the response, what is getting to the core issues here?

R. Kulmala: Within our report, we brought out four key elements. One of them is that it starts with this live hard, work hard approach to construction. Through the conversations we had…. It inevitably started with going for some beers after work, and somebody brought out some cocaine. From that, they did a couple of lines of cocaine, and that was the party.

They’re with means. They’ve got good paycheques. They’re young, vibrant men who are really driven towards performing. They’re really driven towards impressing their peers, and maybe that’s what’s driving it. We talk about that work hard, play hard.

We talk about our culture. Our character of society is…. We have an expectation of an ability to access alcohol, marijuana now. Opioids are just one element of that play hard attitude. I think in men and women…. Particularly, men in our sector are attracted to that, for some reason. It gives them a bump. We don’t know why. We just know it’s there.

We talk about somebody with injuries, lasting injuries — knee injuries, back injuries. They need to use opioids. Where their physicians are otherwise not prescribing enough, they’ll outsource that. They’ll find it off the street. They’ll look to supply, to find a way to help their bodies cope with a day in construction.

Just as a sidebar, we’ve been working with Pain B.C. It’s a huge part of what we’ve been doing. They’ve been exceptional at trying to say…. We’ve already referred, I think, about 12 workers who have come through and went to Pain B.C. because of this program, to say: “How can I get help with what Pain B.C. can offer?”

The other element is…. I talk about the culture in the workplace, the stigma. When there are uses, people put it under the rug. I still talk to people who say it’s not a problem — the “suck it up, buttercup” approach. We have to change that character of conversation so that people can acknowledge and say: “I’m using too much alcohol. I’m using too much whatever.” That is an opportunity, I think, to convey to them that regardless of why they drink or why they’re using it, there’s still a management issue.

Male health and masculinity came up a lot in our conversations. The bravado of male…. They have to come onto the jobsite and do their job. Well, that leads them to…. Maybe they have to supplement their ego with…. That’s the wrong word. They have to supplement their internal fortitude, maybe, by consuming and being in front of the guys. I talk a little bit about that.

I talked about self-medicating, pain medication, the self-medicate. The other part is the mental unwellness that some people, that many of us, have, where their outlet is through alcohol, drugs. Ultimately, the issue that we’re trying to convey is that the toxicity is really making that high risk.

D. Davies: Thanks for your presentation. You kind of touched on a little bit of my question in the last two previous questions.

Obviously, there’s lots of incredible work happening within the construction association or the industry. We heard from the Council of Construction Associations yesterday — doing some really good stuff. Even in your presentation, you cite some of the different associations that you’re already partnered with. You talk about the partnership with the Ministry of Mental Health and Addictions. Island Health is providing this. Lots of little partnerships are happening.

[11:40 a.m.]

My worry is, though…. Roughly 10 percent of B.C.’s workforce is in the construction industry, or thereabouts — a large number of people. I have some very big projects in my riding. Site C is right out my back door. We have a number of work camps in the region that I don’t think this is getting to. These are large projects.

I guess my question is: how are you…? I don’t want to put this on you, but you and your industry. How do we bring everyone together better? You say that you’re agnostic. I think that was the word you used. You’re providing this to everyone. But how do we make sure everyone takes it and uses it and gets this out so that every worker has these tailgate meetings in the entire province — or the country, for that matter?

R. Kulmala: Well, there’s the challenge. That’s the work that we have. We’ve got the program. We’ve got the talk. We know what to say, and we know who to say it to.

Our challenge is getting the audience. Our challenge is getting into Site C and having the powers up there say: “Yeah, we’ve got to get you up there.” I’ve got a resource ready to go up there and be there and say: “We’re going to do them for the next five, ten, 20 days.” We’ll just start cycling them through. I’ll send people up. I’m ready to do that.

We’re trying to get in front of our owners, our sector to make this a priority, and that’s a challenge. It’s trying to find contractors doing a project and saying: “You know, I’m actually going to have this conversation with my workers.”

To be candid, we can have a lot more traction. We’re pushing the rope. Let me put it that way. We’re pushing the rope at times. We’re trying to put it out there. We’ve got banners we’re waving. We’re working with partners in industry associations. Working with our local governments to try and create a more focused strategy, I think, is what I talked about earlier. There are a lot of agencies doing things, and I’ve been trying to figure out, at any given time, who’s doing what, when and where so that we can fit and say: “All right, let’s go at this together.”

It’s kind of hard to do. There are a lot of protected agendas. For us, it’s VICA. It’s like: “Oh, it’s VICA’s program.” No, it’s not VICA’s program. We’re running it, but I want this out there to anybody and everybody.

We also have to remember this isn’t just construction. This is the trades. This is what I would say is the blue-collar element. We’ve been working with the Truck Loggers Association. We’re working with the forestry sector, the aquaculture, trying to get them in to say: “We’re here to have this conversation.”

I think that if we talk about a real strategy opportunity, that’s where it would be. How can we…? What can we do to put everything and say, “Here’s the pool of resources that can be accessed,” and have a coordinated deployment, if I could use that, of this strategy or a strategy?

N. Sharma (Chair): Okay, thanks. I have a question before we go to the next round.

Thanks for not only the work on the tailgate toolkit. It’s really interesting, because it sounds like, as you mentioned, you’re getting into different industries. You’re getting people through at least hearing about this program and then learning about what their challenges are. It kind of seems like a learning feedback cycle when you’re getting out there, which I think is really informative to how we address and how we intervene and how we get supports to people.

I guess my question was…. We hear a lot about a continuum of care that’s built up for addressing this crisis. That involves the detox beds, the treatment centres, the health authorities working together, the support systems that people need for trauma counselling and all of the things that get people to be, really, dealing with the pain that underlies a lot of those issues.

So how integrated would you say you’re able to be? You talked a little bit about needing more. When you get into this work, when people raise issues, you said you’re able to refer them to things. I just am curious about your connections with continuum of care that surrounds some of these workers and how they get the resources they need and what that next step is if they’ve identified.

R. Kulmala: Each of our harm coordinators in the regions are acutely aware of what that front-line resource would be. So if there is a rehab or an emergency 911 or it was 811, the emergency call lines that people can have, our goal is to try and connect the first person in that line — the emergency call, the local health, the 911 call that somebody would make.

[11:45 a.m.]

This has been an evolving initiative for us to try and find out what and how we can do that. We’ve had a few people…. Typically, a conversation with a tailgate toolkit is going to go…. They’ll do the talk, and at the beginning of it, what we’ve seen is those that are told to be there don’t want to be there. They’re just like: “This is dumb.”

By the end of it, there isn’t one person around…. When you give the context, the first we say is: “All right, who hasn’t lost a friend to this?” One in five, somebody knows somebody. They’ll listen. They’ll take an extra card. Friends are starting to say: “Go get help.”

I might be dancing around the issue, but I think that it’s a very complicated issue. When you feed them into this system, the health care system, we are relying on those front-line supports that are already existing in every region to say: “Go talk to them here, and they will be able to take you on and help you find your path.” Access to recovery. Access to recovery beds. It’s $10,000 a month, last I heard. I think it’s really expensive. A lot of people are saying: “I can’t afford that kind of treatment.”

Employers. One employer says: “Well, tell me how much this costs. I’ll send him down there. What if that was me?” I say: “Are you prepared to put in $60,000 for that person, and lose them for six months?” That’s the question. That’s what they have to ask themselves.

The care that’s provided, that ecosystem of care, is often a little bit out of reach, because they’ll go to see their doctor and they’ll get a prescription to fix it, and then they’re sent on their way — well outside of our purview at VICA, in this tailgate toolkit. Our job, as we see it, is just to give information to help you, have a conversation, and then tell our employers: “Don’t beat somebody up because they missed a day and you find out they’re having a withdrawal.”

Those are questions we struggle with every day, but we’re here to provide information to say there is a path — particularly with employers, particularly with workers, particularly…. If you know a worker, talk to them: “Having a bad day? Maybe you should get some help. Here’s the Hammer Time business card. Thursdays, seven o’clock, 1-800. It’s on a sign-up. It’s anonymous.” Have a conversation.

D. Routley: Thanks very much. I think you’ve done a lot of great work to professionalize the sector, in a sense, and have people see it in a different way, but you’re up against long-entrenched culture, for sure.

I’ve worked as a logger, and there wasn’t much…. We all rode a crummy back to town, then people go out to the bar. I worked in a sawmill where people would drink in the parking lot before leaving, heading out on the road, back in the ’80s. Construction — I can remember, as a ten-year-old, meeting a relative to ride home, and he was a bridge builder. Everybody in the car was drinking on the way home.

That was sort of what they did. You work hard and tough, and then you play hard with your friends and go out. Even contractors, probably one of the most common things is if you have a good day as a crew, the boss buys you beer. There was this encouragement, really, and now you have to try to reverse that.

I like it when I hear people not pretend that that isn’t there and deal with it head on and accept that yeah, people are using, and here’s how we address that. Keep them alive for now, until we can make them better.

The bigger companies have more of a duty to accommodate a disability, and more of a drive to demand to cope with a problem. My concern, and I’ve expressed it before at the table here, is more around the contractors — small contractors; office in your truck and three or four guys, or people — and how we ever get to reach those folks, because there’s a big part of bigger jobs, too. So I wonder whether you’re extending your reach outside of the organized part of the sector.

[11:50 a.m.]

R. Kulmala: I’d almost say that’s our focus, because we do have the ears of the major contractors in the province, to some degree. Like most businesses in B.C., 80 percent of our members are ten people or less. They’re small companies. Through every event we do now, we present the tailgate toolkit — at every venue, every promotion, every event, every education opportunity. Our newsletter is just littered with information about the tailgate toolkit.

There is no company too small that we won’t give the talk to. We’ve been on job sites with two people. Forgive me for getting a little bit biblical, but where two or three are gathered, we have the talk. There is no limit. We’re also saying: “Look, we’re going to be doing it at this job site. You’re welcome to show up there. Invite your friends.” We’re really trying to get that outreach, because I think it is important.

M. Starchuk: Rory, thank you for your presentation.

As Doug just explained, it’s a culture change. It is an absolute culture change, and you’re in a culture where…. The weekend stat that I was hearing was that one in five workers are managing chronic pain at a rate where doctors are trying to prescribe differently. They’re absolutely struggling. As you said at the beginning, they show up sore. They leave sorer. So what do they do to manage that stuff that’s there? I applaud you for the work that you’re doing.

My question is around…. Is there an exponential curve that you see right now with buy-in? Usually with new things into a culture where change is evil…. Are you seeing it now? I’m looking at your Hammer Time meetings. Are you seeing it just like this? Or is there this expectation that there’s more buy-in? If there’s not more buy-in, you can have all the supervisor training that you want….

What we heard yesterday was that some of the supervisors aren’t in the perfect role to actually be telling those workers that they’re supervising. What we did hear the other day was a phrase that was: “It may not be for you, but it might be for your buddy, so let’s take care of your buddy.” I’m wondering about that curve.

R. Kulmala: It’s not as aggressive a curve as I’d like. I’ll be candid. We get great traction out of Vancouver, where a lot of companies are picking it up. They have the critical mass to do that. We’ve been working in the North to try and express, get our presentations…. We’re working at it.

In fairness, we’re only seven months into this provincial initiative, where we needed the first six months just to staff and train and get everybody going. Now we’re into what I’m hoping is the big growth curve, getting into it so that I can see Hammer Time start to ramp up, where we can express to the ministry and say: “You know what? I need to hire another coordinator.” Wouldn’t that be the greatest news ever? That tells me that we’re starting to get that traction that we’re talking about.

We’re into a two-year cycle. We’re only six, eight months into a two-year cycle. I think it’s our opportunity to really try and generate what you’re looking for and what we want. I would love nothing more — for my team to be over capacity right now.

S. Chant: Just really quickly, you have a really large population in your sector. How do you address cultural, language and racism issues within this context?

R. Kulmala: Well, we work closely with the B.C. Construction Association. They worked on a…. They have an initiative called the Builders Code. Again, we’re just an association of a part of the construction sector, but we’ve been leveraging everything that’s in that declaration that a contractor would talk about — equality, fairness, non-bullying. We have a huge campaign that we work with right across not only the province but within our region around the Builders Code.

Changing the character. I think, as you talked about, that’s what we need to do. We need to create a different conversation with owners, with workers. We need to see workers behave.

We run a construct your future program about young people. I just put ten people into the workforce on Friday. My parting wish to them particularly, to men and women, was: “Men, you’ve got to treat women better.” Those are conversations I hate to have, but we have to have them.

[11:55 a.m.]

We talk about addictions. “If you need help, ask for help.” The worst part is having somebody come back and say: “I am getting bullied all the time. I’m gay, and I’m having problems.” How unfortunate is that?

But our dialogue has been zero tolerance, right? If I can influence that — and I only use that as little old VICA, for what we can do to have a conversation — it’s saying…. You know, just calling it out.How many times do we witness the witness statement? If somebody sees it, can they call it out?

Similarly with somebody with addiction issues. It’s much different to say: “Hey, you’re a drug addict. You need help.” It’s: “Hey, Bill. I notice you kind of need some help. Maybe we can help.” We do the same with mental unwellness. A lot of that has come out in the last year, about how we can support our workers, our colleagues, our family, our friends, our children by having a simple conversation. But we don’t do it when it comes to addictions or drugs.

We’re still struggling with this toxic drug supply. Around and shrouded in all of this is a toxicity that suggests…. I love beer. I’m going to admit it. I like a good beer. I like a good IPA. But what the reality is, is that one beer that I have on a Friday afternoon…. Somebody spikes it, and that’s what it’s about. It’s about enjoying something that can be tolerable, and all of a sudden it becomes tragic.

That’s what we’re struggling with, particularly with that emergency, I think, what you talked about. We’re kind of at the end state of just reacting. The proactive part is probably a bigger problem that, I think, you have to deal with or help with. We’re here to help. But that’s a really…. We have a bigger problem when it comes to: how do we just fix this at the beginning, not deal with it at the end?

N. Sharma (Chair): On behalf of the committee, I want to thank you for your presentation and the time and the work that you do in a very important aspect of this crisis we’re facing with the industry that you work in. It has been really informative. We look forward to updates on how the program is going and what you’re learning, if you have any of them.

We are going into recess until 1 p.m.

The committee recessed from 11:57 a.m. to 1:01 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Welcome back, everybody. It’s my pleasure to welcome our next speakers. We have a panel with two presenters.

The first one is Nurses and Nurse Practitioners of B.C. We have Michael Sandler here, the CEO.

Welcome.

We also have the B.C. Nurses Union and Aman Grewal, the president, here.

We’re just going to go around and do a bit of an introduction so you know who you’re presenting to.

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

We’ll go to the Deputy Chair, over there.

S. Bond (Deputy Chair): Thank you, Chair.

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

T. Halford: I’m Trevor Halford, MLA for Surrey–White Rock.

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

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

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

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

P. Alexis: Not a nurse. Pam Alexis, MLA, Abbotsford-Mission.

N. Sharma (Chair): Okay. We have about 15 minutes for each of you to present, and then the rest of the time for questions and answers. I’ll just pass it over to whoever wants to start first.

M. Sandler: Thank you. Is it MLA Sharma? Is that the correct terminology?

N. Sharma (Chair): Sure. You can call me that. I’m easy.

Briefings on
Drug Toxicity and Overdoses
Panel 1 – Nurses and
Nurse Practitioner Organizations

NURSES AND
NURSE PRACTITIONERS OF B.C.,
B.C. NURSES UNION

M. Sandler: Lovely. Per the introduction, my name is Michael Sandler. I am the chief executive officer for the nurses and nurse practitioners association of B.C. I am a nurse by trade, a proud nurse. The association represents all four nursing designations in the province: licensed practical nurses, registered psychiatric nurses, nurse practitioners and registered nurses.

We have the privilege of working with our colleagues across the aisle in the union — who represent a significant number of nurses in the province in wages and benefits, etc. — as well as our colleagues at the regulatory body, the college, BCCNM. My understanding is that you spoke with both Cynthia and the physicians. So you’ve had that conversation before. Those make up the three core pillars of the nursing conversation in the province of British Columbia.

Of course, as you are well aware, nursing is not only regulated in the interest of protecting the public, but it is regulated under the Health Professions Act, under the B.C. legislation, which also takes its cue from the federal legislation. So it’s an integral part of what happens, in terms of health care delivery.

You might also know that nurses are the largest group of health care providers within that large umbrella under the Health Professions Act. We live in every community in this province, so we have the distinct privilege of being part of a significant number of conversations. We are definitely integrally part of the conversation related to the overdose crisis.

You are most likely aware, if you’ve had these conversations since May, that nursing’s first principle is to provide safe, compassionate and ethical care, along the lines of our scope. We are entrusted as the most trusted health care profession in Canada and, actually, internationally.

[1:05 p.m.]

That places us in a unique position at the point of care, but also provides us with a unique responsibility to ensure that we’re advocating on behalf of individuals who have the hardest time advocating for themselves. This patient population, in particular, I think, is most often described as being made up of vulnerable populations.

Over the last three years, the overdose crisis has shifted, and it has shifted substantially from what we envision as the illicit substance user — who might be street entrenched, hard to house, dual diagnosis — to the young man or young woman who is narcotic naive, using for the first time in their home while their parents are gone. When we look at the numbers — over six individuals a day in the province of British Columbia dying from illicit substance use — we have to reimagine what the solutions should and could be to solve this crisis.

Unfortunately, as we all know, we had to suffer through a pandemic. That was a significant burden on the health care system, and nurses in particular. It changed the ways in which we access the supports that were previously used to support this patient population to combat this crisis. We haven’t been able to reset that.

I’m privileged to present today, because I think this is a great opportunity to take a look at what the new solutions could be for combatting this crisis. In support of that, I think that, recognizing that you’ve been at this since May, I’m not going to spend a ton of time talking at you. I’ll give you the top three things.

Nurses are the best positioned to help combat this crisis because we live in every community across the province. Therefore, we interact with patients across the province. We are where the patient is at.

The second thing, I think, that’s important is that nursing has not had the opportunity yet to be fully utilized at the point of care to provide the interventions that we could be providing to save lives. What do I mean by that? Well, if we take the opportunity to optimize a few scope-of-practice pieces, you will see a significant improvement in outcomes.

For example, our colleague Dr. Henry signed a PHO order, authorizing prescriptive authority for RNs and RPNs to prescribe OAT and iOAT therapy. That’s still a PHO order. We need to move that away from the PHO into entry-to-practice competencies as part of a standing scope of practice for nurses.

Prescriptive authority for nursing is not a new idea. Our colleagues across the water — or the pond, as it’s sometimes referred to — in Great Britain have been assigning prescriptive authority to nursing with the prerequisite skills, knowledge and abilities for 40 years. So we’re a little bit behind the times on solutions that would allow for optimization of scope for nurses to address these issues at the point of care.

What makes nursing unique in this situation is that we’re not just prescribing iOAT or DAM. What we’re doing is assessing the determinants of health that allow for a more fulsome understanding of where the patient is at, at that point, because we are part of the community that patient is living in. So the important contextual pieces lead to a relationship that allows for better interventions over a long-term relationship.

I think the second thing that is really important from a nursing perspective is the opportunity to actually engage in team-based care as it relates to caring for these patient populations. What do we mean by team-based care? Well, we mean the opportunity for expanded use of diacetylmorphine.

Currently there are only two clinics in the Lower Mainland that are prescribing diacetylmorphine. DAM access is quite limited. I recognize that it’s not a simple solution, in the sense that you have to go for a federal exemption, etc. But I think we need to have that conversation about expanding the opportunities for access to DAM.

There are a few individuals — the Crosstown Clinic has done some research on this — that do much better on injectables. We need to have a conversation about whether or not injectables should be included in the suite of services that are available to prevent overdose deaths.

We know, for example — and your research colleagues at the end of the table will tell you this; shout-out to research — that if you look at the solutions that have been implemented around safe injection sites…. My understanding is there hasn’t been an overdose death this year at a supervised injection site. That is a significant win, and we need to look at what it would look like to expand that level of service.

[1:10 p.m.]

The overall perspective — not from individual nurses, but from a nursing perspective — is that nursing stands ready, and it has the opportunity, based on our proximity to the patients in this particular conversation, to expand the scope of practice and expand competency so that we can actually meet patient needs where they’re at, at the point that they need it — so right patient, right care provider, right intervention, right time, right outcome. We’re looking at that opportunity.

The second opportunity is to really take a look at continuing to push the narrative for solutions that have worked in a limited capacity and expanding those to other areas. There’s nothing that says that we can’t spend more time and energy on outreach, on testing narcotics, on speaking to school kids, on safer supply alternatives.

We’ve done some work around decriminalization. There probably needs to be a conversation about what expanding the decriminalization looks like. Currently I think we are okay with 2.5 grams, right? I think that’s the current standard. Most individuals who use substances will tell you that after a short period of time, tolerance builds, and up to four or 4½ grams are required.

We’re still criminalizing that portion of the behaviour, and we know from the research that criminalization of that behaviour does nothing for outcomes. But when we decriminalize that, reduce barriers and look at it as a health problem, as opposed to a moral or a criminal problem, we get better outcomes overall. We have more individuals accessing care. We have less comorbidities associated with the diagnosis. It becomes a different conversation than the conversation that we’re having now.

I won’t belabour the point. You guys have had these conversations since May. I think the take-home message is that nurses are well positioned to help achieve outcomes related to this problem. All we need is the opportunity to expand access to a scope of practice that includes prescriptive authority and diagnostics, and the opportunity and the ability to be able to lead the care from a nursing perspective.

Thank you for your time, and I’m happy to take questions.

A. Grewal: Thank you for giving me this opportunity to speak to you today. As Madam Chair Niki Sharma said, I’m Aman Grewal, president of the B.C. Nurses Union.

I would like to acknowledge that I am gathered here with all of you on the traditional and unceded territories of the Lək̓ʷəŋin̓əŋ-speaking people of the Songhees and Esquimalt Nations. I raise my hands to them.

This deadly toxicity of illicit drugs and the related overdose crisis in B.C. is an urgent health care issue. I am pleased to address this committee with possible solutions from the perspective of the thousands of nurses who are committed to providing direct care and improving health outcomes for those that are impacted.

Nurses have experience dealing with patients, their families and the communities affected by this crisis. I myself am a nurse. I will speak to that later, but I have seen firsthand what impact this overdose crisis has been having in the emergency departments and within the health care system. This crisis is of significant concern to the 48,000 licensed practical nurses, registered nurses, registered psychiatric nurses and all the allied health care workers we represent in B.C.

We know that substance use is influenced by social and economic factors, and that can impact anyone. It’s not just something that only happens to lower socioeconomic…. It could be anyone. We’ve seen that in the media, where we’ve heard of people overdosing and leaving behind their children because they overdosed together.

It’s throughout the whole system. It can be one of the many consequences of unequal access to social determinants of health and the experience of social and political marginalization. Variations in socioeconomic status, social support and other factors create considerable human and health disparities among British Columbians.

[1:15 p.m.]

Income, as I said, is a major determinant of health. We, the B.C. Nurses Union, continue to believe in a harm reduction approach to address this crisis. This includes many traditional strategies already available in B.C., such as the operation of safe consumption sites connected to nursing care, mental health supports and access to affordable treatment but also more innovative approaches, such as the decriminalization of drugs for personal use — which Michael was just speaking to — and access to a safe, regulated supply for people who use drugs to reduce that risk of overdose from the toxic street supply.

Harm reduction can be understood as any non-judgmental intervention aimed at reducing the harm experienced by people affected by problematic substance use. As well, their friends and families and communities are all impacted by this. People who are coping with challenges related to substance use require compassionate, supportive care. Families and friends of those people also require compassion, support and care.

I’m going to emphasize support, because this is something that they need lots of help dealing with. It has a mental, physical and emotional aspect to it. The practice of criminalizing people who struggle with substance use problems does little to address the person’s health needs or those of their families and communities. Addiction is a disease, and we need to recognize it for that.

The best kind of harm reduction program is easily accessible to everyone and empowers each person and their community, along with the service provider, to determine the appropriate intervention to address immediate priorities and, where possible, long-term goals. When you have somebody that comes in seeking help, yet they’re put on a wait-list to go into a recovery room and secure a bed there, and they’re told to go home and wait two weeks, that may be two weeks too late.

Nurses can play a critical role in ensuring that harm reduction measures address the needs and the concerns of people affected by problematic substance use. On a broader scale, community development and social justice approaches to dealing with substance use are also central to effective harm reduction approaches and will help in the long term to reduce problematic consequences of substance use.

I had a recent opportunity to go to Kelowna and see their outreach program that they had — very discreet. The presence there…. They had it attached to an urgent care centre, primary care centre. They had security present there, but it was such a calm place. The people that were coming in to use, as well as the staff there…. There was just such a respect for each other. I really appreciated seeing that and the steps that they had in place for safety measures for everybody. But also, the fact is, as Michael said, that there hasn’t been a death this year from overdose in these injection sites or substance-using sites.

Nurses play a critical role in ensuring that harm reduction measures address the needs and concerns of people affected by problematic substance use. BCNU has a long-standing commitment to the principles of harm reduction, beginning long before 2016, when the current problem with the public emergency came about here in B.C. with the increase in overdoses and deaths.

One year after the public emergency was declared, we spoke with an RN from the Downtown Eastside. The nurse talked about how extremely difficult it was to watch as the opioid crisis took a devastating toll on the community they served.

They described the invaluable support found within their own close-knit colleagues. A coping strategy developed amongst them to manage the trauma, the losses that they were experiencing and the helplessness of so many that they endured on a daily basis.

[1:20 p.m.]

If you’ve ever gone down to the Downtown Eastside, driven through it or walked through it, you will see so many people that are on the streets right now and in crisis. You’re seeing the police. You’re seeing the fire. You’re seeing the ambulance responding to people who are down. They have overdosed. It just seems to be…. It has increased so much over the last few years. I don’t know how long this can be sustained.

What this nurse said was on the success of the Insite supervised injection facility in Vancouver. While the site did see overdoses, there were no deaths. This nurse credited that success to having access to medical help.

BCNU has been a consistent voice for increased access to safe supply, the ending of the criminalization of people who use drugs, improved health and harm reduction measures, expanded mental health treatment and recovery services. We’ve joined the community groups and advocacy groups to call for urgent measures to address the unrelenting rise in these preventable deaths associated with the toxic drug supply.

In the early 2000s, BCNU was instrumental in working to help mobilize support for that Insite injection site. Since its opening in 2003, it has served the community as a safe, clean, supervised environment where people can connect to addiction health care and other community services.

More recently, during the 2017 provincial election campaign, our union called on government to provide more harm reduction capacity, public detox and rehab services, and better backup and relief for front-line nurses to address the fentanyl crisis. During the 2019 federal election campaign, the union called on the government to decriminalize people who possess controlled substances for personal use. We do have that, which we appreciate, but as Michael has said, as their consumption increases, 2.5 might not be enough. We may need to go higher.

We are pleased to support a new private member’s bill introduced by NDP MP Gord Johns of Courtenay-Alberni, Bill C-216, which aimed to do just that: decriminalize simple possession of drugs so users don’t fear criminal charges when seeking support. Bill 216 also asked for the criminal records of those convicted of simple possession to be expunged and recommended access to a regulated safe supply of drugs and expanded treatment programs throughout the country.

We continue to make repeated calls to the B.C. government through provincewide media campaigns, letter-writing campaigns and other outreach strategies encouraging the public to join in our calls to action. We have urged the government to focus on the development of adequately resourced treatment programs and the harm reduction strategies needed to save these lives and to innovate through new programs of decriminalization and safe supply to get in front of this crisis.

In the wake of February’s grim drug toxicity report, B.C.’s chief coroner, Lapointe, convened a panel of subject-matter experts to provide advice and recommendations on how to stem the unrelenting death rate associated with the illicit drug toxicity crisis. I’m sure all of you have read that.

The three recommendations were to ensure a safer drug supply to those at risk of dying from the toxic drug supply, develop a 30/60/90-day illicit drug toxicity action plan with ongoing monitoring, and establish an evidence-based continuum of care. The action plan I’ve mentioned includes the development and implementation of a strategic management and governance framework that sets clear goals, targets and deliverable time frames for reducing the number of illicit drug toxicity events and deaths.

[1:25 p.m.]

BCNU fully supports the panel’s advice and recommendations, and the findings of that report were shared with our members through our Update magazine. There was a handout that was provided to you as well.

We recognize that in May 2022 the federal Minister of Mental Health and Addictions and Associate Minister of Health announced the granting of a three-year exemption under the Controlled Drugs and Substances Act to remove criminal penalties for people in B.C. who possess that small amount of certain illicit drugs. This is the right step. It’s a step in the right direction, but more needs to be done with this. As I mentioned earlier, people who use substances often face multiple barriers to accessing health care of all kinds, and they’re judged on it, too.

An additional barrier they face today is a systemwide shortage of nurses and other health care workers, which is stretching into and impacting every area of care. There was a shortage of nurses in this province well before the COVID pandemic, and it has exacerbated this shortage and also the other health care crises that we’re facing. Nurses are constantly working overtime, working short, but they’re doing their best to prop up the system. Being overrun by duelling public health emergencies, this just isn’t sustainable.

Our ask is…. We can do more; we must do more. Nurses and health care providers play a critical role in addressing the needs and concerns of people and communities affected by this crisis. We remain steadfast in our commitment to this work and will grieve with the families and loved ones for all of those who have died.

We held a candlelight vigil when we were here in May, to mourn the losses when we weren’t able to join together and families weren’t able to join together during the pandemic. We felt that it was needed by our nurses as well, who deal with this crisis all the time. Being a nurse, as I said, I have seen this, and it is devastating.

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

We’ll go to the question-and-answer part of it.

P. Alexis: Thank you so much. This is a question for Michael.

You talked about allowing nurses to prescribe. We have heard from all the regulatory bodies — pharmacy, physicians and the nurses — and each of them were very protective over their roles. Tell me: have you engaged with other regulatory bodies with respect to that ask, about nurses prescribing and allowing nurses to prescribe? Could you tell us a little bit about any conversation that you’ve had, where that’s gone and where the barriers are with this ask? It’s quite a drastic change from, really, what we have now.

M. Sandler: To be clear, the idea of limited prescriptive authority falling within the scope of practice for nursing as a profession is not a new idea. It is a new concept within the jurisdiction of British Columbia, and the Health Professions Act specifically provides for the opportunity to move in that direction as it relates to conversations with the nursing regulatory body — Cynthia Johansen, the CEO and chief registrar.

Their perspective is they don’t have any concerns with the concept in general, as long as it aligns with the current restrictions on scope from a broad perspective. What I mean by that is section 7 clearly indicates that to be competent as a nurse, you are required to be able to manage the intended and unintended consequences of your actions. By adding prescriptive authority to the current scope of practice, as long as the education, training, knowledge, skills and ability align with meeting the requirement to manage the intended and unintended consequences of that particular intervention — let’s say, a prescription for iOAT — then it aligns with our current scope. There should be no….

[1:30 p.m.]

Really, while I recognize that the physicians might feel that there is some concern there, ultimately, at the end of the day, we are already compounding and administering medications under the order of an authorized prescriber. The fact that we need to phone a prescriber for a prescription for Tylenol — which I could kind of say to you, “If you go across the street to the pharmacy, you might want to pick this off the shelf” — doesn’t really align with the realities of the practice environment that we’re in.

So while it’s a change, in particular, to the current culture, in the way that health care is administered, there are no practical barriers other than to make the legislative changes to the Health Professions Act to ensure that limited prescriptive authority…. As long as it aligns with restrictions on current scope of practice, i.e., section 7, there shouldn’t be any issues related to that. I think it’s an order-in-council, if I recall, but I would have to look that up.

P. Alexis: Just for clarity, have you engaged with the specific authority over this? And have you had conversation?

M. Sandler: Yes. The specific individuals who regulate nursing practice in the province of British Columbia are BCCNM, and I have had conversation with them related to expanding prescriptive authority outside of the PHO order to enshrine it into current scope, and there is significant understanding that this is a good solution, that this solution will save lives.

P. Alexis: Okay. Thank you.

N. Sharma (Chair): Questions, colleagues?

R. Leonard: Thank you. Apologies for being late. I appreciate your attendance here today and giving us your perspective.

I wanted to ask how many nurses choose to work in the addictions field. How many of them are out there actually actively involved directly with the provision of services around harm reduction, around treatment?

M. Sandler: I can take a stab at that anyway, and then you can jump on that. There are 67,000 nurses in the province of British Columbia, various designations. I think all of them engage in harm reduction in their daily practice.

As it relates to specifically dealing with the mental health and substance misuse population, I’m not privy to those statistics, but we can find them for you. It would be a call to the regulator or possibly the employers. Aman, maybe you have a specific number?

A. Grewal: No, I don’t have a specific number, but the same answer is that it’s throughout all of the system. So you’ve got…. Through the emergency department, you have your mental health and addictions unit where they first come in. You will also have that in your acute care section of emergency, if they have overdosed and require intubation, CPR. You will have them up on your psychiatric units. But you will also have them in your medical and surgical cardiac units. So it’s not just in a certain number…. It expands through all.

Your designation may not be…. You may just be in a medical nursing position that…. Even if you’re in, like, gastroenterology, it may be in that area that you also are impacted. We even have that in pediatrics, and we have it in neonatal with our babies of substance-using moms. And community, yes, and public health, so it’s everywhere.

We have patients that also go to long-term care if they have had a severe overdose and now they have had an impact to their brain and now are not cognitively there. They are being looked after in long-term care. It expands the entire system.

R. Leonard: Just a follow-up, quickly.

I guess the reason I’m asking is that we’ve had the information from the coroner’s report that talks about the number of people who have had a point of contact with the health care system. I would assume that with 67,000 nurses, there are probably a few of them out there. And we’re talking about expanding the scope of practice, etc.

Which organization would be the point organization to make sure that the training that’s required to deal more effectively…?

[1:35 p.m.]

Obviously, we’re not dealing with it particularly effectively, given the growth in the lethal drug supply deaths. So who would be that point organization to make sure that nurses are trained and have the sensitivity training, etc., to have that skill set?

M. Sandler: Ultimately, the responsibility to ensure the safety of the public falls to the college, to Cynthia’s team, so the college would be required to place restrictions on practice that ensure that the public is being served by these changes to the scope.

The college can say, for example, if you would like the autonomy to do this, that you will be required to do A, B and C in terms of education, pass an exam, be yearly certified. Whatever they choose to enact in terms of ways in which they feel that the public’s safety will be managed as it relates to expanding the scope of practice in this particular instance.

S. Furstenau: Thanks for the presentation. I attended the vigil in May and had the opportunity to talk with quite a few nurses, but I think it would be helpful for us and for the record just to talk a little bit about the toll — the human toll that this is taking on nurses. I think that would be helpful for us to hear about.

A. Grewal: As I said, I am a nurse, and prior to taking my role at the union, I was the site leader at Surrey Memorial Hospital. We see a significant number of overdoses, and just as you were asking about the toll…. This one evening, we had an overdose situation at a pub down the road from the hospital. We had, I believe, six patients that had overdosed, and we had to do CPR on all of them and we had to intubate them.

There was one woman who…. Somebody else told me about her. They said: “We saw somebody go outside, and we haven’t seen her since.” So I called 911, and I told them that they needed to go there and take a look. They did find her. She was brought in, and unfortunately, she didn’t make it, and we had to let the family know. She was a single mom and left behind a five-year-old. That sticks with me still to this day, that one.

What if we hadn’t told somebody to go look for her? Thankful that somebody did say to me that they had seen somebody, because I was trying to get an assessment of how many more people would be coming. But this isn’t just a one-off situation. We have it all the time. With the carfentanil, when that was really in a couple of years ago, that it was….

We were just finding out about what carfentanil was, and one of our psychiatric nurses in the mental health and addictions emergency area…. They checked the people’s bags, and she checked somebody’s bag, and then she wasn’t feeling well. She said to one of her colleagues: “I’m not feeling good. I’m just going to go lie down.” She went to the break room and laid down, but that other nurse…. Something twigged in her, and when they went, she had overdosed on just the substance that had come into the air.

We’ve heard about police who do checks and check somebody’s car and they go down. Back then, that was happening quite a bit, until they started wearing the masks and the gloves, because we didn’t know what carfentanil was. So it impacts the health care workers physically, but also emotionally.

When you build that rapport with your clients and you see them coming in frequently, you’re trying your best to provide them the supports, and then one day you hear that they’re no longer with us because they overdosed.

[1:40 p.m.]

You think of the family that was coming in to see them, trying to get help for them. You think of the devastation that they are facing now with that loss.

I had mentioned at the start about…. Oh, I can’t remember how many years ago it was that we heard on the news about this young couple that had overdosed — I believe it was around Christmastime — and they left behind young kids, and those kids were in the house.

So it impacts families. It impacts the young children. It impacts the staff, because the staff work with them. They’re trying to provide them the support. They develop that rapport, and the patients are more open with the staff because they do find it is a safe place to come to. The impact that it has on us nurses and the other health care professionals — it’s quite devastating.

D. Davies: Thank you both.

M. Sandler: Sorry, MLA Davies. I was just going to respond to MLA Furstenau.

Thank you for the question. I’ll be brief. I think that illicit substance misuse is an equal opportunity hater. It doesn’t really matter where you come from or what your background is; it will take the opportunity to devastate your life and those around you.

The collateral damage caused by the inability to manage the moral distress associated with this patient population — knowing what the right thing to do is but not being able to do it through various barriers, whether it is moral objection…. It is the fact that we view substance use as a moral failing versus a healthcare diagnosis.

Inability to access naloxone, federal regulation related to safe supply, scope-of-practice issues, the inability to connect with appropriate levels of care — all of those things take a toll, and they lead to what is defined as moral distress. That distress builds, and eventually we lose the practitioner to practice, because you can only come to work so many days in a row knowing what the right thing to do is without being able to impact change.

I think that’s a really important question, in terms of the toll that our inability to move forward on solutions related to this is taking. It’s a complex, difficult subject that requires some more collaboration, not only at the provincial and federal level but between health care designations and providers so that we can approach it from a wraparound perspective. So thank you for the question.

Sorry, MLA Davies. I didn’t mean to cut you off.

D. Davies: Not a problem. Thanks for that.

Over the past couple of years, I know myself and Shirley have met with Danette Thomsen up in Prince George and talked about the toll, the burnout and the impact that it’s had on nurses, and medical staff in general, which leads me to two questions. I guess, first, one of the big recommendations is the ability to become a prescriber as an RN. I assume that would be RNs and LPNs, or just RNs?

M. Sandler: Initially, we’re looking for RNs and RPNs or psychiatric nurses.

D. Davies: Okay. With that being said, my first question. Is there maybe a concern that that is just one more thing on a nurse’s plate that they need to be responsible for that will add, possibly, to the burnout, or is there hope that this might be a result to defer some of the things down the road? I guess that’s my first question. How has the response been from your membership on moving forward with this?

M. Sandler: There has been a small pilot project that has been led by BCCSU and PHSA and the Ministry of Health around limited prescriptive authority for iOAT for RNs and RPNs that has been met with a significant amount of positive feedback. The research is still pending in terms of the return on investment associated with number of lives saved, but I suspect it will be very good.

Then, remembering that limited prescriptive authority is aligned with scope as it relates to individuals who are looking to impact their practice. We can approach the expansion of scope along several lines. It doesn’t have to be a one-size-fits-all solution.

[1:45 p.m.]

You can expand limited prescriptive authority into pockets of practice as it relates to areas of specialty to address specific issues. If you are a dialysis nurse, for example, you can add prescriptive authority for insulin and heparin as it relates to the dialysis run that you’re doing, as opposed to having to phone a resident, who is just going to ask you what you should do anyways.

D. Davies: So you can be very prescriptive on the prescriptive ability.

M. Sandler: Yes.

D. Davies: Okay. That clears up a lot of it, then.

My final question would be: how is this being received by physicians, maybe the College of Physicians, as well as the pharmacists? Is there acceptance? We’ve heard, from numerous presenters over the past number of months, that often there’s a less-than-favourable uptake on change.

M. Sandler: I can’t speak for the physicians and the pharmacists directly, but I can infer. I would suspect that they would be less enthusiastic about the change as compared to nurses.

I will come back to the core point, which is that nurses live in every community that we’re facing these problems in, whereas physicians and pharmacists aren’t always present in those communities. So the opportunity to bring the solution to the patient as opposed to asking the patient to come to the solution, I think, is worth the difficult and maybe slightly elbows-out conversation that will have to happen.

This is about focusing on what’s right for the patients as opposed to focusing on what I’ll call sandbox issues related to “this belongs to me” stuff. I don’t think that serves the patient population that we’re looking to take care of in this particular conversation.

D. Davies: Thanks for that. I represent some of those communities where there is no physician; there is a nurse. So thank you both, and thank you for what you do.

I’m sorry. I think you want to also respond.

A. Grewal: Sorry. I just wanted to add that nurses work very collaboratively with the physicians. There’s a lot of care planning that takes place, and a lot of times it is suggestions by the nurse or a request by the nurse: “We’ve tried X, Y and Z. This hasn’t been working. Have you considered doing this?” Depending on where you’re at, some of those physicians may not be up to speed, where this is the clientele that these nurses see, day in, day out. They actually have that expertise. There are numerous times where the physician will ask the nurse — and especially an experienced nurse: “What do you think? What should I do?”

That expertise that nurses have, especially when they’re in a specialty area such as mental health and addictions, is something that needs to be valued. As Michael said, the little sandbox…. Nurses are not there to overtake somebody’s job. They’re wanting to serve their patients, and whatever can be done to serve those patients in a timely manner and get them on the right track is what we need to support.

S. Bond (Deputy Chair): Thank you very much to both of you. Thank you very much for the work that nurses do every single day.

When you think about where we’ve been for the last, at least, two years, and even before that, facing two public health emergencies — not one, but two — right in the middle of all of that are nurses are on the front lines, day after day. We know and we’ve all heard that burnout, over time…. All of those things are real issues that are going to cause major ongoing problems for our system if we don’t figure it out, so we really appreciate you and your advocacy on behalf of your members.

I’m really interested in the expanded scope of practice, because that is something that is an ongoing debate in health care. It’s not just during a public health emergency; it’s always. It’s: how do you practice to your full scope of practice, first of all? That’s the big issue, because there’s tension there, when you bump right up against that line, whether it’s a nurse and then the nurse practitioner and then the physician — all of those things.

I’m trying to remember. I thought that there was an emergency health order at some point that allowed for RPNs, I believe, to prescribe. But I think it was an emergency health order. I’m wondering….

Michael, when you were talking about looking at the success or not, was that related to the emergency health order? Has that order now ended? Was it a short-term…?

[1:50 p.m.]

I know it was a while ago, and I seem to recall that there was an order that said that RPNs could prescribe. What is the status of that?

M. Sandler: Thank you for the question. You are correct. The PHO released an emergency order allowing for prescriptive authority for RPNs and RNs as it related to the overdose crisis — in particular, OAT and iOAT therapy — as long as they completed the BCCSU course. The education rollout associated with that was through BCCSU.

The number of individuals who have taken the course has, obviously, been small, so the number of individuals — RPNs and RNs — who are prescribing at the point of care is limited. I don’t know where the research is at, in terms of outcomes. The anecdotal evidence that we have heard back has been very positive.

As you know, with a PHO order, that can be rescinded or amended at any point, and that program would then end, at that point. So the question is whether or not now is the opportunity to roll that over from an interim measure to a more permanent measure.

S. Bond (Deputy Chair): If I could just have one follow-up, Chair.

I think that when you think about that, the next piece of that is, as you referenced, the education and the training component of that. It’s one thing to say that you have the authority to prescribe. It’s another whole thing for nurses to actually then have the training and the proper educational package that you need to do that.

I don’t know if there are still concerns about that. I seem to remember there were concerns about how you then support nurses when you’re expanding their scope of practice. I don’t know if that…. I heard you say that there was a course, but are there other educational needs if we are going to look at that expanded scope of practice that, for example, the BCNU is concerned about?

A. Grewal: It would be whatever has been approved through BCCNM. There are always checks and balances that are put in place.

We have nurses in our emergency department, in triage, who have that expanded scope of practice where they’re able to send somebody for an X-ray or have diagnostics done, to get that treatment started right away. So we do have that — and, as Michael said, with renal dialysis, with adjusting the insulin. There are different…. We also have standard orders that have gone through different committees, pharmacists and nursing practice groups.

In terms of concerns that the union would have, our concerns would be if there was something that took place that was not in their scope of practice, and there’s discipline, etc., taking place. In terms of us, it goes back to the regulatories.

N. Sharma (Chair): Okay.

Go ahead, Susie.

S. Chant: Did you have something you wanted to add, Michael?

M. Sandler: For MLA Bond, I think the take-home message around your question related to education is that we’re not reinventing the wheel. There are processes out there that have looked at bringing nursing to whatever prescriptive authority level is required to do the job at hand. So there would be checks and balances, as noted by the union, put in place to ensure that.

I think the take-home message is that what we’re looking to do is align accountability and responsibility. Currently we have a significant amount of responsibility without…. There’s no aligned accountability there. What the expansion of prescriptive authority does, outside of the PHO order, is bring in line that accountability and responsibility.

If it is my responsibility to prescribe this to you as a patient, I’d better ensure that I have the accountability, as it relates to the education, knowledge, skills and abilities to perform the function. So this will just allow that accountability and responsibility to align.

S. Chant: I have watched in awe as colleagues have done CNA accreditation, for lack of a better of a better word, in palliation, wound care, gerontology, etc.

[1:55 p.m.]

Have we talked to CNA — sorry, Canadian Nurses Association — about doing something similar to that in the area of addiction management, drug toxicity, substance use, etc.? Is there any appetite in that area?

M. Sandler: The CNA has not been engaged to create a new subspecialty or a specialization exam related to mental health and wellness and addictions, but there has been work done on an addictions fellowship, at the NP level, within British Columbia. There are several NPs who practise, post-fellowship, specifically with that patient population. One of my colleagues, Zak Matieschyn, is a specialist in addiction care and works out of the West Kootenays. There are several individuals within the province who practise at that level.

But we can definitely have that conversation. Given that health care delivery is a provincial conversation, I think we should ensure that our ducks are in a row, and then we can have a conversation about how to ensconce that nationally. But there’s nothing wrong with B.C. leading the way.

S. Chant: We’re good at it. Thank you.

N. Sharma (Chair): A final question from me. We’ve learned a lot, just from both of your conversations that you’ve had about your perspectives on what’s needed. One of the things that we’re tasked with doing, as a committee, is giving recommendations on the expansion of safe supply and what that looks like.

I know that there’s a pilot project or a group of prescribers right now. I just want to dig a little bit deeper, as maybe the last question: what should we be prescribing? What’s needed, from the perspective of the practitioners that are on the front line, to meet the kind of toxicity that we see of the drug supply with people? If you have any insight on that, I’d be interested to know.

M. Sandler: I’m just looking at my notes, because I do have some notes related to that.

A. Grewal: While you’re doing that, I’ll just say that this is under the purview of the college and the regulatory bodies — the pilot project, etc. We, at the union, are not participating in that, in terms of having any of the…. Unless there were some issues concerning that, we don’t. It’s the regulatory bodies that deal with that.

M. Sandler: The current work is being led by Dr. Scott MacDonald and Anna Bojanczyk-Shibata. Dr. MacDonald’s team advocates for DAM access — that is, diacetylmorphine — and injectable opioid agonist treatment — that is, iOAT therapy. Then there is some conversation about TiOAT therapy. That is a tablet and injectable opiate agonist therapy.

Hydromorphone, according to my notes, is clinically cost-effective, and it is showing significant reduction, but there are some individuals who are not responding to that therapy. So there is the conversation around expanding DAM.

There is also the regulatory conversation about making safer supply a non-health-care issue, similar to cannabis. That’s probably a conversation for another time, but you could look at a retail solution versus a prescriptive-authority solution. I’m not recommending that, but if we want to have a conversation about expanding access, then we could have a conversation about what it could look like outside of the health care environment.

When you were looking for suggestions, those have been the suggestions that have been posited by my colleagues. But we haven’t had the opportunity to engage in a deep dialogue around the intended and unintended consequences of those solutions, except to say that we do know that TiOAT, OAT and DAM access appear to be moving in the right direction, in terms of safe supply.

N. Sharma (Chair): Okay, that’s been really helpful. On behalf of the committee, I just want to thank you both for coming here today. We heard the passion that you have about this topic, and I know that nurses are the heart of our health care system. You do a lot, and have done a lot, in the last few years. We just want to appreciate that for you and your members. Thanks for coming.

We’re going to be recessing for two minutes, and our next presenter is virtual.

The committee recessed from 2 p.m. to 2:03 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): I just, on behalf of the committee, want to welcome our next presenters, who are joining us virtually. We have Pain B.C., including Dr. Launette Rieb; Brenda Poulton, nurse practitioner; Dr. Annabel Mead; Melanie McDonald, master of social work; and Dr. Sean Ebert.

Welcome.

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

We’ll do a quick introduction and go-around. I’ll go to our Deputy Chair.

S. Bond (Deputy Chair): I’m Shirley Bond. I’m 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.

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

D. Routley: Doug Routley, MLA, 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): Excellent. You have 15 minutes for the presentation. Then for the rest of the time, we’ll do questions and answers.

Briefings on
Drug Toxicity and Overdoses

PAIN B.C.

M. McDonald: Good afternoon, and thank you very much for the opportunity to speak today about how pain intersects with the overdose crisis in British Columbia. My name is Melanie McDonald. I’m the director of support services at Pain B.C. and a social worker by background.

I’m calling in today from the unceded territories of the Squamish, Tsleil-Waututh and Musqueam Nations.

[2:05 p.m.]

I’d like to introduce our speakers today. Brenda and I will be presenting, and the other speakers will be bringing in their expertise for question period.

We have Dr. Annabel Mead, who is an addiction medicine physician with expertise in concurrent psychiatric disorders, pain management and women’s health. We have Dr. Sean Ebert, who has been a rural physician for the past 25 years. His work includes anaesthesia, which has enhanced his opportunity to work with acute- and chronic-pain patients. We have Brenda Poulton, who has an extensive background in health care, from front-line nurse educator to nurse practitioner and, most recently, as the clinical lead for pain in Fraser Health.

We’re calling from Pain B.C., which is a non-profit organization. Our mission is that no one be left alone in their pain. We are a network of clinicians, patients and policy-makers. We run a variety of programs, including a pain support line, peer-based support programs and education programs for health care providers.

We’re going to be speaking to you about a few things today. We are beginning by acknowledging that untreated pain is a significant driver of substance use and overdose risk. Chronic pain is a serious public health issue, impacting people across British Columbia, their families, the health system and society. There is an urgent need to address pain in British Columbia, and it has significant overlap with the overdose crisis.

Secondly, government and health authority interventions created in response to the overdose crisis have, really, largely ignored pain — both in the service delivery rollout reports and the response plans — even though pain has a significant connection to this crisis we’re currently in. There has been much attention on harm reduction and safe supply, which are very important components, but pain is a missing link.

Thirdly, restrictions on opioid prescribing without appropriate alternative pain care have contributed to an increase in untreated pain and health-related concerns. There’s a long history of how we got to where we are, on opioids and prescribing. Our big concern is when patients with chronic pain are cut off opioids without appropriate alternative pain care. I personally have experience answering our pain support line. Callers frequently call on this issue. The primary care access issues in the province make this more challenging.

Fourth, there are several evidence-based interventions that can help, which we’ll speak to today. Many of them currently happen on a small scale within the province. They require funding and action to implement — and to improve outcomes.

Lastly, the development of a provincial pain strategy, which would address the above issues and recommendations, has been included in the PHSA contract with the Ministry of Health since 2008, with little progress since. This needs to be prioritized. If you just google “British Columbia provincial pain strategy,” you will see commitments made. Other provinces have made much more progress than British Columbia, even though we were initially one of the leaders in this.

Back to the first point: untreated pain is an important driver of substance use and the overdose crisis. There are many people in Canada who live with chronic pain, nearly eight million people. That’s an estimated one in five. Two-thirds of Canadians living with chronic pain report their pain is moderate to severe, and 50 percent have lived with chronic pain for over ten years. In British Columbia, this is 20 percent of our population. Even though lots of people live with it, we don’t have enough care. We don’t have enough multidisciplinary pain clinics to address the more moderate to severe pain.

Pain impacts many aspects of a person’s life — the ability to work, attend school, participate in their life, community life. It’s largely invisible to those affected. Many of them feel disbelieved by their health care providers and by people in their life and, also, stigmatized. A large proportion of people who use substances also live with untreated chronic pain.

Over to you, Brenda.

B. Poulton: Okay, thank you very much.

[2:10 p.m.]

A small correction to my introduction. I’ll just take a moment. I am a retired nurse practitioner. Our college says we must state that. So I just want to clarify that. I’m a clinical lead, currently, for Fraser Health, in pain management.

Untreated pain is an important driver of the substance use and overdose risk. As Melanie mentioned, it impacts people’s lives, their ability to work, etc. Chronic pain is largely invisible, and those often affected with chronic pain are disbelieved and stigmatized.

One of the factors that happens with this is there’s an increased risk of untreated pain increasing the development of substance use disorder, and the opposite is true as well. Substance use increases the risk of developing chronic pain and mood issues as well. It’s a very cyclical pattern, with injury, trauma, substance use, mood disorder all reflecting off each other and impacting the care that people do receive. Heavy opioid use can also increase sensitivity to pain, and it exacerbates when people are forced to quit opioids without proper tapering and care.

Untreated pain — again, we look at it as a significant driver in the substance use and overdose risk. A 2016 study focused on primary care patients who reported using illegal drugs. About 87 percent of those participants in that study also experienced chronic pain, and 51 percent reported that they were using illegal substances to treat pain. A report out of Vancouver Coastal in May of 2022 this year indicated that 45 percent of people who died from overdose in the Vancouver Coastal Health region in 2017 had received prior treatment for pain at that time. So again, a strong linkage between those suffering from substance misuse and chronic pain.

VGH looked at stories and collected stories from the overdose and drug use report. There are many stories of patients reporting back that they felt pressured to decrease opioids rapidly and often turned to that illicit market in filling that void created when they were not able to manage their pain.

Research has demonstrated that people who experience marginalization are more vulnerable to chronic conditions, including those that result in pain. There are disparities in pain treatment in comparison to Caucasian people throughout people of various ethnic backgrounds. The literature demonstrates that these people receive fewer pain medications at lower doses and are less likely to be screened for pain and are often given less priority when presenting with acute injuries.

Indigenous people experience disproportionate rates of mental illness, substance use and chronic pain. As we know, there’s a strong history, often, of trauma, struggling with mental, physical, sexual and spiritual trauma abuse, and it can lead to that emotional pain that contributes to the overall pain experience. Indigenous people seeking pain treatment often have their pain dismissed. As a result, Indigenous people often may not seek treatment out of fear of having their experience minimized or suffering further marginalization or harm through that seeking of care itself.

Government’s and health authorities’ analysis of interventions created in response to the overdose crisis has largely been ignored, the pain component that is present as one of the drivers. Efforts to address opioid-related harms have led to serious and unintended consequences for some people living with chronic pain, including unmanaged pain, increased stigma and reduced access to care. This has led to some people obtaining illicit drugs to self-medicate, putting them at serious risk for overdose.

[2:15 p.m.]

Despite widespread decreased opioid prescribing and investments in continuing harm reduction, there are still record numbers of overdose deaths in Canada. We must urgently address untreated pain as one of the significant drivers of this crisis. This is coming out of the Canadian Pain Task Force report, released in March of 2021, as they looked across Canada at what is needed as a federal strategy to help manage chronic pain in Canada.

Again, chronic pain is often ineffectively addressed during treatments of substance use. Pain is often dismissed, and non-pharmacal options are not always offered. Many pain clinics currently do not accept patients with substance use issues. It makes it very hard to co-manage both substance use and the comorbidity of chronic pain when they’re being handled in a separate silo of care. Most addiction treatment programs do not accept clients with chronic pain. Again, the addiction medicine often does not feel equipped to treat the chronic pain at the same time as managing opioid management for pain.

Health care professionals lack adequate training regarding the intersection of pain and addiction within our colleges and our early training and ongoing programs. Again, these are often very much siloed programs of either learning about addictions or learning about chronic pain.

In chronic pain, best practice is based on a biopsychosocial model of treatment — so looking at both the physical, the psychological and the social impacts that individuals have within their lives. Access to non-pharmacological pain management, including counselling and physical therapy, is limited for many people due to financial and geographical barriers.

Restrictions on opioids prescribed without appropriate alternate pain care have contributed to an increase in untreated pain and related health concerns. During the mid- to late-1980s and into the early 2000 period, the practice was to prescribe opioids liberally. This was fuelled by big pharma, the understanding of the long-standing pain management practices and was really at the heart of trying to address people living with pain that had not been adequately managed at that time.

In the last decade, prescribing practice guidelines have changed to reduce the risk of opioid use disorder and the adverse effects that we see currently. But an unintended result of this change left many people living with pain taken abruptly off their opioid medications, without proper education and a route towards weaning and a case-by-case assessment. This is often very difficult for the individual. We need, again, that biopsychosocial model to support people that have been on opioids, to help them off opioids if appropriate.

Melanie, I’m going to turn that back over to you at this point.

M. McDonald: There are things we can do. The first thing is to integrate pain management into harm reduction services across settings — expanding access to multidisciplinary pain management for people who use substances, ensuring that primary care physicians who are tapering patients off opioids offer alternative pain management strategies, integrating assessment and management of substance use disorder and harm reduction principles into specialty pain programs in all other pain care settings and facilitating equitable access to harm reduction services.

Second is implementing evidence-based practices on prescribing opioids for pain care, preventing chronic pain by funding transitional pain services — Brenda has a great example of one of those happening at Fraser Health right now — and funding targeted interventions such as rapid access clinics, really looking at this stepped care, people getting the right care at the right time. Improving education for health care professionals — we know people are not getting adequately trained in pain across a variety of settings.

Lastly, integrating pain into government harm reduction strategies, which connects to the development of a provincial pain strategy that really needs to be prioritized. As I indicated at the beginning, other provinces have been able to get their strategies off the ground, whereas we have been lagging.

[2:20 p.m.]

A draft was submitted to Health Minister Adrian Dix in 2018. It’s now in the hands, I believe, of PHSA, and really, little to no progress has been made.

We have a national action plan on pain, so we have solutions as to how to address this. So really, prioritizing the provincial pain strategy is a critical step in addressing the pain component of the overdose crisis.

N. Sharma (Chair): Thanks for that. We’ll switch over to the questions now.

Go ahead, Shirley.

S. Bond (Deputy Chair): Thank you very much for your presentation. I just want you to know how much I appreciate this, because I think that when we stop and think about all of the presentations we’ve heard, at the root of most of the presentations, if not all of them, there is pain, whether it’s trauma and emotional or whether it’s physical. We listened to the construction association talk about pain there, which is one of the highest demographics of people who are impacted.

So I really appreciate this, and I have to admit that it’s something that I hadn’t thought about the way I probably should have. I honestly didn’t know we had a provincial pain strategy and haven’t looked at that, but I will now.

Could you just speak to the issue of…? As the concern around the provision of opioids began to grow, I’m assuming it was anxiety or fear or something that caused there to be a shift in the way that prescribing was done. I’m interested in your comments about people who were taken abruptly off their…. You know, there wasn’t a weaning, a transition to some other plan. Can you speak to that and how you think that links with the overdose crisis that we’re facing today?

B. Poulton: Annabel, do you want to take that one?

A. Mead: Sure, Thanks very much.

I think what happened is that for many years, opioids were seen as a great choice for pain management. As Brenda alluded to, there was the OxyContin, OxyNEO wave of prescribing from physicians who were trying to do the right thing. Pain was seen as the fifth sign that needed to be treated and that for anyone that was left in pain, this was a disservice to them. So many people have pain. So opioids were rolled out. Lots of people took them.

Opioids are a double-edged sword, right? They’re great for pain management in the short term. If you’re having a heart attack, if you break your leg or something, opiates are fantastic for managing. But once you take them regularly for even a week or two, your body becomes tolerant to them, and then they don’t work so well. So you up the dose, and then they work again. Then the brain becomes tolerant to the analgesic effects of the opioids, and dosages need to increase.

This is why we see…. We see this with illicit opiate use as well. You use it for a bit, our brains neuro-adapt to it, and then we need to always be seeking higher and higher doses. This is why so many people with pain — in North American society, anyway; not so much around the rest of the world, but in North America — wound up on very high doses of opiates.

Then we came to the realization of this. The crisis of opiate use disorder spread through the U.S. and Canada, and everyone realized: “Oh, okay. Opiates are not such a good idea. We need to stop this, stop the harm that we’re doing. Therefore, doctors need to stop prescribing.” So it was somewhat of a knee-jerk reaction, I guess. Also, the research and the literature showed us that people on high doses of opiates had just as much pain as people on low-dose opiates or none at all. So in the long term, it doesn’t work for chronic pain.

The solution from our medical regulators and educators, etc., was to stop prescribing so much opiates. Now, this was interpreted and rolled out in an educational way to all of our physicians, and the response from docs was: “Whoa. I’ve got to stop doing this. I’m causing my patients harm.” They drastically reduced the prescribing, leaving many patients high and dry, because that’s not the way to manage their tolerance to these high-dose opiates. The only way to rectify that is to do a gradual tapering down so that the brain and the body can get used to the lower doses.

[2:25 p.m.]

Everyone was trying to do the right thing by reducing the prescribing, but we had this unfortunate effect of patients no longer being able to access their opiates and many of them, by all accounts, needing to turn to illicit supplies of opiates to manage their withdrawal and manage the recurrence of the pain that they were experiencing. So that’s kind of how we got into this pickle.

This was rectified. It became obvious in 2016, 2017, that there was this crisis for pain patients, so our colleges changed their standards and guidelines and really emphasized the need for doctors to carefully reduce medication in these settings.

Again, all of this is very nuanced. Many general practitioners, anyway — family docs, etc. — who are doing the bulk of this work are doing all of their other general practice work as well. It’s a fairly specialized area, so many doctors were uncomfortable with taking on pain patients, particularly if they weren’t already looking for them. When doctors retired, no one would take on their pain patients from their practice. That contributed to the crisis as well.

Obviously, this is not directly affecting the overall supply of illicit opiates or anything like that. But it does contribute, in some degree, to the harms associated with when people need to, or feel the need to, resort to illicit opiate use elsewhere.

D. Routley: Given your experience and the provincial experience and the terms of reference that this committee has to expand safer supply, do you have concerns? How do you think the concerns you might have might be mitigated or addressed in that process?

A. Mead: This is an absolutely great question. Myself and many others, particularly addiction doctors that are experienced and have been around a long time and have seen, have kind of lived through the ’90s and the 2000s with the development of the opiate use disorder, the increase in people with opiate use disorders, are very concerned about the rollout of high doses of potent prescription opiates — currently, most often in the form of hydromorphone — going onto markets and going into the hands of….

It’s fine if it’s going to the person that has high opioid tolerance and is going to use it to avoid using illicit opiates. But we know, in many cases, those opioid prescription medications are being diverted to other markets. There’s a good street value for them. Often, for those people, the amounts…. Even though we’re prescribing, perhaps, large amounts of hydromorphone, it doesn’t nearly go all the way to replacing high-dose fentanyl usage. So, one, it’s a little inadequate. Two, there’s good market value for it, and there’s demand for it in other settings.

We know that a lot of that safe supply thus far is diverted. Where does it go? It goes out of the urban centres and to other areas that don’t have so much access to opiates. But the biggest concern, from my perspective….

I do work in B.C. Children’s Hospital and in other outpatient clinics. We’re seeing an increase in exposure of our youth and our children to opioids. It’s named safe supply, so people that are opioid naive, who don’t usually use, think: “Oh, here’s a substance. It’s safe. It comes from a doctor’s prescription. We don’t want to take that fentanyl; that’s dangerous. But here’s a drug that makes me feel good.” It can then become problematic in terms of using it regularly for some people and then starting on that whole path of opiate use disorder.

Once somebody has an opiate use disorder, you kind of have it for life. It’s like alcoholism, right? It’s with you forever, and you’re always at risk of relapse, even if you’re able to be treated. So we do have great concerns about massive rollout of prescription opiates to the community.

S. Furstenau: Thanks for the presentation. It’s really insightful and informative. I’m just going to share a little bit of an anecdote.

[2:30 p.m.]

An elderly person in my life had a fall. They had surgery; were in hospital for about ten days; recovered really well; indicated very little pain — were managing generally fine, with Tylenol; were discharged with no community care follow-up — so no connection to home care visits, or anything — and a bottle of opioids. We were really….

This was a year ago, and I was already quite familiar with this file, but it was a real surprise to us. This person didn’t ask for pain medication, didn’t need pain medication, but thought: “Since the doctor told me to take this, I’m going to take it.” We intervened really quickly and then got the home care set up.

This, to me…. When you talk about a provincial pain strategy, I would hope it would include some pretty clear parameters around the expectations of: when somebody is discharged from hospital with some follow-up care needed, what are the steps that happen? This could have been calamitous for this person.

A. Mead: Exactly. We know there are settings where people that have a slightly increased risk for developing a substance use disorder are at heightened risk if they’ve got access to even one prescription’s worth of opiates. Post-operatively…. We see it a lot with kids in dental settings having molars out, etc. Dentists used to prescribe 20 Percocets or something to go home with — not needed. Ibuprofen can be managed.

So it speaks to the need, one, for primary care in community. Some 25 percent of people in British Columbia do not have a primary care provider and rely on walk-in clinics. That’s something that needs to be addressed. And two, education of doctors across the board, whether it be orthopedic surgeons or anesthesiologists or anyone discharging patients from hospital post-operatively — surgeons, dentists, etc. We need to educate everybody about the risks of our patients developing opiate use disorder. Particularly, the vulnerable ones are people that have histories of trauma, our young folk and our elderly.

B. Poulton: I’ll also jump in here. Again, you’ve identified a great gap that exists in current prescribing practices and the safety around prescribing opioids in an acute care, post-surgical, injury area.

One of the things that is happening is transitional pain services — pilot projects. There’s a small transitional pain service in Vancouver Coastal at this time. Again, it is looking at decreasing the risk of not only developing persistent pain after surgery, which is something like 12 percent, depending on which surgery it is. It’s much higher in bigger surgeries.

Again, it’s really starting that upstream look at our prescribing practices, shepherding people that are at high risk through surgery and through their surgical journey. Then it’s following them out to ensure that if they have required opioids or they’re at high risk for developing opioid use disorder, we stay on top of that, help them through that period and get them back to their primary care practitioner.

In Fraser Health, we now have two opioid stewards that are, again, looking at that education component — developed discharge orders, looking at how much opioid is really needed for each surgery very carefully. Ensuring that this is…. We need that education rollout. If it’s this surgery, here’s what research shows us. You only need to go home with seven pills. Or in the elderly, let’s make sure they don’t go home with opioids if not needed. I mean, they’re just at such great fall risk after surgery, etc. So it’s really individually looking at what the need of that patient is and ensuring that we’re meeting that need.

Definitely, gaps still exist. As Annabel said: huge education component, upstream prevention issues.

[2:35 p.m.]

R. Leonard: Thank you very much. Yeah, pain perception — that’s what I want to focus a little bit on. I went to a workshop with PNWER, the Pacific NorthWest Economic Region. It was talking about the international…. This was quite a few years ago now. The workshop was around pain perception in our culture and the impact relative to the use of opioids.

Being, I assume, pain experts — I’m not quite sure; maybe you guys can explain a little bit more about who you are as an organization — you must have some research behind alternatives to opioids. I hear counselling. I hear physiotherapy. But I know there are other things out there, too, particularly around pain perception.

I just want to ask, too, around…. I’m just looking quickly at another province’s pain strategy. What I’m seeing, particularly, other than the things that we’ve talked about around education and awareness, is the need for research. I’m curious about what’s going on in the world of pain management and research in B.C.

L. Rieb: Launette Rieb. Sorry, I was a little late to the call. I thought we started at 2:30 for some reason, so I apologize. I’ll just step in.

Pain is really a primal and essential warning system about tissue damage that has either occurred or might occur. There are so many things that go into keeping that pain system alive. It’s really a bio, psycho, social. It can be the dog that bites your limb. You get a fight-or-flight response to kick the dog in the head and run away — this kind of thing.

If that immediate response, that fight-or-flight, doesn’t settle down right away, that can actually help to drive pain — so the distress around it, the memory of the bite that you have and the trauma associated, the meaning of it. Does that mean you think you’re not going to work again? These kinds of things can all spiral in.

That’s why it really needs a bio, psycho, social approach. There is the initial tissue damage or potential tissue damage, but the perception of pain is incredibly complex, both the ascending, up to the brain, the brain integration…. It’s really not pain until it hits the brain. You can get brain changes, once you’re in chronic pain, that actually can perpetuate that, which can be reversed with pain treatment. Then there’s also mood and other things that can get involved that can alter how pain is gated as it comes up through the nervous system.

It’s very complex, and opioids play a role with acute pain management very well. We know, in anaesthesia, it can be used great during surgery, and in palliative care, at end of life. But as a tool for chronic pain management, it really has some limited use — some very important use, but quite a bit more limited because this whole area that Annabel probably, I assume, mentioned at the beginning — that opiates not only reduce pain but can actually cause changes in the nervous system, in many different levels, that actually increase pain and make you pain-sensitive.

So even people who have never been exposed to opiates or had an injury before, if you put them on high-dose opiates, they often will develop pain, and old injury sites can hurt again during withdrawal. I do research in this area. So some of the strategies that we’re using where we’re dumping really high-dose opioids at people created a lot more problems, and it can be hard to bring people back down and off.

It’s one of the problems, among a number of them, that bring up concerns for people who work in this area and work in addiction medicine around the whole safe supply issue. You have people on such enormous doses, instead of actually treating the underlying causes. There are many things going on there.

D. Davies: I’m not sure if I have much of a question left. The last couple of questions were somewhat of mine.

It was very along, what you just said, Doctor, around perception of pain. I was in a traumatic accident in 2018, broke five of my vertebrae and a whole bunch of other stuff. My worry is when you go into a smaller hospital — which I was, up north — the immediate go-to is fentanyl. That was what the doctor…. It was: “Are you in pain?” “Yes.” That was the question I had. It went right to that.

[2:40 p.m.]

I refused pain management, because, kind of what you had just said, in my mind, I was managing the pain. I think this is…. There is this huge disconnect, not with all physicians, obviously, but many physicians across the province, especially in emergency rooms, where they’re under significant pressure. It’s this need to…. “You’re in pain? We need to eliminate it.”

It shouldn’t be about eliminating pain. As you said, it’s a primal function of our survival. Pain is good. I broke five vertebrae. I should know that I have five broken vertebrae and be able to manage it.

There really needs to be this big push…. I mentioned it to Sonia a minute ago. So many of these things we’ve heard over the past weeks and whatnot have been around education. It’s something that has been missing for a long time, unless you’re very specifically in that field. These are important things that really need to be pushed out there as far as training our new physicians, training all our health care professionals that have that engagement on pain management.

I don’t have a question. It turned into a little story. I completely agree with your comments.

L. Rieb: Thank you for that story, though. It does emphasize….

I’ve been teaching physicians for over 30 years. So has Annabel — almost that time. I’m a little bit older than her. We really do try to teach about even simple things, like the literature around how many tablets you give when someone has had an accident or is just post-op. How many days of supply is a better predictor of if they’re going to be on opiates a year later than the actual injury, how they rate their pain at the time or what kind of surgery they had?

It’s this exposure. Prolonged exposure in that initial period can really be an issue. So trying to train doctors…. I teach, also, through WorkSafeBC — we go around the province — and through UBC CPD. We’ve been teaching thousands of family doctors around some of these principles, as well as through the College of Physicians and Surgeons, trying to help people understand.

It’s just hard when people have been put on really high-dose opioids. You need some skill in some of the tapering strategies, which we try to teach. I teach the residents through UBC as well. So we’re trying to teach more. But in all, in education…. Veterinarians have more education time on pain and pain management than physicians and nurses get. So the curriculums really need to change around these issues if we’re going to make an impact.

B. Poulton: I wonder, Sean, if you might speak up and talk a little bit, from your anaesthesia and pain perspective, about surgical procedures and the changes for invasive surgeries that decrease the tissue damage, which help. Also the use of regional anaesthesia, again through that lens of how we’d like to address surgery, from the transitional pain perspective lens, and shepherd people in a much better journey across their surgery.

S. Ebert: For sure. Thanks, Brenda.

Dan, to your point, I’ve worked in Northern Health for 25 years, so I do very much appreciate the context that you’ve described.

I think, further to that, context is everything. When I have my family physician hat on, I will approach pain in a very different way. If I have my surgical hat on, as Brenda is suggesting, I’m going to be discussing the process differently with the patient. When I flip my anaesthesia hat on, it has to be very much around the patient journey and the pre and postoperative experience and offering opportunities and alternatives to patients, depending on the patient. But then again, when I’m in my emergency room managing a postoperative situation or somebody in acute pain from an injury, it’s very different.

The education gap is massive. We really must consider the context of the situation that we’re trying to manage and the pain.

Again, there are lots of strategies evolving as we increase our understanding of the complexity of pain. As Brenda said, I did a lot of regional anaesthesia. There’s good evidence that if we disrupt pain pathways at the outset, we really minimize the need for postoperative analgesic medication, that sort of thing.

Again, lots of context, lots of information gaps, lots of opportunity to train and educate along the way.

B. Poulton: Regional anaesthesia, just in case you don’t know what that is, is the use of a local anaesthetic to actually block the transmission of those pain signals. The perception of pain is blocked right at the area of surgery.

[2:45 p.m.]

We can do that in a local area — very distinct, at a particular part of your body — or we can do it from a spinal or an epidural by putting a local anaesthetic in and numbing a larger portion of the body. People that have a joint replacement often have spinal anaesthetic, where they’re awake or just lightly sedated but have that whole blockage of any information coming up from that surgical site.

The use of that is one of the ways to break that cycle of the development of acute, intense pain afterwards. Just a little background there for you.

S. Ebert: It’s the same in the emergency environment. Dan, when you came in, I’m sure the focus was to mitigate your vertebral fracture pain. If someone comes in with hip fracture, I can block that limb until they get to a higher level of care to get their hip fixed, and we know that improves pain outcomes.

Again, lots of opportunity to contextualize our therapy and train and educate, as Launette and Annabel have said, on how to manage pain holistically.

M. Starchuk: Thank you for your presentation. This story jumps on Dan’s story as well, and it’s right with the topic.

Four years ago I had a joint replacement. I had the spinal, and I had the enjoyment of being awake while they replaced my knee. I say that tongue in cheek. But there was something that took place differently with my physician. The question will be: is this the way it’s supposed to be? Is this the way it’s taught?

We had a very long conversation regarding my personality and my makeup. So when I was going to be discharged, what was I going home with? Was I going home with a suitcase of pharmaceuticals, or was I going home with three days’ worth of pharmaceuticals? I will not answer what I went home with, but I will tell you that that was an in-depth conversation with my surgeon before I was leaving his care and finally leaving the hospital.

L. Rieb: Did you feel seen and heard by that interaction?

M. Starchuk: Yes, absolutely. It was customized to myself.

My question is: is that is that something that is taught in the school? Or is this my own personal doctor’s bedside manner?

L. Rieb: Well, we’re trying to teach that. I’m glad that he did that, for sure, but it is not as common as we would hope.

N. Sharma (Chair): Okay. I’m sorry if I’m cutting people off. I was going to go to the next question. If you wanted to continue on that one, go ahead.

B. Poulton: I was just going to mention the tie-in with the surgical patient optimization collaborative that’s happening right now. It’s a big collaboration, the second time in the province, looking at surgery and, again, optimizing people’s health prior to coming in for surgery. I’m working with the Royal Columbian Hospital on this. We’re tying the transitional pain service with joint replacement into this optimization. So it’s exactly what you’re talking about.

We’re looking at that patient very carefully. Do they have some of the factors that might put them at risk for developing a high reliance on opioids post-surgery? Can we help them with education and other things prior to coming in — good activity, developing stronger muscles in that limb, etc.?

Lots of things are tied in, from a surgical perspective. That certainly includes pain and being discharged with the appropriate pain management, and contact after your surgery to ensure that you’re doing well and recovered, because pain is the number one reason that people return to hospital after surgery, usually — secondary pain problems.

L. Rieb: I’d like to jump on what Brenda is saying. If we look at the injured workers, construction workers are some of the highest risks for overdose right now, for drug poisoning, and sometimes I have heard advocates on the radio saying: “Oh well, that means that they need more safe supply.” But these men and women are usually in safety-sensitive roles, and high-dose opioids and stimulants are contraindicated because they put themselves and their co-workers at risk in terms of their safety-sensitive job.

Instead, we need to be able to treat them, treat their pain, which is often why they’re taking these substances, in programs like Brenda just outlined. As well, if they have opiate use disorder and alcohol use disorder, there are medications like naltrexone, which we could be bringing in from the United States, that can treat both disorders at the same time. We have many strategies. Just throwing a supply at people is usually not a wise thing.

[2:50 p.m.]

Annabel and I are also very happy to come back and have a separate hour on some of the concerns around safe supply and how to mitigate those concerns, as well as legalization, decriminalization, medicalization of drugs. We can help to present and broaden the understanding of those concepts for the committee, if they want, on a separate day.

Just making sure that people have access, especially our workforce…. Through WorkSafeBC, I work in a clinic that gets a lot of injured workers, so we have WorkSafe contracts. We have now started programs that are concurrent care. We treat addiction, pain and mental health all together. We can have, let’s say, an ambulance attendant — we get a lot of first responders — who has post-traumatic stress disorder, has a high-dose alcohol use disorder, may be binging on some opioids and has had an injury at work. All of these things we can co-manage, but that model needs to come out into the MSP system.

We don’t have models like that for the MSP system. The average person who didn’t have a WorkSafe claim doesn’t have access to clinics like this. These kinds of programs are really needed.

N. Sharma (Chair): We have two more questions, in a little less than ten minutes.

R. Leonard: You kind of answered the question I had around the alternatives. At least, you started to touch on that.

Earlier on, one of the presenters was talking about different pain clinics that won’t take people who are substance users. Is your organization one of those? Or do you treat people who are on safe supply?

M. McDonald: I’ll answer that. Our organization delivers…. We’re a collaborative of clinicians and policy-makers. Then in our non-profit operational organization, we run a lot of peer-based support. I’m a social worker by background and work with a team of social workers that delivers more of the psychosocial area of service.

In the first answer to your question about alternatives, Dr. Rieb started to mention some of them — just really bringing in that biopsychosocial model and that we need stepped care. Actually, when the provincial pain strategy was initially drafted in 2018 for British Columbia, Doctors of B.C. got on board as well, talking about stepped care. We’ve got community-based peer support all the way up to multidisciplinary pain clinics.

The people that we work with, for the most part, cannot access multidisciplinary pain clinics without waiting two or three years in this province. This is where the gap really is: there are people who aren’t able to access the service. In our organization, we do work with people who are struggling with addiction and who are wishing to access safe supply, absolutely. But we are not a multidisciplinary pain clinic. Our organization is a non-profit organization.

L. Rieb: Pain B.C. doesn’t have doctors who assess people and prescribe medication. It’s a support organization and an advocacy organization.

R. Leonard: As an advocacy organization, with support for your clinics that are part of your organization, then, how do you support them to serve all British Columbians, those on safe supply and those who are seeking to have a drug-free life?

M. McDonald: Do you mean the health authority, to deliver service? Perhaps we’ll let one of the physicians answer that. That’s happening in the health authority, and Pain B.C. has always tried to advocate for services to be able to be more accessible to people with chronic pain, whether they have a substance use disorder or not.

A. Mead: I think one of the important underlying understandings around this is that it is very difficult to manage pain successfully in someone that has untreated addiction, whether that be alcohol use disorder, stimulant use disorder or opioid use disorder. If you’ve got untreated substance use disorder, we can do all of these things — non-pharmacological and non-opioid treatments — for people, but their pain is still going to be very poorly managed because of their substance use disorder.

[2:55 p.m.]

This is the importance of treating the substance use disorder at the same time as treating the pain. We need to do it together, and I think we have alluded to that nicely. If someone is accessing safe supply and taking high-dose opiates, that’s really an untreated opioid use disorder. That’s really harm reduction without the treatment.

Now, there are a lot of good things about safe supply. We can use it to engage patients in care whilst we’re treating their opioid use disorder, whilst we’re starting them on methadone or other treatments. Certainly, there is some early evidence. We were talking about the need for research before. We very badly need to research and measure the outcomes of what’s happening with the safe supply that’s currently being rolled out. That is super important, and I know there are efforts to do that.

I have to say the efforts around that are very qualitative. Often we hear the voices of the substance users themselves, and we don’t get a lot of research from the prescribers or others in the community that might need to have a voice in this. Again, on the safe supply, people that are accessing safe supply typically are not in treatment for their opioid use disorder. They may be using it. They may be [audio interrupted] whatever to draw people into care and treat both conditions together.

L. Rieb: I’d like to piggyback on that and say that just because you’re using safe supply, it doesn’t mean you don’t deserve a really good work-up and really good care, despite whatever your personal decision is on what’s available.

I’ve seen people who have been given high-dose opiates — either through high-dose methadone or the iOAT program, the injectable opioid supervised program, or through take-home supply of addictive drugs, through safe supply, through all of those programs — who have never had a work-up for what’s going on for their pain condition.

When they’re properly worked up, sometimes you find these horrific things. I had a patient recently who was a high-dose fentanyl user for years. He lost his family and lost his business, but he actually had ankylosing spondylitis, which everybody had missed. So we have him worked up.

I found somebody who was taking these enormous doses through the iOAT program and taking all sorts of other things off the street in addition. But really he had…. Both of his hips had completely collapsed, but no one had worked him up. He’d been in and out of all this care, but no one had done the proper work-up. Other people have had cancers that are undiagnosed and that are eating their way through the liver.

Getting to see somebody who can see them for a person, despite whatever their substance use is — or their pain behaviour, their culture or their colour — just cutting through that and taking a good pain history and a good addiction history and co-managing these issues at the level that patient is ready for and supporting them through and using as much harm reduction as we can and as much good, evidence-based treatment as we can. This is what we need to help people have better quality of life and to reduce harm to both the individual and society.

N. Sharma (Chair): Okay. We’re coming up on time. I think you answered most of my questions. I think we have a lot of members here that would appreciate…. If there are any materials that you could provide us to help with the data and research that you’re doing, please send them our way.

I guess I just have a very quick question. Has anybody done an analysis of the research, from the coroner’s report perspective, of how many people that passed away from an overdose had a pain, had a connection to pain management and that that was something they were interfacing with the health care system on? Is that data that we know? If nobody can answer that now, it would be great if we could get it later on. I think we’re out of time at that point.

L. Rieb: That stat may not be as relevant as you think, because if I put you, without a pain disorder, on those high-dose opiates, you would have pain every time you withdraw even slightly throughout the day. So I can generate pain in you by doing that. At the same time, there are people who have very bad pain conditions that are completely unmanaged, and all they can do is self-medicate. That’s the only thing that they turn to.

The utility of that kind of information is a little complex, I’d say. But we did present one stat on that in the slide deck. It was something like 67 percent of people who had pain, and 45 had accessed some kind of pain — some stat, something close to that, in the deck that we gave you already.

N. Sharma (Chair): Okay. I don’t think any of us have that deck. We’ll make sure that everybody gets that, because we didn’t see it. I appreciate that.

[3:00 p.m.]

M. McDonald: We will certainly provide you with the deck, which has a lot of these statistics and links; as well as the national pain strategy, which kind of outlines the solutions that we would like in the provincial pain strategy. Really, we’re talking about a lot of solutions, and the bottom line is that people cannot access them. So we want to increase access to these various solutions.

Thank you so much for the opportunity today.

N. Sharma (Chair): Yeah. I just want to thank you on behalf of this committee. This perspective, I think, was really valuable to hear — about pain and how pain shows up in this issue. So I appreciate you sending…. We’ll make sure everybody gets the materials that we didn’t have for this one in front of them. If there’s anything else, please do send it in. Thanks very much for your time.

We’re going to take, maybe, a two-minute recess.

The committee recessed from 3:01 p.m. to 3:06 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): I’d like to reconvene here. We have our final guest. On behalf of the committee, I just want to welcome Michelle Bell, director of child, youth and family advocacy for the Federation of Community Social Services of B.C.

Welcome, Michelle. I’m just going to do a quick introduction of everybody that is before you.

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

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

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

S. Furstenau: Hi, Michelle. I’m Sonia Furstenau, from Cowichan Valley.

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

D. Routley: Doug Routley, MLA, 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. Michelle, you have 15 minutes for your presentation. We have the materials that you sent in on our screens here. Then afterwards we’ll have time for questions and discussion.

Go ahead.

FEDERATION OF COMMUNITY
SOCIAL SERVICES OF B.C.

M. Bell: Thank you. I’m just going to read, so I apologize. I don’t have an interpretive dance or anything exciting for you to see today. I’m going to read and try and fit it all in, in 15 minutes.

First, I want to say that I’m grateful for being here. I feel so appreciative, and I know that the Federation of Community Social Services is also grateful for you allowing us to come here and have a voice.

I’m here on behalf of the Federation of Community Social Services of B.C., which is a voice for the social service sector. For those who don’t know, the federation is a non-profit organization that represents a group of over 155 community-based social service organizations. We serve more than 250 communities across B.C. We support members with a broad range of services, programs — B.C. families, children and youth, seniors, people living with addictions or mental health issues, low-income families and individuals.

Prior to coming to the federation, I’ve worked, over two decades, with individuals and families that have been marginalized — in many cases, adults with concurring disorders or youth with complex needs, including substance misuse and mental health issues. At the federation, most of my role is working with social service organizations around managing and strategizing solutions for high-risk children and youth, families that are in breakdown, trying to help children and youth navigate crisis services.

Many of our membership organizations are now experiencing having to support youth who have suffered severe brain damage, or are losing youth at an alarming rate due to overdose. This has far surpassed the pressing concerns of recruitment, retention, wage equity, funding shortages and the many serious issues that threaten the health of the social service sector, which acts as the province’s safety net.

The federation is in agreement that getting access to safe drug supply, harm reduction services and responsive crisis supports are among the essential services that are needed to be put in place to help prevent permanent brain damage and death from overdose. If we’re defining the problem as loss of life, then examining people in the weeks before the end of their life is where you’ll likely find the solutions to preventing death.

This is something the health system is very good at: saving lives and preventing death. For example, if there’s an increase in heart attack rates, you might provide defibrillators in public spaces, do an education and awareness campaign on how to spot early signs and symptoms of a heart attack, and try to catch people before the heart attack becomes fatal. The success is easily measured through the medical endpoint: how many lives have you saved from fatal heart attacks?

If we’re looking at an illegal drug market and organized crime as the problem, then looking within the justice system for ways to reduce and eliminate the toxic drug supply would likely be the most successful, and measuring the success by the medical endpoint would be nearly impossible.

[3:10 p.m.]

Our health system is designed to treat illness. However it has been designed, it has not been designed to support the wellness and well-being of those caught in an endless cycle of trauma and addictions that often leads them to a long path of suffering before any life-threatening concerns are present. If we’re still defining substance use through a medical lens and as an illness, then we will keep using medical professionals as experts, building more treatment facilities and treating individuals years after active addiction, and you’re going to keep seeing the similar results.

Trying to solve the crisis by providing more crisis response is going to create an escalation of crisis. Our systems have shifted so far into crisis response that it has become the only time an individual or family can access government support services.

A quick look at our child and youth family services, based on our current institutional model. Health services are run by experts and specialists. They’re based on illness and diagnosis. MCFD, the Ministry of Children and Families, uses a legal model in courts. It’s based on protection. It’s crisis-driven, and it’s not a support service. These are downstream services. They’re crisis-focused. They require wait-lists, and then wait-lists require triage. Triage creates escalation in crisis.

Where do you go when the family system is breaking down? What if there’s a divorce or financial struggles? If a child or youth is being bullied at school or at home or if someone’s just feeling lonely, if they have experienced or witnessed violence, if they have lost their parents or a sibling due to substance use, what service do they have to go for grief, for trauma, for healing? How do we offer a safe, supportive home life? What do we do to provide for somebody before they turn to substance use or start to get depressed or feel suicidal?

What’s been missing in our current system is the need to understand individuals’ journeys before addiction, homelessness and mental health. Our systems are actually set up to address symptoms. They do not understand or address the actual problems. We need to look at the root causes. We need to look at the entire shift in a way that we define the problems.

We have Western ways of knowing. Our methodologies, our evaluations, our assessments, our education, our support services — everything — have been created on assumptions based on a paternalistic system. We have a Western system of thought. We use this to define the issues that we are facing. We organize ourselves in social and cultural hierarchies reflecting broader patterns of oppression. Racism and inequality are embedded in our systems along with old colonial patriarchal thinking and knowing.

Twenty years ago, when I did my social work degree at UVic, I was taught about power and oppression and about the impacts of inequality, inequity and working with people experiencing mental health and using substance use for coping, through an anti-oppressive practice, trauma-informed lens, understanding Indigenous and intersectional feminist ways of being.

Despite this being the dominant school of thought being taught to anybody who wishes a career in the social service sector, during my entire career, all I have witnessed is marginalized people being bounced from hospitals to addiction centres to shelters and police services, depending on the wait-lists and the presenting issues. I have only had access to mental health and addiction supports that are defined and supported through a medical model.

These failing systems have embedded beliefs and values that people are ultimately responsible for their individual problems and, therefore, people are ultimately responsible for fixing their own struggles. They’re experiencing stigma, shame and blame if they require support services at all. Focusing on individual problems has resulted in the lack of wraparound supports and community solutions. It takes the responsibility off the systems that are actively harming people, and instead, it places the blame on those who are having normal human responses to these oppressive systems, doing their best to survive.

Our systems are riddled with illness, not our community members. Oppression and marginalization result in poorer quality of life, high rates of mental health challenges, suicide, addictions, homelessness and victimization. The systems and the services cyclically reproduce desperate outcomes for marginalized individuals in every metric and leave it up to the individuals to address these issues that are societal in nature.

In the government’s own document, Pathway to Hope, it says: “Mental health and substance use are tied to our general social, economic and physical well-being. Without good physical health, safe places to live, good food to eat, and people who love and care about us, it is hard to remain mentally healthy in the long term.”

[3:15 p.m.]

I would like to present a different way of defining the problem. I suggest that addictions and most mental health challenges are not health problems; they are symptoms of societal issues. They are a result of trauma, intergenerational trauma, poverty, oppression and family struggles. Therefore, they’re best to be addressed in the social services and in communities. This would also suggest that the supports would be in place long before they become a health and justice issue.

I think it’s best to illustrate through a case scenario, so let me tell you the story of young Michelle. Michelle was an average child living in a basic middle-class family. Her dad was a captain in the air force. Mom was a stay-at-home mom. She has two siblings: one bio sister and one adopted Indigenous brother — nothing like the Cleavers, but a fairly typical family. Dad wasn’t home much, and Mom was an authoritarian parent.

When Michelle was 12, her father met a nurse at work, and he left his family to move in with her. They married quickly, moved away and began a new family, leaving her mother with three children, no job, a nasty divorce battle that ensued for several years.

Michelle and her siblings moved from their modest home in a small, two-bedroom bungalow, where they eventually shared with another single-parent family just to pay the mortgage. The legal fees gobbled up the proceeds from their sale of their home, and their mother’s health and wellness deteriorated so much that she didn’t have the desire to fight for child support. The financial pressures eventually resulted in her mother’s undiagnosed nervous breakdown. She wasn’t working. She spent her evenings and weekends just sleeping in her room.

Like most children, Michelle was resourceful. She found friends. She would find people that would take her home for lunch, neighbours that would give her snacks and find things to do outside of the house. Michelle didn’t bring anyone home because her mom was always angry, and they didn’t have any food anyways. She spent most of her time outside of the house.

Michelle’s mother was angry most of the time and would often lash out about her father. Michelle resembled her father and, in her loyalty, defended him against all the family attacks. On a couple of occasions, Michelle’s school called home and asked her mother about some bruises that they found on her legs from being hit with a wooden spoon. No one at the school talked to Michelle about it.

After a couple of years, they moved to Victoria so her mother could find better work. Michelle started a new high school, where she met some new friends. Most of these friends had single-parent households and had similar life circumstances. There was a lot of comfort in having a group of friends that were in the same socioeconomic situation as her.

A typical adolescent, most of her time was spent socializing, which included drinking, smoking pot and going to parties. This was a lot of fun. She had friends, and there was a big group of friends that she finally felt a part of for a long time. It was a large group of friends, and at some of the larger parties, they were joined by older kids that had previously graduated.

She quickly connected with them and her best friend, Candace. Candace was four years older. She preferred to go to bars and parties. Most of the parties were downtown, which was an older crowd. She took Michelle under her wing. They did everything together, including dinners and Christmases with Candace’s family.

Because her new friends were older and an older crowd, her socializing turned into bars, after-parties and to much harder drugs. Cocaine replaced the marijuana. It became hard to attend school because none of her friends went to school, and she was out most nights late.

By this time, Michelle hardly saw her mother, avoiding interacting as much as possible. When they were together, all they did was fight. Being an authoritarian parent, everything became a power struggle. The fights used to escalate quickly, and her mother would sometimes punch, slap or choke Michelle out of anger. Michelle planned most of her days avoiding her mother and would stay out every night as much as possible.

One night Michelle and her friends were confronted downtown by police. Michelle was carrying some alcohol from the party in her purse. She was the only underage person, so she got a ticket for drinking and had to appear in court. Michelle’s mother also appeared in court and told the judge that Michelle was hanging around with older boys, not attending school regularly, not listening to house rules, which were all true.

The courts agreed that these were very bad behaviours, and Michelle was put on probation order: obey all house rules. She was to report to a probation officer weekly, attend psychological assessments. No one asked Michelle how she was doing. They just wanted her to stop her rebellious teenage behaviour.

After a couple months of probation, Michelle had broken several house rules, and her mother insisted that the probation officer do something about it. Michelle was arrested for breach of probation, breaking curfews, and sent to the Caledonia youth detention centre. Some of you might remember it. It was here in Victoria.

After two weeks’ stay in juvie, Michelle was put in front of the courts again, where it was determined that she be placed in a juvenile foster care system in Vancouver. By then, she had missed so much school that she would actually have to repeat grade 10 in a new school. In Vancouver, separated from her friends and family, Michelle made new friends and went to school until she was done probation and foster care.

[3:20 p.m.]

At 17 years, her time in the system came to an end. With no real community ties, no connection with family, no support network, no school and no clear place to call home, she decided that she and Candace would move to Vancouver. This city was much more fun, and they picked up right where they left off. Michelle never returned to school.

Michelle was courted by who later would be her future boyfriend. She was easily swept off her feet with this nice-looking, well-dressed, confident man, who said all the right things and had all the money, all the resources and wanted to take care of her. He made her feel safe. It was all very exciting. Coming from living in care, in poverty, and feeling alone and uncared about, this was actually a dream come true.

Unfortunately, Jeff was a drug dealer, and he was actively involved with the significant drug trade across Canada and the U.S. It wasn’t long before what looked like love and fun turned into control and fear. Michelle found herself isolated, living in the U.S. in an abusive relationship. She lived in terror for six years, with no access to money and no way out, even though she had many encounters with the police that were called to the residence for domestic violence and, on occasion, was hospitalized with injuries from abuse.

As a young adult, there is no system of support to help adults in these situations. It is considered a personal choice. No one presented her with any options, but she could feel their judgments. She was not using drugs. She had no severe mental health issues. The only supports that were available were institutions — hospitals and treatment centres or homeless shelters, which are end-of-the-road services.

Michelle is of white heritage, cisgender, heterosexual, able-bodied and had a fairly stable upbringing — what I would say healthy attachments — to age 12. She had a lot of privilege and what I call protective factors in her favour. If she were Indigenous, a person of colour, a trans youth or in the LGBTQ2SIA+ community, the end would have been significantly different.

Being a young child and hanging around other houses unsupervised made her vulnerable to sexual abuse. Using hard drugs regularly, she could have been given toxic drugs at any time and overdosed. She could have given up and taken her own life. She thought of it often. She could have got arrested with drugs and spent her life with a record.

It was sheer luck that Michelle didn’t become another statistic. But why should survival and quality of life be up to luck in our beautiful province of B.C.? Support could have been offered to Michelle’s mother to help her through the terrible divorce. When she was experiencing a breakdown or showing signs of depression, she could have been provided counselling supports.

There could have been support in place in the elementary school when they saw signs of physical abuse. At high school, Michelle stopped attending regularly. Someone could have approached Michelle or her siblings and asked how they were doing. The probation officer could have provided supports or connected Michelle with youth groups or employment programs.

So many supports and options could have been in place for the many encounters with the police and the hospitals. The systems are set up to look at Michelle’s behaviour, the symptoms, and not look at the real problems — abuse, neglect from family struggles and poverty.

Although the story takes place over 25 years ago, nothing has changed. In fact, it seems to have gotten much worse. We’re not looking at problems or solutions differently. We’re still trying to address the symptoms — addiction — in health. I’m sitting here presenting to a health panel, not a ministry of wellness or a cross-sector committee that provides services for children, youth and families through prevention and early intervention.

We have tried supporting and helping individuals through these Western systems for a long time, and it’s not working. No matter how good-intentioned, it’s oppressive, exclusive and discriminatory. There needs to be a balance in the system. We need a balance between no- and low-barrier services from the community and specialized government services. We need a balance between upstream prevention, early intervention services, and downstream crisis response services.

We ask that you come back to the table with the Pathway to Hope and work with the community to make a viable mental health framework for B.C., with wraparound care that includes the community social service sector and reflects the needs and the strengths of all our communities. Stop just consulting, and start partnering. The community needs collaborative, cooperative leadership from the provincial government and shared decision-making protocols.

N. Sharma (Chair): Thank you so much, Michelle.

Committee members, questions?

S. Furstenau: Thanks, Michelle. That was a really powerful presentation, and I really appreciate the approach that you’ve taken. I know the good work that you do in providing these services in Cowichan.

[3:25 p.m.]

Can you give the committee some context for what a struggle it is to maintain funding, to have enough people to meet the needs, the kind of wait-lists that you see for youth counselling? Can you give that picture that we know too well in Cowichan?

M. Bell: Well, thank you for your support and also for giving Cowichan a voice.

Right now I work for the Federation of Community Social Services, so I have a nice provincial look at social services. I would say that, so far, Cowichan is one of the areas…. There are some areas up North that are really struggling. The social service sector, in general, is struggling because….

For instance, A Pathway to Hope, as a foundational document, we were originally excited about. There is the creation of 350 new positions in that. Those are government positions. If you look in the document, the youth school teams that they’re creating don’t include the community. The community is actually not mentioned anywhere in the document.

The social service sector is like the broke cousin. You know, I heard a little of the presentation before this. When the non-profit came on, the non-profit was like: “Oh, we’re not the experts.” The view I’m trying to present today is that the communities and the non-profits and the social service sector are holding the communities. They’re holding the health of the communities now.

It isn’t till someone usually has a diagnosis or has had a lifetime of crisis before they get referred to an expert, which is a doctor. Most of us have the similar education, just in a different specialty. They’re referred to a specialist. They’re put on a wait-list, and it’s the community that holds them until they get into a service.

If you read A Pathway to Hope, they identify, themselves, that generally people get referred to services that they’re not wanting or needing. So if you have a mental health issue, you’re offered, especially as a youth…. You can only get into an addiction service. If you’re self-harming for coping, you can only get into a hospital. Neither of those are properly treated in those facilities, in my opinion.

N. Sharma (Chair): Other questions, committee members?

I think you made a really important point about the non-profit sector and the social services sector and the kind of front-line work that happens just with identifying the needs of the community and that feedback that needs to be with that relationship government has with the non-profit sector and the social services sector of what’s happening on the ground, where the vulnerable people are, and that policy development that could be such a strong partnership.

I’m curious about your recommendation No. 3 and if you could expand on that, the collaborative teams. How do you see that playing out in communities, and what’s that vision?

M. Bell: Yeah, recommendation No. 3 is: “Invest in community-led multidisciplinary outreach and in intervention teams.” We are in a crisis now. We recognize that. So just flipping to prevention, early intervention, obviously, isn’t going to help us with the people who are dying today.

The community social services are usually a safer, no-barrier, low-barrier place for individuals to go. They’re working with…. When a problem arises or an issue arises, they’re usually the first to see them. If the government were to partner with each community organization within the communities…. Every community is unique, and some have larger gaps and smaller gaps in the services, Cowichan being a great example. If they were to partner to create teams now to fill in some of those gaps — I think that’s an urgent need.

N. Sharma (Chair): Any other questions, Members?

S. Furstenau: I’ll just keep going. We’ve heard — and, I think, not just in this committee but as MLAs — over and over again, about the cycle of the funding model for community social services. You get a one-, maybe three-year funding grant, but you’re in this relentless cycle of having to apply for grants. You don’t have that consistent knowledge of funding.

I’m sort of answering my own question. From the point of view of community social services of B.C., what would it look like to have that real partnership with government?

[3:30 p.m.]

M. Bell: Because there’s not really a home for mental health and addictions other than in the health sector, it’s harder to look…. They’re not all the same. A lot of the funding through the Ministry of Children and Family Development is funding that’s been going on, and they haven’t put out, until the child and youth with special needs…. There hasn’t been an RFP out for years. So that funding, although it never gets upgraded, or 20 years later it’s the same funding for double the service, is fairly stable, but it’s just not enough.

Health doesn’t generally like to contract out. They like to do services in. So the health contracts are a little different, and they like the private–non-profit partnerships. Those are a little bit more stable because they can do a different kind of billing.

Most of the other funding for non-profits is grants or pilot projects. Grants and pilot projects…. To me, a pilot project is a lack of commitment. I, as a practice, never committed to pilot projects, because by the time the community and clients get the project going, get to know about it, and they use it — and then we don’t have it anymore. Fundraising is probably the most reliable and the least reliable at the same time.

The partnerships aren’t just about the money though. I appreciate you bringing that up and putting it out there, but this isn’t actually just about the money. It’s about being a part of the care team. I’ve worked over 20 years. I’ve had the most dedicated, committed non-profit team of workers I would send my family to.

It’s not so much about the funding, and it isn’t even about recruitment and retention. It’s about when you’re with a youth and you take them to the hospital because they’re having suicide ideations, and then nobody will talk to you after that. All of a sudden the youth is released because of confidentiality or because they’ll only talk to doctors and the nurses in there.

We’re the ones working with the families. We’re the ones working with the youth. We’re the ones that are spending time finding out what is going on at home. “Can we talk to your parents? What can we do to help you? We want to keep you out of the hospitals.”

Hospitals aren’t a place to go when you’re feeling bad, mental health–wise. It’s obviously a place to go when you’re ill. We don’t want to give people messaging that they’re ill. They’re not ill. They are normal, human responses to being oppressed, not getting your needs met, not feeling cared about, having no money, no food. Those are normal, human responses. You should be sad. You shouldn’t be okay, especially when you live in a province as rich as ours, seeing people that do have their needs met.

It’s not just about money. It’s about…. We need to be at the table because we are partners. The social services show up every time. There are social workers that work for government, and that’s not in the health system. The social workers are the ones that are there as a safety net too. We’re partners with them.

S. Bond (Deputy Chair): Thank you for the work you do and the presentation. I assume that because you’re called the Federation of Community Social Services, you represent members across the province. Can you just speak a little bit to the breadth of your network? Are you represented…? Are there organizations from across British Columbia? What support do you provide? What is the role of your organization when it comes to other non-profits across the province?

M. Bell: The Federation of Community Social Services of B.C. is a membership organization. People join and pay to be members, and we represent the social service sector all across, in every region in B.C. We have 155 members right now. Some of those members are actually other membership organizations, so we have associate members. We have fewer members in the north, and I would say on the north end of the Island, and a lot more…. We’re all spread out. We’re in 250 different locations, and I think we represent over $1 billion in social service funding.

We have members that support seniors, members that support children, youth and families. I have a youth lens, because I personally have worked with youth at risk. So a lot of the work that I do is supporting organizations.

[3:35 p.m.]

They’ll phone me. Probably about 80 percent of my day, I’m working with assistant deputy ministers and executive directors in the Ministry of Children and Families. That’s a lot of the work I do. I work with children, youth and families, and I advocate when contracts are being renewed, at the Social Services Sector Roundtable, where Parliamentary Secretary Sharma sits, and just try to work on recruitment and retention issues — a kind of higher-level advocacy.

We don’t have any clients ourselves. We’re actually a fairly small team — a team of seven of us. I’m just representing…. I have an executive director, who generally goes to the round-table meetings, and I fill in. They wanted me to do this presentation today because I have more experience actually doing front-line work. The federation doesn’t provide that. We provide support to members. We do conferences; we’re doing training. We’re doing Indigenous training, cultural sensitivity training, trying to achieve systems change. We’re doing systems change work on a bigger level.

N. Sharma (Chair): Okay. I don’t see any other questions.

Michelle, I just want to thank you for the work that you do and also for bringing the perspective of a very, very important sector in our province, in terms of the work that you all do. Thanks for the very clear recommendations.

M. Bell: Thanks for having me. I appreciate it.

N. Sharma (Chair): We just need a motion to adjourn, then, for the day.

Sonia, seconded by Dan.

All right. Safe travels, everybody.

The committee adjourned at 3:36 p.m.