The committee met at 9 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Good morning, everybody. Here we are, virtually gathering for our third day of hearings this week.

I’m on the traditional territory of the Coast Salish people: the Musqueam, Squamish and Tsleil-Waututh.

It’s my pleasure to welcome our first guests here this morning, the Bridge Youth and Family Services. We have Celine Thompson, executive director, and John Yarschenko, director of recovery and addictions services.

Welcome.

I think we’ll do a quick round of introductions so you know who’s here from the committee. Then it will be over to you. You have about 15 minutes for the presentation and 45 for questions and answers.

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

I’ll pass it over to our Deputy Chair.

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

If you see my head looking down, I’m looking at my laptop to see the documents. I just want you to know we all have things in front of us. Thanks very much.

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

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

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

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

I’m speaking to you from the unceded traditional terri­tory of the K’ómoks First Nation.

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

P. Alexis: You wouldn’t want to look at my desk right now. There are papers everywhere.

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

Briefings on
Drug Toxicity and Overdoses

THE BRIDGE
YOUTH AND FAMILY SERVICES

C. Thompson: Thank you very much.

John and I are privileged to do this work and participate in this conversation from the unceded and ancestral territory of the Syilx Okanagan people of the Westbank First Nation.

For background, the Bridge is the largest community-based provider of substance use resources in the Central Okanagan. Working on behalf of and in partnership with the Interior Health Authority, the Bridge is honoured to provide facility-based withdrawal management services for adults and for youth, facility-based treatment programs for adults and for youth, supported recovery housing and outreach overdose prevention services.

A planned expansion of our adult withdrawal management and treatment programs, which are now in progress, will also see the addition of stabilization and transitional beds at all of our adult facilities. Our work is primarily based in Kelowna, but particularly with the expansion, we will be bringing the Bridge’s brand of services valleywide by the fall of this year.

With respect to the specific questions that the committee is grappling with, the Bridge’s position is consistent with what is proposed in the academic and activist literature and likely consistent with what you’ve heard from other panellists thus far. We are on the record in terms of our support for decriminalizing drug use and possession.

The carceral approach to both contributes to the stigma and shame experienced by people who use substances — which, in turn, compels people to isolate and to use alone. Criminal convictions add to people’s addiction legacy, and those barriers pose even more obstacles when they choose to pursue recovery.

We’re aware of and have been a witness to the disproportionate punishment that criminalization of drug use has on Indigenous communities and for all people of colour. Criminalizing people with a substance use disorder has the paradoxical effect of making people less safe and makes their path to recovery even more arduous.

To date, we’ve been less vocal about our support for safe supply, but we’ll state publicly now our endorsement of this as a rational and practical response to a poisoned drug environment. The compulsion to drugs is not often a desire to die. Nonetheless, even knowing that is the risk, it doesn’t seem to deter. A known and regulated supply will undoubtedly reduce the rate of fatalities for people who use.

[9:05 a.m.]

We have, though, stated publicly our objection to compulsory care or treatment, particularly in the absence or lack of voluntary options. Compulsory care risks engendering feelings of powerlessness, hostility and mistrust — which, in turn, directly counters our treatment goals. We were, as a result, incredibly pleased and, frankly, relieved when this government made the decision not to pursue Bill 22, the Mental Health Amendment Act.

We’d also be remiss if we didn’t acknowledge the significant provincial investments in this region to develop a more responsive and accessible system of recovery care. Due to this leadership, the Central Okanagan now has its first publicly funded youth treatment and withdrawal management program — which, at last, allows this community to respond to its youngest citizens who want to pursue their health and well-being. It will, predictably, stem the tide of a lifetime of problematic substance use. It is an investment in the future.

Added to this is the planned expansion of adult withdrawal management services for this region. Within months, we anticipate we will come closer to meeting the incredible demand for the service, which, to date, has not come close to meeting the need. Our small withdrawal management service operates at over 100 percent capacity. It’s witness to over 500 people a year. The wait-lists are incredible. This almost doubling of withdrawal management services for adults in this region is going to be an incredible addition to what we can provide here.

Coupled with the planned expansion of adult treatment services and the addition of the previously mentioned stabilization and transitional beds, we’re optimistic for the future. We will come closer to our collective desire to be able to meet people where they’re at, to respond positively when they’re ready to receive our support, and to tailor their experience to best meet the need.

We also want to positively note the evolution of the regulatory framework for operators, like us, of mental health and substance use facilities. There are now clearer expectations of providing culturally safe services, supporting clients after discharge and specific reference to including opiate agonist therapy as a treatment modality of choice. We look forward to continuing to work with the province to further evolve the standards of care.

The multifaceted nature of problematic substance use makes it likely one of the most difficult public policy challenges of our time. It has proven susceptible to economic, environmental and world events at almost every turn and has consistently frustrated our efforts to make inroads.

The most obvious example of this, of course, is COVID. These two health emergencies coalesced and led to a greater demand for limited services and a heightened acuity in those that we do serve. It highlighted the challenges and deficiencies in the system of care in this region. Isolation protocols further contributed to people using alone. It laid bare the cramped nature of our facilities and compelled us to reduce census at precisely the moment when we should have been expanding our access and our reach.

COVID isn’t the only event that has frustrated our efforts. Events, both macro and micro, have interfered. For example, the heat domes and forest fires compelled us to look for efficiencies so that we could redirect our very limited resources to facility upgrades — most notably, costly HVAC systems.

Labour shortages and supply chain disruptions have impacted the ability to build and staff the new resources that we want to get to market. Further adulteration of the drug supply — most notably, the addition of benzodiazepines — has frightened drug users into using alone even more due to the risk of assault and victimization during blackouts. The list goes on.

Notwithstanding the challenges, though, there is a path forward, and in the Central Okanagan, I think, we are now beginning to realize it. We’ve made the investments and are starting to construct the system of care to which we’ve aspired for quite some time. Key to this work, however, I think, is not to fall into the pathology trap. Although risk-taking behavior is a characteristic of substance use disorder, it’s important that we not lose sight of people’s innate desire for safety and their penchant for quality of life.

We’ve been struck by their incredible courage and tenacity as they navigate our still-fractured system of care and put their lives on hold as they try to wait out a system until it has room for them. We operate a harm reduction vending machine that is emptied multiple times a day as people access the resources to try to maintain a modicum of safety to keep themselves well as they use the substances on which they have come to rely. We’ve witnessed the incredible work people are willing to do as they commit to recovery.

[9:10 a.m.]

Avoiding death is one metric on which we can base our system of recovery care, but I think that if we are able to do this work well, our approach needs to be nuanced and multidimensional. We need to capitalize on and appreciate the strength and courage of the people who seek our support and work alongside them. Our focus has to incorporate all the determinants of health to contribute to a long-lasting impact.

Now I can quit reading, and John and I are available to answer any questions or have a conversation.

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

Colleagues, just put your yellow hand up here if you have a question.

P. Alexis: We’re a little out of practice on this Zoom stuff.

A question. It was the first time I’ve heard of your clients being fearful, being mugged while on benzo. We heard that benzo does not respond well to naloxone, so we’ve got some real issues there. Can you tell me a little bit about those particular clients? That’s the first time we’ve had a reference to that fear of having their things taken. They’re obviously street-entrenched. If you could just give me a little bit more about that.

C. Thompson: Yeah. I heard about this just a few weeks ago myself from our outreach team that is on the streets every day here in Kelowna.

The characteristic of benzo that seems to be frightening people is the blackouts that they have. In addition to not being responsive to Narcan, they are also relaying stories where they’ll lose themselves for as much as two days. The fear is that then they’re subject to sexual assault — particularly the younger folks on the street, as well as the women — and getting beat up and being robbed of their supplies and having no recollection, when they come to, as to who hurt them and no ability to defend themselves. It’s pretty frightening.

M. Starchuk: Thank you for your for your presentation. I have a number of questions, but I guess I’m going to start with…. I’m very interested in the comment about having a vending machine and providing a safe supply. I guess it’s twofold. Where is it located? How is it accessed? Who is accessing it? Is there data to show that it’s actually providing a safe supply and that there’s a downward trend, if there is a downward trend?

C. Thompson: The vending machine is not for safe supply but for harm reduction supplies. It supplies Narcan, syringes, tools for vaping, etc. The volume of access has actually blown us out of the water. A minimum of three times a day, the vending machine needs to be filled, and every morning, first thing in the morning, it is absolutely empty. What we do now is use our staff as well as peers to package the supplies and restock the vending machine.

My joke is…. I mean, it’s on the property here in Rutland where we have our detox program, and that parking lot has never seen such fancy cars coming in. What that tells me is that it’s hitting a population well beyond just the street-entrenched. It’s getting to those people that are the hidden drug users amongst us and actually adding fairly great risk of hurting themselves, because they’re not on the street where we can see them. They’re dying in private residences. So when we see the fancy Corvettes and Lamborghinis coming into the detox parking lot, I know they’re going to the vending machine.

But yeah, the demand for the service is…. I knew that it would be high. I had no expectation it would be like this.

S. Bond (Deputy Chair): Thank you for your presentation this morning. I’m wondering if you can describe for us more specifically what you’re referring to when you talk about withdrawal management services. We’ve talked about a variety of models across British Columbia, and to my knowledge, that’s the first time we’ve heard the use of that. Maybe that’s just other people….

[9:15 a.m.]

C. Thompson: Sure. I’m going to turn this over to John.

S. Bond (Deputy Chair): Okay. While you’re doing that, my follow-up to that is you also have said that there are services, these services, available to youth as well. Again, we’ve heard across the province that it is challenging for young people to get service, so if you could describe how youth fit into this program and what exactly it does.

C. Thompson: Absolutely. I’ll speak to the youth piece after John speaks to what withdrawal management services look like for us here.

J. Yarschenko: It has probably more been referred to in the past, Shirley, as detox. It is traditionally referred to as detox. “Detox” also has a lot of stigma associated with that term, although that’s the term that most people that access the site use.

People are not just detoxifying from the substance which they’re dependent on; they’re also receiving a lot of other health supports. Thinking about withdrawal management and the support of withdrawal is kind of the approach that we take. It’s a mouthful to say, but I think it’s probably been referenced in the past as detox.

I’ll let Celine talk to you about our young people and how young people access withdrawal management services as well.

C. Thompson: I think it’s probably important to flag again, because of the different systems across the province, that this is a medically assisted detox service. We’re supported by physicians. It is staffed by nurses. This is the service that actually is a segue from hospitals. Rather than using up expensive hospital beds, they come and stay with us.

It is my understanding that elsewhere in the province, some people don’t accept folks that are not sober to come into their detox. For us, that is counterintuitive. Oftentimes, people are in the throes of their various substances, whether it’s alcohol or opiates, and they come and receive a safe ability to withdraw without the risk of death in our sites. So it’s key, and it’s usually the first step to a system of recovery that isn’t realized elsewhere.

With respect to the youth, this one always makes me smile. We worked really, really hard and advocated long and hard. We had no system of care in this region for young people. We used to have to send them away to Vancouver. We now have a space dedicated to the 18-and-unders to come and stay with us. Again, those withdrawal management services are available to them so that they can withdraw safely from their substance of choice, which is usually, with the young people, a little different than the adults. Adults — the primary is usually alcohol; with the youngsters, it’s usually different drugs.

Like all of our treatment facilities, it is focused on not just the substances but the other determinants of health. We focus a lot on culture, recreation, with a really strong emphasis on trauma work as well as reconnecting them to community, nature, family. It’s just been remarkable in my tenure to see that come to fruition — a real addition to this community.

S. Chant: Thank you for your presentation. It sounds like you’ve got a really strong program going there.

A couple of questions, one with your vending machine. If this has already been answered, my bad. Where do you get your supply?

C. Thompson: We get our supplies from Interior Health. John can map out the specifics, but there’s a harm reduction team through Interior Health, and they keep us stocked. We, in turn, stock the vending machine.

J. Yarschenko: We actually order direct now, Celine, from BCCDC. We actually order direct. If you come on the right day, we receive about two pallets’ worth of supplies dropped off with a forklift, which we unload and hand-bomb the boxes into our portable storage area. That’s where the supplies are put into the smaller bundles, which we then put in the vending machine.

S. Chant: And you don’t have security worries?

J. Yarschenko: For what?

S. Chant: For your safe supply.

[9:20 a.m.]

J. Yarschenko: Well, it’s not safe supply. It’s the materials for people to be able to use more safely. It’s things like syringes….

S. Chant: Oh, okay.

J. Yarschenko: Yeah. It’s not safe supply.

S. Chant: That’s the piece I missed. Sorry, my bad.

If I may, Chair, another question.

Do you have the capacity to take families, particularly men or women with small children?

C. Thompson: Not right on site. But we do, because the other half of the services the Bridge provides are family focused, provide family counselling, parenting education and support. We have the ability to embellish the services to add a family component. We have the space available for family visits. But we don’t have domestic arrangements for families. We have, though, had couples stay in our supportive recovery housing, but just not children.

J. Yarschenko: The assisted living and licensing requirements won’t allow children and adults to receive service in the same location in a facility of that nature, Susie.

S. Chant: Okay. Thank you.

D. Routley: Thank you for your presentation and the great work that you’re doing. My question is around your…. You mentioned that you were doubling. Your expansion is a doubling. Whether it’s housing or transit, when we increase services, often it’s a real challenge for organizations to keep up with that expansion.

I’m wondering what steps and issues you foresee in terms of staff and awareness-building, dealing with the community response and if you have information that could help other groups as we expand services.

C. Thompson: Well, it’s something we’re learning as we go. I think that would be fair to say. We have a pretty strong culture here that, I think, holds us in good stead. We’ve been around since 1969. We’re also accredited and really values focused. I think the culture holds us in good tide for the expansion.

We are stymied by staff recruitment because some of our staff are medical professionals. We’re dipping into the same pool as the hospitals and clinics across the province, so we have that challenge. We did a small census at our youth recovery house, and the average age of new staff there is 24. We recognize that in addition to onboarding them and making them feel part of the team, we have to actually help them mature on site. We have a stronger investment now for professional development. We just need to be really mindful of all that.

John, this is really your portfolio that’s gone through the leaps and bounds. I think we’re still learning as we go. But do you have anything you’d like to add?

J. Yarschenko: Yeah, no. Just to build on what you were saying, Celine, really, our focus is being a learning organization, where we’re really focusing on developing our people and making this a bit of a magnet where people want to come and work because of the skill-building that they’re going to get, the type of mentoring they’re going to receive and the chance to stretch and grow themselves in a way that, maybe, larger institutions can’t do in such a nuanced way.

We’re really focused on a younger workforce, as Celine referenced, and really trying to highlight the value-add that we can provide in helping them grow into the profession and career they want to have long-term, knowing that they will go to those higher-paid groups like the health authority and other places that are able to pay those higher wages than we can. But really, coming and supporting their development is our focus.

R. Leonard: Well, thank you very much for your presentation and taking the time to speak with us today. It’s been very refreshing to hear your perspective — particularly, as you say, as it’s been a very long serving community organization — and to be able to compare as you move forward. It’s wonderful to see, actually. I really appreciate the focus you have that allows that full range of services that recognize the individual wherever they’re at. So I really appreciate that.

[9:25 a.m.]

One of the things that we have heard is that people go into detox, and then when they come out, that’s often a very vulnerable point where death often occurs from overdose. So I’m wondering if you can speak to that from what your experience is.

C. Thompson: I would echo that. We work really hard on equipping folks that leave our withdrawal management with harm reduction and try to follow them, but the limitations of our services historically meant that we were nonetheless discharging them.

Even if they were actually ready, willing and able to pursue treatment where you could keep them safer, because of the wait-list we were experiencing here, we couldn’t offer that service. We were discharging them to precisely the life they left, trying to equip them with skills, a five- to ten-day stay that you can try to do, but there are just not enough protective factors there.

My enthusiasm for the future, now that we have the buildout of some of these additional resources is…. I characterize it as: we’re going to be in a position where our services will be stickier, right? We will have immediate access to treatment. If we don’t have immediate access to treatment, we have stabilization and transition beds where we can hold people that aren’t feeling confident enough to go back to their previous life. Once they’re done their treatment with the stabilization and transition beds, again, we can hold them. We can offer them housing after.

This is not realized yet, because all of this is still in development over the summer and will be available to this community in the fall. But I think this is where we’re going to at least be able to counter some of those things where we lose folks. Often they don’t want to go. They know they’re not ready. They’re afraid to leave our support, but historically, we haven’t had anything to offer them.

I think by, at the latest, October of this year, we’re finally going to be in a position where we not only can offer them services, but we’re even going to be able to provide the aftercare to provide continuous support even if they don’t want to stay with us. It’s a fundamental shift in terms of our ability to respond.

Yeah, it’s hard not to be somewhat optimistic. I mean, we’ve been failed at every turn with this. But I think the stickiness of the services we’re going to be able to offer, the learning that we continue to do…. I think we’re going to at least do our part to keep them safe.

N. Sharma (Chair): I have a question before we go to the second round.

Thanks for your presentation. I was really struck when you talked about who is accessing the harm reduction services. We learned a lot about the demographics of who, unfortunately, is dying. There’s this demographic of men that are using at home that seem to be really hard to reach when it comes to programs. That’s the first I think I’ve heard, or we’ve heard, of a program that maybe has a way to bridge that gap where people are coming in to access the harm reduction services.

I’m just curious. Is there something about that that could be…? Is it the anonymity that you think is the real thing? Is there a way to get information about further harm reduction or resources for people?

C. Thompson: Absolutely. I think you’re right. I think it is the anonymity. I think there’s so much stigma associated for folks that aren’t street entrenched to reach out for support that the vending machine provides. No one knows you’ve gone. Nobody knows you’ve been. Other than me noticing what kind of car you drive, you go there really cloaked in secrecy. You can go at any time of day or night, even in the middle of the night, to access your resources. Coupled with that, there are phone numbers and other pieces on there.

John and I are in negotiations now with the local community action team to even heighten that. What we’re going to be experimenting with this fall is…. We call it “skip the dishes” harm reduction. Folks can just call us, and our outreach team will actually go to private residences, etc., to deliver the harm reduction materials that they need to use safer. Not safe supply — we’re not there yet. But we would be able to deliver Narcan kits, clean syringes, vaping materials on a house-by-house basis.

[9:30 a.m.]

The outreach team is doing that to some extent already. They’re available by text and will meet anybody at any local street corner or convenience store to deliver the supplies personally to them, really reducing all the barriers. But I think that the vending machine’s appeal, particularly for that demographic, is the anonymity of it. They’re probably not going to go to a safe consumption site. They’re less likely….

Again, the stigma and shame are just such a powerful deterrent, but this provides them a real opportunity to take control of their own health and safety.

J. Yarschenko: I was just going to add…. I think distributing harm reduction supplies is great, and it absolutely is great. The focus of our outreach team and the focus of our vending machine is not just the distribution of these supplies; it’s around engaging people in the health system and in the care system.

The anonymity is important, but also the linkage to build a relationship and some trust where we can actually support people when they’re ready, as they have that moment of desire to actually enter a system of care. We’re not just around preventing death. We absolutely want to do that, and we want to prevent all of the negative health outcomes that come with substance use, but we also want to connect people into services.

We’re the gatekeepers of our services here in the Okanagan, because we’re lucky enough to have a single agency funded to deliver them. When someone’s ready and they’re expressing that to our outreach team, or they come to our withdrawal management site, which is where our harm reduction vending machine is, and knock on the door, they’re going to talk to a real, live person, actually be able to be given some information, and be connected into service if they wish. Really, decreasing those barriers is actually part of the focus as well.

Being able to do those deliveries that Celine referenced is around making connections with people in a nondescript way, where we can start building some trust over time and connecting them with the health system. I don’t want to just have you think that we’re out getting these supplies on the street, and that’s our primary focus. It is a focus, but it’s not our singular focus.

M. Starchuk: Just to maybe finish off the safe supply before I ask another question, can you just tell me if you guys offer testing equipment?

J. Yarschenko: Yeah, we have testing strips that we distribute as part of our harm reduction focus through our outreach team, as well as through the vending machine. So it’s the testing strips for people.

M. Starchuk: Okay, great. My second question is more about…. In your report, you said that you were less vocal about your support for safe supply, but now publicly endorse it. What was the barrier to being more out in front for that statement?

C. Thompson: Most of the folks that we come in contact with are wanting not to use anymore, so it’s just not an area of expertise for me, but we also work with the local KANDU, which is similar to VANDU. We work really closely with Moms Stop the Harm. We recognize their advocacy and their voice. Again, there’s a logic to safe supply. We’re so on the recovery side of things, though, that it’s just not part of our daily conversations here. It wasn’t because of any reluctance to endorse it. It’s just not something that’s kind of a day-to-day part of our work.

S. Bond (Deputy Chair): I have a couple of questions. [Audio interrupted] to a treatment facility. I’m assuming there are beds. Maybe you can tell us how many there are. I have as yet not heard the kind of optimism that you expressed. It’s appreciated, because this is a very difficult topic.

I am surprised, though, you believe that with the expansion you’re about to undertake, you will be close to need, despite there being significant wait lists. I’m wondering what region you serve. I don’t think we’ve heard a single provider that has suggested that they can meet need. In fact, they’re regularly talking about how concerned they are.

Is it different in the Okanagan? Are there fewer people? Are there more services? Maybe describe for me the number of beds [audio interrupted].

[9:35 a.m.]

N. Sharma (Chair): Shirley, I don’t know if you can hear us, but you just cut out.

I think the question was clear enough to the number of beds and how you’re meeting the need with the expansion. If she comes back on, she can clarify.

C. Thompson: John, can you speak to the number of beds, please? I always get my numbers mixed up at the various sites.

J. Yarschenko: For many years, the Bridge has been providing 20 facility-based treatment beds out of our Bridgeway site, which is a 42-day program. It has been alternating cohorts of males and females. We’re having an expansion. I know this is being broadcast, so I’ll be, probably, spilling some Interior Health communication beans in advance of their announcement, but we’re adding to the complement here to have a female-based program with a continuous intake.

What we feel that addition will do is it will more than double the capacity here in the Okanagan. These beds serve the entire health region, all of Interior Health, which is quite a large geographic area. We have people that travel here from the Kootenays and, absolutely, from up and down the Okanagan. We do serve people from across the region.

I don’t know that we’ve properly framed it as that we can meet the need. I don’t think that’s what we meant to say. What I think we want to say, though, is that we believe we’re going to be better able to meet the need with this expansion. We’re excited to see what that does to wait-lists, to the number of people accessing service, to the decreasing of times where people are waiting for access.

We see this as a major improvement. Whether it meets the need — I honestly would hazard that it won’t — it will be an improvement for the Okanagan, in large measure.

C. Thompson: The number of new withdrawal management beds, John?

J. Yarschenko: We’ve had an expansion of withdrawal management beds and this expansion of treatment, which is yet to be announced. We are going from ten funded withdrawal management beds, which is what we’ve had in the past, to 22 — again, more than a doubling of capacity. Those ten beds, as Celine referenced in earlier marks, served between 500 and 600 people last year. The doubling of that will be a significant increase in withdrawal management capacity.

The interesting part of this, when you think about the region, is that we’ve been mandated now…. With this increase happening in Kelowna, there are still not these types of beds in the North Okanagan or the South Okanagan, and they haven’t been able to land those beds there. We’re going to be supporting people to travel up and down the Okanagan to come to these beds. Part of our contract is now to help access from these smaller communities, where these services, because of lots of factors, can’t be embedded.

It’s certainly not intended to be a Kelowna-based service. It’s intended to be a valley-wide service for those withdrawal management spaces.

S. Bond (Deputy Chair): I apologize for disappearing. I’m in Prince George, and the Internet connections in our offices often just seize up. If I disappear, it’s not being disrespectful.

C. Thompson: Whether or not the service will come close to meeting the need, I guess what you’re reading from me is just incredible relief that at least we can try. Those wait-lists are painful.

P. Alexis: I was going to talk about Interior Health and relationships with Interior Health and the array of services. You said that you mostly see clients that are ready to get off the drug. So you spoke to KANDU, similar to VANDU, in Vancouver. But I remember that when the health authorities presented, we got such a different picture from Interior Health because it was so comprehen­sive.

Can you tell me a little bit more about the broad range of services? It sounds like we’re at the sweet spot, almost, with what needs to be done in other communities and other health authorities too. Can you tell me a little bit more about how that works?

I’m sorry this is a very open-ended question, but it’s really important for us to understand the differences in the health authorities, too, so that we can try and figure out where the gaps are and what we can recommend.

C. Thompson: Well, now you’ve made me a little bit nervous in terms of maybe overstating the services here. What we’ve been lobbying for, for the last several years, is to get to the kind of level of services that we’ve seen in other regions with similar population levels.

[9:40 a.m.]

We’ve compared ourselves, region to region, and we’ve leaned in hard on our advocacy for withdrawal management beds. Really, what we’re talking about, I think, in the Okanagan, is finally getting up to par to what the other health regions already have.

When I was all enthusiastic about having a youth treatment bed, other regions had that. When I talked to my colleagues in Vancouver about my frustration of a 16-year-old that’s been literally dying to get into treatment, they looked at me askance. They didn’t understand what I was saying. “Well, why don’t you just put them in the program?” What program?

My enthusiasm, I think, is because we’ve actually been served in a very limited way in this community for a really long time. What I think that we’re finally getting to is a point that is comparable to other communities in the province.

John has worked with the Interior Health Authority and for us for a long time.

John, is that your view of it too?

J. Yarschenko: Yeah. I think there are several factors, I guess, that have benefited the Bridge, frankly, and have benefited the Central Okanagan specifically. I referenced them in passing, around the fact that these beds keep coming to Kelowna and not to some of these smaller communities that are equally deserving and have equally needy communities.

There are many reasons why they’re being centralized, from a health authority perspective, and I don’t think one of them is because that’s what they want. I don’t believe the health authority wants all the beds to sit in Kelowna. I think they have a real desire for them to be more in some of these smaller communities with easier access, where local connection to supports, post-discharge, can be made.

I think because Kelowna has a bit of a larger centre and has a bit more critical mass of non-profit providers — also we have the university here that we can recruit from — we’re actually able to operationalize and deliver services here in ways that some of the smaller communities can’t right now. It doesn’t mean that investments shouldn’t happen in those other communities.

The way the Bridge has been able to grow…. What that means for community is that barriers to access are our own. We don’t have to make referrals to other agencies and go on other agencies’ wait-lists. When somebody is ready and needs to move through the system of care, we are the community-based recovery and addiction system of care in the Central Okanagan. We can help, on a very nuanced and individualized basis, flow people through that system of care for community supports.

The more challenging part, when we’re working with somebody from Osoyoos or from Salmon Arm, is helping them reconnect to those supports that are going to be in their home community and follow up and transition that care plan to make sure that their circle of support is in place when they return. That’s much more difficult with this model.

I think that’s kind of what we’re referencing as an organization that’s benefited. We see the opportunity, but we also acknowledge the deficits that come with this approach.

P. Alexis: Thank you for clarifying. It’s just so many firsts for me. I’d never heard of the vending machine and observations. These are all newish — for me, anyways.

Apologies if I assumed incorrectly that you had everything and that you didn’t. You’re a fighter, obviously, Celine. I can see that. I’m so grateful to you for continuing to advocate, because obviously, your community will benefit.

C. Thompson: Well, I’m just so glad you asked the question. I would hate to leave the false impression that we’ve got everything handled here. I think we’re starting to get things handled here, and I think we’re finally developing the resources here that other people in the province have had the opportunity to enjoy to date.

P. Alexis: Okay. Thank you so much for clarifying.

R. Leonard: We could probably start scratching the surface and get deeper and deeper into a whole bunch of things.

I just wanted to ask you specifically around the comment you made, John, around assisted living rules not allowing services to adults and youth in the same facility. We’ve heard about the need for family treatment, and I’m just wondering if you have thoughts around that.

The other piece of it is…. I really appreciate what you said about bringing people in from outside of the central hub of the Bridge and then returning them to community.

[9:45 a.m.]

In fact, it’s a kind of an unreal situation when you’re in treatment. The challenges you face when you’re back out in community are the things that are…. That’s the follow-up piece of it.

I guess the question I have is…. I recognize the issue of what connects services there are in community that are available, but what do you have to do with follow-up?

On the transportation piece, I’m really curious about how that happens — if you can explain that — because transportation is such a challenge in rural areas.

J. Yarschenko: Yeah, so a lot there.

To your first question around families, we absolutely work as closely as we can with families and with families that are impacted. What we are not able to provide, legislatively speaking, is bedded, congregate care services for families and, I think, for really solid reasons. I’m not advocating for that to be different, because I think that there are safety risks in congregate care environments that are disproportionate when you have young people there. That’s a pretty big liability and a pretty big risk for that family, for that young person and for the organization delivering the service.

We will provide supports to people in their home environment, and there are supports available for people that are in a B.C. Housing environment. It’s not that this group is completely left aside. It’s just that they’re not able to be supported in those specific licensed and registered environments. One parent can…. We can absolutely support with the visitation and things like that, and making sure that it’s not a total disconnect from family. But they can’t be in the service together, as a family.

In terms of transportation, that is an emerging concept that has come with our latest round of contracts, which are yet to be operationalized. We’ve had some amazing support from the health authority around some funding for a vehicle. We’ve also received great support from so many community organizations to support some purchases of some vehicles to support that transport happening. We are going to be working with partner agencies up and down the valley to communicate that this is a way for their community members to access service here in the Central Okanagan.

It’s being written into our contracts. It’s a reportable metric now, for our contracts, and it’s something that we really aspire to do well. Obviously, efficiency and effectiveness will both be really important metrics to track — and things that will probably be a bit of a work-in-progress over the next 12 to 18 months for us. It might be for next year’s select standing committee to get the update on how that transportation has gone.

C. Thompson: Yes. By the fall of this year, we’ll have a fleet of vehicles associated with the Bridge, which is crazy.

M. Starchuk: I’m trying to…. I don’t recall where we heard it from and whether or not it was part of my finance or part of this committee…. Do you guys work in conjunction with John Howard Society?

C. Thompson: Not hand in hand, but certainly as a partner.

M. Starchuk: Very good. Thank you.

N. Sharma (Chair): Okay. It’s my pleasure, on behalf of the committee, just to thank you for coming and for helping us learn about the services you provide in the part of the world that you’re situated in. It has been really informative.

Congratulations on all the advocacy and the expansion to the services that you’re seeing. I’m glad that you’re going to be able to be doing things that you’ve been advocating for, for a long time — for the youth, especially. We certainly learned a lot.

C. Thompson: Thank you very much for having us today.

N. Sharma (Chair): Okay. Committee members, we’ll go into recess until 10:00.

The committee recessed from 9:49 a.m. to 10 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): It’s my pleasure to welcome our next guest. We have Geraldine Vance from the B.C. Pharmacy Association.

Welcome, Geraldine.

We’ll do a quick round of introductions so you know who you’re talking to. My name’s Niki Sharma. I am the chair of the committee and the MLA for Vancouver-Hastings.

I’ll just pass it to Shirley to introduce herself.

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

N. Sharma (Chair): And the Deputy Chair.

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

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

S. Chant: Hello. I’m Susie Chant, the MLA for North Vancouver–Seymour.

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

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

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

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

N. Sharma (Chair): Okay, so that’s everybody.

Geraldine, you have about 15 minutes to present, and then we will switch to questions and answers.

Go ahead.

B.C. PHARMACY ASSOCIATION

G. Vance: Perfect. Thank you very much. Good morning.

Today I’m speaking to you from the traditional territories of the Squamish, Tsleil-Waututh and Musqueam First Nations.

As you know, my name is Geraldine Vance. I’m the CEO of the B. C. Pharmacy Association. Our organization represents B.C.’s community pharmacies and pharmacists. There are about 4,100 registered pharmacists working in more than 1,400 pharmacies in 158 communities across the province, both big and small.

Nearly every community in B. C has a pharmacy within a 30-minute drive. B.C. also has 11 telepharmacies in very remote communities. These are pharmacies where patients can come into the pharmacy and receive pharmacy services and counselling from the pharmacist via video chat.

It’s important to note that community pharmacies have long served as the first point of contact for patients seeking medical care. In a 2018 review, it showed that community pharmacists see their patients anywhere between 1.5 and ten times more than they see their primary care physicians. We know that this number has increased dramatically over the last two years, when nearly all primary care physicians closed their offices in the early days of the pandemic, and many are still relying almost exclusively on virtual care.

Before I talk about the considerations on addressing B.C.’s drug toxicity and overdose crisis, I want to provide some background on pharmacists as health care providers in our health care system. Pharmacists undergo rigorous training and education before becoming licensed health care providers.

To be a pharmacist, you must earn either a bachelor or doctor of pharmacy degree from one of ten Canadian universities. Students must complete two years of prerequisites prior to being accepted to UBC’s pharmD program. Students graduating with a doctor of pharmacy from UBC complete a four-year pharmacy program. Many students entering pharmacy studies already have a science degree.

The pharmacy program curriculum focuses on pharmacology, therapeutics, medication management, case-based learning and Aboriginal health. Just like medical students, pharmacy students are required to do clinical rotations, called practicums, in a pharmacy before graduating.

About 200 students graduate each year from UBC, and those who want to practise as licensed pharmacists must pass the national board examination called the Pharmacy Examining Board of Canada. Once they pass this exam, they can be licensed as a pharmacist and regulated like all other health care providers.

In B.C., pharmacists dispense more than 90 million prescriptions a year. Pharmacists not only focus on what drugs are therapeutically appropriate when dispensing that medication, but they are required to consider which drugs may interact with other drugs that the patient may be taking.

[10:05 a.m.]

Pharmacists also do the work with patients to find coverage by calling third-party payers, spending time on the phone with those private plans or doctors’ offices to ensure that affordable alternatives are available to the patient so they don’t go without their medication.

It’s not just about dispensing medications. Pharmacists also provide diabetes counselling, wound care, foot care, travel medicine counselling and, of course, vaccines. B.C.’s pharmacists provided more than one million flu shots in each of the past two flu campaigns. And since April 2021, B.C.’s community pharmacists have delivered more than 1.6 million COVID vaccines across the province to British Columbians.

But what many may not realize is the role that community pharmacists have played for more than 20 years helping patients with opioid use disorder stay safe. B.C. is the birthplace of the methadone maintenance program, otherwise called MMT. That goes back to 1959, interestingly enough, when it was introduced as an option for patients with what we now call opioid use disorder by two Vancouver physicians.

The program became mainstream in 1996, when the B.C. College of Physicians and Surgeons was given administrative responsibility for the program. Over the years, the program and maintenance treatment options have changed, and the training for both physicians and pharmacists has evolved to meet the changing medication alternatives and also the growing understanding we all have of the complexity of opioid overuse disorder.

There’s no doubt that the MMT program, now called the opioid agonist treatment program — or OAT for short — has saved literally thousands of lives. Every patient who spends even a short time on OAT is a step safer away from needing to access toxic street drugs.

B.C.’s methadone maintenance program has existed for more than two decades. As more alternative medications, such as Suboxone and Kadian, have become available, the program has evolved to meet the needs of prescribers and their patients.

As therapies have evolved, so do the training and education for community pharmacists. Four years ago in 2019, the BCPhA developed and launched a new comprehensive training program for pharmacists who are serving patients with opioid use disorder. This training was developed with the support and financial assistance of the Ministry of Health. The opioid agonist training program is the only one of its kind in the country — and, I believe, in North America — for pharmacists. It’s mandatory for any pharmacist who dispenses OAT medications in B.C. to complete this training.

The aim in developing and delivering this training is to ensure that pharmacists are as well versed as their prescribing colleagues in understanding the issues that their patients face. Since the program’s inception, nearly 5,000 pharmacists and pharmacy technicians have been trained, and it has positioned all of them to do much more in helping to respond to B.C’s overdose crisis.

In December 2020, the B.C. Pharmacy Association made a proposal to the Minister of Mental Health and Addictions that would see a stepped approach to enabling pharmacists to prescribe, in certain situations, OAT for those patients who urgently need continuity of care. Our proposal is to allow pharmacists to, first, adapt prescriptions for patients on OAT. This ensures that there is no disruption for patients in accessing their medications when they can’t have their prescription renewed by a physician, typically, the Friday afternoon or weekend scenario.

B.C’s. community pharmacists already have the required knowledge, the training and authority to adapt and renew many medications, so allowing adaptations for OAT in certain cases is a natural progression of pharmacists’ authority. But more importantly, it can make a difference in saving lives.

We also believe that pharmacists should ultimately have the authority to initiate OAT prescribing. We propose building on the equities and training that pharmacists have, thereby creating new capacity in the province’s response to the devastating public health crisis.

Now turning to safer supply. The province and experts are rightfully focusing their attention on all available options in stopping the overdose crisis. We know one area being explored is harm reduction strategies like safer supply. This includes access to prescribed medication like opioids, stimulants and benzodiazepines as alternatives to toxic street drugs for individuals who are at high risk for overdose. Safer supply is a first step in helping patients move away from fentanyl-laced street drugs and moving them into health and social support networks.

[10:10 a.m.]

The B.C. Pharmacy Association supports the government’s approach in pursuing safer supply as a risk mitigation strategy, and we believe that community pharmacists can be a key participant in an integrated care model, where patients have access to both a prescribing physician and a community-based pharmacist. However, the BCPhA believes that considerable work needs to be done to create a treatment protocol and clinical guidelines that can be understood and implemented by prescribers and pharmacists for their patients receiving safer supply.

In our view, regulatory bodies and organizations representing practitioners must be involved. If safer supply is to move beyond the disparate and stand-alone pilot system that now exists, clinicians and regulators need to be included in designing the implementation program.

We all know that there are not enough practitioners who will prescribe. Not all practitioners will prescribe safer supply. In fact, we know that there are not enough clinicians prescribing OAT throughout the programs. That makes the development of clear clinical guidelines for safer supply even more imperative.

We ask to be part of any discussions and planning of well-developed clinical guidelines and evaluation to ensure that all issues are being considered when delivering important care to patients. We want to be at the table when discussions begin, to bring our experience and expertise in delivering care to patients with OUD.

Another immediate way that community pharmacists can help combat the toxicity in B.C.’s illegal drug supply is through making drug-testing kits available to patients and pharmacies. The association sees an ability for pharmacies across the province to be a location where any individual can pick up a free testing kit that they can use along with a life-saving naloxone kit.

This is not unlike the provision of COVID rapid tests that pharmacies were able to deliver in B.C. Community pharmacies could serve as the distribution point for drug-toxicity kits that would be available to patients on request. There would be no need for an individual to identify themselves or have their personal health information recorded.

In conclusion, I want to highlight the extensive education, oversight and experience community pharmacists have in order to deliver the highest standard of care for their patients. B.C.’s community pharmacists continue to be on the front lines in dealing with patients with opioid use disorder, and they’re required to have mandatory, up-to-date training and education. This education can easily be expanded to help deliver needed medications, safer supply or drug-testing kits in communities large and small.

We look forward to being part of the solution in addressing B.C.’s toxic drug overdose crisis and ask to be engaged as a full strategy and guidelines are developed around safer supply and other options.

Thank you very much. I’m happy to take questions.

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

We’ll go to Susie first.

S. Chant: Thank you, Geraldine, for your comprehensive presentation. It’s appreciated. The overview of the pharmacy training is also, I think, a critical detail.

Where does the B. C. Pharmacy Association stand on a compassion club model in conjunction, for another segment of the population?

G. Vance: I have to say that that is not an issue that we have looked at formally or that our board has considered. Happy to do that if you think that’s appropriate, but we don’t have a position on that.

S. Chant: Very good. Thank you.

S. Bond (Deputy Chair): Thank you so much for your presentation and for the information you shared. Two quick things. The proposals that you’ve made related to the involvement of community pharmacies….

By the way, thank you so much. I represent, as I’m sure others on this screen do, communities that absolutely rely on community pharmacies — the absolute core to what we do in our communities. I don’t know what we’d do without them, frankly, and I do think that people have a degree of trust that is displayed regularly. When we see flu clinics and things like that, they line up. [Audio interrupted.] Thank you, Geraldine. I really appreciate it.

The proposal that you’ve made in terms of things that the community pharmacies could do — is that public? Do we have access to that?

Secondly, I really appreciate your comments about what it would require to look at expanded safer supply — engagement, inclusion, clear clinical guidelines and all of those things. As much as we hear about it at every single meeting we have, many people, when you say “safer supply,” have no idea what a provincewide model related to safer supply actually looks like and what it means, what the implications are.

[10:15 a.m.]

Anything that the pharmacy association has in terms of an ask around clinical guidelines — I think it’s critical that it be shared with the committee. I just really wanted to thank you for raising that important framework for how a potential expansion or provincial model needs work and a lot of it.

I just really want to thank you for those comments.

G. Vance: Okay. I’m happy to submit our stepped-approach proposal. We’ve had engagement with former Minister Darcy and now Minister Malcolmson, and we’re really appreciative of that.

I think part of our messaging is that we obviously have a very critical situation, but we have some tried and true…. We just want to ensure that the OAT therapy program isn’t sort of set aside, that that is a key program for very, very many British Columbians. Even if someone stays on OAT for a couple of months, it means that they’re not accessing medication — you know, street drugs.

I really wanted to come here and kind of reinforce how important the existing OAT program is and how well equipped B.C.’s pharmacies, and pharmacists in particular, are to get engaged and further involved with solving this crisis.

I’m happy that you’re interested in this.

D. Davies: Thanks, Geraldine. I appreciate the presentation.

Over the past little while, we’ve heard from many, many different organizations, from front-line workers to users. We have seen some fingers pointed at the pharmacists on a few issues around accessing methadone at some of the pharmacists, having to stand in line while they’re watched to give the medication and such. We’ve heard some of those stories. We’ve seen some really interesting things around, in Vancouver, some machines being used to give out methadone that use biotechnology and such.

I guess my question is from the association perspective. Two things: your thoughts on these new technologies that are very early and being trialed and seem to be showing some success around providing OAT therapy and such through these machines, and I guess my second question is…. You kind of alluded to it in your presentation, around some of the regulatory issues around the PharmaCare audit process, which may tie your hands, I guess, in having to have a pharmacist watch an individual take their methadone at a clinic. Is that an issue regarding that, or is it kind of up to the pharmacist how they administer the OAT therapy at the pharmacy itself? Kind of two questions.

G. Vance: Yeah, for sure. I’ll start by answering, I think, both of them by saying that we think that it is imperative that these patients have as many touchpoints as possible. Eliminating touchpoints, even small interactions….

I’m going to give you an example from my constituency. I was at a London Drugs and watching an engagement, an OAT therapy. The pharmacist says, “Hi, Dan. How are you doing today?” which means: “Are you in any trouble? Have you taken any other drugs?” “I just want to confirm, Dan. Are you still living at the same place?” So it would say: “Has there been a disablement here?” And “Are you good to go to take your methadone today,” right? So small engagement, but lots of information can be gathered in those types of engagement. That can’t possibly happen with a machine in a corridor someplace.

I think fundamentally, we don’t believe that…. The dispensing-machine model, we think, takes out the most important component, which is that these patients require interaction and support by a host of support systems, from pharmacists to prescribers to social workers, etc. To remove that, we think, is a fundamental error. We do not support that.

I think in terms of the daily witnessed ingestion…. You know, some pharmacies have a lot of patients come at one time. Typically, they come in the morning. It depends on the format.

[10:20 a.m.]

Generally speaking, I think when you think of the thousands and thousands of people that take their OAT therapy every day, there might be small exceptions where an individual might feel that that interaction was not great, but overall, I think it works pretty well.

That answers that.

T. Halford: I just, actually, want to thank you for your comments regarding the existing OAT programs. I think the work that you guys are doing is absolutely invaluable, especially in the neighbourhood pharmacies.

Just what my colleague MLA Davies touched on, in terms of the stigma in people accessing that, I do…. Your comments, which you just made there, were very valuable. I think that it’s important that we all realize the importance of stigma when accessing safer supply.

Just a comment around…. If you had one request right now of us, what is it that you would need today that could make life easier, in terms of what you guys are trying to deliver every day?

G. Vance: I think the stepped approach towards prescribing would be a good place to really start as quickly as we can. That can happen in communities outside of the Lower Mainland.

I think that’s the other thing. I’m sure you all well know, as you look at this issue, that it’s easy to focus on the small geography near downtown Vancouver or Surrey. But in fact, when we look at communities outside — to MLA Bond’s point — there are many communities in which the pharmacy plays such a critical role.

I think that pharmacists are, in general, underutilized. I like to say that pharmacists are the most underutilized health care professionals. I think that you can put us to work quickly to help with some of these issues. That would include safer supply, as appropriate.

N. Sharma (Chair): Thank you. I have a question as well.

It’s really great to think about the importance and the distribution of pharmacists across the province. So that reach is really interesting. Thanks for talking about that.

We’ve been engaging with people that are drug users and that are on some of these OAT therapies. We also have seen some data about the rate of drop-off. People might start but then…. It’s a very big decline of usage on OAT therapy.

One of them was really interesting, just a lived experience story of a gentleman who is on OAT therapy and who is taking his master’s at SFU. He was really expressing how demeaning it was to go to the pharmacist every day, however many times a day, and have to be witnessed to use it, to take the therapy. That was one of the reasons that, from his perspective, people drop off. They just don’t feel like they need to be supervised in that regard. I just wanted a comment, from your perspective, on that lived experience we heard.

Also, with respect to your comment on the treatment protocol and clinical guidelines, that you see that they’re really important in the training, one of the things that we learned from the College of Pharmacists was that there actually aren’t, it sounds like, any actual rules that say: “You have to do this four times a day. You have to come.” The way that some pharmacists are maybe administering the OAT program isn’t necessarily something that the college is saying you have to do. There’s a discrepancy between how different pharmacies are maybe doing it. Maybe some are a little bit more onerous than others in the distribution of it.

Is that what you mean by the clinical guidelines — that we should have something more standardized when it comes to this? I guess it’s really…. A lot of my questions are around this. How do we make it so people stay on it? How do we acknowledge the barriers that people are feeling and experiencing when accessing OAT through pharmacists? Do you have a position on that?

G. Vance: I think we need to set one bucket over here, which is safer supply. That is the new initiative for which there are no guidelines and pharmacists are asked to use their best judgment.

A prescription shows up for a dosage, let’s say, 100 times more. I read a little bit on Dr. Christy Sutherland talking about the levels of doses of medication that a pharmacist might be asked to prescribe. In that instance, the pharmacist is being asked to dispense a medication at a level for which they’ve never seen before, for which there are no guidelines that suggest….

[10:25 a.m.]

That’s a whole set of issues, which is what we think we need to address to ensure that, first of all, more physicians are willing to write those prescriptions and that pharmacists feel that they will, in fact, have some guidance and also not face liability issues from the college, from the patient’s family if something happens, etc. That’s kind of that bucket.

In terms of the more traditional OAT therapy — Kadian, methadone, Suboxone — a primary reason why we set out to develop this new training program was exactly because of some of the issues that you’ve raised. It’s that pharmacists were not well-equipped in today’s world, four years ago, to understand the complexity of the disease and what was required to engage in a productive way with this patient population.

Our training, as I say, is equivalent in terms of the understanding of the complexity of the disease, the issues, etc., that physicians receive. In the past, it used to be that a pharmacist could, if they wanted to, take the physician training. We’ve customized our training for pharmacists for exactly that reason.

It was done in development by talking to people who have OUD. A lot of the program was developed ensuring that we took into account what those patients were feeling when they go to pharmacies. Are there some isolated instances in which patients may feel that their interaction on a particular day is no good? I’m sure that’s the case. Are there situations in which patients would prefer that their physician authorized carries for them to take? For sure.

But what it really points to is the need for that integration between the prescriber and the patient and the pharmacist to look at each of those situations individually. So typically Suboxone, methadone, Kadian is a once-a-day regime, as opposed to if a patient showed up with a prescription for risk mitigation for safer supply. It might be in a very high dose, and it may well be called for to be dispensed several times a day.

N. Sharma (Chair): Just a quick follow-up. Thanks for that. Was that training program also designed with the view to try to make those stats different, of keeping people on OAT once they start it? Did you analyze why the drop-offs were happening and what needed to be adjusted?

G. Vance: That kind of evaluation, frankly, has not been done. There is a degree, for sure, of cycling. I think it would be appropriate for a reassessment to be sure that everybody is judging the success of the program by the same parameters. I think that increasingly there is a view that if patients are on OAT for even a couple of months, that, in fact, ranks as a success marker. So I think you’re right to suggest that there may be need to just look at that entirely again. What do we consider to be success? In the same way, what do we consider to be success with safer supply?

S. Chant: One of the concerns that we’ve heard about ramping up the availability of safe supply is the complexity of compounding and the ability to get sufficient materials available to create the actual safe supply of safer supply. Can you talk a little bit about that for me, please?

G. Vance: I think that B.C. has a wide range of very good compounding pharmacies. We’ve not been asked to look at the capacity issue. I’m not sure if that’s a capacity issue for raw materials. As we know, we’ve got all kinds of problems from a supply chain in any number of goods, so I’m not sure if it’s that.

I feel relatively confident in saying that from an ability to compound, B.C. has a very good, high number of compounding pharmacists. I would believe that that would not be an issue, but we would need to be asked to look at that capacity and determine what kind of capacity we’re looking to fill.

S. Chant: Chair, is that something that we could maybe request?

N. Sharma (Chair): Yeah, we’ll take a note of that.

R. Leonard: Thank you for coming and presenting today. I appreciate all the questions that have been asked.

[10:30 a.m.]

I’m just trying to get a handle on things. I’m just seeing the report for May, and it’s more than a little discouraging. It’s very heartbreaking.

I guess the question I have is…. What we’re doing right now isn’t working. Do we expand what we’re doing, which is basically what I’m hearing, to go down the same path to try and gain some ground over this problem, or are we barking up the wrong tree?

My sense is that not every pharmacy is providing OAT services. I guess the question I would have right now is: what’s the percentage of pharmacies — locations — that are actually providing that service? If it’s a voluntary thing where doctors or pharmacists have that choice about whether or not they involve themselves in that prescribing stream and filling those prescriptions, is there a way to expand it? We can offer more opportunities, but will there be pickup?

G. Vance: On the traditional OAT therapy with the 5,000 pharmacists and pharmacy technicians to train, there is now a pharmacist in, I believe, every pharmacy in the province that could dispense methadone, Suboxone and Kadian. They trained every pharmacy that has dispensing pharmacists there. I think it’s pretty it’s pretty well the 1,400.

On the safer supply, because it’s really being piloted in the Lower Mainland — small, small numbers. Small, small numbers, right? The way in which…. If the decisions are made by those who have expertise that, certainly, I don’t, safer supply should be expanded. Then we go back to our position that if you want pharmacists, first of all, you need physicians willing to write the scripts and then pharmacists prepared to dispense them. That really goes to a confidence and an understanding and a recognition of how safer supply is supposed to work, which goes back to the clinical guidelines. Sort of all roads lead back to that.

If you want a pharmacist in Revelstoke to be involved — there might be two or three patients in their community — and the decision has been taken that safer supply is a good alternative for those patients, both the prescriber and the pharmacist need to feel confident that when they’re providing those medications, they’re not doing harm. That takes understanding and clearly set out expectations and guidelines for how that should be done.

N. Sharma (Chair): I just have a little bit of a follow-up to that. Thanks for helping me learn about this. The current things that are being prescribed across the province, the methadone and the ones that are the traditional therapies…. Then there’s this. What you’re saying is the Lower Mainland, where there’s a safer supply component to it…. I wonder why there’s a distinction.

What we’re learning about is the fact that the street drug supply is getting so toxic and so dangerous. The drugs that are being offered are just being outmatched by what we’re able to prescribe by the traditional program. I kind of see what you’re talking about with methadone and all that as safe supply. It’s just that the traditional ones that were offered haven’t kept up with the toxicity of the drug supply, so people may need something else to get themselves stabilized.

Is there something about the fact that, right now, the more traditional methods of methadone and all the things you’re talking about…? There just needs to be a change of what’s offered by those people that are already trained that is more suited to getting people off of what’s so toxic. I just wonder about that distinction between…. To me methadone is like a safe supply. Am I wrong about that?

G. Vance: It certainly is an alternate. It is designed to be an alternative and something that can help patients stabilize. There’s a daily dose. There’s a routine to that process. Suboxone and Kadian and methadone…. Now, Suboxone is the probably overwhelming choice that is used in the OAT program.

[10:35 a.m.]

The issue with safer supply is because it is not being looked at as a therapy. Methadone, Suboxone and Kadian are recognized therapies. There are clinical guidelines. People know how to use them. Prescribers know how to prescribe them, whereas with the early stages of where B.C. is at in safer supply, that box you would put this in doesn’t exist yet. Certainly, those at BCCSU and Dr. Sutherland and others are, obviously, in the process of determining how wide an application safer supply would have and what happens next. I’m not sure what the timeline on that is. But it may well be that some of the….

If it’s viewed to be an ongoing therapy, if it moves from safer supply as a risk-mitigation initiative to “Is it a therapy?” then I think that’s the distinction and one that I would certainly not be in a position to make, but others with expertise would.

N. Sharma (Chair): Yeah, that helps to clarify it. Thank you.

Any other questions, colleagues?

I don’t see any other hands up. On behalf of the committee, I just want to thank you for your presentation and the knowledge that you’re able to impart to us from your perspective of pharmacists — the role that they could play and they are playing in this. We really appreciate your time.

G. Vance: Thank you very much. Really appreciate the opportunity.

N. Sharma (Chair): Committee will be in recess until our next speaker, which, I believe, is at 11.

The committee recessed from 10:36 a.m. to 11 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): It’s my pleasure to welcome, on behalf of the committee, our next guest, Amber Streukens, Street College coordinator in Nelson, from the Rural Empowered Drug Users Network.

Thank you so much, Amber, for joining us.

We’ll just do a quick introduction go-around so you know who you’re talking to. My name is Niki Sharma. I’m the Chair and the MLA for Vancouver-Hastings.

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

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

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

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

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

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

N. Sharma (Chair): Okay. We have some people with technical difficulties. They’ll jump in when they can.

Amber, you have about 15 minutes to give your presentation and the rest of time for questions and discussion. We’re looking forward to learning from you.

RURAL EMPOWERED DRUG USERS NETWORK

A. Streukens: Wonderful. Thank you for the introduction, Niki.

I’m Amber Streukens. I work with ANKORS as our Street College program coordinator, and I’m here today as a representative from REDUN.

I’d like to first respectfully acknowledge that I gratefully live, learn, rest and play as an uninvited settler on the unceded, traditional and ancestral territories of the Ktunaxa, Syilx and Sinixt peoples, in what is colonially recognized as the Kootenay region of British Columbia.

Here in the Kootenay-Boundary region, ANKORS provides full-spectrum harm reduction services to people who use drugs and to those living with or at risk of HIV/AIDS and hepatitis C. This includes drug checking, overdose prevention services, peer education, take-home-naloxone training and distribution, support and outreach, mobile harm reduction supply distribution and supportive recovery housing. And we have a partnership with a clinic offering opioid agonist therapy and pharmaceutical alternatives. ANKORS holds offices in Cranbrook and Nelson, and we outreach to numerous outlying communities.

With support from ANKORS, the Rural Empowered Drug Users Network has been meeting since 2004. We now have established groups in three communities and a fourth group emerging in the last months. REDUN provides support, education and advocacy by and for people with lived and living experience of illicit substance use. I want to pause and maybe give thanks to this committee for giving us an opportunity to share and to the REDUN membership for giving me permission and courage to share their voices here with you today.

It is very imperative that the voices of those most impacted are centred in our policy approaches and government responses. While the overdose and toxic drug crisis affects our entire society, people who use drugs and those who love them undeniably experience the greatest harm. I’d like, therefore, to pause for a breath here to acknowledge all those whose voices can no longer be heard — those in REDUN’s memberships who are no longer here to share their experiences and give directions to this committee today.

I’m here today primarily to amplify the voices of rural people who use drugs, who are so often left behind in our provincial response to the crisis. While our urban counterparts have growing yet still inadequate access to innovative services and resources, our rural communities are navigating the same crisis with fewer resources and with additional, complex barriers.

In spite of the 2016 ministerial order to provide overdose prevention services “in any place there is a need for these services, as determined by the level of overdose-related morbidity and mortality,” many, if not most, rural drug users do not have access to such services. Despite our lower population density, I assure you that we do not feel the impact of our grief any less than those in urban spaces.

REDUN recommends that the province do everything in its power to ensure that all people who use drugs in all communities across B. C. have full, equal access to full-spectrum harm reduction, including overdose prevention services as well as medicalized and demedicalized safer supply.

[11:05 a.m.]

At present, overdose prevention services are greatly lacking in most rural areas, and those that do exist fall short of reaching the actual needs of people who use drugs, specifically needs surrounding accessibility, peer involvement and inhalation. Acknowledging the diversity across the province, it’s important to highlight that these solutions cannot be one-size-fits-all but will need to be tailored to the unique needs of each community as assessed locally by people who use drugs.

In my work, I have the opportunity to travel between multiple communities in the region and sometimes beyond. What I see is great disparity in access to harm reduction services and resources, despite often comparable need. While this is true across the spectrum of care, overdose prevention services and pharmaceutical alternatives are particularly inaccessible to folks in most rural spaces.

Whereas Nelson is fortunate enough to have two safer supply prescribers, many other communities don’t even have one. Even when we do have compassionate prescribers, prescribed safer supply currently does not meet the needs of most people who use drugs, and the pathways to obtaining and maintaining a prescription are overly complex and restrictive. Just as with opioid agonist therapy, daily witnessing shackles clients to pharmacies, restricting people’s freedom of movement, ability to travel or work.

Underlying this practice is the familiar tone of distrust. Because this medicine is prescribed within the stigma of substance use disorder, the rules are more complicated and more punitive, and this harms clients and inhibits success. I’ve had more than one person tell me, in no uncertain terms: “My dealer is more accessible than my pharmacy.”

Limited hours and locations, inefficient and inadequate public transport and long distances between communities create significant obstacles to rural people accessing prescribed safer supply. Without significant improvements to many layers of public infrastructure, we have a great need for innovative solutions, such as peer-led outreach and delivery for opioid agonist therapy and safer supply prescribing.

Partly, the solution is driven by need, and partly, it is informed by culture. In a service landscape marked by stigma and shaped by distrust of people who use drugs, peer support offers a safe alternative for many and, furthermore, works to shift stigma by empowering peer leadership.

Systemic barriers aside, prescribed safer supply currently does not meet the replacement needs of people who use drugs. The pharmaceuticals we currently have access to are not the correct replacements and oftentimes not in the correct format. People need alternatives that reflect their actual substance use preferences and patterns and their methods of consumption. For people who smoke or inject fentanyl, for instance, a patch is not an appropriate solution.

Under the current model, there is no functional space for people who do not meet the criteria for a substance use disorder diagnosis to access safer supply, despite this population of people who use drugs remaining highly vulnerable to fatal drug poisoning.

Government inaction, cowardice and inefficiency is forcing people who use drugs to engage with organized crime to seek community-based solutions to keep each other safer. By blocking compassion clubs and other innovative solutions, our government is effectively reinforcing the role of organized crime, forcing people to operate in a toxic and variable illicit market and to take on great personal and legal risk in doing so.

The issue of organized crime is and always has been a supply-and-demand problem. Years of prohibition have not been able to regulate the supply. So it seems only logical to focus on demand, for which we have solutions that can be implemented. Medicalized safe supply is failing to meet the needs of all people who use drugs, whereas a demedicalized, community-based model may be able to fill in those gaps. We find ourselves asking far too often: when is it enough? How many more people will have to die before our government will be willing to sanction such creative solutions?

REDUN also recommends that the province put pressure on the health authorities to maximize the reach of harm reduction services, including safer supply — meaning that we all get the full menu of pharmaceutical alternatives in all communities, regardless of whether or not we have a local prescriber available. We need more virtual prescribers, coupled with more local peer workers on the ground. We need overdose prevention services everywhere. We need rapid access to detox and treatment in all of our communities.

The variation among health regions in terms of access to these services creates tremendous disparity for people who use drugs. My region does not have a treatment centre. The closest one is four hours away. We have one detox centre in the region, and while they will take individuals on short notice, getting there can still be difficult if a person doesn’t have support. There is not enough support. REDUN recommends that the province put pressure on professional colleges — the College of Pharmacists and the College of Physicians specifically — to ensure their full, unwavering support for prescribers and pharmacies providing safer supply.

[11:10 a.m.]

Hesitance and stigma among health care professionals, especially in non-urban spaces, is restricting access to new prescribing models. Punitive practices like daily witnessing and mandatory urine drug screenings drive people away from medicalized safer supply. We need more access, less restriction — more support, not more barriers. REDUN recommends, additionally, that the province put pressure on municipalities to reduce barriers, redact harmful bylaws and provide support to health and social service providers working to implement much-needed services.

REDUN recommends as well that the province apply pressure to the federal government as well as Health Canada to work towards true decriminalization. Though a groundbreaking step on the path out of prohibition, a health exemption model for decrim that hinges on a low threshold and excludes youth will do little for those most at risk of harms associated with substance use or criminalization. Whereas decrim will not immediately reduce fatalities over time, the gradual reduction in stigma should enable improved access to health care and other services and thereby enhance wellness for people who use drugs.

Though adjacent to directly reducing fatalities, improving access to health care is a significant factor for a population that experiences great inequity and stigma within the system. There’s an overarching need across all our rural communities for better, safer, more equitable and accessible health care services. This is especially significant for people who use drugs.

In order to reduce harms immediately, decrim would need to enable reduced contacts with the illicit drug supply by allowing folks to possess larger amounts and thus purchase less frequently. A cumulative threshold of 2.5 grams will not meet this requirement, and people who use drugs have been clear about this throughout the development of this application.

In response to the announcement that Health Canada would only consider a lower threshold than the already too-conservative proposed 4.5 grams, REDUN quickly conducted an informal survey amongst our membership. We surveyed 27 people in a few short days and found that 29 percent of our fentanyl users and 43 percent of our meth users regularly purchased beyond this 2.5 gram limit, that 32 percent of fentanyl users and 45 percent of meth users have used more than this limit in a single day, that 33 percent must leave their home community to acquire substances and 47 percent are travelling more than 50 kilometres to do so and that 80 percent of our membership at times will score or hold for others who have less mobility.

What we see here is that a significant proportion of our members will not be protected by low-threshold decrim and that the geographical barriers of rural life are not accounted for in this model. Low-threshold decrim functionally excludes those living and working in rural and remote settings and those who experience polysubstance use or dependency, and this raises concerns in our membership. Despite reassurances that 2½ is a floor and not a ceiling, we have concerns about how this will play out in reality. The historical relationship between police and people who use drugs will not be corrected overnight, especially so in our small towns, where stigma remains quite potent.

Additionally, the complete lack of consideration for street-level survival trafficking leaves many people who use drugs concerned about recriminalization under this model. We have concerns that low-threshold decrim will effectively create a two-tier model within prohibition, wherein those who use the least drugs will be the most protected and those most active in their substance use, most entrenched in the illicit toxic market, most impacted by prohibition will remain criminalized.

We have been clear throughout that this approach is insufficient and does not meet the needs of people who actively use drugs, yet we are told to remain hopeful, engaged and trusting in the process. This is difficult, given the history.

It’s clear to us that solutions exist. Expand overdose prevention and other harm reduction services. Improve medicalized and support a demedicalized safer supply. Increase access to rapid access to person-centred detox and treatment. We need true decriminalization, and we need to continue our work on improving public access to harm reduction education and combatting stigma in all areas of society.

We know these are not small solutions, but they’re obvious, and we’ve said them so many times before. So REDUN recommends that the province prioritize the voices of people who use drugs and take direction from these experts rather than being swayed by the political power of systems that oppress us. This political cowardice is killing those we love.

While I am grateful for the opportunity to speak these truths to this committee, I must acknowledge that I do so with great frustration. People with lived and living expertise, our friends, our families, allies and supporters have been carrying a disproportionate burden in this response, and we continue to do so while becoming increasingly depleted and exhausted. Those of us living and working and loving on the front lines of this crisis are burnt out, exasperated with repeating ourselves and disheartened by the stigma and systemic violence we witness on a daily basis.

[11:15 a.m.]

Long before the development of a provincial response or the establishment of a harm reduction industrial complex, people who use drugs and those who love them have been doing this work — often for free, often without support — forever. Without the hard and unsanctioned work of communities of people who use drugs, we would not have needle exchanges, we would not have overdose prevention sites, and we would not have take-home naloxone. This is our history. Now we operate within this network of professionals where we, too, experience stigma and exclusion, still carrying this disproportionate weight of ongoing loss and immense grief.

We are tired. We are tired of burying our loved ones and counting the bodies while watching nothing change. We are tired of fighting for the ability to provide care to our communities. We are tired of arguing for what we need to survive. We are tired of repeating ourselves to those with the power but without the will to implement the necessary solutions.

People who use drugs, like all people, need trust and support on their path to wellness. Policies and solutions characterized by suspicion and control will never support our wellness. Systems designed to turn people who use drugs into people who don’t use drugs are not safe, inclusive or accessible. Moralistic attachments to abstinence do nothing to keep people alive. Whether in active use or recovery, people who use drugs are worthy of care and dignity, and our responses to this crisis must accept that people will use drugs.

Substance use is a cross-cultural, pan-historical, normative human behavior which, as we have seen play out over the last century, cannot be controlled with state-level prohibition. In calling for an end to prohibition, we are calling functionally for decolonization and acknowledging the ways in which colonialism continues to harm our Indigenous communities and fuel this war on people who use drugs.

Thank you for hearing our concerns and solutions. I look forward to all of your thoughtful questions.

N. Sharma (Chair): Thanks, Amber. We really appreciate that.

Okay, committee members. If you could put your hand up if you have a question.

Go ahead, Susie.

S. Chant: Thank you. You’ve clearly been doing a lot of work in a really tough, tough environment, and I thank you for being able to be upfront with us and direct with us. I feel your pain, and I feel your exhaustion. I appreciate you being able to bring it forward in this environment because that’s a lot that you carry and a lot that your group carries. You say you’re working in a couple of environments — I think I heard Nelson and Salmon Arm — and you have one other area and another one developing, which is spectacular. Thank you.

If you could wave a magic wand and identify one thing that would move things forward, relatively straightforward…. I am making no promises, because my magic wand broke a while ago, but if you could identify one thing that would bring the work forward — in the eyes of your group of people that you represent — what would that be?

A. Streukens: I would have to say, in terms of priority, Susie…. Our number one, I would argue, is safe supply. It’s a really downstream solution. It is really disheartening to have to bracket so many upstream solutions because, truly, we need to be doing both things. But we lost another 2,200 people last year. Our top priority needs to be reducing fatalities, and replacing or displacing the illicit market, I would argue, is the top priority. Thank you for your appreciation of the challenges.

S. Furstenau: Thanks, Amber. I do really appreciate your presentation and also just the honesty of how this is for you and for people who use drugs, especially today. Yet another coroner’s report, and it’s the same as the last one — but worse, right? This is the reality we’re in; month over month, it’s the same, worsening story. Those are people, and people’s lives, I just acknowledge.

[11:20 a.m.]

There’s a big difference between a demedicalized, community-based model and, as you describe, a harm reduction industrial complex. Can you elaborate on that and talk to us about what those differences are and why we need to look at community-based as the priority?

A. Streukens: Thank you, Sonia. They’re very different models. You’re absolutely correct. A demedicalized model, I do recognize, is a challenge to a system of systems, really.

Partly, the differences…. Some of the differences are logistical. Some of them are regulatory. Some of them are cultural. I noted a number of challenging histories, an ongoing experience of stigma and a number of really restrictive barriers within medical models. These are really aversive for people who use drugs, right? When you’ve entered a medical establishment and have consistently been denied your needs and demonized and rejected, that’s not a safe place to seek care. That doesn’t resonate with wellness. It doesn’t feel like you belong.

A demedicalized model is a community-based model of care, right? It’s not top-down; it’s bottom up. It’s people getting together and figuring out what it is that we need to do to keep each other safer. Communities of people who use drugs are tremendously innovative, creative, compassionate, intelligent, supportive and informally illegally have been modelling this in small pockets across all time. These are things that we don’t have good data on, because it’s really hard to study these cultural nuances and the subtle ways that people take care of each other.

There’s also a lot of silence and distrust between academics, researchers, doctors and people who use drugs. These are complex ongoing relationships, and it will take a long time, I think, to bring folks who feel excluded back to a medical system.

Additionally, the medical model is offering a really limited menu, right? Risk mitigation came out with some diverse but not awesome guidance on a few different classes of substances. The second document, Pharmaceutical Alternatives to the Toxic Drug Supply I believe we called it, had a few more opioids but a lot less of everything else. The reality is that it’s not the right drugs. A lot of people who use drugs do not meet the criteria for substance use disorder, are still at tremendous risk of serious harms from drug poisoning and can’t access anything, let alone maybe their drug of choice, from a medical model at this moment.

N. Sharma (Chair): Thanks, Amber. I have a question. I just also want to echo how important it is for us to hear from you and how you acknowledge the burnout of people that have been seeing these things over and over again. I think it also is really good for us to hear about the experience from your part of the province and what you’re seeing.

There are two things that we’ve heard pretty clearly. One is that you need to involve the people impacted by the policies in the decision-making when it comes to that — so the drug users and how they’re kind of experiencing illicit toxic drug supply, the police force, all those things.

I was curious, just as an organization, where you are involved in the conversations about policy or where you think there’s a gap there. I think that would be really good for us to learn about.

The other thing is that in terms of the toxic drug supply and how it’s hitting people in your area, what are the changes that you’re seeing? What are the substances that are hitting people the hardest, and what does that look like?

A. Streukens: Thank you for your question, Niki. Maybe I’ll start with the latter half first, and then, possibly, you will need to remind me about the first half of the question. A little bit of ADHD here.

[11:25 a.m.]

The toxic drug supply. I mean, it has been just increasing in toxicity over all time, right? This is known as the iron law of prohibition. We saw it quite clearly play out in alcohol prohibition ages and ages ago. It has just been evidencing itself throughout all illicit drug prohibition over time.

We have increasing numbers of new and unusual fentanyl analogues that we’re seeing in the region. We are seeing more carfentanil. We are seeing more samples coming back with concerningly high concentrations of fentanyl. And predating but really cemented during COVID, the benzodiazepine contamination of the opioid supply is permanent and consistent. I’m seeing weeks where our drug checkers are finding that 95 percent of our down samples have benzodiazepines in them.

The impact of this is complex and horrifying, if I’m being honest. We’re seeing really complex overdoses. It impacts the way that we can utilize naloxone, because we can have a person respond to naloxone and then slip into withdrawal while still unconscious. It is a messy, awful disaster. It makes training the public really hard. People who use drugs have been extraordinarily skilled at reversing overdose for a long time, but it’s getting more confusing, more complicated, more messy.

Then the other effects of benzodiazepines on people are creating all sorts of other harms — I mean, concurrent addiction, right? Benzodiazepine withdrawal is violent. It is dangerous. It can be fatal. If not managed properly, it is outrageously unsafe. Yet benzos are also a class of drugs that most prescribers are super reluctant to give out because they’re so highly addictive.

Socially, physiologically, at a community level, benzodiazepines are just creating chaos for people. People are experiencing increasing rates of assault, violence, robbery. Just losing all your things or all your time or being unable to make any of your medical appointments or catch a bus or…. It’s really deteriorating people’s quality of life, because it creates so much unmanageable and unpredictable sedation. The benzos that we’re seeing in the drug supply are quite strong. Overall, it’s just amplifying all of the challenges that we’re experiencing.

The first half of your question was…?

N. Sharma (Chair): It’s okay. I threw a lot at you. I just was really…. We’re hearing a lot about how drug user networks should be included in a lot of the discussions about the impacts. You talked about the colleges and how their impact…. Where do you find your ability to give that voice? Where is the kind of gap that…?

A. Streukens: I think somebody else had maybe asked. I guess I could clarify.

REDUN meets actively and for a long time in Nelson and Grand Forks. Over the last two years, we’ve developed a really established group in Trail, and we’re starting to meet in Castlegar and getting soft requests from other areas in the region. The ANKORS East office in Cranbrook is allied with the East Kootenay Network of People who Use Drugs, which is a peer group that meets in the Cranbrook-Kimberley area as well.

I can say that REDUN does have the ear of many different stakeholder groups, levels of government. We are quite engaged in our community action tables in Castlegar, Grand Forks, Nelson and Trail. We are often in contact with or presenting at municipal levels. We are requested at various different tables. I sat on behalf of REDUN on the decrim core planning table. I am an active member of the BCCDC PEEP group.

We have many opportunities to advocate to people with a lot of power to speak to the needs of our region, yet I would say my concerns are characterized largely by, maybe, an inability to hear or a tokenism.

[11:30 a.m.]

We’re invited to these tables, and we repeat our needs. We repeat what we’re observing and experiencing, and we repeat the solutions that we know might work and that we believe to be possible within what we understand of the regulatory systems around us. We are told that it is too much, too risky, not yet, and that’s really painful when we’re watching our loved ones suffer.

N. Sharma (Chair): Thanks, Amber.

Any other questions, colleagues?

R. Leonard: I did hear your presentation. I thank you. I recognize the frustration. It is demoralizing when you feel that you speak your truth, and then you don’t see results. I just want you to know that you are being heard. But there are so many things at play, and one of them….

I’m hoping that you can provide some words to people who are worried about the notion of safe supply and the impact it has in terms of increasing drug users, the access to children. I’m sure that’s a question that’s been posed to you. But I just think it would be helpful if we could hear your response.

A. Streukens: Thank you, Ronna. That’s a great question. Like I said a moment ago…. “Too risky.” We’re often told it’s too risky, and then often find ourselves asking: “Too risky for who?” We are the ones at the greatest risk here.

I hear concerns from people, sometimes, about safe supply putting more drugs on the street. To that, I quite bluntly respond that at least we’re putting safe drugs on the street. At least when people are buying diverted meds, if and when meds get diverted from that system, we know what they are. They’re regulated. This is the aim. It’s to get regulated drugs to the people.

I think it’s a little, I don’t know, fear-based, maybe, to assume that giving people what they need will make more people use drugs. We did not see the sky fall or everybody start smoking weed when we legalized cannabis. We sure did not. Giving people the medication they need is not going to start turning people to drug use.

When people are turning to drug use, if they know that there is a place to access safer drugs, that will keep them safer.

N. Sharma (Chair): Susie, is that a new question here?

S. Chant: It is indeed. Are we able to get a copy of your presentation? You were very clear in some of your recommendations and the wording of them and in the rationale for them. I would love to have a copy of that, if that’s possible, please.

A. Streukens: Thank you, Susie. Admittedly, I’m running into this presentation on the back of four days of taking REDUN camping. It was extremely disheveled and intimidated. I actually did type it all out neatly, and we’ll gladly send it to this table.

S. Chant: Very good, and good job on taking folks camping.

A. Streukens: It’s a curious diversity of hats that we wear on the front line, right? I love that I get to spend time with people in their lives. My community is really nourishing and uplifting and inspiring and supportive.

I left four days of camping and fun and taking care of people’s needs and organizing and strong meetings to the most beautiful thank-you card. Then, you know, we run through three other things all the way up to policy. We’re just flipping tabs so fast lately. It’s hard to keep up, but beautiful, trying.

N. Sharma (Chair): It’s also very impressive that that presentation came together so quickly. It was very thorough.

I have a question. I want to dig a little deeper into the decrim threshold issue that you raised.

[11:35 a.m.]

I really appreciated the perspective of who gets impacted by those thresholds the most. The most entrenched and vulnerable people that, potentially, are buying higher amounts on a daily basis would be above that threshold. When you did that engagement with the 27 people that you talked about, did you ask what a threshold amount…? Did you get close to that conversation about what that number is? It seems to be a lot of different perspectives on that.

I guess another question. Hopefully, it’s linked. We were told that a lot of times, those people aren’t being charged with personal possession anyway. I want your perspective on that comment.

A. Streukens: I have perspective and, actually, data on that, if I can find it quick enough for us. As I was sitting on the decrim core planning table from the beginning…. I’m accountable to my membership. I am not useful if I am just there in my own opinion. I needed to have these conversations at a lot of different meetings, in between those meetings.

I was asking people exactly that. What threshold makes sense to you? What do you need to be able to purchase for a few days? I returned to the committee with an honest and accurate answer of 3½ grams in each category, which brought us, at that time, because we were only looking at four categories of substances, to a cumulative total of 14 grams of substance. That is a large difference to 2½.

I have heard that that decision was largely informed by police pressure. These are the wrong people to be making these decisions. In the words of one of our very young and articulate, intelligent, criminalized members, police are there to enforce laws, not to make them. If we are making laws or changing models based on health care needs, we need to be assessing the actual health needs of the people we’re intending to serve.

There was a second part of that question, wasn’t there?

N. Sharma (Chair): Yeah, just whether or not, from your perspective and the people you are connected with, about whether or not…. One of the stats we heard was that possession isn’t actually being charged very often. It’s not like a….

A. Streukens: I’m just going to pull it up for you. That was…. I asked a few different questions. When we did this brief survey, we asked questions around where do you live, what do you use, how much in a day, what’s the most in one day, what do you usually buy, what’s the most you’ve bought, do you have to travel to buy, do you hold for other people, how far you have to travel — things like this.

Then I started to ask questions about criminalization, specifically. I asked people if they’d ever been detained by police for drug use and whether they’d been detained in the last year. In the last year, a full 37 percent of my respondents had been detained by police in my region for drug use. A full 40 percent had had their drugs confiscated by police in the last year. Additionally, a full 22 percent had been charged with drug possession in the last year. This is still very much happening in my region.

Anecdotally, though not recorded in my data, it is the RCMP, to be very, very frank. Our Nelson city police are a little bit culturally different than the federal RCMP. I’m not seeing as much confiscation or detention within Nelson, though the RCMP is active in all of our small communities, all the way across our province, oftentimes with very small forces. We have communities where there are two, three, four, five members who we see. They have very close and often very toxic and somewhat harassing relationships with people who use drugs.

This does not make people…. A low-level decrim does not reassure folks that they’re not going to be consistently targeted as they have been for years.

N. Sharma (Chair): Thanks for clarifying that.

I don’t see any other questions from our colleagues. On behalf of the committee, I just want to thank you so much for not only the work that you do but how well you do at representing the people that you’re connected with and how much we learned from this discussion. Thank you so much for the work that you do and for coming today.

A. Streukens: Thank you, Niki. It is truly an honour to bring forward these voices. Thank you for hearing them.

Have a great day, everyone.

I will send that report to you, Niki, later. Take care.

N. Sharma (Chair): Wonderful.

Committee members, we’re in recess until one o’clock.

The committee recessed from 11:40 a.m. to 1 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Committee, we’re back from our recess.

It’s my pleasure to welcome our next witnesses, who are from the substance use support and employment program. We have Johanna Li, manager of Eastside Works, and Sarah Tamburri, clinical project manager.

Welcome.

We’re just going to do a quick introduction so you know everybody that’s on the screen. Then we have your presentation in front of us, and there’ll be 15 minutes for you and the rest for questions and answers.

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

S. Bond (Deputy Chair): Hi, I’m Shirley Bond. I’m the MLA for Prince George–Valemount, and I’m coming to you from cold and rainy Prince George today.

P. Alexis: I’m Pam Alexis, MLA for Abbotsford-Mission, and we do have bright sunshine.

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

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

S. Chant: I am Susie Chant from North Vancouver–Seymour, at the base of the North Shore Mountains, and it is actually sunny here too. Remarkable.

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

N. Sharma (Chair): We’ll pass it back to you, Johanna and Sarah, and we look forward to learning from you.

SUBSTANCE USE SUPPORT
AND EMPLOYMENT PROGRAM

J. Li: Well, hello to you all. I think we need to stop rubbing it in how sunny it is here to whoever is in Prince George. I’m sorry about that. But, yes, it is sunny here too, and hopefully Prince George will get some sun soon.

Thanks so much for allowing us to be here to present to you. My name is Johanna Li, as was said. I’m the manager of EMBERS Eastside Works, and I’m here with my colleague Sarah Tamburri, who is the program manager for our substance use sSupport and employment program.

To the first slide, situating ourselves, just to give you a little context around who we are, I work for an organization called EMBERS, which is a community economic development organization that is headquartered in Vancouver’s Downtown Eastside. For those people that have heard of EMBERS, most of you know it as quite a large social enterprise that staffs people predominantly in temporary staffing in the construction industry. We also run a number of different programs. But we have been doing this kind of work in the core of the Downtown Eastside since 2001.

I don’t work in the social enterprise area. I do run a program called EMBERS Eastside Works, which is what we call a low-barrier income generation hub. It’s a little bit jargony, but basically it’s a centre where we try and find suitable income generation opportunities for the most barriered individuals. By barriered individuals, I am usually speaking about folks with substance use and mental health issues. That was started in 2018.

We help individuals, as we say, and we also are…. There is a system change or social innovation project to influence the current employment services system to be truly inclusive of all individuals, including the folks that we serve. Then you can't really talk about, in my mind, when you work in the community that we are, say something like low-barrier employment without looking at other areas like housing; like health; like, obviously, substance use.

We then have started doing, I think, some pretty innovative work that hopefully will help to change the system as well, as we started our SUSEP program — our substance use support and employment program.

[1:05 p.m.]

That’s the program that, actually, Sarah runs. We will be sharing some information about the program but really more about the findings that we’ve learned in the past over a year of operating the program and also some recommendations moving forward. That’s to give you an idea of who we are.

The next slide goes to key challenges. I’ve listed on that slide…. I feel like we’re at the tail-end of presentations. I’m sure you guys have had a laundry list of challenges that I’m sure people have presented to you. Nothing on that slide comes as a surprise to anybody, just from the sheer number of deaths and overdoses. We know that the broken system is clearly not working for people.

I think what’s different for us, though, possibly, which you might not have heard a lot of, is our vantage point, as we manage a low-barrier employment service. What we actually see, or what I’ve witnessed since we’ve been operational, since 2018, is that we are employing people, like I say, with the highest barriers, often, maybe, homeless or living in a shelter, and most likely still active in their substance use. They start working for us, and many of them have come to me and said: “Well, now that I’m working, I kind of have this bit of hope now, and I kind of maybe want to deal with that heroin issue.”

For years, I’ve had to say to them, “Well, good luck with that,” because every service around this in our area is over-subscribed. Yeah, you can call the number, but they’ll say it’s a six-month wait at least, which is not great when a person decides in that moment that they want make some changes in their lives.

Basically, what we are seeing from our vantage point is that folks, because they’ve actually entered into a program such as ours, because they need the money, want to integrate back into employment. That allows them to look at other aspects and realize that we don’t actually have any services that are available to them. This is where we started to come up with this idea around SUSEP.

I realize a lot of the focus around the overdose crisis has been about keeping people alive. So therefore, safe supply, overdose prevention sites…. I get that. I know we need to keep people alive. I also believe we owe it to people to do more than just to keep them alive. The idea of SUSEP is what I’m calling an upstream harm reduction intervention. It is basically a harm reduction model in that it’s not abstinence-based, and it’s really around what each person decides they want to do around their substance use in order to maintain their employment.

We were able to start this program in April 2020, with funding from the Health Canada substance use and addictions program. Like I said, it’s open to anybody that’s employed in the community that wants to manage their substance use so they can maintain their employment or increase their employment. It’s really self-directed by folks. It allows them to continue to work and stay in their communities while they’re actually addressing their usage.

I’ll hand it over to Sarah to tell you a little bit more about the program and some of our findings.

S. Tamburri: Thanks, Johanna.

Thanks, everyone, for being here today. I’m happy to be here. We’re on the “Substance use support and employment program” slide. We call the program SUSEP. It is a Health Canada–funded pilot project in the Downtown Eastside of Vancouver. We test the idea, as Johanna said, that employment can be an upstream harm reduction intervention, ultimately increasing people’s health outcomes and motivating them to manage their substance use.

We do talk about managing substance use rather than substance use treatment or becoming abstinent from substance use, because again, as Johanna said, it’s not abstinence-based. People come in and they’ll be using substances in one way or another. All we do is encourage them to be safer and to have more supports in their lives. Ultimately, we’ve seen with most of our participants that it leads to them not wanting to use substances any more, once they get to a stable enough place where they feel like that’s possible.

In terms of getting people stabilized, what SUSEP does is provide participants with really wraparound, community-based substance use supports. That includes individual counselling. A lot of our participants access the individual counselling at least once a week. It includes accompaniment on appointments for any kind of health care.

A lot of times people are very distrusting and uncomfortable in health care settings because of how they’ve been treated in the past and because of systemic oppressions. What we do is have either a peer go with them or the SUSEP case manager, and we help them advocate for what their needs are. That could be something as simple as getting on gabapentin to help manage their withdrawal, if they are choosing to come off opiates, and different things like that.

The other thing that SUSEP provides is peer groups. We have a bi-weekly peer group that includes a safe space for people to come in, check in, share what’s going with them, and share where they’re at.

[1:10 p.m.]

We’ve had a lot of success with that group and people, often who are living the street, saying: “This is my only opportunity in life to sit down with a group of other human beings and actually talk about my life. This is the only safe space I have to do that.”

Other things we do are employment support. We help people prepare to approach employers or to get prepared for interviews as well as ensuring that people have harm reduction supplies. So that’s things like access to naloxone or using an app like the Brave app or Lifeguard so that they’re not using alone. Those apps do detect overdoses, so if people aren’t responsive within a certain period of time, the first responders are dispatched.

In the SUSEP program, participants come to us, and they set goals for themselves around substance use treatment and employment, and we help them reach those goals. The goals being self-defined is really important, because a lot of times people feel more motivated to reach goals that they’ve decided on rather than a program telling them: “Hey, you have to do this, that and the other thing.”

The holistic nature of this approach really is informed by harm reduction principles, which has taught us that treating vulnerable people as whole people, with respect and compassion, leads to far better outcomes than other service models that are more segmented and medicalized, especially when approaching substance use. We really do provide that enhanced care for accessing things like safe supply, harm reduction medications and various appointments that people need to go to.

Now we’re just going to go to the research findings slide, and I’m going to use an example of a SUSEP participant to kind of highlight those research findings.

We do have a pretty rigorous evaluation component to the program, and our evaluation team uses a community-based research design, where we do research interviews with our participants and that enables us to continually shape the program through those insights that we gain as well as make those wider policy recommendations. The three key findings we have gained so far from the research are around meaningful work as medicine, self-directed goals, and recovering in place.

A fellow named Don came to us, and when he came to us, he was addicted to opiates, he was drinking heavily, he was at risk of being evicted, he hadn’t worked for ten years and he had just been discharged from a case management team because he didn’t fit their criteria anymore.

Don said, “Hey, I want to stop using opiates. I want to manage my drinking, and I want to return to my career as a surveyor,” which he hadn’t done for ten years. So we engaged in a lot of individual counselling with him, a lot of motivational interviewing, and we took him to a few appointments to get him on things like opiate replacement therapy, to get some other health issues sorted out, and our case manager actually went to tenancy court with him and helped him win his case so that he wasn’t evicted.

Really stabilizing his entire life that way gave him the support and the encouragement that he needed to start approaching employers again. And, of course, getting his substance use under control…. To start approaching employers for interviewing for positions as a surveyor…. And that self-directed goal setting…. Because Don is very oppositional, and if you tell him to do something, you know, as a lot of folks can be….

It was so important to him that he was leading his life. Right? It wasn’t us saying: “Oh, you have to stop doing this. You’ve got to start doing this.” And when he would have slip-ups with his substance use, we just came back to him with compassion, and we supported him to get back on track.

Within three months of working with us, Don had gained employment for the first time in ten years as a surveyor and was sending us pictures of him out in the forest saying: “Look. I’m in the office.” He had resolved a lot of his substance use issues. His housing was stable. His mental health was stable.

It really provided that picture of how meaningful work can be like medicine for people. He was doing something he loved. He felt good about himself. He could support himself, and he was really back in that life that he wanted for himself rather than just every day drinking and using and putting his health at risk.

So that was really his story, and many other participants’ stories are a great way of highlighting those research findings. The self-directed goals are very important. We’re really finding that work is impactful for people’s lives in managing their substance use and also, too, the recovery in place. Due to his precarious housing, he couldn’t have just gone to treatment and then come back into his life, and then all of those supports wouldn’t have been in place.

I realize we are about to run out of time, so I’m going to pass it back to Johanna.

J. Li: As far as some key recommendations go, I mean, I really believe.… I know we’re focusing on the emergency piece, but I believe if we continue to just focus on the emergency, we’re going to be in that space always. So more programs that are upstream, harm reduction measures and actually having proper integrated services….

Right now, if somebody wants to access safe supply and they’re working consistently, it’s very difficult for them to do. So if we actually had services that weren’t just about referrals, but you could actually access your safe supply through, say, something like employment programs, that would make it a lot easier for people to actually reach their substance use goals.

[1:15 p.m.]

I think I really liked her saying that what we do is we look at the person as a whole. That is key to the success. I think that might take, again, government taking a look at different funding models that actually require interministerial coordination. Really, we can’t just look at people as a problem — or, more specifically, a drug problem. We need to actually look at their whole lives holistically in order for them to have success in managing their use. These are the things that we found actually, on the ground, are working for folks.

Those are a couple of recommendations that we’re finding. This program will continue, definitely, for another year and, hopefully, beyond that, if the Health Canada funding gets renewed — which we are hopeful of — and we’d like to be able to continue to share our learnings. I believe we’re just getting started in this. We do have quite a robust evaluation component, and we do produce reports quarterly. If this panel is interested in seeing any of those, we can also forward those on to you.

We do just want to thank you for giving us this opportunity to share what we’ve learned and continue to learn about treating people as a whole and looking at their whole lives in order to keep them alive — not just that, but to actually see them thriving as well. Thank you very much.

N. Sharma (Chair): Thanks for the presentation.

We’ll go to questions.

S. Chant: Thanks very much. What’s your caseload capacity?

S. Tamburri: Currently we have assisted 49 individuals in the past…. Johanna had said we started in April 2020. It was actually April 2021.

J. Li: Sorry.

S. Tamburri: It’s okay.

In the past, in just over a year, we’ve supported 49 individuals. The capacity, of course, is not limitless, but we do have the capacity to meet with about 20 different people a week. That is just with myself and the case manager. We’re really a two-person team, but we do have a lot of great peer workers that support us as well. I hope that answers your question.

P. Alexis: Thank you so much. I’ve toured a couple of facilities where there are built-in employment programs, and they’re very, very successful, because they provide purpose, too, for the client. The one thing we have learned — I always refer back to it in all the presentations that we’ve heard, collectively — is: find the source of the problem, and deal with the trauma that has brought on drug use.

Is there additional counselling offered, in addition to the employment program, so that you’re at the same time getting to the root of the problem? It’s so that the person can move on, and you’re providing that sort of positive work environment, but you’re also working on finding the source of the problem too. If you could just talk about that for a sec.

J. Li: The SUSEP program is separate from what we do around employment. Eastside Works provides the employment pieces of that.

Then SUSEP — which Sarah runs, along with her colleague, Kaley, who’s the case manager — specifically provides substance use management support. That’s again, whatever people choose to do. That might be accompanying them to an appointment, advocating for them to get safe supply. It’s also counselling; it’s also group therapy. Absolutely, it’s very…. It’s housed within an employment services centre, but it’s specifically around addressing their substance use — and often, yes, the roots of that, should they choose to want to delve into that as well.

S. Tamburri: Yeah, absolutely. I am a clinical therapist, and that was my career for about ten years before I got into project management. When I discovered this role with Johanna, it was the strangest, most perfect position for me, because it involved project management, but it also involved a lot of actual one-on-one counselling and therapy with people. The case manager is also a trained addictions counsellor.

When I say individual counselling for folks, I really do mean that we’re doing that deeper work, and we are figuring out a lot of things that are impacting them and perhaps fuelling their substance use. At the same time, we’re addressing the structural and systemic stuff that fuels the substance use, like being unstably housed, having poor attachment to health care, all those different things. We’re really trying to address all of it at the same time, as well as having people have some success in their employment.

P. Alexis: Thank you so much for the further clarification. Can I ask a follow-up question quickly? Thank you so much.

Is your model portable? Could I take this model and apply it in a different community?

[1:20 p.m.]

J. Li: Absolutely, and we’d love it if you did that.

S. Tamburri: That’s what we want. We want it in every community.

P. Alexis: Okay. That’s what I needed to hear. Thank you.

S. Tamburri: Yeah. It’s not specific to the Downtown Eastside. That’s my answer.

S. Furstenau: Thanks for the presentation. Sarah, I notice that in the notes it says that your program is a pilot project. We’ve heard a lot about pilot projects and the potential harm that they can ultimately do, because people get in, and as your success story kind of relayed, it can be a place that works. Then if the pilot doesn’t get funded again or it ends, the implications are potentially harmful for the people that have been involved.

Can you talk to us about that? Do you expect to see the program become permanent? What would it take for that to happen?

J. Li: Ideally, the SUAP funding through Health Canada…. They did receive another, I think, $100 million, or something like that. We are, fingers crossed, hoping that it will be renewed. The funding will run out next March, so we are hoping that it will renew for at least another year or two.

I completely understand what you’re saying. I’ve been in a not-for-profit for 15 years now. Yeah, it’s always based on funding. Then funding gets pulled, and what are you going to do? That’s always the funders’ biggest question: “How are you going to maintain this over the long term?”

Because I am also working on policies around employment services, I am looking for this to be maybe integrated into something around employment services, like we offer extra supports, whether it be training, daycare, transportation or workboots. Years ago the models used to include more support around substance use and counselling. Is that somewhere where some of this could live? Possibly.

Absolutely, we are continually trying to let the funders — Health Canada, as well as other provincial and federal ministries — know how much this kind of work is needed and that it needs, actually, some sustainable form of funding. I think that’s where we’re talking about…. It’s not going to take, I think, just one department or one ministry, necessarily, to keep this going. I think it’s going to take a much more integrated approach.

Yes, we are very concerned about that. Hopefully, through another few more years of funding, we’ll be able to find a way to make this more sustainable.

S. Tamburri: To add to add to that, from a counselling perspective, whenever a counsellor enters into a counselling relationship with a client, from the get-go you’re planning how that client is going to exit that relationship and be able to support themselves and maintain their wellness without you in their life.

A lot of times what we’re doing in this program is preparing people and building people up so that they have those internal resources within themselves to have the confidence, the motivation and the coping skills to help manage their substance use and support themselves in an employment setting. We are just helping them get off the ground and learn to do that by themselves.

I very much appreciate your question. It’s a great question — how to mitigate the harm of pilot projects. For the story I mentioned, he is now, so to speak, self-sustaining. He’s in that employment. He’s managing his substance use on his own. He does check-ins with us but not nearly as intensively as in those beginning phases, when he was building that self-confidence and building the ability to function on his own.

That’s kind of how we approach that as well: to lessen the harm. I think if we were to be aware that the funding was for sure coming to an end, in those last couple of months we wouldn’t be doing so many intakes. We would be just preparing those clients to work on their own.

R. Leonard: Thank you very much for your presentations, and thank you for the work you’re doing. I’m curious about the metrics that will say whether or not, as a pilot, it is being successful. Also, do you see your pilot as scalable? You have a very small staff. Is it something that can grow and still be able to provide the same kind of support?

J. Li: Yeah, I wouldn’t see any reason it wouldn’t be scalable. What the funding allows for right now is two people working on this program. But yeah, there’s no reason as to why…. It’s transferable; it’s scalable. I think we’re creating a model that we want to see adopted elsewhere, to whatever situation and size.

[1:25 p.m.]

I think it’s just some of the tenets that we’re coming out with around really, like we say, treating the person as a whole person and looking at all aspects of their lives. It’s not just addressing their drug use as the issue, but really addressing all of the other pieces of that.

As far as the metrics go, like I said, we have an evaluations team that’s working with us on this, and we do have quarterly reports that come out around this. With Health Canada, there are some metrics involved. I don’t find that their reporting template shows that much. I think it’s also a bit bizarre for them.

I’ll be honest with you. Health Canada was a little bit confused about what they were funding, because it’s Health Canada. They’ve never seen anything tied to employment. So they were a bit like: “Who’s employing people? We really don’t understand this.”

As we’ve been in operation for just over a year, I am hoping that we will be able to come up with some clear metrics as we go along, around the efficacy of what we’re actually doing. I think we’re finding that in early findings. We’re seeing quite a bit of success, and I think we’re going to be able to prove that out, for sure.

S. Tamburri: I do have some numbers in front of me, from our research team. Of the entire amount of people that we’ve worked with, we have a 75 percent retention rate, meaning that they continue to be engaged. That would account for some people who meet with us once, do an intake, and then we never hear from them again. That would be sort of like the 25 percent missing.

There’s a 75 percent retention rate, and of all active clients, 60 percent are highly engaged or have graduated. So they’ve met their goals and no longer require our services.

R. Leonard: That’s impressive. Thank you.

I wonder if you could…. I know you felt like you were maybe cut short a little bit on the research findings, but I was hoping you could also speak to recovering in place a little bit more. This is sort of not the antithesis but a different way of operating, rather than residential treatment.

S. Tamburri: Absolutely. It’s not the norm. The norm, when thinking about substance use treatment, is that someone will be removed from their life and go to a facility of sorts, where they will live and receive that treatment.

What we’re finding is that recovering in place — so staying in one’s life and in one’s community, even if someone is unhoused and they’re living in poverty…. Those things actually — what we’re finding — are increasing people’s need to stay in their community because they have so many social and informal supports. If they’re in the process of getting housing and were to leave to a residential facility, that interrupts that process. It’s kind of like the example I made with Don. He was in tenancy court and being faced with these evictions. If he were to leave his apartment at that time, that would have been detrimental for that process.

A lot of people do live in single-room-occupancy hotels, or they live on the street with their street family or their friends. Having that integrated, wraparound community support…. We operate out of Eastside Works, which is a drop-in space. We’re there, and our participants can drop in and see us pretty much at any time during business hours. That works for people who are living highly unstable lives.

Things come up for them all the time. Their belongings go missing, or something happens to their friend, or they get hospitalized. There are so many different things that come up in that kind of lifestyle where leaving completely and going to treatment often doesn’t work for folks. I find that SUSEP is kind of filling the gap for people who don’t want to go, even, to residential detox.

Another person that we’re working with, for example, is living with their terminally ill mother. Even though, at one point, I recommended — he was really struggling with his detox — that he go to a detox facility, he absolutely refused. There’s no way he would do it. So it’s really being there for those people who can’t attend residential treatment.

M. Starchuk: Thank you for your presentation. There was a comment that was made when you were talking about peer groups and that I think I wrote down — that there is “a lot of success” with the peer groups. How do you gauge what the successes are?

S. Tamburri: Great question. Often it is the amount of times that people return to the group. There’s a core group of people — right now I think it’s about six participants — that come every single week, and then there’s sort of like a larger rotating group.

[1:30 p.m.]

How we measure the success with that group is really on the participants’ feedback. I had mentioned that some folks will say things along the lines of: “This is the only opportunity that I get in my life to sit down with a group of people and talk about my life and myself.” People report that it’s a safe space where they feel comfortable. They look forward to coming in.

We also do provide them with food, like a warm meal, when they come in, and a $10 honorarium. A lot of times that can be the buy-in. That can be the thing that gets people. “Oh, I’m going to get ten bucks and a meal. For sure I’ll go. Easy.” Then once they get there, and they find a group of like-minded people who are also doing the same things as them, they’re like: “Oh wait, this actually feels really good, and this really grounds me.”

There’s this idea of tethering people to the Earth through a relationship, because when people are living in such extreme poverty or being unhoused — or substance use or mental illness — there’s this huge disconnect between themselves and other people, and the peer group that we do really provides them with an opportunity to just be human and connect to one another in a way that you or I might take for granted.

Some people do not have the opportunity to even just socialize with another human being in a way that’s not about like survival, that’s not about money or drugs or getting something from someone. It’s just about: “Hey, this is where I’m at. Where are you at? Let’s talk about what we want to do with our lives.” That’s kind of how we measure the success — the report from people.

M. Starchuk: Great. Thank you.

S. Bond (Deputy Chair): Thanks very much for spending some time with us this afternoon. We appreciate it.

In your presentation, you talk about…. You do mention silos, and you also talk about inter-ministerial approaches, in terms of funding models. I’m really interested in that.

I know that your funding is federally based. But is that an issue at the provincial level as well, in terms of that integration between ministries to actually serve the whole person instead of looking at: “This is my ministry; this is your ministry”? It’s evident we need to do something differently. So could you maybe speak to that?

I guess the other thing that’s really interesting…. When you describe meaningful work as medicine, I really appreciate that description. You obviously work with individuals. Do employers come to you? Do you talk to them as well? Is there a relationship with them, as well, in any of the work that you do?

J. Li: As far as the first question goes, yes, there is always a challenge with government and siloing. I always say…. When we’re looking at vulnerable individuals, we tend to silo them and say: “Well, you go here for health. You go here for employment. You go here….” That’s not how people’s lives work. That’s not how our lives work. But if you’re a marginalized individual, that’s how your life has to work.

I’ve been trying, since we started Eastside Works, to get different ministries in the room together. I used to have conversations monthly with ED, ADM levels at the Ministry of Social Development and Poverty Reduction, as well as the Ministry of Mental Health and Addictions. I and these two other ministries used to have phone conversations once a month, because there was a recognition that for us, around who we employ, they’re intricately tied together.

I found that through some of that, they started talking behind the scenes as well. I don’t think it’s gone particularly anywhere else, other than that, but I think that is definitely something that we need to address. All of these things are highly, highly integrated. So if you look at how we treat people at Eastside Works, we have wraparound supports. We have substance use supports. We have employment supports. We have all the…. We help people with their housing. We’ll help people with whatever they need to stay employed, because everything is all so integrated.

Although we run many programs, I can’t really speak about one without speaking about the other, because that’s really how human beings’ lives work. The way the government is designed is not as such. So yes, I think it’s really key for different departments and ministries to be able to work together to support people in a much more holistic way. So yeah, if anyone can fix that problem, that would be awesome as well.

As far as the employers go, we have a number of, for the highest-barrier folks, in-house employment programs, because we don’t find, out there in the world, that it really suits people that are integrating back to employment that haven’t worked for ten years and may be living in a tent.

[1:35 p.m.]

As we progress along what we call the income-generation continuum or spectrum, we do involve, often, social enterprise or non-profits, as far as hiring folks. There are some mainstream employers. It’s not as easy, considering the folks that we are trying to employ. Like I said, we’ve only been operational since 2018.

I think a big key around employment for people with barriers is time. In employment services, we tend to talk about three months, which is a very short amount of time for someone who hasn’t worked in ten years. We’re starting to see the people that we have worked with for two and three years — and we build capacity and build their confidence — being able to move into some employment with traditional employers, albeit usually more sympathetic employers. I’m always looking for socially or environmentally based businesses that may want to hire inclusively.

I really think that that is an area that we struggle with, even with the labour shortage that we have. The more desperate employers get, almost the more demanding they are. I feel like there are other groups around the province here that are working to crack the nut on how we can actually set up a better situation so that employers can hire inclusively.

D. Routley: A few things you’ve said have been really moving, including…. It doesn’t seem like a very moving thing to say, but self-directed goals are very important when somebody is absolutely hopeless. They care less about what happens to them than the people who are even casually observing or are passionately and desperately involved. Getting them to find a foothold, hoping that somebody will find a foothold, is so crucial, I believe.

I love the way you’ve phrased that, the way you’ve worked that into the work you do and the support you give. I think of a steep, loose bank that people are trying to clamber up. They slide down a bit. Then they find a foothold, and they climb back up a bit.

It’s really, really important, I think, having peer input. You mentioned that the questions have been asked about how to measure it. I’d like to ask: do you have any structural mechanisms or peers to input into the management and design of programs?

S. Tamburri: Yes, absolutely. We do quarterly research interviews with our participants. What that looks like is…. I think your question was: do we have any way of implementing input from the peers to our program? Yeah. That’s a large part of the program: having people tell us what’s working and what’s not.

The interview guide was actually peer reviewed by…. There’s a group called OPPRA, which is a peer research association for overdose prevention. We took our interview guide, and we had them workshop it. We gave them the interview guide, and we said: “What do you guys think about these questions? Should we be asking different questions? How should we get to the root of whether or not this program is working, what it does for people, if it’s reaching, if it’s doing what we think it’s supposed to be doing, what we want it to be doing? How do we find this out?” They went through it and gave it back to us.

We ask questions like: “Has SUSEP changed your day-to-day life? If so, how? What are the benefits that you’re gaining from SUSEP?” We have this host of questions that we ask people to really understand what’s working and what’s not. A lot of times people say things like they’re listened to, and they’re respected, and they’re encouraged. It’s very basic stuff.

We ask them: “How does that compare to your experience with other substance use or employment programs?” Oftentimes there’s a huge difference in past experiences. They might have just been treated as a number in the system kind of thing or just a person who is there to fill a pair of boots and go to a construction site. That’s just fundamentally not how we do things.

The structure of the program is very much informed by the peers. If we ever get feedback…. I’m trying to think of feedback where something really didn’t work for someone and how we changed it. Even just the timing of things — we make ourselves available. We say: “When works for you?” We’re not demanding people to be there at a certain time on a certain date. We really try to be as flexible as possible and as open as possible to what works for other people.

I hope that answers your question.

[1:40 p.m.]

N. Sharma (Chair): I have a question here.

Thanks for the description of the program. It’s definitely unique in what we’ve heard, as we’ve heard tons of people testify about how the drug overdose crisis is hitting communities.

The thing I think is really interesting about your program is…. We’ve also talked to, particularly, people in the construction industry about the prevalence of drug use and the impacts that it has and the really shocking statistics. There’s also this really tough interface between what an employer thinks about drug use and what somebody is experiencing, particularly with the people that you’re working with.

You’re not an abstinence-based program, so people come to you. They come to you where they’re at, using what they’re using. Then do they tell you, at that point: “My long-term goal is to work in this industry or to do this job”? Some of those are going to be abstinence jobs — like, you can’t show up for work. I don’t even know if you could on an OAT program. I’m not actually sure.

So how do you work through that whole process? You’re kind of in the space of a lot of different stigma and bias when it comes to drug use with employment sometimes, I’m sure. How does that show up for the people? What does success look like then? What kinds of jobs are they able to get?

S. Tamburri: Yeah, that’s a great question. Sometimes it looks like…. If the person is going into an industry — for example, if they’re operating machinery or if they’re working on a construction site — where they have to be quite literally sober during their shift…. Of course, it’s none of the employer’s business what they do outside of their work hours, although some employers would like to think that it is. We set them up for success by being very straightforward about the realities of that.

Don was a good example. As a surveyor, you can’t go to work under the influence. You’re working in the natural environment; you have to be alert and aware. So what that looked like for him was really just stabilizing him before he started approaching employers so that he had the confidence to know: “Okay. I’m not going to be in this pickle where I wake up and I either go to work dope sick or I go to work high.”

We helped him get attached to opiate replacement therapy. We helped him manage his drinking to the point where he was so excited about going back to work as a surveyor that he wouldn’t drink the night before because he didn’t want to feel sick in the morning. He just reserved his drinking for the weekends.

Often that takes a lot of close work, a lot of counselling — a lot of trial and error sometimes. That is how we prepare people for working in environments or in jobs where substance use is out of the question for while you’re on shift.

There are a lot of peer opportunities for employment that actually do pay a living wage in the Downtown Eastside. For example, there’s the Chinatown steward program, where folks are literally stewards of Chinatown. They help the Chinatown business association by keeping doorways clear. They pick up needles. They do things like that. A lot of folks in that program are still using substances, and that’s perfectly okay.

There are a lot of great employment opportunities in the Downtown Eastside for people who have living experience with substance use.

J. Li: The idea, really, of SUSEP, when I envisioned it in my head, was…. Let’s say you’re working in…. The Chinatown stewardship program is an internal employment program we have at Eastside Works. It’s a very, very non-stigmatizing environment, very flexible, meets people where they’re at — all that kind of stuff.

Somebody may start there — it’s very, very entry level — and then decide: “Hey, I want to start to manage my substance use.” They start working with SUSEP, and then they’re able to actually manage that better and therefore, maybe, get a different type of job and build their capacity more and more towards, obviously, the end goal. It’s just to be able to manage that to the point where you won’t have to be using substances — or using substances in a way that it doesn’t impede your work at all.

It’s sort of happening at the same time. It’s not necessarily that somebody is coming in that is really mired in their substance use and saying, “I want to go work at blank,” which is totally unsuitable. It’s working alongside with them to build their capacity and working on both sides of it — employment as well as their substance use support.

S. Chant: I think I heard that your program is embedded in a drop-in environment. How do people intake? Do they self-refer? Are they referred by somebody else? Is it a combination? Can you tell me about that?

S. Tamburri: We’re open to any kind of referral. Sometimes it is from another agency, where a worker at that agency knows about us and meets someone who thinks, “Oh, this would be a great fit,” and they refer them over.

Sometimes it is from in-house. People who are accessing the employment services at Eastside Works might identify with struggling with their substance use, and then they’ll get referred to us that way.

[1:45 p.m.]

A lot of it has been word of mouth, people in the community just saying: “Hey, I’m working with this program. It has really helped me. You should come with me.” Then maybe they’ll bring them to the peer group, or maybe they’ll just bring them outside of those hours and introduce them to us.

We make the intake as low/no-barrier as possible. We don’t need to sit there and do this huge history of their life. We don’t need official documents and paperwork. We literally just need to know what they want us to call them, how we can contact them and, if they don’t have contact information, what hours work for them or kind of what area they’ll be in. So, say if they’re in a certain area of the Downtown Eastside, we might pop by there and check in on them every now and then.

S. Chant: So do you have some kind of database of your folks?

S. Tamburri: Yup.

S. Chant: You do. And how do they feel about that?

S. Tamburri: There’s been no protest to that so far.

N. Sharma (Chair): I have one more question too. I really would love to know your perspective on how the toxicity and the changes in the drug supply, particularly in the Downtown Eastside, is affecting people that are showing up to access your services. We’ve just heard a lot about, now, carfentanil, all the things that are out there. How does that show up for you? How do you connect with either OPS or harm reduction? Do you have a connection with all those, to make sure that people are safe?

S. Tamburri: Absolutely. That is our first priority when we meet with someone. We ask about the nature of their use and the safety of their use. So we ask them, of course, what kind of substance they use, but we know by now that fentanyl and other toxic drugs can be in any type of drug, whether it’s an amphetamine or cocaine or, of course, opiates. We ask them if they have access to naloxone, if they’re aware….

We have a relationship with what’s called the Brave app, and they install it. You’re probably aware of the Brave app. It’s an app where people can log on if they’re using alone. They’re anonymous, but then, say, if an overdose is detected, so if there’s no response, then first responders would be dispatched.

We ensure that people are connected in that way, as well as offering, if they need us, to help them go to Insite for the first time, if that’s what they want to do. But a lot of people are already connected to those kinds of things.

Something that we’re hearing a lot about lately is the benzo dope and how that is really impacting people’s cognitive abilities. We have someone who is a peer worker with us, and for a week, I think, they had used what they refer to as the benzo dope, which is, of course, just fentanyl with high levels of benzodiazepines in it. They were just referencing how they felt like a complete zombie. Like, their brain barely worked. Those kinds of things.

We’re really noticing, as well, how brutal that is to detox from, how brutal that is to withdraw from. Benzodiazepines are notorious for having a horrible withdrawal period. Then you add fentanyl to that as well, especially if you’re using it heavily and intravenously, and that puts someone in pretty serious medical distress. Those are the kinds of things we’ve noticed recently.

S. Chant: Sorry, did I just hear that one of your peers used it consciously to determine how it felt so that they could help other people?

S. Tamburri: No, that’s not what I said.

S. Chant: Thank God. I mean, bless them if they did. However, that’s a huge risk. No, okay. I’m sorry. I really misheard that and it struck me as….

Can you say that again so that I understand better? What I thought I heard was…. So you’ve got somebody in your peer system that is familiar with the benzo effect and who was willing to talk about it with other people and, possibly, strategies on how to manage it. Is that what I’m supposed to have heard?

S. Tamburri: Yeah, more or less. We have a peer who did use what they referred to as benzo dope for about a week, and they reported feeling just like a zombie. Like, they were basically brain dead. I’m using their words here.

With pretty much all of our participants, they are very open and transparent with us. They have nothing to hide, because we don’t tell them they can or can’t do anything, and they’re not going to get kicked out for doing whatever they want to do. So we do get a lot of good information that way about what is happening with the drugs and what people are experiencing.

We’ve had not just that peer but other participants as well and a conversation that took place in the peer group about the benzo dope and how people noticed that their level of consciousness, as well as their perception of reality, is drastically altered when they’re using fentanyl that has high levels of benzodiazepine in it. The terms they often use are “zombie” or “brain dead” — just a dampening down of executive functioning.

N. Sharma (Chair): Okay. I don’t think I see any more hands up.

On behalf of the committee, I just want to thank you not only for the work that you do but really, it sounds like, stepping into innovation when it comes to what you’re seeing and people that you’re helping through to employment. Thanks for that, and we wish you all the best.

We are in recess until two o’clock.

The committee recessed from 1:50 p.m. to 2:01 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): It’s my pleasure to welcome our next speaker, from the B.C. Association of Social Workers, Michael Crawford. Thanks for joining us, Michael.

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-round of introductions so you know who you’re speaking to. I’ll just let you know that we do have your presentation in front of us, which we can follow along with.

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

S. Chant: Hi there. My name is Susie Chant. I’m the MLA for North Vancouver–Seymour. I’m pleased that you’re here.

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

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

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

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

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

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

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

N. Sharma (Chair): Okay, I think that’s everybody.

Over to you, Michael.

B.C. ASSOCIATION OF SOCIAL WORKERS

M. Crawford: Thank you, Ms. Sharma.

I’m Michael Crawford. I’m the president of the British Columbia Association of Social Workers. I just want to thank you for the opportunity to present today. I’m alone in the presentation chair this this afternoon. The two individuals that we had originally planned to present this have been unavoidably pulled away from this today. Such is the life of social workers, I think.

I want to also acknowledge that I’m not a content specialist. I was going to sit out this opportunity and give two of our members the job of presenting to you. However, like most social workers, I have had a number of individuals with substance use that I provided care and counselling for across my career.

I want to also acknowledge that this document that you are looking at was prepared by a number of people, including myself; Sara Fudjack from UBC; Sian Lewis from Phoenix Centre in Kamloops; Phil Mach from Island Health; Craig Norris, who’s with the B.C. Operational Stress Injury Clinic; and Bruce Wallace, an academic professor at the University of Victoria.

I want to acknowledge that our B.C. Association of Social Workers office is located in the unceded territory of the Coast Salish peoples, including the territories of the Musqueam, Squamish and Tsleil-Waututh Nations. Our members live, work and play across British Columbia in unceded territories. I’m calling you today from the unceded territory of the Tk’emlúps te Secwépemc people, also known as Kamloops.

[2:05 p.m.]

Again, thanks for the opportunity to do this. I want to just give you a quick idea of the B.C. Association of Social Workers and what that organization is all about. I want to start by saying that we work very closely with the B.C. College of Social Workers. They are the regulatory body that superintends the practice of social work for the protection of the public. We are the professional association. We promote social work; we promote social work practice. We provide continuing professional development. We advocate. We do things like we’re doing today, presenting to committees such as this.

When people think about the role of social work in British Columbia, most people not fully aware of the role of social workers tend to think of social workers as being employed in the area of child welfare. That’s true. A lot of social workers do work in that area, in the government, with MCFD, and outside of government, in non-profit as well as private sectors, but social workers really work across British Columbia in a variety of settings, working with individuals, families, groups and communities.

We often work in interdisciplinary teams in a variety of settings, such as health, mental health, community development, corrections, child welfare, education and housing — and the list goes on. We also respond to social issues and address barriers and injustice within society and organizations. Our association advocates for social justice, human rights and fair access to health and social services.

Social workers are a significant part of B.C.’s overdose response. Many of the individuals that have already presented to this committee have identified themselves as social workers, and they’re belonging both to government and non-government organizations. We provide care for individuals — in the form of prevention, treatment, support, recovery — and even to families, colleagues and friends in the event of an overdose death due to the illicit toxic drug supply.

Bruce Wallace would remind us that we are producing research, informing and advocating. I mention him particularly because he, over the last four or five years, has produced some outstanding work, particularly in the area of safe supply and drug checking. Many of us individually have been impacted directly and indirectly by this ongoing issue.

We’ve had a fair amount of contact with the Ministry of Health. We’ve presented to and have been in discussions with the Allied Health workforce development, the Allied Health policy secretariat and the health workforce planning and implementation group. All of that has been in relation to a lack of supply of social workers for the Ministry of Health. Their social workers are in demand in health authorities, particularly in primary care centres and urgent care centres, but really across the board.

On the specific issue of recruitment, we’ve had discussions with a provincial health care–social work working group. That was in relation to competencies that undergraduate and graduate social workers can do and working with that group, through them, to help health authorities understand how best to recruit and what level of social work education is required for which jobs.

Today I’d like to just address three priorities that our group is able to identify with. I do want to say that looking through the documents that have been submitted and the presentations that have been made to this committee, it’s difficult to take issue with any of the recommendations that have been made to you. Our recommendations you’ve heard, I think, before, in a variety of ways. They’re not new.

The big message here is Lisa Lapointe’s message to you, which is that the magnitude of this problem requires a similar magnitude in response. That’s sometimes just to say: “Do things a little bit differently. But whatever you’re doing now, do more of.”

[2:10 p.m.]

I’d like to talk about three priorities: to fully resource and amplify the voice and role of people with lived and living experience; secondly, to support social workers supporting those with lived and living experience, including families; and thirdly, to expand social work capacity to respond to mental health and substance use, including the determinants of health.

On that first point…. If you’re flipping over slides, you’ll see when I’ve done so. The heading on the slide…. This one is No. 1. To fully resource and amplify the voice and role of people with lived and living experience.

As social workers, we do provide advocacy services, and we do take positions on the inclusion of what are sometimes called peer workers. We, instead, tend to use the language “lived, living experience.” But as an association, we would love to see the privileging of the voices and experience of people with lived experience not just in terms of being peer support but putting such individuals into positions of decision-making, where they’re designing, implementing, delivering and evaluating unique services.

We’re very pleased with the B.C. Centre for Disease Control, Mental Health and Addictions and Vancouver Coastal Health for the training packages that they put together for peer workers. We think they’re excellent. There are still issues, we think, around payment for peer workers. There is insufficient funding being made available for services delivered by people with lived experience.

We do support the Pathway to Hope document and just want to note that it includes the goal of delivering peer support worker training resources, implementing peer support coordinators and committing to developing a provincial peer network. There’s been some pretty good progress on those in the last couple of years since that report came out.

I just want to refer you to a Community Action Initiative evaluation of the role of peers in the overdose crisis, and it’s available on the Community Action Initiative website. I just want to draw your attention to their recommendations, and I’ll just read off a few of them.

Firstly, they acknowledge the role and call on others to acknowledge the role of peers in B.C.’s overdose response by ensuring a robust representation of diversity in all overdose response strategy decision-making tables — I think they would emphasize decision-making tables; we certainly are — and providing financial support to initiatives that foster this kind of social inclusion and that help peers build connections between networks and create community.

Secondly, the rapid expansion and funding of paid peer worker positions. Even in their evaluation, a number of the respondents indicated that they were engaged as peer support workers but were not receiving funds for doing so.

Of course, there are recommendations around safe supply, decriminalization. While I’m on the topic of decriminalization, I’ll simply echo the concern that many other groups had about, really, the exemption limit being set far, far too low.

On the second recommendation, to support social workers supporting those with lived and living experience, including families, I do want to say…. This morning, when I found out I was going to be the sole presenter, I did a quick scan of health authorities. I looked in their careers section, and I just searched for the term “social work.” It’s something I’ve done before. I haven’t done it for quite a while.

[2:15 p.m.]

If you go to the Interior Health careers page and you simply say, “What social work jobs are available?” you get 278 hits. If you do that in Fraser Health, you get 138. If you do that in Island Health, you get 268. If you do that in Vancouver Coastal Health, you get 82. There are an awful lot of social work positions, many of them in primary care centres and urgent care centres, but not exclusively. They’re in hospitals and a variety of other places.

What we’re promoting here is an opportunity for Health to sit down — through their various committees, workforce, labour force groups — to contact institutions, possibly through the Minister of Advanced Education, to talk with schools about producing more social workers. We’re not producing enough social workers in this province. We guesstimate there’s between 800 and 1,000 social workers graduating every year.

I think most social work agencies, particularly the Ministry for Children and Family Development, have a very difficult recruitment and retention problem, and social workers move on. But there are other issues — salary, working conditions, ongoing training, supervision, lack of required registration for social workers with the B.C. College of Social Workers. There are a lot of things that the government can do, including, as I said, salary, working conditions, training, expansion of student loan forgiveness programs — that sort of thing — to attract more social workers to the profession.

I’m going to scurry right along through this now. I see I’ve got about a minute and a half left.

No. 3, expand social work capacity to respond to mental health and substance use, including the determinants of health. Social work didn’t invent social and economic determinants of health, but we certainly have used that idea long before we were calling them determinants.

We used to use, and this is going back to the’70s now, the term “problem, person and place,” because it reflected social work’s unique contribution to looking at issues by looking not just at the problem, not just at the person, but at the social, political and economic context that problems exist in. We’ve always taken the position that situating, and I’ll use this example, substance use as a problem within the individual tends to lead to blaming, stigma, that sort of thing. We’re always encouraging a look at the broader context that behavior occurs in.

I do want to say that our association also provides direct service to those who provide service to people with substance use issues. Our association provides support groups for various social workers — primary care, urgent care social workers. We have a group for private practice, people with workplace mental health injuries, etc., and even a group for health authority practice leads.

I see I’m out of time, but I do just want to end with a statement that I made coming in here. That’s that the magnitude of this problem is significant, and it requires a significant response.

On that note, Ms. Sharma, I’ll end my presentation, and I’m happy to take questions.

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

Committee members, any questions?

S. Chant: Thank you so much for your presentation. By trade, I’m a nurse. I’ve been a nurse case manager for many years. I’ve worked with social work case managers for many years and also worked with social workers in a number of others, such as emergency units, such as on the floors in acute care.

Their work is valued so much, and so much of what we hear is, “If we only had” — whatever the resource is — “to support the health of somebody coming out of the acute system,” or coming out of, in this case, trying to deal with substance use, etc. So thank you to your group for the support that they give the social workers and for your advocacy on their behalf.

One of the things that we’re seeing is that team approach is being seen as being a way of dealing with many things, not just the substance use. What we have found is there seems to be a discrepancy between the….

[2:20 p.m.]

A nurse is a nurse is a nurse. When they’re registered, they’re registered — end of story. However, with social workers, they can be registered or unregistered, and sometimes that means the difference in their job. Is that particular thing being addressed within the context of the needs of the province now? Does that make sense?

M. Crawford: I think I understand your question, Ms. Chant. Let me respond by saying that our association…. Again, just to make the difference clear, we are not the regulatory college. That’s the B.C. College of Social Workers.

As the association, we have had a multi-decade campaign to make changes to the Social Workers Act. The administrator of the Social Workers Act is the Minister of Children and Family Development. We’ve made multiple representations to her, as well as her immediate predecessor, as well as MCFD Ministers going back, literally, decades.

We don’t think the public is fully protected unless social workers are registered with the college and their practice is regulated by practice standards created by their peers, utilizing a code of ethics — again, created by their peers. We don’t think the public is fully protected unless they have recourse for their grievances to a college.

Up until a few years ago, social workers in the health authorities were the only ones sitting around the case conference or interdisciplinary table that were not required to be a member of a regulatory college. That was a situation that the Minister of Children and Family Development — about five years ago, I think now — changed. It was changed in legislation, but those particular exemptions for registration were moved out of the legislation and are now sitting in regulation — and are, as you know, much easier to change there.

Our campaign is aimed at removing all of the exemptions, so that you don’t get an exemption if you’re in private practice, you don’t get an exemption if you work for a health authority, and you don’t get an exemption if your employer requires that you be registered. Almost everybody else has an exemption. We just think that because of that, the public isn’t fully protected. That’s our campaign. Thank you for asking that question.

N. Sharma (Chair): Michael, we’ve been delving into…. Obviously, there’s a huge crisis and death toll that British Columbia experiences every day. I just wonder if you could summarize for us — I think it would be helpful — what the key areas of intervention are that you think social workers could have on somebody’s journey to kind of prevent the tragic outcomes we’re seeing.

M. Crawford: I think there’s a huge continuum of care that social workers are engaged with. While I mention that continuum of care, I want to echo the need to produce evidence-based assessment and treatment across that entire continuum. We need to know what works and what doesn’t work. I’m not sure, in most areas, that we’re there yet.

Social workers are engaged with families. We see individuals, and we see their families as the context that they live in. We know that healthy families tend to produce healthy children, and those healthy children grow into healthy adults. So we see prevention as ensuring that people have adequate income, opportunities for education, affordable, safe housing. That list of social determinants goes on.

Social workers see that when we’re engaged in working with individuals and families, providing access to those kinds of services…. We believe we’re preventing a lot of downstream problems. We simply don’t have adequate numbers of social workers in front-line positions, and Ms. Chant made the point, as a nurse, that she has worked with social workers in in the past. We know that social workers are valuable members of the team.

[2:25 p.m.]

We tend to have good outreach abilities to families. We are aware of resources. We build networks that make referrals more possible. We build social supports around individuals as they enter treatment, during treatment, and particularly during that really crucial time of exiting detox or exiting treatment — where, we know, people without adequate resources are more likely to relapse. In that whole range of a continuum of care, social workers are involved.

N. Sharma (Chair): All right. Thanks for that.

Any other questions, colleagues?

R. Leonard: I appreciate you taking the time — a solo journey when you were expecting to have a few other folks at your side. Thank you for coming.

I think the question that I have is…. We’ve heard a lot around navigation, and I personally see social workers as one of those key people in a team that can help with the navigation piece. I’m wondering if you can tell us just how many — if you have any of the stats around where the social workers are involved in the issue around substance use and the services that are being provided or being considered.

M. Crawford: Thank you for that question. I’ll start by saying that I don’t have any numbers. I do know the important role of navigation that social workers engage in. Something that many of you are likely aware of is the Indigenous health care navigators that health authorities employ and typically locate in hospitals. That’s everything from: “Where do I park?” to “How do I get in contact with the specialist that my physician has recommended or referred me to?” So navigation is a really, really important issue.

When you’re dealing with individuals who are going through a process of making decisions about getting into detox, making a decision following detox to get into some sort of treatment and, following treatment, making contact and building that network of supportive people and agencies around them, people need help with that. That doesn’t come naturally. Some people don’t draw on others naturally for help. Others are just unaware of the opportunities that exist to build supports for themselves in the community.

To complicate the whole thing, at every step along the way through that continuum of care, there are delays. When somebody wants to get into detox, they might be told: “I’m sorry. There’s at least a 14-day wait.” So you’re ready to detox — it might even be part of your harm reduction program to get into detox — and you’re told that’s something you have to wait for. Following detox, the demand on available treatment beds is so high that there are very long wait times for that.

M. Starchuk: Thank you, Michael. There were some numbers that you threw out partway through the presentation. You were digging into the number of vacancies that you could find that are listed throughout the health agencies that are there. You made mention of about 800 to 1,000 that would graduate on an annual basis.

Obviously, there are vacancies to be filled, and we’re graduating a great number of social workers that are there. What’s the disconnect, other than…? Is it just a monetary thing? I’m trying to wrap my head around that gap between the numbers that you provided us and the numbers that you say are graduating on an annual basis.

M. Crawford: Thank you for your question, Mr. Starchuk. I realize now that I have made a mistake. I said 800 to 1,000. I would put it more at 500 to 600 graduates. In compiling that data, I think I counted third- and fourth-year BSW students twice, so I think 500 to 600 is a more accurate number in terms of the graduate and undergraduate social workers that are being produced every year in this province.

[2:30 p.m.]

I don’t have these numbers. But anecdotal evidence is clear that people that graduate with social work degrees, as is true in other caregiving professions…. It’s very true for nursing. We have a fair number of individuals who practice for some number of years and then choose another career.

During the COVID crisis, we’ve seen this with social workers, but it’s been way more evident with nurses. People tend…. We need to not only graduate more people. We need to provide them with better working conditions. That’s everything from salary to supervision, to student loan forgiveness, to support for rural and northern placements, all of those things.

The numbers that I found when I went looking at the health authorities career pages are high. Some of that has been generated by the number of primary care centres and urgent care centres that have been developed. Many of those managers are wanting to include a good number of social workers in those agencies.

When you first started really developing these centres, there were a number of social workers who got in touch with us and asked for a bit of a support group. We set that up. People were unclear about the role of social work in those agencies.

Doctors knew almost instinctively that social workers were going to be a great help to them. When doctors are concerned about income because people can’t afford to pay for their medication that they’re being prescribed, physicians tend to want to turn to somebody and say: “What can we do about this? How do we ensure that this person has a place to live, has something to do during the day, has an income sufficient to provide them with the medical supplies and prescriptions that they need?”

S. Chant: The other thing that we need to consider is that the stats, Michael, that you gave us only were the health authorities. It wasn’t the Ministry of Children and Families areas. It wasn’t the other massive numbers of areas where social workers are. It was only the health authorities. There’s a multitude of other places that are screaming for help.

M. Crawford: Yeah.

S. Chant: The other piece that has been brought up in the past is the moral distress of knowing what somebody needs and not being able to do it and not being able to get it to them. That is another piece of the puzzle that is very high in the social work environment.

M. Crawford: Can I just respond to that, Ms. Chant?

You’re absolutely right. I mean, the recruitment and retention problem within MCFD is so great that they’ve lowered the educational qualification required to become a child welfare worker. In our opinion, that’s not a good thing. That’s very, very low-hanging fruit to go after when there are many other things that MCFD, and other employers, could do to enhance recruitment and, certainly, enhance retention and probably, in the long run, save money because of the amount of time that it takes to recruit and train following education.

That’s a good point. Thank you.

T. Halford: Michael, I’m wondering if you can comment on the amount of social workers in B.C. We’re seeing an obvious strain on the system. How many are on leave, whether that’s stress leave, and if they are getting the supports they need from the health authorities when they’re on leave and how that is being backfilled.

We’re hearing a number of stories personally — I know in Fraser Health — with leaves. You obviously must be hearing about that, so I’m hoping you can comment on that.

M. Crawford: Thank you for your question, Mr. Halford.

I don’t have stats on that. I know, anecdotally, that number should be pretty high or much higher than we’d like it to be. Of course, COVID has really exacerbated this. We have two crises going at the same time here — COVID and the illicit, toxic drug supply — and that’s producing a lot of pressure on all health care workers.

Ms. Chant mentioned that sense of moral distress. Not being able to help in the face of a significant need produces that kind of moral distress.

One of the things that our health advocacy committee did a year and a half ago was contact all hospital social workers in the province and ask them about discharging into homelessness. It was a concern that we had, and we took a bit of a demographic look at who was being discharged into homelessness.

[2:35 p.m.]

Almost all of those discharges into homelessness were people who had mental health or substance use issues. This is really in keeping….

I know I’m drifting, a little bit, away from your question.

T. Halford: You are, so I’m good there, because that’s not…. I don’t mean to be rude, but that’s not what I was asking. I’ll follow up later, I guess.

S. Bond (Deputy Chair): I’m a bit surprised by a characterization. I know that we are devastated by the overdose death numbers that were announced today. The comment that good progress has been made, and we just need to do more of it…. Could you just explain for us? The overwhelming number of presentations we’ve heard, including from the coroner, are that what’s happening isn’t working and that we actually need to think about an overarching approach to this.

Perhaps you can single out for me or for us…. I think that in the context of increasing numbers, ongoing numbers of tragic deaths, the main message that we’ve been hearing is: yes, there are some things happening, but we need to do things differently, including less stovepipes, more cross-ministry work, looking at how we fund treatment beds — all of those kinds of things.

Maybe you could just…. Maybe I misunderstood what you said, or perhaps you can give me some sense of a response to that.

M. Crawford: I want to be clear. The magnitude of our response has not met the magnitude of this problem. Absolutely. But we need only go back five years to see what was available to people with substance use issues to see the improvements in the system that have been made.

Foundry programs, for example. The number of primary care, urgent care centres. Numbers of positions created to respond to this problem. Some movement on safe supply. Some movement, although insufficient, on exemption for personal limits. The development of peer training programs that I referred to. The increased number of treatment beds.

It’s not enough. I don’t want to ever suggest that what we’re doing is enough. It isn’t. The magnitude of our response hasn’t been significant enough.

One of the things that I was surprised in reading from the B.C. Centre for Disease Control was some computer modelling that they had done where they estimated that naloxone alone has saved 6,000 lives. So even the distribution of those kits throughout the province has made a pretty impressive difference.

I don’t want to be on record as patting British Columbia on the back for the magnitude of the response, but the direction that we’re going, I think, is one that we could support.

N. Sharma (Chair): Michael, I think those are all the questions that you have. I just want to thank you so much for stepping in for your colleagues today and helping us understand the perspective of social workers and all the important work that they do just for supporting British Columbians.

Committee will be in recess until three, which is our next presenter.

The committee recessed from 2:39 p.m. to 3 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): It’s my pleasure to welcome our next guests. We have the John Howard Society of B.C. We have Mark Medgyesi, executive director, and Shannon Pedlar, harm reduction coordinator.

I want to welcome you on behalf of the committee and let you know that we have your presentation in front of us on our screens. You have about 15 minutes to present, and then we’ll do questions and answers after that.

We’ll do a quick round of introductions so you know who you’re speaking to.

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

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

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

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

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

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

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

N. Sharma (Chair): Okay. Over to you.

JOHN HOWARD SOCIETY OF B.C.

M. Medgyesi: Well, let me get started then. First off, I want to thank you so much for the opportunity for John Howard of B.C. and our affiliate John Howard of the Okanagan to speak with you this afternoon and especially for the work all of you are doing on behalf of all of us. Having had a chance to look more deeply into it, it’s incredible and valuable work.

I want to introduce myself first as a member of John Howard B.C. and acknowledge that as a provincial organization, we do our work on the traditional and unceded lands of many of B.C.’s Indigenous peoples. I’m coming to you as a settler in the territory of the Lək̓ʷəŋin̓əŋ-speaking people.

I’m new in the role of executive director with John Howard B.C. The perspective I bring, however…. I’m a newcomer to the community sector, but I have a dozen years’ experience working with the provincial government in cross-government social services and community partnerships, ranging from the homelessness intervention project to the government/non-profit initiative and, towards the end of my tenure, as a co-author on Re-Imagining Community Inclusion. So my perspective is from cross-government work and less as an expert in this area.

But let me hand it over to Shannon to introduce herself.

S. Pedlar: I’m Shannon. I am addressing the panel today as the harm reduction coordinator for John Howard Society of Okanagan and Kootenay.

I’m speaking to you from the traditional and unceded territory of the Syilx/Okanagan people.

I’m presenting from the perspective of someone who has worked extensively on the front lines of this ongoing crisis. Within my current role, I provide direction, support and guidance to front-line staff in the delivery and development of the harm reduction services offered by our agency.

M. Medgyesi: Thanks, Shannon.

I thought I’d just share a little bit about John Howard in B.C. We are, collectively, an 80-year organization. Currently we have offices around the province in north Island, northern B.C., Okanagan, Kootenay and Victoria. These are service delivery–independent affiliates. Again, collectively, we focus on services for adults and youth, both justice-involved in terms of community reintegration as well as from a prevention perspective on people who are vulnerable and at risk. You can see from the presentation some of the range of services that our affiliates offer.

[3:05 p.m.]

Moving on to the next slide, I want to emphasize that I’m not the expert, but I have had, after your invitation, the opportunity to review a number of reports and submissions. I’m completely struck by the complexity and multidimensionality of both the problem and the solutions that are offered. The ideas and the voices are diverse and many and to be honest with you, as I read the material, in some ways a little overwhelming. We can see a tremen­dous amount of work has been done at all levels, from community to provincial to federal. And we can see, and it’s no surprise to the committee, that the crisis continues to grow.

From my perspective as coming into this somewhat new, but also as an administrator in this sort of cross-government environment, it begged to me a question whether we have an opportunity and a need to step back, focus and maybe do some prioritization. I say that not by way of stopping things so we spend a decade planning, but by way of really getting in on the notion of focus and prioritize.

In line with that, and as a start, we want to support and suggest building on a recommendation from the B.C. Coroners Service death review panel, in their 2022 report. That’s to develop a goal-oriented 30/60/90-day plan with ongoing monitoring. We appreciate the 30/60/90-day urgency, and we really believe the approach can be expanded to inform planning out to longer-term horizons. To this end, what we’re trying to convey with this slide is: as a first step, create very specific and very focused government commitments and accountabilities.

There’s a ton of work that’s been done and a ton of learning that has gone on. We would suggest that there’s probably enough within that to focus on two, three or four key accountabilities that will actually move the needle on the issue.

When we talk about moving the needle, we’re suggesting building goals and targets — not just tracking but understanding how successful we’re being against what we think success looks like; mandating the achievement of clear and very specific priority actions; mandating specific and very focused roles; and establishing responsibilities and accountabilities across the system, again with the notion of specific and focused; then public reporting, and not just of the statistics that describe the issue of progress against targets. We recognize this is a risky proposition, and it risks, in some cases, maybe showing when we fail. But we learn from failures, and we also suggest that what gets measured and what gets reported gets done.

In my experience in cross-government work, these kinds of things tend to work when we establish a centralized senior support system. These are senior officials with the ability to commit and direct their home organizations, in line with government’s mandate, and provide specific direction. They’re able to provide strategic direction and clear barriers and also to report progress.

As a third level, and focused on chosen priorities with very specific — call them — marching orders: establish focused and action-oriented teams. These would be dedicated teams. Their only job is to get the priority action done. They’re cross-functional. They have the expertise and knowledge and skills and connections to be able to get the job done. As well, they’re assigned a defined and very specific priority deliverable, with a clear and public plan, and with deliverables, deadlines, and clear and public resource commitments.

[3:10 p.m.]

This is a fairly simple project management approach, but what it’s looking to do is create a focus on getting specific things done and measuring the progress against targets. We acknowledge and see that there are existing structures — for example, the overdose emergency response centre, with the minister’s mental health and addictions working group and the regional response teams. If structures like that could be refocused with the kind of suggestions that we’re putting out, by all means, it may also beg a more specific and focused response.

Having shared that, we do have some ideas for priority actions. Shannon is going to speak to notions of safe supply, safe use. We’ll both speak to the notion of decriminalization, and then we do have some comments on perhaps how to help and focus service delivery on priorities and on supporting community involvement along those lines.

That said, we need to acknowledge the disproportionate impact of the crisis on Indigenous people and communities. At the same time, John Howard doesn’t presume to speak for Indigenous peoples or to make assumptions about what works for Indigenous peoples. We, though, endorse and wholeheartedly support anything that supports and helps move forward Indigenous-led action. We are available to support, as invited and appropriate. At the community level, our affiliates do work with Indigenous peoples in their communities.

With that, let me turn it over to Shannon to talk about some specific priorities.

S. Pedlar: Thank you, Mark. I just want to open by saying that if you only take one thing away from what I’m going to say today, I do want it to be that the people who use substances have been offering solutions to us for a very long time. This crisis has not been created by the existence or use of substances. This crisis is the result of a war on drugs, a prohibition that has resulted in an illicit and a poisoned supply.

The solution, in truth, is to end the prohibition and address these substances in the same way that we address alcohol. But this can’t be actioned nearly fast enough to end the suffering we’re seeing directly in front of us today, so instead, I’m going to speak to you about an interim safe supply. First and foremost, safe supply must replicate the substances currently found in the illicit market and be available in the quantities that are desired, not in the quantities that have been predetermined by prescriber guidelines.

The current safe supply model, although well intended, is failing, This model fails because it does not adequately address the need and, at best, is maybe replacing 25 percent of the substances consumed daily by an individual. It fails because they are being delivered through the mainstream medical model, where harms have been done and continue to be done to people who use substances. Finally, I’m going to state that they fail because the supply in no way is replicating the substances that are currently being used or actively consumed.

The Drug Users Liberation Front and the Vancouver Area Network of Drug Users have proposed a strategic framework to address the need for a true safe supply and have applied for a section 56 exemption to utilize the compassion club model, previously used for people who consume cannabis. If this application is supported and an exemption is received, it will produce a model that provides safe supply, that replicates the current illicit market in the quantities needed and that will be delivered by people who have lived or living experience.

We believe that this is the only reasonable path forward when considering safe supply, as it acknowledges the realities of people who use substances and empowers this population to support each other where the medical system has failed. With that, of course, we also have to talk about safe use. I bring to you a message from the front line, where there’s a high level of frustration that is felt, at the front line, with the uneven distribution of some of the tools that are available in the province of B.C. and with what is perceived as being an underfunding and underdevelopment of these tools.

In 2016 a public health emergency was declared in British Columbia, which empowered the province to implement services. One of those services was overdose prevention sites that could be supervised by peers and have fewer barriers to development than the supervised consumption site model that exists under Health Canada.

[3:15 p.m.]

Kelowna can be found in the top seven townships where illicit drug toxicity deaths occur. However, Kelowna only has one publicly accessible site for supervised consumption, an SCS that is located in the downtown area and that is open 12 hours per day. This site is unable to accommodate use of substances through inhalation, despite it being known that this mode of consumption has been steadily increasing and makes up 44 percent of current substance use.

John Howard operates Cornerstone, an 80-person shelter located across the street from the supervised consumption site. The shelter offers OPS services; however, we can only provide the service to registered clients under the current funding and subsequent staffing model.

Each week, on average, four toxic drug poisoning events occur within the vicinity of this shelter during the hours that the SCS is closed. Consistently, shelter staff are faced with making the choice, with complete understanding that they are acting as good Samaritans and without WorkSafe coverage, to respond to these toxic drug poisoning events. John Howard acknowledges the challenging ethical dilemmas that staff face each time they make this choice, as it is unthinkable to our staff that someone could lose their life because no one was available to respond.

This past Monday at 11:30 p.m., our staff responded to one such emergency, and it saddens me to tell you that, despite staff’s best efforts, that person did not survive. These situations are challenging for our agency, as this places staff safety and well-being at risk and has the potential to place the shelter’s operations at risk when staff exit the building to respond.

Our staff, and by default our agency, have been unfairly placed in a position where we are faced with making decisions that could impact staff and client safety due to a lack of services in Kelowna — despite the fact that the solution and tools were put in place over five years ago to ensure that safe consumption services could be easily delivered.

The road to the expansion of safer use services must be a pragmatic one. All models must be primarily staffed and operated by people with lived or living experience in recognition of the ongoing harms done to people who use substances within the medical model.

Significantly more publicly accessible services must be opened immediately. These services must support all methods of consumption and not be limited to injection. Episodic overdose prevention services that mobilize supports available through outreach must become the standard of care, and it must be acknowledged that services such as the Lifeguard App have their benefits — however, are widely inaccessible to our most vulnerable populations.

M. Medgyesi: If you want to think of this in terms of targets, think in terms of perhaps including service standards, like: “There will be safe use and supply options within an hour travel for everyone in B.C.” Think of naming specific communities for expansion within three-, six- and 12-month periods, reaching provincewide within the year, and, similarly, three-, six- and 12-month targets in the increases in the number of people who access safe supply or safe use sites by health authority and provincewide — just to put that in the context of our earlier suggestion.

Our third suggestion is to focus on decriminalization, and we acknowledge the work that B.C. has done in obtaining a section 56 exemption that will be implemented. We encourage making public in advance and reporting regularly on the evaluation criteria and success measures and results of that exemption. That’s both to know what we’re achieving and also to recognize success as it’s happening and help to hold the federal government accountable to expansion and expanding in a timely way.

We know work has been done in terms of legislative and regulatory requirements. We just encourage being ready to respond to that success by knowing the changes that need to be made. In parallel, and because this is a limited-scope pilot, we encourage the expansion of de facto approaches to decriminalization through both provincial policing and Crown and, importantly, monitoring the results. How many people actually are referred to services and actually are referred to treatment as compared to being engaged in a long court process?

And then, finally, continue to lay the ground for decriminalization. There’s work to do in terms of changing attitudes and biases, developing the capacity and the health and social service systems to be the alternative to criminal pathways and preparing for law enforcement. If nothing else, John Howard B.C. stands for the notion that we do not need to criminalize behaviour that is not inherently criminal and is due to other root causes.

[3:20 p.m.]

Moving on from there, we want to just offer a comment on service delivery. This is not new thinking, I’m sure, to anyone on the committee. It’s clear that not everyone needs or wants treatment or recovery, and not everyone who needs treatment or recovery comes in through a health or mental health door. People who experience a range of health and social inequities are disproportionately impacted by this problem. To that end, we suggest and acknowledge that services need to be individualized, holistic, compassionate, equitable and low-threshold.

An important concept here is No Wrong Door. If someone comes in through a housing door and needs income assistance or needs mental health supports, that should be available to them, and they should be helped to find it. The focus should be around the individual — the notions of reducing barriers and that harm reduction is a good outcome are very important — and on supporting people to a position where they can actually begin to consider things like recovery. It’s very difficult to focus on recovery when you’re hungry and you don’t have a roof.

Then, finally, acknowledging that there’s a continuum of care and ongoing supports — both within the treatment and recovery spectrum and, more broadly, in terms of supporting people through transition out of that into housing, employment, and so on. That leads to a good quality of life. In terms of community involvement, we suggest that a great deal of the services we’ve just described are actually delivered by community-based social and health service providers. They play a huge role.

The Community Action Initiative and community action team work and support are both inspirational, and community agencies have a long history of making innovative use of what they have, but we invite more of an inquiry here. That is, given that the main tranche of funding in this area comes through contracting, are there other ways to support effective community action focused on the outcomes that would be set as priorities? I’m thinking along the lines of: do contracts pay for activities, outputs or outcomes, and do those activities, outputs and outcomes align with the priority objectives that would be set under our suggested strategy?

Do contracts provide the flexibility to design and integrate services around the needs of an individual? That’s both within an agency, across the boundaries of contracts, and then across agencies. How much time do your service providers spend prospecting and competing with each other for the next funding, and how much time do they spend measuring, monitoring and reporting? How much of the information do we actually use? Those are questions and, I would submit, a helpful lens to apply if we’re looking to refocus and help focus community services and community funding towards specific outcomes.

That’s the end of Shannon’s and my presentation. Again, I want to end with a true and heartfelt thank-you for the opportunity to speak. Thank you for forcing me to learn more about the issue and for helping John Howard to focus its thinking around this.

With that, I’ll turn it back to the Chair, and we’re open for questions and discussion.

N. Sharma (Chair): Let’s go to questions, then.

M. Starchuk: Thank you, Mark and Shannon, for your presentation.

Shannon, I’m going to focus on what you were talking about with regard to Kelowna. What you were saying was way quicker than my pen, but you did kind of delve into it as to that these are the things that aren’t working. Are there things that are working and things that can be improved on because they are working? I know it’s easy to cast a stone and say: “This isn’t. This isn’t. This isn’t.”

[3:25 p.m.]

I think that from a committee perspective, we’ve heard it from a little while of what needs to be done. But if you’re doing something in downtown Kelowna, right across the street, and what you’re seeing…. I mean, I take it for grant, or not for granted, that it’s a very disturbing place at times, and what you and your staff are witnessing on a day-to-day basis. Can you just kind of touch on what is working?

S. Pedlar: I would say what is working…. When the supervised consumption site is able to be open, that works extremely well and takes a huge amount of pressure off the other service providers in the area. Certainly, that does work.

Unfortunately, Interior Health moved into a building, and then, of course, this inhalation piece started to come up. The structure of the building is just not permitting for inhalation at this time. I do know they are trying very hard to come up with a solution to that. The presence of that building is helpful for that 12 hours a day — what is certainly working. In Kelowna, however, each agency is operating their own overdose prevention services, that OPS site, and John Howard is one of them. Inside our supportive housing operations and, of course, our shelter operation, that model works really well.

John Howard in Kelowna launched a peermanship employment program, effective last August, which has had huge success. That provides us with an opportunity to have people with lived and living experience work and deliver those services to their peers. That is going exceptionally well across so many levels. Of course, that lateral approach is always very successful. What that has also permitted, within the scope of our services, is of course, people having the opportunity to make money when they would not normally be able to maintain a full-time job due to substance use or experiencing houselessness, etc.

There’s also the sense of personal self and the impacts that has on their mental health. We started with the intent of having three or four peers at Cornerstone Shelter. These are also people who reside at Cornerstone Shelter. At the current time, the last I heard, we have 63 peers, and they’re working across all of our services and doing so very, very well. As I mentioned, I stand strongly with…. Our solution is within this population itself. They’re standing ready and willing to help, and it appears to me that that’s what we should let them do.

N. Sharma (Chair): I have a question. Shannon, you were talking about the access to harm reduction or prevention sites. One thing we did learn is that different health authorities have different access, so different communities are having problems, on a local level, getting those set up. Sometimes, we’ve heard, it’s challenging in the municipalities — their zoning bylaws and things that are coming up to prevent that. I just was curious as to what the situation is, where you’re from, when it comes to that and the opening up of those sites.

S. Pedlar: I would say two things. First and foremost, of course, is community perception. Everybody wants somebody to do something about this crisis; nobody wants it in their neighbourhood. That is incredibly true here in Kelowna. The downtown area is actually very much not central in Kelowna, so it does place all the services, honestly, closer to West Kelowna than people that, say, live in Glenmore and Rutland, which is the far deep end, on the other side of Kelowna. It’s a hot-button political topic every time somebody talks about opening any type of service.

The other thing that is definitely a challenge in Kelowna is that all service providers — John Howard included — are already maxed out as to what services we’re able to provide. Most of the housing-providing agencies are also now actively involved in shelter, etc. We’re just running out of manpower very, very quickly. Even if we could find manpower, we can’t seem to find a location that will accept the idea that this exists.

N. Sharma (Chair): Thanks for that.

Any other questions, colleagues?

[3:30 p.m.]

M. Starchuk: I’m just curious. Earlier on today we had a presentation from the Bridge.

I think, Mark, you had, in your presentation, how much time your service providers spend prospecting and competing for the next funding. Is Kelowna, in itself, in a position where the organizations that are there are working in their own silos, apart from each other?

M. Medgyesi: I think I could address one piece of it and then ask Shannon to speak to the Kelowna situation.

I didn’t mean, at all, to imply that community agencies were working in silos. In fact, my experience is quite different. The organizations try to work together, and they’re very creative and innovative around how they do that. That’s despite the competitive aspect of contracting. It’s also despite some of the barriers that are inherent in the funding relationships with them.

I can give you an example of an initiative that we ran in a region of the province, and I’m going to be intentionally not mentioning names or whatnot. Some time ago we were working with a major non-profit partner and with a group of organizations in a region that had come up with a very creative way to reorganize their services and be more efficient and effective and make the best collective use of resources.

All was going well and fine. The community had agreed on how to do that. The main barriers were contract structures and funding flows. Once we approached ministries to look to support that innovation, the answer was: “Well, we’d have to rewrite our contracting system so that it did things differently, and we would have to rewrite contracts, which we couldn’t do without procurement, so we can’t even start.”

Again, I really hope I didn’t convey the notion that organizations are working in silos. They’re not. I was trying to convey that we may have opportunities to help them work together even more effectively and to focus their resources on the outcomes that we’ve been talking about in the context of this crisis.

Shannon, did you have something, anything to add from a community perspective?

S. Pedlar: Not much. Certainly, our partners over at the Bridge are exceptional. I imagine they likely spoke to you about the kind of “skip the dishes” distribution concept and the amount of outreach they do, which is fantastic. That idea actually did come forth in the community action team meetings that John Howard and the Bridge, of course, also sit on.

A huge part to the delay on that has been, again…. Probably the biggest challenge we have in Kelowna is which agency perhaps has the capacity to take it on. The Bridge stood up and said: “Okay, well, we’ll do it. We’ve got the vending machine thing going.”

Similar to what Mark was saying, quite often what happens is we have these ideas: “This is something that would potentially work.” We’re lacking in the manpower, or there are red tape and contract issues that are standing in way in the way of us actually being able to do it.

S. Bond (Deputy Chair): Thank you very much for that presentation and the work you do. Could you speak to the provincial reach of John Howard? I know that we have an organization here in Prince George, but the scenario for people who live in the North and other more remote, rural parts of British Columbia is very different than it would be in Kelowna or Vancouver.

Can you just speak to the issue of equity and the steps we need to take to ensure that if you need help, where you live isn’t, in and of itself, a barrier?

M. Medgyesi: John Howard’s reach has varied over the years and, at this point, we are down a couple of members. We do have an organization in Prince George and would happily work with the local community to look at expanding those services in this area.

[3:35 p.m.]

In terms of equity, my mind goes back to putting the onus and the priority and the focus on getting the services available in those areas and having people apply themselves to that, specifically, with the requirement that it get done. I don’t think I would add too much to my response that way other than to say we know that geographic issues and the shape of the problem are different in different areas of the province, and so forth.

Shannon, would you add?

S. Pedlar: No, I think you pretty much covered it, Mark.

N. Sharma (Chair): Okay. I don’t see any more questions, so I just want to thank you on behalf of the committee for coming and presenting to us today and helping us learn about the John Howard Society perspective and, Shannon, particularly your view from the front line. I know it’s challenging, and you expressed a recent loss that I’m sorry to hear about. Thank you so much for coming, and we appreciate your time.

The committee will be in recess until four.

The committee recessed from 3:36 p.m. to 4 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): We’ll come back from our recess now. On behalf of the Health Committee, it’s my pleasure to welcome our final speakers for today.

We have the Central Interior Native Health Society: Shobha Sharma, the executive director; Lauren Irving, nurse practitioner; Phyllis Fleury, outreach; and James Olsen, wellness counsellor.

I want to welcome you. We’ll do a quick round of introductions. Then you have 15 minutes to present, and the rest of the time will be for questions and answers.

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

I’ll pass it to our Deputy Chair.

S. Bond (Deputy Chair): Good afternoon. Thank you for presenting today. I’m Shirley Bond and, as you would probably know, the MLA for Prince George–Valemount.

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

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

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

R. Leonard: Good afternoon. It’s Ronna-Rae Leonard.

I’m calling from the K’ómoks First Nation’s territory.

I’m the MLA for Courtenay-Comox.

S. Chant: I am Susie Chant. I’m the MLA for North Vancouver–Seymour.

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

N. Sharma (Chair): Okay, I think that’s everybody.

Over to you.

L. Irving: Okay. I think that’s over to us, so I guess I’ll get us started. Are we able to share our presentation, Niki?

N. Sharma (Chair): We all have a copy of your presentation on our own screens, and materials, so we’ll be able to follow along with you as you present.

CENTRAL INTERIOR
NATIVE HEALTH SOCIETY

L. Irving: All right. Okay, so we’ll get started then.

My name is Lauren Irving. I work as a family nurse practitioner at Central Interior Native Health Society in Prince George, British Columbia.

If we just move on to the next page of the slide here, we’ll just acknowledge that we’re on the traditional territory of the Lheidli T’enneh First Nation. T’enneh literally means “the people,” and Lheidli means “the people from the confluence of the river.” Currently the Lheidli T’enneh Nation consists of over 400 members. You can see on the picture here…. There’s a beautiful picture of the rivers in Prince George. If you’ve never been here, it’s a beautiful place to be, and this is where we are so privileged to do our work.

Moving on to the outline, what we’re going to review today. First of all, Shobha Sharma, our executive director is going to do an introduction to our clinic. I’ll review — I’m Lauren Irving, nurse practitioner — brief statistics on our current OAT and opiate use disorder and overdoses that we’re seeing at the clinic. Then we’ll have Phyllis Fleury. She’s going to talk about some of the stories and experiences of the patients that we serve. Then James Olsen is going to talk about trauma and substance use. Then hopefully, after that, we can have a quick discussion on next steps.

Okay, so I’m going to pass it off to Shobha, to talk about the slide there.

S. Sharma: Thank you, Lauren.

Hadih bunda hoonzoo to everyone. Thank you so much for giving us this opportunity to connect with you today and to share our experiences and our journey with all of you.

I would love to take a little time to let you know where we’re coming from, the work that we do and what really informs our perceptions of the crisis that we’re in right now. Central Interior Native Health Society operates an equity-oriented health care model. That’s the third slide that you should have in front of you, that looks like a medicine wheel. Central Interior Native Health came into being in the early’90s. It’s really key, I think, to understand how and why we came into being.

Prince George is…. Many refer to it as our central northern capital. As a result, many come into Prince George to seek services — services that are not available in smaller communities, services that are not available on reserves — so our health centre serves a large population of community members coming in to seek services that are not available elsewhere.

The Indigenous leaders in our community identified that there was no primary care model that was actually addressing the impacts of colonization on the Indigenous populations living in and/or coming into Prince George, seeking care. So Central Interior Health was born out of that — an opportunity to provide a cultural and trauma-informed lens on a primary care model.

[4:05 p.m.]

As we started off with a primary care team addressing prenatal to end-of-life care, we soon realized that it was so important for those that are working through intergenerational trauma, residential school survivors, to be able to look at the impact of land theft and to look at the impact of trauma that they were experiencing by addressing the social determinants of health.

So our team soon began to expand to look at the issues around housing, the issues around the access to a social worker and how that could support someone. We have a wellness counsellor and mental health clinicians. Individuals that can truly wrap these supports around clients were very, very important.

Soon we realized that providing access to care was very important. Specialists, even the community, acknowledged that providing care out of Central Interior Native Health would ensure that clients would seek the care that they need in a specialized setting. We have an expanse of different specialists that come in.

Notably, we provide care and clinics around opioid agonist therapy. Substance use management has been a huge part of our journey, even to the point in which it’s embedded in our primary health care model. So while we do have clinics, we also operate and use opiate agonist therapy through our primary health care model in every encounter of anyone coming through the clinic.

Another really important key component of the work that we do has always been decolonizing, trying to create a safe space for clients to come into. While 80 percent of our clients self-identify as Indigenous, we also serve those that are precariously housed, those who are living with or at risk of HIV, HCV, TB. It’s been very, very important that the care that’s provided acknowledges that.

It’s person- and family-centred care, and the biggest component of what we realized was that in order to create a safe space, “decolonized care” meant lending and incorporating Indigenous, ancestral ways of being and healing. So our model and the work that we do incorporates an Indigenous lens on health and healing.

With that, I would love to pass it over to Lauren to speak to the opiate crisis and how it’s impacting our clients.

L. Irving: All right, thanks so much, Shobha.

I think you guys know this from all the work that you’ve already done, but we know that 14 percent of the overdose deaths from January to June were amongst the First Nations people, which is an overrepresentation, and we know that First Nations people died at 4.8 times the rate of other B. C. residents in 2021. Knowing that, I thought we’d talk a little bit about the data that we see in our community at Central Interior Native Health.

Northern Health does have the highest rate of illicit drug toxicity deaths in the province, at 48 deaths per 100,000, and at Central Interior Native Health Society, we offer OAT, like Shobha was saying, with all of our primary care. It’s really embedded into our primary care system.

What we typically provide for OAT at Central Interior is methadone, Kadian and Suboxone. We also provide safer supply. This was introduced in April 2020 by one of our nurse practitioners. Today what our safer supply looks like at Native Health is Dilaudid…. We’ll offer Dilaudid, M-Eslon, methylphenidate.

At Central Interior Native Health, we currently have 1,750 patients who are registered to us, give or take a few, and I just thought we’d look at the people whom we see for OAT. The number of patients at Central Interior Native Health who we’ve seen for OAT in the last three years is actually 242 unique patients. Then the number of patients at Central Interior Native Health who we’ve seen for OAT and who have died from an overdose is 20 people. That’s about 8 percent. This is important to keep in mind.

What I find interesting is, if you look on the next slide…. I did a QI study with a medical student who I was working with, and we looked at the characteristics of our patients who are presenting to the emergency room with overdoses. In this QI study — although it’s a small sample, only 54 patients — we looked at people from April 30, 2020, to April 30, 2021.

Although the sample was small, what the data showed us was that, actually, people who were presenting to emerg were not the patients who were engaging in OAT at Central Interior Native Health. These people were typically less than 25 or older than 55, and they were not part of the people who were coming into care to receive OAT. Knowing that, I think it’s important to think about it, at Central Interior Native Health: how do we access this population? I’m going to pass on to Phyllis to talk.

Off you go, Phyllis.

P. Fleury: Thanks, Lauren.

Part of my job is to go out on the streets and talk to the people. I feed them when I can. We make sandwiches; we try and supply water for them. Most of them were living in the tents last year. The housing is sort of fixing itself, but there are still quite a few people on the streets.

[4:10 p.m.]

The biggest thing is getting on the street and talking to them like they are people. You need a lot more workers like that. Get their input on what they need. Show them the direction that maybe they need to go. As a peer, I myself know what addiction is. You need a lot of peer people out there that have lived experiences to understand these people, the homelessness. A lot of the time they really need something to drink.

The biggest part of them being homeless is…. They’re having to use the washroom. It’s pretty hard for anybody to do that, especially with COVID but coming out of COVID now.

I don’t know what else there is to say about that. Go and listen to them. Talk to them as people, not as something…. I just saw on my phone where somebody had put them down. You don’t ever look down on somebody.

I’ll pass it over to James now.

J. Olsen: Hello, everybody. Thank you.

In talking about the impacts of substance use and trauma…. Again, a brief understanding of how the understanding of trauma has changed over the last years and understanding, again, from Dr. Gabor Maté’s work, that trauma is not what happened to us. It’s what happened in us. What happened in us has had a huge effect on the brain and the nervous system and how we experience life today.

Many of those symptoms of trauma are re-enactment, loss of self-worth, loss of a sense of self, loss of a physical connection to our own body, disassociation, loss of intimacy, shame, loss of trust, loss of danger cues and loss of safety. What we’re understanding and seeing, again, is that substance use is a symptom of trying to treat the underlying trauma.

At Central Interior, we’re really trying to take a more aggressive approach to understanding that treating the person as a whole by treating those trauma symptoms…. Again, not wanting them to relive the trauma but helping them understand how it’s impacted them in their development. Addiction isn’t the problem. What we want to treat is the underlying…. The true problem is the trauma.

How do we treat the trauma? We want to make them feel and develop trust. We want to help them feel more included. We want to help them feel, as a person, as a whole.

Can we all allow ourselves to consider that addiction is just one of the symptoms? The problem is to understand and identify the unidentified and undisclosed trauma.

The Canadian government has done many studies on this. We here, at Central Interior, work really tirelessly. Again, from a study put out in 2011, Honouring Our Strengths, a return to culture, a return to connection, a return to worth and value through a connection to culture are where healing can begin.

On my last slide there. Again, as we look behind the behaviour, there’s a feeling, and beneath every feeling, there is a need. We’re working to meet those needs. When we meet the needs and focus on those, rather than the behaviour, then we begin to treat the cause, not the symptom.

S. Sharma: Thank you, James.

In regards to next steps, there are a lot of things that we, as a community health centre, see the need for. One, as James just spoke to, is access to funding streams that value culture in addressing trauma and healing. So access to funding that will address and give us the money to fund cultural knowledge holders, Elders, etc. That’s been very, very sparse and few in between. It took the affirmation of unmarked graves for that funding to come through, but it’s still not sustainable.

Extended hours. Weekends and evenings create access and less barriers for the 36-year-old men dying of overdose, who are the most represented in the statistics and who we’re serving right now. These are not just those that we serve here. It’s also workers who have come in that are working alone and cannot meet banking hours. We need that continued access.

[4:15 p.m.]

Increase sessional hours, service contracts for PCPs like Lauren to be able to serve in clinics like ours, community health centres, to have the flexibility to care for the whole person and not just a ten-minute appointment. That’s really, really key.

Expanding access to primary health care to attach clients. Currently, Central Interior Health has over 500 clients on our wait-list alone that we cannot get into care. Getting into care means getting in to be able to access all of our other services, such as our counselling services, our mental health services and also to be able to provide medical access to provide low-barrier care for all of the drug-related harms or just skin and soft tissue infections, etc. We need to bring them in and attach them. So we need extended primary care.

We also would like to be able to optimize OAT, so extending prescribers to include full-scope RN and RPN; more support for RN and RPN prescribers; pharmacists to initiate OAT and to continue to restart OAT; also to get prescribed safer supply, as the chief coroner has been requesting over and over again; as well, access to health telehealth and virtual services so that clients are not hiking along the Highway of Tears to access services.

We really need to look at where our clients are at and the impact of colonization that continues to happen to be able to bring services to them or to be able to bring them safely in to be served.

Does anyone else have any last words on our team? This is like doing a TED Talk.

L. Irving: No, I think that was great. Thanks, Shobha.

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

We’ll move on to questions. Committee members, any questions? Maybe I’ll start off.

Thanks for the presentation and going through the different areas where it’s going up in your community. It always really strikes me — the Northern Health region and the impact that the crisis is having up north. When we had the health authorities come in, the different health authorities talked about the different issues with access or opening up prevention sites and the things that are saving lives.

I just wanted to know your perspective on why you think the Northern Health region is being so hard hit by this crisis in terms of the percentage of people that have, unfortunately, passed away.

L. Irving: Shobha, why don’t you start us off, and then I’ll chirp in there.

S. Sharma: When we speak to the Elders in our community, they speak about how harsh the impact of colonization was in this area. We’re serving the Dakelh area. That meant that a lot of culture went underground. It meant that there was a lot of trauma to work through in connecting back to self, connecting back to identity. Getting back to James’s point, it exacerbated a lot of trauma that generations are still working through today.

I think that’s a great reason, potentially, for some of the great trauma that we’re dealing with. I also think that because we’re in the North, we’re just far away from access to community health centres that could provide a more dynamic approach to health care that addresses the whole person.

There are also wait-lists in terms of even getting in to be attached to any primary care home in Prince George. We’ve attached over 500 in our clinic alone over the last few years while a lot of offices remain closed to attachment.

L. Irving: I think in general, as a primary care provider, we do have that shortage of primary care providers. I know this is something that’s been talked about a lot recently, the family doctor shortage and all of that. I think it’s just exacerbated so much in the North. It’s almost like it’s always been there. This pandemic has certainly made things even more challenging, but we’re a little bit resilient, because we’re almost used to it. We don’t have all these resources.

When I went down to UBC for my master’s, I was so shocked at the medicine that was being delivered down there, because I had done my undergraduate at UNBC. Just seeing the specialists available…. It really is different, so that is always a struggle for us.

That’s why telehealth is so important for us. As a prescriber of safer supply and OAT, there are triplicate pads. It is challenging to do over the phone and virtually, because I think a lot of prescribers do feel concerned about how their college will perceive some of these prescriptions that are being written that are just for huge amounts that you would never have seen years ago. I think people consider that, right?

So we really want to be able to provide services to people in the community. But then when you look at opiate prescribing guidelines that say things like, “We need a random urine drug sample,” how do we actually get that random urine drug sample when they’re living out in a really remote area? They can’t travel into the clinic. How do we provide people…? If you’re getting safer supply, you’re supposed to be picking it up every day from the pharmacy.

[4:20 p.m.]

Well, the pharmacies aren’t open all the time, so a lot of our patients do get carries on the weekend, but if they’re living remotely, then we have to give them longer carries. That makes it challenging, and not everyone is comfortable with that. We always worry about what our colleges think, so I think that does impact a little bit about how these services are delivered.

N. Sharma (Chair): Thanks for that.

P. Alexis: I had similar a question about Northern Health. We certainly saw the difference when all the health authorities presented on the same day — the differences and the inequalities technically that Northern Health has to endure.

My question is about stigma. Do you feel that in the North, there is more stigma in comparison to other areas of British Columbia, and is that a factor in how you deliver service? Just if you could tell me a little bit about that so I can understand the psyche a bit.

S. Sharma: James, you’re on mute.

L. Irving: I don’t know if he can hear us, Shobha. He seems to be talking a lot over there, but we can’t hear him.

P. Fleury: I noticed in the last month or so that we have a younger generation going on the streets. I believe they’re coming from the remote areas, which probably coincides with what you’re saying — that they can’t get the safe supply out there, so they come out here and get the real stuff.

My last two Narcan people were like 17, 18. They’re getting way lower, and part of that is us losing our culture, too, you know. It all coincides with everything here. I’m just now learning my language, and that’s a big thing for me. When you have something to take pride in, you don’t look at the downside of life. You look up. That’s all I have to say on that.

S. Chant: Do you feel you’re well supported by your health authority?

L. Irving: I think there’s room for improvement, for sure. I do think that it’s been a really challenging time for us at Central Interior. I mean, I love Central Interior because, as a non-profit, we can react quickly to crises. We have less bureaucracy. But it’s been really challenging to do the safer supply. There are a lot of…. I guess it would be maybe some…. We need more education, I think, for prescribers in the North — that there are different modalities than just methadone in order to treat OAT. So I think Northern Health could do a better job.

I think we’ve been slow to roll out registered nursing prescribing. Actually, when I look at a provincial level, I appreciate a lot of the stuff that the province has done. But I am critical of how we’ve mobilized in the North here. I think we could do better with our prescribing. We might not have a lot of physicians. We might not have a lot of nurse practitioners. But we need to use who we can, and if nurses are able to prescribe, we need to make sure that’s going. We need to see that happening, and I don’t see that happening in town, in Prince George.

S. Sharma: I would also just add to that that five years ago, 100 percent of our…. Right now, in order to…. We had to diversify our funding stream to be able to access funding to support Indigenous approaches to health and wellness. Over the last couple of years, again, as the affirmation of unmarked graves became an issue, creating a lot of trauma in community, there were more federal and provincial as well as private grants that were starting to give money to support those types of functions as well as to really understand the need for mental health supports in addition to that.

We are restricted annually with the amount of a lift that we can request, so we really are diversifying our funding stream. Five years ago, they funded 100 percent of what we did, and now it’s about 30 percent. Our audit is just about to come out to reveal the exact number. But we’ve had to diversify, in terms of funding, to provide the mental health supports as well as the Indigenous supports. So that’s a limitation, for sure.

[4:25 p.m.]

I know, in comparison to other health authorities, people have been surprised that an Elder has been funded through the health authority and did so many years ago. I believe that that is their commitment to understanding we need to indigenize. But again, there are huge limitations, so we’re absolutely needing to, as a community health centre, be agile and expand our services through other avenues.

M. Starchuk: Thank you to you for your presentations. Lauren, thank you for also explaining some of the issues around prescribing, especially for those people in the rural areas, for the longer carries — that they would be required.

My question goes back to those people that are in the OAT program that’s there. We see the numbers of 242 — part of me is curious as to how many of those are part of the safer supply — and then the unfortunate number that you’ve provided to us in the last three years of the overdose deaths that are the people that have come through the system. We’ve typically heard that people are more vulnerable when they’ve gone through a program and they’ve been off for a while and they go back to using at a different dose — or rather, the same dose that goes back there.

Can you elaborate if that’s the case in those cases?

L. Irving: Absolutely. Those, I think, 242 people — I just pulled those numbers earlier this week; that was over the last three years — are patients who are engaged in OAT at Central Interior Native Health Society. A lot of those patients are getting safer supply now. I just was running the OAT clinics these last weeks. I would say, I don’t know, maybe 50 percent. I should have grabbed those numbers, but I didn’t.

We’re doing a lot of Dilaudid and M-Eslon for safer supply for opiates. Then some people are on methylphenidate for stimulant use disorder. So we’re doing a lot of that; I would say at least 50 percent.

For the people who have died from opiate use disorder, I think we all have some pretty upsetting stories about who those are. Certainly, though, we do see people when they’re trying to move away from substances. Then there’s a relapse, and then those drugs are just so toxic. They don’t have the resiliency. That’s when you’ll see some pretty terrible overdoses and deaths.

I think what was interesting about the QI study is it kind of showed that the people who were overdosing and ending up in emerg weren’t actually our patients who were registered on OAT. I think some of these people were quite removed from using substances, and then there was one little relapse. A lot of these people had kids who overdosed and died. Maybe they just went out and bought what they used to buy, and it’s just so toxic. They just weren’t prepared for it, and down they went.

So yeah, we do need to figure out how we can do better, because it’s quite upsetting. A lot of families have been disrupted by the opiate use, by the opiate crisis.

James, I know you had something to say too.

J. Olsen: I just wanted to, again, from the North hearing this perspective of how we address this underlying issue…. I was speaking to our…. We have one male treatment centre within half an hour of Prince George, a couple of adult parolee situations and one other treatment centre within Prince George. It’s a six-week program run through St. Pat’s.

Our services here in the North are so underfunded that, again, for me to send a female client to treatment, it’s a minimum of four hours away, either to Dawson Creek or to the Kitwanga area or down to the Lower Mainland. Then upon return, the services are not in place. They return back to the same condition which they left — of being homeless or underhoused, food insecurities.

We need first-stage housing, second-stage housing and third-stage housing — those supported elements — to help provide these situations so that when we get them stable on a medication, treat the underlying issues, they can return and thrive in a better way. It’s just so difficult because of the limited resources here in Prince George.

And yes, fortunately, we just opened a 50-bed supportive housing facility here in Prince George. But that’s only a tiny step in the right direction to help us support these clients to move forward.

S. Bond (Deputy Chair): Well, thank you very much. I just want to add my deep appreciation for the work that you do. My office is just down the street and over a block or two from yours. I have been very proud of this work and have often spoken to government, whichever stripe — with Murry Krause, for example — for many years about the model and the work that you do.

[4:30 p.m.]

I simply wanted to acknowledge the way that you have described the needs in northern British Columbia. Geography is a barrier. There is inequity in this province, depending upon where you live. There is a lot of work that needs to be done to provide the kinds of services that James was talking about, and Lauren as well. Thank you, Phyllis, for the work that you do and for sharing your story with us today.

I’m interested in the comments about people that presented at emergency, because we have enough other challenges. Lauren said it so well — we’ve always had problems with retention and recruitment. One of the things is if you train people closer to home, they’re more likely to stay here. We can’t cross our fingers and hope that they’re going to come from Vancouver to work here. That will not work. There needs to be an intentional strategy around how we recruit and retain.

Lauren, to the people presenting in ER, were they in that demographic of males, in particular, using alone? We have heard unbelievable statistics related to the demographic. Many of the people that are dying are in that age category. Many of them are in construction and a variety of other places. Obviously, you have a great model and a significant client base of over 1,700 people. Tell me a little bit about who’s presenting, a little more in-depth. Is it construction workers? Are they using alone? Do we know anything more about that group of people?

L. Irving: I’ll say what I can, but I think James probably has more about this, maybe, than I do.

The demographic that I get, particularly — what I see is…. I also do a clinic at Nusdeh Yoh Elementary school, which is a primary care clinic, around once a week, and I love that work. I do a lot of work with prenatal patients and pediatric patients, and we see a lot of families there with one parent deceased, whether it’s a male or female. We’ve seen moms pass away. We’ve seen dads pass away. We’ve seen both.

You think some of these patients…. You think they’ve made it, right? Their kids are in school. They’re living lives, and then boom. They go down. I can’t say if it’s males over females. I just don’t have that data. But I see parents, for sure, and it’s really, really hard.

James, I think you probably have a lot of stories of people you can think of.

J. Olsen: I do, and unfortunately, without going…. I mean, a good majority of the clients that I work for, for their mental health and substance use, are mothers dealing with MCFD and the trauma of being separated from their children, the large uphill battle that that sometimes can present. And yeah, it is as Lauren described, or as you have asked the question. They do really well for a certain period of time, and that one momentary moment of despair from bad news from their social worker — they go out to their same old supply, and it’s toxic and it’s fatal.

We just don’t know, because it’s so unpredictable. It’s a range, everywhere from…. The clients I work with are absolutely homeless to, maybe, underhoused or absolutely working, employed. It’s the full spectrum which we see affected by this crisis.

S. Sharma: I think that that differentiation, in terms of who we serve and who we’re not serving, is really important, because who we’re not serving are also seeking primary care supports that would be available in the low-barrier way, whether that be telehealth services or just weekend or evening support.

So when they do come home from working on construction, or if they do need to call in to receive something, they can do that, as opposed to having to use what they can find more readily available. So I think in terms of who we serve, yes, we can wrap these supports, but there’s that huge group, not even just the 500 who are on our wait-list but the others who, potentially, aren’t Central Interior Native Health clients.

They don’t fit our kind of mandate in terms of who we serve, but they are also seeking primary care that’s not available to them right now here. No extended hours that really fit their needs.

[4:35 p.m.]

I think that’s also super important to understand — that we need to create greater access to primary care for those that are coming in to work that aren’t connected, that are not attached, that don’t have a community, that are here working alone and need more supports and services.

S. Bond (Deputy Chair): If I might, Niki, I just wanted to say to Shobha that that is exactly what I was thinking about, the client population that you serve. Then there are the unserved, completely, and perhaps — just as you point out — the need for extended hours, the need for some form of access, because they don’t fit the client model that you currently have in place. I am deeply troubled about that, when you stop and look at our numbers, as Lauren laid out so well, in terms of the statistics.

That includes, of course, Dan. Dan is a part of Northern Health as well. I’m actually Central Interior, which is why your name is so appropriate. We call ourselves the North. But Dan, imagine how the further away you get from, in essence, the Lower Mainland, the more restricted the services are.

Geography is an enormous factor in this crisis, and I think that your story today was very compelling and helps us recognize that there is deep inequity across the province. Thank you all for those comments, and thank you, Shobha. I think that really captured what I was thinking about.

N. Sharma (Chair): I don’t see any more questions.

On behalf of the committee, I just want to thank you so much for giving your perspective and the way that you approach your work. Particularly, we’ll remember that wheel at the beginning, which really broke down your vision and your approach to how you help people. Thank you very much for that, and we wish you all the best.

We need a motion to adjourn.

Pam and Ronna-Rae.

We’ll see everybody soon.

The committee adjourned at 4:36 p.m.