The committee met at 12:02 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): I want to welcome everybody back to the Health Committee. I hope everybody had a good August.

I’m on the traditional territory of the Coast Salish people, the Squamish, Musqueam and Tsleil-Waututh. I just want to acknowledge that before we start.

I invite everybody else who is Zooming in from different parts of the province to acknowledge and think about the territory that they are Zooming in from.

We have a whole week of committee meetings. This morning we’re starting with a group from MCFD, whose presentations we all have on our screens.

I’m going to go through the committee just to introduce everybody that’s on our committee, that’s present today, to you all at MCFD. Then I’m going to pass it over to you to introduce yourselves and the positions you have. Then you have 15 minutes for the presentation and 45 minutes for questions and discussion afterwards.

We’ll start with Pam.

Do you want to introduce yourself first?

P. Alexis: Absolutely. Good afternoon, everyone. My name is Pam Alexis. I’m the MLA for Abbotsford-Mission. I’ve unfortunately had some connectivity issues all morning, so if I blink out, I will try and get back on again right away.

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

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

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

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

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

N. Sharma (Chair): Our Deputy Chair.

Go ahead, Shirley.

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

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

N. Sharma (Chair): Excellent. Okay, I’ll just pass it over to the MCFD team to introduce yourselves and go for it with your presentation.

Briefings on
Drug Toxicity and Overdoses

MINISTRY OF
CHILDREN AND FAMILY DEVELOPMENT

C. Kamper: Good afternoon. I’m Carolyn Kamper, acting Deputy Minister for MCFD. Quickly, I guess…. We have a number of staff joining us. Perhaps I’ll introduce them, and then when they speak, they can introduce themselves.

We have James Wale, acting provincial director of child welfare. We have Kelly Durand, acting assistant deputy minister for service delivery division. We also have invited Deborah Headley, executive director, provincial services, as well as Kerry Shinners, director of practice. We have also invited to join us today Kelly McConnan, executive director of child, youth and mental health policy at the Ministry of Mental Health and Addictions, as we work so closely together.

[12:05 p.m.]

I’m going to check…. We’ll move it to the slides, Chair, if you’ll be presenting the slides.

N. Sharma (Chair): We all have the slides on our SharePoint in front of our computers or printed out in front of us, so you can just tell us what you’re on.

C. Kamper: Wonderful. I would like to just introduce the presentation, and then I’ll pass it over to James and to Deborah. A number of us, of course, are here to answer the questions.

I’ll just move to the second slide.

First, of course, I want to acknowledge the traditional territory which I’m calling in from, the traditional terri­tory of the Lək̓ʷəŋin̓əŋ people, echoing, as you did, Chair, and taking a moment to respect and acknowledge the lands which we are all calling in from this afternoon.

Next slide, slide 3. I did want to begin by thanking you for inviting us today. I do know that Deputy Minister Allison Bond definitely wanted to attend. Due to a scheduling…. She literally is on the side of a mountain hiking, with no cell service, and couldn’t join us. But wanting to join with staff, to be here today to speak to you about the ministry’s collaboration with community partners to address the overdose crisis.

Always to, first, respectfully recognize the loss and the devastation that the overdose crisis has had and is having on British Columbians. We’d also like to recognize the extraordinary efforts of front-line staff, the sector and our valued partners who work so hard to support those that we serve. Just really wanting to start off by stating our commitment to support children and youth in B.C. to live in safe, healthy and nurturing families with connections to their communities and culture, and our commitment to collaborate with Indigenous communities and recognize that Indigenous peoples have distinct rights, as set out in UNDRIP.

We also recognize that the child welfare system needs significant change, and we are focused on transforming the child and family services system. For those children, youth and families struggling with mental health or substance use, we work within a broader system of care that supports health and development through an array of child and youth mental health and substance use services. We, the ministry and MCFD, provide early intervention and prevention services as well as community-based child and youth mental health, which we’ll describe in this presentation.

We also work very closely with our partner ministries, such as the Ministry of Health, which provides the substance use treatment for youth and young adults. As well, we have the Ministry of Mental Health and Addictions to implement our shared commitment on the Pathway to Hope strategy.

I’ll pass it over to James, and we’ll go to slide 4.

J. Wale: Good afternoon. I’d like to provide some background to the child protection context.

Mandatory reporting under the Child, Family and Community Service Act, the CFCSA, only occurs when a person has reason to believe that a child needs protection. Parental substance use on its own is not a child protection issue unless there is a concern of harm or likelihood of harm to a child. We acknowledge that removal of a child causes trauma, both to the child and to the parent. This is why the CFCSA requires that removal only occurs if a child’s health or safety is in immediate danger or there is no less disruptive measure that is available and sufficient to protect the child.

After removal, the placement priority is to place with extended family and people known to the child. You can see the graphic on the slide that illustrates our placement priorities. MCFD receives child protection reports for about 55,000 children per year. After an assessment, about half of those children are determined to be safe and require no child protection involvement. Of those children who are in need of protection, last year about 87 percent remained with their parents, and about a further 6 percent stayed with extended family. This is achieved through safety planning with parents, extended family and community.

B.C. is currently seeing the lowest number of children in care in 30 years: under 5,000 children. Twenty years ago there were over 10,000 children in care. The number of Indigenous children and youth in care is the lowest in over 20 years.

[12:10 p.m.]

Move to the next slide, guiding MCFD’s work with Indigenous families. When working with Indigenous families, child protection work is guided by key pieces of legislation and policy. The federal legislation, An Act Respecting First Nations, Inuit and Métis Children, Youth and Families, has been enforced since January 2020. There has been an ongoing process to transform MCFD services to support the aims of the federal legislation, including implementation of policy and training as well as plans for future legislative amendments.

The Aboriginal policy and practice framework was developed by the leadership in Indigenous child and family service agencies and identifies a pathway towards restorative policy and practice that supports and honours Indigenous peoples’ cultural systems of caring and resiliency. The framework applies to all of MCFD’s six service lines.

Onward to the next slide — co-occurrence of problematic substance use. Although not all children of parents with problematic substance use will suffer maltreatment, research indicates there is a relationship between child maltreatment and parental problematic substance use. When parental problematic substance use, mental health challenges and domestic violence occur together in the same family, this places children at much greater risk of harm than with the presence of any single factor.

MCFD recognizes the lasting impact of trauma. The Trauma-Informed Practice Guide, developed in 2017, was designed to inform the work of MCFD and Indigenous child and family service agency leaders, system planners and practitioners working with children and families. It is concerned with advancing understanding and action about trauma-informed approaches that support program and service delivery across the system.

Another source of guidance to practice is found in MCFD’s practice guidelines when assessing parental problematic substance use and child welfare. It was developed in 2018. This document addresses trauma-informed practice, harm reduction practice with parents and working collaboratively with addiction counsellors. A trauma-informed approach recognizes the need to respond to an individual’s intersecting experiences of trauma, mental health and problematic substance use concerns, and acknowledges that this is achieved not only in specialized services that specifically treat trauma but also in practice.

If we go to the next slide, fatality data. Sadly, this slide presents data on accidental illicit drug fatalities of children and youth served by MCFD within a year prior to their death. The B.C. Coroners Service shares information with MCFD once the cause of death has been confirmed. This data is presented by calendar year. It can take over a year for the Coroners Service to complete an investigation and confirm the cause of death. This graph does not include fatalities that the Coroners Service is still investigating.

The number of deaths per year is variable, with a high of 20 in 2017. From 2016 to 2021, of the 68 children and youth served by the ministry who died of accidental illicit drug overdose, 28, or 41 percent, were Indigenous, and 24, or 35 percent, were children and youth in care.

If we move to the next slide, measures to reduce the risk of illicit drug fatalities. MCFD has collaborated with health to develop an online training course for foster care givers called Supporting Open and Safe Dialogue about Substance Use. This course was added in 2019 to the mandatory in-service training for foster care givers. The learning outcome is to identify collaborative strategies for caregivers in addressing problematic substance use while ensuring the safety and well-being of children. Another course has been designed for MCFD workers.

Naloxone kit training and provision of naloxone kits have occurred since 2017, with training for foster care givers, children and youth in care, and staff.

[12:15 p.m.]

There are also collaborative provincial partnerships between ministries and community services — such as provincial perinatal mental health and substance use working groups, overdose emergency response centre provincial meetings — and working with partners such as FIR Square, which is a combined care unit that provides care to women using substances and to infants exposed to these substances.

As we go to the next slide, about supporting youth and young adults, the ministry is working towards improved supports to help eligible youth to succeed, especially those at highest risk of poor outcomes in adulthood. Information on this topic was provided to the Select Standing Committee on Children and Youth last April.

This includes housing and support agreements, continuing after the pandemic, along with a new rent supplement program and priority access to B.C. Housing, where appropriate; expanded eligibility to include those with 24 months of cumulative time in any legal care status between the ages of 12 and 19; increasing the program duration from 48 months to 84 months; hiring new transition workers, who will help connect youth and young adults to appropriate services; funding for training in life skills and cultural programming; enhanced medical benefits, including dental and counselling services; and a no-limit earnings exemption, along with an unconditional income supplement for 12 months up to their 20th birthday, and financial support up to the age of 27, based on participation in the program.

These changes will take place in a phased approach. Additionally, for youth ages 13 to 18 who are in care arrangements, we are providing mobile technology for them to maintain connection to significant people and supports in their lives.

D. Headley: If we can just maybe flip over to the next slide.

Good afternoon, everyone. I will be presenting to you today just a really quick overview of the ministry’s services for young people experiencing mental health challenges. Recognizing that I have just a few minutes, I’m going to jump right in and first introduce you to a network of specialized services that MCFD provides to both support and improve outcomes for children and youth in care.

Just to say that MCFD recognizes that young people in care have often experienced a multitude of risk factors and significant trauma. To support these children and youth, MCFD identified the need to develop a structured and integrated network of services and supports for children and youth in care who have complex care needs. The network serves children and youth between the ages of seven and 18 who are in care, who have experienced significant trauma and who also present with concurrent and persistent developmental and/or behavioural, emotional and mental health needs.

As you see on the slide, the network consists of four tiers of service. It begins with community-based interventions and then moves up in intensity to specialized care homes, intensive outreach services and a provincial complex care unit. All of the services are focused on the provision of specialized integrated treatment and service plans that are individualized and typically involve multiple service systems that really help to mitigate the impacts of abuse, neglect, trauma, violence and other adverse childhood experiences on their mental health and help increase their environmental and relational stability.

If we can just go to the next slide, please. In my last little bit, I just want to provide a very high-level introduction of MCFD’s mental health services for children and youth — to begin by saying that each year, child and youth mental health responds to, on average, about 16,000 referrals and provides voluntary, evidence-informed services to over 25,000 children and youth under the age of 19 that are experiencing moderate to severe mental health challenges.

MCFD’s child and youth mental health services offer a continuum of services, from prevention and community-based supports right through to specialized interventions and high-intensity mental health services. The need for child and youth mental health services is high. It continues to grow, and MCFD strives to be responsive and flexible to that demand. Although there are waits for service, children and youth that have urgent needs do not wait. Rather, they’re provided with services immediately.

[12:20 p.m.]

Just to note that this is complex work. We know it requires a whole-systems approach. It’s because of that complexity that MCFD recognizes the need to work in partnership with our partner ministries and agencies and within a system of services and supports from our partners to provide substance use treatment for youth and young adults — and the Ministry of Mental Health and Addictions, towards the implementation of the Pathway to Hope strategy.

Together we are working toward providing seamless success [audio interrupted].

N. Sharma (Chair): [Audio interrupted] about 40 minutes for questions.

Colleagues, any questions?

D. Davies: Thanks very much. Just a couple of questions.

Looking at the accidental death rate chart there that you had. That’s my first question. A significant drop, though, which is great. Zero, obviously, is what we want to see. But the significant drop from 2017 to now — what do you feel that that is as a result of? Is that roughly when the emergency was brought in, you know, that awareness campaign? Can you pinpoint some specifics where that possibly has been reduced?

J. Wale: Yes. I want to start by saying that those numbers are for fatalities. When they’re under 20, a variance of four or five could be for a variety of factors. Although 2017 is the high point for fatalities, we’re cautious about seeing this as a large drop.

I do want to point out that in 2021, the most recent year, there are still a number of outstanding investigations by the coroner, so those numbers will change. I’d say going back to 2020 or 2019 would be probably more prudent.

I just think there can be fluctuations. The difference between overdose and death can be very close sometimes. The high point so far was in 2017.

We do everything we can to lower the fatality of children and youth from illicit drug use. One thing we mentioned was the naloxone kits and training. That occurred in 2017. There was a focus for foster parents and workers on: how do we intervene to save children and youth in care when there is an overdose? So perhaps that’s had an impact.

D. Davies: Yeah, no. I appreciate that and, certainly, recognize the number looks….

Chair, are we doing a couple of questions now, or should I come back for my second one?

N. Sharma (Chair): Why don’t you go ahead?

D. Davies: Okay.

The second one. We’ve heard from a few different groups and organizations over the past while, around parents that are using substances and such, that there are studies that even with that, the child is better off with that parent as stability and such. I’m just wondering what research the ministry has around the whole….

The one point on your one slide, around young people experiencing significant trauma, people in a young person’s life are struggling…. It’s on that one slide. I can’t remember what slide it was. That versus a movement, I guess, of a number of organizations saying: if people are in and out of rehab and supports like that, they are better off, still, with their parent. I’m just wondering if you have research on that.

J. Wale: We certainly had research when we were developing our systems, such as our out-of-care systems, that clearly there’s a benefit for children growing up with people that they know. So we’re building our systems with that understanding and, wherever possible, keeping children with their parents.

[12:25 p.m.]

That’s where our act talks about the less disruptive measures. It is in the child’s best interests, when we look at the best interests factors for children, to maintain the relationships, connections to culture.

That’s our starting point, family preservation. That’s one of our frameworks in our ministry: family preservation. Only where that’s not possible and where the child must leave their home, then the next focus is placement with extended family. In terms of our research, we would agree that children are better off with parents when that’s in their best interest, looking at safety, connections. But where that’s not possible, then we try to place with extended family.

I think that the fact that our rate of children in care has decreased significantly — we’ve gone from 10,000 children in care to just under 5,000 over the last 20 years — is a testament to that focus on reducing the number of children in care. We recognize we still have a ways to go.

S. Furstenau: I want to dig a little bit more into MLA Davies’s questions here. The data from Representative for Children and Youth…. While the graph that you’ve provided us shows a decrease in deaths from accidental overdose, as it says, the number of deaths and critical injuries for children in care has actually significantly increased over the last several years. Just following on the comment that you just made, which is that there are far fewer children in care, yet in 2020, 1,788 reports of critical injuries, 95 deaths. That’s from the RCY data.

I appreciate the comments you’ve made that children are best in their homes and that support for families is really critical. But the data isn’t always supporting this, and the outcomes aren’t always achieving this.

I guess, one, just to speak to the growing number of critical injuries and deaths under MCFD in the last five years as well as the accountability. When we see that there are practice audits done on MCFD practices and that those audits indicate that the practice standards aren’t being followed…. A lot of those audits are quite damning in that it’s well below 50 percent, sometimes as low as 10 percent, that are following the practice standards in those audits that are put out publicly.

Where does the accountability lie in the Ministry of Children and Families, in the system, for when what is said — “We adhere to these values and these practices” — and what actually happens don’t match?

J. Wale: I can speak to that. We have our audits. We have case reviews. The outcomes of those quality assurance mechanisms are brought to the attention of the executive director of service, the directors of operation, the teams involved. So there is that feedback loop to the practice with what is happening in that region, in that service delivery area, with that team, and with recommendations. So that’s part of our accountability that we have. We’ve been looking at these numbers.

In terms of our approach to quality assurance in general, that’s being reviewed in terms of how we can gear this towards a focus on outcomes for children and improve those outcomes.

S. Furstenau: Just to follow up, the first question was about those outcomes. When we have the data from the representative’s office that the number of critical injuries and deaths for children in care have been rising, how do you square what you’re saying with the data and the outcomes that we’re seeing from this system in terms of harms, injuries and deaths to children?

[12:30 p.m.]

J. Wale: Well, I would agree that the critical injuries are rising. Critical injury reports are completed by workers. They apply to children in care and children who have been served by our system at any time in the previous year.

There has been a great focus on critical injury reporting. There has been increased training that’s been provided to our workers. There has been a policy that has come out a number of years ago focusing on critical injuries. So I think it’s a combination — the increase in critical injuries — between the critical injuries themselves and an improvement in the reporting of those critical injuries. We want to have a good sense of critical injuries, not just for children in care but for children served in our out-of-care system as well, as that is growing.

N. Sharma (Chair): Shirley, go ahead.

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

I appreciate the presentation. Incredibly important work and very difficult work in the Ministry of Children and Family Development, so we appreciate you taking the time.

I just want to build on Sonia’s questions. I want just to ask a very basic question, and then I’ll come back with a second one. Who ultimately makes the decision about removing a child from a home when parents are drug users?

J. Wale: That decision of removal is made by the outreach worker in consultation with their team leader, and any removal must go before a court within seven days of the removal for it to be reviewed by a judge.

S. Bond (Deputy Chair): Okay. The numbers of young people being referred or at least requiring support. I think it was mentioned that that number is growing, and the comment was that while there are wait times, MCFD does its very best to try to deal with the urgent and priority children. Of course, we would expect that to be the case.

Could someone please describe for us a bit more about the wait times and for what kind of supports? And I would like to know whether there is an equitable degree of support provided geographically, because we know that as we are dealing with the issue of opioid use and deaths, it’s a big province and it is not one-size-fits-all. We’ve certainly seen some disparity when it comes to rural communities — in particular, First Nations communities.

Could someone speak to the growing need for support for young people? What type of support, and is there a disparity from a geographic perspective?

C. Kamper: If I may begin, Deborah, just to echo what James had shared in the presentation — the transformation that the ministry is working towards to really significantly change the supports for youth and young adults as early as 14, the transition planning all the way up to 27, in a much more significant, youth-centered approach. I think there’s the work underway strategically that we need to pay attention to as we’re moving to implement some of those changes immediately and then some over time to change legislation.

But the reference to, particularly, wait-lists was with respect to children and youth with mental health needs, and that’s where I’ll invite Deborah to share a little bit more. We have a provincial landscape, and if there’s perhaps a need to bring back anything more specific, then we’re happy to do that to this committee. But I’ll pass that to Deborah.

D. Headley: Thank you, Carolyn.

Maybe I’ll just talk a little bit around the demand for services and the wait times and how we manage the wait-list. I think in some previous presentations you did hear that the demand for mental health services is growing, and it is challenging to meet the demand.

I think that what we’re seeing now, post-pandemic, is an increase in the complexity of the young people that are coming to us. They just seem to be more severe and have more complex mental health challenges. What that means is that they need more frequent, more intensive and longer-term services. So we are working with them in more intensive ways. That then also impacts how we can respond to others that are coming in our front door.

[12:35 p.m.]

I think that, combined with what many people are experiencing around unprecedented staffing and recruitment challenges, increases our challenges in terms of being able to be responsive and flexible to the demand.

As I said, there are waits for service, but many children and youth do receive services right away. They’re not placed on a wait-list, but they’re provided services immediately. That’s really the children and youth who are presenting to us with urgent mental health challenges, so things such as suicide concerns. We would see them quickly, do an assessment as quickly as we can, get them connected up to community supports and develop a safety plan.

What that means, because we’re trying to respond to those children and youth who need service urgently, is that the children and youth that have the more mild or moderate mental health challenges wait longer for service because we are needing to attend to children and youth that have those highly acute mental health conditions.

I will say that when children and youth are placed on a wait-list, they are offered brief sessions. They’re offered an initial set of services. That could be brief interventions, group interventions. It could be referrals to community supports that we believe will be of assistance. We also, as I mentioned, will put in place a safety plan and let children and youth families know that if anything changes, they can come back in touch with us. We know that there are maybe about 40 percent of the people who are waiting that will receive those services while they’re waiting. Sometimes that’s all that they actually need.

We continue to look for ways to just work more efficiently. We’re starting to offer provincial virtual groups across the province. We’re streamlining our intake to just try to be more efficient, standardizing forms. And, of course, our partnerships — just working together across the province in a more seamless and integrated way. We know that our close partnership with the Ministry of Mental Health and Addictions is going to provide opportunity to better respond to the demand and ensure that our young people receive service when they need it.

D. Routley: Thank you very much for the presentation. I think when I look at the accidental illicit drug fatality numbers, while they could change as you indicated, if they had gone in the opposite direction, it would certainly be something that would be of note. So I think it’s fair to note that they have gone down, particularly Indigenous youth. It’s very good to see that in the context of the drug toxicity crisis that we’re facing and the fact that the toxicity of drugs has been so much responsible for the increases.

Despite all of the efforts that have been made to mitigate that, it still reflects in increased numbers of deaths, but here we see something else. I’d just like to ask you to reflect on that again in terms of how you attribute that. What steps have been taken in the ministry in conjunction with the communities, and how has the increased toxicity of drugs informed your recommendations and your interactions with community?

J. Wale: I can start a little bit on that. I mentioned the naloxone training. That’s been our main focus. There have been other approaches.

The distribution of cell phones to those in care and out of care, from 13 to 18, is important from a communication point of view. There is something called the Lifeguard App which someone can use if they’re going to be using a substance. They can set a timer, and if they do not respond, it can alert an emergency response to help them and provide their location.

We have resources that focus on harm reduction with vulnerable youth, training for those caregivers. I think there’s just been a focus of the…. Because of the fatalities that have occurred, we are acutely aware of this, and throughout the service delivery areas, whether it be resources, foster parents or workers — putting measures in place.

[12:40 p.m.]

There is also a collaboration, a close collaboration with Health, a critical collaboration, and even with police and other community agencies. There are examples through­out the province. There’s one service delivery area where, every day at 3:30, they meet the police, the health authorities, community agencies and MCFD, and they identify those youths that they’re worried about that night. What can they put in place to keep them safe?

There’s that response, and there’s an awareness, from a harm reduction point of view, that we need to meet youth where they’re at. A harm reduction approach is not abstinence. There may be safe-use sites that that a youth would be brought to. What does it take to keep that youth alive? That’s really a focus that we have. We do our best, but there are still deaths. Every death is a tragedy, and no number, even if it’s a smaller number, is good enough. Our system remains vigilant on how we can protect these youths as much as possible.

N. Sharma (Chair): I have a question before we go to the next round. I just want to dig a little deeper into when there is a death. You talked about the numbers of youth that are in care that have died of the toxic drug supply. I think it’s that narrow — right? — if we can attribute it, from the coroner’s report, to it being a fatality from the toxic drug supply.

Are the circumstances of those deaths analyzed and then fed into a response? Do you know, was it youth alone, or what the circumstances generally were, to help with the policy responses that lead to a response to that?

J. Wale: Yes, both on a broader level but also individually, at the local service level, any death of a child that’s in care always has a case review. There are recommendations from that case review that are shared with the executive director of service and those in management. That is certainly one key approach we have: to learn from any fatality that occurs. That would apply here.

N. Sharma (Chair): Once we learn about that…. We’re diving into solutions to the toxic drug supply, and of course, reducing deaths is one of them. Are you in communication with those reports and with the Ministry of Mental Health and Addictions — or just our larger response to the opioid crisis — to understand the circumstances of death in this category and how it feeds into a response?

J. Wale: I think that’s a work in progress. I think we recognize how our ministries and agencies need to work together, whether it’s information we receive from the Coroners Service, information we provide to the RCY or how we work together between ministries. There’s a close working relationship between MCFD and Health and with the Ministry of Mental Health and Addictions, but there’s always room for improvement. We continue to be open, as our systems evolve, to how we can work in partnership.

R. Leonard: Thank you for the work that you do. This is probably one of the hardest ministries I can imagine working in, day in and day out, for years. The expertise that you’re bringing is really valuable.

One of the questions that I have…. We had presentations from parent groups who say that they won’t call 911 to respond to their own personal circumstances because they are afraid that they will lose their children. James, you were speaking about that reflection on safety, and there’s a sense of subjectivity in that piece.

[12:45 p.m.]

I’m just curious about how objective it can be. What assurance can people be given around being able to look after their own life and still be able to be supported into the future?

I just want to also comment. I appreciate that when there’s more focus and more attention being paid, it does see a rise in numbers because you are seeing it. That’s not a bad thing. Then you’re able to respond. Yeah. Just one question.

J. Wale: Thank you for your question. We recognize the best interests of children: for a child to be with their parent, if at all possible. That’s always our starting place.

As I mentioned in that one slide on the child protection context, even when a child is found in need of protection, almost nine times out of ten, that child stays with that parent. If the child must leave the parent, it’s with a relative, if at all possible. The goal is to return the child to the parent as soon as possible.

That’s the big picture. On an individual situation, depending on the factors involved, sometimes removal is necessary if there’s no other less disruptive measure to protect a child. Workers do a safety assessment. They review that with their supervisor, look at the less disruptive measures. It’s not one person making this decision; it’s reviewed. It’s also reviewed by the court.

In our ministry, certainly following the federal legislation, there’s a reassessment of placement. That’s always considering: can the child go back to the parent? The focus is always about that belonging that the child needs to have, ideally with the parent and, if not, with a relative.

That’s our starting place. Yes, unfortunately, there are times when there are removals, but we will work with parents and their extended family and community. Our ministry is trying its best to get that balance right between child safety and recognizing that children need to be connected to their parents — that’s a key aspect of their well-being — and their extended family and community.

S. Furstenau: I want to build on what Ronna-Rae just asked, and this conversation. We’ve certainly heard, in our committee, from a lot of parents and a lot of advocates, about that fundamental mistrust of MCFD and that there is a risk of reaching out. I think that there’s a need for recognition of the historical role that child welfare has played in creating the trauma that is leading to the outcomes that we’re seeing for so many people. This is multigenerational. With every generation, it seems that the replication of a lot of these practices continues.

I guess my question is around the need for recognition and acknowledgment of the perception and the culture of MCFD, as it’s experienced by parents and families — particularly, as we’ve heard, from people who use drugs, but also from people whose families have been historically in the child welfare system. I’ve seen this in my own riding. I’ve worked on files where the only reason somebody was approached by MCFD is literally because their mother was in the child welfare system. There’s a B.C. Supreme Court case around this one.

I think it’s really critical and really essential that there be recognition, from the ministry, of what we have been hearing, of what we know is happening in our communities, of the lack of trust. The fact is that there are these enormous resources in MCFD.

A lot of parents and a lot of families are unwilling to even extend or to reach out for that support because of that fear that exists. “This puts my child at risk. This puts my family at risk. If I ask for help, if I demonstrate that I’m vulnerable as a parent or that I am a substance user, I am very….” Absolutely, the perception we’ve heard is: “That puts my family at risk.”

[12:50 p.m.]

I think it’s really critical, given what we’ve heard, to hear your take on that cultural problem that we have — that a multi-billion-dollar ministry is perceived by a lot of people and a lot of families, particularly Indigenous communities and families in this, to be a risk to them and their family well-being.

It’s back to the practice standards, right? How do we move a system to accountability and to a change? It seems to me, in the first place, it’s acknowledging that there remain enormous problems in this system and the way that it’s operating. We are hearing that from parents and advocates, and I think it’s important for us to hear that today as well.

J. Wale: Others may wish to respond too. I’ll say….

I do hear that and understand that and would agree that the possibility of removal can cause fear for a parent. This is why our ministry is focusing on, wherever possible, family preservation and support. I recognize what you’re saying.

As I said earlier, we had 10,000 children in care 20 years ago. We’ve come a long way. We’ve reduced that number in half, but there is a long way to go. Our ministry is very committed to transformation and recognizing what needs to be improved [audio interrupted].

N. Sharma (Chair): Sorry, James. Your sound is cutting out, at least for me. I don’t know if something has changed with your microphone.

J. Wale: Sorry about that.

I would acknowledge…. MCFD is focused on changing and transforming its approaches. We recognize the impacts of trauma, and that includes interactions with the system in ways that don’t support well-being. We’re very committed to family preservation and support. That’s a process, and we continue on that process.

The main thing to note is the collaborative approach that needs to occur between our ministry, MCFD, and Health and Education. All of these ministries and community service organizations need to work together on wraparound support for families, thinking of innovative ways to support families.

There’s an example in Duncan. There is a resource where both the mother who’s at risk for removal of her baby and her baby stay together in the same resource. So they stay together.

I think there’s a need for innovation and looking at things differently in order to have a future, for some families who have a multigenerational involvement with our ministry, that’s different.

C. Kamper: If I may add to your response, James, just to echo what you’re going towards.

We need to, as a ministry, as we’ve outlined in our service plan, really look at the system as a whole. We’re working towards a number of transformations, because families need a number of supports and services. We’re talking about mental health, obviously, today, mostly, and the overdose crisis, but we’re also focusing on youth transitions, and children and youth with mental health.

The ministry did share…. I’ll just harken back to the Select Standing Committee on Children and Youth presentation back in April of this year, where we talked about some of our other transformations — working with communities, working towards transferring jurisdiction, working in communities in a different way, making sure that we are fulfilling our obligation to UNDRIP and the Declaration Act, allowing social workers, through clarifying legislation, to be able to do the job in the way that they want to and need to and reduce any confusion with any legislation that may be confusing to them.

There’s a number of steps, from reconciliation to significant transformations to recognizing our colonial past and that there’s multigenerational trauma. There’s a colonial system.

[12:55 p.m.]

We’re working to change that. We’re working to work differently. We’re working to work in partnership, across government, with staff but also with community and with our partner agencies and valued partners.

It very much is a different landscape now. There is, as James and others have noted, the lowest number of kids in care that we’ve had. That still is just a signal that we’re doing some work to support families in a different way. We have a long way to go, because we still have children and youth in care. If that’s in their best interest, then that’s their best interest. But if it’s not, then it’s too many.

I just wanted to echo the work that we need to do across the ministry, across government, that we’re striving to work towards.

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

I don’t see any other questions. So on behalf of the committee, I just want to thank the MCFD team for their presentation and for answering all of our questions today on the work that they’re doing.

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

The committee recessed from 12:56 p.m. to 1:10 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): I’d like to welcome our next presenters. We have two presenters — Lee Allison Clark, the director of health, Native Women’s Association of Canada, and we have Char Leon, counsellor, Pacific Association of First Nations Women.

I want to welcome you, on behalf of the committee here.

We’ll do a quick round of intros, and then I think you each have 15 minutes to present. Then whatever time we have left over, until two o’clock, will be for questions. My name is Niki Sharma. I’m the Chair of the committee.

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

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

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

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

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

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

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

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

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

N. Sharma (Chair): Excellent.

I’ll pass it over to…. I’m not sure which of you wants to go first, but we’re really looking forward to learning from you and hearing about the work that you’re doing.

Lee, are you going first?

L. Clark: I can.

N. Sharma (Chair): Okay. Great.

Briefings on
Drug Toxicity and Overdoses
Panel 1 — Indigenous
Women’s Organizations

NATIVE WOMEN’S
ASSOCIATION OF CANADA

L. Clark: Thank you so much, Chair. Good afternoon — and you, hon. Members. Thank you for the invitation to come here today to speak about the urgent and ongoing opioid epidemic and the illicit drug toxicity crisis, on behalf of the Native Women’s Association of Canada.

I want to acknowledge that the land that I sit upon today is that of the traditional, unceded and unsurrendered territory of the Algonquin Anishinaabe people.

I want to recognize the Sḵwx̱wú7mesh, Musqueam and Tsleil-Waututh people, whose lands the legislative buildings in Victoria sit upon.

I’d also like to take a moment to acknowledge the murders that occurred at James Smith Cree Nation in Weldon, Saskatchewan, over the weekend. NWAC sends our condolences to the victims’ families, friends and communities. Please know that our hearts are with you at this very difficult time.

As you all likely know, NWAC is a national Indigenous organization representing Indigenous women, girls, two-spirit, transgender and gender-diverse people in Canada. As we all know, the opioid epidemic and illicit drug toxicity crisis disproportionately impacts Indigenous people most. Moreover, when compared to their non-Indigenous counterparts, Indigenous women, girls, two-spirit, transgender and gender-diverse people are disproportionately affected by illicit drug use and are more likely to suffer the harms associated with them.

Although British Columbia is one of the most progressive provinces, leading the fight against the opioid epidemic and the illicit drug toxicity crisis, more must be done to ensure that Indigenous women, girls, two-spirit, transgender and gender-diverse people are not falling into illicit drug use; have options for safe use if they do; are provided with culturally sensitive, trauma-informed and gender-based treatment services when they are ready to take that step; and have lifelong support after stepping away from drugs.

Today I’ll provide a holistic and wholistic approach to ending this epidemic and crisis that piggybacks on previous testimony at this committee as well as combining Indigenous ways of knowing and doing with academic and on-the-ground research. NWAC’s hope for today is that B.C. takes these necessary steps to address the opioid epidemic and illicit drug toxicity crisis and, in doing so, paves the way for solutions to address inequities and injustices that affect Indigenous women, girls, two-spirit, transgender and gender-diverse people across this country.

Ultimately, however, addressing this crisis and epidemic means addressing colonialism. I will highlight how the effects of colonialism can lead Indigenous women, girls, two-spirit, transgender and gender-diverse people to use drugs, how systems currently in place fall short once a person is using drugs, and how conventional recovery systems do not meet the unique needs of Indigenous people overall but especially for Indigenous women, girls, two-spirit, transgender and gender-diverse people.

Nevertheless, I want to highlight that if B.C. is sincerely ready to walk the path of truth and reconciliation, addressing the systemic roots of drug use is the most critical step that needs to be taken if we want to see meaningful change.

[1:15 p.m.]

The other options, while critical for care once using, simply do not get to the root of the problem in our never-ending story of use. Harm reduction is one of the life-saving tenets for people who use drugs but is a complex and value-laden phrase whose principles are rooted in western ideologies — mainstream harm reduction such as needle exchanges, supervised injections, naloxone distribution and OAT.

While these approaches are life-saving, they do not go far enough or make the same kind of impact for Indigenous communities, especially for Indigenous women, girls, two-spirit, transgender and gender-diverse people. Mainstream harm reduction models focus too narrowly on substance using behaviours while ignoring the broader systemic context in which drug use occurs. As a whole, Indigenous women, girls, two-spirit, transgender and gender-diverse people consistently face additional barriers to health and harm reduction services and care for drug dependence, leading to drug use practices that increase the risk of HIV/AIDS, hep C, other related drug harms, overdose and death.

The UN has found that women who inject drugs have substantially different needs and experience significantly higher mortality rates, increased likelihood of injection-related problems, faster progression from first drug use to dependence, higher levels of risky injection and sexual risk behaviors, and higher rates of HIV infections. These experiences are further compounded for Indigenous folks. For Indigenous women, girls, two-spirit, transgender and gender-diverse people who use drugs, mainstream harm reduction services remain inaccessible or unacceptable.

Criminalization, stigma, lack of child care, the threat of child protective services, and violence remain constant barriers for Indigenous women, girls, two-spirit, transgender and gender-diverse people who use drugs who try to access not only harm reduction services but health care services as a whole. For these folks, multiple intersecting forms of racism, discrimination and sexism render mainstream harm reduction services, for all intents and purposes, practically unusable.

However, Indigenous women, girls, two-spirit, transgender and gender-diverse people are resilient and innovative and, as a consequence of mainstream harm reduction services being unreachable, have adapted patterns of use for their own survival and wellness and for that of their peers. Studies have found that this includes personal behaviors to modify their use via self-regulation and self-care strategies as well as relying on peers to promote survival and wellness. These behaviors were directly learned from observing their peers, rather than from harm reduction or outreach services.

The resilience practice in the daily lives of Indigenous women, girls, two-spirit, transgender and gender-diverse people who use drugs has led them to become active agents of harm reduction for themselves and their communities. We must indigenize harm reduction if we are ever to have any meaningful impact. As Rawiri Evans, a Maori educator, stated: “Indigenous harm reduction means reducing the harms of colonialism.”

Indigenous harm reduction is a way of life rooted in Indigenous ways of knowing and doing from a two-eyed perspective that focuses on mitigating the living legacy of colonization. We must shape harm reduction services for Indigenous women, girls, two-spirit, transgender and gender-diverse people around cultural wisdom and practices rooted in local Indigenous knowledges, traditions, languages, teachings and practices.

The government must build something new in partnership with Indigenous organizations and communities. This means trusting the agency and self-determination of Indigenous organizations and communities, practising principles of non-judgment and non-interference, and accepting and affirming the identities of all First Nations, Métis and Inuit people, with no- or very low-barrier services. We must meet people’s needs for where they are in the moment.

For Indigenous women, girls, two-spirit, transgender and gender-diverse people, there are additional requirements for meaningful harm reduction services: providing harm reduction spaces and tools for differing drug administration routes other than injection, such as those for inhalation; providing concurrent drug use services — Indigenous women who are heavy substance users rarely only use one substance, which often involves non-opiates; having a greater access to safe supply; offering supervised consumption sites that allow for peer- or health care provider–administered injections — women often rely on partners to inject. This all while being administered in a low-barrier, non-medicalized, Indigenous women–​centred, and two-spirit, transgender and gender-diverse environment.

It is imperative that sexual health and wellness resources are provided as well as drug-focused harm reduction services — these are people who face extreme barriers to these types of health care resources — providing low- to no-barrier, free access to contraception; testing and treatment for sexually transmitted, blood-borne and other infections; and gynecological checkups. These spaces must be Indigenous led, especially when considering the largest barrier to seeking pre- and post-natal care as well as harm reduction care while being a mother or parent is the very real threat of child protective services.

Finally, providing shelter and other services that mediate the impacts of violence, houselessness and other harms for Indigenous women, girls, two-spirit, transgender and gender-diverse people is key. They must not be based on the tenets of sobriety or being clean but rather meeting people where they are at and truly reducing the harms associated with being an Indigenous woman, girl, two-spirit, transgender or gender-diverse person who uses drugs. Any harm reduction program must always provide mental health services — full stop.

[1:20 p.m.]

None of these ideas are radical. They are all available in academic research and have been tested on the ground. What is radical, though, is putting the needs of Indigenous women, girls, two-spirit, transgender and gender-diverse people on the front rather than the back burner.

The fact of the matter, however, is these are only band-aid solutions that do not get to the root of the problem. Canada was founded and built on systems rooted in racism that we continue to enforce, whether passionately or apathetically, that repress Indigenous people. In order to find a lasting solution to the opioid epidemic and illicit drug toxicity crisis, we must work towards the tenets of preventing, in conjunction with meeting people where they’re at in the journey, while also providing treatment services.

It is important to acknowledge that Canada was founded upon the tenets of settler colonialism — that is, the settlers intend to permanently occupy the territory, the invasion is structural rather than a single event, and the goal is to eliminate Indigenous peoples, thereby establishing settler rights to colonial lands.

Settler colonialism is a process that continues to have lasting effects on those who are colonized. This has roots in terra nullius or a New World in a doctrine of discovery, which were established as legal concepts in Europe in the 1600s and applied to settlers as they came to North America in the 1700s and when they began to claim land.

From this, we know what happens. Three concepts, however, are key to understanding why settler colonialism is the main barrier preventing Indigenous people, particularly Indigenous women, girls, two-spirit, transgender and gender-diverse people, from reaching their highest quality of life. These concepts are eugenics, genocide and intergenerational trauma and are inextricably linked not only to the current opioid epidemic and illicit drug toxicity crisis but to many other inequities and injustices faced by Indigenous people today.

Now, one might ask: what does this look like in the Canadian context?

It looks like killing members of a group outright or through systemic deprivation through residential schools or the ongoing MMIWG2S+ genocide.

It looks like causing serious bodily or mental harm through physical, sexual, emotional and spiritual abuse and violence against Indigenous people.

It looks like poor living conditions, which many folks living on reserves contend with every day, or as preventing births through forced sterilization, taking away status through marriage laws and loss of status through the Indian Act.

It looks like transferring of children away from their parents through the welfare system, the Sixties Scoop and the residential school system.

It looks like assimilation, whereby Indigenous people were told their identity is bad and made to feel ashamed of who they are.

From all of this rises a collective and individual scar: intergenerational trauma. This is the key link to the current opioid epidemic and illicit drug toxicity crisis. Intergenerational trauma increases the risk of poverty, crime, gender-based violence, addiction, generational breakdown, family violence, parental neglect and toxic family environments, to name a few.

This is all for Indigenous women and girls, two-spirit, transgender and gender-diverse people, but Indigenous communities overall. Intergenerational trauma affects the entire self, requiring holistic healing that encompasses spiritual, mental, emotional and physical healing. It is why we absolutely cannot speak about this crisis and what needs to be done to solve it without looking at changing the entire system in which it is situated.

Within Canada, Indigenous women, girls, two-spirit, transgender and gender-diverse people have spoken outright about the effects of colonial policies and programs that still exist today, as well as the devastating effects of 250 years of past injustices, as a direct cause of drug use. For many Indigenous people, using drugs is one of the only ways of managing their pain, suffering, shame and hopelessness as a result of an entire system that has failed and continues to fail them. Whether that’s due to experiencing poverty or houselessness, violence and racism, this collective and individual psychological, emotional and spiritual trauma leads to using drugs.

What does this look like on the ground? It looks like Indigenous women dying at twice the rate of their non-Indigenous counterparts in B.C. As many before me have pointed out, the drugs alone are not the crisis, and as long as we continue to focus on the drugs, we will see one fall and another rise up in its place. The real crises are the historic and current factors that place some populations at a higher risk for harmful drug use than others. When intergenerational trauma, current trauma and systems continue to fail those most at risk again and again, the distress becomes intolerable, and drugs become the only option.

We must truly invest in Indigenous people’s wellness, and that is not with pointed funding in silos given to projects that are so disconnected that no long-term change would ever be possible. It’s about sweeping, broad, upstream funding given to the folks who represent Indigenous people and Indigenous people on the ground and in communities and keeping the government at an arm’s length and using audits to ensure accountability.

At a population level, Indigenous women and girls, two-spirit, transgender and gender-diverse people continue to have considerably less access to determinants of good health such as income, education, food security and adequate housing than their non-Indigenous counterparts and are more likely to interact and report negative interactions with child protective services. These are inextricably linked to the overrepresentation of Indigenous people who use drugs, those with experience of sex work and those with experience of incarceration, the trifecta of the experience for many people who use drugs, people who are Indigenous women and girls, two-spirit, transgender and gender-diverse people.

The war on drugs has disproportionately targeted Indigenous people and other people of colour and has resulted in considerable harm, including an increase in drug use and overdoses overall. As many scholars have pointed out, the war on drugs intersects with and reinforces the repression and racialized violence that shape the everyday experiences of Indigenous people who use drugs.

[1:25 p.m.]

Justice Canada’s own studies have shown that drug treatment courts have the inability to engage with and retain Indigenous people, women, sex workers and youth. It has been highlighted that compared to men, women participants experience greater degrees of poverty and mental illness and are more likely to have children and family responsibilities which impede their ability to complete the program.

We can no longer talk about issues in silos if we are going to really end this epidemic and toxicity crisis. We must take a holistic approach and focus on changing the system that continually fails Indigenous women, girls, two-spirit, transgender and gender-diverse people. To be effective at reducing the harms of settler colonialism, we must enact innovative approaches of harm reduction in treatment while, in parallel, dismantling and building a new system that is rooted in Indigenous approaches that have stood the test of time.

This looks like connecting Indigenous people with others, including Elders and grandmothers, storytelling, ceremony, land- and art-based activities, language revitalization and the return of matriarchal societies. We must stop acting as if this epidemic and crisis was not bred out of a long, drawn-out assimilation tactic that began years ago and start acknowledging the truth and investing in the real elements of reconciliation that will lead to the reclaiming of Indigenous identity.

While years of settler colonialism have told them to stop, back down and obey, Indigenous women, girls, two-spirit, transgender and gender-diverse people, their communities and their cultures have pushed back against the persecution and structural violence that was intended to eliminate them, and remain strong and ready to rise up to reclaim their power in place.

NWAC wants to be part of the solution for how to best address these inequities, not only to end this epidemic and crisis but to change systemic-wide issues in the process, leading to healthier, happier and more prosperous Indigenous women, girls, two-spirit, transgender and gender-diverse people not only in the province of British Columbia but throughout Turtle Island and in Inuit Nunangat.

Thank you very much. Miigwech. Hay’sxw’qa.

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

Over to you, Char.

PACIFIC ASSOCIATION OF
FIRST NATIONS WOMEN

C. Leon: Hi. Thank you for that presentation. That was really well done and researched. Thank you so much.

In the way that we do, as an Indigenous person, I’m Anishinaabe, originally from Manitoba. I’ve lived on the Coast Salish territories pretty well all my life. In my immediate family, there are Stó:lō and St’át’imc, in the local Stó:lō and St’át’imc territories here, in the lovely British Columbia.

The territory that I sit on is the Katzie area, not too far from the Semiahmoo people, in the White Rock area. I’m kind of in between there, right in that area of the west Coast Salish territories.

I’d just like to smudge you all down and say blessings for today and blessings for those ones that didn’t make it and those ones that are missing and have gone murdered or are homeless or that are sitting out on the streets today, that don’t have a home for whatever reason. I know there’s been a lot of publicity. I watch Global pretty well every day, and there’s always somebody dying. There are six, seven people a day, apparently, in British Columbia, and those ones that are not accounted for, so there could be even more than that. So blessings for them and their loved ones that they carry in a good way to the spirit world in which they go.

I’ll smudge us all down. And those ones, I’ll just pray for them all. Watch all my relations.

Yeah, I was just really engrossed in all of the information that was passed on here today. I, too, have been impacted through colonization as well, and I’ll just tell a little bit of my story.

I talked to Emma just before I came on and let her know that I didn’t prepare a big, huge speech or anything. She said: “No, just come on in and share what you know.” So here I am. Thank you so much for having me.

So just a little bit about my experience with the opioid crisis and just sharing with past, present and future, and so forth. A few suggestions and services that I looked at and really come right to the forefront that speak to me in helping with the community….

[1:30 p.m.]

I work with the Pacific Association of First Nations Women in Vancouver, and I work mostly with, at the forefront, people that have been impacted through COVID and the restrictions, dealing with loneliness and violence and whatever else has been going on in their life. A big part of that is the substance use as well, mental health, and so forth. I also work with people, as well, dealing with substance use, residential school and COVID and missing and murdered women and girls, in particular, and two-spirited as well — those folks.

A lot of the time, it’s the substance use issues and concerns that do come up within their lives and how they’ve been impacted thoroughly, either through childhood or even in their homes today, and so forth —— how they’re dealing with that. So there’s a lot of different stigma, different things like that that come out of that, even accessing those resources.

For instance, it could be like…. You phone up sometimes to the detox treatment centre, and you’re not able to access the services right away because you get put on the line. You get put on a wait-list, get put on the line, you get told to hold, and so on. That becomes a barrier, for instance, for example. These people who are trying to access these resources, the detox, have to wait, or they’re being told: “Oh, you’ve got to phone every day, every day, every day.” Right now, these resources are not readily available.

What happens with the drug user or the substance user or what have you is they’re very frustrated. They get very frustrated that they can’t access these resources. Then what happens? Like anything else, we give up. So that’s what happens. We want to make sure that we have these resources readily available for our clients and for our participants, especially the ones that are wanting to, right away, deal with this issue on the spot. That’s what needs to happen. I feel wholeheartedly that the situation right now that we’re dealing with is accessing those resources.

When I think about that, I think about the supply, and so forth, the safe supply places. I mean, there are some out there, but there’s not enough, of course, especially in the downtown area. Even in Prince George — the reserves, and so forth — there are really a lot of people that are being impacted by this substance use, and a lot of young people are dying from this, and so forth. So there need to be more services readily available for them again.

The lady before mentioned the harm reduction. Yes, culturally, Indigenizing that, and so forth. I myself am an Indigenous person, and in anything and everything that I do, I try to Indigenize everything that I do, because I feel that culture is a big component of that, along with…. You know, they can work with…. You’re all western in a cultural way as well, and we live in two worlds. Culture, tradition, language — all of those things are really important. And holistic, mind, body and spirit and heart, and making sure that we have a balance in each one of those — that we’re accessing all of those resources and all of those tools and pulling from each one of those our toolkit, so to speak.

As well as opiate agonist treatment, we have methadone, Suboxone. We have those accesses as well. For some folks, substance users, depending on what their need is, they may…. Suboxone or methadone may work better for some folks, or they may not, depending on what their needs are and where they’re at with that. I feel that…. In the beginning, I thought that harm reduction wasn’t such a great idea, but now I see that it does work, and it helps as far as the drug use and the substance use for active substance users in the community.

[1:35 p.m.]

Working hand in hand with that, they may go on methadone for a bit, a year or whatever that might look like, depending on what the doctor is diagnosing at that time, or they may go on Suboxone or what have you. So, yeah, I’m really a long-time supporter of that as well.

Also, just reading on my notes here, I see more services — somebody mentioned it earlier — with less barriers, for instance, towards these resources that are in a community. Being able to access food and shelter as well as substance use services and resources, counsellors, alcohol and drug counsellors — more of those as well. Detox and treatment centres — more of those. Just not having, again, those long wait-lists and having those frustrations come up. And then, of course, they lead to….

I want to say, too, when we talk about that, that sometimes there’s just not enough beds to be able to access. That seems to come up as another barrier. When you phone a resource and you actually get in to talk with somebody on the phone or on Zoom or what have you, or Teams or whatever it might be, they may not have enough beds. You finally get to talk with somebody, and then they say: “Oh, you know, we don’t have beds. We have to put you on a wait-list again.” I think this would be all beneficial to helping the substance use person in their endeavours to become sober or clean or what have you.

Also, with increased checks at the border, safety checks — having those increased as well. Of course, a lot of these supplies, a lot of these substances come from wherever — China. Fentanyl and so forth — that seems to be a big prominent drug out there. Even now, more so with the kids, they are targeting our young folks, and they have these blue and the pink and all of these kinds of different colours, and so forth. Yeah, more safety checks and so forth at the borders to help refrain from these substances coming into our countries.

I think I about covered all that I would like to say at this time.

N. Sharma (Chair): Great. Thank you so much for that, and thank you for starting in such a good way as you did. Really appreciated. We have now a little over 20 minutes for questions and answers.

Committee members, any questions for our guests?

P. Alexis: Thank you both. I have a question for Lee.

When we talk about making the services that we provide more conducive for our First Nations communities to survive and thrive in, have you been in touch with health authorities, providing some direction on how it works and how things could be changed? Has there been some communication up until this point?

I know you’re sharing with us — but some concrete examples of where you would like to see things change. Are you meeting with the health authorities, or are you dealing with the First Nations Health Authority, who has been providing information to the health authorities? If you could, please.

L. Clark: Absolutely. Thank you for the question. First of all, I would like to acknowledge it’s not just First Nations people. It’s Inuit and Métis. Especially Métis people often get very left behind if they’re not included in NIHB.

In regards to communications with health authorities, NWAC does not do that ourselves. We do not. We let our PTMAs, our provincial-territorial member associations, take that lead. We don’t want to overstep any boundaries, of course. However, when we do host sharing circles and we hear from people across the country, it is everyone across the country. They have lived experience, and they are Indigenous. Time after time, it’s a distrust that has been bred for a long time that often leads to not being able to access services even if they are available.

I think repairing our relationship is the most concrete thing going forward. You can’t do things in some worlds. You can’t only provide one thing here and one thing there through a two-year project. It’s having that long-term sustainability that’s really, really missing and that people often point to.

[1:40 p.m.]

In regards to speaking with the health authorities, at NWAC, we don’t do that.

M. Starchuk: Thank you for your presentations. I’m getting almost better at writing things down and realizing what it actually reads after I write it down. So I have two questions. I’ll ask the first one, and it’s for Char.

You made a comment about resources being readily available, and there’s a place and time where you can make those options. Can you tell me: are those options there, or do they need to be there? Or are they there and they’re just overworked or underutilized?

C. Leon: I think that they’re probably there, although not enough. They may be underutilized, but I don’t have that research or those facts in front of me at this point.

N. Sharma (Chair): All right.

Mike, did you have another question?

M. Starchuk: Yes, I did. It was for Lee.

At the beginning of your conversation, you talked about where B.C. was somewhat progressive, and they were out in front, and you’re representing a Canadian organization that’s there. I’m curious as to what you’re seeing, from a nationwide point of view, as to what’s working here in British Columbia that may not be working in another province. I won’t pick on another province. What’s working, and where do you see the actual improvements to what your national lens is?

L. Clark: Absolutely. Thank you for your question. The First Nations Health Authority is a really great example of transferring the power and the money and everything over to an indigenized organization or group, and that increases trust. That was revolutionary, of course, when it happened. It still kind of is in a way, because we don’t really see that in other places. Obviously, we know that FNIHB falls short in a variety of places.

But often when you hear about novel and new things that are being tried, especially related to harm reduction, they’re in Vancouver. They’re in Gastown, and that’s where the people are. You’re meeting them where they’re at, and you’re not trying to push an idea of abstinence as the end goal or the idea of being clean, which is an extremely problematic phrase, overall.

For people who use drugs…. I think that people want to go to a place that’s seen as more progressive, where they will be more accepted and are less judged — or at least perceived to be less judged — and have less racist, discriminatory or sexist interactions.

I think that B.C. is definitely a shining light, especially in the harm reduction space and in the space where you’re really sort of walking the path of reconciliation with Indigenous folks. I think that when that comes together for this topic, it’s a place ripe for new ideas to be funded and to be allowed to happen. Even if it’s a brand-new idea and, say, the research isn’t there for something, I would say the research is there. It’s maybe not on Google Scholar, but I bet you if you go on the ground, you will find stories and storytelling and other forms of data that are more qualitative in nature that will point to the fact that they work.

I think that as we look at what does and what doesn’t work, keeping in mind that data takes all different forms, and especially for Indigenous data, that might not look like a quantitative paper posted on PubMed. That might be going to talk to the local Elder who heard of something that worked or could be doing ceremony. Of course, we have to combine Indigenous ways of knowing and Western ways of doing with two-eyed seeing, but I think that B.C. is the place for innovation when it comes to this.

N. Sharma (Chair): Great. If I could throw in a question there that’s along the same lines, I really appreciate both of your perspectives and expertise that you bring to this discussion. I love the phrase of Indigenizing harm reduction and how that helps frame it in a way that shows the impacts of colonization and how they really need to be undone to understand what harm looks like with the impacts of colonization.

[1:45 p.m.]

I just was really wondering if either of you have examples of this in practice, either through an organization or through work that’s being done, that we should know about as a committee that’s very specific and that we could dig into. That was my question.

C. Leon: Well, from my own experience working with our clientele and so forth, and being and working in the community…. I don’t know how many years I’ve worked — 35, maybe 40 years. I think I’m due for retirement at some point. I think also cloning myself would help within our communities — just not having enough, again, resources, and so forth.

Yeah, I find that with Round Lake Treatment Centre and the one on the Island…. I’m just trying to think of the one on the Island. Does anybody know?

N. Sharma (Chair): Kw’umut Lelum — is that the one?

C. Leon: Kw’umut Lelum, yeah. Just having those experiences, folks that went there — you know, a number of folks. There’s another one up north, North Wind or what have you.

They have a lot of cultural components built into their treatment centres and their facilities, and so forth, so they’re at home dealing with our people who have substance use. Indigenizing their centres and detox as well — just a lot of people getting back to their roots and who they are as an Indigenous person, wanting to find their identity. I think a big part of that is finding their identity. They’ve been lost for a long time and just trying to get rooted back to that. So when they have the access to these resources, they’re able to find out about their culture, their heritage, their background, their history, and so forth.

Our other presenter had given us a little bit of a background of the history and so forth and what happened. So then again, they are able to realize and understand what happened. Why am I doing this? And be able to…. It provides a framework for treatment and helping them on their healing path. So it’s very beneficial to their healing.

L. Clark: I would add to that. The world’s first women-only — I would say “womxn” with an X, not an E — over­dose prevention site, called SisterSpace, does some really great work. If I could combine that with the Ontario Aboriginal HIV/AIDS strategy, where they specifically do Indigenous outreach, that would be kind of the perfect storm, per se, for lack of a better word, for Indigenous women, girls, two-spirit, transgender and gender-diverse people.

Currently, nothing exists for them. They must access services that cater to one group or the other, which obviously is not good for your identity and doesn’t fulfil you holistically at all. So unfortunately, I have no concrete examples for the people whom I represent, but there are spaces that you could combine where this could work.

C. Leon: I just want to say, too, when I think about it…. I know I worked as a social worker in the hospital indigenization as well, with the health area, a few years back. At that point, too, we were implementing indigenization and indigenizing all health and services, and so forth.

They, too, had different services and treatment for the women that went there — the Heartwood at Women’s Hospital on Oak Street. There’s another one that recently opened up as well — I believe that was in Port Coquitlam or Coquitlam — the Red Fish warrior women’s treatment centre. Also in Abbotsford, Raven’s Moon there, they have a men’s…. There needs to be more men’s housing and treatment centres.

We mustn’t forget that because we’re indigenized people, we need to think holistically. That includes the infancy. When we work around the wheel, the infancy and then going into adulthood — going into the youth and then the adulthood and into the elderly as well. So the order — holistically working in balance. We don’t want to leave anybody out, so that means everybody.

[1:50 p.m.]

Just recently, I must say…. Everybody probably knows this. Sts’ailes is opening up their new treatment centre as well — soon, as we speak. That’s going to be in the Fraser Valley, and it’s opening up, along with Cheam Indian band. So more First Nations leadership and taking roles and responsibilities, and so forth, working with the province, not only with Indigenous peoples but also with everybody so that it’s inclusive or welcoming — taking a lead in those initiatives.

That’s great news. I’m really excited and really happy about that, because I want to be a part of that whole initiative as well.

R. Leonard: Actually, what Char was talking about was referencing a question I had around…. I really appreciate her comment that we live in two worlds. Having that trust-building with organizations that are Indigenous-led….

I guess the question I had was around the provision of services in rural and remote communities versus more centres where you can have that tipping point of people to access the services. I guess it’s that first-step question that I have, particularly around rural and remote communities, if I were to ask a question.

L. Clark: If I were to answer a question, I would say that especially in rural and remote locations, the reliance upon Elders, grandmothers, knowledge-keepers and medicine men is a really great resource. We go up there, and we train them — “we” being you, the government; I’m used to speaking on behalf of NWAC.

That’s a really great resource that I think is often untapped and often overlooked. Those are people who hold a really important place in society and that are an easy way, I suppose, to access those locations without having to displace people from their communities. Obviously, that is not healthy at all and would probably increase the harms.

I would say that Elders, grandmothers, medicine men and traditional knowledge-keepers are a good way to do that. Obviously, they can’t provide support and care, but I think that if we are to truly Indigenize anything around harm reduction, treatment or anything talking about opioids, we can’t forget the community and the people who are looked up to within those communities.

S. Bond (Deputy Chair): Well, thank you very much to both of you for your presentations — much appreciated. My questions, actually, are sort of linked to the conversations that you’ve just had.

Lee, in your presentation — I actually wrote it down, because we think about what needs to come next — you said that from your perspective, in the work that you do, conventional recovery doesn’t work and that in harm reduction, the focus is too narrow. As we think about Indigenous British Columbians in particular — of course, your work, then, is to think about Canada — is it about more Indigenous-led resources, supports, processes?

I live on the traditional territory of the Lheidli T’enneh. I know that they are very interested, for example, in creating a partnership to have an Indigenous-led treatment centre here in this part of British Columbia. Can you just help us as we think about: if conventional recovery doesn’t work, what are the key things that we need to be thinking about as we move to a more successful model, particularly for Indigenous Canadians?

L. Clark: Absolutely. Thank you so much. Obviously, the first step is having Indigenous-led services, but the entire 12-step program, for example, which is the most common program, is an extremely westernized idea. It is often held in churches, which are an extremely unsafe place — spiritually, mentally, emotionally and sometimes physically — for Indigenous people. Those resources, at the beginning, are not going to work.

When we think about harm and what “harm” means, it’s not just physical harm. We need to prevent the other harm that is happening, whether that’s providing sexual health and wellness resources within….

[1:55 p.m.]

Some of that might not be Indigenous-led but have an Indigenous coordinator, who can also offer those services. It looks at providing housing, but not conditional on the fact that you must stay sober — or have abstinence or clean time being anything attached to it. That is often an extreme barrier for any harm reduction services for people to access, because as soon as you use, you’re kicked out or “three times and you’re out,” or whatever. We also need to look at preventing violence against women, especially Indigenous women, two-spirit, transgender, gender-diverse people — and girls, unfortunately.

Any service that is going to be provided cannot only look at opioids or illicit drugs, because the problem is so much larger than that. It goes to every nook and cranny in society. So if we’re going to set up something new and refreshing, it needs to provide everything, and not just, like: “Oh, we have this over here if you want to go do it.” No. There should be a whole centre to do that.

And if there isn’t going to be only an Indigenous centre, there needs to be an Indigenous person, and especially someone who identifies as a woman — or transgender or two-spirit or gender-diverse person — to work with women, because often men are seen as unsafe due to previous violence.

Overall, I think that if we’re going to do it, it has to be Indigenous-led, but not only Indigenous-led. The whole thing…. We need to talk with people on the ground and hear what they believe will help them most.

Obviously, I represent an entire country, and I cannot speak to everyone. But if we go to the places and we speak to those people with sharing circles and do things in a good way, with the government very at arm’s length, I think that you could elicit, probably, a lot more pointed responses to exact services that are required. I think that’s going to obviously differ by whether you’re First Nations, Métis or Inuit — and within those groups.

That’s also something else that needs to be said: what works for you may not work in another place. Understanding that it needs to be flexible is going to be really, really important. I know that isn’t the easiest thing to do in government. Having flexibility is really, really hard. But when we’re talking about Indigenous people, I think it’s critical, or else the whole thing is for naught.

Additionally, another service I think would be really, really smart is more complex care beds, and the ability for retention of nurses and counsellors and anyone who deals with folks who come into the hospital is really, really important. The lack of critical care beds that are staffed properly is really alarming. No one comes in with just an addiction. They come in with other things that have led them there. Unless we are tackling the things that have led them there, they will go back out, and the same thing will happen again. It’s just a cycle that repeats itself. I believe Char actually brought that up earlier — about complex care beds.

N. Sharma (Chair): Okay. Great.

We’re coming up on time, and I don’t see any more questions. On behalf of the committee, I just want to thank Char and Lee for presenting such passionate, detailed and really wise presentations about what’s needed to support Indigenous women in this opioid crisis.

Thank you for the work that you do and for making a submission to the committee today.

C. Leon: Okay. Thank you for having us. Take care. In the work that we do, I wish you all, all my relations, well.

N. Sharma (Chair): Thanks a lot.

All right, committee. We have about two minutes before the next one. So a quick little break, and then we’ll see you in a couple of minutes.

The committee recessed from 1:58 p.m. to 2:02 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): On behalf of the committee, it’s my pleasure to welcome our next speakers. We have two organizations that are here to present to us. We have the Peers Victoria Resources Society and PACE Society. I think we have a team from Peers and from PACE Society. It’s Nour, managing co-executive director, who is here.

I just want to welcome you both and thank you so much for your time presenting today.

My name is Niki Sharma, and I’m the Chair of the committee, the MLA for Vancouver-Hastings. I’m just going to go around and introduce the rest of the committee members, and then we’ll pass it over to you.

Each organization has 15 minutes to present, and then we’ll have 30 minutes for discussion.

I’ll start with the Deputy Chair.

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

P. Alexis: Good afternoon. My name is Pam Alexis, MLA for Abbotsford-Mission.

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

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

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

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

N. Sharma (Chair): We’ll pass it over to you. I think we had PACE starting first, if you want to start.

N. Kachouh: Just as a heads-up, we were told we had 15 minutes and 30 minutes of questions.

N. Sharma (Chair): That’s right. Fifteen minutes, and then 30…. It’s 15 for each organization, and then 30 at the end.

N. Kachouh: I just wanted to check. Thank you.

N. Sharma (Chair): No problem.

[2:05 p.m.]

Briefings on
Drug Toxicity and Overdoses
Panel 2 — Community
Organizations — Sex Workers

PACE SOCIETY

N. Kachouh: [Arabic was spoken] on unceded Coast Salish territories of the hən̓q̓əmin̓əm̓-speaking Musqueam and Tsleil-Waututh peoples and the Sḵwx̱wú7­mesh sníchim–speaking Squamish peoples.

[Arabic was spoken.]

In English, salam. My name is Nour Kachouh, in Arabic. Nour Kachouh is fine in English.

I’m an immigrant, on the unceded Coast Salish territories, from Lebanon. I’m on the territories of the hən̓q̓əmin̓əm̓-speaking Musqueam and Tsleil-Waututh peoples and the Sḵwx̱wú7mesh sníchim–speaking Squamish Nation. I raise my hands to the stewards of these lands, who have taken care of the land, the people, the community and everything around us for time immemorial.

I join you today as the co-executive director at PACE Society, which I will speak on later. I also wanted to speak from my own position as a public health professional. I’ve called the Coast Salish territories my home for the past almost two decades, and I’ve worked in the non-profit and anti-violence sectors, and in the Downtown Eastside specifically, for almost 13 years.

In August of 2019, I completed a master’s of public health degree at Western University, graduating among the top of my class and being presented with the Dr. M. Abdur Rab Award in public health excellence.

Throughout our studies, we learned the main idea behind public health: prevention, prevention, prevention. We were told to work upstream to the issues at hand, to work our way upstream and find the main and root cause of the issues we are attempting to prevent. We were taught to use evidence-informed decision-making, which considers the valuable evidence of a variety of sources rooted in community health issues, the local context, existing public health resources, the community and political climate and the best available primary research.

Unfortunately, though, what I have seen is a public health response to the overdose and drug poisoning crisis that has not only gone against this main theme of my studies but has also lacked the evidence-informed approaches we were taught to consider when making public health decisions. This reactionary public health approach to the drug poisoning and overdose crisis continues, with this committee being a perfect example of the lack of systemic and policy-level work that has taken place thus far.

I do not mean this from a place of anger. Sorry, I do not mean this from a place of…. My apologies. I missed my word. I do not mean this in a rude way. I mean this in a factual way.

The fact that the committee only reconvened in April of this year, even though overdose deaths have not subsided since the drug poisoning crisis began 6½ years ago, speaks volumes. Since then, and in our seventh year of this crisis, more than 10,000 people have died due to the drug poisoning and overdose crisis. They are and were friends, community members, workers, advocates, family members and loved ones. Some I knew, and most I never will.

With ever-increasing amounts of evidence that allows the province to create policy change, the fact that we are having to present yet again — at another committee, to beg for changes to policies and laws which we have named before, so that people stop dying — feels like another attempt to put a band-aid solution on top of systemic failure after systemic failure.

At PACE and among other organizations I’ve worked for over the past seven years, I have seen the impact of the drug poisoning and overdose crisis firsthand. PACE has lost workers, community members, founders and leaders in the community we work for, and we’re tired.

Who is PACE Society? We are a sex worker–led organization that has been providing services by, with and for the sex work community in Vancouver’s Downtown Eastside and beyond since 1994.

I want to be clear that I am not experiential and that folks did not feel safe presenting to this committee and outing themselves. That speaks volumes to the way that sex work, labour rights and the intersection of drug use have shown up for us as a grassroots organization.

In addition to our support services…. We offer our services through peer-led and non-judgmental approaches grounded in harm reduction, human rights and labour and sex worker rights principles. Our services provide members, as well as the wider community, with harm reduction supplies for safer substance use and sex. Our harm reduction window was prioritized as one of the few in-person services that remained available throughout the pandemic.

PACE’s membership has sustained devastating losses throughout the toxic, poisoned drug supply and overdose crisis. Supporting members of the sex work community who use drugs is of critical importance to our work. Harm reduction, whether in regard to sex work or drug use, is what keeps our community safest.

[2:10 p.m.]

I’m going to speak to our recommendations that we had, each one highlighting a critical need.

The first recommendation is on improving care. The nexus between the stigmatization and discrimination of sex work and drug use creates serious threats to sex workers’ lives and safety. Training on colonization, harm reduction and culturally safe, trauma-informed approaches must be required for all health care providers at all levels. Further, safe channels for reporting stigmatizing behaviour must be made accessible and equitably available for all.

Sex workers who use drugs face compounding layers of criminalization, stigma, judgment, discrimination. It creates complex barriers to accessing services and resources and to accessing the justice system in and of itself.

The barriers to safe access to health care are deadly. Members of the sex work community may avoid seeking medical attention and medical care due to traumatizing experiences, being stigmatized and even turned away by health care providers due to their drug use and involvement in sex work. This fear can be even greater for sex workers with children, who may already have to conceal their sex work to health care providers to avoid being viewed as an unfit parent and even reported to the Ministry of Children and Family Development. Adding drug use to this already fraught web of stigma is a risk that may render health care services completely inaccessible to those most in need of care.

Indigenous sex workers, who make up just over half of our membership base, face further barriers to accessing services and systems, including the health care system. The findings from the In Plain Sight report highlight the importance of having an anti-racism approach at all levels of the health care system, as systemic issues require multi-pronged and systemic approaches.

The intersection of criminalization and stigmatization of Indigenous peoples, drug users and/or sex workers is highly exacerbated by the ongoing colonization and gentrification, specifically what we see in the Downtown Eastside. Within the context of the brutal syndemics of housing unaffordability, COVID-19 and the poisoned drug supply, this is all further magnified.

Our second recommendation is around government response. Decriminalization must drastically reduce police contact with drug users. Policing practices and legal reforms must be tailored to minimize any drug-related police contact, including through ending the use of the Civil Forfeiture Act to seize money and drugs from street-level drug users.

Sex workers already face criminalization through the policing of their clients’ workspaces and communications with clients, which in itself creates major barriers to access to justice, such as the ability to safely report crimes to police and navigate the legal system without judgment. Using, possessing and buying criminalized substances are similarly heavily policed activities. The status of being both a sex worker as well as a drug user invites high levels of police scrutiny under the current models of criminalization, resulting in an impediment to access to the justice system in and of itself.

Drug user–led groups have long spoken out about the harms to their communities that result from policing drug use and have called for decriminalization, calls which have been echoed by health authorities around the world, including our own provincial health officer, Dr. Bonnie Henry. This happened in April of 2019 in the Stopping the Harm report, which specifically outlines the ways the Police Act, which is provincial, can be altered to decriminalize drug users.

I believe that approach has not been taken. Instead, the approach of applying to the federal government or Health Canada to alter amounts of simple possession was taken. However, drug user–led groups have also now cautioned that the current proposed approach to decriminalization falls short of ending criminalization of drug users.

We, as PACE, support the submission of the B.C. Association of People on Opiate Maintenance, the Coalition of Peers Dismantling the Drug War, the Vancouver Area Network of Drug Users and Pivot Legal Society on these points.

The harms of police contact and harassment are elevated for people at the intersection of sex work and the drug war. Drug users faced frequent police contact on the basis of their substance use, such as being regularly stopped and searched, having drugs, money and drug paraphernalia, including harm reduction supplies, seized and being surveilled while accessing harm reduction sites.

[2:15 p.m.]

The application of the Civil Forfeiture Act, through the criminalization of drug users and sex workers, leads to the seizure of money and drugs from an already marginalized and stigmatized community. The seizure of money and drugs from sex workers who use drugs has the specific risk of leading sex workers into unsafe work situations out of the need to avoid withdrawal. Predatory clients who seek to exploit those in vulnerable states push workers’ terms and boundaries.

We found that as many as 66 percent noted a loss in income, and 52 percent noted police surveillance was increased during the pandemic. This was an internal PACE survey of our membership.

Further, the negative police experience associated with the twinned criminalization of using drugs and engaging in sex work makes reporting and pursuing charges for violence experienced on the job significantly less likely due to safety concerns and a lack of trust.

Additionally, the application of the Civil Forfeiture Act leads organizations similar to ours, who support members of the Downtown Eastside who use drugs, to be forced to apply for funding that could have been seized from the same community members we support. The choice between not having this funding and having funding that could have been seized from members is a Hobson’s choice, leading to decisions from a place of non-choice, rather than decisions from a place of empowerment and support of the members that we serve. The criminalization of drug use and users directly and indirectly impacts users and the support systems around them.

Our last recommendation is around addressing the toxic drug supply. Simply put, increasing access to safe supply must be prioritized, including creating a clear pathway for prescribers of safe supply, increasing the availability of and access to safe supply and ensuring safe supply is available for all modes of drug use. A low-barrier, harm reductive and trauma-informed approach that would support users with meeting their health needs in a sustained way would be to ensure that all people who use drugs have access to safe supply.

Safe supply refers to a drug supply that is safe and regulated, allowing people who use drugs access to supply that will not kill them, rather than accessing unsafe, toxic, criminalized and unpredictable supply. Recent evidence from the B.C. Centre on Substance Use confirms that access to safe supply decreases the risk of overdose, including fatal overdoses. Unfortunately, while the newly introduced B.C. policy on prescription safe supply will support curbing overdoses due to the toxic drug supply, its implementation equitably across B.C. remains to be seen.

With no clear pathway for prescribers, nurse practitioners or general physicians to supply safe supply…. Many members who use drugs have fallen through the cracks with the implementation of this new policy, having to remain reliant on a toxic and criminalized supply. This has exacerbated the overdose crisis, with approximately six people dying from a toxic drug supply every day in B.C., according to the B.C. Coroners Service.

Barriers that people who use drugs bump up against include discomfort and a lack of training amongst prescribers of opioids; overly narrow prescription guidelines that do not account for maintenance goals or the criminalizing, toxic-street-level market; and prescription restrictions, such as bans on carries, mandatory witness doses and urine screening. All of these speak to our recommendations, which I spoke to earlier.

These barriers force people who use drugs to turn to the criminalized and toxic market, leading to a higher risk of overdose due to toxic supply. By ensuring equitable and low-barrier access to safe supply, the provincial government will be taking a clear stance on the overdose public health crisis, centring health and safety for all people who use drugs.

In conclusion, I’m submitting these remarks to you as a tired human. I’m a tired leader, and I’m a tired public health professional. I’m tired of seeing people die around me from what I believe to be preventable deaths of a highly criminalized and stigmatized population.

I want to end with a quote from Leslie McBain, who is the co-founder of Moms Stop the Harm, with a small addition from me. She said: “A regulated legal supply that saves lives is not impossible; therefore, it is imminently possible.” What I want to add is the following: drug policy and law changes that save lives are not impossible. They are imminently possible. Therefore, not doing anything means we are complicit in the deaths of thousands.

I believe this is the responsibility that we have to act on. So please, please act on it.

N. Sharma (Chair): Thank you.

Over to Katy.

PEERS VICTORIA RESOURCES SOCIETY

K. Booth: Hello. Good afternoon. Thank you so much for having us here today.

My name is Katy Booth. I use she/her pronouns, and I’m the education coordinator at Peers Victoria Resources Society, also a by-and-for sex worker organization.

[2:20 p.m.]

I am joined today by Chass, Eric and Donnie, who are peer responders at our overdose prevention and peer services sites, a model that I will speak to in a little bit.

I would first like to acknowledge the land on which we’re calling in from today, the land on which we live, work and play, the homelands of the Lək̓ʷəŋin̓əŋ-speaking peoples, now known today as the Songhees and Esquimalt Nations.

I would also like to thank and acknowledge all of those who contributed to what we’re about to present. In the next 15 minutes, I will summarize and discuss the problems and solutions that a group of approximately ten folks, ten peer responders and people who use substances, developed based on their lived experience.

Since 2016, over 10,000 British Columbians have died due to a toxic drug supply, a staggering statistic for everyone to hear, undoubtedly. But for myself and for the folks here with me today, this number is representative of so much more. It is people. It represents lost partners, friends and loved ones. It also represents a toxic supply of substances, failed drug policy — including the war on drugs and people who use them — and a lack of resources and services responsive to the needs of community as dictated by community.

The issue of toxic drug supply is not new, yet since the pandemic began, illicit substances have become even more toxic and unpredictable. Benzodiazepines and other similar analogues such as etizolam have hit the supply, and naloxone does nothing to reverse them. In July of this year, benzos and/or etizolam were found in 46 percent of all expected opioid samples submitted to the Vancouver Island drug checking project. This means that almost half of the substances checked contained one or more ingredients that we have no response for. We have to hope for help and continue breathing and, as said by PACE and many others, we’re tired.

Additionally, now that close to half of expected opioids contain benzodiazepines, folks are beginning to develop physical dependency and subsequent withdrawal when they get opioids without them, thereby creating a new demand and additional concerns. Providing safe and safer supply is one way that we can help mitigate the staggering loss of life, and the province of B.C. began doing this at the start of the pandemic.

The safe supply program that is currently available in Victoria has helped many people and undoubtedly saved lives. Folks have reported numerous benefits to being with the program, such as increased connection to supports and service providers, a reduced need to buy illicit substances from the street, and pain management. Unfortunately, there’s not enough access for everyone who needs it, and if you’re not already on the program, wait times can be deadly.

Safe supply, as it stands in Victoria, is medicalized and requires folks to be present for their dose, whether that is waiting for daily pharmacy drop-off or going to the pharmacy on their own, many of which close by 6 p.m. Visits to the doctor must be maintained, and like other opioid agonist therapies — or OAT, as I will call them — such as methadone, missed doses and positive urine screens carry punitive measures such as reducing prescribed doses and forcing people to buy from the street, punitive measures described by folks with lived experience as stupid, dangerous and impractical.

Often doses of safe supply are not high enough to meet the actual versus perceived need as, since fentanyl has hit the market, increased tolerances have been seen to heights never before, making dosing difficult for both professionals and people who use drugs alike.

Medicalized safe supply programs work for some people and not for others, just as we have seen in other opioid therapies such as methadone and Suboxone. Colloquially, methadone has been described as liquid handcuffs, and in many ways, the current safe supply is repeating this pattern. Often the biggest barriers to adherence lie with the medicalized aspect of substitution and, as discussed above, making a person’s day revolve around their medication and well-being and, in turn, making daily life activities such as employment, self-care and community connection incredibly difficult.

By no means are we advocating for less access to medicalized support like safe supply and OAT. In fact, we are encouraging expansion on current supports. But through a reduction of barriers, supports and care could improve. These services are a vital component of a robust response to the opioid crisis, but as they currently operate, they are overmedicalized and undersupported. They simply do not work or are accessible to everybody. But with the identified barriers removed, safe supply becomes even safer.

Alternatives to highly professionalized safer supply programs and community-run supplies such as buyers clubs or compassion clubs like that run by the coalition of the Drug Users Liberation Front, known as DULF…. These are by and for community solutions that offer support to those that the medicalized alternatives do not or cannot.

[2:25 p.m.]

People who use drugs see alternative options and community initiatives such as compassion clubs as viable models to supplement other formalized and medical substitutions, especially for those who have not had access or success in traditional safer supply and OAT options to date. Under the current Criminal Code, compassion clubs and community safe supply are illegal, and this needs to change.

In addition to community buying for opioid supply, access to medical heroin and fentanyl is needed to complement. The specific medications that are often prescribed through safe supply, such as oral Dilaudid and Kadian, are not always tolerated well, make some folks incredibly ill and are often not prescribed in doses high enough to cover a person’s withdrawal and cravings. Another important fact is that people do not get to participate in the ritual for substance use: they are expected to use oral medications, whereas the substance use was previously through smoking or injecting.

Medical heroin, fentanyl and hydromorph give those options. Successful pilot programs for injectable heroin, hydromorph, etc., have been conducted in Vancouver, Calgary, Edmonton and various other cities but have yet to move much past piloting and into the plethora of required available options to address the toxic supply. With the addition of medical heroin, fentanyl and hydromorph, opportunity to provide injectable, pharmaceutical-grade substances and ethical dosing based on individual need will address some of the missing components of a robust medical safe supply program.

Addressing the overdose crisis via safe supply is imperative, yet it’s only one piece of a responsive plan. When asked what would make the biggest difference in response aside from safe supply, the responses were great: increase detox and publicly funded treatments that are responsive to the folks that use them.

For example, often wait times are weeks or months long, funded beds are unavailable, and folks are expected to abstain from all substances, not just the substances that they’re choosing to withdraw from. The demand far exceeds supply, and months, even weeks, are too long to have to wait for a person when they’re ready for detox or treatment. We need immediately available and funded options for folks, because people deserve care whenever they’re ready, and every day a person waits is another day they risk overdose and death.

Detox and treatment are often unresponsive to people’s needs and the substances they are using. Some things have come up as examples. Detox facilities in British Columbia do not allow cigarette smoking, for example, even in designated outdoor areas. For someone who is detoxing from heroin and other opioids and has not said that nicotine is a concern, why are we asking folks to withdraw from substances that they’re not looking to?

The same goes for alcohol. Some folks would like to continue to use alcohol but would like to stop using opioids, but therefore are not eligible for any detox or treatment facilities as they stand today. This is unacceptable. We need people to be able to continue to choose their own health and well-being, and we need to provide choices. The lack of choice is a big barrier, and if people do not have access to solutions that include choice, less people will go.

It is anticipated that withdrawal support will be increasingly necessary for folks as we see more benzodiazepine dependencies. The illicit supply requires that the government increase access to beds and timely intake.

Folks also mentioned a lack of safe spaces to use. There are few supervised consumption sites, and they often have limited hours and do not allow for smoking of substances — often only injecting or oral.

In a few moments, I will discuss a model that aims to address safer spaces to use in sheltering those sites, but even with the inclusion of these, more safe and non-criminalized spaces are desperately needed, especially services that are open 24-7. The lack of safe spaces forces folks to use in riskier ways, often in public spaces or isolated alone in locations such as bathrooms, where overdose response is unlikely.

Peer solutions via buddy systems have been vital to respond to the lack of formal services, but such community efforts are typically unsupported financially, and helpers carry the risk of being criminally punished for saving lives.

The criminalization of substances and the people who use them is a dangerous foe in our efforts to respond to the crisis. Criminalization thwarts community efforts, and measures such as the Good Samaritan Act are extremely limited and only pertain to overdose response and not overdose prevention.

[2:30 p.m.]

We call for not just decriminalization but full decriminalization — decriminalization of all drug possession for personal use, including the sharing or selling of drugs for sustenance, to support personal drug-use costs or to provide a safe supply in the community. Thinking beyond simple possession and decriminalization is vital as an efficient response and will aid in peers helping peers, activities that are already happening. Others helping others, especially in the context of a long-declared provincial health crisis, should never carry the risk of arrest and jail.

We have long relied on injectable naloxone for overdose response, but with heavier and prolonged overdoses, responders are having to administer many more doses and breathe for people for extended periods of time. Having to give so many doses, folks in communities are going through their kits and needing replacements immediately. Naloxone is often given to folks post-overdose in case they are to overdose again but rarely offered to responders of overdose in the community.

Providing emergency services such as EMS and other services that responders engage with, kits to be given out would allow them to respond again immediately, as opposed to having to find new kits at two o’clock in the morning. Along with replacement naloxone, we also ask for increased access to nasal naloxone. As mentioned, with such prolonged and deep overdoses, nasal naloxone gives folks an efficient and simple way to administer multiple simultaneous doses without having to mess with ampoules that break and that cut fingers, and syringes in multiples to fill. We simply need more access.

Folks with lived experience see access to more education, increased peer involvement and enhanced recognition of peer roles and skills as additional and vital solutions to the crisis. Specifically, people want more peer responders and more peer representation in health care, more input in changes, more utilization of peers to one’s work, more accessible training and education and, finally, more recognition by staff in the community services for the expertise that they bring.

One tangible way to do this, as briefly mentioned in the beginning introductions, is that Peers Victoria operates what are called housing overdose prevention and peer service sites in three, soon to be four, sheltering sites. The HOPPS model, as it’s called, was developed initially and implemented in Vancouver and other locations and was recently adopted in Victoria near the beginning of the pandemic. This model is designed to have staff teams from the operating organizations identify and work with interested residents as peer responders to provide harm reduction supplies, overdose response, witnessed consumption and community engagement.

Folks describe this work as an opportunity to give back to community, to earn income and bridge the knowledge transfer from residents to staff as well as reducing stigma. There’s a high demand for these positions, yet overall, few supports exist to do this peer-based work.

Finally, building on the inclusion of peers in overdose response, expanding the reach of peer programs into any and all services that people who use drugs utilize, is vital. Unilaterally, every experiential person described poor treatment at hospitals and services that they regularly access. Peer programs provide advocates, safer spaces, welcoming spaces and reduce stigma. This model could be used in many different locations but currently is working incredibly well in sheltering sites.

There we have it. To briefly summarize, we need more medical supply with reduced barriers; community options for non-medicalized supplies and supports; enhanced access to treatment and detox; full decriminalization; more naloxone availability, including nasal; and more peer inclusion, validation and peer-run services and supports in all places that people who use drugs access. As aid service organizations and peer drug user groups have said from the very beginning: “Nothing about us without us.” It’s time that we, as a caring society, listen and act accordingly.

Thank you so much for your time and for your invitation to speak today.

N. Sharma (Chair): On behalf of the committee, I just want to thank both you, Katy and Nour, for your passionate and very detailed and knowledge-based presentations, and for you all joining us. We have time, about a little less than half an hour, for questions and answers.

Colleagues, do you have any questions, comments, discussion?

S. Bond (Deputy Chair): Thank you to our presenters. It’s very much appreciated.

[2:35 p.m.]

Katy, I appreciate it. Hello to the others that are joining you today. We’re glad to have you as well, and thank you for sharing this time with us.

Katy, I’m wondering if you can just speak to a couple of things for me. One is the availability of nasal naloxone and where that’s accessible today. Is it…? We certainly have heard a lot about naloxone kits, but I admit, maybe I…. I would like to know a little bit more about the nasal form of naloxone. Who gets it? How do you get it? Is it used, obviously, much less frequently? So maybe just if you could speak to that.

Then I was really struck by your comment — maybe just walk through your thinking — that peers can be…. I wrote it down: “Peers can face criminal risk for saving lives.” Can you walk through that for me and tell me what that means? Specifically, what are your suggestions for changing that? I think those were two very important points that I heard in your presentation.

Thank you, Nour, as well.

Those are my questions, Chair.

K. Booth: Thank you so much. To address, first of all, nasal naloxone, it’s incredibly difficult to get. Folks who do have Indigenous Status with the federal government of Canada do have access, via pharmacies, to nasal naloxone. That’s it. The average person does not have access.

We have found some community organizations, such as St. John’s Ambulance, that have provided kits when someone has done the training, but overall, they are very, very difficult to get. And they’re expensive, so they’re also not something that non-profits or grassroots organizations are able to pay for, yet we know that they’re needed, so that is a huge, huge issue.

One naloxone nasal has the contents of ten times the amount of injectable, so it is more doses. Now, it doesn’t work out to ten times the amount because of the way that it’s given — it’s given within the nose as a spray that goes through the mucous membrane, versus an injection — but it does end up being more than one dose, which is what’s in each vial, and three vials are in the average injectable kit. Two nasals go into a kit, so that would be the equivalent of, in theory, 20 doses, but not actually. It’s less because of how it’s absorbed in the body and administered. So that is a huge issue.

As to the criminalization while people are responding…. Just being a person who uses substances is a criminalized venture, just by what PACE had mentioned before with stop and seizure, with different paraphernalia. If somebody stops to respond to an overdose and they have substances on them that could be considered enough to be distribution, then that person can go to jail. So the risk of just being in a space where police are present during a health emergency is criminalizing in and of itself.

Sometimes it does not result in arrest and jail. Oftentimes it does involve a lot of harassment and a lot of community tension. All of the pieces are important. It’s not just about whether somebody ends up in jail. It’s the whole criminalization from start to finish.

N. Sharma (Chair): Maybe I’ll jump in now with a couple of questions where I would love to get deeper into your knowledge.

There are kind of two things, including others, that we are tasked with really digging deep and coming up with recommendations through this work. One is expanding access to safe supply, and another is implementing decriminalization. You both kind of touched on that in different ways. I’d like to just get really clear with….

First of all, we’re at this process now where we’re stepping into the implementation phase of the decrim for possession up to the threshold that was given by the federal government. What are your thoughts on the implementation of that and your advice and specifics related to that? I would love to know, from both of your perspectives.

Then in terms of expanding safe supply, it seems to be…. I’ve asked many people that have come forward to say: what does that look like? It sounds like it’s different for different users in different circumstances. From your perspective, what would be the one or two key things that you think would help with the expansion of safe supply in terms of the way we provide it and how it’s provided?

Just really specific on those two, I think, would be helpful.

[2:40 p.m.]

E. Van Pelt: [Audio interrupted.] Going around some of the more difficult areas in Victoria, we were pulling carts full of harm reduction gear such as pipes, stems, tinfoil, sharps, sharps kits, naloxone kits, snacks to draw people in. That’s a big, big one. Having something like a snack to give someone — that breaks the ice, so to speak.

Having water, and then having little kits made up, like premade kits with two syringes and a cooker, some gloves, some alcohol swabs to help fight the infections. That’s a big one too, right? People who are using in dirty environments pick up a lot of infections that expand into a much larger tug on the resource and hospital aspects part of it.

K. Booth: Sorry, I don’t want to interrupt. What Eric is speaking about is something that multiple organizations have done. With safe supply, or safer — as the program is called in Victoria, that’s how they started. That’s how they started engaging folks into safer supply, even being a medicalized system. They started with outreach and relationship-building because sometimes that is a huge part — especially with newer services and an intense distrust of the medical system — of how to engage and how to get people to engage within the systems and see what works best for them.

Those services are no longer available. That was one thing that we did want to say. The services together — we can’t just look at a person as a body and as a medical entity. We need to look at the whole well-being of a person. Oftentimes, basic needs are a very good place to start.

N. Kachouh: To speak on your two questions, Chair Niki Sharma, I think the first thing would be to speak first on the drug possession piece.

I think one of the responsibilities of the B.C. government would be to push back on the amount, as I know that drug user organizations and drug users have said that that amount is too low for daily users. I would say that’s the first thing: to push back on the amount that was decided by Health Canada. I know that was halved from the application that the B.C. government put forward.

The second piece around that would also be around, and is really connected to, decriminalization and the way the Police Act is enacted on members, sex workers and drug users, who are criminalized by the police and the policing system. Those two, coupled together, would be my first instinct, around safe supply specifically.

In terms of the implementation piece, I think the clear pathway for prescription will be one of the tools which general physicians and nurse practitioners can utilize in order to safely prescribe safe supply. The reality is that right now, there is no clear pathway for that. Doctors, medical professionals, nurse practitioners get to choose and decide who gets to fit their bill and who doesn’t.

If they don’t care, if they don’t want to, if they don’t believe in harm reduction, they just get to decide: “I’m not going to prescribe safe supply for you.” That’s the reality that we’re seeing on the ground. Many members have come up to us and said: “I can’t get safe supply. I tried, but I can’t. I don’t fit these specific requirements that they have.”

Having something where it’s — not standardized, because I think standardization can also lead down a rabbit hole — a bit more of a nuanced approach to prescribing and then a pathway for prescribing, and maybe even a list of like safe prescribers, would be a great place to start — places we know that actually support harm reduction, support safe supply for folks, doing lists like that, where we can actually know, when we’re sending people to those general physicians, those nurse practitioners, those health care providers, that they are safe people to send them to.

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

Any other questions from our colleagues?

[2:45 p.m.]

On behalf of the committee, I just want to thank you both so much for coming — also the team there that you have with you, Katy. Thank you for the work that you do every day, saving lives and protecting people that you work with. It’s much appreciated, and we appreciate you.

Did somebody want to say something there?

E. Van Pelt: A big emphasis on the destigmatization from how society is frowning upon people that are using. A lot of people that are using…. Drugs have no barriers. They don’t care who you are, what status or what place in society you are in. Yeah, they hit home — the large numbers in the poorer communities — but they’re hitting in the high communities as well, except they’re more behind closed doors and stuff.

That stigmatization has to get resolved before things are going to move forward a lot more. It’s sad to say, but I think more rich people are going to have to start ralphing in their parents’ bedrooms before things are going to start getting done for the people out on the street.

N. Sharma (Chair): Thanks, Eric, for adding that.

Nour, did you want to say something as well?

N. Kachouh: Just to add on to what Eric said, that’s why that education piece for all levels of health care is so important as well. Two years ago, approximately, I revamped the gender-based violence educational pieces for the Provincial Health Services Authority. I don’t know where that’s at, but something along those lines: what is the toxic drug supply looking like now? What are the policies? How to prescribe, revamping those educational models, will be super important for prescribers of safe supply.

K. Booth: Just one little bit to add. I also think the inclusion of peers is something that has been really forgotten in so many different ways. I am not an expert. I have been working in this for over ten years; I am not an expert. The folks here are experts, and we need to start listening to what people need and not deciding for people what they want and what they need.

We need to ask questions. We need to include people. The more we include folks with lived experience into services and various different things, the more opportunity we have to reduce stigma and to educate folks on their expertise.

We talk so much about evidence-based practice and expert-based things. When we start to see peers as experts in their own lives as well as the systems we’ve created that work for them, then it really provides an opportunity for an approach that is well-rounded, that is accessible to everybody and responsive to all.

N. Sharma (Chair): Great. Thank you for those final thoughts, everybody. Again, we really appreciate your time and the work that you do every day. Thanks for coming.

Committee, we will have a little over ten minutes before the next presentation. We’ll go into recess.

The committee recessed from 2:48 p.m. to 3:02 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): It’s my pleasure to welcome our next guests here. We have a group. From Still Here recovery we have Kevin Diakiw, founder, and Shelley Shadow, board chair, from Trailhead Recovery. I just want to welcome you on behalf of the committee.

Maybe we’ll do a quick round of introductions of who we are, and then I’ll pass it over to you. I think you have 15 minutes for presentation and the rest of the time for discussion.

My name is Niki Sharma. I’m the Chair.

I’ll pass it to the Deputy Chair.

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

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

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

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

D. Routley: I’m Doug Routley, MLA for Nanaimo–​North Cowichan.

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

N. Sharma (Chair): Ronna-Rae?

We see you now, Ronna-Rae — MLA for Courtenay-Comox.

We will pass it over to you, and we’re looking forward to learning from you. We have a presentation that you’ve provided, in our SharePoint.

Briefings on
Drug Toxicity and Overdoses

STILL HERE

K. Diakiw: Good afternoon.

We’re honoured to be speaking to you today from the unceded and ancestral territories of the Semiahmoo, Katzie and Kwantlen First Nations.

As noted, I’m Kevin Diakiw, the founder of Still Here recovery, as well as a board member of Trailhead Recovery, a not-for-profit company specifically created to make recovery coaching services more accessible.

I’m grateful to be joined by Shelley Shadow, chair of Trailhead Recovery, as well. She’ll be around to answer any questions that you might have afterwards pointed to her.

[3:05 p.m.]

We want to thank the committee for the invitation to address you on this important topic today. We’re here to explore the potential of an addition of an evidence-based continuum of care encompassing prevention, harm reduction, treatment and recovery. We’re talking about the addition of recovery coaching to B.C’s. emergency departments. Such an initiative has never been implemented in Canada, but it is definitely a proven quantity in other areas of the world.

If you’ve never heard of recovery coaching, you’re in good company. Recovery coaches are well trained paraprofessionals, most often with lived addiction and recovery experience. They walk alongside those who are seeking recovery as well. They are people who are trained in several areas, including active listening, establishing empathy, building relationships, and the scope and size of recovery boundaries, ethics and motivational interviewing. The latter is the ability to, through important questions, gently move people through the stages of change.

For instance, a good recovery coach can deftly move those with substance use problems from a pre-contempla­tive, “I can’t” or “I won’t,” to a contemplative stage: “I can” or “I might.” A recovery coach builds on strengths and shores up supports enhancing recovery capital — those critical underpinnings of good and lasting recovery.

Uniquely, this is a collaborative plan initiated and implemented by the person with substance use disorder. That plan could be abstinence, but it could also be moderation, harm reduction, medically assisted treatment, medically assisted recovery or the use of countless supports within the community. Everything is in play. Because this plan is conceived by the client for the client, recovery coaches see immense engagement and success rates for those seeking recovery.

Before 2018, recovery coaching was an unknown concept for me as well. I was 26 years into my own continuous recovery from alcohol abuse when a friend, Dr. Ray Baker, told me about recovery coaching. He described its absence as a gaping hole in B.C.’s system of recovery care. I was intrigued. In 2018, Ray and I traveled to Hartford, Connecticut, where recovery coaches were being trained en masse and deployed with great success. We brought the training back to Canada.

Recovery coaches, I learned, embrace multiple pathways, whether that’s 12-step facilitation like AA and ACA, any of the anonymous programs; cognitive or dialectical behavioural therapy; LifeRing; medication-assisted recovery; SMART Recovery; or a host of other methods of breaking free of addiction’s grip.

The multiple pathways approach is unique. People in recovery tend to embrace the method that they used, often seeing it as the best or even the only way to break free of addiction. After recovery coach training, people are often shocked at how broad and numerous the scopes of recovery actually are. With that in mind, I often ask my colleagues at Still Here: who are we missing?

Still Here has trained 85 recovery coaches, 58 from B.C. The rest are flying in from across the country. We have trained people in almost every province in Canada. We train in person only, and this number of trainees was achieved during the pandemic, working within windows between restrictions. We expect this number to increase as restrictions are now lifted.

For the first two years, students were primarily addictions counsellors, addictions medicine doctors, nurses, heads of wellness for airlines, lawyers associations and other professional organizations. Now we’re seeing more people with lived experience who are looking for a career change or just want to give back.

We are continually asking ourselves: who are we missing in our training? Who are we missing in the delivery of recovery coaching? With that in mind, Shelley Shadow brought an important Indigenous element to the training, and we’ve since started an Indigenous scholarship program. We are currently looking to train people within the South Asian community.

[3:10 p.m.]

We’re also looking for a way to reach out to the newly excarcerated, who are extremely vulnerable to overdose. A 2017 study from Massachusetts found that people leaving prison were 120 times more likely to die of overdose than those who haven’t been to jail. The reference is in appendix 1 of your handouts. As with most citations in your handout, if you click on the image, it’ll take you to a full, if you like looking at the in-depth stuff. These are some of the people we’re missing.

My primary role at Still Here is to work as a recovery coach and train others to responsibly do the same, mainly for private practice. Our clients have the financial means for our services. We typically see people pre- and post-detox and after treatment. Some people prefer not to go to treatment and simply work with a coach. For the cohort we’re working with, this is extremely effective.

Again, who are we missing? We realized that we needed to reach out to some of those most in need. Still Here looked at some of the outcomes from the U.S. and saw some excellent potential for B.C. hospitals.

In 2017, the Connecticut Community for Addiction Recovery, CCAR, launched a pilot project in four Hartford hospitals. Engagement with recovery coaches resulted in a 90 percent connected-to-care ratio, meaning people were linked with detox, treatment, medically assisted treatment or other community supports. After that was established, the client would, on request, receive daily calls, over ten days, from the recovery coach for check-ins.

CCAR started with four hospitals, and they now serve 23 hospitals throughout Connecticut. Seeing the outcomes from the pilot, the demand has been huge. Such success is not long kept secret. Delaware, Georgia, Indiana, Michigan, New Jersey, Rhode Island, New Mexico and Vermont have all followed suit and are seeing similar results.

What do these interventions mean for the current crisis in B.C.? A 2021 report by the Canadian Medical Association Journal indicates that people arriving in B.C. emergency departments because of an overdose were 3½ times more likely to die in the following year than those who hadn’t been to the hospital due to an overdose.

Now, this may seem unsurprising, given the reason that they’re in the emergency department to begin with. However, if the overdose patient leaves the hospital against medical advice, the study found that they are 7.1 times more likely to die in the following year. The report also said that those who left against medical advice represented “missed opportunities to intervene.”

Pairing recovery coaches with those with substance use disorders increases that opportunity for that critical intervention. Evidence also shows that integrating recovery coaches into a care team also reduces the strain on hospitals.

In 2010, a study from Delaware showed that brief interventions with a recovery coach resulted in a 58 percent decrease in medical admissions, a 13 percent decrease in emergency department visits and a 32 percent decrease in substance use admissions. There was also a 32 percent increase in out-patient substance abuse admissions. I’ll just explain that briefly in a minute.

Between 2015 and 2017, Massachusetts General Hospital tracked 1,171 opiate users who were connected with recovery coaches. In a six-month span, the participants’ chances of rehospitalization dropped by 44 percent. Over a year, there was a 66 percent increase in out-patient services, like I just mentioned. They were using things like primary care physicians, community health centres, mental health facilities and labs.

In short, people were using the system the way it was intended, through family doctors, clinics, etc. In addition, engagement with medically assisted treatment almost doubled, and opioid abstinence also increased. This is a potent mixture of outcomes for saving lives.

[3:15 p.m.]

In March, I reached out to Dr. Jim Barrett, the assistant medical director for the emergency department in a hospital in New Jersey. He told me recovery coaches are a critical addition to his care teams. Barrett said: “Recovery coaches and specialists are still a major part of our emergency room patients. I can tell you anecdotally this program works.” It’s a million times better than just giving people a piece of paper with a list of resources.

Alberta recently invested $1 million in the training and deployment of recovery coaches, along with several other recovery-centred measures. Last month the province reported a 44 percent drop in opioid deaths since its peak in November 2021. However, what we are proposing is a singularly unique approach aimed directly at emergency departments — providing recovery coaches when they’re needed and where they’re needed.

You heard from Upkar Singh Tatley on August 3 about the value of community peers, saying: “So peers are absolutely integral to offsetting this crisis.” Imagine having trained peers with experience in a clinical setting. Imagine they are skilled in meeting people where they are, without judgment. Imagine having them trained in motivational interviewing. Imagine how effective that would be.

Connecticut and eight other states are showing us how effective that is. The applications for recovery coach intervention reach far and wide. Last year, the Connecticut prison system called CCAR and said it would take every spare recovery coach CCAR had. The state wanted to pair those with substance use disorder with recovery coaches upon release from jail. There’s also a good application within the justice system, diverting those with substance use disorder from jail.

However, these promising possibilities aside, hospital emergency departments present a unique opportunity. People there have caused themselves harm, often through their own substance misuse. Many of them will be wondering if there’s a better way that they could be living their lives. A recovery coach is trained to cultivate that discussion.

How would a program like this look in British Columbia? We suggest recovery coaching in emergency departments could begin as a six-month pilot, which would measure the efficacy of such a program. We recommend using recovery coaches to respond, on call, to hospitals within close geography of each other. The coaches should operate from 8 a.m. to midnight, seven days a week. Some alterations and scheduling may be necessary to adjust for peak periods.

The coaches should respond to calls within two hours, which should be manageable under expected call volumes. The coaches would meet with the patient, get an idea of where they are along the stages of change and proceed from there. With good motivational interviewing skills, as mentioned, an experienced coach can definitely move the client from a pre-contemplative “I can’t” or “I won’t” to a contemplative “I can” or “I might.”

The expected time of the visit would be about 30 minutes, give or take, which would be long enough to determine what viable plan is best for the client — and remember, the client is coming up with this. Similar to the CCAR model, the recovery coaches would give those with substance use disorder the attention they desperately need while allowing front-line staff to attend to other patients.

We recommend that recovery coaches require 40 hours of intensive basic training and 12 hours of emergency department recovery coach training. They should undergo on the job supervision as well.

Several implementation hurdles are identified in a February 2022 New Mexico report, on appendix 6 of your handouts, and Phil Valentine’s words of warning from CCAR are on appendix 7. You’ll see how we recommend that those challenges should be met in appendix 8.

Applicants for these position should require a criminal record check and a minimum of two years continuous recovery time. More on hiring, training and operational specifics are available on request.

Before I open it up for questions, I’d like to ask the committee: who are we missing?

N. Sharma (Chair): Thanks for that, Kevin.

Shelley, did you want to add anything, or should I go to the questions and answers? Okay. Thanks for your presentation.

I’ll just ask my colleagues, if you have any questions or comments, to just raise your hand, and I’ll get to you.

[3:20 p.m.]

P. Alexis: Shelley, did you say that you are the ED for the Trailhead Recovery? Is that correct? Did I hear that correctly?

S. Shadow: I am the board chair for Trailhead Recovery.

P. Alexis: Board chair.

S. Shadow: Yes.

P. Alexis: I’m sorry. All right.

That takes this concept, the recovery coaches, and uses this concept in your recovery centre. Is that correct?

S. Shadow: Yes. So to differentiate….

P. Alexis: Yes, please. If you could just explain so that I’ve got a little bit more of a frame of reference. I find it fascinating.

S. Shadow: Of course, yeah. Thanks for the question. Trailhead Recovery was recently formed to meet the needs of people….

As Kevin mentioned, who are we missing? It’s meeting the needs of people that really do need these services but, perhaps, aren’t part of what is sometimes called the silk-sheet set. They maybe can’t afford the services of a recovery coach. That may be beyond their reach. So we want to meet them where they’re at.

Still Here recovery is…. We do training of recovery coaches. We are also recovery coaches ourselves and mindfulness coaches. That is a for-profit company that Kevin started in 2017.

Trailhead Recovery is newly formed to bring recovery coaching to the most vulnerable.

Thank you, Pam.

P. Alexis: Thank you for answering. I just needed a little bit more clarity, and now I understand.

S. Shadow: Mm-hmm. Of course.

M. Starchuk: Thank you for the presentation. I think we, as a committee, have heard a number of things that are here with regards to the check boxes — lived experience, peer delivered. Those are some of the things that we’ve heard today, along with people talking about…. People don’t want to wait weeks or days. If they’re in a position where they want to seek treatment…. They want it at a time when they’re, I guess, somewhat vulnerable.

I’ve got a couple of questions, but I want to touch on one that’s there. You had talked about coaches that had a certain requirement of being in recovery of some sort for a period of time, and you’ve talked about your journey that’s there. You’ve talked about abstinence, and then you’ve also talked about treatment.

What’s the answer? What is it that recovery coaching is going to do for that person when it comes to the treatment aspect? Is there a preferred model? Is there a less preferred model, whatever the case may be?

K. Diakiw: What a great question that is. Yes, there is a preferred model. From our perspective, that model is the one that the client or the person with a substance use disorder prefers. Which one are they most drawn to? Which one are they most likely to become part of and to stick with? That’s what makes this approach so unique. It’s that the client decides what’s going to be the best fit for them.

They may decide it’s mutual support. They may decide it’s abstinence. They also may say: “Hey. You know what? I want to stop doing heroin. But I really like preparing my dinner with [audio interrupted] on the weekends.” “Okay. Let’s work with that. Let’s build a life around that.”

Things progress really well when it’s the client’s idea and when we can just be here, cheering them on, going, “Absolutely, let’s do that,” just blowing a little wind into their sails, having them build their best life.

I hope that answers your question.

N. Sharma (Chair): Did you have another one, Mike?

M. Starchuk: Yeah. Actually, there are two.

Inside of your report, it said that Alberta invested $1 million into the training and deployment. This is the first I’ve heard or read of Alberta investing in any way, shape or form. Can you tell us how that would work with regards to what they’ve done?

We heard it earlier on today, where things happen differently elsewhere in the country. Sometimes we’re taking best practices and bringing them back to B.C. and branding them as B.C. initiatives. Is this along the same lines?

K. Diakiw: Yes and no. I really want to give a deep bow to people like CCAR and Alberta. We’re learning from these experiences. We’re learning how to sculpt this to make it the best possible fit.

[3:25 p.m.]

We’re learning from Alberta’s experience and, in that regard, making it a much more targeted and kind of surgical approach, if I can use that terminology, and bringing it to the emergency departments, rather than scattering it widely. Bring it to where it’s really needed the most. Bring it to where we can absolutely do the best change with regards to implementation.

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

Thanks for introducing this concept and the work that you’ve done.

I’m curious. When there are trained recovery coaches integrated in a team…. One of the things we’re tasked with is to figure out not only how to save lives but also to save people from the toxic drug supply and all that goes along with using alone and the things that lead to death under the crisis that we’re in.

When you envision this recovery coach working with a team, do you see…? Is the scope of the training related to helping the person on the path to recovery, or is there a harm reduction component to it? Would they be potentially working with prescribers that can give safe supply on the way of that person’s journey? What do you see that as in terms of integration into the current system of supports that are out there that we need to work on expanding?

I just was curious.

K. Diakiw: What a great question. It is working with all of those great pieces that are already in place. If I could boil it down to its dry ingredients, I would say that a recovery coach is a connector in a disease of disconnection. So we’re connecting people with substance use disorder with their internal resources, but we’re also connecting them with all of those really good outside resources.

Yes, it does include…. It could include abstinence. It could include harm reduction. It could include treatment — whatever. We connect those and just make sure that those are available, should the client decide, “That feels like a good fit for me right now,” and, when it’s not, brainstorming for an alternative.

Like I said in the presentation, everything is in play.

N. Sharma (Chair): Right. Is there an example of…? You were talking about Alberta, this example. It’s getting data and stats that are helping to understand the success of it. I think you were talking about how it’s working.

K. Diakiw: The report I read didn’t directly tie the improvement to the recovery coaching. It was just policy in general.

They reported a 44 percent drop. These are just some of the initiatives that led up to that. How well that’s tied between the two, I’m not sure. I haven’t seen any really hard data. They might have just gone…. It’s fresh news. It’s out there. People are talking about it, so I thought I would make mention of it anyway.

It’s a reported drop. I don’t think any really good science or data is out there saying exactly why.

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

I see a few hands up.

S. Bond (Deputy Chair): Thanks very much. I appreciate the presentation and the introduction of what is a new concept, for me at least.

Just a couple of basic questions. You’ve described the person as a connector. They are not addiction counsellors. They are not social workers. They are somehow integrated into a team in emergency departments. I assume that’s correct.

Who pays them? Who supervises them? Is there a job description? One of the things we know is that scope of practice is a challenge in health care at the best of times. Who does what, and to what extent? So perhaps explain the mechanics of how this person is integrated into an emergency department. You’ve noted that….

I’ll stop there, Niki. I may have some other questions.

Maybe just the mechanics. They’re not a social worker; they’re not an addictions counsellor. How do they fit into an emergency room when there are scope of practice issues?

[3:30 p.m.]

Do they connect with the person more than once, or is it a 30-minute conversation?

Maybe just walk through those pieces for me, please.

K. Diakiw: Thank you for the question. It’s a great question.

You’ve got a busy emergency room. There’s a ton of stuff going on. Somebody comes in. They’ve just been restarted with Narcan. They look around, and they go: “I have to get my stuff together here. I can’t continue living my life like this.” A nurse or an attendant, upon hearing this, goes: “Do you want to speak to a coach?” “Yeah. I wouldn’t mind.” So they go and make a call.

A coach comes in and just engages with that person’s substance use disorder, builds a relationship and, essentially, goes: “Okay. You want to change. How do you want to change? Do you want to look at recovery, and if so, what does recovery look like for you?” It’s just a series of really good questions that gets this person thinking on their own. “Yeah. Well, maybe recovery is this.” You go: “Okay. Well, let’s play with that. We can work with that.” We can work with anything, really.

We work with them along those lines, and no, it isn’t our first engagement with them. We normally follow up with a number of phone calls, if they decide that they want to go to treatment or detox, and probably check in with a doc to make sure that that’s absolutely necessary and what form the detox would be. Daytox might be possible or whatever. There’s a whole host of approaches that might be….

We work alongside the medical staff, not to get in their way or second-guess their calls but to basically lift up the client and make them a little bit more ready for the suggestions that are coming to them.

P. Alexis: When I first read your report, my first thought was: “Oh, it’s a case where a mom would be useful.” I kind of see a mom and a recovery coach as a similar entity. You know how sometimes you just say: “Oh, that person just needs a mom to step in and help out.” So I do kind of see the parallels.

I’m along the lines of Shirley, with how it works. I get what happens at the ER, but how long does the coach stay around in the person’s life? Does the coach have a multitude of clients that they’re responsible for? How does that work? Has a system been tried so that there’s a weaning of sorts? I just want to know how that works.

K. Diakiw: Great question.

Shelley, do you want to handle this one?

S. Shadow: Yes, thank you.

I love what you just said about having the heart of a mother. Yes, what a beautiful way to describe that, coming alongside someone in that situation.

In terms of meeting them, whenever I meet someone for the first time who I may be potentially working with, I love to just find out what’s happening for them in their life right now. What has happened for them and me to talk? What’s happened? What’s brought them here?

When I meet them with non-judgment, acceptance, compassion and good listening, it’s amazing…. I find that people will tell me things. I’m sometimes just aghast that they will tell me, in such a short period of time, what’s happening for them. It’s like they’re being listened to for the first time in their lives. That’s the beginning of a relationship. That’s the kindling, and we can grow from there.

Typically, in an emergency department situation, we’ll have, maybe, a 30-minute chat. From there, there may be some arrangements that will be made. There’s contact information that’s shared. Following the CCAR model, they have a ten-day phone call with that person. So there is a connection that’s made with that recovery coach in the hospital, and it may continue from there. If a coach is, say, entering a weekend or a couple of days off, they will do a warm handoff to a co-coach but pick it up again later, when they return to their shifts.

[3:35 p.m.]

That’s part of what’s happening for a recovery coach working in the emergency department, say, where there is no active call. They’re not on their way. They would be, in fact, making connections with the patients that they saw last week. They would be connecting with nursing staff. That’s something….

If I may just kind of divert, because when I took the emergency department recovery coach training, one of the things that was mentioned that’s difficult at times is that the staff in the hospitals don’t know who we are. They don’t know why we’re there, and there can be a bit of friction.

One of the things that we feel is really, really important is to do that groundwork initially, where we would have several meetings with hospital staff and the board to talk about what it is that we’re doing, why we’re there, how we can help and benefit the staff as well as the patients. We feel really strongly about that groundwork being laid in advance.

Yes, we don’t just meet them. We are aware also that there are some peer recovery programs or peer support that’s available in certain hospitals — at St. Paul’s for example. That’s wonderful. We support that fully.

One of the things that’s different with a recovery coach is that we also follow them out into the community. So there is that follow-up where it’s not just a nice conversation in the hospital, and you never see them again. We actually intend to follow them into the community and to continue developing and fostering that relationship and, hopefully, whatever their recovery plan is.

N. Sharma (Chair): Shirley, did you have another question?

S. Bond (Deputy Chair): I do.

Just quickly perusing what Alberta has done. It’s actually not specifically, although emergency rooms may well be included…. There are also volunteers that are being trained with the $1 million, and they will be involved in parks and prisons. Is there a comparable…? We may not call them recovery coaches, but do we have people in British Columbia who do this work already that may not be called that but may be part of a team that works in community? I’m just curious about that.

Yours is very focused, the presentation, on having people in emergency rooms. Obviously it sounds like a paid part of a team. Alberta is looking at a mixture of staff and volunteers and also a much broader community focus. Are there other people in British Columbia doing similar things to this, perhaps being called something differently, as they work on outreach teams or other services in the community?

K. Diakiw: There are. As Shelley mentioned, at St. Paul’s there, they have peer support workers who do volunteer work within the wards and just sitting alongside people, and there are anonymous groups that work in hospitals through service work and volunteering, helping people along the 12-step path. There is kind of a mishmash of different services in varying degrees, most of them volunteer and unpaid.

Most, if not all, of the reports that I was reading…. Talking about learning lessons from other areas. Just this one from January from CCAR was saying that you absolutely actually have to pay these people a living wage. They tried to mix. They had a hybrid of volunteers and paid, and they said actually one of the warnings is make sure you’re paying them a living wage. They are trained paraprofessionals. They need a living wage. The New Mexico report also said similar things.

And we are different. One of the things when Ray and I went to Hartford in ’18…. It was a wild, wild west out here. There are people hanging shingles and saying they’re a recovery coach, and they had zero training. It was just dangerous, some of the things that were being recommended.

What Ray and I wanted to do was flood Canada with really well-trained recovery coaches so that it buoyed this service up into a really effective method of helping people get into recovery, whatever recovery looked like for them.

[3:40 p.m.]

M. Starchuk: Just to add to what you’ve said. I think I heard Shirley say something along this line. Kevin, you had just said the bit about hanging the shingle. There are two questions, just so we’re aware. What is the certification? What is the credentialing of a recovery coach? Where is it recognized, and how is it recognized?

K. Diakiw: Great question. In Canada, it’s through the CACCF, the Canadian Addiction Counsellors Certification Federation. They offer a CCRC designation, Canadian certified recovery coach. Through the U.S. and sort of internationally, there’s the RCP designation, which is recovery coach professional. Both are sort of equal standards. Shelley and I both have both.

M. Starchuk: If I may, it’s more about, Shelley, your role, which Kevin had touched on at the beginning — or part of your role, rather — about involving the First Nations role in the recovery coaching. If you could just touch on that a bit.

S. Shadow: Absolutely. I am developing…. I am Cree, from the Sturgeon Lake Cree Nation in Alberta. I am familiar with the conditions in which many Indigenous people may be found within the emergency department. Part of my role, and part of my heart for service to Indigenous people, is to ensure that our training is culturally diverse and sensitive to the needs of those people that arrive in the emergency department. Unfortunately, our Indigenous people are highly represented in addiction and in the hospital usage as well.

My plan and hope is to provide training that would help those that are wanting to work with Indigenous people in the urban setting, as well as providing liaisons with the hospital staff that may be working with Indigenous people in the hospital setting, just really making sure that there is a lot of groundwork done ahead of time so that we can meet the needs of these people.

They are unique needs. In terms of residential school attendance, so often there is that existence of people in authority and having fear of being in an institution. That would be something that I would want to include in our training: that culturally diverse training for people that are wanting to work with Indigenous people. I’m currently working on that.

N. Sharma (Chair): Great. I don’t see any other hands up. On behalf of the committee, I just want to thank you, not only for the passion that you hold for the work that you do and the lives that you’re impacting through that work. It has been very good to learn from you today, and I want to thank you for your time.

K. Diakiw: Best of luck to the committee and the job that you’re doing.

N. Sharma (Chair): I appreciate that.

S. Shadow: Yeah. Thank you for your questions.

N. Sharma (Chair): Committee members, we will be in recess until our next presentation at four.

The committee recessed from 3:43 p.m. to 4 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): I’d like to welcome our final presenters for this day at the Health Committee.

Welcome, and thanks for being here. We have two groups here, and each will get 15 minutes to present. I’ll just name you all for the record.

We have South Asian Mental Health Alliance and Students Overcoming Substance Use Disorder and Addictions. From there, we have Kulpreet Singh, founder of South Asian Mental Health Alliance; Shilpa Narayan, coordinator, South Asian Mental Health Alliance; and Gurkirat Singh Nijjar, founder of SOUDA.

We also have Archway Community Services — Natalia Deros, project lead.

I just want to welcome you. I’ll do a quick round of introductions here so you know who you’re speaking to. My name’s Niki Sharma. I’m the Chair and MLA for Vancouver-Hastings.

I’ll just pass it to the Deputy Chair, Shirley, to go next.

S. Bond (Deputy Chair): Thank you very much, Niki.

Good afternoon. I’m Shirley Bond, and I’m the MLA for Prince George–Valemount.

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

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

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

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

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

N. Sharma (Chair): Okay. I think I’ve got everybody.

I think the first presentation is a group.

Kulpreet, you’re going to lead that, I think. You have 20 minutes. Is that right? Two groups are presenting together. That’s my understanding.

I’ll pass it over to you. Then you have 20 minutes for the first go and then 15 minutes for the next organization. Then we’ll have the rest of the time, until 5:30, for questions and answers.

Briefings on
Drug Toxicity and Overdoses
Panel 3 — South Asian Voices

SOUTH ASIAN MENTAL HEALTH ALLIANCE,
STUDENTS OVERCOMING SUBSTANCE USE
DISORDER AND ADDICTIONS

K. Singh: Thank you so much. It’s a pleasure to be here with you all today.

I reside on the unceded territory of the Kwantlen First Nation and shared territories with other First Nation communities.

I’m currently in the Dominican Republic, and I’m not sure which Indigenous communities this land belongs to, but I would like to acknowledge that I’m on vacation here.

This work is very important, so I wanted to make sure that I joined from wherever I would be in the world. I would not miss this, because this is very important work. This is an emergency that we are in.

I want to introduce my colleagues. Shilpa Narayan is our project coordinator with the South Asian Mental Health Alliance, and Gurkirat Singh is a former South Asian youth mental health ambassador. After attending the South Asian Mental Health Alliance training, Gurkirat founded his own non-profit society called Students Overcoming Substance Use Disorder and Addictions, which branched off. They have an entire team of their own. They do outreach in the community, and Gurkirat will share more about their work.

For those of you who are unaware, I can give you a short introduction to SAMHA. South Asian Mental Health Alliance was founded in 2010. We started by hosting the first South Asian mental health conference in North America here in Surrey, B.C.

Over the years, we connected with different stakeholders, who provided us with funding and mentorships and connections to build capacity within the community around mental health and substance use. One of our niches became youth capacity-building and skills training.

[4:05 p.m.]

Because of that, we connected with Ravi Kahlon, and Ravi Kahlon connected us to the then Minister of Mental Health and Addictions, Judy Darcy. Through the connection with them, we received a grant for funding for our South Asian youth mental health ambassadors program. We had done this program previously, in 2014, but we repeated the program in 2019, which was focused on Punjabi youth born and raised in Canada.

The second cohort that we did was international students. Then, from the international students, that led to the inspiration for Gurkirat to start his group called SOUDA. The pronunciation is kind of like “soda,” but the “d” is a hard, Punjabi-sounding “da-da.” SOUDA also means to sort something out or to clean up a situation or to set something right, so it’s kind of like a “pull your sleeves up and get to work” spirit that motivated these youth.

I’ll let Gurkirat share a little bit about their work, the amazing work that they did not only recently but through­out the pandemic when there were a lot of restrictions. When the pandemic was first announced and people had a lot of fear in their minds around going out in public, these young people were out in every local park in Surrey, wearing protection, wearing masks, using sanitizer, wearing gloves, but still teaching people about how to use naloxone in Punjabi, in Hindi, and speaking to anyone who was out there who might be at risk.

I’ll pass it over to Gurkirat.

G. Nijjar: Thank you so much, Kulpreet Singh, for the introduction.

Good afternoon, everyone. My name is Gurkirat, and I’m a former international student from Punjab. I came to Canada in 2015. I was working in a gas station when I saw some posters of the overdose crisis in B.C. I was totally unaware of what was going on in the province.

As time progressed, I had an opportunity to attend a South Asian Mental Health Alliance retreat, and over there, when we were doing our mental health first aid certification, there was a small chapter, or a module, I would say, which talked about overdose response and prevention. So me and my fellow friends…. We thought maybe we can pull this chapter out of books, and then we can bring it to the community where people are dying and where the need is really high.

So that’s how it all started, with one simple training section. Then a bunch of volunteers came together, and we started hosting overdose response and prevention booths at various gurdwaras, other religious centres like mandirs, mosques and community parks. We have been doing this since 2019, September.

Our main job is ending stigma and shame around overdose, building capacity through community outreach, introducing harm reduction skills to vulnerable populations, people with language barriers, people working in trades, construction workers, truck drivers and other niches where language barrier is a big thing. Also, we have been focusing on people who are on temporary resident visas like work permits, international students and other community members.

We strive to provide culturally relevant and language-specific overdose response and prevention trainings right at our booths. We also connect families with mental health and substance use resources available in the community. We have connections with other organizations, and we are really thankful for SAMHA, for their support.

So that’s, in brief, what we have been doing since 2019.

K. Singh: Thank you, Gurkirat.

I want to go back to Gurkirat in a few minutes, but I also want to introduce Shilpa. We’re very fortunate. Shilpa has been, actually, a mental health advocate and a leader in this space for young people, a role model for young people, for quite a while, and that’s what led me to know about her and to connect.

Recently, the next cohort that we introduced was the Fijian community, and after that we are working on doing another cohort with the South Asian LGBTQ2S+ community. These are two projects that Shilpa is currently working on, and I’ll pass it over to her to introduce some of the work that she’s doing and how the drug toxicity crisis intersects with that.

S. Narayan: Thank you, Kulpreet Singh.

Good afternoon, everyone. Thank you for giving us the opportunity here to speak with all of you today. My name is Shilpa Narayan, and I am a mental health and addictions worker as well as a consultant. For team SAMHA, I am the project coordinator.

[4:10 p.m.]

As Kulpreet mentioned, the two sectors that I’m currently working on are working with Indo-Fijian and Indo-Caribbean youth. Those youths can be born here in Canada. They can have ancestry back in Fiji, like myself. And something that’s very important going with the drug toxicity happening at the moment, is this community. What’s the basis of how we come together and help one another? That’s community.

My role has been to come in with not only the Indo-Fijian community but also start a community with the South Asian LGBTQ2S+ community, which I’m also a part of. With these two different groups, my goal and my hope is to bring both of these groups together to have retreats. In these retreats, we’ll be having different community-building, cultural safety and diversity. We’ll be working with teams through that to do naloxone overdose-prevention training, as well as mental health first aid, mental health certificate, peer support — things like that that are building blocks to building community within a community.

As we know, right now the drug toxicity crisis is affecting everyone at every corner, no matter where you come from or how you’ve grown up. One of the things that I always tell people, in my many years of work, is that addiction does not discriminate. So by bringing in communities like this and having myself, having Kulpreet Singh, having Gurkirat Singh and having SAMHA and SOUDA here, we’re able to bridge these connecting blocks. Connection and conversation is what saves lives.

What I’ve been doing is…. I work together. I go out. I recruit in the community. I sit with the youth. I ask them: “What do you think is most important for you to bring your community together?” Just this last week SAMHA hosted a networking picnic for Fijian youth to be able to come together. We did an expressive arts therapy workshop. Team SOUDA was there to do naloxone training. We even actually had other community members coming to our table and asking us: “What is this? What is this initiative? What are you doing?”

That’s what really brings us to the work. For myself, I’ve been in mental health and addictions for over eight years now. I’ve worked everything from project coordination to front line at supervised injection sites. I’ve sat on different panels and committees as well, especially for our South Asian community, because it’s very important. It’s something that’s taking away members of our communities each and every day. My role in SAMHA is to bring that community together, through education, through our retreats and through our different seminars.

K. Singh: Thank you so much Shilpa.

One of the things that we wanted to address with you today was the lack of equity in programming that’s provided from the government and the lack of equity, in general, that we see in mental health care and substance use. This is something that we’ve seen across the board with racialized communities, whether it’s Indigenous communities, Black communities or people of colour.

Recently there has been census data that’s been released that shows that the Punjabi, Hindi, Gujarati languages are increasing in Canada. Punjabi is the third most spoken language across Canada now, especially in different regions. In the Fraser Health region, there’s a high population. Then there are new immigrants who are coming to Canada, but when they’re trying to access services, they face a lot of barriers.

When it comes to health provision or public health promotion, there still continue to be a lot of gaps. Although the intentions might be good, there’s still harm caused by the systemic gaps. For example, when it came to COVID-19, we see that Black communities and South Asian communities were the most disproportionately affected in Canada by the COVID-19 pandemic, according to the recent data that came out last week.

During the pandemic, when public health promotion was done, all public health press conferences and health updates were conducted in English with some French. We repeatedly advocated and requested that the Ministry of Health and the B.C. government please provide these conferences in South Asian languages, but that was not done.

[4:15 p.m.]

What is being done, which is a small step, is the translation work. But what we’ve noticed, from the community itself…. Whether it comes to SAMHA or SOUDA, we work with a lot of other local non-profit societies, like One Voice Canada or Moving Forward Family Services, that are interconnected with the community.

What they’ve told us is that people who are born and raised in Pakistan, Bangladesh, Sri Lanka or India, a lot of times, are planning — or their parents are planning — to send them over to Canada, U.S.A., Australia or U.K. They’re raising them with the national language of that country, but more so with English. So a lot of people are able to actually read English more than their own mother tongue, but they speak their mother tongue.

When it comes to speaking, they actually prefer their mother tongue. When it comes to reading, they actually prefer English, because this is what they were taught. In elementary school and high school, they were taught to read English. But with their friends and family, they always spoke their mother language. When they come to Canada, all of the press releases are translated into their mother language. That is not as beneficial to them. What is more beneficial to them is audio and video in their mother language.

There’s been a real, I think, gap in this, in having that information reach people, so the burden has been put on the South Asian media outlets. Throughout the pandemic, a lot of the different racialized communities’ media outlets tried to do the best that they could. It was very inspiring to see that work, but it was also disappointing. Why should a private media outlet have to do health updates when that’s exactly what the government is doing — health updates?

Those health updates…. If we want to show equitable outreach, if we want to prevent whatever it is, whether it’s the spread of COVID-19 or whether it’s saving people from toxic drugs and making them aware that there’s a crisis going on and where they can access naloxone from their local pharmacy, where they can access harm reduction supplies…. If that is available in audio and video on official government channels, that would go a long way in actually helping those individuals to get that information.

I want to use the rest of our time to ask Gurkirat to share some of the stories of outreach, because these are some of the powerful stories that we need to hear to understand what the challenges are that the community is facing. I’ll pass it back to Gurkirat.

G. Nijjar: Thank you, Kulpreet Singh.

Since we have been on the ground, for more than two years, I have personally heard a lot of stories which talk about the barriers people, especially new immigrants and international students, are experiencing in general.

For example, we were conducting our outreach at Bear Creek Park in summer 2020, and we met two truck drivers who were on work permits. They were temporary residents. We asked them if they were using harm reduction whenever they were injecting drugs. Surprisingly, they told us that they were using the same injection, same needles, whenever they were doing drugs together. We told them: “How come you’re not using clean needles or other harm reduction skills to lessen the harm?”

Their response was, basically, first of all: “There is a lot of stigma in my community. If I have clean needles on myself, in my house, my family will get to know that I’m doing drugs.” Secondly, another thing which surprised us was that basically, they were like: “We really want to get out of this vicious cycle of addiction, but the problem is immigration status. That is holding us from getting any treatment.”

We were like: “What’s stopping you from getting treatment?” They told us that whenever they go to a health authority or a hospital — somewhere for addiction treatment — they are unsure whether their health records will be shared with Immigration Canada, IRCC, later on, when they will apply for a permanent resident status.

This was one of the barriers. One guy told us that 70 percent of people who are working in the trucking industry and construction industry and who are using substances just to manage their pain, which was caused due to an injury at the worksite, are all ready to get treatment, but again, their immigration status is holding them from getting any kind of treatment.

[4:20 p.m.]

This really shook me, because everyone knows about the healthy immigrant effect. Whenever a person comes from another country into Canada, they have their medical checkups and their entire medical report, which is documented in their immigration documents. But the lifestyle of Canada is actually pushing them to use illicit substances, because they are fearful that if they get into treatment, they will be deported back to their country.

So this is the one thing I would like to bring up here. Maybe there could be some kind of intervention that can lessen this barrier and that can encourage people to get access to health care treatments, especially in substance use and addictions. That will save a lot of lives.

Secondly, we have met family members who have told us…. There was one lady whose son, 18 years old, and her husband both overdosed within a year in Surrey. She was like: “We went to different clinics and hospitals, but their focus was more on harm reduction rather than treatment.”

Also, whenever people send their loved ones to addiction treatment centres, they are fearful that upon going into that kind of treatment, which is not culturally relevant, they might end up in an even worse place because they are not sure, and some people are not…. They’re having a hard time trusting the health authorities, based on the English model of health care, because addiction is seen differently in different cultures.

For example, in India, most of the de-addiction centres keep a person for a certain period. So people have the mentality…. For example, if there is a clinic which sends people home at the end of the day, then they might be judging the level of appropriateness of the treatment.

I think there are a lot of things to improve. Firstly, involving family members in the treatment. They should be told what the mode of plan and action is that the clinic is doing.

Another example I have, on a similar issue, is that there was one mother — she was about 50 — and her son was suffering with schizophrenia and substance use disorder. So when they took the patient to Roshni Clinic. Roshni Clinic advised OAT, which is opioid agonist therapy. But the parents were, again, not sure whether to pursue the treatment because they were not involved in the mode of action of that treatment.

The mother actually told me: “How come they are giving more drugs to my child, when they are claiming that they are just treating him for overdose prevention?” That model of medical care actually falls down at that very spot when we exclude the loved ones who are the caretakers of those patients.

These are some stories which I have personally heard. All these stories convey a very deep message that we should be including everyone involved in the treatment of that person, not only the patient, and also, having more culturally relevant doctors and health care staff members can minimize this overall crisis that we are facing, and we are losing loved ones every day. Thank you.

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

We’ll pass it over to Archway Community Services. I think there are 15 minutes for your presentation. Then we’ll go to questions and answers.

ARCHWAY COMMUNITY SERVICES

N. Deros: Hello, everyone. My name is Natalia Deros, and I’m the project lead for The Cabin, which is a drop-in centre for the street community, many of whom are unsheltered and do have substance abuse issues, in Abbotsford, B.C.

I just want to say before we begin that I am on the unceded, traditional and ancestral territory of the Stó:lō people, specifically in Abbotsford. That is the land of the Sema:th First Nation and the Matsqui Nation, as well as a bit of Leq’á:mel and the Nooksack, because when colonialism happened, there was an arbitrary border between Canada and the U.S. I want to acknowledge that I am very honoured to live on this land.

I just want to give a brief history of Archway Community Services. I was the only one who was able to come here, so I am very honoured to be able to represent the entire organization.

[4:25 p.m.]

A brief history. Archway Community Services was formerly known as Abbotsford Community Services and was founded in 1969. They are very rooted in the community. In fact, I’d say that there is probably no social service sector that Archway has not been working with for decades on whatever issue. That could be advocacy and social equity, such as the food bank, seniors, supportive housing, disabilities, settlement, diversity education, Foundry, counselling — everything like that.

Abbotsford has a very large South Asian population, around 30 percent, and I am representing…. My job is very much with the street community itself, so I do not want to represent the South Asian community at all. I understand that this is mostly supposed to be about that, but I will be talking a bit about The Cabin, because that’s what I know, and I don’t really want to represent a community.

I did go and talk to the Abbotsford Addictions Centre and the opioid agonist treatment centre in Abbotsford, B.C., which is the only Archway program that focuses specifically on substance abuse. The opioid crisis, of course, touches all of us in all programs. All Archway employees, in some way, because of the way non-profits work, are dealing with the opioid epidemic, especially around intersections around inequity — like poverty, gender relations, racial and immigration status, etc.

The Abbotsford Addictions Centre has become much busier since COVID-19. Referrals, self-referrals intakes have both increased. They started in 1988. It has a team of dedicated mental health workers, counsellors, school educators, and three doctors. The OAT clinic, started in 2017, helps stabilize people who use substances and significantly reduces the harm associated with opioid use. A mental health support worker is there throughout every step of the journey as well.

It’s interesting because Archway, in almost all programs, has tried to reflect the demographics of the community. I know it’s ironic, because I am not South Asian myself. I do want to say that approximately…. At Abby Addictions, they’ve tried really hard to represent the population that is working there. There are quite a few staff that are South Asian, including the school educators as well as the doctors. There are three Punjabi-speaking doctors, and that is really very much community focused — a lot of referrals around that.

They’ve also found that more men are coming in than women. A little bit more than about 60 percent are men. A high number of seniors are accessing the program as well. As a result, I asked them what they wanted me to represent.

Abby Addictions said that stigma is still the number one barrier to accessing help amongst all demographics. This is lessening through some of the Archway programs. Archway have their fingers in everywhere. They’re very community development. In that way, whether your child is going to school programs, whether you’re doing family education, whether you’re learning English through LINC, whether you’re going to the food bank, there are a lot of workers that all know each other and are really working to reduce stigma around mental health and substance abuse.

There is still, of course, a huge intersection around mental health issues and substance abuse, which is why we really feel like it’s very important to have the intersections between both. And, of course, it should be a holistic approach.

Then there’s, of course, SACRO as well, which is the South Asian community resource office. They work with In It Together, which is creating relationships between youth workers, family educators and school supports with youth that are highly vulnerable to gangs. They’ve found a huge increase since COVID-19 around substance abuse as well as gang activity.

I did want to talk about that, but then, of course, what I work for is The Cabin, which is the street community specifically. That’s what I know the most about. The Cabin is a drop-in centre for the street community. I want to be very clear that many homeless people do not use substances at all, but a great many do. In fact, through the discussions with the Abby Addiction Centre, we both agree that we find that sometimes when people become homeless, that’s when they actually start using substances, or it becomes worse. That just shows the importance of housing first.

[4:30 p.m.]

The drop-in centre was focused specifically on providing daytime space for people who are the most marginalized in society. If you think of the shelters, shelters are often only open between 8 p.m. and 8 a.m. There is nowhere to go. If you think of the way that our municipalities or the way our space is organized, we generally don’t have places for people to go during the daytime that isn’t private — our homes, businesses, etc. — except for parks, which is a whole other kind of shelter, basically, daytime shelter.

This was a unique partnership within different groups. Let’s say Drug War Survivors, which is an Abbotsford advocacy group. We’ve had about 800 visits per month, with about 150 to 200 unique individuals coming per month. That’s quite something, because Abbotsford’s homeless count is actually around 300. We have pretty much the whole eastern Abbotsford group coming towards us for help with service navigation, which is like supportive housing, shelters, food. We have library books. We have a whole community that’s happening.

The other unique part is peer employment. So 35 peers, strengths-based. A lot of them are currently on the streets or currently suffering with substance abuse. Some use substances but are able to function quite well. Others are quite low-barrier, and we have an overdose prevention site.

For Abbotsford, this is quite new to have this kind of place. In many ways, it kind of challenges the status quo, in that having a place specifically for people who have nowhere to go is actually a very powerful place and a very powerful movement. The opioid epidemic hit the street community very hard. We know that a lot of overdoses happen in residential areas and in private, because of the shame and stigma around that, but for the street community, they’re still affected very strongly.

Just in the ten months since we’ve been operating, we have lost quite a few of our folks. It’s a really big blow to people, because you’re dealing with living through a lot of survival. Your nervous system is always on alert. You’re always looking for the next thing. Day-to-day survival is really hard when you’re on the streets. Then you’re also dealing with the grief of losing beloved ones, whether it’s your partner, your best friend or even somebody you’ve known for a few years. It’s a true community. People do take care of each other.

This drop-in center is very much low-barrier. No last names are taken. There’s no real intake. It’s all about: you’re here; it’s community; let’s just exist. We’ve actually found that through the peer employment program, having that OPS, where people feel safe enough to use and safe enough to not be judged, it really helps. That’s when people can start talking about where the worst supply is. Or maybe they want to go to treatment, etc.

There are so many barriers to getting there, and there’s so much stigma around just being unsheltered, even just how you’re dressed, that that is really difficult for a lot of people. That’s why I really wanted to talk specifically about the importance of having daytime spaces or just spaces where people can actually exist, be substance users, and not have that stigma and that shame.

The other thing I really wanted to point out is that from our street community, about 80 percent of our unsheltered folks are Indigenous or have some Indigenous background. Again, like the previous group were saying, racialized groups or marginalized groups are the most impacted by every intersection of any sort of social issue. The opioid crisis is not any different. Indigenous homelessness, of course, is also the spiritual disconnection from traditional lands, the culture, the extended family. It’s not just finding a shelter.

It’s really important to have those kinds of safe places, also, for people to connect to their culture, which is what we were starting to do with partnerships with the First Nations Health Authority, as well as Semá:th Nation Elders — that kind of thing, to really make sure that people felt safe.

In some of our peer employment, they find that there’s meaning. Maybe they’re not able yet to do full shifts, but maybe they can work two hours a day or two hours a week. It’s that kind of meaning and that value that they find, and the fact that they are not judged, even though they’re struggling with substance abuse or are not treated very well by the general public because of the discrimination against the street community.

[4:35 p.m.]

It has been very powerful to see the change in a lot of people and the decisions that they might make, like even going into supportive housing — which, for a lot of people, is a huge step, and not everyone wants to do it. I would say that it’s having physical spaces around harm reduction — not just harm reduction in the sense of safe supply or overdose prevention sites, but harm reduction in every sense — all the dignity and access to basic human rights and belonging too.

One person said: “I feel like I actually belong here.” That’s something we’ve heard quite a few times from different people. They can bring their dog. They can feel like a normal human being. They can have a space that actually feels like they’re living room or their porch, they can chill with friends, and there’s a sense of belonging there. Of course, the stigma is still very much there, and the intersectionality of all issues.

I think that to really focus on the opioid epidemic, it’s not just safe supply or clean drugs. It’s looking at what Gabor Maté says about trauma and the pain that leads to addiction. When your nervous system is always so on edge and there’s no sense of rest or belonging, it’s really important to have safe spaces — whether that’s housing, daytime centres or employment. I just want to really emphasize the social aspect, the bio-psychosocial aspect of all of that, which is what The Cabin provides.

Then — again, very much — the intersection between mental health and substance abuse is very, very strong. That systems gap or that systems failure is something, on the front lines, where I and a lot of our staff really feel frustrated, because we know that there are so many barriers for those folks to get to that place of getting that medical treatment or medical help. That’s frustrating, but to really focus on the intersections between the mental health and the substance abuse is really important, I think.

The other thing that people bring up a lot is the crime. I would say that most of our folks at the street community are not exhibiting criminal behaviour at all, and there’s huge discrimination against them. For those that do, it often comes out of mental health, like psychosis, or it’s survival crime.

I’d say that probably 95 percent of the time it’s because they’re not getting what they need financially. Whether that’s even disability cheques, their income assistance or just, in general, the rising cost of everything, survival crime…. I do think crime would go down a great deal and it would affect their sense of being able to live, which would also affect the addiction part as well.

Anyway, thank you very much for your time, and I really appreciate having this opportunity.

N. Sharma (Chair): Thank you. We’ll go to questions and discussion now.

Colleagues, any questions? Maybe I’ll start, because I had a couple, and then more people will jump in.

One of the questions I had is that you were talking about the stigma and how that keeps people from accessing services sometimes or even talking about it, and then the culturally appropriate services that need to be built up. I just was wondering. In your work, when you’re interacting with people in the South Asian community, what is that thing that helps bring people into services? Is it the individual connections you make in the parks? What is the service that’s working the best for that, and how do we figure out how to expand that? I guess that would be my question.

Then kind of tied to that is that part of the thing that we’re doing is examining the impacts of the toxic drug supply. When you’re interacting, particularly with the South Asian community, I just would love to know what the mix of drugs being used is. How do you respond? What are you hearing that’s being used in that community in terms of the toxic drug supply?

K. Singh: Niki, would that be addressed to me or Gurkirat?

N. Sharma (Chair): I guess whoever wants to respond. You all have expertise and understanding. I’ll leave it with you.

[4:40 p.m.]

K. Singh: Sure. One piece that I can say, and then I’ll pass it on to my colleagues, is that there was a tailgate toolkit, I think it’s called, that was developed by the Vancouver Island Construction Association. It was given a $1 million grant from the Ministry of Mental Health and Addictions. The CEO, Rory…. I contacted him to ask if this toolkit is developed in Punjabi, and the response was no, it’s not.

Keep in mind that, for example, in 2019, the Fraser Health medical health officer report highlighted that South Asian males are disproportionately affected by the drug toxicity crisis — and the other statistics that I shared, like how South Asian communities are disproportionately affected by COVID and then, also, that there are more people who speak South Asian languages. It was really surprising to me that in such a large program, which must have gone through so much vetting and so much consideration, there was zero consideration given to language.

That’s a real barrier. Again, it comes down to…. I’m sure the intentions are always great, but there’s harm caused when people are missed out on big programs like that. So that’s one large gap.

Like Gurkirat mentioned, there are people who work in the trucking industry, people who work in the construction industry. If their managers are able to train them in naloxone in Punjabi, if they have that capacity or they’re able to warn them about the harms….

But it’s actually been the reverse. Gurkirat can probably share it. I’ve heard of examples where, on some sites, workers have encouraged other workers to take illicit substances so that they can have more stamina, endurance at work. So it’s actually the other way around. That’s a gap that I see.

If Shilpa or Gurkirat have anything they’d like to share.

G. Nijjar: Yeah. In terms of a few names of the drugs which are affecting people living in Surrey, the two names that we hear a lot are benzos and fentanyl. In Punjabi, there is only one word, called chitta, which means white powder.

Now, some people confuse that with heroin, morphine — or fentanyl, benzos — because they’re unaware of the different nomenclature of drugs present in North America. Every region, or every language, has its own slang terms. People are unaware that there is some kind of naloxone service that exists in Canada or that there are drug-checking sites present in British Columbia.

Again, there is a gap. There is this barrier of language, and there is a gap between health care and the general populations living in the Lower Mainland.

Other than that, I have heard stories where employers have encouraged their workers to take illicit substances — for example, in construction companies — so that they can get more work done in one day. Similarly, truck drivers have reported that people who go on longer loads are encouraged to take cocaine or other stimulants to be alert behind the wheel and to have an aroused state of their mind. These are some anecdotes we have heard during our outreach.

Also, you asked about the biggest barrier. If we talk about work permit holders and international students, the biggest barrier is their immigration status. For example, when we apply for permanent resident status in Canada…. When I did back in 2019, I had a full medical checkup. There were two questions which were asked by the medical provider: “Do you have any mental health disorder?” I didn’t have any at that time; I said no. Secondly, they asked me: “Do you use any substances, or are you addicted to anything?” I was like: “No.”

People are really stressed out that if they go to treatment in a health care setting that maybe, when their records will be pulled out for their permanent resident status or citizenship of Canada, those medical records could be a hindrance for getting Canadian residency in the future. So that stops people from accessing health care services.

[4:45 p.m.]

Other than that, most of the work permit holders are working during the daytime, so they do not have time to go to a medical clinic. Most of them are working seven days a week because of the exploitation happening in our society. You might have already heard about the case of selling LMIAs and other documents, where employers demand huge amounts of money to provide immigration documents. They have to work day and night to manage their bills and get their immigration status expenses.

If we had clinics which had more flexible timings, according to the needs of the people who actually need care, I think that could also help a lot in providing the care that they actually deserve. Maybe in the future, the British Columbia government could have a meeting with different employers of different niches, like construction workers and truck drivers, and maybe you guys should bring out a report on what the reality of the situation is, with some scientific evidence. I think that could clear up a lot of doubts in the community.

Also, maybe on your immigration websites, it should be clearly written down: “If you have an addiction, or if you’re suffering with addiction and go to treatment, these will be the consequences.” There is a lot of fog around that topic. Maybe if people know that if they go to a treatment centre, get treated and get medical help, there will be no punishment in the future…. These are some suggestions which we have heard during our outreach.

N. Sharma (Chair): Thank you. That’s very helpful.

M. Starchuk: Thank you for your presentations. As an MLA here in Surrey, I do hear it from time to time. Especially — I guess it was a few years ago — I think the drug they talked about the most was doda. For the trucking industry, that was out there. That was keeping them out there on the roads a lot longer.

Kulpreet, I have big props to you — I’m glad you’re not doing this from the pool in an oasis and rubbing it in — for taking time out of your vacation to be here as a presenter.

My question is about the collection…. All of you are giving us some anecdotal evidence about what you’re hearing and what people are saying, but is there an actual collection point of what it is that that you’re hearing?

I think we heard from The Cabin that there’s no sign-in, and there’s no intake; there’s none of that. You’re just sharing your stories. You’re providing a place. You’re doing those kinds of things that are there.

I think I heard somebody say you’re bringing out some scientific evidence. Is there some data collection that is showing how the industry or the culture is, essentially, for all intents and purposes, being pushed into a corner of darkness where there’s no truth to what’s over there? It seems like there’s a fair bit of intimidation. Which employers are out there saying that to their workers and reporting that into some sort of an industry that basically says that this has got to stop?

K. Singh: I’m not sure if Natalia or Shilpa want to speak to that first.

S. Narayan: I can speak a little bit.

N. Sharma (Chair): Shilpa, you’re frozen, unfortunately.

I don’t know, Natalia, if you wanted to jump in.

N. Deros: I will say…. I should have clarified that The Cabin does take names; we just don’t take legal names. We are conducting a large study and evaluation on the project, actually, with UFV and community health, SACHSS. They’re looking at that.

[4:50 p.m.]

We are really trying to get some hard data, some scientific — you know, looking at it quantitatively.

I think the other question was a little bit more directed to Shilpa.

K. Singh: Before she comes back, there is information from, like I mentioned, the Fraser Health medical health officer with regards to how many people in the Fraser Health region have been affected by the drug toxicity crisis. That was a 2019 report, and there’s been no recently updated report on that, but the recent census data speaks to the demographics, and then the recent data about COVID speaks to the impact of COVID.

Like Natalia mentioned, these crises are intersectional. So when there’s one crisis that affects racialized communities, it will be a similar presentation in a different crisis. It’s the same kind of story in the drug toxicity crisis.

S. Narayan: I just wanted to continue. I think, Kulpreet, you said a little bit about the different reports that have come out since the census and the COVID-19 report.

Another hat that I play…. Alongside working for SAMHA, I also work the front line in various different supervised injection sites. I have since 2015. One of my biggest roles in that has been community connection.

Myself, as someone who sees both sides of it, as a worker and someone with lived experience who sees people in my own South Asian community going through this, I’ve made quite a few connections, when folks come in, to see where they are in their journey and how I can make that next connection, whether it be to go and take them to another clinic or get in touch with the social worker and things like that.

What Gurkirat was saying — I’d love to echo that. We need to be more flexible. Unfortunately, addiction and health are not Monday to Friday, eight to four. Many crises happen outside of those hours. So it’s important that we bring that flexibility, bring more of an outreach approach.

Again, like my other colleague said, intersectionality plays a very large role in this — socioeconomic status, education, cultural background. Any sort of experience that comes to that actually does determine our access to services, whether we really cognizantly think about that or not.

In the last year or so, I’ve also been working for UBC in a coordination position. Working, actually, in partnership with Foundry, as well, we did a study on the impact of COVID-19 on youth mental health. A large thing that came out of it was substance use.

Also, looking at it from a cultural perspective, many of which we’ve talked about today, of there being a lack of cultural support and safety…. Newcomers to Canada, students that are coming to Canada…. Unfortunately, these are situations that, very much like health care situations, don’t stop when you move to a different country. So it’s important that we support that in that way.

P. Alexis: It’s along the lines of Mike’s question. I just want to put it out there.

First of all, thank you for your honesty, and thank you for this really important presentation for us to hear. A lot of it I kind of knew, but you’ve solidified the things I think I have heard over the years.

Can you help me to provide some suggestions on how we deal with the employers who are encouraging drug use? Do you think we should be going through the training authorities? Tell me how we combat this. I understand, leading up to it…. This is not okay. I want to try and figure out how we deal with that, if you could.

G. Nijjar: Kulpreet Singh, is it okay if I share some thoughts on this, or would you like to?

K. Singh: No, please go ahead.

[4:55 p.m.]

G. Nijjar: There was actually a report from One Voice Canada, I think last year, where it talked about LMIA trading. LMIA trading is basically employers who are profiting from this phenomenon. This involves selling fake jobs, through LMIAs, to international students and work permit holders to settle in Canada.

The current rate, if I talk about the price of buying one LMIA right now in Surrey, is around $50,000. So now, when someone who is buying an LMIA for $50,000…. He has to pay back that money to the employer and also has to work day and night so that his employer is not mad at him or doesn’t fire him in the future or doesn’t sell it to anyone else.

It’s a vicious cycle where the person who is being affected by this is unable to get out of this vicious cycle until or unless he or she gets their permanent residence. This opens doors for all kinds of exploitation, whether it is having to take illicit substances to improve their work performance or having to submit fake documentation to Immigration Canada. Maybe if we can work on this LMIA trading at the moment, that can help a lot of people out there who are very vulnerable. This can also put a halt to employers who are indulging in this kind of trading and exploiting people.

Other suggestions. I’m a previous international student. I remember I had to work, for example, seven days a week without off. If I was asking for a day off, let’s say, for my medical appointment or going to see my friend, my employer would say: “No, you cannot, because we are helping you, so you have to help us back, in getting our business to run smoothly seven days a week.”

Maybe there should be a platform or, let’s say, an online website where people can anonymously report these kinds of exploitations so that government can actually know what is happening in the community and the identity of that person remains anonymous. That’s one suggestion.

Government has to put this out on bus stops, on radios. We have to advertise it everywhere so that people who are actually affected by this can see that there is some kind of helpline or service available which will hear them and can protect their rights as new immigrants in Canada.

S. Narayan: I strongly believe that labour exploitation and drug exploitation very much go hand in hand. Many clients, many folks I’ve worked with who work front line in trades are either working 13- to 15-hour days or doing long-haul trucking. Oftentimes these individuals who have come into our OPS, into our safe injection sites, or if I’ve met in the community…. It’s often stimulants, with crystal meth and cocaine.

But as we know, right now both of those are also being laced with fentanyl. Especially if…. The higher the benzodiazepine in that drug, as well, it’s harder to actually reverse that overdose, leading in the largest cause of death. Many of those situations are happening here on our trade lines.

Something that would be important to look into is a form of a labour law, something that we can go into and actually structurally put in, because we do know, unfortunately, that those who have used exploitation as a means to “succeed” will continue unless something very structural, very much into our labour law, is changed. Like I said, those two things very much do go hand in hand.

K. Singh: Yeah. I agree with Gurkirat and Shilpa that the exploitation is across the board. It’s very deep-rooted, and it’s in all industries. It’s not only in employment; it’s in education as well. We’ve actually spoken to the minister of higher education, had a meeting, and unfortunately, there was no follow-up after that meeting either.

A lot of international students get exploited within their schools. They pay exorbitant fees, but they don’t receive mental health care in their language. We’ve had meetings with institutions of higher education. We’ve met officers of internationalization and international student relations at different higher-education institutions. We’ve sat down with them and given our suggestions, and then we’ve been completely ghosted.

[5:00 p.m.]

When we try to follow up and ask, “Is there a way that we could support your counselling centre to provide more services in South Asian languages?” we receive no reply. There’s no accountability towards new immigrants or towards international students.

N. Sharma (Chair): I have another question. I don’t see any other…. Pam, did you have another one, or were you done?

P. Alexis: No. I just wanted to say thank you for all of the information.

N. Sharma (Chair): This has been really informative, I think, for everybody.

I have a question about — Shilpa, this may be directed towards you — accessing safer supply for the South Asian community. One of the things that we’re meant to make recommendations on is expanding access to a safer drug supply, what that looks like. I just wondered if you, through your work, are connected with programs or how that shows up in the communities you work with or whether safer supply is even a topic or…. I just am curious about that.

S. Narayan: Yeah. Absolutely, Niki. Thank you.

Gurkirat and Kulpreet, please do chime in as well, especially from your experience in team SOUDA, Gurkirat.

My experience with the safe supply…. It’s there. However, the steps to access it aren’t quite there yet. I’ve seen different safe supply programs both here in Surrey and also in my time working in Victoria. Both of them, of course, are new — in the past couple years. Now it’s been coming up. As you know, earlier this year is when that conversation came more into media. So there are places that are now offering a safe supply. However, the process is quite hard.

There are quite a few steps in order to get to the place where you can get safe supply. Many of our street folks who are trying to get onto safe supply…. Some of them may not have homes. Some of them may not have adequate access to any sort of service, basic needs. Having to then go every day at, say, 12:30 p.m. to make it to your appointment to receive your safe supply can be quite difficult in some ways.

So what needs to then happen is the positioning from A to B…. How can we get our folks to go and get the safe supply, which is there, being generated? How do we make the access lower barrier but also keep the safety a priority? The health of our folks who are going to be accessing that is a priority.

Then on the other hand, as well, is the longevity and sustainability of the programs. The funding is happening, slowly but surely. However, the supply and demand — there’s inadequacy there. Having that conversation and trying to bridge those gaps is…. Yes, this is something that is so very much needed. There is research. There are reports out there saying that it is helping many, many, many individuals now, even get into treatment, getting into places that…. They thought before that they were absolutely hopeless. “There is no hope in me being able to access treatment.”

However, safe supply is often that next step as well. That’s why I truly believe that we need to be putting in more resources in terms of accessing the service.

D. Davies: Thanks very much. I certainly echo the other comments around that this has been a very interesting and very enlightening presentation. So thank you for that.

Thank you for the link in the chat there as well. I just took a quick scan through it. Certainly we’ll be looking at it a little bit closer in regards to the realities of international students and the conversation around the exploitation of immigrant workers and such, which leads me, I guess, to my question.

With your organization, the South Asian alliance, have you, as an organization…? Again, I presume this is across all immigrant communities — the Filipino community…. You know, the list goes on and on. Has there been some work with your organization to work with some of these other communities to move forward with some positive results and advocacy work?

K. Singh: Yeah. Thank you, Dan.

[5:05 p.m.]

We have continually worked with different advocacy groups that represent new immigrants. One Voice Canada represents…. It’s an advocacy organization for international students. Then Moving Forward Family Services provides low-barrier, culturally relevant, language-specific counselling services across the Lower Mainland in various different languages.

Then we are also part of the various community action teams and different organizations like that that we connect with, but I would say maybe not so much on a collective level, in terms of issuing some kind of a request or an open letter or something like that to government. But with One Voice Canada, like I mentioned, we did have the meeting with the Minister of Advanced Education. That was with various different advocates. We presented a lot of these different concerns, which are kind of like the precursors to people burning out and getting introduced to substances or feeling like they need to start using substances.

Like my other colleagues have mentioned, if these sociocultural, socioeconomic determinants of health are factored in, then people may not be facing those hard times. They might not feel so burnt out or so exploited or so exhausted from their work situation that they need to look towards substances.

The other thing I just wanted to mention, regarding the previous question as well, is that when it comes to the point of care, like when someone is trying to access emergency services, it’s a revolving door. A lot of times, people have a stigma already towards people who use substances, and then there may be an inherent, unspoken bias towards new immigrants or people who can’t speak English fluently.

If someone comes into an ER with an overdose, they are treated and released, treated and released, treated and released. That’s it. There’s not enough follow-up to make sure that they’re connected with a social worker, connected with detox, connected with what treatment services are available out there or even, sometimes, connected with an interpreter. A lot of times, people don’t speak English fluently, and there just isn’t the capacity in the health care system to arrange an interpreter on the spot.

These are some of the places where people actually could get help, that they could find some kind of medical support. Then they go back into this world…. Like Gurkirat mentioned, they go back into the cycle again. Then, maybe after two or three weeks, or two or three months, they come back to the ER, and then there’s another chance. But that opportunity is missed again, and they go back out. In that cycle, many people lose their lives from overdose.

N. Sharma (Chair): Okay, I don’t see any other hands up. I just wanted to, on behalf of the committee, thank you all so much for your time but also the work that you do. It’s so important to have voices that are highlighting those that don’t have a voice. I feel like you really did that today very well, and I want to thank you for that. I’ve certainly learned a lot, and we appreciate that. All the best.

I guess I would need a motion to adjourn for the day.

I see Dan and then Pam.

We are adjourned, and we’ll see you tomorrow.

Take care, everybody.

The committee adjourned at 5:08 p.m.