The committee met at 2:04 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Welcome, everybody. We’re reconvening our committee for today.

I want to start by acknowledging that I’m on the traditional territory of the Coast Salish people, the Squamish, Musqueam and Tsleil-Waututh.

[2:05 p.m.]

I want to welcome our first speaker today, who’s Ben Perrin, University of British Columbia professor at the Peter A. Allard School of Law.

I want to welcome you on behalf of the committee. I’m just going to go through who you’re speaking to so you have a little idea of that. Then it will be 15 minutes for your presentation and the rest of the time for questions and discussions.

I’ll pass it over to our Deputy Chair first.

Go ahead, Shirley. Introduce yourself.

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

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

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

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

N. Sharma (Chair): Okay. I think a couple of others are joining us very soon.

I will pass it over to you, Ben. We appreciate the opportunity for learning from you.

Briefings on
Drug Toxicity and Overdoses

BENJAMIN PERRIN

B. Perrin: Thank you very much. I really appreciate being invited. I’m honoured to speak to you today. I’ve got the terms of reference from the committee, and I thought it would be helpful to just highlight a few points with respect to those. I’m really looking forward to your questions.

The starting point for me with looking at the opioid crisis began about 4½ years ago. It started with hearing case after case of people overdosing and dying. Back then we were still hearing about individuals. It was hearing about their lives and the people they left behind. Very quickly things got much worse, and it became just increasing numbers of people, and we never heard the stories of people much — if anything, anymore. They had to be outlier cases, someone who was very young or some extraordinary reason.

I guess that’s where I start. That’s a very harrowing place to be in a public health emergency: that it has become a blur of numbers. Would it make a difference to the public, to government, if we added a zero to the number of people who died of illicit drug overdoses this month, this year? I don’t believe so. I think the numbers have…. People have become numb to numbers and statistics.

The issues, as I found in my research, as I began to speak firsthand with people who had lost loved ones, people who use drugs, police officers, Indigenous harm-reduction workers, addictions medicine experts, the border officials, prosecutors, judges…. In my study that I did for my book Overdose, I interviewed all of those folks and also had the opportunity to go firsthand and spend time at an overdose prevention site, to spend time at the Crosstown Clinic where, as you know, safe supply has been made available for years now with great, great effect. That was really what transformed and changed my heart and mind about this crisis.

Initially, the thought I had was that I would prepare a white paper. It would be a list of policy recommendations for government — that that’s what would come out of my research. Instead, it became very clear to me, doing the study, that it was not the policy recommendations that are the confusing part about the issue of the opioid crisis. It is about marshalling adequate public support and political leadership to do what we already know needs to be done.

This is not a committee which, I would suggest to you, is looking for a silver bullet: some new policy recommendation, some new idea. The policies that have evidence to back them up, that we know have benefited and made an impact in saving lives…. There would be many more lives that would have been lost already were it not for many of the things that have already been done, but much, much more is needed.

This is, as you know, a highly political issue, a very charged issue, a very polarizing issue. It’s one where people have very deeply held opinions, beliefs, and have been profoundly personally affected by substance use addiction and overdose deaths. So it is it is a very challenging public policy and personal issue.

My approach in addressing it — I put it forward. I shared with you the policy recommendations that came out of our study. I’m happy to talk about any of them. But again, I don’t think this is mainly about hearing me for 11 minutes more on why we need to do more to decriminalize drugs or provide a safe supply or invest in further recovery measures, and so on and so forth. It’s mainly about: how do we as a society, how do you as committee members, participate in shifting public opinion and helping to change those hearts and minds?

[2:10 p.m.]

I found that there were a couple of things that were really profound in my journey, that began to change my view. As I wrote my book, I’ve had multiple people — many, many people — contact me and say that it changed their minds too.

What were the things that shifted me from thinking, “Drugs are killing people and bad, so we should do more to suppress them” and “Why can’t people just stop using”? All the questions I ask in my book ultimately came down to a couple of things. Number 1 is we need to get back to seeing this as a crisis of individual people and families and communities. It’s not about the numbers. The numbers are horrific. But like I said, I don’t believe that the answer to this is that if it got worse, it would somehow get treated more differently.

We need to be profiling and supporting those who have been most profoundly affected. That includes people who use drugs and the family members and surviving family. They need to be given a much greater profile. That would include — I would suggest to you, if I may, in your committee report — these stories, the anecdotes, the accounts. Those are powerful. People need to see how someone came to use drugs, efforts they often took — multiple efforts — at recovery yet still ended up overdosing and dying.

There’s a very substantial segment of society — which I say not anecdotally but from public opinion research as well — that believes the answer to this is forcing people into treatment. That’s an example that we are hearing more and more of — that somehow that could be effective and work. That is just, of course, more part of blaming people who use substances, and we know it doesn’t work. It’s ineffective. So that would be my first point, I guess: to really humanize the crisis again.

The second thing would be to profile, in addition to that, uncommon voices in the debate. For me, that included judges — having sitting judges who went on the record, remarkably — and police officers. This is before the Canadian Association of Chiefs of Police came out supporting decriminalization. I had multiple police officers, border officials, telling me: “We can’t find the fentanyl entering Canada. We’ve tried. It’s a needle in a haystack.” We need to hear from people who are not the usual suspects on this topic. That’s why I’ve been happy to speak to anyone who will listen.

I’m an unusual suspect. As you know, I was a former senior criminal justice adviser to Prime Minister Stephen Harper. In writing this book, the analogy I had is a bit like the atheist who goes out and then suddenly converts to becoming a believer. Or it’s someone who was a carnivore their whole life and became a vegan. Something happened there. What’s going on? It’s an unusual voice. People sort of stand up and listen. I think we need to do more to do that.

The third thing is greater coalition-building, and this is something that I’m not sure how much the committee can support. This issue has not been one, unfortunately, that we have seen a broad coalition of individuals come alongside and support. It’s been, for whatever reason or for various reasons, a very splintered group of individuals and organizations that are advocating for change. That has, I think, been very unfortunate.

Fourthly, I think the part where I do come to you folks as elected officials, as members of political parties — I was involved in party politics heavily for decades — is that I would just really plead with every one of you here to take this message back to each of your leaders in your caucuses. This needs to get depoliticized now, here in the province and federally, but we’re talking in B.C. I have absolutely no time for anyone who wants to make political gains off this issue. I will 100 percent call you out, and I’ve done that with federal and provincial leaders already.

I know how crime and law-and-order politics work. I understand that they win votes. I know that people are scared of drugs. They’re afraid to have overdose prevention sites anywhere near their neighbourhoods. They don’t even want supported housing.

First and foremost, I believe that every one of you is in here for the right reasons, and I know some of you. I met with some of you in the past, on other issues, and I know that you are people who are deeply committed to your communities, to this province. The best thing that could come out of this committee’s report is an unanimous report that supports a compassionate, evidence-based response to the crisis. I hope that’s helpful.

I do have a few minutes left, so I do want to highlight a couple of policy recommendations, since I know that your report will undoubtedly include some of that material.

[2:15 p.m.]

To start with would be to do the opposite — to say what I would not recommend. What I would not recommend is any form of involuntary, forced, coercive forms of treatment, and those take many forms. I would definitely not recommend that. The research that I did was very clear, from multiple sources, that that is ineffective. It doesn’t work. Ultimately, that’s just putting the blame of someone developing a substance use disorder back on them, when, in fact, we should be looking in the mirror.

Most of the people in our society, in B.C., who are addicted to opioids…. We know that it stems from things that are beyond their control, like childhood trauma, genetics, stuff like that. So I think that needs to not be part of this.

The second thing is that abstinence-based recovery programs are very popular. They also put the blame and onus on someone who is using substances to just stop, just go cold turkey. I again go to the evidence here. I mean, the guidelines published in Canadian Medical Association journals, other medical studies, have found that abstinence-based recovery alone, on its own, is dangerous and ineffective. It actually increases the risk of overdose death.

There’s an article in a British Medical Association journal that was referred to me by one of the chief medical officers on the Island, actually. It found that people who successfully completed a 28-day abstinence-based detox program were more likely to overdose and die than those people who had “failed to complete the program.” So that should tell us something quite striking — if your treatment program is actually leading to worse outcomes, you’ve got a pretty big problem.

I would encourage you to follow those medical studies and not anecdote. Absolutely, we can find people who will say, “Cold turkey worked for me. I’m alive and well because of it. I needed someone to force me” — X, Y, Z. We’re not dealing with anecdote here. We need to deal with evidence, and we need to deal with peer-reviewed medical studies and that sort of thing.

Certainly people who have had support…. There are other ways that that can be done. But the medical guidelines on this are pretty clear, and I don’t see any reason why a political committee formed of elected officials would want to depart from that. I think there are very clear guidelines on what works for recovery and what is ineffective. The reason for that, quite simply, is that people’s tolerance rapidly declines when they stop using opioids in particular. That happens in detox centres. It happens in provincial custody and federal custody and remand.

Just to give an example, someone who is released from prison is 50 times more likely to overdose and die, because this is a chronic, relapsing condition. That’s a pretty serious piece. Those are some things which I would not recommend.

Another one would be…. This is not something that can be solved by policing, by more funds being given. I would encourage the committee to be very skeptical and ask a lot of questions of any police witnesses that come before the committee that have statistics on trafficking charges, for example.

I’m grateful that the VPD was very transparent with us, in our study. When we’d asked for information about the number of trafficking convictions, it turned out that the overwhelming majority were street-level people who were dealing. Most of those folks would be dealing to, for example, sell nine hits and use one themselves. These are not kingpins. These are people who would otherwise not be able to obtain those drugs. So that street-level trafficking sort of data is really suspect.

The other reason why going after traffickers and keeping this war-on-drugs approach going is that…. The research also shows that if there even was any kind of minor increase, with a major bust, in the price of drugs, that is a temporary measure. Over the decades, the data coming out of the U.S., in particular, is that the iron law of prohibition — which some of you are familiar with or read about in my book — is alive and well in the opioid crisis. That’s the harder the enforcement, the harder the drugs.

We’ve seen that as increasing quantities of heroin have been seized globally, organized crime doesn’t pack up their bags and go home. Somehow, somewhere, someone discovered the formula for fentanyl, which as you know, was created in the late 1950s as a palliative care medication. That now can be created anywhere and everywhere, and we are simply not able to find it at the border in any kind of quantity that would make a difference. So going after the supply angle on this is not only a losing game but actually can make things worse and leads to increased potent drugs like carfentanil as well.

Finally, I would refer to the policy recommendations that I sent to the committee earlier. You have those in writing. There are seven of them with some sub-bullets. We call this the Vancouver declaration because it came out of research that was primarily done in Vancouver but also in Victoria and Surrey, which were the three, at the time, most predominant areas for opioid-related overdose deaths.

[2:20 p.m.]

You’ll see some things in there that are, again, quite common, but I would be happy to answer any questions about those.

The final point I would make is — I don’t see it profiled often in the press or in public debate about this — point 6, which is that we really need to increase support for Indigenous communities, front-line and peer-based organizations, and families of people who are either grieving the loss of a loved one or who are supporting someone in active addiction.

We talk a lot about decriminalization, safe supply, harm reduction. I fully support all those measures, but the piece around that last one is really crucial. Then also, hopefully, we can talk a bit about B.C. provincial custody, because as we are aware, that’s the greatest at-risk population.

That’s my time. Thank you very much for the opportunity. I really appreciate your time.

N. Sharma (Chair): Okay. Thanks so much.

We’ll go to questions, discussion. Any questions, committee members?

S. Furstenau: Thanks so much. I did read your book a couple years ago, and your journey was so well documented in there. It changed my mind, too. It really had a profound effect on me to read how you started in one place and where you ended up. I really thank you for that, because I think that is a powerful way to talk about things.

B. Perrin: Thanks for saying that. I appreciate it.

S. Furstenau: One of the things we’ve heard about…. I see it in your recommendations around research to develop new treatment options, holistic response. One of the factors we have in B.C. is that this is not a regulated or evidence-based world, whether it comes to addictions treatment or even mental health in general.

Could you talk to us about the risks of that non-evidence-based…? I mean, you touched on it, with the increase in overdose risk. But I’m wondering if you have insights around how to make sure that the programs that are being developed aren’t actually perpetuating more harms.

B. Perrin: Yeah. Thank you for the question. I think, like any area of health, there needs to be…. I’m not a health expert, but I did speak with many who are, and I know you will. There should be standards of care for recovery. I think that’s something that we could talk about — that there should be a standard of care.

We have a standard of care for all other medical conditions. Whether you go to the hospital for a broken arm in Victoria or Prince George, there’s a standard of care for that. You’re not going to get some kind of treatment from someone who came up with an idea and now runs a camp in the middle of nowhere. Like, what’s going on? There are the billboards; I mean, we’ve all seen them. Especially when government is funding it, there’s also an issue there, I think, as well.

I think coming around that…. The other thing I would mention, though, is that there are many pathways to recovery, so it is a bit different than the broken-arm analogy. We know that people do respond differently to different treatments.

We know that some people respond very well, for example, to something like Suboxone, and others don’t; some to methadone, and others don’t. Maybe in combination with those or on its own, there’s a huge faith-based component for some people. For others, it’s Indigenous ceremony and culture and tradition. So we have to recognize that there’s a diversity of things, but we also need to see — and measure, I think it’s fair to say, as well — the outcomes of those.

Some of the harms…. The biggest one, as you flagged that I’d mentioned, is that our treatments are worse than the disease to begin with. That is a message I heard time and again on the cold-turkey, detox-only approaches.

The committee will no doubt be aware of the Brandon Jansen inquiry — the coroner’s inquest into that particular abstinence-based recovery centre. Mr. Jansen was recently released from custody and, of course, at that much higher risk of overdosing and dying, like I said; going to what I understand to be a private — and most of these are very expensive — recovery centre; and released on conditions, undoubtedly, that he not use.

This is a very common type of thing. I’m bringing up that case as an example of a detox-based program and of someone who did, tragically, die. There’s very good documentation around that.

[2:25 p.m.]

More broadly, we see that pattern again and again. The death panel review — not the most recent one but the prior one — that the coroner did really focused on the role that provincial corrections plays. So there is another piece related to recovery and treatment, which is: what happens with people who are incarcerated in B.C. corrections facilities? What access do they have to harm reduction supplies, safe supply, evidence-based treatment and recovery? What support are they given on release?

That is the crucial time. The days, weeks and months after release are really significant. I haven’t seen current statistics in B.C., but we need to have them. Alberta disclosed this year that 50 percent, half, of all overdose deaths in the province was someone who had recently been released from custody.

This is about a very stigmatized population, a very vulnerable population. It’s one where, again, if we start to wonder why — people always ask, “Why hasn’t more been done?” — it really comes back to that. You’re dealing with an intersection of people. Of course, we know it affects all branches of society, but the disproportionate piece is people who are poor, people who are Indigenous, and people who’ve spent time in jail. And if you combine any one of those two or three, you’re at way higher risk, right?

I think a big rock that has not been picked over and looked at in this province is the corrections piece, to be quite frank with you. It’s not a popular one to do, but that’s the kind of work that the committee can do. The government has full control over what goes on in corrections facilities. It doesn’t on private recovery sites, but it is fully accountable for that. Those folks’ lives matter, right?

Remand is a big part of that too, people who are presumed innocent. We’re sending them into a place where they have limited access to the drugs that they’re depen­dent on. When they get released, they’re at significant risk of overdosing and dying.

The last thing I would say on that is that it’s essentially a death sentence, in many cases, to send someone who has a substance use disorder to jail or prison.

P. Alexis: Your comments are timely, because we did have B.C. Corrections on yesterday in presentations, and we asked the question about treatment options while those are incarcerated. We learned that the shorter sentence is problematic, in that they can’t work with a person who has only been given 34 or 35 days. There’s a whole, I think, rethinking.

We talked about it, for sure, and we inquired as to what was working right now within their system. She did reference a treatment centre that Corrections runs in Nanaimo, but they’ve certainly got some human resources issues, as everyone else does.

There are a number of things. I think, too, that they were missing data and not really able to speak to a whole lot of it because they hadn’t done that deeper dive within their client base. So I think you’re absolutely right. There’s some room for conversation there, but it’s limiting, I think, with the rules that are in place right now. It’s a big conversation to have and, absolutely, it’s going to be challenging for those sorts of institutions that have been set in their ways for many, many years.

Anyway, I really appreciate your work. I think it’s simple, but it’s brilliant. Congratulations. I’ll be looking at this, certainly, a little bit more deeply after we finish, and I just wanted to hear you speak, mostly, first. Thank you so much.

B. Perrin: Thank you very much. Yeah, on the short-sentences piece you mentioned just briefly, there’s also evidence that shorter sentences not only serve no public safety benefit but that they actually are criminogenic, which means they make it more likely that someone is going to reoffend.

Just on the issue of short sentences, Michael Bryant — who is, as you know, the current CEO of Legal Aid B.C. — was formerly the head of the Canadian Civil Liberties Association. In that prior role, at least when I spoke with him for the book, he spoke about the need to get rid of short-term sentences because of the lack of public safety benefit.

They have the additional harm that that’s more than enough time…. Those 30- to 60-day sentences are enough time for someone to rapidly lose that tolerance and then be released — also released without naloxone, released without a safe supply.

[2:30 p.m.]

One of the physicians I spoke to in my book said that an individual who had been released from prison, basically just a “walk out the front door” kind of thing, ended up hiking his whole way across the Lower Mainland to get to the Downtown Eastside to get a prescription filled for his medication.

I don’t know if it was Suboxone or methadone, but it wasn’t even safe supply. He wanted to not use. This is someone who is committed to trying to get help, and that’s the kind of treatment that this province gave that man.

I don’t have any time for B.C. Corrections saying: “Well, we’re just trying to figure this out.” We’re six years into this. The coroners death review panel is four years old now. Before that, there was plenty of evidence that corrections custody could directly contribute to overdose deaths.

The fact is that the state is the cause of those deaths — directly the cause of those deaths. They’re not being counted. Why? It’s because they don’t happen in the institution. If they happened literally in the institution, then there would be a bigger outcry. But because of the way that this health issue plays out, it’s in the community when the person uses again.

I actually do think that the pressure needs to be really turned up on B.C. Corrections. Again, why hasn’t it? It’s because these people are “criminals,” and their lives don’t matter as much, or they’re deemed criminals, and they’re Indigenous, or they’re poor. I really think it’s incumbent on us to treat them with dignity. None of them were sentenced to death, yet that’s the outcome, in many cases.

Thank you very much for what we had to say.

S. Bond (Deputy Chair): Thank you for being here. I know that we have had conversations in the past — not about this topic. I think it was child trafficking, when you were working on that — again, a very difficult topic. Like Sonia, though, I am currently reading your book and on that journey. So I appreciate it. I appreciate that you are, actually, an uncommon voice, and I think that’s really important.

I just want to build on the conversation about corrections and then move to one of the recommendations that you’ve made, Ben. In fact, what we learned yesterday was that in B.C., 66 percent have been clients of B.C. Corrections at some point in time, of the people that die of overdose. The funnel is narrowing when we think about the overlapping things, in describing who is dying in our province.

When you talk about moving public support and bringing people along with public policy change, part of it is that people don’t have a good understanding of who is dying. It is, right now, characterized, and tragically so, as a sort of Downtown Eastside or homelessness or whatever it is…. We know that the construction industry is one of the most significantly impacted. I think you’re right. It is a journey. I am on that journey — I have said this to this committee numerous times — and continue to be. I’m learning as we go here.

What was staggering to me was that 10 percent of that 66 percent die within a month of release. That is a staggering statistic. Why? It’s because there are no supports. What I found shocking yesterday, frankly, was that there has been no work done on whether or not the 10 percent of the people that have died within a month of release had any form of support or treatment at all. Apparently, we don’t know that. That matters, too. If they are completely disconnected from support at their release, that is a huge gap. We were talking about that yesterday.

I do appreciate your comments about Corrections. I just want to, also, though…. In your recommendations, your list of recommendations, there are some challenging ones there, but I appreciate the way you’ve described how the provision of safer supply might be considered.

[2:35 p.m.]

It isn’t simply: “Let’s just expand the provision of safer supply.” You have some very specific criteria that you include in that recommendation, including: “under medical direction and supervision,” “to people with opioid use disorder,” etc.

Can you just talk a little bit about what a provincial model looks like with appropriate clinical guidelines? One of the reasons that people are concerned is that there is that image of: “Well, let’s just hand out ‘free drugs.’” If we’re going to have that conversation, there needs to be a framework for that. When I started on this committee, one of the questions I asked myself was: what does a provincial model look like? We don’t know what it looks like. If you could speak to that.

I also wanted to thank you for reflecting, ironically, on what we learned yesterday, around the prison population. Interestingly enough, the statistics that were included did not include those who had community involvement. They were not incarcerated, but they are still clients of B.C. Corrections. We learned a lot yesterday about that, and I think we have some more work to do on that.

Anyway, I appreciate seeing you again. Thank you for presenting. I’m continuing to take my journey as I read through your book as well.

B. Perrin: Thank you. The first thing I would say is that it’s really exciting to hear the openness that you have. I’ve always seen that in how you approach issues. You want to kind of hear the evidence yourself.

It took me a while. I had to actually go through that process. When people that I speak with say, “Well, I don’t agree with you on decriminalization or safe supply,” whatever it is, I say: “Hey, that’s okay. That’s where I was too.”

You’re not saying that, but my point is: I was the skeptic. You could literally take pretty much all of these on the list, except for maybe the naloxone one, and I was opposed to all of these things before doing this work. I have a lot of respect for folks, for that reason, who maybe aren’t fully on board with all of this stuff yet.

The reason for that is that I grew up in the war on drugs era, the “just say no.” There were billions of dollars put into the war on drugs and the DARE campaign. That’s what we learned, and that’s what we knew. I grew up with “Drugs are bad; don’t use them. People shouldn’t use them. If they use them, they should go to jail.” We’re confronting, as a society, not just decades but over a century of drug prohibition. We’re right at the inflection point right now. That’s where I do see a real opportunity and need for political leadership, too.

In the “safe supply” language there, first of all, these recommendations weren’t approved or signed off by anyone else. Well, mildly signed off. Just so you’re aware, I did have one of the medical experts, a representative of one of the organizations of people who use drugs, and an organization that represents surviving family members review these in detail. They gave feedback, made changes. So they’re my recommendations, but it definitely is something that I’ve consulted on. All of these came out of the research that we did.

In terms of a safe supply, there are some folks who support a legalization model that would look like B.C. Liquor, B.C. Cannabis. That is a substantial minority that I heard from. I think that’s still the case, I would say, broadly, to just sort of continue to follow this issue.

I’m not sure how much more the committee is doing in terms of witnesses, but there’s a physician in Alberta whom I really respect and have done some work with — I met him through Doctors for Decriminalization — Dr. Monty Ghosh. He came and spoke to my criminal law class, and I would really commend his work. As a witness, too, I’m sure he’d be interested, if you’d like. He has a graph which he showed. It’s basically a bit of a bell curve, where it talks about the different models, from legalization to full prohibition.

The idea of a regulated safe supply is the one that…. You’ve got it there. Hey, there we go. Great, you’ve already seen it. That’s where I landed.

Now, in what that looks like, the language I use, the first part is: it needs to be a legal supply. That means that people need to be allowed to use it, carry it and have it — in sufficient quantities that they’re not going to be criminalized. I have a problem with the current thresholds that have been set with the federal exemption. That’s something else we could talk about. It needs to be legal enough for someone to reasonably use and have sufficient quantities to carry.

[2:40 p.m.]

The second criterion is: it needs to be low barrier. I would just underline that. Later on, I do talk about some sort of medical supervision or direction, but the key is low barrier. We need to make this stuff accessible. Why? Well, because the current toxic supply is very low barrier.

I made the comment…. I don’t know if this made it in the book or not. I think it did. It’s easier for me to drive from my home here in Vancouver to the Downtown Eastside and purchase illicit drugs than it would be to find unpasteurized milk. Why do I make that analogy? Because it’s a regulated supply — the milk supply is regulated. Can I go and get milk at the store right now, in a shorter period of time? Yeah. It’s very low barrier.

We want some products, which are of known contents and potency, that are regularly available. The idea is that we want to make them easy to substitute. It needs to be as easy or, ideally, easier to get the safe supply than what you would otherwise use. I use that language in the recommendation, for folks who maybe haven’t read the book, because I think it makes a key point about safe supply. That’s really one of the things that helped me get on board with safe supply.

People who have a substance use disorder are already going to use drugs. They are going to use them. The question is: do we give them the increasingly contaminated Russian roulette game or provide them with a supply that is of known potency and contents? Life preservation was the top priority in writing these recommendations — and, as you can see, followed up with shorter-, middle- and longer-term solutions to help people get into sustained recovery and treatment. So low-barrier, regulated access is really key.

Now, the medical direction, supervision, I wouldn’t want to be overread. I would read that along with the words “low barrier.” I do believe, as Dr. Bonnie Henry has done, that increasing the number of professionals who can prescribe a safe supply…. Those are measures I absolutely support. It doesn’t say: “a medical doctor.” I think you want to have this sort of thing readily available. This isn’t something I’d want to say has gotten medical recommendations behind it, but as accessible as walk-in clinics or pharmacies. I mean, it should be more accessible.

We’ve talked about witnessed use rooms and that sort of thing. I think people should be able to take the drugs with them, just to be clear. They don’t need to be monitored while they’re taking them.

I don’t support a legalization model. I have to say, though, that I’m not particularly concerned about diversion. That’s usually one of the things that comes up in talking about safe supply. The police, in particular, are very concerned. Some police, I should say, keep bringing up this idea of diversion. The idea there, of course, is that if someone is given a certain quantity of a safe supply, they will take that and, instead of using it themselves, they will sell it or give it away to somebody else. That person could, presumably, die.

A safe supply is infinitely better than what we have now. That’s where some people go further than I go and say that we should really turn the taps on, on safe supply and make it really widely available without some of the safeguards that I would suggest. I think a meeting with a health professional makes sense to get someone started and then make it very easy for them to get going — peer-based entry points and that sort of thing.

I don’t have a specific operational framework in mind here, but those are the key components to it. I hope that helps elaborate a bit more.

R. Leonard: I really appreciate hearing from you today. There are so many things that we heard yesterday that you’re speaking to. It just makes me…. The conversation piece is just so important.

One of the things that we heard from drug users yesterday was that some people do not want recovery. They do not want treatment. They do not want to move towards recovery.

A lot of what you’re talking about in the recommendations is focused on bringing people to that place of living their fullest lives without drugs — but moderated by some other things that you’ve said. I’m just trying to get a sense of what you would say in terms of those recommendations that take people to places of recovery versus being able to live their lives as they choose without stigma.

[2:45 p.m.]

B. Perrin: Thanks for the question. I think the reason why, maybe, I wasn’t easy to pin down is that I don’t subscribe to either of those two extremes. The approach that I take is we need to meet people where they’re at. We need to meet them where they’re at.

So number one is: we need to keep people alive, whether they go into recovery or not. I think a safe supply is an important thing for people to have. I’m not recommending that they have to be tapered off on any timeline or even at all. I would like to give people the opportunity to be able to get access to evidence-based treatments and programs.

But I’m not someone who sees harm reduction and recovery, the recovery Alberta model, as contradictions at all. I think we need to be doing all of it. I think we need to be doing the harm reduction. We need to be supporting evidence-based recovery and treatments, which the province of Alberta is not doing. They’re very much focused on funding abstinence-based programming and profiling that a lot of the time.

I think that would be my answer to that. I want to give people every opportunity to enter into those recovery and treatment programs if and when they’re ready. But we can’t force people into…. Most people who shared their recovery stories with me were very diverse. But what we do know is that when you have a substance use disorder and you come to a place or a moment in your life where you do want help, in the sense of wanting to stop using or use less, there’s a very narrow window. I was told by a physician that it’s as narrow as 72 hours that you have.

So when we think about wait-lists and rapid access to treatment and recovery, and I think then about rural and remote or northern communities or Island communities, it makes me really go: “Wow. This is an emergency thing.” We need to support people now. Saying: “We’ll get you on a program wait-list. We’re doing intake in a week or a month or six months….” At that point, the ship has sailed, unfortunately. So providing that rapid access to evidence-based recoveries and treatments is really crucial.

On stigma, since we haven’t talked about it a lot and you did mention it, I think there’s a lot more we can and need to do about stigma. Everyone says that they want to reduce the stigma. That’s what all the posters say and all that stuff. I go running, and I often run by the B.C. overdose prevention posters. You’ve seen them all. There are always two people in them, and it talks about reducing the stigma.

I find that interesting because every one of us can guess who the drug user is in those photos. Why is that? Why is it…? There’s one with an elderly Asian man and — it looks like — his daughter, maybe. He’s looking kind of down and sad. Why do we assume he’s the substance user — that it’s not her and he’s grieving that she’s on that path right now?

Every one of those posters…. My point is even the stigma campaign is embedded with these stigmas and prejudices about who the drug user is. Do you know what I’m saying? I think we have a really long way to go on that.

But we cannot talk about stigma reduction without the decriminalization piece, and it goes way beyond just the federal criminal law piece. B.C. provincial prosecutors are another big piece to this. Most people who…. We talked about the pipeline to prison and that being a place of focus. The prosecution and the policing piece needs to get some attention too.

I think, on the prosecution piece, where I would go is with release conditions, whether it’s released on bail…. We could also talk about parole and probation as well. But any time anyone is in the community under a condition that they not use drugs and they have a substance use disorder, that’s cruel and ridiculous. Those are routinely being sought by…. You know, Crown prosecutors are on the picklist, which is the sort of standard language list.

Going beyond that, we also see conditions not to possess drug paraphernalia, which would include — unless there was some exemption for it, which usually there isn’t — harm reduction supplies. That would include clean syringes. That would include naloxone kits, even. Now, we’re not seeing that prosecuted that I’ve ever heard of. But the point is that the conditions themselves in the criminal setting don’t line up with the millions of dollars we’re spending in public health money.

Saying that criminal law is the way to go with having people under these no-use conditions and then breaching on those, I think, is a big problem. In the context of the ongoing crisis of Indigenous incarceration, it bears noting that the research shows that Indigenous offenders are more likely to be readmitted to custody for administrative breaches like these condition breaches, not for committing new offences. That is a significant piece here. That’s curfews. That’s no-use conditions.

[2:50 p.m.]

I’ve been in court and seen people…. The case I’m thinking of specifically, out in Surrey, was a few years ago. It was someone who had a substance use disorder related to alcohol, and everyone knew it. He was put on these conditions not to use and not to go to bars, and everyone in the courtroom nodded. He signed off on them. What’s he going to say, right? Either you go to prison or you sign off on the conditions.

The judge had a bit of a “you be a good boy” talk to this accused person, and everyone in the courtroom knew. You’re releasing someone who has a multi-decade alcohol addiction with a condition that he not drink again, and if he does, he’s going back in custody.

I mean, we’re wasting lives. We’re wasting time. We’re wasting a lot of money in society doing that. It’s really the wrong way to go about it.

S. Furstenau: It makes me think. Imagine if the onus of those release conditions was actually on us, on government, to say: “We’re not releasing you until you have a safe home to be in, until you have the supports, the ability to reintegrate and be healthy and well.” The onus is put on the institutions, as opposed to on the individual. That’s not, but it’s a really….

It reminds me of MCFD. It’s the same kind of conditions that are put on, particularly, mothers and result in removal of children over and over again.

What you raised in your initial presentation around the inclination to respond to this with a law-and-order response…. For the public, the perception is that this is chaotic. When you see it — the images that we have, the cleaning, the removal of people’s housing on Downtown Eastside — it all looks very chaotic. So of course, the response from politicians is: “We have an avenue to reduce chaos, to solve this.”

Can you talk to us about how to turn that around and change that narrative around law and order, harsher responses to this? Is the answer to reduce chaos, as opposed to…? What is the answer to reducing chaos?

B. Perrin: Yeah. That’s a great question. It’s not everyone, but we know it’s a substantial risk factor in people developing substance use disorder and experiencing homelessness and becoming either a victim or an offender, health issues. It goes back to those childhood trauma issues and indicators.

I find that’s very helpful in talking with folks about this issue. It’s to say…. Then drawing in the line, as well, about: do you know what fentanyl is? I always ask people, or I tell them. Sometimes I start my talks by saying: “I’m not sure if you know, but I’ve had fentanyl.” The room drops. People go really quiet. I’m like, “Yeah, it was in a medical setting. I had to go through a procedure, and there were two reasons why I was safe. I was being monitored, and it was known content. So if I did overdose, there was someone to revive me” — that sort of thing.

My point there was that these drugs that we’re primarily talking about, opioids, are pain relief medicine. They’re not party drugs. I didn’t know that until I started the research, and I don’t think most people know that. I think people think that this is like a rave drug or people getting high. You hear that language.

This is pain relief medicine, created in a lab — it does not naturally occur — for palliative cancer patients. That’s what this drug is. That’s what it was created for — people who are dying, to help them. People are medicating with it today with respect to the physical, but very typically it’s the emotional, the psychological wounds and scars that they and their families and their nations have experienced. That’s how it’s being used today.

The strongest anecdote that I ever heard was from Judge Elisabeth Burgess, who sits in the Vancouver community court, who I’m very grateful not only did an interview but went on the record, which is, I think, a really brave and important ethical thing that she did, to be quite frank.

She told me that not one but multiple accused persons who have appeared before her in court on drug related offences…. I asked her to tell me about their history, like: “What do you know about them?” She said that both of these adults now, when they were children — toddlers, in fact — had witnessed the murder of their own mothers and were left alone with the body for days. That is what their childhood started like.

[2:55 p.m.]

That’s not what my childhood was like, so who am I to judge those men who survived, by the way, through self-medicating? I don’t know that I would have survived that ordeal. The use of substances with respect to trauma is a coping strategy. It is a way people survive. The pain and suffering that, particularly, Indigenous folks have been continuing to endure in this province is absolutely incredible — the amount of pain that there is there. This is a this is a form of medicating that pain. It’s a way to get through the day, to survive, to cope, to numb those feelings.

The chaos that we witness throughout B.C. now with the tent cities and the cleanup, supposedly, and “Why won’t people just move into housing if it’s available?” and all the hatred and that…. I say that the real moral wrong here is not folks who are turning to drugs. It is on our society. It’s on us. We are reaping what was sown over the last 200 years in this province. That is what we are reaping now. We are seeing it now, and we’re going to continue to see it.

Using an enforcement mentality is precisely the wrong way to go. It doesn’t help. It makes it worse. I also say to people, too, that if you want to waste a lot of money, keep doing what you’re doing in terms of an enforcement approach. It costs over six figures to incarcerate someone federally, and there’s no evidence that that benefits society.

We should instead be investing in treatment and support. Studies in the U.S. find that for every dollar spent — in those studies — around treatment and recovery, you save $12 in terms of health care and criminal justice expenses. So we know that there’s a there’s a financial argument here as well as a moral one.

N. Sharma (Chair): Ben, I’m going to try to get Shirley’s question in. We have three minutes left. Let’s see if we can get to it.

Go ahead, Shirley.

S. Bond (Deputy Chair): Mine is related to…. I hear what you say about the previous iteration of “drugs are bad.” I still believe there’s a role for prevention and education.

B. Perrin: Yes, me too.

S. Bond (Deputy Chair): There is no such thing as safe supply, There is safer supply. I believe there needs to be awareness of the risks that come with drug use.

I just wanted to hear your perspective on that because you were very, very passionate about the fact that previous messaging has been part of the problem. I think we also are not taking our responsibility seriously if we don’t include prevention and education as part of how we deal with this crisis. So just your reaction to that.

B. Perrin: I agree with that in terms of the prevention piece as well. There’s, in my book…. I’ll just mention the page number, if you folks have it. I’m happy to send it to the committee. You don’t have to pay for the book, by the way. If anyone doesn’t have one, I’ll send a free copy to you. It’s on page 224.

What we know does not work is telling children drugs are bad — if you use them, you could die — and trying to scare them. That does not work. Those campaigns backfired. I mentioned DARE specifically. There have been studies done that found that the “just say no” messaging actually led to increased drug use and had no positive benefits on youth behaviour. It actually led to riskier behaviour. If you have kids and you tell them not to do something, what are they going to do? They usually go do it.

Instead, what the research finds is beneficial and supportive is — I’m pretty sure this is off the B.C. government website — having open conversations. Get informed. Stick to the facts. Don’t use scare tactics, but look for opportunities to talk about it. My kids and I — we do that. We talk about: why would people turn to substances? How do you deal with things when they’re difficult? How do you deal with life? What are healthier ways to deal? And then becoming informed yourself about the substances that are out there and what to do….

Absolutely, yeah, prevention is important. I think if we take prevention back, though, it’s not just about talking to kids. Prevention is actually doing the work of supporting families and supporting children, supporting pregnant women.

There’s a study being done here in British Columbia on the nurse-family partnership right now. Some of you are familiar with that program. That has been proven to be exponentially beneficial around things like people becoming involved in crime or developing substance use disorders later in life. So if you want to talk prevention, that’s where I would go. I would also be looking at some of those programs, as well, if we want to zoom out.

[3:00 p.m.]

In terms of the language, I agree with you, actually. I think “safer supply” is a more appropriate term than “safe supply.” I think that is true. I don’t quibble with that at all. I think that actually makes a lot of sense.

S. Bond (Deputy Chair): I’ll just say I haven’t gotten to page 224 yet. When I do, I’ll have that familiarity, and I appreciate that. Grandparents need that information too. I have the best conversations with my grandsons when I have to drive them somewhere and they’re in the vehicle. So thanks for that, Ben. I appreciate it.

B. Perrin: Thank you.

N. Sharma (Chair): Ben, on behalf of the committee. I just want to thank you not only for the work that you’ve done on this subject but for coming here and answering our questions and helping us appreciate your perspective on everything. It’s much appreciated.

B. Perrin: Thank you for your time.

P. Alexis: Could I also ask…? I’d like a copy of your book please.

B. Perrin: Please just, through the Chair or the Clerk, send me a list of names and addresses, and I’ll have those sent out to you. Probably next week; we’re on Thursday already. I’d be happy to send you one.

N. Sharma (Chair): Okay, committee members, our next presenter is here.

Christine, I just want to welcome you on behalf of the committee. My name is Niki Sharma. I am the Chair and the MLA for Vancouver-Hastings.

I’m going to go around and introduce everybody else that you’re going to be speaking to, but first, just for the record, I’ll say we’re welcoming Christine Wilson, director of advocacy for Indigenous women at the Downtown Eastside Women’s Centre.

We’re just so pleased to have you here and to be able to learn from you today. We have about 15 minutes for your presentation, and then the rest of the time we’ll have a good discussion.

I’ll just pass it around to do some introductions. I’ll start with the Deputy Chair.

S. Bond (Deputy Chair): Good afternoon, Christine. Welcome. My name is Shirley Bond. I’m the MLA for Prince George–Valemount.

P. Alexis: Good afternoon. My name is Pam Alexis. I’m the MLA for Abbotsford-Mission.

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

S. Furstenau: Hello. Good afternoon. Sonia Furstenau, MLA for Cowichan Valley.

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

DOWNTOWN EASTSIDE WOMEN’S CENTRE

C. Wilson: Simgyget, Sig’ha’maa’nakx, Gubu’guu’­waay’skx, T’ooaxs’y’niism.

[Ladies and gentlemen and honoured guests, I thank you all.]

[Gitxsanimx̱ text and translation provided by C. Wilson.]

My English name is Christine Wilson. My Gitxsan name is Attijup, which means “the cub that wanders off and returns a bear.” I am the director of advocacy for Indigenous women here at the Downtown Eastside Women’s Centre.

I am a guest of the unceded and traditional ancestral territory of the Squamish, Tsleil-Waututh and the Mus­queam. I’m honoured to be here today.

What I chose is opioids and the health care. But before I get into that, I wanted to speak of the Downtown Eastside Women’s Centre a bit. Our mission to the Downtown Eastside is to provide a safe, non-judgmental, environmental space for self-identifying women, trans and two-spirit from all walks of life who live or work in the Downtown Eastside. To achieve the goal, DEWC provides supportive surroundings with meals, counselling, advocacy and programs which nurture and empower our members.

Our purpose is to provide a safe, comfortable environment for women in Vancouver’s Downtown Eastside. We provide basic needs services, programs, specialized supports and emergency shelter services. We provide recreational and self-help rehabilitation programs to help alleviate lack of proper facilities in the area, and we act as a source of information by assisting women with referrals concerning their basic needs. We educate the general public as to conditions and issues concerning women in the area, and we work towards constructive social change in the areas of the economic and social well-being of women in the area.

[3:05 p.m.]

We are a membership-driven organization where all women accessing our services are given a vote and a voice to steer our services and programs. We believe women are the experts in their own lives. Every woman is entitled to their basic necessities of life including safety, autonomy, nutrition, stable housing, clothing, education and other practical needs.

We have an anti-racism and anti-poverty mandate. We understand that poverty is systemic and not the problem of an individual. We are a feminist organization with feminism as our guiding philosophy. We respect and welcome cultural diversity. Each woman’s strengths and experiences are valued and respected.

We believe every woman is entitled to self-determination, self-respect, self-esteem and safety. We define “woman” as anyone who identifies and lives as a woman, including transgender women and two-spirit women.

The programs and services that we do provide here…. Our meals program. In July, we served over 900, close to 950, meals a day, and that’s with our three programs. At 412, our shelter, we provide meals. We have a kitchen there. Here at 302, we have a kitchen, and we provide meals here as well — breakfast and lunch — and 25 as well. Sorry. Our meals program coordinator broke it down to 900 meals a day in July and August.

Now, I’m just going to go by Red Women Rising as part of this presentation to the Legislative Assembly. Red Women Rising is the submission of the MMIWG inquiry in which DEWC staff gathered input from 113 Indigenous survivors of violence. All 113 women are quoted in the report and, in addition, 50 non-Indigenous women who are friends or street families of Indigenous women who are missing, have overdosed or died from violence in the Downtown Eastside.

Red Women Rising addresses colonial, systemic issues and recommendations made by the Indigenous women who participated in, created and have driven the process. It incorporated diverse Indigenous mythologies in the research design, and the central knowledge holders.

In this report. 200 recommendations within it are based on their leadership, lived experience and expertise as Indigenous women in the Downtown Eastside. The report is also the first comprehensive project with Indigenous women survivors in the Downtown Eastside at the very centre of the community research, rather than a secondary statistic. This difference drastically shifts the research lens from pathologizing poverty to illuminating and amplifying resistance and colonialism.

The Indigenous population, which we did get from StatsCan…. In 2016, there were 270,585 Aboriginal people in British Columbia, making up 5.9 percent of the population. The majority of the Aboriginal population reported a single Aboriginal identity, either First Nations or Métis or Inuit.

[3:10 p.m.]

Aboriginal females make up 4 percent of total population in Canada, according to the data from the 2011 national household survey, NHS. There were 718,500 Aboriginal women and girls in Canada, who made up 4 percent of the total female population in Canada. In Vancouver, the percentage…. Vancouver’s urban Indigenous population is estimated to number 14,000 persons, which is 2.2 percent of the population here in Vancouver.

In Red Women Rising, there’s a section called the declaration of mental health and opioid crisis.

“The municipal government declared a mental health crisis in the city in 2013, and the provincial health officer declared the opioid crisis a public health emergency in 2016. There’s a correlation between the mental health crisis and the opioid crisis.

“According to the findings of a 2018 report by the B. C. Coroners Service, more than half the people who died as a result of drug overdose in the province during the years 2016 and 2017 had a clinical diagnosis or anecdotal evidence of a mental health challenge, and 79 percent who died were in contact with health services in the year prior to their death.

“Indigenous women are disproportionately impacted by the opioid crisis and experience eight times more overdoses and five times more fatal overdoses than non-Indigenous women.”

That’s a pretty staggering report there.

The opioid crisis in the Downtown Eastside…. There’s also correlation between the mental health crisis and the opioid crisis in the Downtown Eastside. According to the findings of a September 2018 report in the B.C. Coroners Service, more than half of the people who died as a result of drug overdose in the province during the years 2016 and 2017….

New statistics in 2022: 84 percent of illicit drug toxicity deaths occurred inside; 56 percent in private residences; 27 percent in other inside residences, including social and supportive housing, single-room-occupancy shelters and hotels and other indoor locations; and 15 percent outside, in vehicles, sidewalks, streets and parks. In Vancouver Coastal, other residences, 45 percent, were the most common place of illicit drug toxicity deaths, followed by private residences, 36 percent between 2019 and 2022.

Now, the recommendations in Red Women Rising…. Part of the calls for action is an Indigenous health and wellness centre in the Downtown Eastside and Indigenous-run health programs that use Indigenous methods to address physical mental, sexual, emotional and spiritual harms. Also, fund more mobile health care vans and community-based clinics, street nurses and health care providers in the Downtown Eastside.

Recommendation 21: rapid, easy access to Indigenous women’s detox on demand, where there is no time limit; Indigenous-run treatment centres; indoor overdose prevention sites and consumption sites for Indigenous women only; access to safer drug supply; and a full spectrum of substitution treatment options.

Recommendation 22: guarantee 24-7 Indigenous mental health and addictions counselling programs that are low barrier, drop-in based, available on demand and include overnight street-based counselling in the Downtown Eastside. Also ensure long-term mental health and addiction services ranging from prevention, early intervention treatment, crisis care, home visits and aftercare.

Recommendations for Indigenous women’s wellness in the Downtown Eastside. All levels of government must acknowledge that the current state of Indigenous health is a direct result of colonialism and government policies.

Recommendation 1: strengthen all the social determinants of Indigenous women’s health by ensuring access to government over land, culture, language, housing, child care, income security, employment, education and safety. End all the health risk associated with living in the Downtown Eastside by ensuring healthy environments and built environments of all buildings, residences and outdoors….

[3:15 p.m.]

This includes the right to clean air and clean streets, green space and urban ecological systems, sanitation, accessible and clean public washrooms, potable water and functioning water fountains and more access to water resources.

Culturally safe health care. An Indigenous health and wellness centre in the Downtown Eastside and more Indigenous-run health programs that use Indigenous methods and medicines to address physical, mental, sexual, emotional and spiritual harms.

End the medical pathologizing and diagnosing of gender identity. Train health care professionals to provide gender-affirming care that is safe for and respectful to trans women and two-spirit people.

Reframe mental health and addiction services so they mirror Indigenous women’s social and economic realities and aspirations towards healing. All health care workers must believe Indigenous women and treat them as credible experts about their own health.

All medical and nursing schools in Canada must require courses dealing with Indigenous health issues, including the legacy of colonialism and its impacts as well as skill-based training in anti-racism, human rights and trauma-informed care.

I can actually speak on that from my own personal experience, having dealt with one of the hospitals here in the Lower Mainland. In regards to the health care, there’s still systemic racism, where families are being pulled apart intentionally under the Mental Health Act.

That stigmatization of a person who lives in the Downtown Eastside or a family member living in the Downtown Eastside actually impacts how they get treated in emergency. They’re not treated with respect and dignity. Their rights are breached and infringed upon unless they have a family member, like myself, who can advocate effectively on their behalf.

Recognize Indigenous healing practices and have more health professionals trained in Indigenous health practices. Recognize the role of Indigenous reproductive and birthing knowledge, including ceremonies related to healthy sexual development.

More Indigenous patient navigators and Indigenous medicine people in hospitals to bridge between Indigenous patients and the Western medical system. More Indigenous healing spaces and sacred spaces in hospitals and hospices. For example, in Victoria, M’akola Housing has created hospices specifically for First Nations — that is, employs First Nations so there’s cultural sensitivity and cultural humility, and those who are non-Indigenous have that extensive training and knowledge as well.

Hospitals, including security guards, need to be welcoming and supportive, not judgmental and criminalizing their interactions with Indigenous patients. I had a client who had that elephant trunkitis, and the only place that he could receive treatment was at St. Paul’s. Because he had been treated badly many times, he chose not to go back. Within months, he ultimately passed away.

So the health care needs to be really looked at, still. Like I said, the racism is still there, the systemic racism, in how there’s no cultural sensitivity or cultural humility being exercised at all. Nor the nurses’ union. The principles of cultural humility and cultural safety — they’re not being exercised by the nurses as well.

Ensure timely, culturally safe, evidence-based mental health and addiction services in the Downtown Eastside, ranging from prevention, early intervention, treatment, crisis care, home visits and aftercare. Mental health and addictions in Red Women Rising is…. It states that the two are connected. You know, one does not go without the other.

I think that’s pretty evident, especially when Riverside closed its doors — how there was an influx of individuals with mental health that had no supports, really. They became homeless and ended up in the Downtown Eastside.

[3:20 p.m.]

It’s a struggle. There’s no detox. There’s lack of recovery houses, and there is lack of treatment centres. We only have two detoxes.

I know women here at the Downtown Eastside Women’s Centre express wanting to go to detox. But when we phone in on their behalf, it’s a two-week wait period, and then you have to expect a call on this certain day. With our clients, there’s that small window of opportunity. You know that if they don’t get that detox and if they have to wait two weeks, then they go back to spiralling down. That drive and that wanting to stop using…. The window of opportunity is gone — and recovery and then treatment and then recovery.

I think recovery is really important. I actually ran a recovery centre myself — before-treatment and after-treatment, five women for six months. I had a 98 percent success rate. That was for youth ages 16 to 24 — two beds specifically for women that have had children that had been apprehended. The success rate was incredible. There is a lot more need for that.

The take on the drugs — overdose, the opioids — I think there has to be a different approach to that as well. We do have our Insite safe injection, but we need a lot more than that, like decriminalizing, looking at other methods to take the place of the opioids that they’re using, and practising more harm reduction.

Ensure that people with mental health- and substance use–related disabilities have means to enforce their human rights related to accessing and maintaining their housing and employment. I mean, if there are mental health issues, then accessing, securing and maintaining housing can be difficult, especially if they don’t have any family in the area and they don’t want to access a service like Bloom Group, where there’s a trust agency that will oversee their financial money.

Replace the deemed-consent provisions of the Mental Health Act and the consent-override provisions of the Health Care (Consent) and Care Facility (Admission) Act and the Representation Agreement Act with a legislated mechanism that protects and respects the patient’s autonomy in making health care decisions and allows the patient to include trusted family members and friends in their treatment and recovery process.

Create legislated standards regulating the use of isolation in mental health facilities and the use of physical, mechanical, environmental and chemical restraints against mental health patients to ensure compliance with Charter rights.

Declare the opioid crisis a national public health emergency that disproportionately…. We’ve already done that.

Provide a full spectrum of recovery supports, including immediate access to Indigenous women’s detox on demand in treatment centres; Indigenous-run treatment centres that use cultural treatment with Indigenous healing methods and land-based practices; more indoor overdose prevention sites and consumption sites, including culturally safe Insites for Indigenous women only, because Indigenous women have a high rate of gender-based violence. I think it’s important that there be a culturally safe site for Indigenous women only.

Decriminalization and access to a safer drug supply, opioid-assisted therapy programs, a full spectrum of substitution treatment options and longer-term funding for a range of culturally safe treatment programs. Provincial regulations to oversee all recovery programs and facilities.

[3:25 p.m.]

I’ve been in my field for 23 years, and for 20 years, you know, it has been addiction. That’s actually my background: addictions. There are not enough culturally appropriate programs for First Nations. That’s for both women and men, and youth.

There’s not enough representation in the health field. Just like when there was a shortage of nurses, there was a call out for nurses. Vancouver Community College has one building specifically to train nurses and teach nurses. I think there needs to be more aggressive recruitment for First Nations in the health care field to break those barriers and stigmatization and, also, for First Nations to feel comfortable.

Myself, I would rather go to Lu’ma medical clinic than any walk-in clinic. I prefer to go to Vancouver General Hospital, as opposed to St. Paul’s, only because I think that they are a little bit more advanced when it comes to being culturally sensitive and exercising that cultural humility.

I think it needs to be addressed more, and there needs to be follow-through with repercussions, if there is a complaint from an Indigenous woman, person who files a complaint. It’s just like anything. If I’m late for work for 30 days, I get a warning letter. There’s always a repercussion, like a reaction to an action.

That’s it. Was I…?

N. Sharma (Chair): Yeah, that was great. Thank you, Christine. We really appreciated it.

We have about a little over half an hour for questions and discussion. Colleagues, if you have a question or a comment, you put your hand up, and then I will go in the order I see them.

C. Wilson: Can I make another comment too? I know that when it comes to health…. I’m not really 100 percent sure, but for the northern health care, there’s that pot of money. But it’s a big stretch from Boston Bar all the way to the northwest coast, I believe. Me, being from up in northern B.C., there’s a lack of services.

Last year we were having one overdose per week of a youth member in the Hazelton area. I’m sure Dan Davies is aware of that. Nobody knew how to use naloxone, either the needle or that inhaler. There’s not enough education and training up there in regards to opioids and illicit drugs at all. There’s just such a lack of programming in health care, whether it be mental health or counselling and treatment, recovery.

I’m a big believer that culture saves lives. I’ve worked with a lot of youth who have grown up to be productive people that contribute to society. It wasn’t any of the programs that I ran, but ultimately, they would go back to where they’re from and connect with their Elders and learn their culture. Then that identity, knowing who they are, was so impactful on their road to recovery. The Wet’suwet’en have this treatment center that offers that. I think that’s something that should be emulated for all Indigenous people.

Yeah, like myself…. I know who I am. My mother instilled that in me since I was a child, because she’s a sim’oogit, which is “Chief” in English, a Hereditary Chief. So I know who I am.

When I moved to the city, it was such an eye-opener that nobody really knew who they were, where they came from. That’s the dispossession of land; that’s their culture being taken away, their language. That’s a symptom of residential school and Sixties Scoop.

[3:30 p.m.]

I’m fortunate. I come from a matrilineal line. My mother and my grandmothers taught me who I am. I don’t know my language. Again, that’s a symptom of colonialism. They didn’t want me to have the dialect and to be made fun of the way they were when they went to Indian day school and residential school.

I think land-based treatment centres and facilities would be beneficial for First Nations people who want to connect to their culture and find out who they are.

N. Sharma (Chair): I’m going to go to Ronna-Rae.

R. Leonard: Thank you very much for presenting today. Also, thank you very much for the work that you’ve done for 23 years.

You had spoken about a recovery program that you worked at for a few years where there was pre- and post-treatment time. I’m curious for some details about how long that program was, where it was, how it was funded, when it did happen — that sort of thing.

C. Wilson: Okay. I worked for the Urban Native Youth Association from…. From 2015 to 2017, I ran the Young Wolves Lodge.

That was actually privately funded by the church. They would fundraise to pay the wages and to pay the property tax. I think we were partially funded by Vancouver health but not much. The church actually kicked in a lot of money to keep the program running.

It was before and after treatment. We had five beds. Three beds were for single women. Two beds were specifically for women who had children that were in the care of the ministry. It ran for six months. I didn’t have one woman drop out. Actually, I had one woman drop out twice, which is why I had a little less than a 100 percent success rate.

We were the first project to have a connections worker/outreach, where we would help the women to find housing, secure housing and work towards not only having them maintain their expectations from the ministry but to keep them on track. She did follow up for one year with the women who were working towards gaining custody of their children.

Yeah. It was pretty incredible. I implemented therapeutic interventions, healing circles. We brought in a doctor, who would come in once a month, from Raven Song. We’d pay her an honorarium every time she came in.

Essentially, we would meet our clients where they were at. We’d bring in the services to connect with them, just to be respectful. If they didn’t find the connection, then we would work elsewhere. That’s where my outreach worker would become very integral. If we couldn’t invite them in to meet with the women that we worked with and the youth, then she brought them to them.

Yeah. It was my baby. It actually won an award from Vancouver shortly after I left. A lot of sacrifices and a lot of love went into that program.

D. Davies: Thanks, Christine, for your presentation today. Thank you for your work that you do on the Downtown Eastside. It sounds like some of the work you did when you were up in the North as well. So thank you.

[3:35 p.m.]

A couple of things. First, you talked, in your presen­tation…. You mentioned recommendations and such. Do you have a presentation? Do you have those recommendations that you could share with us?

C. Wilson: I can email them to you. My email…. I don’t know where to put it.

D. Davies: I’ll maybe get Artour…. He can reach out, and he can connect and get that out to all of us. It’s nice to have that in writing. Your presentation was quite full, so I’d definitely like to have that as well. That would be great.

C. Wilson: Absolutely. All of the recommendations came from the women who spearheaded this project, all 133 of the women that participated. Those were their recommendations that were put into the Red Women Rising submission into MMIWG. I know they’re incredible.

In our Red Women Rising book, we actually have their personal stories that they’ve shared, which is pretty powerful and impactful. I mean, their shared stories of oppression, racism, their struggles with housing, SROs, the Residential Tenancy Act, B.C. Housing — all of it is in there. It’s so comprehensive and very moving.

D. Davies: Right. That’d be good. Thanks.

Your comment about services up in the North…. I am up in the northeast. It is a similar story across the North — the lack of resources, whether it’s detox, recovery. My hat goes off to all the different community organizations that do work in our small communities that are doing their incredible level best to deliver what little services we do have on our streets. That’s across all of our northern communities. That’s certainly in my mind and something that we’ve heard as a committee, from a number of organizations.

Downtown Eastside. You were talking about a lot of the things that you guys are doing. We’ve heard from a number of organizations in Vancouver. I’m sure it’s just a small selection that we’ve heard from, because there seems to be a lot of organizations. I’m just wondering what your organization has done in regards to collaborating with some of the other groups that are in Vancouver.

As well, I’m just wondering what…. You talked briefly about a little bit of provincial funding. It doesn’t sound like very much. What does that relationship with the ministry, that relationship with the health authority in Vancouver look like to you?

C. Wilson: What does our relationship with the ministry and health authority look like to me? Vancouver Coastal Health actually funds our mental health advocates here. As far as programs like ACT, COVID really shut a lot of things down. We haven’t yet seen them come back in full force here, unfortunately. But we are putting it out there every chance that we get, calling them out, saying: “Come on back. We need you guys.”

What do you mean by ministry, the Ministry of Social Development and Poverty Reduction?

D. Davies: Well, I guess all ministries. I mean, this this isn’t a one-ministry problem. This is the Ministry of Health, Ministry of Mental Health and Addictions, Ministry of Social Development and Poverty Reduction. This does touch with many touchpoints on many ministries.

I was just wondering what the relationship is like with your agency to these ministries, and that support. Obviously, we need more, but what does it look like now?

C. Wilson: In my position, I work with provincial and federal, so I am developing those relationships with ministers. I recently met with the Minister of Social Development and Poverty Reduction. I’m going to be meeting the new…. David Eby, the guy who took his place. I met with Patty Hajdu. We’re making those connections and inviting them to meetings so that we can talk a little bit more in depth about the barriers and challenges.

[3:40 p.m.]

Now that we’ve gotten there, our next step is accountability, especially when it comes to implementing the recommendations in Red Women Rising and MMIWG.

As far as funding, there were grants out there, but they were specifically for First Nations organizations, band offices, First Nation individuals. I was very fortunate that Patty Hajdu stepped up and said: “If there are any non-profits that find this a barrier, please let me know, and I’ll send a letter of support.” I took advantage of that and said: “Hey, we have two grants, and we’re not an Indigenous organization. Can you support us with a letter?” And she did.

I’m not sure if I’m answering your question correctly.

D. Davies: Yes, you are.

C. Wilson: We’re building those relationships, and so far, so good. I will be reaching out to all of you guys individually later on, too. I actually have a bill that I’m introducing — well, an act, from our neighbours in the United States, to protect Indigenous people. I’m meeting with the Attorney General and Minister of Housing in October, and I’m meeting with the Solicitor General’s team in October as well, to talk more in depth about it.

I don’t know. I guess once you guys email me for the presentation that I put together, I’ll also include the Savanna’s act and the Not Invisible act. If you want to talk about those more in depth with me later, too, I’m more than happy to.

Sorry, I went a little bit off topic there.

N. Sharma (Chair): No worries, but you’ve now piqued my interest in what that act is about, if you don’t mind telling us about that.

C. Wilson: Savanna’s Act. A young lady, at the age of 22, was eight months pregnant in the United States — an Indigenous woman. She was murdered.

The National Indigenous Women’s Resource Centre, in Montana, I think, created the bill. Before that, they’d created many bills that didn’t go through. They actually managed to connect with one of the…. What are the roles? The senators? I don’t know what the roles are. We have our MLAs and MPs. I don’t know what the proper term is for their government bodies there. Anyway, the woman was of Indigenous background. I think she was Spanish or Mexican. The bill was supported and pushed through in 2020, and Trump approved it, surprisingly. I was impressed by that.

What the bill entails. Savanna’s Act is a mechanism of FBI, tribal police, tribal band offices, Department of Justice, their sheriffs — like our RCMP and VPDs, you know, all over Canada — who will submit statistics and collect data and information on how many missing and murdered Indigenous women there are in all of the United States. That’s Savanna’s Act.

The Not Invisible act is a mechanism, when there is an MPR filled out, for how the RCMP or the VPD would handle that, the steps that the VPD and the RCMP are to take.

Then there’s the accountability as well, like for Noelle O’Soup. That was very unfortunate. She was in that apartment for how long, before she was found deceased. They found the man first before they found her. She had been deceased longer than him. She was 14 years old.

[3:45 p.m.]

The Not Invisible act will hold the RCMP accountable, and there’ll be more thorough investigation, more communication between the families, victim services workers in the searches that go on that are coordinated to the families, and there’ll be supports. These are things that are actually in MMIWG recommendations. These two acts just kind of pull it together. When I read them, I was very impressed. I actually have B.C. Civil Liberties on board with me, partnering, and UBCIC as well.

There are 250 non-profits. I just spoke to the Yukon, the MMIWG2S+ advisory committee panel. As soon as we released the letter in October, they said that they’re on board to support us as well.

N. Sharma (Chair): It sounds like you’re doing a lot of work and impacting a lot of Indigenous women’s lives. It was really great to have you here presenting. One thing that I will certainly keep from this presentation, along with the recommendations, is that culture saves lives and that that was something that you’ve seen in your work.

I just want to thank you on behalf of the committee for coming here today. We look forward to receiving any other information that you want to send our way, including the recommendations you made today. We wish you all the best.

C. Wilson: Thank you so much. Thank you for having me today. I was a little bit nervous. This was my first time ever doing a presentation and talking, so thank you. I appreciate it. Please email me, and I’ll send you all the presentation.

N. Sharma (Chair): Thanks a lot, Christine.

Committee members, we’re in recess until our next presenters at four.

The committee recessed from 3:47 p.m. to 4:01 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): On behalf of the committee, it’s my pleasure to welcome our next guest here today. We have the B.C. College of Family Physicians — Dr. Christine Singh, director, and Toby Achtman, executive director.

Welcome, on behalf of the committee. I’ll just go through intros, so you know who you’re talking to before we get going. Then you have 15 minutes to present and then the rest of the time for our discussion.

My name is Niki Sharma. I’m the Chair of the committee and the MLA for Vancouver-Hastings. I’ll just go to our Deputy Chair, Shirley, next.

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

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

P. Alexis: Hi. Good afternoon. My name is Pam Alexis. I’m the MLA for Abbotsford-Mission.

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

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

N. Sharma (Chair): Wonderful.

Now over to you. We have your presentation that you provided us, on our screens. We each have it individually, so we won’t be sharing.

B.C. COLLEGE OF FAMILY PHYSICIANS

C. Singh: Well, first of all, just thank you very much for having me here. I’m certainly a little bit nervous, but everyone looks friendly. I’ve been reading the transcripts of the previous reports you’ve had. It’s an honour to be here amongst all the other people and groups and organizations that you are listening to and to have this sort of thoughtful committee go forward about how to deal with this very significant issue.

My name is Christine Singh, and I’m a family doctor. As said, I’m on the board of the B.C. College of Family Physicians. Again, storytelling, I guess, is quite important sometimes to understand, and I’m hoping, through this presentation, to give you a little bit of my personal story, what I’ve been seeing and how that might contribute to this conversation.

On the next slide, just introducing the B.C. college. There are so many different organizations, and it might be quite overwhelming. The next slide is a chart showing a bit more about that. One of the big things to say is our mission and our vision…. The vision being: “Inspired family physicians providing and supporting equitable, culturally safe, longitudinal care for all British Columbians.” I think this is really important when we’re thinking about dealing with addictions and this toxic overdose crisis — strengthening and encouraging all those qualities.

The B.C. College of Family Physicians is different than a lot of the other organizations in the sense that we are representing family doctors and trying to speak for the experience. Again, I’m grateful to have this time with you today. We also are really involved in education and trying to keep and create a cohesive, supportive relationship for all the family doctors in our province so that we can be ongoing contributors to the health of British Columbians.

I myself have worked on the front lines of the opioid crisis, I guess always. When I look at my work between 2007 and 2017, I worked at a community health centre down in the inner city, and I did a lot of work with high-risk youth, including youth detox. I really remember the time when fentanyl started showing up in the urines and when we started just checking for it more regularly, when Suboxone was finally coming out as a pretty accessible option and how those things started shifting things.

[4:05 p.m.]

I had a lot of patients pass away over the fentanyl crisis, especially in those early, early days, and I guess even now. But I did have some good success stories, based on having a really good relationship with my patients.

I thought it was a very important turning point when this was called a public health crisis. I really appreciate the leadership there.

I did eventually leave the inner city, although I hang out there a little bit still, sometimes. Now I work at a couple of different places. Throughout this presentation, hopefully, I’ll just give you an idea of why. I think that’s an interesting perspective.

I work at Lu’ma Medical Centre, which is a full-service, team-based-care practice for Indigenous people. It’s new. It’s been really well supported. We have a model about two-eyed seeing, and I’ll say more about that later. I think this is a model, going forward, that would be incredibly helpful to have translate across the province.

I also work at one of the post-secondary school youth health clinics, again, addressing earlier down the line, before people end up in more severe situations. There’s so much early intervention and care that can be done. I’m happy to be part of that stream as well, rather than the downstream, where people are, unfortunately, dying.

Then I work at Downtown Eastside Connections, which is a low-barrier opioid clinic in the east side. Those are the folks on Hastings Street that are homeless. You’re seeing them, and they’re very unwell. In many ways, it might be called palliative addiction care at that point in time, because the chances of their addiction killing them are so strong.

As a family doctor, a sort of whole-body, holistic model of understanding health is where we are situated and trained. When we’re working in the right conditions, we can really do a good job with our patients by addressing all these aspects. Sometimes the current structure of care doesn’t fully allow this sort of holistic approach to happen. I think it’s pretty essential when we’re working with something as complex as addiction, mental health, overdose and the consequences of that.

In each of those circles, you can see the different parts about biology, the physical health, the drug effects, and in this case, the toxic drug supply — where even a small amount is enough to be lethal — and the psychological effects. I think a lot about…. COVID comes into this part as well — what’s changed about drug use and COVID as well, and the social aspect. I think all of this is happening in the context of relationships, whether they’re individual or community, or even larger in the sense of government — provincial relationships, municipal.

Again, just as a family doctor, I do feel really honoured that I do get to work with patients very closely. The relationship is probably the intervention a lot of the time, and then I can offer the other addiction care, whether it’s offering opioid replacement therapy, whether it’s using other supports to get them into treatment, connecting them to resources. I think these things are essential for a sustainable response to this opioid crisis — teamwork, leadership, interprofessional practice. The system design and the care delivery are really important.

Again, we just have to create a healing culture, because addiction care, historically, has been quite punitive. We talk about decolonization. That’s probably part of it. How do we remove the violence from the system itself when we’re dealing with addictions and folks that are suffering from those?

A few insights. I’m probably going to run out of time soon, so a few insights. COVID did really exacerbate the drivers of addiction. I don’t want to say…. I guess I said a “failing of the system.” I don’t know if that’s a little bit harsh. That’s a lot of the language used in the media these days. But certainly some of the holes in the social safety net were highlighted, for sure.

I was grateful that the expansion of safe supply occurred during COVID. It really opened up a lot of things around different treatment options, even going forward, now that people are not necessarily having to self-isolate as often. The harm reduction methods, especially in a place like Vancouver, really got to expand. I know that in different parts of B.C., the access to novel or more various models of care are a bit more limited.

I know that there’s lots of work going on to try to make that more equitable, but it takes a lot in a huge province like our own to do that. But COVID, of course…. Lots of worsening mental health, the isolation, so much loss, so much grief and trauma, especially amongst those who are losing folks to the overdose crisis, as well as the infection of COVID itself.

[4:10 p.m.]

I think, as a front-line person, I’ve always understood that there is this real challenge with community capacity for mental health and addiction supports. I think everyone tries their best, but it’s just not enough or not widespread. I’m not sure. Other people have spoken about this, and I’m sure there are lots of ways for that to keep getting better.

Another insight is that the lack of access to relationship-based care is probably worsening the opioid crisis, in the sense that if people don’t feel trust or safety with their health care providers, they’re unlikely to be able to ask for help. Again, as a family doctor, when I know people over time, we can just have really vulnerable conversations, and we can try to really create an environment of safety.

I really do hope that my profession manages to continue to thrive and that more and more young family doctors come out, because they’re learning wonderful things. I hope they’ll come out and practise full family medicine with addiction care being just a part of what they need to do for their populations wherever they work.

There’s a lot of mention about insufficient access to early supports for families, children and youth. I think many people speak to the early years as a place where we can do the most, probably, to really change trajectories. Even if it’s going to be a result we see ten years down the line, to start now is super important.

Another insight: one of my colleagues who does a lot of work in the Downtown Eastside was commenting: “The drug supply is increasingly toxic; it’s constantly changing.” It just means that people are always trying to be adapting to this experience, and a lot of the current treatments quickly may become obsolete, or they can’t keep up with the street supply. I know that the Portland Housing Society does lots of super interesting things, trying to find some ways around this for a very specific group of people, and I think there are lots of thoughts about maybe what could happen here.

Crystal meth — just that substance makes me feel so sad for all the people that I see using it and all the other health effects that come from it. Alcohol use disorder, of course, is super common, and that just makes the possibility of overdosing so much higher if someone is already intoxicated with alcohol. So the opioid interventions are just, certainly, one piece of the toxic drug supply. There are other factors there as well. Again, a lot of people have trauma. Then these events create more trauma and poverty, and all those kinds of things that have been talked about before just compound the problems.

It’s certainly something that crosses all boundaries, but of course it really does affect those with less resources, whether it’s socially or economically. I really appreciate what Dr. Perry Kendall had commented in his discussion with your committee — that a lot of people don’t actually fit the description of opioid substance disorder.

A really lovely student I work with just revealed to me that one of the friends of her family just died from an opioid overdose, probably, or a toxic drug overdose. He had been with the family that evening, helping out a grandfather who had just come home from the hospital. Then, when he left their place, he was drinking something. That something had a toxic drug in it, and they’ve lost this beautiful young person who was connected in the community. Yeah, there’s just a lot of sadness there for them.

Another insight, I guess…. This is coming across, probably, from everybody’s different presentations: there are systemic and structural changes that just need to happen throughout our government and society to address the crisis. There are just so many different levels where changes and opportunities lie to make this a better, more healthy, more kind, more compassionate society, in which people will, hopefully, feel less inclined to need to use substances that put them at risk for death and other issues.

I think we’re becoming more and more trauma-informed throughout different levels. I think that’s a phrase that we hear very frequently in the mainstream now, and I’m so glad that that’s happening. It just, again, offers a lot more compassion and underpins the roots of what’s going on.

[4:15 p.m.]

I think homelessness and poverty are health issues. When I fill out a disability form for somebody, I’m frequently putting those down as medical conditions. I really do somehow wish that the provincial rates could go quite a lot higher. The level of poverty a lot of people are living in is so extreme, and a lot of them are really quite unwell. I look forward to that changing for people.

The criminal justice system…. Lots of complexity there. I think for the people that I see, who are just the average sort of person….They’re more likely to be penalized by the justice system. I think restorative processes are probably much more effective, things that would allow them to reconnect or stay with their families and that would allow them to continue to parent. Different things like that.

I wish, somehow, it was easier to catch the top people in all of this, who are creating the mass supplies of drugs, and stop it there. That is certainly harder to do, I’m sure.

As far as family doctors…. Finding common ground for different values and philosophies regarding people who use drugs is something our profession is certainly working on. We all come from different backgrounds. I think the B.C. Centre on Substance Use is doing really great work in the sense of having provincial guidelines and other places for people to keep on learning so that we can all appreciate that this is a health issue rather than a moral issue.

I think my younger colleagues, coming out of training, are learning to understand substance use in a much more judgment-free type of perspective. I think that is going to engender a better future for addiction care throughout the bigger system.

Again, I work a lot with Indigenous folks. The cultural humility and anti-racism efforts, from all the services, are so important as we create policy, as we design systems. There’s just so much harm that’s been happening for folks that don’t fit into our regular system. I think this cultural humility certainly is for the Indigenous folks but also for everybody. There are just so many different ways of knowing and being. If we can honour that and honour the relationships, we’re going to get a lot further ahead in this crisis.

The last slide that I put out is another quote from Dr. Kendall. Primary prevention is healthy relationships. I think that’s healthy relationships within the family, the family unit, having secure families that have enough to eat, that have a safe place to live, healthy children and babies. That’s environmental issues, and that’s access to food. And then, of course, healthy relationships amongst the services or the infrastructures in which people live. So healthy health care systems and healthy criminal justice systems.

They’re lofty goals. As a family doctor and for the B.C. college…. I know that we are motivated to be a part of the solution and the changes that need to happen.

I really appreciate your time. Thank you very much.

N. Sharma (Chair): Thank you very much, Dr. Singh. We’ll just go to the questions and discussions now.

Colleagues, if you have any, put up your hand. I’ll go to them as I see them.

Go ahead, Ronna-Rae.

R. Leonard: Thank you very much for your passion and for coming and presenting today. I think our experience has been…. Not everyone has that kind of a passion and the energy to focus so determinedly on this issue. So thank you for the work that you do and the leadership, being involved with the College of Family Physicians. I think that’s really part of what we need, in terms of building solutions.

I guess the question that I have relates to the attitude of family physicians and the ability to attract prescribers. I’m just wondering if you could comment on that and how you see us moving forward to build that system where every family physician could take on that role.

C. Singh: Thank you. That’s a great question and definitely near to my…. It’s something I’ve always cared a lot about.

A bunch of different things can be occurring. I think one is that addiction medicine become part of a core curriculum for any kind of medical student and learners going through.

As far as attracting prescribers that already exist as practitioners…. I do think the way that the B.C. Centre on Substance Use has been trying to offer widespread education to anyone who is involved in the care system is really important. So I hope that they’ll continue to have the ability to do so. Even with COVID and stuff, they were able to do so much because of our ability to use computers and technology.

[4:20 p.m.]

Our regulatory college being less strict, less conservative, is really important. That’s been a barrier for a really long time for a lot of practitioners. It was very…. There was a lot of warning off from practising addiction medicine in certain ways. I think once those things become easier….

I also think…. When I used to work in the youth detox, I would sometimes call somebody up and be like: “Please, can you get your Suboxone prescribing because this person needs to discharge to your community, and the closest place otherwise is 2½ hours away. How can we get you to just keep taking care of that patient?”

Outreach, I guess. Inviting people into the practice and destigmatizing it and then just destigmatizing those that use substances. Education, I guess, in the end, hey? I guess a lot about education. Thank you.

P. Alexis: Along the same lines, I was really pleased to hear that you’re seeing change in the approach that some of your younger colleagues are bringing to the job, which is really encouraging.

Is there anything else or is there a mechanism for you to impart other expectations that would be valuable for our new family practitioners? Is there anything else that you can bring to us that might help open the door in Advanced Education or whatever in doing the job that’s required?

Does that make sense? I don’t know if I’m making sense.

C. Singh: I think that does make sense. I think it’s because it’s a complicated way for us to all figure out how to do this the best. From the B.C. College point of view, I think our ongoing efforts for continuing medical education…. We do stuff with medical students and with residents. We try to really embrace them into our fold and, hopefully, encourage them to have this as part of their practice.

I’m glad nurse practitioners are prescribing. I think it would be great if pharmacists could prescribe. I think anyone who is able to get this…. For the OAT anyhow — that’s just the opioid assisted therapy part. There needs to be other things going on. I’m happy for it to widen who prescribes and just have a bit more freedom around that. Having said that, I know we do need our regulatory things because sometimes things can go amiss.

I don’t know if Toby has any suggestions about other things we can do. I know education and collaboration are features that we really try to promote for our membership.

T. Achtman: I guess I would just add that one of the things that we, as Christine mentioned, try to do is, for example, have a medical student conference, and we highlight a family physician who does addiction medicine.

We’re trying to bring different kinds of practice and just really help the younger people who are interested in family medicine learn more about the wide scope and breadth and what they can do and give them opportunities to speak to those family physicians and ask questions and learn more about the role and the work.

N. Sharma (Chair): I have a question. I found it really interesting — all your experience that you’ve had, Christine, on the front lines of this. I just wonder if you could walk us through….

Somebody comes to you as a patient that’s addicted to fentanyl. What do you do? What do you prescribe them? How is that treatment plan? How does it show up for you? What does success look like in that context?

C. Singh: Okay, thank you. That’s a good question. I’ve got two settings that I work in, and the approach would be a little bit different both those settings.

For example, if I’m in the Downtown Eastside, I’m working at a low-barrier opioid replacement therapy clinic. Often people are fairly street-involved if they’re down there. So that is definitely a multidisciplinary approach. They’ve got really strong nursing programming there which does the intake, We would let people know about options for fentanyl replacements that are available and each site can have different ones.

Where I work, I could offer people Kadian. I could offer them methadone. I could offer them Suboxone. Potentially, also, safe supply, so that while we’re trying to stabilize them on some replacement therapy, we can offer them medicine like hydromorphone to use so that they don’t overdose while we’re trying to get them to a therapeutic level of the replacement drug.

Of course, fentanyl has been really hard because its potency is just so different from the regular opioids, and this is an ongoing challenge and why there are lots of different, novel approaches being tried.

[4:25 p.m.]

At that clinic, it is shared care. The pharmacists are really involved. There are other community supports that are there. As the doctor, to be honest, I am there mostly as the prescriber, but I also deal with health conditions like abscesses and the different things that folks come in with. So primary care, which is general care, often does need to go along with addiction care.

In my own family practice, the Indigenous clinic that I work at, those are the patients that I follow long-term and I’ve got an ongoing, committed relationship with. Some of the things would be quite similar, but at that clinic, in particular, I would definitely also be engaging people with our Elders, with our social navigators, because often, again, there are multiple issues going on.

As a doctor, I can approach things like the general health checkup, approach the prescribing of medications to reduce the use, possibly eliminate the use. But one of my bigger jobs is to actually help people connect into these other parts of the support that are going to actually keep them healthy and alive.

I hope that’s been a good answer. I’m not sure if that’s quite right or not.

N. Sharma (Chair): Just a little follow-up before I go to the next one. There are two things you said I would love to know more about. What do you mean by “novel approaches,” and are they working? Then the other one is you used a term in your presentation about palliative…

C. Singh: …substance use addictions.

N. Sharma (Chair): If you could explain that more.

C. Singh: Yeah, I sure can. I guess, for novel approaches, when I think most about that, I do think about, for example, the Portland Society, where they are trying to have fentanyl they can prescribe or sell just to give people something that’s equivalently potent to substitute. Again, a lot of the things that I personally could prescribe are not nearly as strong as fentanyl, so it doesn’t….

I think those things are really interesting, as those kind of approaches emerge, with the research behind them. I’m very proud of Dr. Sutherland and all the other family doctors and everyone else down there who are doing really interesting work.

From the palliative addiction approach, folks, especially in the east side — their life expectancy is super low. There are people who are elderly at 40, at 50, so their bones and their bodies and everything else that has happened. They’re in survival mode, and the chance of the thing that’s going to kill them being their addiction is incredibly high. It’s probably not going to be the lung cancer that they develop in ten years if they live that long. They’re probably going to die of the overdose or the addiction, a bad infection.

I think, when I say “palliative,” I mean doing the most to offer people comfort in their lives, not expecting a cure. The best palliative-care hospice setting would be a safe bed. It would be sanitation. There would be food. There would be someone to check in on you, maybe offer spiritual care. But you’re not looking for a complete resolution of the disease process. I guess that’s what I mean.

S. Bond (Deputy Chair): Thank you very much. Thank you for speaking to the value of being a family physician. I think all of us recognize that it’s a pretty critical component of health and wellness generally for people. Birth-to-death care would probably be one of the things that helps on the prevention and relationship side.

I’m really interested in the slide that you’ve referred to, one of the insights. It’s related to safe supply. I appreciate the way you’ve described it. You say: “Safe supply is a strategy, but increasing access to treatment is a necessity.”

Can you just talk a little bit about that? We have certainly heard that there’s inequity in terms of access to treatment, depending upon where you live. If you are incarcerated and released into community, the chances of you getting the resources you need are not necessarily there. So can you just explain that thinking — that we need the strategy, but we also absolutely must have an increase in treatment options?

C. Singh: Thank you so much for pointing that out. I think many other people have spoken to this as well.

When somebody is ready to engage in help, how can we get it to them in a timely way where it’s not detox? Intake is in three months’ time, or the treatment beds will take such a long time to get to or the very limited amounts of beds for various people, whether it’s based on gender or other things.

[4:30 p.m.]

I think the treatment length of time needs to be much longer for many people. Again, they need a safe place to rest and recover. I guess, if I want to use a kind of a similar metaphor as palliative care, we want people to go into remission. We want them to have a long time where they’ve got the supports they need so they can go back out to the world in a healthy way and, hopefully, have a long period of time, if not lifelong time, free.

So time, ease of access, the rapidity of response are really important. The trauma-informed practice I think is super important as well. There’s a lot of gentleness.

I think the two-eyed model is really important for a lot of other folks — for some of the Indigenous healing centres, just having that other level of medicine and culture. Culture heals for lots of people.

I guess we just need that ongoing funding and support to allow these programs to exist and to expand. So just, really, a lot more, because there are so many people that are affected by this disease and this situation.

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

I don’t see any other questions from any of my colleagues, so on behalf of the committee, I just want to thank you so much for the work that you do every day and for being such an important component of our health care system when it comes to longitudinal care.

I know you’re helping a lot of people through your work. We appreciate the expertise that you brought on the front line. Certainly, I learned a lot from that, so thanks for your time. We appreciate it.

C. Singh: Thank you very much, everybody. Thanks for your good work in this committee. Take care.

T. Achtman: Thank you for this opportunity. Bye.

N. Sharma (Chair): Bye.

Committee members, we’re in recess until five.

The committee recessed from 4:32 p.m. to 5 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): On behalf of the committee, it’s my pleasure to welcome our final presenter today. That is Andrew Montgomerie from WorkSafeBC.

We’re pleased to have you here today. I’m just going to go through who you have in front of you here so you know. We have your presentation in front of our various screens. You’ll have 15 minutes to present, and then the rest will be for questions and discussion.

My name is Niki Sharma. I’m the MLA for Vancouver-Hastings and the Chair of the Committee. I’ll just pass it to Shirley.

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

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

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

R. Leonard: Good afternoon, almost good evening. Ronna-Rae Leonard, MLA for Courtenay-Comox.

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

N. Sharma (Chair): Wonderful.

Over to you under, Andrew.

WORKSAFEBC

A. Montgomerie: Hello. Nice to meet you all, and thanks for having me.

I wanted to first acknowledge that I’m coming to you from Vancouver, the traditional, ancestral and unceded territory of the Coast Salish peoples.

I’m going to start through the slide deck. I presume you have it in front of you. Is someone is going to navigate that, or can I assume you can see it?

N. Sharma (Chair): We all have it in front of us.

A. Montgomerie: Perfect. Okay. Well, let me know. I’ll have to multi-task here. I may not always be looking up at the screen. I will start at the top here.

I’m going to cover off, basically, three different prongs of our strategy for harm reduction when it comes to injured workers and the use of opioids. I thought I would start with a bit of context around our mandate, just in case you weren’t familiar with it.

We were established by provincial legislation as an agency with the mandate of overseeing a no-fault workers compensation insurance system for workplaces in the province of B.C. We administer the Workers Compensation Act.

A couple of specifics about our mandate. First and foremost, we promote the prevention of workplace injuries, illnesses and diseases. When someone does get injured, we provide rehabilitation and support them in their return to work. We provide compensation for loss of wages while workers are recovering, and we oversee the system and ensure financial management so that the system is sustainable in the very long term.

A couple of notes regarding our approach and role to play in opioid management. We do not prescribe medication directly. The prescribing physician, nurse practitioner or other clinician is responsible for that. We pay for the drugs that are provided to injured workers in relation to their compensable injuries. We do, however, work closely with practitioners, clinicians in the community — those prescribing physicians and nurse practitioners — in order to make sure that we have supports for injured workers as they need them, to make sure that drug use, opioid use, is safely done.

In addition, for workers who are struggling with addiction, whether it’s related to their compensable injury or as a non-compensable condition, we have treatment programs and other supports that are in place to help injured workers, should they need it, to ensure that drug use is done safely and to perhaps transition them to more appropriate, safer, longer-term pain management approaches.

We use a harm reduction strategy that’s focused on preventing the chronic use of opioids and, like I said, connects and works with community physicians and other clinicians to help support injured workers and provide alternatives to opioids through other means. I’ll cover some of that off in the presentation.

[5:05 p.m.]

A little bit of an overview, just so you’re maybe familiar with the terminology I’m using about the teams and the people that work at WorkSafeBC. First and foremost, we have claim owners — they tend to be our case managers — who work directly with injured workers in the day-to-day interactions and discussions. They’re supported by medical advisors, who are physicians, who provide expert opinions on medical issues — all sorts of recovery and treatment recommendations. They also do outreach, phone calls and other interactions with community physicians as needed.

That group works with our injured worker population that is consuming opioids at a lower rate than our watchful limit of 120 MEDD, MEDD being morphine equivalent daily dose. We have a specialized medication review team that supports our case managers and works mainly with workers who are taking doses above that 120 MEDD. That team includes a pharmacist and an addiction specialist physician, as well as case managers and administrative staff.

Then, sort of in the background, we have our pharmacy benefits management team that works in our finance division and interacts with our bill payment and the data that flows from the financial side. They’ll monitor transactions for patterns — changes in usage or prescribing or payment patterns — and raise that to the attention of the case management team. You’ll see in a minute here that they’re involved in the process of reviewing our entitlements. Then lastly, our health care programs department oversees all of the provision of health care around the province. They manage our contracts and our quality assurance, and they make sure that workers have access to the care and supports they need in their communities as much as possible.

The first piece — the first prong, if you will — of our approach to opioid management for workers is our entitlement process at the start of a worker’s prescription for opioids. In our system, there’s really only two entry points to begin taking opioids. One would be when there’s an injury, and the physician prescribes opioids for pain management post-injury. The second would be when there’s a surgery. As any of us, I suppose, or close family, or any of you on the call…. If you’ve had surgery, typically you’ll come home from the hospital with a supply of some type of opioid pain medication for immediate post-surgical recovery.

In our system, our initial entitlement of opioids is for four weeks after either the date of injury or the surgery. What we’ve seen in our data is that most workers — 88 percent of workers that had surgery, for instance, and 59 percent that didn’t have surgery but had an injury — don’t approach us for an extension of that first four weeks. They’ve either stopped using the opioids or they’ve never used them at all, and they don’t seek out an extension from us.

If, however, there is an extension requested, we interact with the prescribing physician as well as the injured worker. We send out a letter to each of them, and we facilitate a conversation around the treatment plan. How long is the extension meant to be? What’s the plan for other alternatives for pain management — perhaps rehabilitation and other ways of getting the worker safer alternatives? We extend that initial four weeks to eight weeks in order to wait for those forms to come back, because essentially, the physician and the worker have to have a conversation and determine a plan. They sign and return those letters.

If an extension is requested beyond that eight weeks, our team, our medical adviser will review that. They’ll talk to the physician to just confirm the plan and other alternatives. Then we’ll extend it in keeping with the physician’s request if everyone agrees that it’s a safe and reasonable plan. At that point, if someone continues beyond eight weeks, we would switch to our medication team reviewing those claims at the six-month mark and then, again, annually. That would be for workers where the daily dose is over the 120. For those under 120, it’s reviewed and monitored by their case manager and the medical adviser supporting that case manager.

A bit more detail on the data we see on workers and the timing, I guess, of the last prescription through our system. On the left-hand side, you can see the percentage of workers that flow from a surgical intervention, and on the right, it would be for those that are not surgical. What we’re seeing is that in the first four weeks, 88 percent of workers post-surgery don’t ask for an extension beyond four weeks, and 59 percent of workers without surgery.

Then you can that see it tapers or funnels off as you move along down the calendar. At the six-month mark, probably 93 percent of workers post-surgery are no longer requiring opioids, and 83 percent on the non-surgical side. Then it goes down from there.

[5:10 p.m.]

The second prong of our strategy would be on our health care programs. I’ve shared here four of our most frequently accessed programs that we have in place for pain management. I won’t go into tremendous detail about these four. I can certainly provide more details if you’re interested.

These are all multidisciplinary programs. Typically, these are run by an occupational therapist and/or a physiotherapist with access to an addictions physician, a psychologist or a clinical counsellor. All of these programs are going to be focused on safer alternatives, reducing dependency on medication, functional restoration, activity, sometimes things like yoga or mindfulness as well as stretching and exercise — safer and healthier, longer-term avenues to pain management that reduce that dependency on medication. In the last couple of years, we’ve averaged about 1,200 to 1,300 workers per year going through this combination of programs or one or more of these programs.

In addition to these, we also have access to residential addictions facilities, where that approach is appropriate and the worker is interested and wants to do that. Those are typically abstinence-based residential programs. They’re less frequently used than these four, but we do have access to those as needed.

Then the third prong is our outreach and community involvement with health care providers. I think that in May our deputy minister shared some information and a bit about this, but I’ll elaborate a little bit more.

Our most frequently provided outreach is what we call our Not Just a Prescription Pad education session. This is typically hosted in the evening. It’s a two- or three-hour session. It provides physicians with continuing education credits, and we tend to get pretty good enrolments in this. There’s a lot of content in this seminar. Basically, it’s going to present some options for pain management that are safer than ongoing opioid use, strategies for tapering and picking up some of the other, safer, active pain management techniques that I mentioned before.

When we were doing these, pre-pandemic, there were really two key reasons for hosting these. One is the education-sharing of this information in supporting physicians. The other was that we would host these seminars around the province, and we would invite not just physicians or nurse practitioners but other clinicians from the community — other physiotherapists, massage therapists, chiros, whoever else was working in that community — to attend this.

The benefit there was introducing these clinicians to each other. It gave the physician — usually the physician, at least — a few more contacts in the community that they could draw on and call on, sort of forming a multidisciplinary team, if you will, to support the injured workers.

This is just a summary slide of where we’ve hosted these seminars since 2017. Like I say, prior to the pandemic, we went out in person and did these. Over these six years, we’ve reached over 1,700 participants.

Of course, over the last couple of years we’ve held these virtually, via Zoom. The benefit of that is that we can reach more attendees, but the downside is that you don’t get that community of people in the same room meeting each other that we were getting pre-pandemic. Our plan is to resume in-person sessions, once we feel like it’s appropriate and safe to do so, and to get back to that community connection.

The other thing I wanted to highlight is our physician information line. This is an 800 number that any physician in the province can call. It’s supported by our internal medical advisers and provides guidance and support for any of the topics we’ve just talked about — whether it’s tapering, alternative approaches, non-opioids or non–​pharmacological treatment strategies, information about our programs and how to make a referral to the programs, that sort of thing.

Lastly, what does this all sort of reflect? I think I would say we’re proud of what we’ve been able to achieve. I think it’s, obviously, a very complicated and always evolving problem that we certainly don’t feel like we’ve solved. We’ve made good progress, though.

From these stats — I think you saw some of these before — we’ve seen a 30 percent reduction in the number of injured workers with an opioid prescription since 2017. We’ve maintained, I would say, a relatively low and stable median MEDD per worker. More importantly, we’ve seen a 53 percent reduction in the number of workers who are on that high, over 120 MEDD dosage, from 239 workers in 2017 to 113 last year.

[5:15 p.m.]

Then lastly in this slide deck, I wanted to…. I presume many of you saw or heard about a recent study, released in July by Fraser Health, that referenced, among the findings that they outlined, that they had observed a protective effect for workers in the WorkSafeBC system. That was highlighted by 18 percent less likely to be prescribed opioids and 38 percent less likely to experience an overdose. This framework and approach that I just outlined, I would say, explains at least some of that effect that they saw in their data.

There, I think, I’ll pause and take a breath and maybe a drink of water and look forward to your questions and discussion.

N. Sharma (Chair): Thanks, Andrew.

Colleagues, any questions, comments, discussion?

R. Leonard: I know we’re getting a little bit tired at the end of the day, and I appreciate you coming to expand a little bit more on what we’ve heard — quite early, actually — in our proceedings here. The big thing, the last thing you spoke about, was the protective factor of this new framework that you’re working under. If you could just expand on that just a little bit more.

A. Montgomerie: I was referencing the findings that were shared in the Fraser Health study in July. When we saw the results, which they had determined from their data, of the 18 percent reduced use of opioids and 38 percent reduction in overdoses, there was some questioning about what we think is causing that: why do we think that they’re seeing that reduced or that protective effect?

The framework that I described around the initial entitlement period of four weeks and the check-in with physician, sending injured workers to treatment as they need it…. That, I think, is what led to the protective effect that was observed in the study data. That’s what I meant. The framework is not necessarily new — we’ve had that framework in place for quite a long time — but the study was the first time we had seen that publicly-shared data on better outcomes for injured workers in the system. Does that make sense?

R. Leonard: Yeah. If I can just ask a follow-up question. We know that there has been this particularly predominant sector of overdose deaths with construction workers, and we have heard, over and over again, about the injury rate within the construction industry and of that being one of the contributing factors to overdose deaths and the use of opioids. I’m wondering how those two statistics actually relate. What you’re talking about is a pretty good outcome, whereas what we’re seeing, in the statistics on people who are not making it, is that it’s growing.

A. Montgomerie: I don’t know how much more I can offer. I think you know that our organization works pretty closely with some with organized labour, with health and safety associations. In particular, in the construction sector, we work with the B.C. Building Trades, as well as the B.C. Construction Safety Alliance. I think you’ve heard from them; if not, you will. We work with them on strategic initiatives to address risks that they’re seeing in their industries.

On the framework that I described, I can only reiterate that that would apply to workers in the construction industry as well as in others. We use the same model for them. I don’t, unfortunately, have data on hand that I could share. I could go back and find some, and I’d be happy to share it if I could find anything that I think would be useful for you and that would speak to the prevalence of this within construction versus other worker populations, with respect to what I’m sharing today.

[5:20 p.m.]

S. Bond (Deputy Chair): Thank you for your presentation. I appreciate the work that you do. I’ll do a quick follow-up on what Ronna-Rae was just talking about. Do you do a breakdown and articulation of the sectors where people are being injured? Does it correlate with the very significant statistics related to construction?

A. Montgomerie: Certainly, we have data on injury rates and prevalence within various industries, and we would have that for construction. I don’t have it on hand, but we do track that, for sure. That is something I could go back and find, if there’s a specific data point or question that you guys would like to see.

S. Bond (Deputy Chair): Well, I think the key issue is that statistics tell us that construction workers are the vast majority, or a large portion, of the people who die of overdose. If there are construction workers that are dying at a rate that is significant, then it would be important for WorkSafe to be able to correlate that information.

I’ll leave that with you. I’m sure you can provide that to us.

I’m interested in the fact that 88 percent — you point out in your slides and have mentioned it — who had surgery, and 59 percent of workers who did not, do not request an extension. The number is far lower for people who didn’t have surgery. They have some other kind of injury. Again, I guess the…. I’m interested in those who continue to need help and those who don’t. Is there a touch-base with those workers to know that they…?

For example, in your presentation, it says one of the reasons they don’t ask is that opioid use has stopped. Do we know that? Are they potentially using other things to deal with pain? Is there a follow-up? When the person says, “Okay, I’m not getting an extension,” does that necessarily equate to the fact that they are not still requiring some form of assistance with their pain? What kinds of touch-bases are with workers to understand where they are in their injury and managing pain?

A. Montgomerie: Just capturing the question here. There’s a few…. To answer your question, I don’t believe we have a specific touchpoint to say: “What are you doing to manage your pain that you don’t need opioids anymore?” I don’t think we specifically request that of workers.

I know, in our system, there is the regular interaction between the injured worker and their claim owner, whether it’s the case manager or some other person on the team. I think those conversations around return-to-work planning and the connection with their employer, as well as connections to the family physician, would reveal if there was a problem there.

As far as I’m aware, there’s no specific question that says: “We noticed….” For instance: “You did not request an extension. Is there something else you’re doing to manage pain?”

I would think that a lot of the folks that don’t request the extension are not feeling a need to manage pain in a specific way. Many of them are no longer within the system at that point too. Most of our injuries are fairly short in nature. Some of them, the ones that are longer, tend to be the more complex and expensive claims.

S. Bond (Deputy Chair): Maybe also just…. What is the relationship between WorkSafe and employers in terms of helping to co-manage the situation when there’s a potential for ongoing use of opioids? What is the relationship between WorkSafe and employers?

A. Montgomerie: During the return-to-work planning and coordination conversations, that would need to be something that the case manager and the worker and the physician are aware of.

Obviously, it’s not safe to work in certain roles while using opioids. So those would need to be…. Within privacy parameters, that would need to be part of the return-to-work plan with the employer — and finding suitable, safe employment, whether it’s part time or full time, whether it’s part of a graduated return or stay at work.

[5:25 p.m.]

They’d have to consider the safety parameters around opioid use. That’s part of the conversation that we have, involving the physician and the worker with the employer.

N. Sharma (Chair): Thanks for your presentation. I have a question. As you can tell from the committee members, we’re all very troubled by the stats from the construction industry. It wasn’t just the contributing tragic deaths that had a touchpoint with the construction industry. It was ongoing pain management. It was also the substance use. I think there was a survey done, and one in three construction workers reported problematic substance use.

I’m interested in the…. Very early on in your presentation, you talked about the preventative work that WorkBC does. You talked in detail about when you step in, in the injury at work, and the planning that you do and the protective factors that can help that person. But if you take a step earlier than that, in terms of preventing harm or workplace culture that contributes to potential harm to employees, is there some kind of special work that you’re doing when you see an industry that has the kind of stats that we’re seeing reported out of the construction industry, particularly with this?

That’s one question. The other one is: would you track…? I don’t know if WorkBC has ever done this. If you look at the coroner’s report and the death is there…. Sometimes we’ve seen — with different, I guess, government bodies — interfaces with people that have died, if there were touchpoints and what the stats were.

For example, for Corrections, we heard a stat yesterday. I think it was 55 percent, or something like that, of people that have died in the coroner’s report had a touchpoint with Corrections B.C. I would be really curious to know if we have a stat like that with WorkSafeBC, that helps us understand. From the perspective of who is dying, is there a touchpoint with WorkSafeBC? If you know that, that would be helpful.

A. Montgomerie: I have not seen that stat in terms of a touchpoint with WorkSafeBC. I don’t know if that’s something that’s tracked. I’ve never seen that stat before related to WorkSafeBC.

Each year in our annual report, we publish work-related deaths. If there was, for instance, an overdose death that was a result of the compensable injury, it would be reported there. I know there’s typically a small number of those in each annual report, but I’ve never seen a stat like you just cited before related to WorkSafeBC.

To your first question regarding prevention, I should first say: I’m not involved on the prevention side of our organization, but I can speak to it at a high level. The work tends to be…. We’ll either work with health and safety associations, like I mentioned before….

The B.C. Construction Safety Association — their alliance tends to be the primary avenue for us when it comes to construction. They have funding that comes from a levy that’s charged to the employers within their classification unit. They use that money to fund initiatives and campaigns and tools for their employers in their sector. I think that avenue would be the most prevalent way that they would support their member employers.

I’m not familiar right now with a specific prevention initiative when it comes to opioid use in that sector — that I can think of. I think it’s something that we would more connect with the safety alliance and support their initiatives. Again, as I say, not being in the prevention division, it’s something I can go and ask my colleagues and see if there’s something more I can share with you.

N. Sharma (Chair): Just a quick follow-up. Do you think there’s an ability for us to get this stat that you talked about — about if there are any touchpoints with the coroner’s report and the death reporting and WorkSafeBC? Is that a possible…?

A. Montgomerie: It would be…. You’re curious to see, of the folks in B.C. who died of toxic overdose, how many of them had an interaction — or a claim, I should say — with WorkSafeBC?

N. Sharma (Chair): That’s right. Yeah.

A. Montgomerie: Okay. I can ask for that and see if anyone is aware of that.

R. Leonard: Thank you for asking that, Niki. That was my question before, but I’ve developed a new one.

Thank you for the work that you’re doing. I really appreciate your presentation. My question is a little bit of sort of the precursor to it.

[5:30 p.m.]

You walked us through the dosage and the time length and those statistics. Where did you come up with 120? Where did you come up with four weeks, eight weeks, etc.?

A. Montgomerie: The genesis was, I believe, 2011 when an internal practice directive was designed to address and manage some of the risks related to opioids. At the time, I believe the 120 MEDD was the watchful dose noted by the College of Physicians and Surgeons in B.C. One of the things we’ve done over the years is make adjustments and fine-tune to the system. Originally, I believe that four weeks was six or eight weeks, and we’ve reduced it over the years to, now, four weeks.

We are also considering changing the 120, to lower it to perhaps 100 or even 90 MEDD. And I believe that’s in keeping with the current watchful dose from the college as well. But historically, we followed the guidance that the College of Physicians and Surgeons had issued to set the 120, and then we’ve fine-tuned the four weeks over the years just to try to get that sweet spot of not being too early but making sure we are preventing any long-term, habitual or dangerous use of opioids as best we can.

N. Sharma (Chair): Actually, just if you could clarify something for me. I don’t see any other questions after this.

If somebody does report that they have…. Well, I guess there are two sides to this. If they were having a problematic substance use issue, would the back-to-work planning be something that would disincentivize them from reporting that problematic substance use, or not? Does that process keep people hiding something that might be problematic because of their work or employment security issues?

A. Montgomerie: That’s an interesting question. It would require that the worker was very motivated to go back to work, and perhaps in those cases, that would happen. I think you’re right. I think that could happen. It’s not something I’m all that familiar with in terms of a common situation in our system.

I think, more frequently, it’s the fact that the compensable or non-compensable opioid use is a risk factor that we need to manage and maybe put the worker through one of those treatment programs that I’ve talked about, or work with their family physician on another plan that would allow them to participate in a safe return to work.

I guess it could happen where someone would not report substance use because they’re worried about losing their job or not being able to return to work, but it’s not something that I hear very commonly in our system.

N. Sharma (Chair): I guess it would be hard to track that too.

A. Montgomerie: It would be. Yes.

N. Sharma (Chair): Yeah.

I think those are all the questions that committee members have of you. I just want to, on behalf of the committee, thank you for your presentation, helping us understand the perspective of WorkSafeBC when it comes to the opioid crisis that we’re facing in B.C. We appreciate your time.

A. Montgomerie: Thank you very much. I appreciate the invitation. Have a good afternoon.

N. Sharma (Chair): You too.

Okay, committee members, we need a motion to adjourn for today.

I see Ronna-Rae and then Sonia for a seconder.

We’ll see everybody tomorrow.

The committee adjourned at 5:33 p.m.