More addiction treatment needed as B.C. drug decriminalization pilot enters 2nd year: doctors, advocates
A narrow, winding corridor at Vancouver’s St. Paul’s Hospital leads to a clinic offering quick access to addiction treatment for people seeking help on their own or after a referral from an emergency room, a family doctor or social worker.
Nurses and physicians at the Rapid Access Addiction Clinic see people with severe dependence on alcohol or drugs, with the vast majority of the 20 to 30 daily patients needing support to quit using illegal opioids.
They are typically prescribed methadone or Suboxone, medications that ease the pain of withdrawal and cravings for potentially deadly drugs as part of a brief intervention. The goal is to stabilize patients before connecting them to a family doctor for followup treatment and rehabilitation.
But there is no clear path to continuing care for many of the patients without a family doctor, said nurse lead Victoria Ramos.
“We have such limited resources for where patients can go so we kind of hold on to them until they can be transferred,” Ramos said of the clinic that opened in September 2016, five months after British Columbia declared an ongoing public health emergency due to rising overdose deaths.
More than 13,500 people have fatally overdosed in the province since then, and the coroner’s service issued a public safety warning earlier this month about a sharp increase in drug-related deaths.
Ramos said Vancouver’s only rapid access addiction clinic needs to be expanded to include family doctors so patients are better supported in the midst of a crisis.
While addiction specialists maintain that a lack of readily available long-term treatment represents a major gap for those who take the step to access immediate addiction services, others, including the advocacy group Moms Stop the Harm, are calling on the province to also regulate dozens of private residential treatment facilities to ensure they provide evidence-based care by trained staff.
Patients need easy transition to support: doctor
Concerns about access to treatment are increasing as the province embarks on its second year of a three-year decriminalization experiment, which allows drug users age 18 and older to carry up to 2.5 grams of opioids including heroin, morphine and fentanyl, as well as crack and powder cocaine, methamphetamine and ecstasy for personal use.
The pilot project is a first of its kind in Canada and aims to treat illicit drug use and addiction as a health issue, not a criminal one that stigmatizes people and prevents them from seeking help.
Toronto has also filed an application with Health Canada for an exemption from federal drug laws, but with no age requirement or limit on the amount of illegal substances someone can possess without police seizing them.
The Vancouver Area Network of Drug Users has said having police officers hand out health service referral cards to encourage people to seek treatment as part of B.C.’s decriminalization model doesn’t help because of waitlists and programs that require users to detox before they get care.
Dr. Sukhpreet Klaire, the physician lead at the rapid access clinic, said patients who have been stabilized need to be easily transitioned to ongoing support, especially as illegal drugs, often laced with fentanyl, have become increasingly dangerous.
“I think patients often struggle with the idea of needing to wait for care,” he said.
“There’s certainly been an expansion of stabilization and treatment beds but I’m not sure I can say that the expansion at the current state has met the need.”
Access to drugs without prescription also key: coroners
Access to regulated opioids and stimulants without a prescription is also important for the many people who are at risk of dying from street drugs but do not meet the criteria for a substance use disorder, Klaire said.
“Otherwise, there’s never going to be a shift in the mortality rates. None of the tools that I have are really helpful here.”
The B.C. Coroners Service death review panel has made the same proposal, saying about 225,000 people in B.C. use unregulated substances but fewer than 5,000 have monthly prescriptions for safer alternatives.
Michael Egilson presented B.C.’s latest review over the toxic drug crisis, which calls for the province to expand access to safe supply and better consult those with lived experience.
The change would require the province to request an exemption from federal drug laws as part of an urgent response that the panel said would come with a robust monitoring and evaluation system.
However, the province’s Mental Health and Addictions Minister Jennifer Whiteside immediately rejected the idea, even before retiring chief coroner Lisa Lapointe announced the panel’s recommendation last month, saying drug users would need medical supervision.
“There is no jurisdiction anywhere that provides the kinds of drugs that we’re talking about here on a basis that does not have some kind of oversight,” Whiteside said in an interview.
“We have implemented a prescribed safer supply model to try to find ways in which we can separate people from the illicit drug supply. We’re the first jurisdiction in Canada to do that.”
More registered nurses and registered psychiatric nurses are getting training to join doctors in prescribing safer and controlled doses of drugs, including opioids, to reduce withdrawal symptoms for those entrenched in addiction, Whiteside said in response to claims from advocacy groups that not enough care providers are participating in those programs.
Lisa Lapointe says she understands that safer drug supply is controversial and seemingly contradictory, but defends the work by a death review panel showing how it can be done safely in the province, outside the health-care system.
Ensure trauma-informed care: advocate
Leslie McBain, co-founder of Moms Stop the Harm, said access to residential treatment centres that offer longer intervention is also important but the province needs to regulate the industry, subsidize it and ensure staff are trained to provide trauma-informed care.
She and four other parents met with Whiteside earlier this year to discuss their concerns.
“If we’re spending a big whack of money on these places we want to know that the care that our loved ones are getting is actually worth something, that it’s actually going to help them on the road to recovery,” said McBain, whose son, Jordan Miller, was a patient at a private centre. He died in February 2014 from an addiction to oxycodone prescribed for a workplace back injury.
Whiteside said the province is expecting to release a report in the spring on unregulated treatment facilities.
“We’re in a process, right now, of engaging with that sector around what kinds of services they’re providing,” said Whiteside.
“But I will be very clear about this point … this is care that is really critical to the health and well-being of British Columbians. Our government thinks it’s very important that we work collaboratively with community providers.
“They’re providing important access to care, but it has to be evidence-based and we have to have certainty that is what will be happening.”
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