Harm Reduction and Addiction Treatment Systems of B.C. are riddled with gaps (2023)

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In the same week that the province's introduction of decriminalization marked a turning point in drug policy, dire figures were leaked from B.C. The Coroner's Service, which shows people continue to die in near record numbers from the supply of toxic drugs, exposed gaps in the province's harm reduction and addiction treatment system.

The approach to filling these gaps varies greatly depending on where you are on the political spectrum.

BC Liberals say the NDP government is focused on distributing "state-provided drugs" rather than investing in a publicly funded treatment and recovery system. The BC Greens say the 2,272 drug toxicity deaths last year are a clear sign that the province's harm reduction strategies, which include using prescription opioids as a substitute for toxic street drugs, are not reaching enough British Columbia residents, particularly in rural ones and remote areas of the province.

And the province's mental health and addictions minister says the NDP has inherited a broken system and is trying to build a comprehensive model for mental health and addiction services from the ground up.

Proponents say it is wrong to politicize the province's drug policies and that harm reduction and treatment exist on a spectrum, all aspects of which are woefully underfunded.

dr Paxton Bach, co-medical director of the B.C. Center for Substance Use, said there is a narrative that public money could be spent on harm reduction or treatment as if the two approaches were in conflict.

"Once we started down that path, we already lost," Bach said Tuesday after lead medical examiner Lisa Lapointe released the drug toxicity figures. "The reality is that we don't need to invest in a strategy, but in a range of treatments that our patients desperately deserve."

Bach, an addiction medicine specialist at St. Paul Hospital, said he has patients who have been in treatment or recovery for weeks, months and even years. If they do relapse, it's important they have safer alternatives to toxic street drugs to avoid a fatal overdose.

B.C. Liberal leader Kevin Falcon accused the government of focusing solely on harm reduction, which keeps people trapped in addiction.

"Harm reduction is just a small fraction of what a comprehensive approach should be," he said.

On Thursday, Falcon submitted a "major change of direction" for B.C.'s addiction treatment system. a. He said that if he becomes prime minister, his government would spend nearly $1.5 billion over three years to build a "free, accessible, recovery-focused care system for everyone struggling with addiction."

Falcon said it would triple the capacity of the 105-bed Red Fish Healing Center, which is on the site of the former Riverview Hospital, which treats patients with severe and complex mental health and addictions.

The plan would include mandatory treatment for people who harm themselves or others, Falcon said. He also wants a nationwide centralized addiction treatment waiting list so the government can better estimate how many extra beds are needed to respond to the shortage.

On Tuesday, Lapointe denounced the fact that B.C. It has no data on the length of waiting lists for the province's 3,260 publicly funded drug use beds or outcomes for people using them.

"There's not yet a provincial framework for regulation and reporting of outcomes, so across the province we don't really know where these beds are," Lapointe told reporters. "Actually, we don't know what it means when a bed is funded. How many people does this help? What are the results for these people?

When asked about the missing data, Jennifer Whiteside, B.C. Secretary of Mental Health and Addiction, acknowledged that the province needs better access to treatment bed waiting lists, but gave no timeline for when they might be available.

"We need to do some groundwork with health authorities and our partners to get the information that we need to be able to provide that information," he said.

According to Bach, people in Vancouver typically wait several weeks to detox, which "is an eternity for someone who continues to use drugs and has potentially been exposed to so many different harms during that time."

From there, if the person wants access to a publicly funded bedside treatment program, they have to wait three to four months.

"This means that once their detox is complete, they remain in limbo while waiting to access the treatment program they want," he said.

Harm reduction advocates have warned against detoxing people who use opioids because they are at greater risk of overdosing on strong street drugs if they relapse after a period of withdrawal. For this reason, many in addiction medicine have turned to harm reduction interventions, such as B. the opioid agonist therapy, the prescription opioids suchMethadone, hydromorphone, or suboxone to control people's addictions.

Garth Mullins, a drug user who used heroin for at least a decade before being prescribed methadone in 2002, said withdrawal treatment doesn't work for everyone. Therefore, he advocates for barrier-free access to non-toxic opioids to prevent people from dying, which is particularly lacking in the more rural and remote parts of the province.

“I went to 12 steps (programs). I went to all of these things. That shit didn't work for me. I've never gotten sober and clean," said Mullins, an activist with the Vancouver Area Drug Users Network. "You have this problem, if you've been in rehab for a while, you slip, your tolerance changes, and you die."

Guy Felicella, a fellow clinical consultant at B.C. Center on Substance Use in Vancouver said the debate between harm reduction and treatment had boiled down to political boasting.

"If we believe that sending people for treatment is the solution, then we're going to let more people down again," said the 53-year-old, who has been sober for 10 years after decades of heroin addiction.

It's part of the solution, Felicella said, but equally important is second-stage housing to support people after treatment and publicly-funded counseling to help cope with the underlying addiction-related trauma.

“My children would not live without harm reduction and I would not have the life I have today. Gone are the days when it was a matter of either/or. Are both."

kderosa@postmedia.com

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