There’s no shortage of ideas to ease B.C.’s fentanyl-overdose crisis: Supervised-consumption sites, more treatment beds, free naloxone, more supports for addicts after they go through rehab.
Implementation, however, is another matter.
The Times Colonist’s series On the Front Lines of Fentanyl has shown people in Victoria who have been most affected by an unprecedented number of overdoses and deaths. We’ve talked to drug users, first responders, social-service workers, doctors, politicians and law enforcement.
But when might we see change in Victoria?
> Read the other stories in this series here.
Politicians, bureaucrats, advocacy groups and users agree that supervised-consumption sites are the most critical intervention to prevent illicit-drug overdoses. Yet there isn’t one in Victoria.
Chief medical health officer Dr. Richard Stanwick said Island Health is working on two applications for supervised-consumption sites that would include a range of health and social supports. Island Health plans to submit them to Health Canada in December.
“We should be able to announce something soon,” Stanwick said.
One location has been confirmed; the second is still being negotiated. Both locations are downtown and involve a partnership with a service provider.
Public consultation, which is part of the application process, could take place in the next two to three weeks in a town-hall session where the public could ask about the services and neighbourhood impacts.
“We are also getting up a basic set of questions and answers on our website,” Stanwick said.
Harm-reduction advocates at AIDS Vancouver Island, Our Place Society and Cool Aid Society have expressed interest in operating safe-consumption services.
For two years, a group of drug users, researchers and advocates have visited community centres, church social rooms and social services agencies to talk about how safe-consumption services could save lives in Victoria.
“The response has been overwhelmingly positive,” said Katie Lacroix, with Yes2SCS (supervised consumption services). “People want to do something about what’s happening.”
Lacroix and other advocates want to know what’s taking so long.
The City of Victoria included supervised-consumption services in its strategic plan.
“The city has been clear about its goal to have supervised-consumption sites, but we are acting as more of a facilitator on the application process,” said Coun. Marianne Alto. “Island Health is the author, and what’s included is up to them.”
Once the application is submitted to Health Canada, it’s not known how long approval will take given that other cities are expected to apply.
Victoria MP Murray Rankin has pressed Health Minister Jane Philpott on the need for a safe-consumption site in Victoria. The first step in doing this is to repeal Bill C-2, the Respect for Communities Act passed by the former Conservative government in 2015, which makes it more difficult to open harm reduction sites, Rankin said.
He has advised Philpott that Island Health will submit an application in December.
Since the process to obtain an exemption requires a letter from the head of the police force responsible, the RCMP in B.C. is co-ordinating its response to move forward on supervised- consumption sites.
Eight months after he declared a public-health emergency to raise awareness of the increase in opioid-related overdose deaths, provincial health officer Dr. Perry Kendall is cautiously optimistic that fewer people will die from illicit-drug overdoses due to fentanyl in the coming months.
“With all the awareness and training out there, people who overdose are more likely to be revived than they were six months ago,” said Kendall.
“But I don’t think we’re seeing fewer people having overdoses.”
Kendall believes the B.C. government is doing more than any other government in North America because it supports harm-reduction services.
Making naloxone available to first responders, family and friends of drug users has been effective, Kendall said.
Last week, Island Health announced it would open 93 additional treatment beds. With the current 103 substance abuse beds and 38 more promised next year, this brings the total number of treatment beds on Vancouver Island to 196.
Treatment beds are part of the solution, but not the only option to the opioid crisis, Kendall said. Abstinence-based programs have a very high relapse rate.
“You can do very well in a program for 28 days, but unless it’s linked with treatment support in your home community, the tendency to relapse, especially with opioids, is very high,” said Kendall. “And if you haven’t been doing opioids for a month, you’ve lost all your tolerance, so your risk of dying from an overdose is greatly increased.”
Addicts need rapid access to counsellors or physicians to talk about whether they want to withdraw under supervision or whether they want to move on to medications used to treat opioid abuse, Kendall said.
Sometimes people who are addicted to drugs do better if they can see a counsellor a doctor quickly and get a prescription for Suboxone, he said.
Last week, B.C. Health Minister Terry Lake said the new front-line treatment in most jurisdictions will be Suboxone, an opioid replacement.
“What you will see is more and more people have access to opioid-substitution programs, and it is covered on a sliding scale under Pharmacare,” Lake said. “This switch in the new approach to opioid-substitution programs, I think, will eliminate a lot of concerns about barriers to treatment.”
Grey Showler, the manager at the Cool Aid Community Health Centre on Johnson Street, said the clinic has seen an increase in Suboxone program usage over the past year.
“Anecdotally, the numbers are up. There are more prescriptions,” he said.
The clinic, which operates in the same building as AIDS Vancouver Island, has more than 4,500 clients, the majority of whom are on social assistance as persons with disabilities. The clinic also has a pharmacy.
Showler said part of expanding the clinic’s Suboxone program has been to train the six staff nurses to do the majority of the intake work — which involves interviewing clients about their health and drug-use history.
“We want to make sure that someone who comes in the door can see a doctor. If they see a nurse first, this makes for shorter consultations with the doctor,” Showler said. There are eight part-time doctors at the clinic.
Showler said that while the harm-reduction services have been crucial for Cool Aid Society, the other long-term solution is increasing access to housing.
“We know that when clients have a home, they are more safe. Looking at the bigger picture of what is going on, this is one of the important pieces,” he said.
Surrey NDP MLA Sue Hammell supports a supervised-consumption site in Victoria and thinks options should be available to help people with addictions and/or mental illness. “It would be naive to think every person you put in a recovery bed, recovered,” Hammell said.
“Recovery is different things to different people. You can move to methadone or Suboxone.
“But I think it would be unconscionable if you did not believe that someone would become clean and offer that path. Maybe you really want to go down the path of abstinence and you keep working on it until you are successful. Or you take Suboxone where you can function effectively in life.”
Hammell also believes in the need for a strong public-education program to inform street users, recreational users and potential users about the drug.
Treatment for addiction and mental health is broken in B.C., Hammell said.
“It’s not clear where you go to get help. We don’t have a robust, effective mental-health and addictions system in our province, and we have to fix that. Many people with street addiction are also mentally ill. Fifty per cent of people in jail are addicted and/or mentally ill and some are both.
“We need a system where we can address mild, moderate and severe addictions and mental illness and we don’t have that in B.C.”
The series: On the front lines of fentanyl
In this series, the Times Colonist will take you to the front lines of the overdose crisis in Greater Victoria to better understand illicit-drug users and how fentanyl is increasingly involved in overdoses.
Day 1 — Overdose deaths up; the people who use; anatomy of a crisis
Day 2 — The stress on front-line workers
Day 3 — First responders adapting to overdoses
Day 4 — Fentanyl and the criminal courts
Day 5 — A doctor’s frustrations; the political challenges
Day 6 — Victoria-based solutions in the works
