B.C.’s addictions treatment system is an infuriating mess that’s not working.
Let's start there, and say it out loud, because it’s true. The politicians know it. Two successive governments have failed to fix it. Years tick by, and people keep dying. The only thing that seems to change is the name of the minister on the self-congratulatory press release about whatever random bed or program is being opened on whatever random day.
We witnessed it all again Tuesday when chief coroner Lisa Lapointe announced 2,272 people died in 2022 of suspected drug toxicity. That was just shy of the provincial record for annual deaths, set the year before.
"I hope that we can sit with that grief and that outrage,” said Dr. Paxton Bach, the co-medical director for the BC Centre on Substance Use.
“I hope that every citizen of the province reflects on this report and feels that outrage and uses that to drive the advocacy that is needed to generate change."
B.C. has responded to the public health crisis the past seven years in several ways, but each has fallen short.
It pushed the envelope with safe supply, yet that’s not available widely-enough to reach everyone who needs it.
The province is the first to try decriminalization, but the personal possession thresholds are too low to capture most users.
Both of those are emergency measures to keep severely addicted users alive until they are ready to enter treatment and recovery. And yet, B.C.’s treatment system is largely inadequate to the task. Beset by years of underfunding, it is a patchwork mess, filled with gaps. As experts have repeatedly said, people are literally dying while waiting for help.
“The reality in Vancouver is for someone wanting to access the treatment system, to access a detox program, just the initial step is a two, three or four week waiting period for detox,” said Dr. Bach, who works in addiction medicine at St. Paul’s Hospital.
“That is an eternity for someone who is continuing to use drugs, maybe who is vulnerable to so many different harms over that time.
“That’s just the beginning. From that point, they want to access a bed-based treatment program, a publicly-funded program, they may be waiting as many as three or four months for that program.
“Which means once they finish their detox they are left in limbo while waiting to actually access the treatment program they are seeking.”
How is it possible that after years of this public health crisis, in which more than 11,000 people have died, the provincial government still can’t get its act together on a basic treatment and recovery system?
The answer to that question is even more frustrating. It turns out, nobody really knows what’s going on in the 3,260 publicly-funded substance use beds in this province — not even the provincial government that funds them.
B.C. does not track the waitlist for beds. It doesn’t know how many patients are helped by a treatment bed in a given month or year. It doesn’t know what beds are empty. It doesn’t know if the people who use them recover, relapse, or die. And, most importantly, and perhaps most depressingly, it has no idea how many new beds it needs to fund to fix all these problems.
Instead, the government makes scattershot announcements about new beds and programs, while dodging questions about how it all fits together. Because the true answer is, neither the health minister, nor the mental health minister, nor even the premier, have a clue.
“We have heard many announcements about beds,” said Lapointe.
“There is still no provincial framework for regulation and reporting on outcomes, so we don't actually know across the province where those beds are. We don't actually know what it means when a bed is funded, how many people does that help, what are the outcomes for those people – those types of evaluations, so that we know that where we are investing is adding value and that people are being helped.”
None of this is ideological, or entirely the fault of one political party or another. But our politicians pretend it is.
“We have inherited a fragmented collection of services that needs to be brought together so that we have care and treatment pathways for people,” Mental Health and Addictions Minister Jennifer Whiteside said Tuesday, in an attempt to fob off the lack of progress from her government over the past five and a half years onto the previous BC Liberal administration.
Don’t blame Whiteside – yet. She’s new to the job, and just reading the same awful attack lines written by partisans who equate governing to wedge issues. There’s actually quite a bit of optimism in political circles that Whiteside is the reformer needed to get things moving after seven years of inertia, two largely-ignored coroner death review panels and a report from an all-party legislative committee that’s been collecting dust within her ministry.
She and new Premier David Eby have a chance to break the cycle here. They can follow through on Eby’s idea of a “seamless” continuum of care for treatment, from hospital emergency rooms, through to treatment beds and housing, all without wait times or gaps.
Plus, they can backstop it with basic data and metrics used in the rest of the health care system. If B.C. can craft detailed plans on how to speed up wait times for knee replacements, surely it can figure out how to track addictions treatment beds as well.
“Access to waitlists is something that we, at some point, need to be in a better position to respond to,” Whiteside said Tuesday.
“We need to do some groundwork with health authorities and with our partners in order to have the information that we need in order to be able to provide that information.”
The obvious criticism is that we’re half a decade into a New Democrat government that is only now doing the “groundwork” to start to create a functional, measurable, addictions treatment system.
Make that criticism if you want. It’s totally valid, and the NDP certainly deserve the shot. Then, get over it. Because lives are still at stake, and the real issue right now is how to improve, not who to blame.
The new Eby administration has a chance to alter course. All eyes are on the February provincial budget to see if the funding is there to start the major reforms needed to fix a treatment system that is very clearly not working.
Advocates can only wait and hope.
“I desperately, desperately don’t want to be back here next year,” Dr. Bach said to end his presentation at Tuesday’s press conference. “But in order for us to do so we need to start treating this like the emergency that it is.”
Maybe, hopefully, finally, we are getting close.
Rob Shaw has spent more than 14 years covering B.C. politics, now reporting for CHEK News and writing for Glacier Media. He is the co-author of the national bestselling book A Matter of Confidence, and a regular guest on CBC Radio.
