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B.C. takes action to save lives, build new connections of care with drug decriminalization

January 30, 2023 at 10:44 am  BC, News, Politics, Provincial

The Province continues to enhance B.C.’s response to the toxic drug crisis, investing $430 million through Budget 2022 over the next three years.

Visit the BC Centre for Disease Control’s (BCCDC) website for more data on the drug poisoning response:
http://www.bccdc.ca/health-professionals/data-reports/overdose-response-indicators

Take Home Naloxone Program:  https://towardtheheart.com/thn-in-bc-infograph

Data on prescribed safe supply is available from the BCCDC: http://www.bccdc.ca/resource-gallery/Documents/Statistics%20and%20Research/Statistics%20and%20Reports/Overdose/2022.02.22_BCCDC%20Infographic_RMG.PDF

Recent actions:

Enhancing treatment and recovery

New beds for addictions and recovery care

The B.C. government has prioritized making new treatment and recovery beds available to those who need them.

Budget 2022 continues with prior investments, which result in $144.5 million over the fiscal plan to continue the Province’s historic investment in the development of a full-spectrum system of substance-use treatment and recovery services. This includes the implementation of 65 new and/or enhancement initiatives resulting in approximately 195 net new withdrawal management, transition and treatment and recovery beds over three years in all regional health authorities, as well as through the Provincial Health Services Authority.

This is in addition to investments in treatment and recovery beds over the past two years:

  • 105 beds in 14 organizations administered through the Canadian Mental Health Association, BC Division in all regional health authorities;
  • 123 new youth beds throughout the province; and
  • 105 beds at Red Fish Healing Centre, the first-of-its-kind in North America, to treat complex mental illness and addictions simultaneously.

As of September 2022, there are 3,260 publicly funded adult and youth community substance use beds. Data on beds is updated four times annually.

During the past year, B.C. has also announced other initiatives that are helping to close critical gaps in the system of care:

In addition to the above investments, the Province continues to add new health-care workers to bolster services across the full continuum of substance-use treatment and recovery services in all corners of the province:

  • Withdrawal management (detox): ensures people are safe and supported through the sobering process and during the acute stages of withdrawal. For example:
    • Increasing staffing at Creekside Detox to ensure the service operates at full capacity (two nurses, Fraser Health);
    • Enhancing staff for sobering and assessment beds to provide the necessary clinical services and support care co-ordination in Terrace and Prince Rupert (six health-care workers, including a nurse and substance-use clinicians, additional recruitment underway, Northern Health); and
    • Expanding the Prince George Mental Health and Substance Use Detox by implementing an enhanced staffing model to support people with more complex needs (3 health care workers including nurses and mental health/detox workers, Northern Health)
  • Transition and assessment: ensures people can transition seamlessly between services, staying connected to care during their recovery. For example:  
    • Adding new substance-use clinicians to help ensure older adults throughout the Fraser Region are connected to the substance use services they need (three social workers, Fraser Health)
  • Specialized treatment and recovery: range of outpatient and bed-based substance-use services, including initiatives targeting alcohol and stimulant use disorders. For example:
    • Expanding the capacity of the Adult Addictions Day Treatment programs in Smithers, Terrace, Dawson Creek and Fort Saint John (four mental health clinicians, Northern Health)
    • Expansion of substance-use counselling in Sechelt (one social worker, Vancouver Coastal Health)
  • Aftercare: provides community-based recovery focused supports and follow-up services post treatment. For example:
    • New aftercare services for people returning home after participating in bed-based services (two social workers, Interior Health)
    • New Peer Support Workers in Nanaimo (3 Peers, Island Health)

Expanded scope of nursing practice, a Canadian first

To increase the number of clinicians who can prescribe medications for opioid-use disorder, particularly in rural and remote parts of the province, registered nurses (RNs) and registered psychiatric nurses (RPNs) can now complete training to begin prescribing opioid agonist treatment. In November 2021, the British Columbia Centre on Substance Use (BCCSU) launched  education and training to enable RN/RPN prescribers to offer methadone and slow-release- oral-morphine (Kadian), in a phased approach, in addition to existing education and training focused on buprenorphine/naloxone.

As of January 2023, 226 registered nurses and registered psychiatric nurses from all health authorities have enrolled in training, and 105 have fully completed their training. From these fully trained nurses, 62 have completed the buprenorphine/naloxone stream and 41 have completed the new opioid agonist treatment (OAT) stream (which includes training for buprenorphine/naloxone prescribing and limited scope prescribing of methadone and Kadian). Nurse prescribing for opioid use disorder is being implemented in collaboration with First Nations communities, and training is also underway.

Medication-assisted treatment

In November 2022, 24,608 people were dispensed OAT medications. The number of clinicians prescribing any form of OAT increased from 773 in June 2017 to 1,965 in November 2022. Access has also been significantly expanded through Rapid Access to Addictions Care Clinics in all health regions, so more people can access the care they need, where and when they need it.

More flexible treatment options

More options for medication-assisted treatment are available than ever before − including injectable opioid agonist treatment (iOAT) and low-barrier pharmaceutical alternatives like tablet iOAT (TiOAT) programs in most health authorities in B.C. In November 2019, government approved the expansion of TiOAT in every health authority in the province. Currently, iOAT is available in high-need communities as determined by overdose surveillance data, including

Surrey, Abbotsford, Kelowna, Victoria and multiple Vancouver locations. In December 2020, the Province approved plans for Northern Health’s first integrated iOAT and TiOAT program in Prince George. The Ministry of Health and the Ministry of Mental Health and Addictions, as well as health authorities, are continuing to work to expand programs where needed.

Improving the substance-use system of care

New teams to keep people connected to services and treatment

Sixteen substance-use teams throughout the province help people stay connected to health-care services, treatment and recovery. Services are tailored to each community, provided by a range of professionals including nurses, counsellors, social workers and peers. Teams support adults, including young adults, in communities throughout B.C., including Vancouver, Abbotsford, Kelowna, Prince George and Nanaimo.

24/7 support for people living with serious mental-health challenges

People living with severe mental-health challenges have access to 29 Assertive Community Treatment teams throughout B.C. that provide 24/7 supports. Teams are located in every health authority in B.C, including in Kelowna, Kamloops, Vancouver, Surrey, Victoria, Nanaimo and Prince George. Services include crisis assessment and intervention, psychiatric or psychological treatment, medication management and more.

24/7 helpline for prescribers and pharmacists

Provides live, in-the-moment support to doctors, pharmacists, registered nurses, registered psychiatric nurses, midwives and nurse practitioners as they treat patients with opioid-use disorder and consider prescription alternatives to the toxic drug supply.

Enhancing mental-health crisis lines

Planned enhancements to crisis line services include additional responders to increase crisis- line capacity to answer calls, improved recruitment and retention strategies, upgraded and improved technology, and standardized training for call responders.

Preventing drug poisoning

Access to prescribed safer supply, a Canadian first

B.C. is the first province to offer prescribed safe supply.

People have been accessing prescribed safe supply since March 2020, when the Province introduced the first phase of the program. From March 2020 to November 2022, approximately 11,670   people were prescribed safe supply medications.

The second phase of prescribed safe supply is being implemented in health authorities and federally funded SAFER program settings.

Government is investing $22.6 million over the next three years to support health authorities in implementing prescribed safe supply. Funding will support expansion of existing and creation of new programs, increasing staffing capacity through hiring new full-time-equivalent positions, and robust monitoring and evaluation of the policy’s implementation.

Decriminalization

B.C. is the first province to receive a three-year exemption from the federal government to remove criminal penalties for people who possess small amounts of illicit drugs for personal use. Decriminalization of people who use drugs will reduce the fear and shame that keeps people silent and leads so many to hide their drug use and avoid treatment and support. Reducing the stigma of drug use is a vital part of B.C.’s work to build a comprehensive system of mental-health and substance-use care. Decriminalization comes into effect on Jan. 31, 2023, and the Province is working with a broad cross-section of partners to train police and prepare health authorities for this change.

Overdose prevention and supervised consumption services

B.C. is expanding access to overdose prevention services that offer observed inhalation services in communities hardest hit by the drug-poisoning crisis. From January 2017 until November 2022, there were more than 3.7 million visits to overdose prevention services, approximately 22,386 overdoses responded to and survived, and one death. The number of OPS sites has significantly increased from one site in 2016 to 42, including 14 sites offering inhalation services. In the month of November 2022, there were 27,135 visits to inhalation-overdose-prevention and supervised consumption services.

Drug-checking services

There are a number of drug-checking services throughout the province to help people learn what is detected in the substances they are taking to reduce the risk of drug poisoning and connect them to supportive services.

More than 80 distributed drug-checking sites have opened around the province: 24 in Fraser Health, 28 in Interior Health, 23 in Island Health, two in Vancouver Coastal Health and 11 in Northern Health. These sites reduce rural inequities and improve access to drug checking services for more British Columbians.

There are currently 25 Fourier Transform Infrared (FTIR) spectrometres in operation in B.C.: Fraser Health (three); Interior Health (seven); Northern Health (two); Island Health (seven); Vancouver Coastal Health (three); and three additional instruments owned by the BC Centre on Substance Use.

In addition, government has invested in HarmCheck, a cutting-edge enhanced drug-checking technology developed by Vancouver Island University. HarmCheck helps people have even more accurate information about what substances they are taking, further helping to reduce the risk of drug poisoning.

Lifeguard App

The free app helps save lives by automatically connecting people who use drugs to first responders if the user becomes unresponsive. From May 2020 until the end of December 2022, the app had been used more than 114,305 times by 16,100 app users. To date, no drug-poisoning deaths have been reported through the app. Lifeguard now provides drug alerts.

Take-home naloxone kits

As of December 2022, more than 1.69 million kits have been shipped and 151,046 have been reported as used to reverse a drug poisoning. The kits are available at more than2110 locations, including 828 community pharmacies in B.C.

The Facility Overdose Response Box (FORB) program provides community organizations with naloxone, supplies and training so staff can recognize and respond to drug poisonings. There are 764 registered sites in the province and 3,191 drug-poisoning reversals reported from FORB sites as of October 2022.

Community response

Community Crisis Innovation Fund

Supports community-driven, innovative strategies and actions that draw on the expertise of local service providers and people with lived experience.

Grants totalling more than $1.5 million have been committed to escalate the drug-poisoning response in rural, remote, and Indigenous communities. The grants will also provide supports, including groups for grief and loss, family services and networks for people and families affected by the drug-poisoning crisis.

Community action teams (CAT)

$2.75 million supports these teams in B.C. communities. The 36 CATs in high-priority communities throughout the province help communities form partnerships and strategies to address the drug-poisoning emergency at a local level.

People with lived/living experience

People with lived and living experience are supported by investments to be involved in building a provincewide network of people who use drugs to share that experience and expertise, as well as funding for peer and family support networks. Moms Stop the Harm – B.C. is leading Stronger Together, a provincial family support and development project.

Indigenous-led solutions

First Nation-run treatment and healing centres

Eight First Nations treatment and healing centres operate throughout B.C., and two new facilities are being planned − one in the Vancouver Coastal region and the other in the Fraser Salish region.

These facilities are supported by $20 million from the Government of B.C., matched by $20 million from each the federal government and the First Nations Health Authority (FNHA), to support the renovation and replacement of First Nation-run treatment centres throughout B.C.

$38 million was provided by the B.C. government to the FNHA to support the design and expansion of land-based and culturally safe treatment services. As part of this initiative, the FNHA has provided funding to First Nations to increase the number of treatment options available to First Nations clients with a focus on land-based, family-based or group-based treatment services.

The Province and the FNHA committed $10 million each to support a new partnership for mental health and wellness.

Provincial drug-poisoning emergency response for First Nations communities

$24 million over three years will support the FNHA with the drug-poisoning emergency response, with an increased focus on addressing the impact of the emergency on First Nations people.

Métis-led mental health and wellness initiatives

$1.13 million has been provided to the Métis Nation BC to support Métis-led mental health and wellness initiatives, including the development of a cultural safety and wellness curriculum and a harm-reduction and stigma-reduction campaign.

Gwa’sala-‘nakwaxda’xw partnership

Extension of the Indigenous-led program for alcohol treatment and recovery in Port Hardy.

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