Suspects going through withdrawal in Abbotsford jail cells are now offered an iPad to communicate by video with a doctor and can have pharmaceutical replacement drugs delivered to them while in custody, in an innovative effort to get them off deadly street drugs.
The novel initiative was started three week ago by Abbotsford police, and so far three people have participated, said Abbotsford police Sgt. Kevin Murray, with the department’s SORT (Street Outreach Response Team) unit.
“We have secured the services of a series of doctors, local in Abbotsford. We then hand (the suspects) an iPad while they’re in a cell. And they get to do a live, two-way conversation with a doctor where they get to describe for them what their drugs have been, how much they’ve been on. The doctor will then write an alternative therapy treatment, usually Suboxone, hand that script to a pharmacist in their same office. The pharmacist fills the script, they courier (the safe-supply drugs) down to the police department,” Murray said.
“And once they’re released from cells, we have an outreach worker take them back to that pharmacy to renew their prescription. … We’re just looking for ways that we can help connect these people to social services. And we just don’t have enough. Our mental health system is failing.”
Murray is not aware of any other police department running such a program, and said it was only made possible by the federal government changing pharmaceutical dispensing rules this year to improve access to alternative medication in response to the overdose crisis.
It’s one example of the desperate efforts being made across B.C. to help drug users at a time when more than four British Columbians are dying every day of fatal overdoses — a dire stat that has spiked during the COVID pandemic.
The provincial government has also taken action and promises more. But advocates and drug users continue to argue that the response to the overdose epidemic, which has killed 6,215 British Columbians since 2016, when a state of emergency was declared, lacks the urgency shown for the COVID pandemic.
“I don’t think it’s a high enough priority on the government’s list of things to do. The NDP went through an election campaign and they basically said more of the same. And to me, more of the same means a lot more people are dying,” said Garth Mullins, a member of the B.C. Association of People on Opioid Maintenance.
Because the NDP has earned credibility for its handling of the COVID crisis and now has a majority government, it is in a good position to end the overdose crisis, if it chooses to do so, Mullins argued.
“The fact is, people are dying in greater numbers than ever. So, yeah, there’s been progress, but it’s just not enough. It’s not courageous enough,” added Leslie McBain, who lost her son Jordan to the poisoned drug supply.”
The NDP is also facing heat from some mayors , such as Kelowna’s Colin Basran and Victoria’s Lisa Helps, who called this week for an immediate expansion of treatment and recovery options, saying, “There seems to be no hope on the horizon for those struggling with mental health and substance use.”
And Vancouver Mayor Kennedy Stewart has demanded an improved safe supply .
Health Minister Adrian Dix insisted this week that overdose deaths won’t be overshadowed by B.C.’s other health crisis, the global COVID pandemic, which has seen new cases here rise to more than 500 a day. He said much work was done by the previous NDP government in the ministries of both housing and mental health and addictions, and that will continue.
“To say that there’s more to do is an understatement in both areas, and so they’ll be top priorities in the next government as well,” Dix told Postmedia. “I think everybody understands the urgency.”
Devastated by grief
Lyn Nicol perhaps understands the urgency better than anyone. Her 34-year-old son Bryn has been fighting addiction for two decades and she lives in constant fear of getting a call that her son has overdosed.
“If the phone rings at any kind of odd time of the day, you’re like, ‘Oh my God,’ … I’m a mom, just like every other mom who loves her son, and I’m devastated by the situation that all these kids are in,” she said.
“Bryn would give you the shirt off his back. He’s funny, he’s totally the most sensitive, kind person. He goes out of his way to protect his dad and I. … He loves animals, he loves nature.”
Bryn has ADHD (attention deficit hyperactivity disorder) and his struggles in school while growing up in Powell River couldn’t be fixed by multiple tutors or counsellors.
Nicol turned to doctors when her son was about 14 years old, and was rightfully worried when they prescribed benzodiazepines and Ritalin. Bryn became hooked on the strong pharmaceutical drugs, and the chaos in his life intensified. A year later he was smoking pot, and eventually started using street drugs.
He tried methadone, and multiple treatment centres, but they were hard to find, had long wait-lists and have not been successful. Nicol wants to see stigma removed from this issue, and the provincial and federal governments working together to fill the gap between the harm-reduction, supportive housing where her son lives now and a true recovery where he might feel a “sense of purpose.”
“More education programs, more life skills programs, more training to help people with mental health and substance use problems. People have problems and it’s a long wait-list to get in to see anybody for any help,” she said.
Nicol knows the grief of this epidemic, as she has lost two siblings to overdoses: a brother, who was a construction worker, in 2018, and a sister, who worked as a nurse’s aide, in 2019. Both of their addictions began with strong pain killers for injuries, and Nicol believes access to safe alternative drugs could have saved them when they relapsed the last, fatal time.
“I really feel their loss,” she said.
Safe supply limited, difficult to access
Provincial Health Officer Dr. Bonnie Henry said in August, after three straight, record-setting months averaging 180 overdose deaths, that “the overdose crisis has been made worse by the COVID-19 pandemic and the unprecedented tragedy of death and loss to families in our province continues.”
She has called for increased access to safe supply: The border shutdown impeded drug smuggling, which led to more toxic drugs on the street, and the social distancing rules meant people were more often using illicit drugs alone .
This concern was echoed by the national chief public health officer, Dr. Theresa Tam , who said in an October report that vulnerable citizens, including drug users, were disproportionately harmed by the pandemic. She singled out both British Columbia and First Nations communities.
Tam’s report said “safe supply can make a difference” and noted the federal government last spring issued temporary exemptions that allowed provinces to open more safe consumption sites, and for pharmacists to give more prescriptions for replacement drugs.
At the provincial level, Dix said, the NDP has expanded supported housing, distribution of naloxone kits, treatment options including First Nations-run centres, and harm reduction facilities such as safe consumption sites and opioid agonist treatment. The B.C. Centre for Disease Control has estimated these moves have saved thousands of lives since 2016.
Overdose deaths did decline through 2019, but the situation drastically worsened this year . In response, the province made it easier in March for some drug users to access some pharmaceutical alternatives, such as hydromorphone for opioid dependants, through measures such as prescriptions via virtual medical appointments and home delivery.
Since then, the government says, there has been a 319 per cent uptick in patients getting hydromorphone from a pharmacy, from 677 prescriptions in March to 2,824 in September.
Those are important increases, to be sure, but to put them into perspective, the University of Victoria’s Canadian Institute for Substance Use Research found 4.4 per cent of British Columbians over age 15, or close to 200,000, had used an illicit drug in the past year.
“So there might be one per cent of all the drug users in B.C. who have been able to access hydromorphone or find their way (to safe supply) since March,” said Mullins, who provides drug policy advice to the province.
The small number of people being reached, so far, is likely due to the limited types of safe supply being offered and because some doctors have been reticent to participate in the program, Mullins said. The government has said about 3,000 clinicians have taken webinars so far this year to learn about the new rules, representing about a quarter of B.C.’s doctors.
“People who use drugs were finding it very difficult to find a physician, or a prescriber, first of all, and second of all, the drugs that they were able to access through the safer supply are not the drugs that they need to stay in balance and not go into withdrawal,” said McBain, who co-founded the advocacy group Moms Stop the Harm .
She credited the federal government for launching a pilot project in B.C. in July to provide pharmaceutical-grade medication, but noted it will reach only a handful of drug users. Prime Minister Justin Trudeau said in Vancouver in September that Ottawa is moving “aggressively” on expanding safe supply, but gave no timelines.
Organizations in communities like the Downtown Eastside continue to do heroic work to keep people alive, but are also demanding an improved safer supply.
No timeline on policy changes
Also in September, the province announced more new measures, such as nurses being able to prescribe alternative medications, expanding the types of safe supplies being offered and the eligibility for who can access them, and increased locations where the prescriptions will be dispensed
But the reality is that none of these things is happening yet.
Dix denied the election slowed progress on these promises.
“It’s full steam ahead, but that doesn’t happen instantly. But it could not be a higher priority,” Dix said.
He said nurses have to be trained and guidelines changed, and hoped they would be prescribing “as soon as possible.” The health ministry was unable to provide a more specific time frame.
It was the same answer when Postmedia asked for more detailed information about the other September promises.
Mullins noted that last Saturday, Henry announced new COVID public health measures that involved limiting social gatherings and shutting down some sports and other inside activities, and they were to take effect by 10 p.m. that same evening. And, yet, the drug policy changes could take months to implement, he fears.
“It’s interesting how these two emergencies operate at much different speeds and senses of urgency,” he said.
In August, Mullins, McBain and other advocates walked away from government drug policy committees because they were frustrated by the slow pace of change in B.C. They are back at the table now, to continue to push for future action.
“When a person dies in B.C. from a preventable cause, or four people die every day, that, for me, is heartbreaking,” McBain said. “I’m hopeful, but I also feel like I’m in a war. We feel like we’re in a war that we’re not winning right now. And the other army that could fix it is not engaged.”
Dix said he respects the passion of these advocates, but maintains British Columbia is doing more than any other province and will continue to move forward as quickly as possible on this “very, very challenging” issue that tragically “affects people all over the province.”
Calls for decriminalization
There have been demands for another bold move to address this crisis: decriminalizing drugs to reduce the stigma around their use and remove barriers for users to seek help. B.C.’s and Canada’s top doctors, Henry and Tam, and the Canadian Association of Chiefs of Police (CAPC) have echoed those calls.
Oregon residents voted last week to decriminalize the possession of hard drugs , such as heroin and cocaine, a move that can hopefully re-energize this discussion in B.C., said Abbotsford police Chief Mike Serr, who is CAPC’s point person on this issue.
Serr said he understands governments are working hard on COVID, but lamented that nothing concrete has happened here yet around decriminalization, such as establishing committees to discuss the move. “A lot more needs to occur,” he said.
His department issued a stark warning last week about increasingly toxic drugs circulating on Abbotsford streets, and Serr noted the sad reality is that 2020 is likely to surpass the previous annual record of 1,547 overdose deaths, set in 2018.
“This year could be for B.C. the most significant year to date. We’re on pace, sadly, for 1,600 overdose deaths,” he said. “And the numbers you really need to look at, too, are the numbers of overdoses that have been reversed. And it’s significant.”
Premier John Horgan has asked the federal government for drug decriminalization, but his government still hasn’t made changes to B.C. police policies recommended last year in Henry’s report. Trudeau has stopped short of endorsing decriminalization.
In the meantime, Serr’s department is also linking up homeless drug users with organizations like the Salvation Army to try to get them some housing stability, and ideally on a safer drug supply. It’s been challenging work, though, since so many social services have shut down since the pandemic hit.
“Most of these drug users are property crime offenders. They won’t need to steal for their drug supply if they can go to a pharmacy and get it for free. That is a thing that we’ve instituted here in Abbotsford ourselves just to try and do something,” said Murray, who has been with the SORT unit since it started in February.
Guy Felicella, a peer advisor at the B.C. Centre on Substance Use and the province’s Overdose Emergency Response Centre, said it was easier to access drug treatment in the 1990s than it is today. Felicella, who overdosed multiple times when he was using illicit drugs, hopes the province’s new regulations around nurse prescribing and better access to more safe supply will be in place before the end of this year.
“The waiting is killing people,” he said, but he is optimistic the NDP’s plans will make a difference.
“I hope that 2021 is just a better year for drug users getting not only treatment on demand, but they can have immediate access to a safer drug supply, and also that they can have immediate access to treatment and recovery services, where they don’t have to wait six weeks,” said Felicella.
“I’m saddened by the continual lack of urgency and response to the amount of lives lost over the last four years. … These were really good people, that I broke bread with for many years and they shared many of their stories with me. And now I know their mothers or their family members. I just fight for them because they don’t have a voice anymore.”