BC Addiction Ministry Ignored Coroner’s Recommendations
Government Giving $52 Million to Poorly Regulated Addiction Treatment Centres
More than 5,500 people in BC have died as a result of drug toxicity since the Provincial Health Officer declared a public health emergency in April 2016.¹
As part of their response, the BC Ministry of Mental Health & Addictions (MMHA) recently announced that the Province of BC will be giving $16 million in multi-year operational grants to private and not-for-profit service providers that operate residential addiction treatment centres and recovery homes for adults.²
The Canadian Mental Health Association (CMHA), in consultation with the MMHA and provincial health authorities will decide which service providers get the grants. The MMHA estimates the money will create 50–70 new publicly funded beds.
The Province will be investing another $36 million over 2.5 years to fund residential addiction facilities for youth. The funding will be distributed by provincial health authorities, in consultation with the MMHA. Private and not-for-profit service providers will have an opportunity to submit proposals for funding. According to the Ministry this will add a total of 123 beds at residential detox, treatment, and recovery facilities.³
Unlike other health care services in BC which are delivered by provincial health authorities, most residential addiction treatment centers are operated by not-for-profit societies, and for-profit companies.
In 2016, CBC investigative journalists phoned 150 addiction facilities (detox centres, treatment centres and recovery homes) in BC to determine the quality of care.⁴ In August 2020, I followed up by investigating 35 addiction treatment centres.⁵
Here’s what we found:
Almost every residential addiction treatment center in BC uses an abstinence-based approach. Patients are often required to be abstinent before entering the program, are subjected to random drug testing and are kicked out of the program if they test positive for non-prescribed drugs.
Some treatment centres in BC do not allow patients to use pharmacological treatments such as Opioid Agonist Therapy (OAT) and others encourage or require patients to taper off OAT. Facilities that do allow OAT often require patients to be stabilized on their medication before arriving.
Only one third of the treatment centres said they allow patients to use the OAT medication Kadian. No residential treatment centres offer injectable OAT (iOAT)⁶ and none offer the medications recommended by the Province’s “New clinical guidance to reduce risk for people during dual health emergencies”.⁷
Some addiction treatment centres in BC are based on Christianity. The majority of treatment centres use the 12-step model or require patients to attend 12-step meetings.
Some treatment centres in BC have no medical staff, and there is an inconsistency in the qualifications of staff working at facilities. Very few facilities accept patients with severe mental illness. Facilities charge up to $118,000 for a year-long stay.
Guy Felicella, a Clinical Peer Advisor at the BC Centre on Substance Use says that even if a person’s goal is to be completely abstinent, it’s important for addiction treatment centres to adopt harm reduction principles and provide a full range of treatment options including OAT. He says he disagrees with policies that result in patients being kicked out for positive drug tests.
“I don’t call that a patient centred approach. If we know it’s a chronic relapsing condition why aren’t we using more harm reduction in the facilities?”
“If we want to help people, let’s do that. Don’t kick people out. Handing someone a naloxone kit as they’re walking out the door is not enough- this is someone’s life.”
Karen Ward, who has been contracted by the city of Vancouver to advise on drug policy says that all addiction treatment centres should offer a full continuum of treatment options including OAT, iOAT, and Safe Supply Prescribing.
“Why shouldn’t they have that option? It shouldn’t be- “you get this”. That’s typical of how drug users are treated in the medical care system. It should be what the patient desires, what the patient prefers. Treatment is - “is your life better?” - that’s treatment.”
“You’re not there to meet someone else’s standards, it’s so paternalistic, where is the self-determination?”
Addiction treatment centres in BC are licensed as Residential Care Facilities⁸ under the Community Care and Assisted Living Act (CCALA).⁹ Health authorities are responsible for licensing facilities and making sure they’re in compliance with the Act.
In 2018 a BC Coroner’s Death Review Panel was convened to determine what can be done to prevent overdose deaths.¹⁰ They found that in BC there is no dedicated regulation under the Community Care and Assisted Living Act specific to substance-use treatment facilities. The CCALA mainly regulates health and safety requirements relating to the physical structure of facilities and does not address treatment standards.
There is also no provincial certification requirement or regulations for substance use counsellors. As a result, there is an inconsistent provision of evidence-based treatment and treatment outcomes are unknown or not monitored.
The Coroner said that addiction treatment needs to be held to the same level of provincial regulation and standards that all other chronic disease treatment is required to meet.
The Coroner recommended that by September 2019, the Ministry of Health and the MMHA in collaboration with the First Nations Health Authority develop provincial regulations for public and private addiction treatment facilities, set standards for provision of evidence-based treatment and require that treatment centres be evaluated and monitored to ensure compliance.
In 2017 the jury of a Coroner’s Inquest into the death of a young man at a BC addiction treatment centre, recommended that to prevent future deaths, all addiction treatment centres should educate patients about OAT, and every opioid dependent person should be provided with ready access to OAT. They also recommended that the government create educational qualifications for people working in addiction facilities.¹¹
Karen Ward questions why the government has not implemented the recommendations of BC’s Coroner.
“The Coroner has been really solid, those are great recommendations. Just do what the Coroner said. What are you waiting for?”
Leslie McBain, co-founder of Moms Stop the Harm (MSTH), a network of Canadian families that advocate for changes to drug policy, knows many families whose loved ones have died at treatment centres or shortly after leaving.
“This is where the government has fallen down, is subsidizing places that are less than successful, that don’t follow evidence, that don’t offer different types of recovery, that don’t have the professionals to deliver it. It should always be patient centred.”
“I don’t understand why you would get these recommendations from really good sources- why is it that they won’t move on these things?”
The 12-step model, used by the majority of treatment centres in BC, is based on a belief in a higher power. U.S. courts have consistently ruled that the 12-steps are religious¹², but Canadian courts have never considered the issue.¹³
The BC Humanist Association has submitted reports to the BC government arguing that when treatment centres base their programs on the 12-steps, that is a barrier to treatment for the 26% of British Columbians who do not believe in a higher power.¹⁴
The Humanists recommended that the government establish guidelines for addiction treatment centres that would prevent them from including the 12-steps as a mandatory part of their programs. The Humanists also recommended that the government only provide funding to non-religious treatment centres.¹⁵ The BC Government has not implemented the Humanist’s recommendations.
Ian Bushfield, the Executive Director of the BC Humanist Association provided a written statement:
We’ve been pretty clear that we think the government cannot reconcile its duty of religious neutrality with funding faith-based treatment facilities. When you add to that the fact that these facilities largely rely on unproven and unscientific approaches, it makes no sense that we continue to throw good money after bad. A growing number of organizations and experts, including Dr Bonnie Henry, the chief coroner and BC Centre on Substance use, are providing roadmaps for the province, yet the ministry continues to ignore them and continues to drive us in the wrong direction. People are dying, we need to take this crisis seriously as a province.
A 2020 study in the Harm Reduction Journal found that when Indigenous people in Vancouver accessed substance use treatment, they found incompatible and culturally inappropriate practices at treatment facilities such as forced Christianity.¹⁶
Karen Ward says that despite the government’s claims that people in BC are free to choose whatever recovery pathway works for them, that is not the case.
“It’s not a choice if that’s the only thing there.”
“Practically anyone I can think of who uses or has used (drugs) have all kinds of experiences with negative power-which is having none. They’re not going to go into that-I’m not. That can be perceived as just more judgement.”
Guy Felicella says that for some people, the 12-steps don’t’ work. “I would like to see facilities use a bunch of different approaches- Cocaine Anonymous, SMART Recovery, (Indigenous) cultural programs. You can’t have just one model. You have to have multiple models to best suit the needs of the person struggling- and I would love every facility to have that.”
“When you go to the hospital they give you the full continuum of care, they don’t say you can’t have this and you can’t have that.”
Tracey Draper is an Indigenous Woman from the Peepeekisis Band, in Saskatchewan. She is the Program Coordinator at the Western Aboriginal Harm Reduction Society, (WAHRS) which provides low barrier cultural services in Vancouver’s Downtown Eastside.
WAHRS was part of a research team that recently published a journal article identifying the lack of culturally appropriate addiction treatment programs for Indigenous people in Vancouver.
“We don’t have good experiences with any kind of medical facilities,” says Draper.
“A lot of people are afraid to go to the treatment centres and go to these places for help. There’s fear that they will not be accepted or thinking that they’re “another drunken Indian”
Because of the lack of services locally, Draper has to refer people to a program in the Okanagan to get culturally appropriate care. Wait times and costs create barriers. “You have to jump through a lot of hoops.”
“A lot of us on the Downtown Eastside don’t have a connection to our own culture which is what drove us to drink or use (drugs) in the first place.
“It really helps when you’re getting well to have your own people, cultures and traditions”.
Draper would like to see programs developed in the lower mainland that are similar to the one in the Okanagan. She says that if treatment centres can’t have that programming, they should at least bring somebody in for an Indigenous person so they have access to elder care.
Draper wants all treatment centres to embrace a harm reduction approach. She sees the need for residential treatment centres dedicated to helping people get off street drugs and stabilized on OAT, particularly injectable OAT.
Draper supports the BC Coroner’s recommendations for the government to set and enforce evidence-based treatment standards for residential facilities.
“It would be nice if someone took the Coroner’s Report and really did something with it instead of just saying — oh that’s nice.”
Reached by email, a spokesperson for the MMHA and Ministry of Health did not provide an explanation as to why they haven’t implemented the BC Coroner’s recommendations.
The MMHA and Ministry of Health did not answer whether addiction treatment centres will be required to incorporate harm reduction, Indigenous programming and a full range of treatment options in order to be eligible for government funding. They said that the eligibility criteria for the grants is still being developed.
“We respect all the different options available to patients on the road they choose to recovery. Research shows that having choice and personal agency in mapping one’s recovery journey is an important factor to a person’s success.”
Jonathan Morris, the CEO of CMHA said in a phone interview that it’s uncertain if all the grants will go to abstinence-based 12-step treatment centres because the eligibility criteria are still under development, and there is a need to see who applies.
“There is a significant emphasis on wanting to ensure that supports are provided to high quality evidence-informed care and prioritizing underserved communities in need.”
CMHA say that they will be engaging with a wide range of stakeholders and partners to develop the eligibility criteria for awarding the grants.
Brenda Plant the Chair of the BC Addiction Recovery Association (BCARA) was unavailable for an interview but confirmed that many members of BCARA have already been involved in these discussions. The BCARA is a non-profit society whose leadership committee is made up of individuals who work at abstinence-based 12-Step addiction treatment centres.¹⁷
Guy Felicella, Leslie McBain, Karen Ward and Tracey Draper all say that they want to sit at the table of stakeholders but they have not been invited. Ward says that drug users need to be involved in the conversations as they are the ones that the services are for.
It may be too late though. The Ministry says that the eligibility criteria for the grants is being published this coming week.
Karen Ward says a lack of meaningful consultation with people who use drugs in not unusual.
“People who use drugs, our knowledge and what we say is not taken with the same legitimacy as the others.”
Morris says the grants will be distributed to applicants using a transparent adjudicated process.
1.BC Coroners Report. June 30, 2020. (Figure 1 & Table https://tinyurl.com/yy4rbkek
2. Ministry of Mental Health and Addictions Press Release. July 10, 2020: https://tinyurl.com/yy84lmpv
3. Ministry of Mental Health and Addictions press release, August 13, 2020: https://tinyurl.com/y3qomhf5
Ministry of Mental Health and Addictions press conference, August 13, 2020: https://tinyurl.com/y2znz568
4. “What we learned phoning every drug rehab facility in British Columbia”, CBC, Sept 11, 2016: https://tinyurl.com/yx7pkn73
Data from CBC investigation (above): https://tinyurl.com/y6879gu4
“Are there enough beds for drug treatment in BC”, CBC, Sept 11, 2016: https://tinyurl.com/y2ux6nyz
5. List of BC addiction treatment centres with descriptions: https://tinyurl.com/y6eb7cl9
6. “Guidance for Injectable Opioid Agonist Treatment for Opioid Use Disorder”. BC Center on Substance Use, BC Ministry of Health: https://tinyurl.com/y6j6pl8r
7. “New clinical guidance to reduce risk for people during dual health emergencies”, British Columbia Government: https://tinyurl.com/y2wwjoq9
8. Residential Care Regulation of the Community Care and Assisted Living Act: https://tinyurl.com/y6ynp979
9. “A guide to community care facility licensing in British Columbia”, British Columbia Ministry of Health: https://tinyurl.com/y5c6e87s
Community Care and Assisted Living Act (2020): https://tinyurl.com/y3glxd3o
Residential Care Regulation of the Community Care and Assisted Living Act: https://tinyurl.com/y6ynp979
10. BC Coroner’s Service Death Review Panel: A Review of Illicit Drug Overdoses. Report to the Chief Coroner of British Columbia. April 5, 2018. P. 2–3, 21, 30–33: https://tinyurl.com/y4uqfdbd
11. Verdict at Coroner’s Inquest. Minister of Public Safety and Solicitor General, Coroner’s Service, Province of British Columbia. File No: 2016: 1027: 0004, p.9–13. https://tinyurl.com/yy7ozdgy
12. Destefano v Emergency Emergency Housing Group Inc, 247 F. 3d 397 (2d Cir. 2001).
Hazle v Crofoot, 727 F. 3d 983 at 987–90 (9th Cir. 2013)
Kerr v Farrey 95 F. 3d 472 (7th Cir. 1996)
13. Wood v Vancouver Coastal Health and another 2016 BCHRT 91 CanLii. para 91, 110. https://tinyurl.com/y4yvsp9e
Knight v. A.A. World Services, Inc., 2016 HRTO 208 (CanLII) para 7: https://tinyurl.com/y38ku5ug\
14. “Religious and Secular Attitudes”, Insight Wests poll commissioned by the BC Humanist Association, 2016: https://tinyurl.com/y247p2og
15. “Ending religious coercion in addictions recovery”, BC Humanist Association, submission to the Select Standing Committee of Health of the BC Legislature (2016) page 9: https://tinyurl.com/wcbcaer
“Ensuring choice in addictions recovery”, BC Humanist Association, submission to the BC Ministry of Mental Health and Addictions (2018): https://tinyurl.com/yyzywtkb
16. “You just have to have other models, our DNA is different: the experiences of Indigenous people who use illicit drugs and/or alcohol accessing substance use treatment”, Lavalley et al. Harm Reduction Journal (2020) 17:19: https://tinyurl.com/y4c93psv
17. BC Addiction Recovery Association-Backgrounder (twitter July 11, 2020): https://tinyurl.com/y66msjbk
18. “They treated me like crap and I know it was because I was Native”: The healthcare experiences of Aboriginal peoples living in Vancouver’s inner city”, Goodman et al. Social Science & Medicine 178 (2017) 87e94: https://tinyurl.com/y4h5aat5
19. “Safe Supply Fact Sheet” Canadian Association of People who Use Drugs: https://tinyurl.com/y4dyr5o6
