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Hansard Blues

Select Standing Committee on

Health

Draft Report of Proceedings

3rd Session, 42nd Parliament
Wednesday, September 7, 2022
Victoria

The committee met at 9:03 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): My name is Niki Sharma. I'm the Chair of this committee and MLA for Vancouver-Hastings.

I j want to welcome our first presenters this morning and start by acknowledging that I'm coming to you from the traditional territory of the Squamish, Tsleil-Waututh and Musqueam people and the Coast Salish territories.

I know we're all Zooming in from different parts of the province, and I just would invite everybody to acknowledge and think about the territory they're Zooming in from.

I'm very pleased to welcome our first presenters, who are on the Construction Industry Steering Committee on the Opioid Epidemic.

I'm going to go through the list of who I have as speakers just so it's on the record: Vicky Waldron, executive director, Construction Industry Rehabilitation Plan; Lee Loftus, chair, Construction Industry Rehabilitation Plan, former president of the B.C. Building Trades; Chris Atchison, chief executive officer, Vancouver Island Construction Association; Dr. Dave Baspaly, president, Council of Construction Associations; Chris Gardner, president, Independent Contractors and Businesses Association; and Colby Young, project lead, Tailgate Toolkit.

I'm going to introduce who you have before you on the committee before you start so you know who you're speaking to.

I'll pass it over, first, to our Deputy Chair, Shirley.

S. Bond (Deputy Chair): Good morning, everyone. Thanks for joining us. I'm Shirley Bond. I'm the MLA for Prince George–Valemount.

M. Starchuk: Good morning. Mike Starchuk, MLA for Surrey-Cloverdale.

P. Alexis: Good morning, everybody. I'm Pam Alexis, MLA for Abbotsford-Mission.

N. Sharma (Chair): Ronna-Rae Leonard is the MLA for Courtenay-Comox. We'll let her fix her sound, but she's right there.

D. Davies: Hi. Good morning, everyone. Dan Davies. I'm the MLA for Peace River North.

[9:05 a.m.]

D. Routley: Good morning. My name is Doug Routley. I'm the MLA for Nanaimo–North Cowichan.

N. Sharma (Chair): Wonderful. We'll pass it over to you.

You have about 15 minutes to present, and then the rest of the time will be questions and discussion.

Briefings on
Drug Toxicity and Overdoses

CONSTRUCTION INDUSTRY STEERING
COMMITTEE ON THE OPIOID EPIDEMIC

D. Baspaly: Thanks, Madam Chair and esteemed committee members. I had the fortunate ability to present to this committee before on the issue. Some of you may remember me. I'm with the Council of Construction Associations. I appreciate you doing introductions, because I know we only have a hard 15 minutes here. We want to make sure we get as much information to this committee as we can.

We've assembled a subset of our committee called CISCOE. Really, what this is, is our industry response to the epidemic that's taking place within our sector and across B.C. We have a kind of a….

I see our time has started, so I want to move pretty precipitously to our presenters here. We've got a few minutes each to talk about it.

The first person who's going to speak is Vicky. She's going to give us an explanation of the background, some of the contributing causes of the epidemic and how it affects our sectors. So let's go straight to Vicky and get you on your way.

V. Waldron: Thank you, committee members. We really appreciate the opportunity to be coming to talk to you again about this. I want to talk to you about the opioid epidemic. It continues to impact the construction industry disproportionately, as you all know.

A reminder of some of these numbers. Approximately 55 percent of those who have overdosed have worked in the construction sector. The impact of COVID, which was already raging throughout our province, the country and the world, has had devastating impacts on the opioid epidemic.

In our program, at construction rehab, we saw a 64 percent increase in the demand for services. We received about 6,500 calls for help last year. We served 542 clients, and we delivered about 4,500 counselling sessions. It has just devastated the construction sector. We have had 10,000 lives lost in British Columbia alone since the epidemic was declared a public health emergency.

What we perhaps don't talk about more often is that there is actually a clear link between the opioid epidemic and the construction industry. We know, as I said, that more than half of those that have lost their lives have either previously worked in or are currently working in the construction sector. We also know that it's predominantly men. We know that it's predominantly men between the ages of 20 and 59 who are fatally overdosing. The construction industry is made up of approximately 90 percent men.

While you may already have heard the numbers — and these may be quite familiar to you — what you may not know is the why of it all. This is something that's not very clear. There hasn't been a lot written about this. I know that certainly within our sector we need to try and better understand the why.

CIRP partnered with WorkSafeBC, previously, to explore the attitudes and beliefs towards mental health and substance use within the construction industry as a whole. We looked at both unionized and non-unionized sectors, and the results were quite telling. What we found was that there was a workplace culture that was a contributing factor. We found that there was an overwhelming consensus of a "work hard, play hard" culture — play hard, of course, being the drugs and alcohol.

It's an environment that is inherently quite stressful. Stresses were also worn as a badge of honour, or stress was considered a normal part of the job. The machismo culture that exists in construction also was contributing to this.

We know that there's a high prevalence of mental health issues. One in two workers were self-reporting problematic mental health issues. We found a high prevalence of substance use. We knew that one in three workers were self-reporting problematic substance use.

Just think about that for a moment. If we were to extrapolate that number out and we base that number on the entire size of the industry here in B.C., it is just jaw dropping, that number. That one in three self-reporting problematic substance use is staggeringly high.

We also found that there's a culture of normative use. What this means is that substance use is ubiquitous on the jobsites and within the construction industry. It has led to uncertainty about whether or not an individual's own use is problematic or whether what they're using, when they look to their left and their right, is just a normal amount.

So 77 percent of the people that we spoke to said that they felt that it was due to stigma that they wouldn't actually report substance use to their employers. Due to the safety-sensitive nature of the industry and due to the insurance inquiries, policies are often designed for zero tolerance.

[9:10 a.m.]

We need to do more to raise the awareness of what harm reduction means within the context of a safety-sensitive issue. That's an issue that rarely gets talked about, but that's, I feel, a significant contributor to what's going on as well.

The opioid issue is no longer a crisis. It really is, truly, an epidemic, not only among the Canadian population at large but within the construction industry itself. The problem within the industry is complex; it's very complex.

It's complex because (1) we know that we have a serious issue; however, we don't have access to primary care resources and primary care tools, life-saving tools such as take-home naloxone kits that can reverse construction worker deaths, and (2) we're learning more about the why of this epidemic, so in theory, we can begin to design interventions that we know to make a difference.

In fact, we have a model that worked. We've been doing this at CIRP for many number of years. However, ironically, the more successful we become at prevention and raising awareness and the more successful the industry becomes at prevention and raising awareness, the worse the problem becomes, in terms of the lack of resources; the worse the wait times for services grow; the worse the wait times for beds grow; and the worse the wait times for detox programs grow.

Before I came here today, I checked in with one of my team members. As of this morning, we had 15 people waiting for treatment beds with an average wait time of almost two months.

This brings me to the third reason as to why this issue is a complex one. Timely treatment is becoming a scarcity. The complexities of lining up a detox bed to coincide with a treatment bed is nigh on impossible now.

You may wonder why I'm bringing this up as an issue. The reason I bring this up is because public health guidelines, quite rightly, advise that due to exponentially higher risk of overdose following detoxes, people really should be going straight to a treatment bed once they leave detox.

Every day at our program we make choices to send people to detox knowing that there might be a wait for a treatment bed. We make these incredibly difficult decisions because the risk of overdose is high if we don't send them, but it's also equally as high if we do send them. It should not be overlooked that there is a tremendous toll on staff each time we do this.

I'll conclude by saying that while the industry is working actively to try and stem the tide of overdose deaths — and make no mistake, the CISCO committee is evidence of the commitment and resolve that we have to try and work at resolving this issue — we are working within a system of care that is unable to meet the needs of a very, very serious problem, a problem that the last six years has shown us will inevitably worsen without more resources. Put quite simply, we cannot do this without your support and partnership.

D. Baspaly: Thanks, Vicky.

We're going to move pretty precipitously through this, given the time that's here. I'm going to Lee, and it just shows the support of labour and the employer standing in solidarity on this issue.

Over to you, Lee.

L. Loftus: Thank you, Madam Chair, for the opportunity to speak here today. Vicky talked about a lot of pieces and a lot of condensed information in a very short period of time. I just want to take…. Rather than repeating a lot of what she said, I really just want to talk about access.

I want to talk about that phone call. I want to talk about that opportunity to have that conversation with that person that's in need at the time and the ability for us to provide a service and a benefit and a pathway for them to find a solution that's in front of them, rather than where they may end up. We want to be able to open those doors and do the things that we do best when we're offering assistance to people in need.

Vicky talked about today…. I was actually quite shocked about the stats that she talked about today. We have 15 people waiting, and we're looking at 60 days before we can provide services. That doesn't work for someone makes a phone call. That doesn't work when someone walks up to you in a workplace or calls you in the evening and says: "Hey, Lee. I need some help." If you've got to wait 60 days….

We have access. We've got beds. We've got all kinds of different things. We are better off than most people in the industry. And we only have a slice of the industry if you think about the construction industry as a whole, because construction rehab only manages a little piece.

That phone call is important. That reach out is important. If we miss those windows, they may not come back and we may lose them totally. It may take them a year to come back, or it may be another overdose that we read of. It may be another obituary that we see in the newspaper that's an unreported death. That's the importance of this. It's access. We need that.

I'm mindful of time. I'd be more than willing to talk about what that really means at another time. Thank you for that opportunity.

[9:15 a.m.]

D. Baspaly: Good words, Lee.

I'm going to go over to Chris Atchison from the B.C. Construction Association to talk about A Kit in Every Hand, which we've been working on for a number of years.

C. Atchison: Great. Thanks, Dave. Good morning.

I'm speaking to you today from the traditional territory of the Lək̓ʷəŋin̓əŋ peoples, whose historical relationship with this land is guided today by the Esquimalt and Songhees Nations.

My name is Chris Atchison. I'm the president of the B.C. Construction Association. I'm also a trustee with the BCCA Employee Benefit Trust, a health and services benefits entity that offers, among other things, counselling services and mental health and addiction support for those in and connected to our industry.

The facts before us today demonstrate that there are very few industries that remain as overwhelmingly male as construction, and that's something that we're working on for so many reasons. Our current lack of gender diversity puts us on the front line in the fight against opioids, alongside other male-dominated industries like transportation and building maintenance, but it also makes us a powerful ally with the province in this fight.

Construction is a massive industry employing upwards of a quarter of a million people in B.C. alone, and we're the No. 1 employer in the goods and services sector in the province. And 94 percent, 95 percent, well over 200,000 workers are British Columbian males. We all know that men make up nearly 80 percent of the illicit drug deaths.

This is why construction has an important role to play in the fight against opioid overdoses and deaths provincewide, and we're ready to step up. We want to put a naloxone kit in the hands of every worker in our province. It's as simple as that. All 200,000-plus of them, the men and the women who work alongside them — a kit in every hand. We are offering you a built-in distribution system that will take these kits into every community, every neighborhood, every apartment building, into the orbit of every ballpark, hockey rink, golf course and home.

People are not dying on the job sites. They're using an illicit drug supply on personal time and often alone. So let's demonstrate some leadership in showing that we care so that not only will these life-saving kits be out there but so that more men in B. C. will get the message that they haven't been hearing, and they'll ask for the help they otherwise wouldn't seek.

An industrywide program like this, supported by communications and resources, will help reduce stigma, create awareness and make a real difference. A Kit in Every Hand — and literally, it's in your hands.

D. Baspaly: Good words, Chris.

We're going to the other Chris, Chris Gardner from the Independent Contractors and Businesses Association.

Over to you, Chris.

C. Gardner: Thank you. It is a real pleasure to be here. I just wanted to take a few minutes and give you a perspective from ICBA. We are one of the largest independent providers of group health and dental plans in the country. We have 150,000 people on one of our health and dental plans.

When we look at the data, in the top three drugs prescribed on every single one of our plans, within that, you're going to see drugs prescribed for depression, anxiety and sleep disorders. So what we're seeing in the opioid crisis that's raging across the sector and the economy in so many communities is people who are self-medicating, and it is a significant challenge. Since the opioid crisis was declared a crisis, we've seen the numbers of deaths increase from about 2½ a day to now seven a day.

At ICBA, what we did was, during the middle of the pandemic, look at our data and say: "We've got to do something." So we consulted with experts, with employers, with workers to develop a mental health program that is geared towards the construction worker. The construction worker is at the centre.

What we've done is…. We rolled it out last year. We offer it free, and it's a holistic approach. It's a year-long program, and there are some unique features to it that are specific to this sector.

One is that everybody in the company enrols in the program. It's not just site workers, not just office workers; everybody enrols. The company appoints wellness ambassadors to be the interface between our program coordinators and the workers. There are toolbox talk kits, information. There's an online learning module. There are posters.

Every month there's a different theme. Every program starts with…. The first theme is the stigma around mental health, about having a conversation. The goal of the program is very simple: start the conversation — how to have someone feel comfortable putting up their hands and saying: "Hey, I think I need some help." And for someone who receives that on the other side of the conversation, give them the ability to say: "Okay. Here's what we can do." We're not trying to make everyone a counsellor, but we're pointing them in the right direction.

[9:20 a.m.]

We've now got 10,000 people enrolled in the program. It is free. Phase 2 of that…. We've enlisted Corey Hirsch, former NHL hockey player. He won a silver medal as the starting goalie for Team Canada in the Winter Olympics. We're doing a speaking tour with him across the province. Next week we're going to be in Kamloops, speaking to 1,000 pipeline workers at two different events. That part of the program has been enormously successful.

What we've seen is if you look at the numbers from 2021 to 2022, the employee assistance programs, which are attached to all of our benefit plans, the use of those plans…. People calling for help has doubled. And to the point that Lee and Vicky were making, the challenge is that what we're seeing is the lack of resources that's symptomatic of our health care system, which is in crisis and unable to respond. So this is a crisis, and we've all got to work together if we're going to put a dent in these numbers and save lives.

D. Baspaly: Back to you, Madam Chair.

N. Sharma (Chair): Okay. Thank you, everyone, for your presentation.

I'll take questions in the order I see them.

Go ahead, Pam.

P. Alexis: Thank you. And thank you again, Vicky, in particular. You are so knowledgable.

I just want a little bit more information. Of the 15 that are currently wait-listed, are we looking at a smattering of centres that they're wait-listed for, one particular centre? Are we looking at the 15 in one health region? Can you just give me a little bit more detail about that, please?

V. Waldron: For sure. That, in and of itself, is a complicated response because the health authorities now have what we call access central points. So anyone that wants…. They were originally set up to streamline, so the idea was….

Prior to these access points, what happened was that health authorities would have their own treatment centres. People would apply individually to treatment centres, and they were…. Before the epidemic, before what we know today, there would be empty beds, so this centralized system was set up whereby you go through this one system — they are aware of all the empty beds — and you slot people in, which is what makes sense.

The problem that has now created is …. The 15 people that we have on our wait-list is to go to any beds, right? It's across wherever we can get them. It really doesn't matter. However, it's problematic for us because we serve people across British Columbia as a whole. So these…. While they are central access in terms of the beds that people get funnelled into, there are catchment areas, so they belong to health authorities.

I've got someone that's coming in from Kamloops who's coming and accessing our services. I can't get them into Fraser Health beds because they're for Fraser Health folk. Right? I can't get them into Vancouver Coastal. I can only get them into Interior. There are no beds, practically no beds, available in the Interior for most people. There are such limited resources.

Most of the options are private beds, so what we tend to do is have a number of private, what we call rapid-access beds. We will save those, where we can, for out-of-province workers so that we can get those workers into those beds. The ones that are able to get into the different health authorities — VCHA, Vancouver Coastal Health, Fraser Health, for example, Tri-Cities, wherever we can get them — we're funnelling those clients into those beds. So we're using a mixture of rapid-access beds that we have purchased plus the provincial services.

I should also say that getting women into treatment is…. You just can't get beds. One of the biggest issues we have is that any time we have a woman come forward and say, "We need help," we are discussing this at our case conference, we're trying to figure out where we can get that person to go. It's almost impossible to find a provincial bed for that person.

P. Alexis: Thank you. I might have a follow-up, but I'll let somebody else speak.

N. Sharma (Chair): Go ahead, Doug.

D. Routley: Thanks very much. I just wanted to…. Probably more of a comment than anything else. I really appreciate the approach and the openness that's shown. We spoke in the last meeting, and I made comments about my experiences in the construction industry and other industries.

[9:25 a.m.]

A lot of what's happening reminds me of the crisis that professional cycling faced with Lance Armstrong and all the people who were using performance-enhancing drugs. They used the term "the omertà," the code of silence. Teams were sponsoring programs to provide drugs and drug programs to athletes.

We heard from people yesterday talking about how some exploited worker populations are encouraged to use drugs to keep them on the job longer. There's history in different industries. transportation. but that word omertà and the code of silence and the silence around the culture is something that is really difficult to challenge.

There has to be, kind of, that truth and reconciliation moment where people can come forward without suffering the kind of penalties they would if they were, you know, in cycling and other sports — that they can declare their use and not suffer the same consequences.

I think it's really encouraging that the employers in this group, you as a collective, are challenging that silence. If you could comment on how the tension is between the demand for zero tolerance on the job, where dangers are so high, and the consequences with WorkSafe versus the openness to challenge the omertà, or the silence.

D. Baspaly: I'll jump in, and I'll pitch it, if I could, Doug, because there are a couple of pieces here. We do have a silence problem, a code if you will, out there. We also have a lot of rugged individualists that tend to want to do it their way and separate private from life. But in reality, who you hang out with, who you work with all becomes somewhat of the same group.

This is one of the reasons why when we looked at it as a committee…. We have a number of different strategies designed to really address some of these components, the first being that with a code of silence, you're not going to admit you have a problem, but you will want to save your buddy or your friend.

This is where the kit-in-every-hand strategy comes from. It's not to stigmatize anybody or make anybody come out of the silence. It's basically to saturate the system with enough kits so that there's always a buddy next to you or a colleague next to you that you can hand a kit to or support them if they're using within a small group or a party or an environment like that. That's sort of how we get at that.

Then there's what I think Chris Gardner — and Colby is on this thing too — does too, from the south Island construction association. Both have programs designed to remove the stigma, provide supports, anonymous supports. Sometimes they're information exchanges in order to give people the right information to make smart decisions and to be able to know that they're really half a step to any kind of support. Usually, it's free. Almost in every case, it's free in our respective industries.

It's designed to open that up, the idea being to crush that stigma and the silence so that we understand that it exists, that it's a disease, not something you'd be stigmatized for, and know that your employer and your labour side are all here to help. We want, wherever we can within a system — through programming or through these kits — to try to get it done.

The last thing I'll say there, Doug, is that, really, we need government's help. Honestly, as I think Chris Atchison said well, construction can do logistics better than anybody else. We stand up buildings and bridges every day. But where we can't do it is that we can't get our hands on these kits at a price point where we can actually saturate our sector.

That's the problem. We're giving them in dribs and drabs here and there. We would like to do a campaign that is full force and really make sure that everybody knows that. That actually gets at your silence issue. It actually enhances the programming and supports we have there. It actually practically, pragmatically, puts a kit in every space that we possibly can to make sure that anybody who might be close to needing those supports has it in hand.

V. Waldron: I'd like to add to that, if I may. This issue of silence — you're absolutely right.

There is a culture. Right on the nose there. There is this issue of silence.

However, I will say that the research that we did also showed that there were 88 percent of the respondents that we spoke to — including employers, not just works on the ground — who were saying, actually: "We would support somebody if they had a substance use issue. If they came back from treatment, we would support them."

What that tells me is that there is huge opportunity for us to do something, but we can't do this without the help of partners, the help of government in reaching the goals that everybody wants, which is to reduce the impact of the opioids epidemic, to reduce the deaths.

[9:30 a.m.]

We have an opportunity where…. We've done enough work. We think we might have. We've started the work within the industry. We need the kits to help move that along a bit. We also need more access to other services. In doing so, we can now leverage around the awareness that's beginning to occur, that's starting to occur within the industry. We're kind of stuck at the minute — as I said, it's a catch-22. The more work we do, the more resources are needed to keep up with the work that we're doing.

S. Bond (Deputy Chair): I appreciate the opportunity to hear from you today. I'm actually really grateful to see the coalition that's on this screen, because while you might differ in opinion about a variety of other things, there should be no difference of opinion about the fact that people are dying in big numbers in the construction sector. The fact that all of you are together is important to me, and I hope we'll continue to see that kind of approach.

I have a number of questions, but I'll start with one. Then I'll come back when we have the next opportunity. I really appreciated what Lee had to say about access. When you get that phone call, a person can't wait 60 days, six months or a year when they get to that place where they're looking for treatment. It is not just the construction industry that's waiting for beds. We have heard that all over the place. That is certainly an issue.

I wanted to ask about the Tailgate Toolkit. Yesterday we heard from organizations that talked about the lack of availability of resources in other languages. Workers are not unilaterally English-speaking. I see that Colby is on here and has some connection to the Tailgate Toolkit. I'm wondering if thoughts, plans, resources are being considered to look at a multilingual approach to the issue of providing that support.

C. Young: Thank you, Shirley. Yes, shortly. Of course we are considering, currently, the capacity that we have to develop that in multiple languages. For all of our resources, in our education, it takes a lot of work. It takes a lot of outsourcing to people who are able to translate and make those resources more accessible in that way.

We are using this current funding period to hone in on what this project is intended for, which is a lot of reaching out, honing in on the educational components that we need to feature in our training and getting word out there currently. While we understand that, of course, there are language barriers in place — our industry is increasingly diverse, and we are seeing many people of different backgrounds — it's something that we are currently not able to work at, but we are looking at how we can. It will likely be a dedicated ask for funding that we really hope that we can put in place.

S. Bond (Deputy Chair): Bottom line, Colby, your answer is that you can't do it at the moment because you don't have the capacity. I don't mean that in the sense of capability, but you don't have the resources to look at multilingual. I think you need to flag that for us, and I think certainly that's an important part of the discussion.

D. Davies: Thanks, everybody, for your presentations. Good to see a couple of you again. I know we talked about that toolkit, and I certainly echo Shirley's comments about language. It was quite compelling yesterday, the presentation that we had. Over the past number of meetings that we've had, there have been some incredible recommendations made, including what each of you have said here today, and the different pieces that have been discussed.

[9:35 a.m.]

That leads me to my question around, as a body, the construction industry. In each of your organizations, what kind of interaction or collaboration has been made with the agencies that need to be driving this? I'm talking within the Ministry of Mental Health and Addictions, the Ministry of Health, our health authorities, the College of Physicians, the different groups that are really going to be making decisions, recommending policy, and so on and so forth.

Is there is there a body within your body that is designated directly to that, to make these? We need to make changes at the top. That needs to be driven…. You guys are doing a fantastic job as an industry, but it's not solely your job, for this to be on your shoulders. This is a provincial piece. I appreciate what you're doing, but is there that piece within your organization that is advocating, working and collaborating with these other agencies that are going to make a change?

D. Baspaly: That's a great question, Dan. Maybe I will tee it up and kick it around here a little bit. Our committee was designed because we needed to pull all of our disparate pieces together into one house. We wanted to have a committee where we could draw on expertise in the different ministries, etc., that were there.

Over the last six months, we've concentrated on two major strains. One is programming and education and awareness, the best we can. You've seen that. Chris Gardner gave an excellent example. We've got Colby, who did the kits that he's doing through there. That stuff is getting circulated around, with great penetration in our sector, for uptake.

The other thing that we worked on tremendously was A Kit in Every Hand and trying to get that initiative up and running. We worked with Mental Health and Addictions. The problem is that in their funding cycle, by the time they got to consider the proposal, they were running out of their fiscal year. What we ended up with was a small investment to try to maybe test the waters to see where it is.

I think we would benefit by being forced, in a shotgun marriage, to come together and actually work as a team through this. From Mental Health and Addictions' perspective, they don't know who we are, per se. We need time to build that relationship, to build the trust and show the transparency.

What CISCOE offers here — the B.C. construction industry, ICBA, all of the collective members that you see across our sector — is that we can be the other side of it. If we are connected to and stood up alongside those government supports and agencies and Crown corporations, like the health authorities, that can really help us move this thing forward and do some real work on the ground.

We are at a holding pattern right now. We've got a proposal that we've done. We've done all of the hypotheses and tried to get it as good as we can. We've got pilot projects taking place everywhere. We've got awareness stuff through the B.C. Construction Safety Alliance. A lot of stuff is happening, a lot of pockets to pull it together into a coherent strategy that sort of goes beyond or supersedes the borders of any one organization. This is where we need government's help.

Anyone else from our team that's there want to address that?

C. Gardner: I'd like to make a comment on that. When we look at this from ICBA's perspective, we were in the middle of a pandemic, and government was overwhelmed with dealing with the global pandemic and everything that flowed from that. Our view was we weren't going to wait to get funding from government or put together a proposal. We were going to build something from the ground up that was focused on the construction worker.

Sometimes folks outside of government have the energy, the creativity and innovation and can move faster than government is able to do.

To Dave Baspaly's point, we've got a lot of a lot of different frameworks in play and that have been developed. There is an opportunity for government to partner with industry in lots of different ways now that so much of the heavy lifting has been done.

I don't think we could afford to wait two years to get through the pandemic. In the fog of the pandemic, no one knew when it was going to clear. Building it from the ground up, when we started, back in 2020, was vital for the success of our program.

N. Sharma (Chair): Colby, did you want to say something?

C. Young: Yeah. I briefly wanted to mention that through the Tailgate Toolkit, which is a provincially funded project, we have had the opportunity to collaborate with members of the health authorities, the BCCDC and a number of different local service providers as well.

[9:40 a.m.]

It has been a great opportunity to really share information, get information across and also have a bit of a guide in terms of where we can refer people for support. Of course, we still speak to that issue of limited access and availability, but there has been collaboration that is taking place — relatively small-scale at the moment, though.

R. Leonard: Thank you very much. I first want to acknowledge the work that's being done in the construction industry and the attitude that you are portraying here, which is really open and recognizing of the issues that you face and making space for this conversation to happen in your industry. That's a big step forward.

I was just at the Overdose Awareness Day in my community and got to see the toolkit display and talk with folks — hello, Colby — and I think that's a really important first step as we're talking about dealing with stigma. I really appreciate the work that's being done in terms of addressing the stigma issue.

This is a cultural change that we have to make. It's not just in one industry. It's not employers. It's not employees. It's everybody. So I just really want to applaud the work that you're doing, taking a step back and saying: "Over time, we're seeing this exponential growth of this problem." I mean, the construction industry has been around for a long, long time. What is it that is driving this change, this exponential change? That was one thing.

I know that the issue around opioid misuse has had some trigger points along the way. We did have a presentation from WorkSafeBC, who were talking about how, with the knowledge that's being built up, the understanding of addictions…. What is a better way of proceeding when there is a workplace injury, so that people can address their pain issues and still be able to persevere and come back to work.

I'm curious about how that is playing out on the ground, in terms of people returning to work after injury. I'm just trying to get a better sense of the things that have been put into place. There have been a lot, including the…. Some of it is in early days, yes, and some of it feels like a pilot, but I'm curious about the sense of impact of the things and the directions that are being taken.

Then one other…. I'm not sure who can answer that. But the other thing that really has struck me, because of my history, is that we keep talking about treatment beds. Treatment beds — it means a lot. It means resources for people, human resources. It means finding space. It means the kind of training…. And it takes time. It just takes so much time to build.

My husband was an outpatient counsellor. I'm wondering how much access is being taken up, if there's a space there that needs to be filled in terms of that immediacy of when you're in community, wherever you are, to have access to that helping hand along the way. Maybe a treatment bed isn't always the answer.

D. Baspaly: Ronna-Rae, that's a five-part question, but we'll do our best, on our side, to give you what we've got.

R. Leonard: My apologies. This is what happens when you've been silent for so long.

D. Baspaly: Fair enough.

Vicky, I think you're probably the best one to take a shot at the precipitating reasons why things are as bad as they are on the ground right now. Why don't we start with that piece?

V. Waldron: Sure. That really is the million-dollar question. I get asked this a lot, and one of the things I always say is that I feel that we have the perfect storm that has happened in construction. It's a whole bunch of different variables that have come together at the perfect time, at the right time, and we have the issue that we have today. Any one of those variables needn't have been there, and I don't think we would have had the issues that we have.

[9:45 a.m.]

I've spoken about this before. We've got an industry, and I'll let the other gentlemen here speak to this more, that's short-staffed, that we don't have…. It's an industry that's booming with not enough people to feed that industry, which creates inherent pressures. We've got an industry that's made up of a lot of small organizations, so those pressures exponentially increase.

We have an industry that's predominantly male. We have an industry that has a tough-guy culture. So that, coupled with the stresses…. No one's talking about how stressed they are. They then start talking about what they can do to manage that stress, which often leads to substance use.

The other side of that is that we also know that within the construction sector, we have a 77 percent higher injury rate than other industries. Again, I've spoken about this. This is high, but it is to be expected, because it's a very physically demanding job.

What we actually need…. One of the things that we tested in 2020, just prior to COVID, was an opioid-free pain service. We had very, very good success with this, and the industry really took to it. Our sector — certainly, the folks that we were able to reach — really did respond well to this.

I'm a big believer in not banging my head against the wall, right? I always say I'm going to get a headache if I do that. So let's find solutions that actually work, because once they work, people adopt them very quickly. It's the basic psychology of human behaviour change: find something that works.

The industry themselves were coming to me frequently. Employers would come to me and say: "We need something that isn't opioids. If opioids are a problem, we need to manage pain without opioids." So we did pilot a pain service, which worked phenomenally well for the very short amount of time that we had this. We had to close down because of COVID, unfortunately.

Since then we haven't had the resources to pilot this again, which is something, I think, as a committee, we will probably be very open to try again. But we had phenomenal results with that, and it was completely pharmacology-free, which works for the industry. It means that the adoption comes very quickly as well, because there's none of that culture shift that we're having to do — which we should do, but we can get in very quickly with this.

That's around the pain issue. In terms of the counselling, I couldn't agree more. Prior to the opioid epidemic, prior to…. Really, 2016 is when it was declared a pandemic, but 2012 is when we started seeing the numbers rise. Historically, when you look at addictions throughout the world, you'll see that over the last 20, 30, 40 years, the numbers pretty much stayed quite stable. They haven't really…. Apart from the odd spike here and there, they pretty much stayed the same over decades.

Then in 2012, it started to go up, and we started seeing this. Of course, that's when fentanyl started coming onto the scene. Prior to that, treatment beds weren't our first choice. The first choice was to say: "Where is this person in terms of their stage of change, in terms of behavioural changes towards substances they're using?"

Very often a small proportion of people were ready to go into treatment. Most of them you kept in counselling so that you could work with them to move them through the psychological changes that they needed to go through to get to a place where they were ready for treatment.

However, the opioid epidemic has completely changed that. It's turned that on its head. We are now…. The choices we make every day, which are incredibly stressful on the team as well, are that we either keep that person, get them ready for treatment so the treatment sticks, knowing that that person could overdose now, or we get them into a safe place, into a bed, where we know that they're away from supply, and then we hope that we can grab them on the way out and get them back into counselling.

The whole industry, the health care industry, is grappling with this, because sending people into treatment is a choice you make. Either you're worried that they're going to die waiting while you work on that psychology to get them ready for treatment, or you send them into treatment and try very desperately to get them back out and grab hold of them again.

There's huge health care…. Everybody is battling with a shortage of counsellors — everybody. The reason for that is because…. I've spoken about this before — the fact that my industry, the counselling industry, has never been in such high demand, ever. We're losing staff left, right and centre to private practice.

N. Sharma (Chair): We have about ten minutes left. I think we have three people, including myself, that want to ask. Let's see if we can get through all the remaining questions.

I had a couple of quick comments and then a question. I have to say that…. This is probably one of several times we've engaged with some of you on this call, and I think that every time I hear the stats, I'm shocked, as I'm sure all of you are — one in three, problematic substance use. And 55 percent of the people that have died have been part of the construction industry. It's devastating and shocking every time I hear those stats of the loss of life and the impact.

[9:50 a.m.]

I hear from you that you're tackling or wanting to partner with us to tackle it on many levels, including this whole workplace culture thing — the idea that the "work hard, play hard" thing leads to these high numbers and contributes to the high numbers of substance use that is just part of the culture there.

I have many questions, but since we have a little bit of time, I'm really wondering. I've heard some things in the course of the question period of what you're doing to attack that culture component of it. What about young people when they're entering this trade or profession or working with the various organizations I see here? Is there a way to get at them when they're at that stage of just entering, before these kinds of problematic issues come, to prevent the stats from rising?

Maybe if we could talk a little bit about that before I go on to the other question.

D. Baspaly: Well, I think what I'll do is I'll just tee it up on what our industry is like. It is usually a whole cadre of small, medium-sized employers, the small family affairs. Traditionally, the old tradesmen and tradeswomen that used to participate used to be the keepers of knowledge that they would pass on to the new individuals that came into the workforce.

Today safety is the culture that underpins everything we do. We want to make sure that there's no tolerance for any kind of substance abuse on our sites, because any impairment can lead to a serious injury. That's why you've got certain things that have taken over and changed that mentorship component to more of what you'd see as a sort of academic, almost, safety culture that's there — toolbox talks, tailgate discussions before people start, an onboarding of orientation, and these kinds of things.

To your question about whether or not there's an opportunity here, absolutely there is, across the board. We're already doing that in tailgate talks and toolbox talks on a regular basis, to make sure that people know that that exists across the sector, right? "Take it out of the shadows" was one of the major initiatives that the construction industry wanted to push through. It was making sure that substance abuse is no longer stigmatized. We want to make sure that the supports are there to help everyone.

We can go a lot further than that. There's work to be done, again, in our partnership together with government or the health authorities, etc. We'd be more than willing to build out those sections and see where it goes.

Quickly to the panel, any other comments on that?

V. Waldron: Talking about the apprenticeships and apprentices, I think that you're right. There's a many-pronged approach to this. There's the immediacy. We've got to deal with what's going on right now, and that's where the naloxone kits are going to be so valuable, on two fronts. One is to deal with the issue here and now, in the immediacy. But also, when you have that many naloxone kits, when everybody has a naloxone kit, the second advantage of that is we reduce the stigma. It becomes normalized, right? This is a normal thing to do. So there's that piece.

Then there's the preventative piece, which is going on with the apprentices. We have developed a program already which is around…. We call it a stress inoculation program. Along with some of the other partners here, the industry is…. There are pockets of work being done across all of the industry, and I can certainly speak to the piece that we're doing.

We call it stress inoculation. It's really kind of a snappy name that really is talking about stress management. We do that with apprentices across a number of different colleges. In two or three of the colleges, it's now been embedded into their actual apprenticeship program, where it's a mandatory course.

Now, we recognize that that's…. We have such limited resources that we are now in the process of developing a CIRP app. The app itself will also have some of these training courses that reach apprentices. They will be able to access some of these courses from the app as well. That's something we're looking to do as well.

D. Baspaly: Back to you, Madam Chair. We've got a couple more people.

N. Sharma (Chair): Okay. We'll try to get the rest of the questions, two of them. Let's be quick.

S. Bond (Deputy Chair): I really appreciate the opportunity. I guess I will just say this. I will just say that I am concerned when the majority of our conversation is talking about normalizing a reaction to overdose in our province.

[9:55 a.m.]

I understand the comments. I would really like to see some emphasis on prevention and talking about the fact that there is no such thing as safe supply. There is safer supply.

While I certainly appreciate a kit in every hand…. I don't know how that can be so complicated. I understand that you're doing your work, and we appreciate that. Naloxone kits are free. They're handing them out all over the place, whether you are a user or whether you are at risk of seeing someone overdose. In fact, Dan Davies, on this screen, has been trained in the use of a naloxone kit and has them in his office.

Considering the crisis and the proportion of this issue in the construction industry, certainly I hope that…. Maybe you can just speak to where that proposal is at and if there have been roadblocks.

I also think maybe you could speak to the fact that…. Is there a front-end piece that says: "The use of drugs is risky, and it comes with potential consequences"? For me, it's an entire package. It starts with prevention education and then works its way through the spectrum. Maybe you could just make some comment about that. Thank you very much.

D. Baspaly: Good words, Shirley. You've characterized it perfectly. That's the continuum that we want to bring into our sector and make sure that we do all of those pieces well.

The problem with the epidemic right now is that one exposure, one time using, can be your last. So where we had the opportunity to really build out education, awareness and prevention early, now if somebody's just experimenting or finds their way into the drug, that could be it.

The kit-in-every-hand component that we designed into a proposal and handed to the Mental Health and Addictions Ministry was designed to…. Let's saturate the community, because it takes the stigma down, puts the kits there where they're needed. So if somebody tries it once and has a bad experience, they're not going to die. Then we, at the same time, saturate the entire sector with education, awareness and programming.

By doing all of it in concert, at a scale that is commensurate to the amount of people in our industry, what you end up doing is having another effect. That is, just making it understood that (1) this is dangerous, (2) there are supports available, (3) the stigma is gone, and (4) programming is available, for everything from the actual addiction itself to the mental health supports that Chris Gardner, perhaps, spoke to, and also Colby. And the toolbox is there. They're there in the community, ready to use.

I would just want to say, Shirley, as always, that's the approach we want to take in our sector.

P. Alexis: I'll be as quick as I can. Scenario: someone has successfully completed treatment and wants to return now to work. Tell me about that, and tell me if there's something that you can share with us that you have found successful with respect to fighting that work culture that we've talked about, getting people where they need treatment.

How do you deal with the other side? How do you deal with those that have successfully completed and want to transfer back into that worksite again, given the culture that we know exists? If you could just speak to that. Maybe Vicky. I don't know if Vicky's the right one.

D. Baspaly: Yeah, perhaps.

Vicky, do you want to take it? I was thinking Chris Gardner, too, with the mental health program and some of the speaking engagements we've had go out there. Either of you, if you want to hit that one.

V. Waldron: I could take that, and then Chris, perhaps you want to follow up too. I could certainly speak for what we have found at the program.

Our greatest success comes with clients when they are able to go into treatment and we're able to retain them, bring them back into counselling and then work with their families. It's the holistic approach. It's nothing new. We're not inventing the wheel here. We know this. This is well established in research, when we involve the families, when we involve the individual, and when we involve the employers.

I can give you an example. This week on Friday, we're actually running a three-hour workshop for one of our employers who is bringing in 16 of his employees, the entire company. We spoke to him. He asked the gentleman to come into treatment. We sent him to treatment. We brought him back. Everyone's talking about this, but not in a negative way. The employee has received the help. He is going to continue to get counselling for the next 12 months.

That's the other key thing that research tells us. We know that short-term counselling doesn't do it. We need long-term counselling.

[10:00 a.m.]

Then we get the employers involved, and we talk about…. We deliver workshops on mental health awareness, reduced stigma and building resiliency workshops. How do we keep your staff resilient? We deliver all of these, and that's where we find that we get the most success. It's almost always positive outcomes when we can get that. It's not always easy to get that, though.

D. Baspaly: Let's go to Chris for the final word.

Over to you, Chris.

C. Gardner: I would say that as we do our speaking engagements…. We had Corey Hirsch in front of 300 mechanical professionals two weekends ago in Whistler. At the end of that session, there was a lineup of 30 people to talk to him, pouring their hearts out. It was very emotional. People were crying. There's definitely an acknowledgment that this is a challenge. People are more open about it. There's not a single owner who has not approached me and said: "Hey, we've got a challenge." We get calls every day.

It's wrapped up in mental health. You've got substance abuse. You've got a suicide rate in the construction sector that's five times the national average. Just two weeks ago, at a large, well-known construction company that everybody would recognize, a worker walked off the job site and went down to the river. He left all his belongings, went into the river. Four days later the RCMP recovered his body. Those stories are not uncommon, and it's devastating to the entire workforce, to their families, to the communities.

So there is a willingness. There's no reluctance at all. We're pushing on an open door. In fact, there's no need to push. There's no door. Everything that we've all talked about today…. Everyone is, I think for the most part, pulling in the same direction. We recognize the problem — employers, workers. No matter how the workforce is certified, everybody wants to tackle this problem head-on.

N. Sharma (Chair): Okay. On behalf of the committee, I just want to thank you all not only for coming together in the way that you have to tackle this issue and figure out how to save lives for your industry but also for coming today to help us learn about all the work that you're doing. Much appreciated and all the best.

D. Baspaly: Thanks for the work the committee is doing as well. Thanks for the opportunity. Have a great day.

The committee recessed from 10:02 a.m. to 10:04 a.m.

[N. Sharma in the chair.]

N. Sharma (Chair): Okay, welcome, everybody. I'll just give everybody a second to log on and have their audio connected.

H. Peterson: My name is Hawkfeather Peterson. My pronouns are they/them. I'm a person with living experience as a substance user in British Columbia.

[10:05 a.m.]

I work as the regional peer coordinator for Northern Health and have worn a lot of hats in this work, but primarily, they're all as a person with living experience. I'm going to be helping to facilitate today.

We're going to start off with….

N. Sharma (Chair): Sorry. I don't mean to interrupt. This is Niki Sharma. I'm the Chair of the committee here.

I thought it would be great for you and everybody on the call to have a little bit of introduction so you know who you're speaking to from the committee. Then I'm very happy to hand it off to you and have you facilitate and introduce everybody else. Does that work?

H. Peterson: Thank you so much. I'm helping just with the timing.

I'm going to pass it on to Tanis Oldenburger, and one of the things she's going to do is introduce people. Thank you so much for that. I'm going to pass it on to Tanis right now.

N. Sharma (Chair): Okay, great.

Tanis, like I said, my name is Niki Sharma. I'm the Chair of the committee and the MLA for Vancouver-Hastings. I'm just going to introduce the rest of the committee members.

Go ahead, Shirley, the Deputy Chair.

S. Bond (Deputy Chair): Good morning. I'm Shirley Bond. I'm the MLA for Prince George–Valemount.

M. Starchuk: Good morning. Mike Starchuk, MLA, Surrey-Cloverdale.

P. Alexis: Good morning. I'm Pam Alexis, the MLA for Abbotsford-Mission.

D. Davies: Good morning, everyone. Dan Davies. I'm the MLA for Peace River North.

D. Routley: Hello. I'm Doug Routley. I'm the MLA for Nanaimo–North Cowichan.

R. Leonard: Good morning. I'm Ronna-Rae Leonard, MLA for Courtenay-Comox.

T. Halford: Hi there. I'm Trevor Halford, MLA for Surrey–White Rock.

N. Sharma (Chair): Excellent. I think I caught everybody.

We're just really looking forward to learning from you all.

I'll pass it over to Tanis and Hawkfeather for introductions and to let you present.

T. Oldenburger: Hi there. My name is Tanis Oldenburger. I'm an executive director and co-founder of Mountainside Harm Reduction Society here in Chilliwack. I'm also someone with lived and living experience with mental health and substance use.

Throughout the presentation, I think everybody will give a little bit more of an in-depth introduction to themselves, but I wonder if we might just follow suit with a quick little introduction the way that the committee did.

I'll pass it to Jenny, as she's next on the screen here.

J. McDougall: Hi, everybody. My name is Jenny McDougall. My pronouns are she and her. I am the co-founder and lead of the CSUN PAPAP program, which is the prescription alternative and peer advocacy program, and also a member of PEEP. I am somebody with lived and living experience with substance use and mental health and addictions as well.

Thank you for having me.

J. Lamb: Hi. I'm Jess Lamb. My pronouns are she and her.

I'm calling in from the unceded, ancestral and traditional territory of the Ktunaxa Nation.

I'm the co-founder and project coordinator of the East Kootenay Network of People who Use Drugs, and I also work for ANKORS as the peer lead development coordinator in Cranbrook. I'm thankful to be here.

L. Parnham: Good morning, folks. My name is Lyric Parnham. I'm the executive director for SNOW, Society for Narcotic Opiate Wellness, here in Fort St. John and Dawson Creek. Thank you for coming.

F. Cameron: Hey. I'm Fred Cameron. I'm the programs director at SOLID outreach society. Thank you very much. It's an honour to be here.

P. Choisil: Hi. My name is Paul. My pronouns are he/him. I'm the harm reduction leader at Robert and Lily Lee, an educator, a peer mentor. I'm also with PEEP, and I'm also with the people with lived and living experience council with Health Canada.

K. Sedgemore: Hey there. Kali Sedgemore, with PEEP and Coalition of Peers Dismantling the Drug War — and they/them pronouns.

[10:10 a.m.]

K. Cadieux: Hi there. My name is Kat Cadieux.

I am calling in from the traditional, unceded territory of Lheidli T'enneh, also known as Prince George.

I am a person of lived and living experience. I am the ED and founder of UNDU, which stands for Uniting Northern Drug Users Undoing Stigma. I'm also an intergenerational survivor [audio interrupted].

Thanks for having me.

T. Oldenburger: Thanks, Kat.

Billy, if you want to introduce yourself briefly.

B. Morrison: Hello. My name is Billy Morrison. I am a wellness coordinator for Nisga'a Valley Health. I'm calling in from Laxgalts'ap, British Columbia.

T. Oldenburger: Great. Thank you.

Then for B.C.-Yukon — is that Shawn, if I'm not mistaken?

S. Wood: Yes, it is. Hi, I'm Shawn, B.C.-Yukon Association of Drug War Survivors, a provincial drug user network. I'm a person with lived and living experience in substance use, incarceration and all that fun stuff.

T. Oldenburger: Great. Thanks, Shawn.

We did have Laura here a second ago.

Is that you on iPhone, Laura?

L. Shaver: Hello. My name is Laura Shaver. I'm with the British Columbia Association of People on Opiate Maintenance. I am the provincial peer navigator for advocacy of the iOAT and the OAT programs. I'm also a VANDU member. I'm a person with living and lived experience.

I'm sorry if you can't hear me well, but because of the way that the system is, I am on my way to get my safe supply on.

Good morning. Thank you for having me.

Briefings on
Drug Toxicity and Overdoses
Panel 1 – Professionals for Ethical
Engagement of Peers
and People with
Lived and Living Experience,
a BCCDC and BCCSU Joint Committee

RECOMMENDATIONS OVERVIEW

T. Oldenburger: Thanks, Laura. We heard you great. Thanks for tuning in.

All right, I think that was everyone. Please correct me if I'm wrong. Otherwise, I will get started.

My name, like I said, is Tanis Oldenburger.

I was born, raised and continue to reside, work and rest safely on the traditional unceded territories and spiritual realm of the Stó:lō Coast Salish people, or the people of the river, here in Chilliwack.

I'm the executive director of operations and co-founder of Mountainside Harm Reduction Society here in the Fraser Valley. I use she/her pronouns, and I live a blessed and full life as an autistic woman who uses substances.

Though I'm a daily fentanyl user, I consider myself in recovery. I'm in recovery from the instability and chaos of problematic substance use due to self-medicating undiagnosed childhood autism, among other complex traumatic contributing factors, which contributed to debilitating suicidality and borderline personality disorder. Medicating myself throughout my life when the health care system failed me has literally kept me alive.

Today I'm a co-founder and an executive director of a budding harm reduction organization. We have a wonderful and in-kind board of directors, an awesome team of drug-checking technicians and peer support workers.

I'm in recovery from domestic violence, from harmful criminal activity and from cycles of correctional system institutionalization. Most importantly, I'm in recovery from the isolation and loneliness that came from the shame from overwhelming stigma towards my addiction. Today my family has cut the tough love act and subsequent constant rejection and instead accepts and supports me as someone who uses substances, just like any other family member who drinks wine or smokes pot.

Moreover, I've been incredibly fortunate to find a conscientious substance use navigator who has been able to keep me constantly supplied with tested and measured blended fentanyl and caffeine, on which I've been able to maintain a stable daily dose, unsupported by anyone but my family and my supplier, for nearly two years now. You'll hear many versions of what safe supply can be today from my colleagues, and that is my version.

This past year and a half of my life has been the most successful and fulfilling year of my life. Evidence is clear from my case alone, and the instability and chaos of my substance use lies solely in the hands of the police. The only time I find a barrier to my safe supply is when they have interfered with the supply chain.

Now, I've been working with the BCCSU as a person with lived and living experience on this committee since around 2018. Our committee of peers at the BCCSU have worked on various clinical guidelines together over the years, and most recently, I helped to write the drug-checking implementation guide and became an official partner of the BCCSU in the provincial drug-checking project.

[10:15 a.m.]

Many of my colleagues at BCCSU also take part in the BCCDC's Professionals for Ethical Engagement of Peers. Today you'll meet and listen to a combined effort from the membership of both of these dignified groups. Our speakers and supporting colleagues today represent the networking strength amongst the leadership in our community. We are often referred to as the Provincial Peer Network or the provincial coalition of drug user groups.

Today we will bring forward a carefully compiled agenda of recommendations which has been amalgamated by myself and my colleagues over our extensive careers as people with lived and living experience working in industry roles, from peer support workers to founders and executive directors of organizations by and for people who use drugs. Each recommendation stems from long-standing issues that have plagued our industry and our people.

These issues have been discussed at great length amongst people with lived and living experience and within our organizations. Throughout various research projects, interviews, Zoom meetings and conferences, we have all had unparalleled opportunities to hear from people who use drugs, across the provinces, continually voicing their concern in these areas.

I led and worked on a project with the Canadian Mental Health Association called OD PREP, or OverDose Prevention and Response, Essential Practices, where I had the opportunity to meet, collaborate with and interview most drug user groups and community action teams across B.C. These conversations struck chords with each of these recommendations time and time again. It is time that this list was put to good use, and I'm grateful for this opportunity to combine and share these grievances so that we may look to the future with a better understanding and stronger resources.

Myself and many others with me today have projected these voices time and time again in various presentations and speeches in an attempt to establish platforms that may allow us to invoke systemic changes in relation to these matters. We feel that our cries are falling on deaf ears. What else can we do to be heard? Are our leaders even listening? Are you listening now? Are you working on something else, merely playing our presentation like any other podcast for background noise?

Our collective was very disappointed to hear that we would not be presenting in person today. This presentation may not be as powerful as it would be in person. We know that we ooze charisma and can turn ears and draw tears with our firsthand testimony today.

For our words and stories to be powerful, they need to be heard, and that's up to you. We urge you to put down your coffee, close your clutter of browser windows, turn on your camera to look us in the eyes and listen respectfully. Show us that you care and that you heed our desperate calls for these imperative changes.

Our recommendations:

(1) Meaningfully include and respect people with lived and living experience at all levels in B.C. This meaningful engagement really reflects what I just said at the end of my introduction there. These changes need to be heard and then implemented. We can scream at the top of our lungs as long as we want, but if our advice and our expertise don't actually get put to good use, then what's the point?

(2) Significantly expand safe supply options. Access to this safe supply needs to exist beyond the prescribed model. The prescribed model that does exist is just not good enough.

(3) Significantly expand access to youth-informed and youth-specific services. This means expansion and tailoring of treatment, wraparound services, harm reduction, OPS, safe supply, recovery to all people who are compoundedly marginalized.

(4) Significantly expand access to community-specific services, which includes LGBT2Q, Indigenous, rural and remote residents, parents, tradespeople, people with mental health barriers, people who are living unhoused.

(5) Provide long-term, sustainable funding for peer-led organizations. I'll talk more near the end of the presentation about the landscape of funding for our peer-led organizations in the province at this time and some of the extreme barriers that some of our colleagues are facing due to the competitive nature of the granting system and the exponential growth of our peer-led organizations in B.C.

I'll pass it back to Hawkfeather to transition us on.

H. Peterson: That was really powerful, Tanis. Thank you.

We're going to move on now to Jessica Lamb.

PROFESSIONALS FOR ETHICAL ENGAGEMENT
OF PEERS STATEMENT OF RECOGNITION

J. Lamb: Hi. I'm Jess Lamb, as stated before. I think I forgot to say that I'm a person with lived and living experience.

[10:20 a.m.]

I am here today to share with you the PEEP statement of recognition. I am grateful for this opportunity to share with this group the letter of recognition that PEEP has put together to address all of you here today.

Before I begin, I recognize that some of you here share the values we are going to express today, while some may not. For those of you who do understand and recognize the lack of humanity in our drug policy, I ask you to continue to bravely challenge the system that we are working within right now towards the bold change that is needed so badly to alleviate our suffering.

We, as people who use drugs, are often pathologized, told that we have a disease to explain who we are, told that we are good people who just make bad decisions, told that we just need help, told that we have the power to change, told that we can rise above, told that one day we can be people who don't use drugs and then become contributing members of society. Myself and my fellow people with lived and living experience are here to make it understood that there is nothing inherently wrong with drug use or living with a drug dependence.

The reasons why we use drugs cannot be generalized. Many of us do not have a background of trauma to explain our drug use, and many of us do. The reasons for our drug use are many. They are often good reasons that make sense to us, but we do not need to explain the reasons for our drug use to anyone.

Many of us do arrive at a point in our life where we decide our drug use needs to be managed or stopped, and under our own reasons, we appreciate the availability of resources to help us address our needs. But there are many of us who exist happily as people who use drugs and refuse to be shamed to identify as such. Despite the oppressive structural barriers that exist, many of us live functional, comfortable lives, and you could say many of us flourish. Many of us credit our drug use for improving the quality of our life. For many of us, our drug use forms part of our identity.

While we work here today with an intention to better the lives of people who use drugs, it is necessary to recognize the following: we are operating within a system of injustice that is designed to invalidate, oppress and punish people who use drugs. The essence of our being as people who use drugs is forbidden by our legal, political and social institutions. The explicit goal of this system that we are currently working under is to coerce people who use drugs into people who don't use drugs. This is the major injustice and the main driver in the extreme suffering that we are living through today.

We need to recognize in a deep sense the ongoing injustice that is taking place. As people who use or used drugs, we deserve to exist in society on an equal level with everyone else. But how can we move towards this ideal when the abuse of people who use drugs is sanctioned by our legal system? Our suffering and death is acceptable to so many people because our humanity is not respected by our institutions.

We must end the goal of policy that aims to invalidate our existence. It is only through the emancipation of people who use drugs that our suffering will end. This needs to be stated repeatedly. Our suffering will only end when we are accepted, allowed and supported in society to be people who use drugs. This means that as we work on tweaks to the current system that aim to ease our suffering, we must push and fight for systemic change so we do not need these measures that protect us from harmful drug laws.

This crisis will not end through optimized treatment programs, mass spectrometers or naloxone kits in every hand. It will only end when decision-makers allow for us to be who we are without discrimination and develop policy accepting of our rights to use drugs.

[10:25 a.m.]

This means accommodating the interests of those who wish to use drugs as well as the interests of those who want to stop using drugs. This means more than allowing us to ingest drugs of unknown quality with clean harm reduction supplies. This means allowing us to access a reliable supply of drugs we seek for use on our own terms, like the access we have to safe, regulated supplies such as tobacco, alcohol and, recently, cannabis.

As we go through the priorities developed by people with lived and living experience from around the province, we recognize that these priorities developed by people with lived and living experience are necessary conditions to be met in order to end the crisis and keep us alive and safe.

The necessary conditions are not currently reflected in the governing institutions of this province. The policy that governs our life is still designed to dehumanize and make us suffer. The policy is still being guided by the goal to turn people who use drugs into people who don't use drugs. This underlying mindset infects almost all aspects of drug policy, and it is the key reason why the overdose crisis persists.

The statement of recognition has been worked on by PEEP for a while now, and at every meeting that we go to with policy-makers, we read the statement of recognition. For me, the most important part of that statement of recognition is not just meeting people who use drugs where they're at but accepting us where we are at as people who use substances. If we are going to continuously try to change people who use drugs into people who don't use drugs, we're going to back-pedal in this crisis. That's what I see is happening right now.

It's okay that people use substances. Throughout history, there have been many identifiable groups that have been stigmatized in order to justify their social exclusion and mistreatment from broader society: people of colour, women, people attracted to the same sex, people of certain faiths. This is no different than people who use drugs. We demand our rights and ability to live without fear of suffering or imminent death.

I was a person who used substances. I stopped using substances for a period of time in 2015, when fentanyl came into the drug supply and all my friends were dying. I chose at that time to make some changes in my life. But two years ago I found myself at a period of my life where I was experiencing a lot of trauma. Thankfully, I was able to advocate for myself to get access to the pharmaceutical alternatives through the risk mitigation guidelines, and it probably saved my life.

Today I am a person who uses my drugs through intravenous, and I am just as capable as anybody else in society. I just really want to stress this idea that people who use drugs are contributing members of society already and that we just want to be treated humanely and have a say in the policy that guides the conditions of our lives.

So that's where I'm going to leave us off and pass it on to the next speaker.

H. Peterson: Thank you, Jessica. That was beautifully said and powerfully stated.

We're moving on now to Paul.

Paul, if you want to go ahead.

HISTORY OF PROHIBITION AND
IMPACTS OF STIGMA

P. Choisil: Hello, everyone. My name is Paul. I'm a person with lived and living experience. Basically, what I'm here to talk about is the racist history of drug policy.

If we look at a bit of a timeline, alcohol prohibition was around the 1500s. Basically, we had colonizers come in to Canada — fur traders, missionaries and European colonizers from Britain and France. They introduced alcohol to Indigenous communities when they settled in land in Canada. Alcohol was exchanged at trading posts for various items like furs. Basically, what this had is a huge, devastating effect on the Indigenous community.

[10:30 a.m.]

At the same time, there were white moral reformers that were focusing on converting Indigenous communities to Christianity. That was the goal, and along with that, prohibition of alcohol became their focus.

After that, what happened is that…. That was the goal, to basically convert Indigenous people to western Christian religions, morals, values, including sobriety. That became a goal of the temperance reformers. This went on up until the 1800s and early 1900s.

Also, the moral idea of the view on drugs from the shores of Europe…. As Britain's settlers arrived in Canada to eventually colonialize Indigenous land, more specifically, prohibition grounded the idea that drugs are inherently bad and immoral. This was basically a means of social control over radicalized nations and communities. These communities were viewed as a threat to white European supremacy.

Now, this hasn't changed. We're still dealing with this kind of supremacy thing. I always like to joke around that you can't spell "colonialism" without "colon." If we start moving on, there's more of this. Drug prohibition has also been intrinsically tied in with colonialization. As views shifted, there was the influence of Protestantism. This was kind of the reason: they were figuring that this was a threat to white communities, the white middle class — substance use.

This is old. The worst part is that alcohol was the drug of choice in Europe, and they were using cocaine and opium for pain management. China was using it. It was being used in India and in some of the Middle Eastern countries. Even in Canada, they were using psychoactives for medical reasons, up until the Opium Wars. With the Opium Wars, Great Britain was taking full advantage of the fact that they were making a lot of money over this, until China decided: "Okay, we don't want to do this anymore."

Then there was a huge war. There were actually two wars. I believe there was one in 1838. Anyhow, the point is that when China decided they didn't want to do this anymore, there were these wars, and there was a growing anti-Chinese type of racism. That was also the opportunity for people to seize on that here in Vancouver. The beginning of narcotic control was between 1880 and 1920. Vancouver was the birthplace of prohibition in Canada, driven largely by anti-Chinese racism and a perceived threat to white middle-class purity. We're still dealing with this now. There's still that fear.

In order to go against these drug policies, we've got to also realize that its root is in colonialization and racism. This needs to change. You know what I mean? When we start talking about structural racism or that kind of thing, a lot of people, especially people that are in that privileged position, have a tendency to not listen. They say, "Oh, there you go with racism. It's the race card" — that whole thing. This is a real thing, and once we start acknowledging it, then we can start making changes.

[10:35 a.m.]

There's more information. In 1907, there were the race riot wars that were sparked, igniting the drug prohibition. Through these wars, on September 7, 1907, angered by the perceived threat to their employment security — a "they're coming to take our jobs" type of attitude — a whole bunch of men marched into Chinatown, and they vandalized and destroyed Chinese- and Japanese-run businesses, while stirring up violence and mayhem in the process. There was the head tax. There was a whole bunch of stuff.

Then there was Mackenzie King in 1908. This is a quote from him: "The Chinese with whom I converse on the subject assured me that almost as much opium was sold to white people as to Chinese, and the habit of opium-smoking was making headway not only among white men and boys but also among women and girls…. To be indifferent of the growth of such evil in Canada would be inconsistent with those principles of morality which ought to govern the conduct of a Christian nation." All of these sentiments are just horrible. I think it's probably time that we're aware of this.

There's also a lot of the propaganda that came from Emily Murphy in the 1920s, with their anti-drug propaganda. She had a bunch of articles that were written in Maclean's magazine and that would be later compiled into a book called The Black Candle. That was in 1922. Her writings depict substance use as a destabilizing, corrupting force within a civilized society and cast racialized others as a threat to white nations. Murphy blamed opium-smoking for crime and women's sexual immorality, even argued that white women in close proximity to crime, to racialized men, would lead to their inevitable downfall and would threaten the white Christian nation. This continues on. This is the 1920s.

Then in the 1940s and '50s, they started the criminal act and criminal addicts and psychedelics. We're going to talk about its origins. I believe I've talked a lot about it. There's more information. I've actually posted a link, whereas some of these quotes I've taken from Dr. Susan Boyd's Drug Prohibition in Canada. Anyhow, there's more information on that.

When we're looking at also…. Abstinence-based programs don't always work for people. I know for me, personally, I used to use crystal meth, and I was able to do it on my own. That's the only way you can do it. You have to actually make the decision. So when we're trying to push and force people into being people that don't use drugs, that doesn't work. You have to actually make that decision yourself.

The problem is, too, with that, when you're putting people into recovery or forced recovery, there's always a chance and possibility they might go back to using again. At this point, with the poison toxic supply on the street, when you quit for a while, you lower your tolerance. People's tolerance on the street level is super high, so you're actually putting that person at risk.

There are a lot of functional people. I'm functional. I pay my bills. I do this kind of work, and I've been doing it professionally for 13 years, but harm reduction has been something I've done for a long time, not realizing what harm reduction was. You can't turn people that use drugs into people that don't use drugs. That doesn't work. There are a lot of functional people out there that use substances. When you look at the amount of people that are functional compared to the people that have problematic substance use, it's a small percentage of people. You can't paint everybody with the same brush. We are functional people.

[10:40 a.m.]

Like Jessica had said earlier, there are people that are working. They work on the boats. The fishermen spend hours up. You have people that work really hard jobs, and they use substances to ease the pain. A lot of people also use substances for pain management. That's why it's being used in the health authority, and that's why people use it if they're able to find it on the streets.

I don't know how I'm good for time — if I have more to say. If I can say more, I can.

H. Peterson: You're good for a bit, Paul.

P. Choisil: Okay, great.

The thing is that we're not criminals. I haven't stolen everything. I've never been to jail. I have raised a boy and a girl. I'm a grandfather of a boy and a girl also. I'm a musician. I'm very creative. I'm very social. I help people out.

As soon as you mention drug use or you see someone who uses drugs, you're like: "Oh, no. This person is a criminal." I'm not a criminal. I've never been. I've met tons of people that use substances, and they don't have problematic substance use.

We can't paint everybody with the same brush. You have to understand that a lot of people that use substances use it for all kinds of reasons, spiritual reasons. I mean, if you look at prohibition, prohibition is not that old. Substance use is ancient. All these substances that are being used by the health authority for pain management for operations and stuff are all — I want to say it — artificial versions of the real thing. Most of these substances could be found in nature.

It's funny how, when you look at what happened in Canada with the Christian reformists, at the same time, you had a pope that basically was endorsing…. There was a wine. I forget the name of the wine. There was a wine that was mixed with some of the coca leaves they found in South America. Basically, it was a stimulant.

The people in South America were using those coca leaves because of the high altitude. It was easier to do work, climb hills and do a bunch of stuff. When the Spanish came in to colonize South America, they noticed that the locals were chewing on these leaves: "Oh, it's bad. You have to stop." Then they realized that the process…. The people were working more slowly. They said: "Okay. You can chew those leaves again."

Those leaves were taken to Europe. They were mixed with Bordeaux, I believe. I forget the name of the wine. It's somewhere in here. There was a pope that endorsed it. It's funny how Europe was engaging in a lot of substance use. Despite that, you still had people coming here and telling people that they can't use substances, where it was used widely in Europe. It's kind of hypocritical.

I believe I'm done for now.

H. Peterson: Thank you, Paul. That was actually super enlightening. I appreciate it's hard to believe that we're still arguing that we deserve basic rights and freedoms, when the basis of the laws oppressing us were never medically or evidence-based. I think that's super informative.

We see what happens historically when we try to force marginalized populations to assimilate. We see mass graves, murdered and missing Indigenous women, and all sorts of absolutely horrific devastations and genocides, including our own.

I'm going to pass it on now to Kali Sedgemore. I'm looking forward to what they have to say.

[10:45 a.m.]

I'm wondering if we should come back to Kali and have Fred come up.

Fred, are you ready to speak?

F. Cameron: Sure.

H. Peterson: Right on. Thanks.

This is Fred Cameron from SOLID.

SAFE SUPPLY

F. Cameron: I guess I should just give a little bit of background. I'm currently working as the director of programs at SOLID Outreach. About seven years ago, I came into a recovery facility after years of crack use, and various drugs before that. I'd got to a point where I was in psychosis for a number of years. I was certifiable, and I would have been diagnosed as a schizophrenic.

In my own mind, though, I knew that I could recover with a little bit of work. It was a result of pattern thinking and pattern behaviour. So I came into a system where, in order to access health care, I had to lie to doctors, to addictions professionals. All of the support that was offered was counterintuitive for me, and I got better by taking my own freedom and finding what worked in the system for myself. The problem is that it took me 15 years of toil to get to a point where I was able to raise a white flag and give up.

I don't know how I got there, but as a stimulant user, there was next to no support within the system. I was pushed out over and over again. I was told to go into detox, but then there's no support in terms of safe supply. There's absolutely nothing out there in the system. I was someone that used crack, primarily. Cocaine is easier to come by than milk for most people out in the street community. The government, with billions of dollars, can't find anything that works for people in my position.

I went out and did a little bit of research, and I talked to probably a dozen or so people that had various versions of what safe supply looks like to them. The only thing out there that works — on any level, it seems — is Dexedrine. Everyone kind of chuckles about it, because if taken in the way that it's given out, it has absolutely no value, but if you take four times the amount the doctors recommend, it gets you out of bed and gets you through that first hour or so of the day so that you can grind or hustle to get some actual drugs that work.

The big flaw in that, though, is by giving people drugs that don't work, you're pushing them out of the entire system. Those are people that lose their faith in the medical system and, by extension, don't access all of the other services.

In the last couple of years, we've had safe consumption services pop up all over the province. Those are pretty much designed to help injection opioid users. There's an environment that just is not conducive to stimulant use, as far as I'm concerned. I would not have been caught dead in a place with neon lighting and mirrors set up. When you have a paramedic staring at you, it just does not work.

As I said, it's easier to come by cocaine than milk, especially in Alberta where I'm from, but through most of the major centres. I'm just thinking back to stimulant use in rural settings or in other communities. Everything that I've said so far is just amplified or magnified many times.

[10:50 a.m.]

All of the tools we need to help people — to get them to re-engage with society, to offer them supports in health care, in housing…. Those tools all exist. But you know what works for cocaine withdrawal is cocaine. I don't understand why that concept is difficult to understand within the medical system.

What's allowed me to get back to a point where I'm in control of my life was…. It had nothing to do with the supports that were pushed on me. All that did, actually, was push me out of society.

For 15 years, I used. In and out of AA. Pushed into counselling. That went right back to high school. So to be honest with you, I was never able to handle my drugs, and everything that was offered by the system did nothing but push me further away.

Something as simple as having the substance that people want, that allows them to function on a day-to-day basis, allows people to trust the system, to engage with it and to improve our lives. So until we get to a point where people aren't forced to run over and over again, it's just going to be more of the same.

Yeah. I don't know what more I can say to simplify that further, but one more bit.

Am I going over time?

H. Peterson: Fred, I'm so sorry. We're about at time for you. That was perfect. Perfect timing for you, Fred.

We're going to try again for Kali.

Kali, if you're available, go ahead.

K. Sedgemore: Yeah, sorry about that. I'm at work.

Hi, I'm Kali Sedgemore, and I'm someone with…. Yeah, I forgot to mention I'm someone with lived and living experience working in the Downtown Eastside. I'm working at the OPS mobile intervention unit, one of the first…. Or not the first. One of the few in Vancouver. I've also worked with youth that use drugs.

Working with youth that use drugs is very interesting, because youth don't really have access to safe supply like we do. Like, a lot of times when you want to access any type of safe supply or any type of opioid alternative therapy, they're often pushed towards going to treatment or going into recovery, even if the youth isn't ready for that.

Oftentimes, also, it's up to the doctor's discretion as to whether they will give them an opiate replacement therapy or what. Most times they're often pushed to…. Also, they need informed consent in some ways, through a parent or something like that. If a youth is trying to not let their parents know, or especially if a youth is in care, it's very difficult for them to get access to a safe supply or get safe supply.

The guidelines are set for people over the age of 18 only, so it's really…. And youth use drugs. That's just something we need to all understand. It's just to comment back that youth use drugs, and they're going to use drugs no matter what. Like all the prevention, education and stuff like that does not really work that well, because it's not something that…. And it's been proven to not work well, because youth would rather learn harm reduction education that teaches them how to be safe around drug use. That's what we need more of — just education and services around harm reduction for youth.

When it comes to safe supply, a lot of youth, too, don't have…. Like, youth are overdosing. We've lost 17 youth this year already. If they had access to safe supply, there would probably be better options for them — to make things a lot simpler and easier for them to be able to access a safe supply just like anyone else can, or almost anyone can.

Then for youth, too, it's up to the doctor's discretion. They really push for the efforts to be made for alternative interventions and additional education. Also, by them being in the system too, by putting them in the health care system and denying them this, it makes them mistrust the system a lot more. It's really frustrating, because it's like they will no longer access health care needs, any type of thing.

[10:55 a.m.]

And then it will also deter their need for calling 911 if there's an overdose or anything like that, because they just don't trust the health care system due to the fact that they've been so pushed into a bad place in it because they've either been denied safe supply or they were forced or pushed into treatment or recovery when they weren't ready for it.

For youth, too, it's being in collaboration with them. Working with them and working in collaboration with them, asking what their needs are, is often better. You get better results that way, and you get better outcomes because the youth will see that you actually care for them and you actually want to listen to them.

For youth, when it comes to drug use, often you are finding that youth are…. Youth who use drugs are starting at a really early age, and oftentimes, they're really heavy into their drug use. Why not find them an alternative that will actually help them instead of trying to force them into abstinence-based programming?

Youth start off with drug use really early, and it's sometimes often at 11, 12 — as I've seen, and so have other people. It's really frustrating that they can't get access to the same things that adults can because apparently, they have a different mindset. I believe they can consent for themselves, like I've noticed with a lot of youth.

I can't think of anything else.

H. Peterson: Kali, I think we're about at time. Thank you so much. I am profoundly grateful that you bring the youth perspective into the dialogue, because it is grossly overlooked. We're losing so many young people.

I'm going to invite Jessica to speak again.

Jess, if you're ready, you can go ahead.

J. Lamb: What Kali was saying segues perfectly into what I was going to say. Anybody who is at risk of a drug poisoning should have access to a safe supply of substances, so that includes youth to however, whatever age. I'm currently working with some youth in the community, and trying to tell youth to do something that they don't want to do often just pushes them farther away from us.

One of the things that I know that people…. This group advocates a lot for the inclusion of people who use substances within drug policy. One of the things is if peer engagement was being done in a meaningful way, then at this point in the drug poisoning crisis, we would have access to both non-medical and medical models of safe supply. The provincial response right now is a little bit lacking.

I advocate in my community. I'm in rural British Columbia. Our mayor is telling the community that drug users in Cranbrook are getting free drugs. It's totally spreading misinformation, because here in our community in Cranbrook, we don't even have access to things like Dilaudid. In communities like Vancouver, that's an old thing, right? We're so far behind, and I believe that the provincial government could be doing more while we're waiting for the section 56 exemption for the non-medical model of safe supply. We want demedicalized models which require that federal exemption, but in the meantime, B.C. could be doing much more.

We could create low-barrier prescription programs that dispense pharmaceutical-grade heroin, fentanyl, Desoxyn and cocaine. Right now, there are 130 people who have access to heroin in this province through the federal government, which is really frustrating, because why doesn't everybody who uses opioids in the province have access to that?

We can create user-pay models. I know when we're advocating and when we're on these meetings with health care providers, diversion is one of the big areas of contention that comes up. Doctors don't want to give this prescription to somebody because they could turn around and sell it.

[11:00 a.m.]

There are other models, like telehealth, that can get around some of the doctor issues. Under the provincial compounding framework, we can provide drugs that do not have approvals yet from Health Canada, such as inhalable heroin and fentanyl. We can dispense the drugs out of OPS sites, pharmacies and compassion clubs.

In the short, the provincial government must stop hiding behind the need for an exemption. Prescription heroin is proven to be safe and effective. It is the opioid that is still most preferred. The research that's coming back from people who use substances is saying, from all demographics, that heroin would be their opioid of choice, not fentanyl. Those are what all the programs seem to be going towards.

It's coming back to this idea of really listening to people who use substances because we're the experts. Why do we want to put a bunch of money into a program that's not going to work for somebody? That seems pointless, right? It's just a sign that we're not being listened to as people with lived and living experience.

In the B.C. guiding framework for public health, they talk about patients as partners, and they do it with other ailments. If you have diabetes, they go to people with diabetes and ask what works best for them. I believe this is what we need to be doing with drug policy and people who use substances.

It's not just people who use drugs who are saying this. It's also the families. I was somewhere last night talking to the mother of a person who uses stimulants of the sleep that she loses knowing that her son is accessing a completely toxic and unregulated drug supply, knowing that there could be a better option for them. But it's a lack of political will that's keeping us from moving forward with safe supply. She doesn't know if she's going to wake up to a phone call that she's lost her son.

It's not just people who are using substances that are saying that we need access to safe supply. And not just in urban centres — throughout the province, we're losing people to the toxic drug supply.

That's my bit on safe supply.

H. Peterson: Thank you, Jess. That's awesome.

What you're saying, we do observe it a lot — that blame is passed. The provinces blame the federal government. The federal government blames the provinces. The health authorities blame the provincial government. Meanwhile, no one steps up to actually make demands of care, while we are having our community completely decimated. Demands absolutely can be made, but we just see responsibility passed around with zero accountability.

Next we have Kat Cadieux.

Kat, if you are ready, you can please go right ahead.

RURAL AND REMOTE NEEDS

K. Cadieux: My name is Kat Cadieux, and I am calling in from Lheidli T'enneh, also known as Prince George. I'm a generational survivor.

I grew up…. Yeah, I just didn't really understand a lot of the reasons why I grew up…. It was only a few years ago that things started to fall into place. Me and my mother are finally starting to work on a lot of the trauma. We have self-medicated in trying to break that cycle. Thank you for having me.

We need access to non-medicalized safer supply and pharmaceutical models across the province, equally. Provincial-level policies often don't have rural remote impact. Policies need to reflect the realities of rural remote experiences, and there needs to be equity across the province.

[11:05 a.m.]

We often get missed up in the North, and we're so far from being able to grasp other options, services and programs that are being offered, like in downtown Vancouver. Prince George is the main hub in the North for most of the rural remote settings to try and gain access to some type of systemic health. We have a university hospital, a small detox centre, the jail, pharmacies, doctors and nurse practitioners, so you would hope that this would be the next best place to go before having to feel the need to travel to Vancouver.

Many people come here or are sent here thinking that this is where they can access services, but the problem is that we are so far behind. The medical accessibility options are minimal. It's next to impossible to get a doctor to prescribe any type of safer supply, never mind OAT. And in most cases, if someone does get a prescriber, it's abstinence-based.

People travelled from all around to Prince George and hoped to access some type of support and ended up getting nowhere except feeling forced to look to the street, even for some type of pharmaceutical alternatives so that they at least knew it was a safer option. Doctors weren't taking on new clients. If someone missed a couple of days or appointments, they were cut off or had to restart the program and were expected to refrain from any other substances in their system or were recommended to go to detox in order to get started on Suboxone or methadone.

In most cases, any other additives that have been added to the street drugs weren't being properly accounted for, and people were going through immense withdrawal from benzos or weren't being given enough to take away the withdrawal from the higher tolerances from the fentanyl. That has left people more vulnerable to overdose if or when they left to go to try and self-medicate. When nurse practitioners were able to step up and prescribed safer supply, they got no support but, instead, backlash and pressure and were pushed away. They were treated as "part of the problem" or the reason why people were overdosing.

There is no proof of someone overdosing from solely prescribed safer supply. If anything, it would be a situation where they didn't have enough prescribed safer supply and felt that they needed to use unsafe street drugs in order to feel anything.

This is where we're failing. We need to have more options. We need to stop telling people that this is the only way or else you take the risk of dying. We need to be able to start meeting people where they're at. They know what is going to work for them at that time. Or if they don't know, then we work with them to keep finding something until it works for them. We are all unique in our own way. What works for one person doesn't mean it will work for another or just because someone with a master's degree or a title says that this is the solution. This is colonial thinking, and we need to break this cycle.

The North doesn't really seem to have much options. Vancouver has had an injectable diacetylmorphine or heroin for over ten years. They have TiOAT. There's fentanyl and Fentora being prescribed in a couple of different places within the province. These all need to be equally accessible and available across the entire province.

We need to recognize that street drugs are toxic. We need to access a non-medicalized safer supply for regulated drugs and a wide variety of other pharmaceutical options and alternatives. We need to look into the different methods of ingestion and take that into consideration too. We need to work with people that have lived and living experiences.

We know what needs to be addressed. We know where to start making the changes. We know how to start saving lives right now. We just need to be heard, included and engaged with everything.

We also need to start including peers within the medical system, having peers help bridge those gaps or start building mutual relationships without any judgment, stigma or discrimination. But instead, we are willing to work with each other. VANDU has been trying to access a prescriber who can prescribe hydromorphone for a MySafe vending machine. But because of all the backlash and resistance against prescribed safer supply, the prescriber we were hoping to collaborate with had to step down from things and take a leave.

This isn't the first time we've lost champion prescribers that have stepped up, knowing that this was a safer alternative to what was being used and that there were no other safer alternatives or access to a regulated, safer drug supply. So every time they prescribed safer supply, they knew they were helping save a life and preventing fatal overdose due to the toxicity and poisoning in the drugs on the streets today.

Even if the prescriptions ended up being diverted, they knew it was going to someone, but they weren't acknowledged this way from others. Instead, they were unable to do what they wanted to do. They wanted to start bringing services like iOAT, TiOAT, fentanyl, Fentora, always open to working with their clients and meeting their needs, and understood the importance of working with people with lived and living experiences and drug user groups in a safe, low-barrier environment.

[11:10 a.m.]

They didn't receive the support that they should have received. Instead, they were met with resistance and higher expectations. They were constantly challenged and having complaints made on them from others who would use their title or occupation as a hierarchy within similar fields to try and shame or discredit them.

This type of model isn't realistic. There needs to be some enforcement and support encouraging prescribed safer supply. It needs to be clear that it is okay and accessible, with autonomy with their prescriptions.

We need to fund and support non-medicalized safer supply. If we were able to operate a compassion club model, we wouldn't be able to hold enough on site to operate at 2.5 grams. Decriminalization is a great stepping stone forward, but it's exactly that. We need people with lived and living….

H. Peterson: Kat.

K. Cadieux: Yeah, am I done?

H. Peterson: I just want to let you know that that's your time for safe supply. I just want you to know. I don't want you to cut too much into your rural and remote.

K. Cadieux: Okay. I'm just blending it in with rural. It's going in there. Thank you.

If we were able to operate a compassion club model, we wouldn't be able to hold enough on site to operate at 2.5 grams. Decriminalization is a great stepping stone forward, but it's exactly just that. We need people with lived and living experience as stakeholders sitting at policy-making tables as well as in the development and implementation of programs.

I feel that if people with lived and living experiences were included in decriminalization, I believe it would have been identified that 2.5 grams is not going to be realistic for several reasons. There is no such thing as 2.5 grams for sale, to begin with. Compassion clubs won't work with such a limited amount.

For more rural remote settings, people have to travel to come buy in larger quantities so they can go back to their communities to spread it out as needed. Buying larger quantities is cheaper to buy, instead of smaller amounts. The further up north and the smaller the community, the more expensive street drugs get.

People who like to try and keep it on the down-low — they are using street drugs due to fear and stigma or consequences of losing their jobs, family and homes — need to grab larger quantities to spread out and prevent the need to go back and forth to grab their drugs.

When we get a prescription, we get enough to last us anywhere from a couple of weeks to months, but access to prescribed safer supply has barriers. Many people need to pick it up every day at the pharmacy, for daily witnesses, and because of that, most people end up leaving their homes due to barriers or costs of travelling. Many pharmacies only want to distribute the generic versions or stopped distributing entirely in Prince George, and some are still required to pay for their OAT.

When it comes to parents who want to have access to safer supply, they are now in jeopardy of losing their children. Any credibility they might have had is all of a sudden gone. You are now labelled as an addict and liability. For people who work or want to work in trades or camps, the same stigma follows. They are unable to come in to witness their medication at the pharmacy every day. There is no safe space for anyone just to go use at an OPS without fear of judgment for being seen to go there.

Access to safer supply is extremely hard. You can't go to a walk-in clinic or emergency to get OAT or safer supply. You instead get told to go to detox. Most times the ER is extremely rude. You are treated as non-emergency. Everyone else who comes in gets seen, and you are ignored until you finally just leave or you get upset and are kicked out.

If you go to the hospital emergency with a serious medical condition or in extreme pain, in most cases, you are treated as if you're just trying to drug-seek, and they won't give you any time of day. If the person is on OAT, they aren't allowed to be prescribed any type of pain meds.

There needs to be accessible, non-medicalized low-barrier access as well as pharmaceutical options widely available and covered. If there was heroin prescribed or buying models where they order in bulk, have it drug-tested, tested again and distributed as needed, on a daily basis, we would see the drug crime rates slow right down. We would see violence rates related to drug wars die, because there would be no competition. It would be covered, available and accessible, so toxic drug-dealing would eventually fade away.

People want to know what they're putting in their bodies. People have a right to know what they're putting in their bodies and that it's not a 50-50 chance that they might die from toxicity within the street drugs available today. We need to access a non-medicalized model for a safer, regulated drug supply so that people can know what they are using and putting in their bodies.

We need to be able to offer safer substances that are easily accessible and not so expensive or that are covered like medications. We need to have larger amounts, other than 2.5 grams, that can be picked up and to not have to worry if they get caught carrying a larger amount while they're on their way back home in a more rural and remote setting — that they're not going to lose everything that they've worked so hard for.

That's my little blurb.

[11:15 a.m.]

H. Peterson: That was awesome. That was super great. You're all done with both? You're good?

K. Cadieux: Yeah, I was trying to keep time.

H. Peterson: Perfect. You did amazing.

We're going to move on to Shawn now.

Shawn, are you available?

S. Wood: Basically, I'm from all around B.C. and Turtle Island. I travel a lot. I have travelled a lot in my history. Most recently I've been in Fort St. John for several years [audio interrupted] a big industrial town. We're on the Island here.

Currently I'm down in the Interior right now, and throughout the entire area in the North, I'm seeing the same thing. That's the lack of prescribers for…. Kat and a few others have said that they want to prescribe, but they are limited by either the college or the area, so to speak, that they live in.

What I see in that is a need for education and acceptance in the North. In the northeast area, we don't have any detoxes. We don't have any beds. We don't have any mental health beds. We don't have anything like that up there. The nearest place is Prince George, which is already full. For somebody like myself, who…. I did go to treatment back in 2017, because I wanted to and I needed to.

I see my daughter. I know some of us have kids and everything. I mean, this is the biggest eye-opener for me, especially being an Indigenous male and a single father. I was asked if I wanted my daughter dating a gentleman like me. I definitely wasn't a fucking gentleman at the time — sorry for my language — and I had to change. That was my catalyst, and I went and changed. For our youth, it's monkey see, monkey do. As I said, my daughter…. I had to change.

Then fighting the health authority to get in, especially up there, against Northern Health especially…. I have an education. I gave away my power for a certificate that says I'm smarter than you. The difference between a scholar and somebody that's living on the streets is one decision. That same decision can change the scales pretty quick, right?

Up there, it's like the judgment that they're facing because they're educated is…. I know pharmacies, pharmacists that have no problems. They would love to help out and meet people where they're at, then: "Here you go."

Accessing it, especially in the more remote communities….. Let's think about Burns Lake, Tache, Hazeltons, Gitsegukla — areas like that, where not only do you have the community kind of looking down the end of their noses at you, so to speak, as well as…. Yet you have to go in there every day. Now you're going to see your family. You're going to see…. There are going to be kids. There are going to be other people there. The judgment and the stigma that's going to come along with it is an extremely high barrier.

The accessibility to safer supply, as it is called…. Originally it wasn't…. You said safer supply of illicit substances to start with and it just kind of got co-opted. Over in Alberta, they got $72 million because of it. Education…. And then you send leadership up to Northern Health, specifically, that has a better idea…. "I'm here to save you." That's the Anonymous programming. We can even take a look at the Anonymous programming that needs to change with the way society looks at it.

Red Road to Wellbriety — 200 summers older than the Anonymous programs. So that education that I got…. The ideology, I feel, needs to change.

I'm getting sidetracked on this. I just need to stop talking for a second.

H. Peterson: That actually is pretty much exactly your time, Shawn, so you were perfect. Thank you so much for sharing.

We are now going to invite Lyric. Lyric, are you ready?

L. Parnham: Ready as I'm ever going to be, I guess.

My name is Lyric Parnham, and like I said before, I'm the executive director of SNOW, which is Society for Narcotic Opiate Wellness, in Dawson Creek, here in the North. We are a drug users group, so folks with lived and living experience.

[11:20 a.m.]

Everything that happens in our OPS has been the peers voice. There has been no outside authority to help us create the space that we have. The barriers we have up here in the North…. Either we have limited OPS provisions, or there are no options whatsoever. If an option is created by the health authority, the expertise of us, as peers, is not seen as legit, even though we live it 24-7. We're hustling. We're moving along. We're doing our work.

When it comes to the actual OPSs, they are needed. They are harm reduction. They are a service that saves lives daily. I mean, we have HOPPS, which are home OPSs. They're all over the place. There are supervised consumption sites. There need to be more. It was mandated, federally, that OPSs need to open, especially when we're in crisis.

We're still in crisis. We end one crisis…. We hadn't ended this crisis, but another crisis occurred, which was our COVID. We had solutions, within months, for COVID. We had vaccines. We had a plan, months into the second pandemic. For the opiate pandemic, we don't have any solutions. Conversations started, and then they petered out.

We've told folks. We've told the authorities that this is what we need, and we're still being ignored. In the North, we have limited resources. We have limited money. We have limited personnel. We have a lack, even, of community support. Education needs to happen, and knowledge exchanges need to happen. We just need to be heard.

Peers show up all the time. We are at any table that we can be invited at, but that's the thing there. We aren't invited to tables. We are the experts on what we do. I mean, I know you folks have heard that over and over again, but we need to be heard. We keep coming; we keep showing. We keep losing friends, families, family members, our brothers, our sisters, and it isn't getting any better. Like I said, we're six years into this pandemic. We're a little bit ahead, but we could be so much further ahead.

We need to work with our communities. When it comes to municipal interaction, there is no action. There's a lack of action. They blanket rules on us. It's a blanket rule for anything. Whether it's a nail salon, a Subway shop or a bank, the rules are blanketed all across. I mean, they create regulations, bylaws and zoning bylaws. It's barrier after barrier.

All we're trying to do is save people's lives. It just seems that higher authorities are just saying no. We need to fill out this documentation and see where we fit in the files: "How does this problem fit into the system itself?" Well, I think saving lives fits anywhere.

As I said, the thinking — all the paperwork, rules, regulations and zoning — is a colonialist way of thinking. There's no compassion. There's no love. There's no caring in the community. We need that. We're human beings. At the end of the day, we're human beings trying to save human beings' lives.

When kids were getting hurt on bicycles because they didn't have a helmet, we said: "Okay, we need to make a helmet law." Or a seatbelt — stuff like that. Yeah, it happens: "Okay, we're going to fix it. Let's create the rule. Let's create the law. Let's have that conversation." The next thing you know, it's implemented.

We've been talking about this forever, and nothing is moving forward. People are still dying. We're still suffering in silence, with stigma, in shame. It shouldn't be like that. We need to continue on. Like I said prior, we need to be at these tables. You can't do anything about us without us. Why talk about us when you really don't know? We are the experts. We should be at all the tables.

In Dawson Creek, we had a shelter being put up. They had a subcommittee, and there were no peers on the subcommittee. They were just like: "Well, we think we need this. We think we need that." Where are the people that are living on the street or have lived on the street? Where is that information? It's not happening.

[11:25 a.m.]

The shelter, another shelter for the Nawican, was built. They moved forward in Dawson Creek, and they opened up an OPS. I went and vetted it, and it was the most stigmatizing place you could ever go to, because it was created without the view or information from the peers.

I don't know how many more lives it's going to have to take. I don't know how many more of these conversations…. These peers and my fellow colleagues here have been sitting at table after table, year after year. How much more time? How much longer is it going to take before something, real action, is done?

H. Peterson: Thank you, Lyric. We're right at time for you. That was perfect, what you said.

To reiterate, too, I just really don't understand, when we have a deep understanding that stigma still informs so much of this dialogue, why there's no oversight. Why are we still seeing…? Why is it allowed that municipal governments are making bylaws that prevent life-saving services? Why isn't the provincial government stepping in when health authorities are failing us and our community's being decimated? There's so little oversight, despite the creation of a ministry that was supposed to have oversight.

I think Lyric really nailed it — that there's barrier after barrier, while we bury our loved ones.

Thank you so much, Lyric.

Next we have Billy.

Billy, if you are ready and available, it is your time to shine, my friend.

B. Morrison: Hello. My given name is William Morrison. My family name is [Nisg̱a'a was spoken], translated to "protector of the dark water." My spirit name is [Nisg̱a'a was spoken], "black thunderbird man." I am a person with lived experience. I live and work on the homelands of my ancestors in the Nisg̱a'a Nation. I'm the newest member of PEEP, and I represent the northernmost region of British Columbia.

Here on the north coast, we have four small hub cities, Prince Rupert, Terrace, Kitimat and Smithers, surrounded by 25 Indigenous communities made up of seven tribes: the Wet'suwet'en, Gitxsan, Tahltan, Haisla, Tsimshian, Haida, and my people of the Nisa'a Nation. Every single community is currently feeling the effects of our failing war on drugs and addiction.

There was a time during colonization when tribes first started to encounter addiction in the form of dangerous alcohol consumption. It was believed that this liquid contained a spirit. When the spirit entered your body, it took the place of the spirit gifted to you by our Creator. Our people also believed that our community members who carried this spirit of addiction were carrying it for the rest of the community, and they were held on high and highly respected and looked after by everyone within the community circle.

Fast-forward to present day and the rule in Indigenous communities of the north coast, and that love and respect is a thing of the past. We have Elders, adults and young people dying from dangerous alcohol consumption, and it is being labelled as "natural causes" — either at home alone, within their community, or on the streets of their nearest municipality — because they feel more welcome living within a community of other stigmatized individuals and would rather risk life on the streets than face the shame and hate that they feel from the community that they once called home.

In the North, there are little to no alternatives for the unregulated street drug market. Safe supply is not even a conversation that is being had, even with legalization coming soon. When you speak about safe supply or even harm reduction efforts, you are speaking a foreign language to most of our policy-makers.

The very few who are trying to create space for these important conversations are silenced by the masses, just like the people with lived and living experience that they are trying to represent. It is only within the last few months that the hub towns of our region have seen some changes begin to happen.

[11:30 a.m.]

There are now four organizations — one in Prince Rupert that I know of, and one in Kitimat — who have hired outreach workers. Unfortunately, there has been no movement in Smithers yet that I know of.

Only two of these organizations have hired actual peer workers to do their outreach, one being Kermode Friendship Society and the other being Ksan House, both located in Terrace. There are a total of 24 Indigenous communities within this area, and only two are providing outreach to their people who are living out of their pain on the streets.

These communities are Gitaus, a small reservation on the outskirts of Terrace, and my nation, the Nisga'a Nation. We have societies within Terrace and Prince Rupert that have both hired outreach workers, but currently the only services being provided are wellness checks and trying to help find detox and/or treatment. So basically, if you are not ready to let go, you are not yet worthy of our help.

At the same time, the city of Terrace has hired and retitled bylaw officers as safety officers, to keep our communities and our people living on the streets safe. Meanwhile, these safety officers are harassing, taking tents and giving litter, open alcohol and open consumption fines that start at $120 and go upwards of $400, forcing our vulnerable people up into the hills and woods, where they're being attacked, robbed and, in some cases, almost killed by other people living on the streets.

When they reach out for RCMP assistance, they are further demoralized or simply told: "Maybe you should just go back home." There's a lot of work to be done here in the northern regions of British Columbia, starting with some peer-led sensitivity training for our public servants and health officials. We need more emergency beds for our community members living in stigma. Terrace, our biggest hub, only has 25 beds in our damp shelter.

The other two shelters will not accept you if they feel you have been using alcohol or drugs within the past 24 hours. Our homeless crisis is actually a lack of affordable and adequate housing. People are paying $1,500 a month for a one-bedroom dilapidated apartment.

Young parents are giving up, turning to a life on the streets because, even with a job, they can barely survive in the current economy of the North. We have children losing their parents because they feel they can't adequately take care of them, leaving our young people feeling alone and unloved and starting this vicious cycle for them all over again.

Right now our loved ones are dying at an alarming rate. Within the past two years, I myself have lost eight family members and close friends to this failing war on drugs and to the lack of empathy within communities and city councils. The streets are flooded with toxic drugs, and it feels like nobody cares.

I feel the real crisis we are facing is the stigma that follows our community members living in addiction. I myself was hired by our health authority because of life experience that I carry from overcoming my own addictions and my time on the streets. But even with that, in my contract, it states that I need to be living a lifestyle that reflects wellness and I am not to be using alcohol and drugs. And if it can be proven that I am, I could lose my job.

This is how little empathy we have for our people who are living in pain in our region, and it needs to change.

T’ooyaḵsiy̓ n̓isim̓. Thank you for listening.

[11:35 a.m.]

J. McDougall: That was amazing, Billy. Thank you.

H. Peterson: Thank you so much, Billy.

We are returning to Jess to speak.

J. Lamb: Thank you, Billy, for that.

I'm talking about decriminalization under the rural-specific needs. I'm not going to take up too much time, because the two previous speakers have touched on the issues well enough, I think.

People who are living in rural and remote locations are with this decriminalization. It just goes to show, again…. There was a group of people with lived and living experience who were a part of the discussions, I believe, for decriminalization. They were coming back with a higher number than the 2.5, but Health Canada said that they weren't even going to have these conversations unless it was 2.5, which just goes to show that even the people who are the experts in this are not being listened to. This 2.5-gram threshold is just not going to work for a lot of people and puts us at the heightened risk of criminalization.

It was touched on that in these rural and remote communities, oftentimes we have to venture out of town to go get our substance. We're picking up larger amounts because we're not just picking up for ourselves, but we're picking up for our friends as well.

We've got people who work out of town. Usually when you're working out of town and remotely, you're picking up more substances. So just this 2.5 is really built to protect the weekend warrior, the person who's just using a tiny amount. It's not to protect the people who are actually using substances. I'm just going to leave it at that, because I think the others went over the rural and remote needs pretty eloquently.

H. Peterson: Thanks, Jessica.

Next we have Jenny.

PEER-LED SYSTEM NAVIGATION

J. McDougall: Hi, everybody. I'm going to just say one sentence about what everybody was just talking about. I just wanted to echo what people are saying about the rural remotes and the lack of supports that we're getting here. I have six people, all who have had major bone infections. One of them already lost 1½ legs. Somebody else is on the list to get surgery to get his amputated. These people have been turned away time and time again, with doctors saying: "Oh, we don't know what's wrong." Us advocates are saying: "It's a bone infection. Please check for a bone infection."

The last person in there was kept in the hallway of our hospital. She was in full withdrawal. She had sepsis arthritis in her leg. Her leg was three times the size, and she was kept in a hall because they needed the room for someone else. We don't have any beds for our detox or for a mental health crisis stay. I was told: "Oh, yeah, we have other rooms for them." But then my friend ended up in the hospital in the hallway, so I don't believe that. I'll just let that go at that.

What I'm speaking about today is the program that I do in Quesnel, under CSUN and in partnership with Northern Health. I am the peer advocate for the peer prescription alternative and peer advocacy program. What I do on a daily basis is, first, I start with going out and doing outreach in community. This is how I started. I got the intake forms. I did the majority of the intake forms outside with people. Then I book them an appointment.

Because I did those forms, we didn't have to do a full intake appointment, so they could come in the day of their actual appointment to get their scrip. The nurse could see them briefly, finish up their blood pressure and a little bit on the forms that I couldn't do. Then they go right in to see the doctor to get the prescription.

We have an amazing prescriber here. He's not from Northern Health. He's from Interior. Thank God he was willing to come up and help save lives in our community, because nobody else was willing. We have a doctor also coming from Prince George one day a week, and she's also helping to save lives. That's what this is. There's no beating around the bush. It's either you want to save lives or you don't give a shit about whose lives are being saved. There's no middle ground.

[11:40 a.m.]

We are allowed and encouraged to be having these medications. They are saving lives. I can testify to that. I have about 50 people that I see on and off on a regular basis. I also do the medication deliveries every day to our shelter, to the supportive housing building, to homes and to people living on the streets.

When I do these deliveries, people are maintaining on these medications. The only ones who aren't are those who are in entrenched addiction of fentanyl and benzos, who can't get the medications here that they're actually allowed to have, such as fentanyl patches, Fentora, Desoxyn and morphine — the meds that other places are getting a little bit. Nobody in the north is getting this.

We have been left behind in this area with very unprogressive policies up here, both with municipalities and within our health authority leadership. We also have allies who are fighting towards things like this, which I'm very grateful for.

This program has done so many wonderful things for people. People come into our clinic. We have two OPS booths in the clinic now. So when they're waiting, they don't have to go and use outside in public. They don't have to take up the bathroom space. They can go use safely. If there's a wait, or after they're done, there's a clothing donation room. We have a table with snacks and drinks. They encourage people to come and hang out there after hours if they don't have a place to go. There's a roof over top of the ramp, and they let them sleep there so that they're sheltered from the elements.

That's what we have to do here because there are only 25 beds for our whole city. Actually, 15 are funded for until winter, and then there's an extra ten. Needless to say, the majority of our entrenched populations — including seniors and youth — are sleeping outside even in the winter. We don't get emergency cold weather shelter beds outside of that 25. We don't even get the cooling centres in the summer in extreme heat, unless it's in an area where nobody can walk to.

The program. I'm going to just tell you a couple of successes that I've had. I have people that are now allowed to live back with their families, and they haven't been allowed in those family homes in ten years. They still use sometimes, but they don't have to, so they're not stealing off their family members. They're not in full withdrawal in front of other children or people who are in recovery in their families. They're able to sleep and eat meals with their family members and engage and play with their younger brother and sister and their children.

People are able to make their MCFD visits if they have children in care and not be dope sick but not be out of it either. They can take their meds and go and do their responsibilities that they need to do. And they are.

We have people now working. We have two clean teams here and two peer-run organizations who employ peers. There are many, many entrenched populations who are working in our community.

We still can't afford housing. Like Billy said, the housing that we get here…. They're dilapidated, mildewy places that can't even be rented out as a hotel room anymore because of the condition they're in, and that's what we get for affordable housing. People have been sent to the hospital because of the deer mice feces. They ended up with diseases, breathing issues, and they ended up in the hospital. This is what we have for people to live in.

I'll tell you that many of the people on these medications ended up in stable housing. I can tell you myself. I was on the heroin program in Vancouver when I was on the streets there many, many years ago. I can't remember the name of it, but within a month, I was in housing. I wasn't selling myself on the streets. I wasn't getting rocks thrown at me while I was standing out there by people driving by. Nobody was throwing Slurpees at me. Nobody was shooting me with pellet guns. I was not being ridiculed and shamed every time I stepped outside. So I didn't hate myself as much.

Once I got on that program, I didn't have to do those things anymore. I didn't have to do crime. I was able to stay at home and manage my housing. I didn't have to let a dealer move in and sell out of it, and all that traffic gets me kicked out. I didn't have to do any of that. This is what we need to save lives. This is what we need for our housing crisis. We need these programs. Yes, we need the funding.

Thank God…. I did this for no money for about the first eight months, and then FNHA realized how wonderful this was doing for their communities as well. They started funding me, and then Northern Health stepped up, and they funded it too.

[11:45 a.m.]

Not only do I help our peers, but I also build relationships with the health care staff, myself, and the peers that are coming in, so they're accessing other services, not just our methadone and safe supply clinic. Now I can take people to urgent primary care, to detox, to treatment, to emergency. They're willing to do these things now, because they're being treated better.

Again, we have to be with them, because when they do go to ER here alone, they're not helped — or very seldom, unless you have, by fluke, a really good doctor on.

I'm just saying that this program has so many successes, and it could be even more successful if people were getting the medications that are actually available to them. The Dilaudids are not cutting it. People still have to go use, on top of them. They're not strong enough. It's the same with methadone.

Methadone saved my life, but I was addicted to heroin. It is a way different thing when you're addicted to fentanyl with the benzos mixed in. I have never seen a withdrawal like the benzo withdrawals I've seen with my son, and it wasn't taking. He was projectile-puking everywhere. He was crying. He's 30 years old. I've never seen this before.

It's the same with the peers that I help. People are not just suffering in withdrawal. They're suffering from infections, from losing limbs, from being outside and being raped and beaten, from going and having to sell themselves and getting bad dates and being murdered. How many missing people do we have? This is because of these policies and these laws that are keeping us out there, suffering.

Peers can only do so much. We need your partnership. We need doctors, we need MLAs, and we need the government to step up and listen to us. We know what works. I'm seeing what's working with my own eyes, and so are the other health care staff that live here. So are our community partners. There's so much help that people with lived experience are available to do and want to do. We just need support to do it.

We need our health authorities not to fight the doctors that are willing to do this. It's discouraging. They want to save lives. We need to allow them to do so. We need to realize that we are human beings. We don't deserve to be treated like shit just because we ingest a substance. Everybody ingests a substance. Ours just is illegal right now.

Please help us. Please listen to us all today. We are begging for your help.

H. Peterson: Thank you so much, Jenny. That was really passionate. Thank you for sharing from your heart. That's really beautiful.

Laura, you're up next. Are you able to speak right now?

I know Laura was out and about, working and giving meds and stuff.

L. Shaver: Okay, I'm available.

Hi. My name is Laura Shaver. I am a person with living and lived experience. I am the president of the British Columbia Association of People on Opioid Maintenance and a 13-year board member of the Vancouver Area Network of Drug Users, as well as a paid peer advocacy navigator for the iOAT program, which has actually almost turned out to be an outreach program. I have to tell you that Jenny was speaking to you about the successes, and unfortunately, I am speaking about the failures. I have been working as a peer navigator now for a while.

I've been on an opiate replacement for 23 years, and it has taken me this long to finally get onto something, since the Methadose change, that is working for me — which is the patch program. But I had to end up in the hospital for that first, and I'm the person that is the one who is supposed to be able to direct and take people to these places to get these services. Yes, Vancouver has a variety of services, way more than everybody else, and I am so thankful for them, but it seems like it's if you know somebody, you can get it, and if you don't, you don't.

I need you guys to get off the fence and stand on your own two feet instead of ours. These programs…. You bring us to these meetings to listen to us. But why? If you're not going to implement our policies, it doesn't work. Every clinic, every pharmacy, can do whatever thing they want to. They don't have to put…. They do not have to offer any of the safe supply programs. They don't have to offer any of the opiate replacement plans if they don't want to. That's unfair.

[11:50 a.m.]

We know that, for sure, there are going to be 3,000 people that are part of your families and friends, as well, that will die by the time the decrim is brought in, if we're reading the numbers that are read now. We have all the evidence-based research already. We need no more. We've shown it. We've shown you the programs in Vancouver that work, but they're not accessible to people. If they're not accessible to people, then they're useless.

I am very thankful that I've been able to have this opportunity to speak with you and have all of this group of amazing comrades to come and speak to you — to speak to you of the truth that you are sentencing us to death, including myself.

You know, I have been in transit this whole time because I have to go from one place to another to have my patches applied because the pharmacies aren't even covered for the supplies to put my patches on. And because I am no longer an injector, I can't be at the first place that prescribed me my patches, and because I am clean from injecting and do not want to be in an injection service, I need to go to someplace where I need to cover the supplies for the safe supply that "you offer us."

There are people dying. The people in rural communities don't even have….They have none of some of these programs. I don't understand why people seem to think that…. Why does Vancouver have more important drug users than anyone anywhere else? We're not. We bleed the same colour as you do, as they do, and the programs need to be there.

I don't understand what we're waiting for. You have this meeting with us. Does that mean it's because you're implementing what we're giving to you? Like somebody said at the beginning, are you looking at other things while this is on? Or have you got us on full screen?

H. Peterson: Sorry, Laura. We're just running a little bit short on time. Are you okay if we move on?

L. Shaver: I am. Just please, please, these programs need to be implemented. We've been working so hard. We work just the same hard as you do. We work hours overtime, undertime.

Okay. Thank you for the option to do this. I'm going to be doing double, because I have a client to help right now as well. So sorry, and thank you.

H. Peterson: Thank you, Laura. That was perfect.

I know we are getting very close to the 12 o'clock Q-and-A period. We are almost done. We just have two more speakers that have a very small allotted amount of time here, so I'm hoping that we can cut into the Q and A a little bit.

Next up we have Tanis.

FUNDING OF PEER-LED WORK

T. Oldenburger: Hi, everybody. Thanks, everybody, for sharing. It's been a really powerful morning so far.

My next topic here is about the funding — the granting cycles, the funding pools available for our organizations. Basically, funding for initiatives, programs and organizations that are by and for people who use drugs is incredibly unstable, and this level of uncertainty has always plagued our demographic.

This kind of uncertainty actually creates debilitating trauma responses in our people who are trying to do this work. Financial and job instability can bring up things such as housing instability and food insecurity. It's an awful feeling, now that we have finally found careers and community within these organizations, to not know whether these careers have any longevity.

Our organizations do not just create jobs for ourselves and our peers, but our very existence and success battles stigma by furthering the voices and stories of people who use drugs and doing for ourselves what the government and other service providers have failed to accomplish. We create non-judgmental and low-barrier places for peers to not only find successful mentorship and work experience but also find personal safety, security and support to just be.

Funding instability causes job instability for those of us who have found careers within these organizations, but moreover, it causes program instability for those who we serve. For example, at Mountainside, we run a cell phone program. We've distributed over 200 cell phones to street-entrenched individuals across the province. These phones provide overdose prevention and reconnection with loved ones as well as a safety barrier for those engaged in sex work or for folks simply trying to catch a cab.

[11:55 a.m.]

The funding instability for this program puts us in a precarious position. We would like to be able to promise stability and consistency for our loyal participants, but at this time, it's just month-to-month uncertainty. We never really know when that rolling funding will disappear and everyone's phones will be disconnected. I will add that when speaking to funders as well as other long-standing community organizations and non-profits, they believe that this program of ours is actually quite radical.

So why do our programs have to be risky and radical for them to be effective? When will our programs be supported to find longevity and success like many other programs available in community? When will we be securely supported to continue to save lives and create massive impacts in our communities?

Programs and organizations which are led by people with lived and living experience have proven themselves incredibly effective not only at preventing overdoses but creating positive change in the lives of individuals that we serve through non-judgmental understanding that is unparalleled by service providers who do not bring experiential expertise to their respective positions.

Why do we face increasing levels of financial uncertainty while numerous other organizations in the province thrive? Because of stigma against people who use drugs? Because this stigma says that people who use drugs make poor leaders or poor employees?

We deserve better. Those of us who do this work for personal reasons are not just in this for a paycheque. This is our entire lives, and we should be supported more adequately and better recognized in this community as capable, thriving partners.

At this time, the main line of funding for our peer-led organization comes from the overdose emergency response centre's provincial peer networking grants. In the last few years, the number of groups accessing core funding from this pool has literally quadrupled, yet the actual funding pool has stayed the same. This has created an increase in competition amongst groups and even left some major organizations without funding this calendar year. This is unacceptable, and our municipal, provincial and federal leadership must do better for us and for people who use drugs.

This crisis will not end without implementing these policy and procedural changes which we have discussed in great detail today. The colossal numbers of lost loved ones will continue to grow if you do not listen to us, the experts, and our factual recommendations that we will continue to draw attention to and support for until we see an end to the suffering of our people and the loss of our colleagues and loved ones.

If all or one of our messages gets heard today, let it be this one. Three weeks ago our PWLLE committee at the BCCSU lost a treasure and long-standing member, colleague and friend. She was taken off of life support on Sunday, August 14, by family members, after a traumatic brain injury due to toxic, unregulated supply. This is someone who had every resource and support at her fingertips. An expert and leader in her community, she would have been here speaking her experience alongside us today.

We miss you, Paige. Your brilliant smile and caring energy in these rooms is irreplaceable. Paige Phillips, her loved ones and, most importantly, her two young daughters deserve better.

Paige has been added to the end of my quiet prayer when I share a moment of silence with my friends and colleagues: Ryan, Adrian, Natasha, Maddie, Alyssa, Matt, Kaia and now Paige. I'll just ask now, before the final person shares, that at the end of our presentation, Laura from VANDU and BCAPOM guide the call in a moment of silence and mindful reflection on the 10,000-plus lives lost in B.C. due to outdated, ineffective, racist, colonist, fascist and harmful controlled substance policies.

H. Peterson: Now I'm crying. Yeah, thank you for honouring Paige. I'm really missing her today. She would have been here, for sure.

Kali, you're up to speak last. I know you're working right now and actively supporting people. Are you available?

K. Sedgemore: Yes, I am.

H. Peterson: Right on. Thanks, Kali.

K. Sedgemore: I've locked the door, so I'm good.

Peer funding is scarce for drug-user groups, and it's really frustrating. How are drug user groups supposed to have programming that lasts, that can run at full capacity? A lot of time we're running at half capacity due to the fact that our funding can run out at the end of the month or whatever. We don't know what our funding is going to be the next month, so we're running at half capacity and not able to pay — going month to month and not knowing if we're going to get moneys. We're playing the waiting game, because usually we're let know at last minute that we're getting funding for the next month.

We're also using scarce resources due to the fact that supplies…. You need to preserve supplies just be able to run for the next few months if you do not get funding. That's really not how programming should be running. Programming should be running at full capacity without using scarce supplies and stuff like that or even having to close down earlier or close down for a few days of the week just because you don't know if you're going to get the funding the next month.

[12:00 p.m.]

A lot of drug user groups are running on a month-to-month basis, where they're not knowing if they're going to get the funding next month or if funding is going to even come in, which is really frustrating for a lot of us. It means that we are running at lower capacity. We're trying to preserve funding just in case we do get shut down or we don't make the funding the next month. We're having to save some funding in order to get that done.

When it comes to granting processes and stuff like that, people are making decisions for us, for the drug user groups. It really needs to be with drug users. It can't be just two people sitting behind a table that never experienced drug use or who have never felt…. If they've had family members that are drug users too, it's still not the same. We need people that are actually drug users at the table, just to make sure that the granting process gets done ethically and fairly, because drug users know what they need, and drug users understand the needs of drug user groups.

A lot of times, a lot of drug user groups can't plan long-term things. They can't plan unless they see that it's going to be long-term funding, especially when you're hiring peers and stuff like that. It's really inadequate to be funding these programs month to month instead of funding them for longer terms. Everything needs to be…. It seems like we're not knowing about our funding until the last minute, which would be a week before the end of the month or something. We're still having to wait for the funds to be deposited or wait for a cheque, and it's really frustrating.

A lot of the time, these people that are doing granting and stuff don't think that we have the ability or the skills or the education to understand the paperwork, or anything like that, when it comes to granting. Drug users, apparently, don't have the capacity.

We definitely do. We learn things. We know how to do things properly. We know how to do things. We learn through education, just through ourselves but through other people too. We all learn from each other It's one big thing that drug user groups really lean on — each other. Just because we use drugs doesn't mean…. Our capacity and our ability to do grants and stuff like that isn't hindered, because we definitely can. We learn.

I can't remember what else I was going to say about that. We just need more funding that can be offset, where we can do long-term funding so we are able to run our OPSs and stuff like that without having to run them at low capacity.

Also just giving people the option, when we have traumatic situations happen, like if we have a death or something like that, that we're able to take time off instead of us just grinding our gears and getting on with the day after we have a death. It's really frustrating that we don't get the same opportunities as other people to take time off.

A lot of times, peers are stuck in the roles of needing to continue on. Even if a situation comes in hand that's really difficult to deal with, we just kind of have to dig in our boots and just go on with the day. A lot of us will do that, but we need the capacity to be able to take time off and the capacity to just reflect on this moment, instead of just grinding our gears and digging in our heels to deal with situations like that.

We are losing people at a fast rate, and it's starting to be really hard on a lot of us. But we want to be out there to save lives. We want to be out there to keep our people alive. The funding is just not.

H. Peterson: Thank you, Kali. That really nails it.

That's all our presenters. I really want to thank them all for sharing. People brought their raw hearts and souls to this conversation, which is completely necessary. Believe it or not, we are often fired or not included at tables because of this raw emotion, which I think is ludicrous, since we're just here trying to live and survive while facing the imminent risk of death and the loss of our loved ones on a daily basis. Yet we get sort of frowned upon if our emotions slip out.

But that's the truth that you're seeing. That's the real truth of what this is like for us, living in an environment where our lives are considered lesser than to a degree that are deaths are actually tolerable.

Thank you so much to everyone for coming and presenting and sharing your truths and trying desperately to create change and to save the lives of the people we love.

I'm wondering now if there are any questions from the committee that people can address.

[12:05 p.m.]

N. Sharma (Chair): Thank you all. I just want to say, on behalf of the committee, how grateful we are to all of you for sharing your experience. We were all very engaged, and we know this is an important part of our work — to hear directly from you with lived and living experience about what you're seeing on the ground.

I wonder if we could, as Tanis suggested, have a moment of silence all together right now before we go into questions, just to honour and respect all of the lives that were lost. Then I will go on to taking people's questions.

I ask that everybody have that moment now.

T. Oldenburger: It's a tradition that Laura from VANDU will guide us in a few words.

L. Shaver: It's a tradition here at VANDU, and for all the drug user groups and the poor and stigmatized people, that we have a moment of silence at the end of our meetings to remember those we've lost to the drug war, to the stigmatization of the work that we do. If there are any dedications, right now would be the time.

Chelsea, Dana, Charlie, Cind, Melissa, Dave, Les. This moment of silence is for them and anybody we may have missed.

[The committee observed a moment of silence.]

L. Shaver: All my relations.

Thank you for that.

Thank you, Tanis. That means a lot.

N. Sharma (Chair): Thanks, Laura and Tanis.

I'm just going to take questions from the committee in the order that I see the hands go up.

Pam, go ahead.

P. Alexis: Thank you so much. Very important that we do hear from you. Often we hear — you're absolutely right — from those experts and not from those with lived experience. So I really appreciate your honesty and taking the time to share with us.

I have a question for you. There was a comment, I believe, when you were talking about decriminalization and interim measures that might work while we're waiting for that policy to come into effect. If we could just touch on that for a moment. We did hear from the representative from the chiefs of police officers to say that they're not really arresting folks, at this point, for low amounts that people are carrying. I just want to make sure that's the same message that we're hearing from you.

Is there more, as far as interim measures prior to this policy coming into effect, that you could comment on? I'm not sure who would be best, so I will leave it in your hands to determine who's best to speak to this.

J. McDougall: Can I just say something real quick? That might be the case in some of the cities, but in rural communities, that is not the case at all.

I don't believe that this 2.5 grams will change that. It will give them more of a reason to stop and make sure we're not having more than that on us. I don't think they will even give it back, even if it is the same weight. I think they'll just take it or ruin it or go use it themselves.

L. Shaver: I believe the same thing. I believe that now we've just given them the opportunity to stop us at any time, no matter what. Anybody they see or think may use drugs, they'll be able to stop them and strip them down to see if they're carrying the right amount. We need choices, and it's something. But I also believe that it's going to be damaging in some ways to some people.

H. Peterson: Also, I just wanted to point out that while decrim has the potential for long-term effects to save lives and will affect the amount of stigma that we're living in, it's not actually overdose prevention.

An immediate response to overdose prevention looks like real, actual safe supply — not replacement therapy or safer supply, but the actual access to the drugs people are really using that is a regulated supply. That's the real…. If we're looking at interim measures, I'm hoping that's what's on the table — the actual, real concrete measures to save lives immediately.

K. Cadieux: I can answer that question quite honestly. Just last week I had somebody who was released from jail who was arrested for less than half a point of heroin and has court coming up.

[12:10 p.m.]

I actually brought up that it will be interesting to see if all of these charges of minute amounts get waived or dropped or taken off their record or if they're going to do something similar like they did with the marijuana. I know for a fact people are still being arrested for small amounts.

T. Oldenburger: Yeah. That's really interesting that he said that they're not really arresting people for small amounts right now. Maybe that is true in some communities.

My biggest problem with this sort of 2½ threshold is that this is a supply chain issue. It's not an issue of people carrying around two grams or three grams or five grams, walking down the street. This is a supply chain issue, and suppliers have kilograms and kilograms of stuff.

My thing, in the terms now that the safe supply, if you guys heard my version of safe supply…. The only time that my safe supply is not available for me to function and work hard and run this organization and network with my community is when the police interfere with that. And that's not arresting people for small amounts. That's interfering with the supply chain. And the supply chain issue affects entire communities and multiple communities. The supply chain that I'm referring to does affect multiple communities.

That's a huge issue, and that's not going to be addressed with this new, temporary 2½ measure. And if this is what we're calling this, the toxic drug supply crisis, it needs to be addressed at the supply. And how do we protect those conscientious suppliers who are running, basically, compassion clubs for people and working hard and handing out harm reduction and providing peer support and driving around handing out water bottles during the heat? All these things are being done by drug dealers.

I'll just leave it there.

H. Peterson: It's that myth of the big, bad drug dealer that really keeps us just taking in a toxic supply. I think that people have this idea that there's this dark entity in the alleys, but truthfully, people that are selling drugs are just usually other drug users or, you know, people within the community. And targeting people for having more than what is perceived to be a usable amount is just one more way of criminalizing the drug user community and ensuring that our supply stays toxic, exactly like Tanis just said.

I'm not sure if we even answered you or if we went off on a tangent there. But, yeah, interim measures –– I'm not really sure who spoke to that earlier.

N. Sharma (Chair): Fred, did you want to say something? I see your hand.

F. Cameron: Yeah, really quickly. I just wanted to say you don't have to prosecute to criminalize a person. The decriminalization framework is pretty much set up to help people that are in stable housing. The people who are on the street, the low-hanging fruit, are being picked off left and right. Bylaw and police are still going and disrupting the lives of people at street level.

Like we saw with cannabis, legalization took some time. It's a totally different image when you think of somebody smoking a joint now than back in the '90s, when they were running from police and the paranoia and everything. The psychological damage comes from the criminalization.

So until police are going to stand down and allow people to get better and a community to grow, decrim is not a solution. It's just the starting point of conversation.

N. Sharma (Chair): Anybody else want to weigh in on the first question before I go on?

J. McDougall: Can I just say something real quick? I just wanted to mention….

L. Shaver: I'm sorry. I've got to go. Jenny, you're perfect to take over any question that anyone would have directed towards me or what things are happening in Vancouver. Thank you for the time, guys.

N. Sharma (Chair): Thanks, Laura.

J. McDougall: Thanks, Laura.

I wanted to mention quickly that if people were housed and had services that worked for them, we wouldn't have people using outside in our downtown business districts. We wouldn't be seeing that. And I know that's what a lot of people don't want to see and why they fight against drug reform, against the evidence-based things that we would like to see happen. But I don't believe that would be happening anywhere near the amount it is right now if we didn't have to do the things we had to do to get our medication, our drugs.

[12:15 p.m.]

You know what I mean? Like, if we didn't have to do crime, if we didn't have to let dealers move in –– so we would be able to not be sick –– and take over our places and stuff like that…. If that wasn't happening, people would not be outside. If we had our needs met, they would not be outside.

N. Sharma (Chair): Thanks, Jenny.

I think I'm going to move on to the next question, unless anybody else wants to give their perspective.

Okay. Go ahead, Mike.

M. Starchuk: Thank you, Niki.

Thank you to all the presenters. You're driving the message home very well.

I have one question.

Tanis, I think you had started talking about the overdose response funding.

I believe Kali talked about funding models that were month to month. There were also comments that it's created competition. I want to know whether or not that's creating competition in a good way, a negative way. Or is it just less money to go around?

S. Wood: A very negative way.

K. Cadieux: All of the above.

T. Oldenburger: Yeah. Like Kat said, all of the above.

Basically, the core operating funds that were proposed by the OERC three years ago were $3 million over three years. In the first year of that funding cycle, or three funding cycles, there were about seven groups that were pulling core funding from that $1 million. Over the second and third years, that number has grown to over 30 groups. In this last calendar year, there were over 30 groups applying for that $1 million, which actually left some of the more prominent alumni groups, for this granting cycle, unfunded by this core money and having to go elsewhere.

It's been quite wild. Even through that three years, there have been some bumps and bruises and mistakes made. I will say that the OERC has done some work this year to address some of these concerns or, at least, discussed some of these concerns with a lot of us. There's been a lot of engagement around what this fourth year is going to look like, but it's complete uncertainty at this time.

Like I said, $3 million over three years. The end of that three years is in December. So we're all in this third year, not sure what's going on. A lot of us have smaller funding sources, like micro grants and stuff like that, that we're all kind of surfing on right now and unsure what this fourth year is going to look like.

H. Peterson: I'd like to add something, too, if it's okay.

N. Sharma (Chair): Please go ahead.

H. Peterson: I feel like we've been researched to death, so I hate to bring up research. Drug user groups…. We don't really have a lot of research going to show, but anecdotally, what we find on the ground and share, since we have such a cohesive network and we can engage, is….

In drug user spaces, we're not just seeing less deaths. We're seeing less overdoses. We're seeing wound treatment, which isn't happening elsewhere. We're seeing remarkable stories of people thriving, and well-being, that really just aren't being…. These stories and this reality just aren't making it back to you guys. It's just not affecting the funding that we're seeing.

If we're talking about really making a difference here…. That's not really happening based on the reality we're living on the ground. The drug user spaces are really leading the way here in the overdose crisis, and that's not what we see. We see us fighting for scraps and our community being harmed by unnecessary conflict and competition.

If there was research, I swear it would be showing that the funding should be a priority to the spaces where lives are really being saved the most, and that's within our communities and our spaces.

N. Sharma (Chair): I see Fred and Jess with their hands up.

Fred, why don't you go first?

Then we'll go to Jess.

F. Cameron: Yeah. I just wanted to say…. First off, I think the funding should go directly to the drug user groups.

SOLID, as one of the highest funded groups in the province…. Almost 100 percent of our funding is attached to programming coming from the health authority.

The actual biggest value-add, I think, that we give to the community is the support that we have around our staff. We bring people in from street level as volunteers. We brought the vast majority of them into market rent housing. They're working full time. They're on safe supply. They're able to get access to the wraparound services.

[12:20 p.m.]

There's no funding for that. We absolutely have to make things happen on the fly, and we operate in complete chaos. Having that funding that's not attached to anything would allow us to add supports within our system.

What we see with the overdose numbers for people that are working with us compared to people on the street are…. It's just impossible to deny if you look at the benefits of having the wraparound supports within our team. That funding doesn't exist unless it's independent from the health authority and universities.

J. Lamb: I just wanted to touch on the big impact when this funding is unstable for us or we don't know. I hope not to take up too much time. We're one of the drug user groups, the East Kootenay Network of People Who Use Drugs, who has been…. We're one of the newer groups, and we've only been around for a couple of years. But in that time….

The best thing about these drug user groups is the sense of community and space that we give people who are the most marginalized in the community. It's been so amazing to watch. We do drug user meetings, right? It was just a couple of people showing up. Throughout the three years…. We're at a point where we have about 80 people. That's huge for Cranbrook and these small communities, where stigma is so rampant that it is killing people.

To bring those people in, to give them a place where they can find the sense of community and well-being and come out and get involved in their lives…. It's capacity-building, getting connected to jobs and all of this stuff, and empowering people to really know that we're not the scum of society because we use drugs.

The impact of not knowing where that funding is coming from…. That's who this is affecting the most — those people who are coming and connecting with us every single day, those lives. I just really wanted to…. When we don't know if we have or what we can do the next month….

We're trying to move forward with an OPS. We've been told we're not going to get safe supply in our community from the health authority until we have the infrastructure, which would be the OPS. But we can't even make a decision on whether or not we can move forward with this because our funding is hanging in the balance. Everything comes back to this idea that drug users are the ones who can make a difference, and we are, but the funding is screwing us.

Anyways, I'll stop.

N. Sharma (Chair): Charlene and Kat.

Go ahead, Charlene.

C. Burmeister: As a person with lived and living experience that has the privilege of a full-time position at the BCCDC, I recognize that I come to this work with great privilege. But the reality is…. When it comes to CSUN, which was the first drug user organization in the northern region of B.C., and the power and effective work that I saw with other drug user organizations in the infancy of my work and how I really valued and needed to bring that to our community….

The reality is the difference of money that's being offered towards treatment options as opposed to harm reduction and, certainly, the minuscule amount that is being offered to drug user organizations that, in many cases, are doing the work of their health authorities with complete resistance — certainly, in the northern region — to support, financially, work in collaboration with Northern Health in our community, kind of locally and regionally….

I have spent much of my time, and free…. I don't get compensated for my work, quite often, while I [audio interrupted] vicarious trauma and immense workloads and really struggle with being able to continue to have these services. We at CSUN [audio interrupted] the health authority to having safe injection and safe consumption services while they held onto money for three years. They're still refusing to support us financially because there is a conflict of interest within leadership within Northern Health.

We, as people who use substances and run peer-led or drug user–based organizations, need adequate, accessible, sustainable funding in order to be providing services that are really the responsibility of health authorities. They are not doing the work in a respectful way, while we still continue to have resistance within municipal leaders and all those pieces.

[12:25 p.m.]

Money being offered to our group — and the accountability to groups around the money that they do get — really needs to be looked into. There's no way that drug user groups can continue to do the amazing work they do, with longevity, with the $1.2 million that's being offered to us. It's insulting. We are not being valued or validated in the work that we do.

N. Sharma (Chair): I have a question. One was partially answered there, but maybe I'll go into a different area.

I'm really curious about learning about compassion clubs, how they show up and examples of them from your experiences. If anybody could offer that for the committee to learn about, I think that would be helpful.

H. Peterson: Right now there's a wonderful organization called DULF, which is peer-led. It provides safe supply to people, really on a basis of…. It can't really be considered a compassion club at this point, because a lot of the supply is really just handed out, sort of as a statement.

There was the BCCSU white page that we did around compassion clubs and work that was going towards that. It broke down in a really unfortunate way that was completely unnecessary, in my opinion — that conversation. But we were working towards it.

There was an active compassion club that peers, who did that work with BCCSU, were doing — which, for many of us, saved our lives. I wouldn't be here today if I hadn't taken part in the compassion club that existed then. The only reason it didn't work — it broke down eventually — was, as was brought up earlier, that the supply was corrupted due to criminalization. It was a completely safe supply that was fentanyl-free.

Most of the people that were accessing this model were doing so because they were still supporting their families, still employed, still just trying to sustain life. They wanted to live and not die, but it broke down, really unfortunately, because of criminalization. The conversation kind of broke down, I think, due to stigma and backlash. Those conversations haven't gone as far as they need to.

DULF right now is, I think, doing amazing work. People should really take the time to look into DULF and the work that they're doing.

C. Burmeister: Hawkfeather, I just want to add…. Some may agree to disagree with me, but I really am not comfortable calling the DULF substances a safe supply. I think it's important to note that they're doing what they can to prove compassion clubs are accessible and to prove that people with lived and living experience have a way to navigate this.

Calling the DULF model a safe supply still does not feel comfortable to me. The reality is that the substances are tested, but they're still bought out through the black market, and they still support organized crime. That does not feel comfortable.

I believe that as Canadians, we should have access to a safe, regulated supply, with prescription and non-prescription models, in the same way in which we do alcohol, tobacco, cannabis. That makes the most sense to me. I just want to reiterate that I caution calling that a safe supply.

N. Sharma (Chair): All right. Any other comments?

K. Cadieux: Yeah. I just want to echo what Char said. I think it's important to also…. When I think of alcohol and tobacco, I feel…. The first thing that pops into my mind is age limits. I think it's really important to not have it in that type of method, where it's legalized in a way where there are age limits. Again, we're blocking the youth who really need access to a safer supply and are getting blocked off on every angle they go to.

N. Sharma (Chair): Any other comments?

Okay, I don't see any other of my colleagues' hands up for questions.

On behalf of the committee, I just want to thank you all for the very informative and very powerful presentations that you all gave on your experiences — the living and lived experiences that we all needed to hear and learn from. We're all very appreciative of that time. I know that if we have any follow-up questions, we know who to connect with. We're just really grateful that you all, from across the province, joined us here today.

All right. For the committee, we're in recess until our next presenter, which I think is at two o'clock.

The committee recessed from 12:30 p.m. to 2:01 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): It's my pleasure to invite our next speakers today. We have, from B.C. Corrections, Lisa Anderson, assistant deputy minister, corrections branch; and Erin Gunnarson, acting provincial director, strategic operations division of the corrections branch.

I just want to welcome you on behalf of the committee here today. We'll go through a quick round of intros so you know who you're speaking to.

I'll just start with myself. My name's Niki Sharma. I'm the MLA for Vancouver-Hastings and the Chair.

I'll just go to our Deputy Chair, Shirley.

S. Bond (Deputy Chair): Good afternoon. I'm Shirley Bond, the MLA for Prince George–Valemount.

M. Starchuk: Good afternoon. Mike Starchuk, MLA for Surrey-Cloverdale.

P. Alexis: Pam Alexis, MLA for Abbotsford-Mission.

D. Davies: Good afternoon. Dan Davies, MLA for Peace River North.

T. Halford: I'm Trevor Halford, MLA for Surrey–White Rock.

R. Leonard: Hi. I'm Ronna-Rae Leonard, MLA for Courtenay-Comox.

N. Sharma (Chair): All right. I think that's everybody. We'll just pass it over to you. There's 15 minutes for a presentation and 45 for questions and discussion, if we need it.

Briefings on
Drug Toxicity and Overdoses

B.C. CORRECTIONS

L. Anderson: Thanks so much. It's Lisa Anderson speaking here.

Just before we get started, I wanted to acknowledge that today I'm coming to you from the traditional territories of the Katzie and Kwantlen First Nations in Maple Ridge.

I will do my best to stay within the 15 minutes and keep it tight. I know there are probably lots of questions, and I look forward to being able to answer those at the end.

Just as an overarching statement, the opioid crisis obviously has impacted our clients. On one of the lead-in slides, they're referencing just some quick data from the death review panel that B.C. Coroners released in 2017. I'll touch more on that a little bit later in the slides.

In that initial review panel that looked at just over 1,800 deaths over a 19-month period, 66 percent of those that died had been clients of B.C. Corrections at some point in time. Of that 66 percent, 10 percent of those had died within the first month of release from custody — so certainly a big connection there. In addition, we do have impacts within our correctional centres as well.

Just to set some context around B.C. Corrections — and moving forward in the slides to what we do, which is slide 4 — B.C. Corrections looks after individuals that are 18 years and older. We either have them in custody…. We have ten provincial correctional centres around the province, and those hold both sentenced and remanded individuals. "Sentenced," in the provincial system, are people serving two years less a day. Of course, those that are on remand status are those that are pending trial or a court outcome and are with us during a period of time.

[2:05 p.m.]

We also have community corrections, which offers bail and probation supervision. "Bail" are those whose court matters are pending and who have some type of condition that ties them to our probation offices, and probation officers look after, of course, those that are sentenced to a period of community supervision. There are 50 of the probation offices across the province.

Moving to the next slide, just to talk a little bit about our system and, perhaps, start to paint a little bit of a picture of what we see as some of our challenges. One is that there's a high volume of people that we're in contact with. At present, we have about 1,650 people in custody across those ten correctional centres and then 17,000 people under community supervision in the community.

I just want to talk about those numbers briefly, because the pandemic did have an impact on them. Pre-pandemic, the in-custody counts were approximately 2,200, and then the community counts were 20,000. So we've certainly come down, but then to sort of step back even a little bit further, we already were seeing a downward trajectory.

From 2017, the numbers had been decreasing. In 2017, we had 2,600 people in custody and 22,000 plus in the community. Just by comparison for that difference, from 2017, we had over 2,600 in custody, and we're almost 1,000 less. There are a number of reasons, potentially, for that, not just the pandemic. We can touch on that a little bit later.

A high volume of people in custody are under our supervision — a high turnover. From a custody standpoint, it's almost a tenfold number on the number of admissions that come through. Part of that is just the short stays that people who come into contact with B.C. Corrections experience. For those on remand status, their average stay in custody is only 50 days. For those that are sentenced to provincial custody, the average stay is 81 days.

That number is higher, actually. Through the course of the pandemic it had increased a little bit. In 2019, just by comparison, for those on remand status, it was only 44 days with us. Then the sentence ones were 69 days. So it's creating a significant challenge on what you can effectively do, whether it's looking at programming or at other types of options to intervene.

Moving to the next slide, just to talk a little bit of our clients. The profile of our population has changed substantially over the years, and we do see a more hardened population and people with much more complex needs than we ever used to. Illustrated on this page is just the number of individuals in custody that have either a mental health or substance use disorder. That's at 69 percent. Then those that have both in custody are 42 percent. On the community side, the numbers are a little bit lower but still significant.

Looking at the next slide, to touch on our representation of Indigenous clients, as you can see here, clearly they are still very much overrepresented in both custody and community. Those numbers have not shifted much over recent years. Thinking of corrections as the back end of the justice system, despite all efforts at the front end of the system, we're not seeing any significant movement on the numbers. When we look at the adult custody Indigenous population, it's at 34 percent. In 2017, it was 31 percent, so there has been an increase over that bit of time.

Another note there as well: females make up 5 percent of the custody population, yet of the females in custody, 46 percent of them are Indigenous.

[2:10 p.m.]

Over the course of the next number of slides, I'm just trying to illustrate some of the challenges that we face and how the opioid crisis has impacted us in B.C. Corrections — specifically, in this case, on the custody side of things.

The one slide there shows the number of non-fatal overdose incidents per year in provincial custody. That's taken from primary incident forms. As you can see, since 2014-15, where numbers were lower, there's been a significant increase over recent years.

Moving to the next slide where we speak to overdoses in custody, this is now tabulated for looking at it per 1,000 admissions into custody. You can see that increase again since 2014. There's been a steady rise in it.

Then moving to the next slide. This is data that's been pulled from the B.C. Centre for Disease Control site. This is information about overdoses in the community that were attended to by B.C. paramedics. You can again see that trajectory from 2014. This, of course, is per 10,000 people in the community.

Then moving to the next slide. Really, this is for illustrative purposes, to just show the correlation of what's been going on in the community, which is represented as the blue line on the slide, for 10,000 people, from paramedics data, and then the corrections line, being the yellow line, for 1,000 admissions. You can see that same sort of trajectory and growth. To sum that up, what's happening in the community is really reflected inside the custody centers as well.

Moving to the next slide, looking at the suspected overdose deaths in custody. Just a note that we refer to them as suspected overdose deaths. We, of course, don't categorize them, and we need to wait for B.C. Coroners Service to actually determine the cause of death. So our reporting remains a suspected overdose, and we will periodically go and have updates done. But for consistency, we'll maintain it as that.

From 2013 to 2021, you can see that there's an increase. We have had an increase in deaths in custody. The other reasons for that may be natural causes; at times, there are suicides; then unknown factors; sometimes at the hands of others. Or, as you can see by the yellow bars, there are also overdoses that have been occurring. Of interest — and the data is not reflected on that slide — is that for 2022, at this point in time, there is only one suspected death due to overdose.

Moving to the following slide, just a comparison between suspected overdose deaths and then the non-fatal overdoses — so combining that data. You can see the percentages of the incidents involving toxic drugs and the number that are resulting in deaths or where there have been interventions that have prevented that.

Then moving to the next slide. I'm wanting to talk a little bit about the B.C. Coroners Service death review panel from 2017. I know that this committee is very familiar with the more recent death review panel that was done. B.C. Corrections was not part of that, so that's why I'm referring to this information. There's nothing to suggest that the data would be any different from a percentage standpoint. But overall, we are a very, very small number, and our interventions are, perhaps, somewhat limited in the broader work that is being led by B.C. Coroners Service.

From 2017, there was a determination that a substantial number of overdose deaths occurred among persons who had had previous or current contact with B.C. Corrections. You can see on the table there the numbers in relation to the time frames from their last encounter with B.C. Corrections.

[2:15 p.m.]

So 66 percent of them had been our clients; 16 percent were under supervision at the time of their passing. And then for 10 percent, it was determined to be that they died within one month of being released from custody.

That review panel resulted in a couple of recommendations. One was around utilizing naloxone and being able to give that to our clients, whether they were leaving custody or in the community when they were reporting. Since 2020 — our data from January 2020 to March 2022 — from custody, we have provided 2,400 kits that have gone out to the community as people have been released. Then from our community offices, 350 kits have been provided to those that were seeking them.

The other recommendation that came out was an increased connection to addiction resources. I think this committee may have heard that in 2017, the correctional health services moved from a private contracted service provider to the PHSA. With that, there has been a real increase in continuity of care for those that are in custody as they transition out into the community.

There's also been a real increase in those that have been placed on opioid agonist therapy. Data from early 2020 shows that approximately 40 percent of our population is on some form of OAT therapy, primarily either Suboxone or methadone, while they're in custody. There's significant discharge planning for those people and, newly formed in the last number of years, community transition teams to support that transition from custody into community. Obviously, that's a significant period of time for people, and despite perhaps having really strong continuity on the health side, there are other factors at play that make it an unstable time if people don't have a source of income or they don't have shelter and whatnot.

Moving to the next slide, I just want to touch on the broader scope of what we're doing and what's at play within our custody centres and our community teams to try and minimize the impacts of the opioid crisis on our client base. So a very multifaceted approach — there are many interdiction strategies. I won't go through everything that's noted on this page in the spirit of time, but I'm certainly happy to answer any questions around that.

I will just touch on…. In 2017, we introduced body scanners, and I think that that's been a real benefit for those that used to pack drugs into a correctional centre, once word got out that anything that's of a larger quantity is going to get picked up on these body scanners. So I think that, as a method of bringing things in, has decreased. That being said, with the current drug supply out there and just how little of fentanyl or some of the other drugs right now that you need to have a fatal dose…. It's such a small amount that it may not get picked up.

I touched on the health care in custody. There are drug and alcohol counsellors [audio interrupted] assessments. There's a team of people, including those community transition team folks, to assist. There are correctional programs, both in custody and in community, and a much greater focus around transitional release planning.

One of the challenges with that — I'll talk about that as we roll into the next page — is around unplanned releases. When somebody is on bail and they go to attend court, if the court determines somebody is going to be released, they need to be released right then and there, so you don't have time to pre-plan for that release. That makes it exceptionally challenging. In our current population, about 69 percent are remanded and only 30 percent are sentenced — so a challenge on that front on a number of aspects.

But overall for challenges…. Short stays — I've touched on that. It is a continued churn of turnover within the centres. Trying to do any type of meaningful programming for…. Or that release planning is challenged within that short time period.

[2:20 p.m.]

On the contraband side of things, people will go to extraordinary lengths to get contraband inside correctional centres. There are so many ways. I'm happy, if people are interested in hearing some of the sort of unique ways that that's occurred…. That continues to be a challenge. I don't know that we'll ever get to a place that there will be zero, just because every time you stop off one opportunity for it, you know, somebody comes up with a new creative way of doing that.

Anther challenge is limited community supports. I know that in talking with the probation officers in, quite honestly, all parts of the province, they try very hard to connect people to other resources in the community. One of their common concerns that they raise is that the client comes to them, because they're there and available, and needs help, and they are constantly looking to support them and trying to find them some type of shelter, some type of program, maybe a referral to forensics or what have you. There just aren't enough. People are on wait-lists, and it's not helping them in the moment that they need it.

Another challenge I touched on earlier, around the change in profile of the people that are in custody. Not only do we have far more that are remanded than sentenced, we have those now that, I would say, have exhausted almost all other opportunities for not being in custody before getting to us. They are of the highest risk and needs, and oftentimes, you know, there aren't the appropriate mental health supports available for them. Forensics has significant backlogs and wait-lists.

We have people whose ability to function inside the correctional centre is really quite limited. That also, then, touches on the voluntary care piece. You know, important to note that any care that's provided by our health professionals in custody must be voluntary. Unless somebody is certified under the Mental Health Act and moved out to a forensic facility, there are limits to what can be provided.

All that to say, in looking forward and where we see that there are opportunities: increased resources to really support that transitional period, both from an in-custody standpoint in the release planning aspects but also for when they get out to community and connections to community resources.

Moving into number two there, and looking to…. It would be really helpful to have dedicated space for correctional clients for that transitional piece. That hasn't been the case. Oftentimes, people are being released and being placed on a wait-list, and that leaves them at their most vulnerable time without the supports that they need.

The next one speaks to the need for increased psychiatric space, and not just for those that meet the specific diagnosis required to get into a forensic hospital. We have people who are low-functioning or on the autism spectrum or FAS, or others that…. Even the results of previous overdoses and sort of the effects of that on their brain function create a really difficult class of individuals to manage that, quite frankly, would be better managed outside of our correctional environment in more of a care environment.

Then, of course, what we'll continue to do and look for: whatever opportunities there are to engage in and support broader cross-ministry research, to look for and find better ways to manage our population.

I think I probably went a little bit over, but that's a lot of information and probably a lot of questions. I'd rather open it up now to those.

N. Sharma (Chair): Great. Colleagues, any questions?

Okay, go ahead, Ronna-Rae.

R. Leonard: Great. Thanks very much for your presentation. It was nice to have an hour off to kind of recharge. I sat out in the sun and warmed up again.

I had a couple of questions, just sort of drilling down into some specifics without getting into that sort of broader picture.

[2:25 p.m.]

You said that…. What I saw in one of your graphs was that in 2019, there was quite a jump in the number of non-fatal overdoses than in other years and also in comparison to what was going on in the general population in British Columbia, which is that we were seeing a decrease. I'm curious. Is that because there was a lack of availability of naloxone? What is the current status of being able to access naloxone on site, in custody?

L. Anderson: I would only be speculating on the reason why. Unfortunately, what could happen is that somebody does bring in a quantity of drugs and shares them with others. So you have a bit of a spike around that. I can't speak to that particular increase and be able to qualify it in some way.

With respect to the availability of naloxone in the correctional centres, there are the health services staff that are there, and they, in most correctional centres, are not 24-hour nursing. There's a gap through the night. Sometimes it's five, six hours, depending on which correctional centre. They have the injectable kind of naloxone, and then we also have, in all of our centres, trained correctional staff that have the nasal naloxone to provide. So there are always people on site able to administer that.

P. Alexis: I too had to warm up in the sunshine like Ronna-Rae. It must have been chilly in here.

Thank you so much for your presentation. We've heard from a couple of presenters — we've been at this for three months, I think, now — that if there were only drug treatment services in correctional facilities…. I see in your slides that you do have, under your programs, case management. But I don't understand Guthrie House therapeutic initiatives. So if you could explain what that means, and then tell me about that comment that we heard. Is this at all possible? You do offer emergency treatment for sure. But is there something that we can take away — a piece that might be missing that might help people? So there are two parts.

L. Anderson: Sure. To your first question around Guthrie House therapeutic community, in our correctional centre in Nanaimo — which is a lower classification level from a risk level, so only certain of our client population can go there — we actually run a therapeutic community treatment program, and we have a partnership in the community. So people start the program while they're in custody, and then they can transition out and stay as part of that program — a very successful model, something that we haven't been able to replicate in other places for a variety of reasons based on the type of client base you have and the remand versus sentence.

Even the Guthrie House…. They're having difficulty because of the short stays. You need people to be there for a significant amount of time. You really would want people there for at least six months to be able to become fully integrated with that program before being released to custody and then having to sort of figure it out on their own before they've had that level of immersion in it.

With respect to…. Can you just repeat your second part of the question?

P. Alexis: Absolutely. We've had comments from individuals to say: "If only there was a drug treatment program that could be offered in correctional facilities." I just see that you have, certainly, medical treatment and emergency response, but I think it's different than drug treatment. You do have, certainly, drug and alcohol counsellors. But can you just tell me if there's something there that might be missing that might assist us?

[2:30 p.m.]

L. Anderson: You know, that's a really, really tough one. I would say of course to have a robust treatment program and, as I said, to replicate something that we have at Guthrie House would be great to be able to do. But the challenge with those short stays means your turnover is continuous, so you're not going to get a core of people in there that are going to get, I think, the necessary benefits, when you're only touching that program for a short period of time.

Then one of the other challenges is inside the correctional environment from a programming perspective. Those that are awaiting trial are deemed to be, of course, innocent until proven guilty. They don't have to participate in any programs. Anything that they do is essentially voluntary. Whereas if somebody is sentenced and we identified certain risk factors, we would have the ability to say: "If you want to earn full remission and be able to get out on your probable release date, you need to participate in these aspects of the case plan. But that number is shrinking so dramatically. I mean, right now we're at only 30 percent of our population that is sentenced and then very much short-term stays.

When you think of some of the longer sentences that we have, those are offset by a large volume of 30-day, 45-day sentences. By the time you bring somebody in and really get them settled to a place that they're able to take part in something…. Again, it's just that short window of time that's just so challenging.

D. Routley: I think most of my question was just answered. Being a rep from Nanaimo, I was going to ask about Guthrie House and whether it could be scaled up and the benefit between using existing mechanisms or purposefully designing mechanisms to deal with the current crisis. But I think you pretty much answered it, other than perhaps that part. Can we use these existing programs, adapt them to address this current crisis more effectively by changing some of the parameters you just described around Guthrie House? Or do we need to start from scratch?

L. Anderson: I wouldn't say we would ever want to start from scratch, because we have had some really good success in not just Guthrie House but in our community corrections in our substance abuse management program, which is cognitive behavioural programming.

We do have some really good data and whatnot. So we would never want to start from square one, but we would need to modify things to fit the population. I'm not the expert on what it would take for somebody to have the success for length of programming. I know that there's a variety of recommendations out there. But it's also being able to have good partnerships in the community so that on release, you have that continuity. That's where there's often a challenge.

The resources in community are so oversubscribed, which I'm sure you've heard many times. When you release somebody and they have to go onto a wait-list or what have you, it's not going to fit what the needs are.

T. Halford: Thank you for the presentation. Over the last few months, we've heard from a number of individuals, and the word "trauma" keeps coming up. I want to focus specifically on the women that have come and presented before us and the trauma they speak of, especially the moms, and if you guys are able to speak about maybe if there are programs existing, or a lack of, that we could try and advocate for, with moms coming into the correction facilities — ensuring how we're helping with that bond with the young children, maybe older children, and whether or not they're going into treatment and able to do that with their treatment.

[2:35 p.m.]

We've heard from some of those facilities. How is that being fostered? I know it's a very sensitive subject, but it's one that's come up every single time. I just would like your thoughts, if appropriate.

L. Anderson: Sure. The women…. I was actually the warden of the women's centre for just over four years. The women that come into custody — the streets are harder on them, and not only are they there because they're accused of something, but more often than not, they're also victims of things.

You speak to that trauma aspect. It's really important that the environment is one that supports that trauma. There are a number of programs that have either been in place for a while now or that are newer in trying to really build even in the absence of perhaps the drug and alcohol or mental health piece, but the therapeutic community type of living. So we have special units where people can go. and they live like that therapeutic community.

There are specific programs. One is called Thinking Leads 2 Change. It's designed for women, specifically, recognizing the different challenges for the women coming into custody, and of course, one of them is being potentially separated from family, from their children and what those aspects are.

We have different partnerships — Elizabeth Fry Society. We work closely with agencies like that that are really women-centric to try and optimize the best outcomes for them.

S. Bond (Deputy Chair): Thanks very much for your presentation and for the important and challenging work that you and your team does.

I have to say that I found the numbers that you shared at the beginning of the presentation…. When we stop and think about it, 66 percent of deaths have been clients of B.C. Corrections at some point in their life. One of the things we're doing, as we listen to these presentations, is we're starting to get a clearer picture of who's actually dying in British Columbia. When you start to align the statistics, we can start to have a very different picture, perhaps, than some British Columbians have about who's dying as a result of an overdose.

What I'm concerned about is that 10 percent of that 66 percent died within their first month of release from custody. As your presentation evolved, we get to the place where we find out, which is what we have seen in countless other presentations, that you can't find services or supports for those people when they transition back to community.

Have you done a correlation…? The 10 percent of the people that died within their first month of release — were they being provided with support? Were they not? Have we looked at what the factors were that led to those deaths? That is a very high number, and it's very…. One would want to be assured that there is a transition plan back into community, whether that's housing or all of those things.

So when you look at those deaths, were those people able to get resources, support? Were they getting the kinds of support they needed on their release or not? Do you know that?

L. Anderson: You know what? I don't, but I'm going to look to my colleague Erin here, because she was more involved with that panel at the time.

E. Gunnarson: Yeah, thank you.

At the time, we did not look into some of the causal factors that might have existed for that group of people. There were a few other things that happened around that time, as well, including the Provincial Health Services Authority taking over responsibility for health care just after that death review panel happened. So there has been a change in some of the services that are provided.

There are a number of services, including the community transition teams, that have been added to support people in their transition, so that is a Provincial Health Services Authority–provided program.

[2:40 p.m.]

In short answer, we have not looked at the details of who had support and who didn't. However, one of the suggestions that we had at the end was supporting more research in. That's certainly an area that we would be interested to do more research in.

S. Bond (Deputy Chair): Also, if I might, Madam Chair, in the statistics that we're talking about, you describe, for example, in the charts that you've provided us with, the number of overdoses per of people who are in institutions? Your clients…. The presentation refers to clients — which I'm assuming would include community-based support, community-based programming plus incarceration. Do people…? First of all, could you just tell me that? When you talk about the number of overdoses per 1,000 people, are those incarcerated people?

L. Anderson: Yes, they are. Those are of that 16,500 that are admitted annually, under those admissions, into actual provincial correctional centres.

S. Bond (Deputy Chair): So it is. So when you have people in community that are also clients of B.C. Corrections, how are those clients monitored, cared for, resourced? For the issues related to overdose and to drug use, are there separate statistics for that group of people in terms of what B.C. Corrections does? Am I making sense? You have a very large client base. We are seeing statistics for those that are incarcerated. What role does B.C. Corrections have, in that whole drug use situation, in community-based clients? That's probably a better way to say it.

L. Anderson: Yeah, that really is going to depend. Oftentimes it's going to be very much linked to what types of conditions the court has ordered. That's where that level of intervention will come from the probation officer. If there are conditions to attend drug and alcohol counselling, we would very much be connecting them to service providers in the community and being able to have an understanding of how they're progressing through that programming and what have you.

In the absence of a court-ordered one, the probation officer is going to have a conversation with individuals on what their risk factors are, what their history is and whatnot. Is there any type of tracking mechanism around that that's easily able to be extracted to show data? There is not. We have the basic data that speaks to the mental health prevalence and substance use prevalence, but beyond that, the focus of their interventions is not on that aspect of it.

S. Bond (Deputy Chair): Chair, I have an additional question, but I'll wait to see if others have and do a second round, if I'm allowed to, later.

N. Sharma (Chair): Sounds good. Put your hand up, and we should have time.

I have a question before we go to the second round of questions. It is really kind of Shirley's first point, when she was talking about this fact that we're getting a clear picture, as a committee, of what the touchpoints are, of different systems, with people that have ended up in overdose deaths. Corrections is a big piece of that, so I appreciate talking to you today.

I also was struck by the stats, not only about how high the percentage of people was that died and that had interfaced with corrections but also — I think the stat was 69 percent of the population — of those had a mental health or substance use issue.

I guess I have two questions, but they're kind of related. The first one: how many of those people that you're seeing are drug-related offences? Are they related to…? Do you know? Do you track? Then, with decrim steps coming in, I'm just curious about how that might change the direction of where this population of people might go and where we might be able to reach out to them.

[2:45 p.m.]

L. Anderson: In answer that, I see Erin busy trying to pull up the data on that. We do have that data. I don't know if she has it on hand. It's not a high number. Do you have it there, Erin?

E. Gunnarson: Unfortunately, I don't. We can certainly provide it back to the committee if it's wanted, but I don't have that at hand right now.

L. Anderson: It'll be a smaller number.

N. Sharma (Chair): Okay. Maybe if I could ask another question, then. In your stats, when you talked about not only the suspected overdose deaths but also the non-fatal overdoses — you have them laid out in that one graph — 2019 is a high year, and then it seems to go down. Are there any specific interventions that you would point to? Or is that just the nature of the stats that you presented — that they're not related to interventions and that those numbers are going down in terms of overdose incidents?

L. Anderson: That 2020 number will be that much lower, I think, simply because of the pandemic. The count plummeted from 2,250 down to 1,400 in a very short period of time, and it has taken time to build up by a few hundreds. It still would have been a lower number than in the 2019 year if you increased the count by that other third that it was missing, but largely, that will be attributed to the count just dropping so rapidly.

N. Sharma (Chair): Okay. I may be a bit confused. It could just be me that's not understanding. I was looking at the graph that said: "Suspected overdose deaths versus non-fatal overdose deaths for overdoses in custody." You're saying that the 2019 numbers, where it's 66 non-fatal [audio interrupted], and then the 2020 and 2021 appear to be going down. It's just something to do with the way it was counted during COVID. Is that…?

L. Anderson: These are numbers. These are not based on per 1,000 or what have you. These are actual numbers of incidents. The number of incidents has just dropped substantially as the count dropped.

N. Sharma (Chair): I just was wondering if that was attributed to any particular interventions that you were having or to anything that had changed.

L. Anderson: No. There was nothing, I would say, specific going in. I shouldn't say that. I think one of the things…. There was certainly heightened monitoring, from a health perspective, and everybody being admitted into custody had to be placed in an induction unit. There was a different degree of assessment as it relates to looking for COVID symptoms and whatnot. As to whether that scrutiny contributed in any way, we won't have data for that, but there was more monitoring and more separation of people from each other.

N. Sharma (Chair): Okay. Maybe we'll go to the second round here.

R. Leonard: I guess great minds, all of us, have asked similar questions to what has been going through my head. This morning we heard a lot about ways to end stigma and a lot about accepting and recognizing drug use. I would say that, by and large, in terms of conditions of release, we're seeing, still, prohibition — taking steps to end their addictions.

I'm not asking you to answer all of that, but I wanted to relate it to the use of OAT. You said that 40 percent of the population is on OAT. I'm curious if they came in on OAT, or if they accessed OAT while they were in custody. Do you have any…? What does it look like, among your clients in community?

L. Anderson: On clients in community, we actually wouldn't have that information. They would see their own personal health care provider, and we wouldn't be able to access that information.

[2:50 p.m.]

With respect to OAT therapy, I'm not going to know the actual numbers that people were admitted on. Certainly, on admission, anybody that had been on OAT therapy in community would continue on that. Then as well, people are being placed on it if they meet that need. Those numbers continue to rise, because that is being — I don't want to say "advocated" — the focus of our health team, in making sure people are getting that treatment.

R. Leonard: So it is on offer, as it were.

L. Anderson: Absolutely.

R. Leonard: Okay. Thank you very much for that.

S. Bond (Deputy Chair): I'm still thinking about the gap in terms of community and all of those things.

I just wanted to pursue something. You noted at the beginning of your presentation that there are currently 1,650 people in custody. I'm fully aware of the fact that numbers dropped, which is why the statistics dropped, because you had fewer inmates during COVID because it couldn't be managed from a health care perspective. So those numbers were lowered.

But we're still now at 1,650 people in custody. You suggested that that has frequently been much higher than that, incarcerated in British Columbia. Can you tell me: is that a result of things like alternative sentencing, where they may be going to another form of sentence other than being incarcerated? Or are sentencing practices changing so that fewer people are actually being sentenced, which is why we're seeing those numbers drop?

L. Anderson: I think there are a couple of things, one being recent legislative changes at the federal level –– Bill C-75, which really pushes that all alternatives are sought prior to incarceration. I think that that…. As you said, different opportunities for diversion along the process, whether from first charge or even prior to being charged.

And then, I think, there have also been some shifts in B.C. Prosecution Service policy, so that again is contributing to really looking at that diversion aspect or finding alternatives. There's obviously the pandemic that has created much lower counts, but we were on that trajectory already. One would wonder as well, knowing the linkage with the opioid crisis and our clients — that touchpoint — who of our population is part of the cohort that has passed away, of those people that were those frequent admissions for us?

N. Sharma (Chair): Okay. I don't see any other hands up. I think everybody's asked their questions.

On behalf of the committee, I just want to thank you for presenting and answering all of our questions today. I think we learned, definitely, a perspective that you are seeing with the data that you've provided. So thanks a lot for that.

Committee members, we're in recess until our next presentation at three.

The committee recessed from 2:53 p.m. to 3:01 p.m.

[N. Sharma in the chair.]

N. Sharma (Chair): It's my pleasure to welcome our next guests here today. My name is Niki Sharma. I'm the Chair of the committee and the MLA for Vancouver-Hastings.

Joining us for our final presentation today are AVI Health, Katrina Jensen, executive director; Pacifica Housing, Carolina Ibarra, chief executive officer; and Jeffrey Baergen, Salvation Army Victoria executive director.

I just want to welcome you on behalf of the committee, and I'll do a quick go-round of introductions so you know who you're talking to. Then each of you will have 15 minutes, and then we'll go to questions and discussion.

I'll start with our Deputy Chair, Shirley.

S. Bond (Deputy Chair): Good afternoon. Welcome. I'm Shirley Bond. I'm the MLA for Prince George–Valemount.

M. Starchuk: Good afternoon. Mike Starchuk, MLA for Surrey-Cloverdale.

P. Alexis: Good afternoon. Pam Alexis, MLA for Abbotsford-Mission.

R. Leonard: Good afternoon. I'm Ronna-Rae Leonard, MLA for Courtenay-Comox.

T. Halford: Hi there. Trevor Halford, MLA for Surrey–White Rock.

D. Routley: Doug Routley. I'm the MLA for Nanaimo–North Cowichan.

N. Sharma (Chair): Wonderful. That's all of us, and now over to you.

Going first, although it's up to you, I think I had Katrina; you're up first. But if somebody else wants to go, go for it. But I'll pass it over to you.

Briefings on
Drug Toxicity and Overdoses
Panel 2 – Community
Organizations – Victoria

AVI HEALTH

K. Jensen: I'm happy to go first, unless Jeffrey or Carolina has any time issues or anything here.

Well, I want to start by acknowledging that I'm speaking to you from the Lək̓ʷəŋin̓əŋ-speaking people's territory, the Esquimalt and Songhees First Nations, here in what is known as Victoria. I'm also an immigrant to these lands, and I'm really grateful for the stewardship of the Indigenous people of the lands.

I also just want to take a moment, as I'm sure you've taken many moments over the last few months, to really just remember the people that we have lost to toxic drug poisonings. My organization, like many, many others across the province, has rarely had a week go by in the last few years without the loss of someone that we know.

My friends in the drug-using community, or the community people that use substances, have a saying called: "They talk; we die." As an ally, I really feel it's my responsibility to just make sure that my words count. There's so much we could say on this topic and so much that needs to be done, but I'm really just going to focus on three key areas that, from my place in this crisis and from my experience, I see are potential for change.

First, just a brief bit about me. I'm the executive director here at AVI Health and Community Services on Vancouver Island. We're a multidisciplinary community organization, providing a range of substance use, HIV and hep C services across the Island. We've been in existence for about 35 years and have offices up the Island. Myself, I've been working in harm reduction services for more than 30 years, and I've been at AVI for the last 24.

[3:05 p.m.]

I just wanted to make a quick note about harm reduction. For us, it's an approach as well as it is a service, and we see it as a continuum. We don't see it as either harm reduction or abstinence. We see it, actually, as being in relationship with people. It's a way of being in relationship. For us, harm reduction is the tool that we use, but it's the relationship, really, that is the intervention.

The first area that I want to focus on is safe supply. As you know, the B.C. government developed and released a policy document outlining access to safe supply last July and also, as part of the budget in 2021, committed $22.6 million in funding over three years to the health authorities to implement safe supply programs. So my question for you to consider as you listen to me talk is: have you heard about what the progress to date in the health authorities, more than a year after that policy and those funds were released…? Do we know what that progress is?

I mean, it's been said — here, I'm sure you've heard, and when I read the papers — that there are lots of challenges in setting up safe supply programs. You've probably heard about more than a few of them. My organization, AVI — we know those challenges. but we also know that it can be done.

We have been really privileged to operate the Victoria SAFER initiative since 2020. In 2019, we'd applied for a grant from Health Canada to set up a safe supply program, but we weren't successful in that grant. But when COVID hit, Health Canada called us and offered us $1 million to urgently implement a safe supply program. They said: "Can you do it?" And we're like: "Well, I don't know, but we have to."

We had to try something, because we had hundreds of people living in parks, had people dying in tents, and we knew we needed to do something. So our AVI team, including nurses who we were able to bring on, and physicians, hit the parks and the streets in a matter of weeks and were able to immediately connect people to a safe alternative at the time when toxicity of the street supply was at an all-time high.

The success of this program led to a further two years of funding from Health Canada, which ends at the end of next March — March 2023. Our program, over this last more than two years now, has seen significant success separating people from the toxic street supply, with more than 78 percent of participants reducing their dependence on that supply.

How it works is that we provide what we call a flexible model of safe supply. That means we work with the participant to find the pharmaceutical alternative that best matches the street version that they're using. This includes access to a range of fentanyl products.

This range of options, along with the support of a low-barrier multidisciplinary team, is really the key to the program's success. We're not saying: "We have one medication to offer you. Take it or leave it." We're saying: "We will work with you to find something that will really separate you from the street supply." We also provide both fixed-location services, now in a clinic, along with outreach to increase that access to care.

We've also been really working hard over the last few months to expand those options to include inhalable substances. As we know, many people still use by inhalation. But what has stymied us right now is that we actually just can't find a location in Victoria to be able to provide those inhalation services. We're going to keep working on that, but as I'm sure you've heard, locating harm reduction services is very, very challenging. We also provide support to stimulant users and are really keen to expand those options as well.

And then in June of this year, we applied for and received further funding from Health Canada to provide safe supply programs in Nanaimo, Campbell River, Courtney and, hopefully, Port Hardy. Our Nanaimo clinic is opening next week, and that will be sort of integrated within our community health centre up there. Then our Campbell River and Courtney programs will open by the end of the month. We have physicians and nurses in place who are eager to provide that care but want to do so within a multidisciplinary team.

I think that's key to the challenges recruiting physicians. I was even…. You know, I saw, on the CBC, an article earlier this week about a physician in Nelson who really wants to provide safe supply, but he doesn't want to do it by himself. He wants to have the support of a nurse or a team. I think that's a really crucial model. This can't just be about the prescriber and the participant. It has to be about that wraparound support and care.

[3:10 p.m.]

Equally as important is having people with lived and living experience working in those programs and providing continuing and consistent input into the development of those programs.

There are lots of challenges in rural and remote communities developing any kind of health care program, as you know. What we're doing in Campbell River and Courtenay — which I'm really excited about — is that we're working directly with a pharmacy and are co-locating part of the service so that we can reduce the amount of nursing care and just the logistical legal challenges around counting the opiates that we're giving out.

We're really lucky to have pharmacists in those communities that are really eager to provide this kind of service to people. But again, it's Health Canada, so that means we only have 15 months of funding, and that funding will come to an end at the end of August next year. Health Canada doesn't provide ongoing funding for health services that are what they consider in the jurisdiction of the province.

We know — and our physicians kind of pointed this out — that we are taking a risk by offering people a service that may only exist for a certain amount of time. But we feel like we have to do something, because it's better than doing nothing. It has to be better than waiting for the health system to catch up and to develop and deliver this system. The policy is there. The policy is an excellent policy. We just need to see it enacted, and we need to be holding the health system accountable for enacting that.

Our model is definitely still a prescriber model. You may have heard about other models. We feel, even with the prescriber model, that there's more work we can do to remove barriers to access. We also obviously need more public health–focused models. That's not necessarily within my area of expertise. We also need these models to be scalable and to go beyond more than a few hundred people. We do have a vision for an integrated health service for substance users where safe supply can be embedded within a comprehensive program.

The second area I want to cover, really quickly, is access to opioid agonist treatment. Hopefully you've heard a lot about that. OAT allows people to receive treatment in their home community and have the support of their friends and family. But to be able to be effective, people have to stay on it.

In B.C. right now, only 50 percent of people who access OAT are still receiving treatment 12 months later. We need to stop asking how many people have access to OAT, and we need to know how many are on it at six and 12 months later, because that is that consistent access that makes a difference. People need a range of supports in place to maintain that consistent access. I believe health authorities need to be reporting out on those OAT retention rates.

At AVI, we were fortunate to operate two substance use clinics. We were able to maintain a retention rate of 90 percent throughout the pandemic. We were grateful to participate in the BOOST collaborative from the Centre for Excellence in HIV. That focused on improving OAT retention and was really helpful. There's also been a lot of great work done not only through BOOST but also through [audio interrupted]. I hope the committee has the chance to look at that work because OAT retention is really key.

Then the third area that I want to focus on is funding for community-based organizations, including non-profit and peer-based organizations. Our recommendation is that we need a dedicated funding stream, controlled by the province, to support community-based organizations to provide low-barrier harm reduction services, including access to safe supply. We are an underutilized resource in the response, and we receive only a small portion of the funds allocated.

Community-based organizations are on the ground where…. Really, we, AVI and many other organizations across the province, were part of the community-based response to the HIV crisis and were able to see that turn around. We believe that resourcing the community-based response to the overdose crisis and the drug poisoning crisis is something that we haven't done and could do.

[3:15 p.m.]

Because we are a community-based organization in the health sector, we fall under the Health Authorities Act. The health authorities receive their funding from MOH and deliver the majority of the health care services in the province. The health authorities, under the Health Authorities Act, decide, within parameters, what to do with the funding and whether to keep it themselves or to put those services out to tender.

That means organizations like AVI don't actually have any core funding, but we compete under a procurement process that essentially treats us like a business. It doesn't allow us to build services that are responsive to the community from the ground up and to continuously be influenced by the participants, whereas the funding we got from Health Canada did allow that. It allowed us tremendous flexibility to provide the services and to pivot, when appropriate, to provide the best service.

Obviously, we have to be accountable for the funds. I understand that. This isn't really even about people in the health authority. People in the health authorities are hard-working and are really well-intentioned. It's just the restrictions under which they operate and the mechanisms that they have in providing funding for community-based organizations that are the challenge.

The same process for determining maintenance contracts is what is used for funding life-saving, harm reduction services. Often the contracts we get are short term in nature, and that puts us in the position of constantly having to advocate for new or sustainable funding.

Okay. Sorry, that's been a mouthful. I have two minutes left, and I really want to thank all of you for this work. I have a lot of faith in this committee. I've read some of the transcripts, and I've been really impressed by the questions that you've asked and the work that you're doing. You have given me hope that we can really make a difference.

There has been so much hard work done by everyone at many levels in our province, and I want to acknowledge that. We have so much more we have to do. COVID has shown us that we can rapidly implement programs to save lives. Now we need to put that same effort into the drug poisoning crisis.

N. Sharma (Chair): Thank you, Katrina.

Next up I had Carolina.

If you wanted to present on behalf of Pacifica Housing, go ahead.

PACIFICA HOUSING

C. Ibarra: Sure. Thank you, Members of the Legislative Assembly, the committee and my peers. I'm so excited that I got to listen to two of my peers in the community.

I'm CEO at Pacifica Housing.

I'm coming to you also from the traditional territories of the Lək̓ʷəŋin̓əŋ-speaking people of the Songhees and Esquimalt Nations.

I'm very thankful that I get the opportunity to speak to you today.

I'm going to go over a little bit about who Pacifica is — and does. I'm not going to go into detail. You have the information. I'm sure you'll go through it at your leisure. But I just want to paint a picture as to where I'm coming from in our presentation.

I talked to some of our staff at supportive housing sites in preparing for this to see what the most impactful and useful information I could share was. We decided that our perspective, from what we're seeing in supportive housing, would be a really good place to start.

Who we are. Pacifica Housing is one of Vancouver Island's largest operators and providers of affordable homes and supportive services. We operate in greater Victoria as well as Nanaimo.

We also offer housing across the continuum. With the exception of shelters, we do service encampments. We provide supportive housing, low-end-of-market housing, rent geared to income and market housing. We also support people with a history in homelessness to live independently in market units that are not our own, with the help of rent supplements and a support worker. So we have a really wide view of what is occurring out in the community.

On page 6 of the presentation, it just shows you what our entire model is, which starts with the person, where they're at, whether it's outreach in an encampment…. We've now incorporated Indigenous outreach workers so that we can provide more culturally appropriate support to individuals needing our help.

We provide housing and financial navigation and then the different types housing, which culminate with our efforts for housing stabilization. Throughout the continuum, we have support workers that assist people in stabilizing and retaining their housing. Obviously, we also provide homes to people who don't need supports. But as we know, there are drug users everywhere, from every background, from every socioeconomic level.

[3:20 p.m.]

I wanted to start with what's working today in low-barrier harm-reduction supportive housing sites. Our lowest-barrier site is located in Nanaimo. It's called Nikao. It's a temporary site on leased land from the city of Nanaimo. It was set up in a very short period of time to house people that were in an encampment.

I'll be honest. It has taken a long time to stabilize the site, because it's very high density. It's got over 60 people living there. Not all of them knew each other. The site is not purpose-built. I specifically put the photo in there to give you a view of the type of site that would be challenging for us to serve, because it's really difficult to get to people when they need help when there are long, narrow corridors and people sharing washrooms.

Having said that, we've had some phenomenal positive outcomes.

In purpose-built, fully funded and staffed supportive housing programs, residents have a community to support them. They have harm reduction and safe supply, which results in less fatalities. At this site, in Nikao, we also have 24-hour security. The security guards actually also are trained to respond to overdoses and provide harm reduction equipment to the residents, so people are less likely to use alone.

Our staff are trained. Residents are trained. The community supports each other. One of the outcomes is that, for example, Pacifica responded to five overdoses across our entire portfolio, and fortunately, none were fatal, due to the residents or staff who responded.

At sites where we're not fully staffed, it's a lot more difficult for us to gauge the extent of the overdoses, because we don't have staff on site all the time, which is more of a danger. But often neighbours are able to respond. I will say that we've asked ourselves in the past, when there was an overdose at a supportive housing site where we're not funded for 24-7 staffing: what would have happened if we had had staff on site, someone to respond?

Also at Nikao, our residents are connected to a pharmacy that supplies and monitors safe supply of opiates and other drugs. The pharmacy delivers to residents, and both have support from site staff. So if our residents aren't comfortable with the pharmacist or the individual that comes, staff can help with that relationship-building. What that means is that residents are more successful in their transition to safe supply because it's convenient. They can be found easily and therefore are a lot less likely to miss a dose. Safe supply requires verification and witnessing, which of course can be facilitated through staff.

In terms of the continuum of care, people in Nikao also have access to food and basic needs, which immediately reduces police interaction, charges for theft and other issues that clog up our system, while having them be able to think about their health care. If you don't have food, you can't think about anything else. So once they have food and shelter, we can provide much better outcomes.

At Nikao, we also have regular internal health supports, offered by Island Health, whereby physicians and nurses regularly visit the site, and the impact is massive. This started in 2020, during the pandemic, so this hasn't been ongoing since the opening of Nikao in 2017. What I'm hearing from staff is that it significantly reduces emergency room visits, because staff know when the health professionals will be on site.

For example, if someone needs wound care, they can wait for the physicians to come on site. Our residents rarely have ID when they enter our programs, let alone family doctors, so they would be going to the emergency room for anything and everything if these physicians weren't attending.

It also helps bridge the gap between residents and the health care system. Care on site makes them feel in a much safer space, where they're not judged. They can rely on staff to help them feel safer, because they've built those relationships, as well as advocate on their behalf. They can start building more trust in the health care system, as they often feel stigmatized when they're in hospitals.

[3:25 p.m.]

That talks, so far, about preventing overdose, about harm reduction and safe supply, not just keeping people alive but starting to help them be healthier and safer. It also actually helps them remain housed, alive and able to make better choices about their future.

We do also support those who choose access to recovery. Availability is a challenge, but typically, we will hold a unit for someone who goes to recovery so that they can come back and be housed. However, housing after completing a recovery program is a big challenge due to the lack of sober living and other types of housing and suitable supports.

We welcome people back into harm reduction–focused supportive housing. But what I've heard often, not just from residents…. Actually, we have quite a few staff who are from the recovery community. They want to be in a sober environment, and it's really hard to access. Then, of course, they still need supports. They're not the same supports. Those just are really hard to come by.

I talked about reduced ER visits. Sorry, I jumped around a little bit on this. When physicians come to the sites, our staff has estimated that ER visits have been reduced by about 50 percent.

Now going to some of the barriers. When all of the mentioned supports are not present, the toxic drug supply triggers crises, violence, criminal activity, brain and other injuries due to overdose and, unfortunately extremely commonly, death. Not having purpose-built environments hinders the ability to effectively manage the sites and support residents. Sites that are not purpose-built are at higher risk for fire, violence, overdoses because we can't reach them in time.

I've put a different picture on this slide, which is our Uplands Walk site. It's a purpose-built site. It's beautiful. It fits right into the community. The community of residents is amazing. Having the supports, with that purpose-built environment, takes those positive outcomes to an entirely different level.

It's worth mentioning that not all sites, including many of ours, are equipped with all the necessary supports. The reality is that the people who need supportive housing need wraparound, full supports, if nothing else, to prevent overdose death.

Other types of housing are needed as well, as I mentioned. They require different models and criteria for access.

What we see, from our view in the homeless community, is…. There's a lot more complaints at our sites about people loitering. What's actually often happening — in addition to trying to be safe, in general, and have shelter — is that users are often buddying up with someone who is housed and in supportive housing because they know it's a much safer location.

We're put in the unfortunate position where we're starting to patrol our sites and have people move, which is actually really unfortunate. We know that when we're asking them to move along, we're putting them at risk of overdosing and even dying because they're using on their own. At our Nikao site, our staff has been in the position of responding to people who use alone, across the street, in the park, where someone can see them, so that someone can respond, and we do.

Outreach workers provide harm reduction supplies — and they're very, very needed — whereas overdose prevention sites, as Katrina mentioned, are required desperately to keep people alive. However, it's not going to be a long-term solution. People need to be housed. They need that safe space. They need that community.

In terms of solutions, I would say that housing first, with wraparound supports, is and has always been the answer. It's not housing on its own. We need partners such as AVI, which is what supportive housing providers rely on to be able to deliver those medical services in that safe space. We need a comprehensive plan that includes target numbers of units with target numbers of supports.

[3:30 p.m.]

We need more purpose-built supportive housing and services such as AVI's to be able to provide this life-saving help and ensure that people can make the choice, their own choice, for more positive outcomes, where they're safe and they're contributing to their own communities, as they do every day when they live in supportive housing. The staffing model is really important, as well as sober living options.

The last thing I will say is on a robust program to attract and retain professionals in the field. I know that we've talked about this a lot in the medical realm, but also, I think, the services that supportive housing staff provide are extremely specialized. They're trained in a lot of areas. I think that's not recognized enough. That is why we often have a very limited pool of people that we're working with to be able to provide these supports.

Thank you again for allowing me this time to speak. I'm also thrilled to have the opportunity to listen to Jeffrey next, whom I recently met and learned a little bit about everything the Salvation Army is doing.

Thank you again, and best of luck with this project.

N. Sharma (Chair): Go ahead, Jeffrey. Over to you. That was a good intro.

SALVATION ARMY

J. Baergen: Well, I thank you for that. Nice to see you as well, Katrina, Niki and some other familiar faces, actually. So thank you for this.

My name is Jeffrey Baergen, and I'm the executive director of the Salvation Army Addictions and Rehabilitation Centre here in Victoria, B.C. I've been working in the social services sector for more than 20 years now. I began my career in the field as an outreach worker in the Downtown Eastside of Vancouver, where I spent ten years working for one of the largest social service providers in the city. My job then was to care for vulnerable humans on the streets, in the alleyways and in the SROs of the Downtown Eastside.

Of course, it was at that time that Insite came on line, the first legalized safe injection site in North America. As a proud and vocal supporter of Insite myself, I watched all of the positive change that Insite made in the community — positive, incontestable change. Most noticeably, of course, was the steep decline of HIV/AIDS, hep and overdose in the city.

I am a proponent of any program that prioritizes health. I'm a proponent of overdose prevention programs. I really want everybody to hear that clearly as I begin, Carolina and Katrina. As you all know, when I started working in the Downtown Eastside, that was long, long before Narcan or naloxone. That was a period of time when people just died; we just buried people. So I'm a huge proponent of harm reduction. Thank you for letting me say that three or four times.

Since the early 2000s, I've watched the industry move from what was, at the time, a controversial clean-needles and pipe supply, from one safe injection site in North America and a top-secret managed alcohol program to what it is today. Safe injection sites are common in most cities— overdose prevention units, safe inhalation sites, managed alcohol programs, safe drug supplies. And, of course, no-barrier shelters and low-barrier housing that actually operate as all of the aforementioned programs, all in one place — with sometimes, occasionally, maybe even often, an insufficient number of unqualified staff charged with managing clients with complex mental health care needs.

Knowing my audience, clearly I'm speaking to those in the know, so I'll assume that we all agree that a wholesome, fulsome, robust, complete continuum of care is the ideal paradigm that we're all striving to achieve. It's easy to imagine an infinite number of doors, access to an infinite number of services tailored to an infinite number of unique individuals experiencing every kind of psychosocial health challenge. Let's agree that that's the perfect archetype.

Unfortunately, however, our continuum of care has become as polarized as our politics. On one end of the spectrum, abstinent recovery; overdose prevention on the other, and very little in between. Overdose prevention advocates and service providers coined the phrase years ago: "We keep people alive so that they can make a different decision on a different day." Recovery is that different day, and unfortunately, if current resources and funding streams continue to almost exclusively support overdose prevention, then there simply may not be services available for that different day.

[3:35 p.m.]

Social services that provide recovery options for our community have been a little bit neglected as policy-makers, politicians and health authorities double down, year after year, on what some believe is a magic bullet: overdose prevention. Yet every month we set a new provincial record for high overdose fatalities in our province.

At the Salvation Army in Victoria, our multipurpose facility provides live-in programming to nearly 200 men. Our facility has 91 emergency shelter and transitional housing beds available to our city's homeless community. We're full every day, yet only 21 of those beds are funded.

We've been providing compassionate care to Victoria's marginalized communities struggling with poverty, homelessness and addiction in this city since 1897. It's a true story. We've actually been on this corner for more than 95 years — at Johnson and Wharf. We've been committed to providing a safe, drug- and alcohol-free space where humans can heal and reconcile their lives since the day we first opened our doors.

Our wait-lists are infinite. We don't have empty beds. Yet we struggle to garner support anymore, because we prioritize the clients in our care who come to us actively seeking out a safe, drug- and alcohol-free place to be. As you're also aware, on Vancouver Island, were almost it. We're one of the last standing drug- and alcohol-free facilities of our kind on the Island.

The commitment of the Salvation Army in Victoria is to end the cycle of homelessness for those in our care. Our intention is to educate, empower and equip clients in our care with the knowledge, skills and abilities necessary to be successful outside of our facility. At the Salvation Army, we've adopted an anecdote that's become our mission: "We love you so much, we never want to see you again." We think we're hilarious. But in that is our truth. Everything we do is to get people healthy enough, relatively, to maintain the housing once they're able to secure it.

We believe wholeheartedly that only a health-first approach can end the cycle of homelessness. We know that putting unhealthy people into places doesn't work. We know that. When we put unhealthy people into housing, it's not long before, for whatever reason, they're evicted. They lose their housing. Then we put another unhealthy person into housing. It's not long before they're evicted, and so on — the endless cycle of homelessness.

I've personally struggled for years to understand how a housing provider has been charged with resolving a health crisis. Poverty, addiction, mental health, overdose — first and foremost, primarily, it's not a housing issue. It's a health issue.

I did want to talk a little bit about things since COVID. In March 2020, COVID-19 was declared a pandemic in B.C. When that happened, Victoria saw a mass exodus of humans fleeing our shelters for fear of living in close proximity and shared accommodation. Rather, our sheltering community opted to tent outdoors where they felt safer.

The immediate migration compounded a number of already existing problems. The homeless community tenting in Victoria's parks bred contempt for our city's marginalized like we've never seen before. The inability of the unhoused community to maintain physical distancing elevated the risk of infection and spread. A change in the drug supply, met with increased desperation, led to increased toxicity and riskier drug use and behaviour and, contrary to some belief, a very real migration of homeless people from other communities came. We can testify to this, because we came to know them through our emergency meal program.

As a response, the city and the province stepped into high gear and managed to secure more sheltering space than we've ever seen before. Between the province, the city of Victoria and the CRD, the community bought, rented, leased, borrowed, even appropriated every square inch of real estate that we could find. Eventually, we opened an additional 500 beds for community sheltering outside.

With every good intention of keeping the unsheltered community indoors and in place to minimize spread, the next exceptional emergency measure to be put into place was the implementation of a safe drug supply and managed alcohol programs. We know, and we trust, that everything done for our vulnerable community during this time was done to care for the people in the best way we knew how, and everything was done in an attempt to curb the spread of COVID and keep our people safe.

I'm super proud to live in a city that is as adaptable as we are, but there have, however, been a number of unintended consequences as a result of these efforts. Most noticeably for us here at the Salvation Army, since the onboarding of what we have come to know as the homeless hotels, the appetite for recovery in Victoria has diminished markedly.

[3:40 p.m.]

Pre-COVID the wait-list for our drug and alcohol recovery program was infinite. Since COVID, with the homeless hotels coming on board, we've been operating at approximately 30 percent of capacity. It's my understanding that we're not the only program that could say the same thing.

We had a client in our care who'd been sober for months. His health was improving. His life was on the mend. Then he was offered a hotel room — private room, private bathroom, three squares, drugs and alcohol delivered to his door. On his way out, he told us that this was every addict's dream come true and left our care. He was one of many. People opted out of recovery to go to safe supply.

We are staunch supporters of overdose prevention models. We know that it's a critical part of the continuum of care that we're striving for, but as a result of some of these services that are provided, there's been a shift from providing for humans in their care to actually enticing humans into their care, humans who struggle with addiction.

My appeal to you as decision-makers and policy makers is to really consider a health-first model. Anywhere, any time in the city of Victoria today, a human in need of a pipe, a syringe or a safe place to smoke or inject can find that support. But to a human asking for recovery in the city of Victoria, we say: "Sorry, friend. Come back in eight weeks. Detox is full."

In recent years, we've seen every available resource invested in overdose prevention models. It seems sometimes, through a recovery lens, as though policy-makers double down on what they believe is the only way. An argument is that it can't be the only way, because every single month more and more people are dying. Everyone is saying that, on that end of the harm-reduction model, and that we just need more and more and more. I think the numbers aren't speaking to that being correct. There's so much out there, yet more and more people are dying.

At the Salvation Army, we've been meeting people where they're at for 130 years in Victoria and Canada. You all know who we are. We're the largest shelter provider in the country, and we're in 152 countries. We're a bigger organization, but we've been around for a long, long time. We know sometimes we get the reputation of not being up to speed, but I'm telling you from the 200 men who are in our care, who are in desperate need every day of a safe place to be, there's still a real need for recovery options.

I just hope and pray that people remember that. It is a really, really important, critical piece of this continuum that we have to continue to provide. We've been meeting people where they're at for more than 100 years. We just sometimes feel like we care too much to leave them there.

Thank you for allowing me to say all these things in this very safe space.

N. Sharma (Chair): Thanks for that. We'll switch over to questions and discussion.

R. Leonard: Thank you, everyone, for your passion. Yeah, it is a safe space, because everybody needs to weigh in on what we're looking at here.

Jeffrey, I just want to ask you…. You say: "health first." You spoke of unintended consequences of providing housing. I'm curious, when you say, "health first," if you have reservations around housing first. I'm just trying to figure out what this is, the path that you're talking about.

I totally appreciate all that you've said. You've said it with great passion and really great clarity. I'm trying to look at the consequences, as well — first of all, of understanding what you mean by "health first," and then of the potential unintended consequences.

[3:45 p.m.]

J. Baergen: Sure. Just to be super clear, the reason I don't say "housing first" is because I genuinely believe that we're not…. You know what? With the exception of some new things that have come online recently, I'm not certain that what we're seeing in B.C. is the intention of what housing-first was supposed to be.

If you look at housing-first and the intention in the Chez Soi and all of the things, housing-first was actually supported with wraparound services and all of the things it was supposed to be. But when we look at some of the models that are out there and that are deemed housing-first, they're not housing-first, as intended. They're a roof.

I'm super careful always, because you know B.C. Housing funds us. We support the housing-first model as it was supposed to be. Carolina was just talking about all of the supports that she has in her new facilities, with staff and health care and all of the things that it's supposed to come with. The models that we see, a lot of them in the city, aren't that. They're literally just a place where people have a door and no further supports. There's a difference between that and housing-first.

I often use the term "health first," because it's safe. It's safer than…. Again, I don't believe housing-first is what it's meant to be or what it should be or could be. When you say "housing first," people get quite hotter than I can get sometimes.

Does that answer your question? I'm trying to be….

R. Leonard: No, no. I understand, and I understand the housing-first model. There are a lot of different conditions that are around proper housing first.

I guess, in terms of health first, are you talking…? Yeah, I'm still just trying to put the two together. How you can…. You started off talking about harm reduction — that you have to be alive to be able to seek recovery, if that's the path that you choose. I know that we're putting money into housing. We are putting money into different treatment beds and different modalities, and it's a historic amount.

I'm curious about how we would cut up the pie. This is a question I've asked a lot of different people. How would you cut up the pie for mental health and substance use if you have that control of the knife?

J. Baergen: With the first part of that question, when I'm talking about "health first," I'm talking about getting people healthy enough so they can be successful in housing. That, of course, looks like a million different things.

I've got guys in here who just struggle with poverty. That's it. They just need some help affording their place to live, and we will equip them that way. But there's so much….

The majority of the clientele that we deal with here have complex mental health. They literally cannot handle, or they cannot manage, living on their own. Then you think this is the kind of client who definitely could use a wraparound, supportive housing-first model, or maybe a doctor. If you literally are too unhealthy to manage a place, then housing doesn't help. Health-first is about being healthy enough that you can be well outside of supportive facilities like ours.

How would I cut up the pie? You know, I really meant what I said. We've got two ends, and there's so much missing in the middle. Half of our guys here are over 55. True story: a huge percentage of the people in our care have brain injuries, and there's not a lot of support for that. I know that a vast majority of people who are on the street struggle with mental health and addiction issues. I'm not suggesting that we do less of anything. I'm suggesting we do more of everything.

[3:50 p.m.]

It's a true statement, and a fair statement, to say that it's a lot harder to find funding for our piece of the pie than it is for the others. True story: if I went out today to VIHA and I said, "We're going to go to a housing-first, no-barrier model, and we'd like an OPU in here," the funding would look a little different. I hope that I never…. That's not the plan. Just saying.

M. Starchuk: Thank you all for your presentations and the differing but similar views with putting people first at the end of the day.

My question is around, Katrina, some of the comments that you were making and the funding formulas that were coming and the windows of opportunity, and there were a couple of things that you said. I'm really glad to see that when it comes to OAT, taking a look at where those people are six months later, 12 months later, and reporting back those numbers that are there…. You said that your rate was 90 percent. I'm not sure what the time frame around 90 percent was.

Also, you talked about being accountable for the funds that you're receiving for what's there, so if you could define what "accountable" really means.

K. Jensen: I'll tackle that first, and then I'll come back to the OAT retention. The procurement process, the fair business practice that the Health Authorities Act is governed by, means that non-profit agencies…. Even Jeffrey couldn't go to Island Health and get an OPS without having to jump through a lot of hoops. And Island Health has been saying for months that they're not going to put any more money into harm reduction.

That system is set up because the government is concerned about its funds and where they go and wants to see really strict parameters around them, and all of that is fair enough. But my point is that with Health Canada, we're under a grant process. There is accountability built into that in terms of financial reporting and audit reporting, but it's just not the same level of accountability that we see from the RFP process, the request-for-proposal process, that's under the Health Authorities Act. The health authorities don't have a choice.

This is what they have to work with. I imagine it works well with a whole bunch of services like getting a boiler replaced or having a maintenance contract or any of those things. It just doesn't work for community-based organizations, and we're all pushed in together into this model.

What I'm suggesting is that there be a separate stream through either the Provincial Health Services Authority or through some other provincial organization as a dedicated funding stream that community-based organizations can access that's for core, ongoing funding for some of these services, rather than having to rely on this other model.

Does that answer your question?

M. Starchuk: Yeah. I guess what I was really looking at is that when you evaluate, and you're responsible, and all of those things…. I was wondering if it was more along the "take a look at the intake of this many people, and this is how many people that we have in the continuum of care."

K. Jensen: Oh, yeah, for sure. All of that is provided to Health Canada as well.

The OAT retention rates. We, until recently, operated a clinic in the West Shore area, and we continue to operate one in Nanaimo. We were part of the provincial initiative run through the B.C. Centre for Excellence in HIV/AIDS a few years ago to increase retention rates for OAT. As a result of that, we were at 90 percent, both at six months and at 12 months. We basically…. It's a multidisciplinary team. The physicians aren't, on their own, prescribing these medications.

Monday morning comes around. We're on the phone, making sure that anyone that didn't pick up their scripts over the weekend had the chance to connect. We provide outreach to people. We take medications to them. We take an iPad to them so they can talk to their doctor.

In the West Shore, where we unfortunately had to close, it was a really good example of an area where there are a lot of people who are using alone. The majority of our patients were men who had been using alone, and through the access to OAT, they were able to achieve health and wellness and get back to work and school. It was really amazing to see that happen.

[3:55 p.m.]

P. Alexis: I am still fascinated by Ronna-Rae's question and Jeffrey's position.

I have a question for you, Jeffrey, about the complex care beds that the province is opening up, where we recognize that there may not be just one issue, like addiction, and that there might be other issues — mental health issues, etc. — where that wraparound service and services would be available. Are you familiar with that, and can you speak to that? It's a new program. We have, I think, four pilot projects in the province, and I would really like it if you could look at it and see if it fits where you see us going.

Your comments about housing are right on as far as what a lot of people have said over the last few months — that it's a necessary ingredient. But the health, of course, is on par with the housing. So these complex care beds…. I am very hopeful that it will be more of a multi-pronged approach to the healing of the person. And I get it. I remember, as former mayor in Mission, one that we housed who spent six years street entrenched and lasted two weeks in housing because it just was so different. There was not much leading up to the readiness of being in housing and how it would help support, not hinder.

I think in my community, we did even try mini courses to kind of prepare people for being housed, and it did help some. But I am fascinated by your perception, and I would really like for you to look at the complex care model and see if that satisfies where we need to go.

Just a comment, and if you want to comment back, thank you so much.

J. Baergen: I would just like to say thank you. Sometimes when we, on this end of things, share our perspectives, it's not the most popular, so I appreciate it. It's very encouraging. I'm definitely going to look at it.

I will say that for those of us — I know Katrina, for sure — who've been around in this industry for such a long time, this was not new. I remember, 15 years ago, asking B.C. Housing for their eviction numbers, which they would never…. You'd never find them. They were happy to post how many people they were getting in, but you could never find how many were going out.

When you know the community as well as I did, particularly in the Downtown Eastside…. I knew the community by name. You'd be having a party one day for one of our clients, and then you'll be having another conversation a week later because they'd burned it down. It's a real thing. There's no argument there.

So getting people the skills and abilities, the tools that they need to be successful in the limited housing that we have — I think that's definitely the start. Yeah. Thank you. I will find it and look.

N. Sharma (Chair): Okay. I don't know if Carolina or Katrina wants to comment on that, especially Carolina. You do housing.

C. Ibarra: Yeah, absolutely. I think there are a couple of things that this discussion has brought forward. One is the need for collaboration, right? If you have the health care and harm reduction, but you don't have housing, you're still going to need that at some point. If you have housing but you don't have health care, don't have recovery for those who choose it, there's still going to be no success. So from my point of view, you need them all. There needs to be a continuum.

[4:00 p.m.]

In terms of housing readiness, the challenge, I think, is with the semantics, because people need different things at different stages. If you try and force someone into recovery who's not ready for it, they'll fail. I can share that my father is…. In his own terms, he's an alcoholic. He hasn't had a drink for almost 40 years now.

When I was little, my parents were very open about that, and they would…. You know, I had this idea that one day my dad was like, "I'm not going to drink anymore," and my mom set me straight. He tried many times. It was the moment when he was ready, and he had the supports.

Now, if someone had taken him at the age of 19 and told him, "You have to become sober in order to have a home, in order to get supports," he would have failed. I think we just need to…. I want to make it clear that I'm not contrary to what Jeffrey is saying. I actually think we quite agree. It's just that we have to have the entire continuum.

Housing remains core, though. We often try and make solutions based on the fact that there isn't enough housing. There is not enough health care. The supportive housing that there is — very little of it actually meets housing first. I have been in the meetings related to complex care, and I think it's an additional service that's very much needed, but in all the consultations, all us housing providers said the same thing — or most of us: complex care or supportive housing properly funded.

There are no new units. There are no new beds. I don't know. Maybe in some of the other jurisdictions. There aren't in Nanaimo, and there aren't in Victoria. It's basically services at existing sites, which is not a bad thing. It's a very good thing. I do worry that the impression that is being shared is maybe a little bit misguided.

I don't know if that answers the questions. I do think that, in different language, Katrina, Jeffrey and I are probably on a similar page in the sense that we need to provide all of it. People don't live linear lives. They're in a different space at a different time in their life. If we want to support them, we need to have those services available, whatever they are, at whatever time.

N. Sharma (Chair): Go ahead. Shirley.

S. Bond (Deputy Chair): Thanks very much. Really appreciate the conversation.

Jeffrey, diverse opinions and voices matter in this discussion, because if we keep doing the same thing over and over again, try doing it faster or whatever, we're going to get the same outcomes. So I really appreciated you having the courage to say what you did.

From my perspective, it's not either-or health or housing first. It's both.

The last comment is absolutely accurate about complex care. I asked this question in estimates, and I won't digress, but it is not about new beds. From my perspective, wraparound services mean just that: wraparound support. You can't just create spaces and have a receptionist at the front desk. You know, there's a whole discussion that has to take place about that. I really appreciate the candour of this discussion and agree with much of it. From my perspective, it's not either-or.

I would like, though, to ask Katrina a question, because she referred to something, and it was really…. You just sort of skimmed by it in your conversation about safer supply. I think that is what you were referring to. I just would like to go back for a moment. It seems like a while ago now that you said it.

You said that the policy exists. It just needs to be enacted. Can you give me some details around that? What policy are you talking about? Is it related to the allocation of funding that was provided for safer supply? You asked about: had we seen results related to that? So can you just go back to that for me and tell me what you were talking about? What policy exists, and what needs to be enacted?

K. Jensen: Yes. I was talking about the policy that was released last July by the Ministry of Mental Health and Addictions on access to safe supply. That's the policy. Then there was the funding that was allocated in the budget, which I guess was last February or March.

That money was given to the health authorities. So, yeah, my question is: were you told or are you being told where that money is at and how many services the health authorities have implemented and where they're at?

[4:05 p.m.]

S. Bond (Deputy Chair): I actually think that's a pretty fundamental question to the work we've been assigned to do, which is to explore the concept or the utilization of safer supply in British Columbia.

I think knowing that there has been policy put in place about the provision of safer supply, outcomes matter. What has happened? Has it worked? Where has the money gone?

It's not like we're starting from ground zero here, which is…. A lot of the discussion that we've heard about is, "We need this; we need this; we need this," but that's exactly what I thought you were referring to.

I think that in our work as a committee…. I know that the Clerks and staff are listening. I mean, that is a fundamental piece of what has already been done in this province. Does it work? What are the outcomes? Where did the money go? Those kinds of things. I really appreciate you raising that.

You just sort of skimmed by it, but I think it's really foundational to one of the tasks that this committee has been given. It's not starting from scratch, in fact.

I'll leave it there and let you comment.

K. Jensen: Yeah. And it's not about…. It's the same with OAT retention. It's not about how many people have accessed safe supply, because that just means maybe they picked up a medication once. Safe supply refers to a whole range of medications, and sometimes it even refers to OAT as well.

It's about where that money has gone. How many programs have been set up? Are they working? Are they flexible? But also, how many people are being retained on safe supply at six, three, 12 months? It's the same as OAT. If people aren't on it every day, then it's not going to be effective.

S. Bond (Deputy Chair): I just think it's important from the perspective that outcomes matter, and steps have been taken in the province. Part of our job is to look at: did that work? Is working? Is it expandable? All of those questions — based on that.

I just really want to thank you for that, and thank you again to the other presenters. I've really appreciated the discussion.

K. Jensen: Part of my point in making that is that AVI was able to show with our Health Canada funding that it can be done. You can rapidly implement safe supply programs if you're given the resources and the flexibility to do so. So why aren't there more of these across the province?

N. Sharma (Chair): Yeah. Thanks for that. I do think that that was an important comment that you made early on about the discrepancies. We had a panel earlier on in our Health Committee that brought in the different health authorities to talk about where each health authority was at in terms of their programming, and certainly I think we all noticed that there was a discrepancy across health authorities when it came to harm reduction sites, opioid prevention sites, safe supply and also different programs in each health authority. I think that's a definite thing that we've all noted.

I actually don't have a question. I had more of a comment on how interesting this panel was in terms of the front-line service delivery, the recovery and the housing perspectives that you provided and how, to me, it really is the balance of the supports that are needed to tackle this. I think one of our presenters called it a very wicked problem that involves a lot of interventions at different times and important places. I feel like all three of you provided your perspectives pretty clearly on that, and what you're seeing is working from different angles. I just really appreciate that.

I didn't see any other questions from any of my colleagues, so I just want to, on behalf of the committee, thank you for coming and presenting and for all the work that you do every day and all the lives that you're touching in this province and in the area you serve. It's really important, and we really appreciate connecting with you today. Thank you.

Okay, committee members, we just need a motion to adjourn for the day.

Pam I see, and then Ronna-Rae for seconder.

We'll see everybody tomorrow.

The committee adjourned at 4:09 p.m.

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