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Innovative Responses to BC's Opioid Crisis
This story was originally published in the 2018 issue of the Vancouver Foundation Magazine.
Written by Robin Brunet
No matter how much media attention it receives, the opioid crisis is still too frequently perceived as a problem plaguing the disadvantaged.
The British Columbia Centre on Substance Use (BCCSU) is trying to combat this dangerous misconception as it pursues its mission to support the development of an addiction system of care – the absence of which is contributing to the ongoing opioid overdose crisis. “The system of addiction treatment in BC isn’t broken, because there is no system,” says BCCSU Director Dr. Evan Wood. “At least, not one that is effective and equally accessible to all.”
This is compounded by the stigma associated with substance use. Marshall Smith, a senior advisor for the BCCSU working alongside Dr. Wood, explains why the stigmatizing perception of substance users is so persistent: “At one end of the spectrum you do indeed have those who are on the streets because they’ve reached rock bottom; and at the other end you have people wealthy enough to get the best treatment for their addictions.
“But 95 percent of the substance-using population consists of people in the middle: working professionals with careers and families. They can’t afford top-drawer treatment, and they don’t qualify for the public care those at the bottom receive – until they become so sick they lose everything.” As the huge gulf between the perception of people addicted to opioids and the reality implies, considerable community engagement must happen in order to bring about real change – which is why grants of $1 million and $224,000 from Vancouver Foundation to St. Paul’s Foundation (the fundraising arm of St. Paul’s Hospital, of which the BCCSU is a unit) were recently given for Dr. Wood’s organization to support not only drug checking and clinical trials, but also engagement with those who have first-hand experience with addiction and the treatment system.
“95 percent of the substance using population consists of people in the middle: working professionals with careers and families. —Marshall Smith, Senior Advisor, BCCSU
Specifically, the BCCSU hired three people to engage with three groups: peers and patients (people who use drugs); families and caregivers affected by addiction; and the recovery community. Smith is one of those leads. A former B.C. government bureaucrat, Smith became addicted to cocaine, eventually leaving him unemployed and living in a shipping container. Following recovery, he built a career in the addiction treatment field and engaged provincial and federal governments on addiction issues.
Another lead is Dean Wilson, a former substance user who became a high-profile street-level harm reduction activist. The third lead is Leslie McBain, who in 2014 lost her only child, Jordan Miller, when he was just 25 years old, to an accidental opioid overdose. McBain joined with a group of similarly bereaved mothers to work for harm reduction changes to drug policies at all levels of government.
Under the BCCSU banner, these three leads have met with provincial officials to identify priorities and develop recommendations to address gaps in the addiction system of care. “Previously, people with addiction haven’t been well represented at the policy table, but we firmly believe a big part of the solution lies in listening to people who use drugs and their families,” says Dr. Wood.
Fortunately, the BCCSU’s efforts are starting to pay off big time. Dr. Wood says, “Just recently we released a guideline for treatment of opioid addiction. We’ve finally come up with a blueprint that will have national ramifications in the way the medical community responds to this problem.”
"We’ve finally come up with a blueprint that will have national ramifications in the way the medical community responds to this problem." —Dr. Evan Wood, Director, BCCSU
Key recommendations in the guideline include avoiding practices such as rapid withdrawal, “because this results in an 80 percent chance of relapse, along with an increased tolerance for the drug that compels the patient to consume even higher levels,” explains Dr. Wood. The guidelines also call for the use of buprenorphine-naloxone as the preferred first-line treatment over methadone, in part because it comes with a lower risk of overdose and milder side effects. The BCCSU has also made considerable headway training health-care providers in addiction medicine, including leading the largest addiction medicine fellowship program in the country.
“About 180 medical students annually go through our program,” says Dr. Wood. “However, we view this only as a good start – there’s still a huge amount of work ahead, plus we need much more investment in addiction recovery facilities.” Nonetheless, the trajectory is upward, and the three knowledge holder groups will also be releasing reports with their recommendations. “We will soon initiate significant conversations about systems change,” Smith concludes. “We’re optimistic that this time out, policymakers will listen.”
THE CHALLENGES OF TODAY
Vancouver Foundation takes its role in identifying urgent community needs very seriously and, as a community foundation, has a responsibility to take action.
Since 2014, our foundation has granted nearly $2 million to assist with the opioid crisis. Our financial support has landed in five main areas including: public engagement, knowledge exchange, drug checking services, clinical trials, and assisting frontline agencies.
Through our community granting programs, we’ve provided funding to major public health institutions including St. Paul’s Hospital and the British Columbia Centre on Substance Use. We’ve directed support to leading charities including the Canadian Mental Health Association (CMHA) BC Division, Public Health Association of BC, and the Community Action Initiative.
We’ve also provided funding to major academic institutions including the University of Victoria’s Centre for Addictions Research. None of this work would be possible without the generous support of our donors, several of whom have also made significant grants (through their Donor Advised Funds) in support of this important issue.