Dr. Bonnie Henry speaks to ‘massive gap’ in B.C. addictions help

Editor’s note: A previous version of this article incorrectly suggested Dr. Bonnie Henry was speaking about the COVID-19 pandemic. This story has been updated to correct that she is speaking about the opioid crisis.

Just weeks after B.C. marked six years of officially being in an opioid crisis, the province’s top doctor spoke to a “massive gap” in support and acknowledged there are still too many barriers.

“We can’t stop people from using drugs right now,” Provincial Health Officer Dr. Bonnie Henry admitted to the Select Standing Committee on Health.

Henry estimates about 60,000 British Columbians have a substance use disorder, and due to several reasons many are not accessing treatment.

“Not everybody is at that place for recovery as an option and we’re also learning that everybody’s recovery journey is unique because of where they’ve come from and their background and their life.”

She says it’s complex problem, and the province needs to provide more compassion to those who use drugs and work to educate and bridge the gaps.

“If anybody’s had fentanyl, it’s a great drug and [I] certainly had it when I had a colonoscopy not that long ago and you can see why people feel good on this drug and physical dependence on opioids can happen very quickly. And that’s one of the things that we work on,” Henry said.

“We work on with surgeons, for example, giving people small amounts of opioids for pain after surgery, because you can get physically dependent on it very quickly. But for some people, it’s that physical and mental dependence that happens and then it becomes you need more just to see it start to continue to feel normal.”

A province-wide problem

Henry says they know illicit drug deaths in young to middle-aged men have surged during the pandemic, and often they are men who live alone. She says a large portion of these men worked in the trades and efforts are ongoing to reach out to those industries to put programs in place to help.

However, while men make up the largest group in terms of deaths, the loss of life in the Indigenous community is also rising, especially among First Nations women. Henry suggests systemic racism leads many to hide instead of seeking help.

“They are reticent to get help for their issues because the same organization that takes their children away is the organization they have to go to to get help. I believe and I expressed this many times that we need to move Children and Youth Mental Health and Substance Use back into Health so that we can understand it and build those more longitudinal supports for people so that there’s not that massive gap when they go from one system to another.”

Dr. Nel Wieman, Acting Deputy Chief Medical Officer at the First Nations Health Authority, says they continue to see Indigenous people disproportionately affected.

“The loss of First Nations life is now more than 1000 family members, extended relatives and friends,” Wieman said. “This loss of life is immense in both absolute and relative terms. While First Nations people represent 3.3 per cent of the provincial population today, in 2021 15 per cent of the toxic drug deaths were among First Nations people. This means that First Nations people died at 5.4 times the rate of other residents of B.C..”

She says First Nations women die at 9.8 times the rate of other women in B.C.. She says they are also able to see that those numbers go up following child apprehensions.

“I can’t stress more strongly how important the ability to develop trust is not just for First Nations people but for people with mental illness and people with substance use issues,” Wieman said.

Henry says it’s important the systems in place are there to help people, and not put those people in places where they will be unfairly penalized. She adds decriminalization is a factor, a message which advocates and many government officials have echoed in recent years. While federal approval is still needed, Henry says it’s just one of several courses of action needed; another is to make sure doctors have more training in addictions.

Henry says some doctors are still encouraging patients to quit doing drugs, which shows a lack of understanding of the complex issues at work.

“Abstinence is an important treatment modality for people who have addictions to alcohol, but it does not work for opioid addiction, because it is a chronic, relapsing brain disease. And we know that abstinence is, especially in the same ways that we did it with alcohol, just doesn’t work for people who have a dependency on opioids,” Henry said.

Both Wieman and Henry say there are gaps in the provincial systems, as well as at the primary care level. Both agree family doctors need additional training in addictions, so that they can know what to do and how to help effectively with up-to-date resources.

B.C.’s public health emergency

The province recently marked a sombre anniversary. April 14 marked six years since B.C. declared a public health emergency over the increase in overdose deaths from illicit drugs. Since then, more than 9,400 people have died, and experts say the toxicity of drugs has only gotten worse.

In the first year of the emergency, formally known as the “Fentanyl Crisis,” 900 British Columbians died from illicit drugs. 2016 toxicology reports found illegal fentanyl was detected in 60 per cent of them, which was a massive increase in the previous years reporting connected to the opioid, which is 100 times stronger than morphine.

November 2016 was the first month ever in which deaths surpassed 100.

It’s now been nearly a year and a half since B.C. reported fewer than 150 deaths per month connected to toxic drugs, which have only gotten increasingly inconsistent and volatile. Extreme fentanyl concentrations have jumped in the last year alone, found in 21 per cent of deaths, compared to 13 per cent in 2021.

Related Articles:

• Six people under 19 among B.C.’s skyrocketing drug death toll

• B.C. advocates say feds proposed lower threshold for drug decriminalization is harmful

• Jurisdictions looking to decriminalize small amounts of drugs to curb overdose deaths

Last month, B.C.’s mental health and addictions minister said the province is doing everything in its power to address this crisis.

“If this public health emergency could have been ended, if we could be saving lives with the tools that we have as a province, it would be over by now,” Sheila Malcolmson told CityNews.

She admitted the province’s efforts have not been enough, and touted her government’s push to decriminalize possession of small amounts of opioids (including heroin and fentanyl), powder cocaine, crack cocaine, and methamphetamine.

Saying “there’s no single magic bullet” to fixing this, Malcolmson argues multiple approaches including reducing wait lists, increasing access to detox treatment, and overdose prevention are all key to reducing deaths.

There have been calls for more accountability in this public health emergency, including some demanding the premier remove Malcolmson as the minister in charge. Malcolmson defends her ministry’s efforts, arguing the B.C. government is trying things unique from other jurisdictions in Canada.

“We’ve given nurses the ability to prescribe medication-assisted treatment. We’re prescribing safe supply, nobody else is. We’ve pursued decriminalization, nobody else is. That’s all under my watch. If my resignation saved a life, absolutely. But I hold British Columbia’s effort up against any other province.”