Pilot project to pay B.C. drug users to go through treatment coming under criticism

A pilot project that would pay people $20 a day to participate in a drug treatment program out of St. Paul’s Hospital’s Road to Recovery Program is coming under criticism from an advocate in the field.

Tyson Singh Kelsall, a Downtown Eastside social worker and health sciences PhD student at SFU, says he fears the project — which is set to begin in 2024 and aims to expand addiction services to meet increasing demands — can actually further endanger drug users, because once people finish inpatient programs, they are even more susceptible to the toxic street supply.

“Ultimately, what we’re seeing right now in emerging research … in the era of the toxic drug supply is that these inpatient programs actually increase people’s risk of death and overdose,” he said.

That, he explains, is because the people going into these programs come out with a lower tolerance to drugs. If they use the same amount of drugs after leaving treatment as they did before they started the program, it can lead to deadly outcomes.

The program is led by Guy Felicella, a peer clinical advisor with the BC Centre on Substance Use, who had previously suggested this approach in response to the idea of involuntary treatment.

Felicella tells CityNews that this program can provide financial support to those in treatment by removing a lot of barriers for people so they can focus on other meaningful things outside of recovery.

“When you go into recovery treatment, you get about 90 bucks a month … and you can’t really do anything outside of a treatment facility, like buying a gym pass or taking somebody for lunch or your kids. It’s very hard to do life things and we want people to practice healthier coping mechanisms,” he said.

Felicella adds that tolerance concerns can happen with any type of medication and “this program is for people who are trying to stop, not for people who aren’t.”

“We can’t say to people, ‘Don’t bother going because your tolerance will go lower if you go back and use again,'” he said.

“There’s just as much risk as using the toxic drug supply, given how unpredictable it is … and then in treatment, you can be on evidence-based medications in a lot of places.”

But Kelsall says he is concerned that this project “essentially bribes people.”

“It’s coercion, right? If people are already stuck [and] already have very few resources to be brought into this program, that very likely is going to cause harm.”

He adds that the pilot program is being funded by an anonymous donor who is planning on giving $500,000 to the project.

“If someone has $500,000 of unconditional funding, it can be used to definitely better people’s lives, to create safety maybe for a small group of people … but this neo-liberal, individualized solution to the systemic-poisoning crisis is really concerning because a lot of people will be harmed, most likely.”

For the third straight year, the BC Coroners Service says at least 2,039 people have been killed in a year by the unregulated toxic drug supply. That came even as there were more than two months to go in 2023’s reporting period.

According to the latest figures, 189 people were killed in October, marking the 37th consecutive month where at least 150 people were killed by toxic drugs.

“Unregulated drug toxicity is the leading cause of death in British Columbia for people aged 10 to 59, accounting for more deaths than homicides, suicides, accidents, and natural disease combined. The lives of at least 13,317 British Columbians have been lost to unregulated drugs since the public-health emergency was first declared in April 2016,” the Coroners Service in November.

Kelsall says there’s no room for error in the ongoing drug crisis.

“We are living through an era where using a toxic supply once after a period of abstinence can lead to death,” he said.

“Until we have a regulated drug supply, it’s going to be really difficult for people to detox, and it’s going to be really risky to run through these programs.”

Felicella says that this project will be important for the community’s harm reduction service.

“We can’t have recovery treatment without harm reduction services,” he said.

Key details of the program are still being finalized before the 2024 start date.

-With files from Charlie Carey