IT’S TIME TO TALK TREATMENT

Second pillar of drug strategy needs more focus, Daniel Jordan and Jude Walker say.

The recent spike in overdose deaths in the province has rightly attracted media and government attention.

The 170 people who perished in May are added to the 4,300-plus others who have already died in B.C. as a result of what has been termed the opioid crisis. These deaths of despair could have largely been prevented through people using with others, accessing safe ingestion sites and a more regulated drug supply, all supported through decriminalization and perhaps even legalization of drug use. Petty shakedowns of marginalized peoples using drugs are, thankfully, now widely viewed for what they are: cruel enforcement of outdated laws. While we applaud the province’s decision to ease access to safe drugs and Dr. Bonnie Henry’s endorsement of decriminalization, we note the absence of much conversation on treatment — the second pillar of Vancouver’s Four Pillar Drug Strategy, which was laid out in 2001 by then-drug policy co-ordinator Donald MacPherson.

THE FOUR PILLARS

The four pillars to drug policy comprise prevention, treatment, enforcement and harm reduction. Talk of a four pillars approach to our drug strategy was all the rage 15 to 20 years ago, which was quickly supplanted by conversations focusing almost entirely on harm reduction, and safe injection sites specifically, as a way to manage the heroin problem the province was facing. There’s been much criticism of the third pillar, and we’d do best to seriously question the role of police and enforcement of drug policy. As the thousands of overdose deaths attest, we’re not even doing a great job of the fourth pillar — harm reduction — even though, arguably, this has been the city’s and province’s focus. As Coun. Melissa De Genova said, Vancouver has never implemented the four pillars, and has particularly fallen short on prevention and treatment. We couldn’t agree more, and while we’re skeptical anything will happen, we hope it will.

BRING IN SOCIOLOGY

The late French sociologist Pierre Bourdieu coined the term

“positional suffering” to describe the suffering certain groups of people, such as many addicted to substances, undergo due to their low position in society. They experience what Bourdieu termed “symbolic violence,” the ways social hierarchies are reinforced, through, for example, minimal Band-Aid measures. We see this, for example, in the focus on CERB benefit payments as a cause of overdose deaths without a broader discussion of the reasons for drug addictions and the lack of treatment options. We see it, too, in the offering of a safe supply of drugs, alongside promises of shelter and medical attention, to those camping in Oppenheimer and CRAB Park. While this paternalistic “goodwill” of the city is a welcome change from the criminalization of the “deviant” behaviours of sleeping rough and using drugs, it does nothing to challenge structural inequalities, as some temporary residents of CRAB Park noted. It is also not a coincidence, we believe, that residential addictions treatment was not offered as part of this incentive package to vacate the parks.

THE SECOND PILLAR

Addiction can stem from trauma, colonization, stigma, racism, poverty, lack of perceived life choices and lack of healthy relationships. As Vancouver addictions expert Dr. Gabor Maté has noted, addictions are very rational responses to our past and current life circumstances. The second pillar is an easier place to start. The vast majority of people who overdose likely don’t want to die. But this is not the same thing as wanting to keep living the way they were living; and, as a rich city and province, we have a responsibility to help others live well. While we should be preventing deaths and allowing people to use drugs as they do alcohol, this does not absolve us from helping those who want to change their relationship with drugs.

Right now, many British Columbians want access to residential care to treat their substance addictions. There are approximately 25 public and private treatment centres in B.C. The waiting lists for public treatment range from a few weeks to more than six months. This has been exacerbated by the closures of treatment centres during the pandemic, and the reduction in beds that can be made available due to physical distancing requirements. Further, private treatment centres in B.C., like the one operated by one of the authors of this article, can cost up to $1,000 per day. These centres are a privilege not afforded to many who don’t have tens of thousands of dollars or who do not get subsidies or coverage from employer health benefit plans or their band councils.

In treatment, over a period of 30 to 90 days, people receive counselling, participate in group psycho-education workshops and recreational activities and benefit from allocated time for reflection and dialogue. Through sharing stories, people get to see that their experiences are not unique and they have options. Through residential addictions treatment, people cannot only break their addictions, but as a study recently published by one of the authors suggests, the experience of learning in residential treatment can lead to individuals transforming the ways they relate to the world.

This is not to claim treatment outcomes are always positive, and that we do not also need to address the wider barriers people face when they get out of treatment. However, we believe people who want access to treatment should get it, not because “drugs are bad” but rather because residential treatment can help people lead more meaningful lives.

TREATMENT FOR ALL

Not making access to substance addictions treatment a priority reinforces positional suffering and betrays our low expectations for poor people. After massive policy change enacted following the pandemic, many of us are no longer willing to put up with claims that certain social services are too expensive. If the police force in this city is partly defunded, how about we put those savings toward the creation of more public treatment centres and subsidies to allow more people to attend private centres? The second pillar can support us all.