AFTER YEARS OF HARM REDUCTION, ADDICTION TREATMENT NEEDS FUNDS
New report advocates that province shift toward medicare-paid recovery programs
With every new drug crisis in the past three decades, the B.C. government’s response has been harm reduction — needle exchanges, safe injection sites, opioid replacement therapies, prescription medical-grade heroin and naloxone.
Missing have been corresponding increases in addictions treatment and recovery, despite promises made 17 years ago in Vancouver’s much-lauded four pillars plan.
Lives have been saved and infection rates for hepatitis C and HIV have decreased. But there’s still daily chaos on the Downtown Eastside and, by the end of May, 3,064 people had died in the provincial fentanyl overdose crisis that’s in its third year.
This is why the focus on recovery in the B.C. Centre for Substance Use report released on Wednesday is so important.
Because of the overdose crisis, the authors said “at times, this has meant that the overwhelming focus of the health system response has been on reducing the spread of disease ... and the saving of lives.”
Co-authors Evan Wood and Marshall Smith went on to say, “Without question, countless lives have been saved ... ( but) British Columbia must also establish a full evidence-based continuum of care including building an effective and co-ordinated addiction treatment and recovery system that has been traditionally lacking.”
If the government accepts their recommendations, treatment for addictions would be accessible to all. Counselling, detox, residential treatment, methadone prescriptions and recovery supports would be covered with by medicare.
Right now, the situation is dire for far too many addicts. The cost of treatment — especially residential care — can be out of reach financially. When it comes to in-patient treatment, there’s a tragic paradox. In the midst of the overdose crisis, there are long waiting lists for government-funded treatment, but also empty beds.
Treatment is expensive whether it’s outpatient or residential care. To afford residential care at up to $375 a day, most people would have to sell assets or remortgage homes, if they’re lucky enough to own one. The other option is to wait until they are penniless and homeless. Then, if they qualify for welfare or still have to wherewithal to figure out how to get it, addicts are eligible for the limited number of care spaces funded by the government.
For the wealthy and employees with good benefits packages, it’s a different story. Within 24 hours, they can usually have a bed in the accredited, well-staffed, recovery centre of their choice.
“It’s not right,” Wood, director of the B.C. Centre for Substance Use, said in an interview. “It’s just not right. This is the Canadian health care system and it’s not just that we are not providing care, because that’s what we do for every other disease in the health care system.”
He cited U.S. National Institute for Drug Abuse research that estimated that $12 in medical costs are saved for every $1 put into addiction treatment. Those savings may be lower in Canada because of our medicare system.
But, as Wood points out, that’s a small part of it.
In June, the Canadian Centre on Substance Use and Addictions estimated that in 2014, substance abuse cost Canada $38.4 billion or $1,100 for every Canadian. Those costs were for health care, lost productivity, criminal justice and other direct costs. That’s equivalent to $40.2 billion in 2018.
Lost productivity cost the most — $15.7 billion in 2014 — followed by health costs including hospitalization, emergency room visits, specialist treatment for substance abuse, physicians’ time and prescriptions at $11.1 billion. The cost to the justice system was estimated at $9 billion.
By contrast, Smith says providing the best possible residential treatment care to the most acutely addicted in B.C. would require an infusion of $70 million a year to the existing addictions treatment and recovery system. His ballpark estimate is based on the current private-care costs of residential treatment of $375 a day, multiplied by 500 beds. However, the senior adviser on recovery initiatives at the B.C. Centre is quick to note that most addicts never require residential treatment.
The Canadian Centre for Substance Use surveyed 855 recovering addicts in 2017 and found that 92 per cent did not use formal, governmentfunded programs. Instead, they attended 12-step mutual support groups. It also found that 51 per cent achieved stable recovery without a single relapse.
If financial barriers to treatment were removed, however, it’s unclear how high the demand might be. Extrapolating from national figures, there are an estimated one million British Columbians who are substance abusers, with alcohol being the most common addiction. By a factor of about four, alcohol addiction is the most common substance-abuse problem in Canada, followed by cocaine and cannabis. All of those people may need some kind of care, but would they seek it?
Another way to look at Marshall’s $70-million ballpark figure for the most acutely ill is to compare it to how much is spent on harm-reduction programs tailored to the needs of injection drugs users and opioid addicts, who account for fewer than 15 per cent of all substance users.
Last year, British Columbia spent $90 million on opioid substitution therapies including the cost of the drugs (methadone and Suboxone), pharmacy dispensing fees, consultations, and physicians’ fees for case management and counselling.
The number of people with prescriptions for methadone and Suboxone has risen from 8,319 in 2006 to 27,553 last year. Within five years, the Ministry of Mental Health and Addictions forecasts that there will be 58,000 British Columbians in opioid treatment plans.
There’s also a pilot project that supplies diacetyl morphine — medical-grade heroin — to 130 people at a cost of $3.25 million a year, roughly $25,000 a person. Then, there are the costs of naloxone, needle exchange programs and supervised injection sites.
Among the other recommendations in the report released Wednesday is a call for better education and prevention programs. It’s an acknowledgment of the tragic truth that even the best-designed and best-funded services won’t ensure that no one will become addicted or even that every addict will fully recover.
Harm reduction is an important first step in treatment, but it’s not the only one. What the Centre for Substance Use is urging is a comprehensive care system with readily accessible paths to recovery for those who need and want it.
This isn’t only for the sake of addicts, their families and loved ones. Helping substance users recover so that they can once again become fully participating citizens is good for everyone.