Lonnie Whiteman, 51, at her Downtown Eastside apartment building in Vancouver on May 18. Whiteman is a drug user who was hospitalized five times last year for pneumonia.Jennifer Gauthier/The Globe and Mail
British Columbia health officials say a new provincewide policy on illicit substance use in hospitals could lead to better, more consistent care for people who use drugs, but that more addictions specialists and overdose prevention services are needed for it to succeed.
The new policy, introduced by the B.C. government as part of a significant walk-back of the province’s drug decriminalization pilot, includes a zero-tolerance approach to the use and possession of illicit substances in hospitals outside of designated overdose prevention sites – spaces where people are permitted to use illicit drugs, with someone there to monitor and reverse an overdose if needed.
It follows weeks of growing pushback over public drug use and related disorder, including by some health care workers who said decriminalization had created a more permissive environment for drug use in hospitals, where it was negatively affecting other patients and staff.
Health Minister Adrian Dix announced a task force aimed at developing consistent protocols to ensure the safety of those in hospitals, but it had only begun discussing objectives when Premier David Eby announced changes to the decriminalization pilot. Instead, Mr. Eby’s government introduced the new policy, which was distributed to hospital and provincial health services on May 1 and is now in effect.
Under it, health care workers are to ask patients in outpatient clinics, emergency departments and during admission to inpatient care about potential substance use. Patients are to be explicitly told that any “self-management” of illicit drugs is prohibited outside of designated sites and that non-compliance will be addressed by hospital security through an escalation process that could include discharge from hospital or police involvement.
Health care workers are then directed to provide patients with supports to manage their addictions such as methadone, Suboxone or a prescribed alternative to their illicit drug, such as hydromorphone.
But to implement the new plan, British Columbia will need more addiction specialists, which are in short supply. The province’s policy says such specialists will be added to every major hospital, along with virtual clinical consultations in smaller rural and remote hospitals.
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Réka Gustafson, the vice-president of population and public health and chief medical health officer at the regional health authority Island Health, said the new policy is a commitment to improve care for people who use drugs through increased staff capacity, increased training and incorporation of screening for substance use into patients’ care plans. However, she said it will be a “significant challenge” to staff up.
“I think everybody recognizes that it’s not going to happen overnight,” she said. “But in order to create a system of care, recognition for that need and a systematic plan to get there is a really important foundation.”
Silvina Mema, deputy chief medical health officer at regional health authority Interior Health, said it will be critical to create capacity not just in hospital, but in the community to support patients postdischarge.
“We don’t have enough doctors that can provide addiction medicine across the Interior,” she said.
The Ministry of Health said it is working with health authorities to recruit and retain health care workers of all specialties as part of a health human-resources strategy launched in 2022.
While the policy states that existing overdose prevention sites will continue to operate, it makes no mention of rapidly increasing them. Very few acute care facilities in B.C. currently offer such services; St. Paul’s Hospital in Vancouver has a dedicated site, while other hospitals can employ a mobile site, or engage a peer or health care worker for episodic witnessed consumption.
Dr. Gustafson and Dr. Mema emphasized that they are needed because a complete prohibition of illicit drug use could lead some people to use in unsanctioned places, self-discharge or avoid the hospital altogether.
“We know that substance use is a chronic relapsing condition,” Dr. Gustafson said. “Creating sanctioned, safe and dignified spaces where people can use is part of the continuum of care, and I would say that is one of the critical components for a successful implementation of any policy that limits the use in public spaces.”
The task force announced by Mr. Dix in April was supposed to issue recommendations in several weeks. When asked by The Globe on April 11 whether a directive to provide “active supports” to help people manage their addictions would mean all hospitals would be required to have overdose prevention sites, Mr. Dix said “that’s the purpose of the effort.” The Globe confirmed the comment and the directive with the Ministry of Health.
The comments generated backlash, including from BC United Leader Kevin Falcon, who said it goes against a promise made just a month earlier that there would be no overdose prevention site at a hospital in the Vancouver suburb of Richmond, where earlier council meetings exploring the possibility had drawn raucous protest by residents.
In a follow-up interview on April 15, Mr. Dix said he had never made such a commitment.
“What I want people to do is engage with the health care professionals in the hospital to make sure they’re safe, both in dealing with their addiction issues, and other issues, and with other patients in the hospital,” he said. “It’s neither practical nor desirable to have smoking spaces in hospitals.”
The task force, which includes representatives from each health authority, public health and the ministry, met once to discuss goals and was soon directed to pivot and implement, monitor and report out on the province’s new policy.
Lonnie Whiteman says she is reluctant to disclose her substance use to health care workers because some are prejudiced against drug users.Jennifer Gauthier/The Globe and Mail
Vancouver resident Lonnie Whiteman, 51, was hospitalized five times last year for pneumonia. A user of crack cocaine for about 20 years, Ms. Whiteman said she abstained during the first three admissions but that physical pain that couldn’t be managed with prescription medications the last two times drove her to clandestinely use in the hospital washroom.
Ms. Whiteman said while it would be ideal if people with addictions could be prescribed something to effectively manage their withdrawal symptoms, it won’t be that easy. Available prescription stimulants, such as ADHD medications, would “not do anything at all” for her, while many doctors are reluctant to prescribe illicit fentanyl users anything nearly as strong, she said.
She added that she is reluctant to disclose her substance use to health care workers because some are prejudiced against drug users.
“I’ve heard nurses snickering and talking when the unit doors are open: ‘This one’s a user too, life wasted, going down the drain,’ ” said Ms. Whiteman, a member of the Ahousaht First Nation.
Asked what hospitals could do to improve care for people who use drugs, she said to employ non-judgmental staff, expand medications available as prescribed alternatives, make overdose prevention services safe and accessible, and permit visitors such as partners and friends to accompany patients while using those services.
The new provincewide policy supersedes those of individual health authorities. While those outgoing policies have technically prohibited illicit substance use in hospitals, they have been paired with clinical guidance intended to avoid escalating situations or creating scenarios that could cause a patient to leave.
A guideline from Island Health, for example, said that if a health care worker encounters a patient using illicit substances, the patient should be permitted to finish, if safe, before engaging in dialogue.
Northern Health’s policy directed health care staff to inform patients that small amounts of controlled substances are permitted in health care settings, and where they may safely use.
Across all health authorities, the smoking of anything indoors has always been prohibited.
Dr. Mema said the new policy sets expectations for how the system of care should work for people who use drugs. She said her health authority’s previous policies supported the principles of harm reduction but did not explicitly detail how various scenarios should be handled, which led to inconsistent approaches.
“There will now be a focus on trying to stabilize the patient, as opposed to just overlooking their addiction and focusing on the fracture or whatever it is,” she said.