Scotty Archondous stands in front of the emergency entrance at St. Paul’s hospital in Vancouver on May 27. He says when he tried to get into detox at the Rapid Access Addiction Clinic at St. Paul’s, he was initially turned down and had to wait several days to get in.Jimmy Jeong/The Globe and Mail
Dozens of detox beds in British Columbia sit empty because of a shortage of addictions physicians and nurses needed to staff them, according to internal health authority data obtained by The Globe and Mail.
In the Vancouver region, this has meant that up to half of the spaces at 24- and 18-bed withdrawal-management facilities remain unoccupied at times despite long lists of people waiting, according to the data, which covers the past several weeks.
In the Interior, 25 detox beds are currently unoccupied for the same reason. The Globe was not provided with a total number of detox beds available and or occupied throughout the province.
B.C.’s shortage of addiction physicians and nurses is part of a broader crisis in the health work force that has played out across Canada for years.
The province is in the eighth year of a declared public-health emergency linked to toxic drugs that have killed more than 14,000 people since 2016. In April, Premier David Eby pledged to add addiction specialists to every major hospital as part of his government’s significant rollback of its drug decriminalization pilot – a move that health leaders applauded but said would be a major challenge.
Vancouver resident Scotty Archondous experienced the resulting delays in April after he awoke one Tuesday in the throes of opioid withdrawal, his aching body twisted into knots and in feverish chills.
He had slept for most of a day, knocked out for so long by the THC-infused cookies he had eaten the day prior that he had begun withdrawing from the street drugs that had kept him in a mindless stupor – fentanyl that had been cut with tranquilizers, he suspects.
“I went, ‘What the hell have I been doing the last six months?’” Mr. Archondous told The Globe in an interview. “That’s the moment when I said, ‘I need to go to detox. I’m done with this.’”
With his body in revolt, the 36-year-old hastily packed a bag and phoned 911. Attending police officers brought him from his Downtown Eastside apartment to St. Paul’s Hospital, where the Rapid Access Addiction Clinic acts as an entry point to addiction services throughout the region.
Through a central intake process called Access Central, the clinic can help facilitate referrals to inpatient treatment services, such as the withdrawal management that Mr. Archondous sought.
Access Central was introduced last September to streamline entry to a range of substance-use treatment services. Instead of trying dozens of different service providers, a person seeking help can now call one phone number, or present to St. Paul’s Hospital, and be assessed and placed by a health care team. Most people are treated in outpatient settings in the community.
In the Vancouver region, people needing more intensive inpatient withdrawal-management services are triaged by level of risk across three sites, two operated by Vancouver Coastal Health and one by Providence Health Care. For example, youths, pregnant people and those experiencing life-threatening withdrawal would be considered high-risk or urgent and be admitted within a few days, if not immediately. Someone who is more stable would be deemed “routine” and put in a queue that can stretch to weeks.
When waiting times for detox reach several weeks – sometimes a month or more – many people fail to show up. This is because some people grappling with addiction may struggle with keeping appointments that far out; for others, the desire to get help may simply have passed.
At St. Paul’s Hospital, Mr. Archondous says he did a urine test, which showed that he had in his system slow-release morphine and hydromorphone, medications that were prescribed to him for his opioid-use disorder but which he says had been growing ineffective. He was then told that there were no beds available.
“They basically said, ‘Sorry, not today,’” he recalled. “They said they didn’t have space.”
In fact, there had been more than two dozen empty detox beds in the Vancouver region that morning, as Mr. Archondous and 180 others waited for spots, according to the data obtained by The Globe.
Knowing that he would relapse if he returned to the Downtown Eastside, Mr. Archondous camped outside the hospital, checking in each day to see if there was space. On the sixth day, he was informed that there was a cancellation and resulting spot for him at Vancouver Detox in the city’s Mount Pleasant neighbourhood. Upon arrival, he observed that the 24-bed site was half empty.
“There were tons of empty beds,” he said. “An entire room of empty beds.”
In a statement, Vancouver Coastal Health said the goal is to admit the highest priority clients within 24 hours, and that the health authority maintained this as a median waiting time for the month of April. It did not comment on those who are deemed lower risk and subject to weeks-long waits.
The health authority also acknowledged that it is facing continuing challenges with health human resources that are not unique to the Vancouver region, and said it is actively recruiting and training addiction specialists.
In the B.C. Interior, there are 69 publicly funded detox beds, of which only 44 are able to offer detox services because of nurse staffing levels, according to Interior Health. Eight more beds are expected to resume service this week, while the remaining are being used as stabilization and transition beds.
Island Health said it has 33 publicly funded medical detox beds and 10 social (non-medical) detox beds, while Northern Health reported 20 beds at its adult withdrawal-management unit in Prince George, and an unspecified number at other acute-care facilities.
Neither health authority provided data on the impact of staffing levels on bed availability, but Island Health said in a statement that the increased toxicity and unpredictability of the drug supply is causing additional resistance to previous harm-reduction and treatment measures, adding pressure on staff and affecting the availability of beds.
Paxton Bach is an addiction medicine specialist at St. Paul’s Hospital and director of the B.C. Centre on Substance Use’s clinical addiction medicine fellowship program. The program produces about 10 fellows per year, making it the largest such fellowship in North America.
Dr. Bach said B.C. is “richer than most places in Canada” when it comes to addiction doctors, yet there are not enough to meet demand.
“At St. Paul’s, for instance, we have over 40 addiction medicine doctors on staff – which is unheard of – but we are still barely able to staff all of the different sites and lines that we would like to,” he said.
He called for expanded access to fellowship programs, as well as shorter training opportunities for physicians seeking to learn new clinical skills in addiction medicine, noting that just a few people could dramatically expand support at smaller hospitals.
Mr. Archondous said his addiction stemmed from physical, sexual and emotional abuse that began in his late teens. In April, he spent eight days at Vancouver Detox, where he was initially prescribed liquid morphine and hydromorphone. On the last day, he was given an injection of extended-release buprenorphine, a medication that staves off withdrawal symptoms and cravings for up to a month at a time.
Now free of illicit drugs for more than five weeks and living away from the Downtown Eastside, Mr. Archondous described his efforts to get help as difficult and eye-opening.
“I’m one of the lucky ones,” he said. “I had all these supports, I had people rooting for me. A lot of my peers, they’ve got nothing but themselves. And that one whim that they get, that they want to get clean, may come once in a year.
“If it’s not readily available, they’re not going to get that opportunity.”