On Vancouver Island, 214 people died from illicit drug overdoses in 2018. Various forms of treatment are available, from public to private programs and facilities. (File photo)

Addictions treatment: barriers and doors on Vancouver Island

Parksville activist says process failing some; service providers explain why process required

Nearly 1,400 people died from illicit drug overdoses in B.C. in 2018.

Two hundred fourteen of them were from Vancouver Island.

Addicts are dying, some out on the street without a home. Various forms of treatment are available, from public to private programs and facilities. Many people are accessing those services.

Still, others are dying either never having received help, or having not accessed it. Some have tried and felt their way was blocked, or that what they needed wasn’t available to them. Whose fault that is is a difficult question to answer.

But some feel that support — what they feel is the right kind of support — doesn’t come fast enough.

Kelly, a Mid-Island addictions recovery advocate and a recovering addict herself, says she knows a number of homeless people in the Parksville area who are ready for treatment — who want it, but can’t get it.

“These people come to me and they’re crying, like, ‘We want in, why aren’t they putting us in?’ And I don’t have an answer for it,” she said.

The kind of treatment she’s referring to is residential treatment: a program where people first detox, and then they have a bed and food and counselling for a period of time, sometimes months. It’s a place where people work on their trauma, learn to deal with their emotions and develop coping mechanisms to get back out in the world.

That’s what worked for Kelly, she said, explaining that addressing trauma is key.

“Most of us as addicts… we deal with trauma,” she said, noting the many stories she’s been told of childhood sexual or physical abuse among many other kinds of trauma.

“We all have stories of scars that we like to medicate through our drug addiction. And when you go into treatment, they teach you from step one to step 12 how to deal with your inside turmoil, because you’re in a safe environment where you’re getting clean, you’re getting nutrition, you’re getting rest and you’re able to work out what’s keeping you sick,” she said. “In treatment they teach you how to deal with your pain without medicating.”

Kelly has been trying to get her friends off the street and into residential treatment facilities, but she’s been told ‘no’ more and more often and doesn’t know why.

Comox Valley Recovery Centre’s facility administrator, Aymen Shymko, said bringing homeless addicts directly to recovery centres like his isn’t a good idea. There is a process that needs to be followed that protects clinicians, the facility, other recovering addicts and the individual themselves, giving them the best chance to succeed, he said.

“Bringing people in off the streets as self-pay (where they haven’t gone through Island Health) is not usually very good,” he said.

“To take somebody off the street where they don’t have any of these tests done and then just bringing them in here and trying to stick them into the midst of a program when they are not ready, we have no history of the medications they’re on… that leaves us in a void where we’re like, ‘Who is this person? What are their needs? How do they act in a group? Do they have social anxiety? Do they have violent tendencies? Are they HIV positive?’”

Shymko said residential treatment facilities like his are a sort-of last step option if other kinds of support and treatment hasn’t worked.

Island Health’s director of Mental Health and Substance Use for Central/North Island, Lisa Murphy, described options available to addicts as more of a spectrum where someone looking for help gets in contact with a substance use clinician or a family doctor, gets an assessment done and a treatment plan is developed.

Murphy explained that Island Health works to provide supports for anyone with a substance use issue, from a person living on the street to a parent with a home and a job and everything in between. That means treatment options are quite varied.

Some people go through their family doctor, others access 12-step programs, Alcoholics Anonymous and others on their own, and others go to Island Health.

“Many people would either make an appointment with Mental Health and Substance Use with an addictions counsellor, or some communities have walk-in times,” she said. “Oceanside (Health Centre), for example, has some walk-in hours. So they would walk in, see a substance use clinician or get an assessment and then together, they would develop a treatment plan.”

That treatment plan can include a range of options, she said, including 12-step programs, individual counselling, or a referral for an assessment and opiate agonist therapy (OATs) where a person using opioids like heroin, oxycodone, fentanyl or others is provided doses of another drug like methadone that helps prevent withdrawal symptoms with a goal to reduce and eventually stop using drugs.

OATs therapy has some good evidence behind it, and is gaining traction in becoming “one of the best forms of treatment for an opiate addiction,” said Murphy.

Some people, like Kelly, are very skeptical of OATs.

“It’s going to keep them sick. All that’s doing is medicating the problem,” said Kelly.

But Shymko said the method is helpful for some.

“Some people agree with it and some people don’t, but what we do is we’re willing to give everything a try… We are an abstinence-based program, so we do believe in abstinence. We don’t want people using drugs, but we also do have people here that are on the replacement therapies that seem to be doing quite well.”

Still, some people need more than these methods of treatment, and so Island Health also has detox and bed-based treatment available.

When it comes to paying for these services, things like detox, stabilization, sobering and assessment beds are free to the individual with the relevant health authority covering the cost.

Community-based outpatient treatments, such as OATs, are covered by a medical services plan.

Residential treatment, however, does have a cost to the client, however “Island Health clinicians work with clients to make sure that inability to pay is never a barrier for someone who is ready and willing for treatment,” according to an email from Island Health.

One barrier, according to Kelly, is the paperwork people are asked to do, and the time between accessing Island Health services and getting to residential treatment. Some people aren’t capable of providing all the relevant information, and others have trouble arranging transportation back to Island Health offices if they aren’t immediately given a bed, said Kelly.

“It isn’t intended to be onerous, and it isn’t intended to create barriers,” said Murphy. “What I know to be true is that our substance use clinicians, our intake clinicians do the paperwork with people.”

Information Island Health asks can include a medical history, what a person’s goals are, if they’ve gone to treatment services before, history of trauma especially if it might get in the way of recovery, any history of acute withdrawal symptoms, symptoms of psychiatric disorder and more. This information helps to determine if a person is capable of detoxing with or without constant medical supervision, as acute withdrawal symptoms and other medical conditions can make detoxing dangerous.

Murphy also noted that Island Health tries to set up a safe-exit plan for if a client chooses to leave bed-based treatment.

“What we don’t want to see happen is, late in the evening, a person is gone, they don’t have money, they don’t have… transportation,” said Murphy. “We really hope that… (we) have permission from the individual to call their family, call a support person so that we can ensure that, if they want to leave early, and these are voluntary services, that their needs are met and that they can leave safely.”

Asked how long it can take for a person to get any kind of treatment bed, Murphy said sometimes they can get it that some day, other times it can take a week or a little more.

Shymko said that beds at Comox Valley Recovery Centre that are contracted by Island Health are basically constantly full, while the centre’s private beds recently have also been basically always full. Asked if more publicly funded beds are needed, Murphy said “certainly we could use more,” but she added that’s true of many of their services, including sobering and assessment beds, OATs and outreach services.

“I think we would always want to build it out in terms of the full continuum, because bed-based services are one option. It’s often an option that people focus on, but it’s not the perfect option for everyone,” she said.

Asked if bed-based treatment is what’s needed for the homeless more than any other demographic, Murphy said she didn’t think so.

Shymko pushed the need for people to go through a process before getting into residential treatment.

“Yes, people do need help and I fully understand that, but there is a reason that there are the processes to go through, and those reasons guard everybody. They protect the clinicians that work here, they protect the facilities, they protect the other clients that are here, they protect the individual that is trying to get in.”

ISLAND HEALTH BEDS:

Here’s a list of the number of beds Island Health has available in the area, including residential treatment as well as sobering and assessment beds:

No. Beds/Region/Description

5/Port Alberni/Stabilization

21/Victoria Supportive/Recovery Group Homes

3-6/Comox/Amethyst House

4/Nanaimo/Serenity Lodge

4/Comox/CV Stabilization Beds/CV Recovery Centre

12/Nanaimo/Clearview

5/Nanaimo/Sobering & Assessment

6/Cowichan/Sobering & Assessment

2/Port Alberni/Sobering & Assessment

6/Mt. Waddington/Sobering & Assessment

9/Campbell River/Sobering & Assessment

1/Mt. Waddington/Youth Supportive Recovery

3 Campbell River John Howard Society

6/Nanaimo/NARFS

4/Nanaimo/Youth Shelter Beds

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