Code Grey: Realities of substance use, opioid epidemic

With B.C.’s opioid crisis set to enter its seventh year in 2023, there doesn’t seem to be a corner of the province that has gone unaffected by the epidemic. Nor does it discriminate on who its victims are. 

Unfortunately, many who may struggle with problematic substance use often do so alone due to the stigma associated with addiction and substance use in general.

The BC Coroner’s Service said that those most impacted by this crisis are those who work in trades as well as those in Indigenous communities — especially Indigenous women.

A recent report by the Select Standing Committee of Health in the BC Legislature contained 37 recommendations to tackle the escalating number of deaths from overdose in the province, but will these recommendations be effective?

While most of the data featured in this story is provincial, residents in Northeast B.C. are significantly impacted by this issue.

Northern Health said that Fort St. John has the second-highest number of overdose deaths in the Northern Health jurisdiction, following Prince George.

The health authority’s jurisdiction has the highest proportion of Indigenous people in the province, as well as a high population of trades workers. There are also fewer resources for those who may be struggling with problematic substance use in the north.

According to Northern Health, the Northeast rate of overdose deaths is still higher than 2016, but has shown a slight decline in the past two years. Meanwhile, overdose deaths have continued to increase since 2019 in the Northern Interior and Northwest areas, with the Northwest seeing a 208 per cent increase in the past three years.

This is part three of Energeticcity’s series Code Grey, where we look to decipher the current state of the health care system in Northeast B.C

In this edition, we delve into the toxic drug crisis. We’ll look at why Indigenous people and tradesfolk are disproportionately impacted by overdose and find out what the provincial government is doing to bring an end to the deaths caused by the unregulated drug supply.

Timeline of B.C.’s toxic drug crisis

On April 16th, 2016, B.C.’s public health officer, Dr. Perry Kendall, declared a public health emergency after the province saw a jarring increase in overdoses and deaths due to drug toxicity.

Since then, over ten thousand BC residents have died of an overdose, which is now the leading cause of unnatural death in the province — more than homicides, vehicle incidents, drownings and fire-related deaths combined, according to the BC Coroner’s Service.

Data from the BC Coroner’s Service shows that the highest rates of overdose deaths occur in the Northern Health jurisdiction, with both the Northeast and Northern Interior health service delivery areas seeing a significant peak since the onset of the COVID-19 pandemic.

Drug Toxicity Death Rates by Northern Health Services Delivery Area (per 100,000 residents)

In a recent report by the Select Standing Committee (SSC) of Health titled: Closing Gaps, Reducing Barriers: Expanding the Response to the Toxic Drug and Overdose Crisis, the committee heard of the groups who have been disproportionately impacted by the toxic drug supply.

B.C.’s Ministry of Mental Health and Addictions told the committee that, as of May 2022, 77 per cent of those who died were male. The average age of people who died is 42, with the leading cause of death among those aged 19 – 39 being caused by the toxic drug supply.

The ministry said that 35 per cent of those who have died of overdose were employed at the time of their death, and 52 per cent of those who were employed worked in trades, transportation, or as heavy equipment operators.

Construction industry “devastated” by opioid epidemic 

While presenting to the Select Standing Committee on Health, Vicky Waldron, executive director of the Construction Industry Rehabilitation Plan, said that the industry is “in crisis.”

“There is not a meeting that I attend anymore where somebody at the table is not telling me about another worker — a funeral they’ve had to go to because they’ve buried another worker — or a colleague or a friend that overdosed recently,” Waldron said.

Christina Chant with the BC Centre on Substance Use said there is a plethora of reasons why there are such high numbers of overdoses among employees who work in trades, transportation, and as heavy equipment operators.

First, she said the demographic of those most impacted by the toxic drug crisis is the same as those who primarily make up the construction industry.

“This year when they looked at who’s been dying from the toxic drug supply, 78 per cent are men, and 70 per cent of those are people who are between the ages of 30 to 59. So, considering the scale and size of the construction and trades industry in B.C., that’s just a large portion of that group,” she explained.

Chant added that men typically don’t seek out health care and often struggle speaking about their mental health and substance use.

“We also know stigma around drug use is still incredibly prevalent and plays a huge part in why people don’t access health care. Also, when they do try to disclose that they need health care, they often experience judgment and stigmatizing ideas about their substance use.”

Charlene Burmeister, executive director of the Coalition of Substance Users of the North, said this stigma further harms those who use substances and challenges the public to examine their thoughts around substance use and educate themselves about evidence-based interventions. These interventions include harm reduction models currently unavailable in B.C.

Burmeister is also a person with living experience and a stakeholder engagement lead with the BC Centre for Disease Control.

“Canadians need to understand that one of the majority of the populations who are dying is middle-class white men who are dying behind closed doors. I think the reason they’re hiding behind closed doors is because of the way that people think of people who use substances,” said Burmeister.

“It’s also the internal stigma because of the constant messaging that we get in our communities about how people who use drugs are just horrible people who are incapable of moral decision making.”

After engaging with tradesfolk with lived experience, the Vancouver Island Construction Association created the Tailgate Toolkit Program. The program’s purpose is to increase access to harm reduction services for those working in construction and includes region-specific resource guides.

“The Tailgate Toolkit Project consists of four components; on-site/virtual toolbox talks, supervisory training for site and company leaders, an industry support group, and extensive, region-specific resource guides for folks working in the construction/trades industry,” the website reads.

According to the SSC report, other factors that may be putting trades workers at a higher risk for overdose include a “macho” workplace culture that causes employees to not speak about their mental health.

“The committee also heard that a workplace culture of “work hard, play hard” is a contributing factor to this overrepresentation. The Construction Industry Rehabilitation Plan referenced the “macho culture” in the industry and shared that being overwhelmed is viewed as being weak and not up to the job,” the SSC report reads.

Presenters told the SSC of the barriers that may stop people who may be experiencing problematic substance use from seeking resources. These include stigma and rigid zero-tolerance policies, which were “created because of the industry’s safety risks.”

The Council of Construction Associations told the committee that high rates of chronic pain and recreational drug use in the sector may also be behind the over-representation of trades workers.

Fort St. John Salvation Army executive director Jared Braun said that some of the people that go through the organization’s substance use programs began using substances after their prescription for opioids ran out following an injury.

“It’s related to the inadequate resources to support people all the way through whatever medical situations they have — if it’s a workplace injury or a vehicle accident or other health-related things that have got complicated and they’re looking for other means of managing their pain,” Braun said.

However, Braun believes the primary reason why people use substances is to numb their emotional pain, which is often caused by past or ongoing trauma.

Indigenous people disproportionately impacted by opioid crisis

The SSC on Health heard that Indigenous people died at 5.4 times the rate of other B.C. residents in 2021, with Indigenous women dying at 9.8 times the rate of other women in the province.

An Indigenous advocate and former substance user Connie Greyeyes said this grim statistic doesn’t surprise her.

Connie Greyeyes, Northern Case Manager for Missing and Murdered Indigenous Women and Girls through the Indian Residential School Survivors Society. (Spencer Hall, Energeticcity.ca)
Connie Greyeyes, Northern Case Manager for Missing and Murdered Indigenous Women and Girls through the Indian Residential School Survivors Society. (Spencer Hall, Energeticcity.ca)

“Having the experience that I have with my own addiction and the hard work that’s needed to come out of that kind of trauma and that kind of lifestyle. It’s so hard if you don’t have proper support,” Greyeyes said.

“I had every opportunity to succeed because my family was so supportive of my sobriety.”

Greyeyes said that because Indigenous people are more likely to live in poverty and are tasked with dealing with intergenerational trauma, it makes sense that they have higher rates of overdose in their communities.

“There are so many feelings of despair in Indigenous communities. We deal with whole family generations with intergenerational trauma from residential schools and day schools trying to strip us of our traditional ways, knowledge and ceremonies,” Greyeyes explained.

Greyeyes said that this trauma is constant and is a major factor in why Indigenous women have such a high rate of addiction. She recalled the impact the “Sixties Scoop” had and continues to have on Indigenous communities.

“Can you imagine what the reserves were like with no kids? Like no kids. They’re all gone. The only ones that would be there were the ones that got hidden or they didn’t find.”

“That feeling of community not being there because all of the kids, the ones that bring that good medicine, were all gone. People turn to alcohol and drugs in that sadness and despair,” Greyeyes continued.

Burmeister also noted the deep impact the opioid crisis is having on Indigenous communities across the province.

“This is the new Sixties Scoop. People are overdosing and dying. Their children are being put into care. Children are being taken away by the ministry of children and family development simply because their parents use substances,” Burmeister said.

“Incarceration, child apprehension, overdose incidents and overdose deaths are much higher within our Indigenous populations. Where is truth and reconciliation in this piece?”

Greyeyes also shared her story of addiction, which began at a young age after experiencing multiple instances of sexual assault.

“Those kinds of things cause you to really hate yourself. [You think to yourself] what did I do? I could have done this, I should have done that. Then you just carry that trauma with you.”

Greyeyes said she used drugs and alcohol to “drown out” that trauma. By the time she was in grade 10, she said she was using cocaine on the weekends.

“Of course, because you know, it was casual. That’s what we tell ourselves,” she said.

Her substance use continued to escalate while she went through school and began attending college in Kamloops. She attended a program called NITEP or “Native Indigenous Teachers Education Program” which was reportedly based out of the former Kamloops Indian Residential School, where the remains of 215 children were found in 2021.

Greyeyes said this experience was very traumatic for her, as both her parents are residential school survivors.

“It was probably the worst that I’ve ever used drugs. I was smoking crack cocaine every day. My dad bailed me out many times from dealers,” she recalled.

She says her drug use continued until she was about 32, when she received a phone call from a close friend informing her that her brother-in-law was in the hospital after suffering a heart attack.

“I was getting phone calls like crazy, and I was ignoring them because I was smoking crack cocaine. I was drinking whiskey, you know, leave me alone. I’m partying with my friend,” she said.

“One of my close friends called me to tell me that my family was looking for me and that I needed to get to the hospital. I was so wasted, but I still had to go.”

Greyeyes said that by the time she made it to the hospital, her brother-in-law had died. She said that this moment changed her.

“I was ashamed. There’s me playing with my life. I could have had a heart attack from smoking crack cocaine any day, and there was this father of three, my sister’s husband laying there, no longer living.”

“I had the audacity to play with my life the way that I did, meanwhile my niece and my nephews have no dad, and my sister is a widow.”

She said that a few months later, in February 2012, she made the vow to go to treatment and has “never looked back.”

“My dad told me, and it always stuck with me, that when somebody you love dies, you should honour their lives by changing yours, and so I did, and my kids have a good life because of that.”

“We are failing horribly when our only approach to this [crisis] is trying to make people abstinent from substance use,”

Charlene Burmeister, executive director, founder of the Coalition of Substance Users of the North

Key recommendations from the SSC on Health report

The Select Standing Committee of Health’s report contains 37 recommendations aimed at combatting the rising number of deaths caused by the current toxic drug supply.

The first is to “rapidly” expand an extensive, low-barrier, evidence-based continuum of care, which doesn’t currently exist in Northeast B.C.

North Peace MLA and member of the SSC, Dan Davies, said that, in Fort St. John, there are no detox beds, which he says means people who want to access those services are either put on a bus to Prince George with no continuum of care or are simply turned away.

“I’ve been working with a couple of organizations up here, and I’ve talked to Northern Health and the ministry, saying we need detox services here in Fort St. John. We used to have a couple of beds in the hospital, but it goes back to a health system that is not capable of just doing the basics right now,” Davies said.

In its 75-page report, the committee said that it heard from multiple organizations and individuals that a more cohesive continuum of care is needed for people who use substances. The committee said the system needs to include prevention and education, harm reduction, safer supply, and treatment and recovery elements, as well as post-treatment supports.

Dr. Danya Fast, a research scientist at the BC Centre on Substance Use and assistant professor in the Department of Medicine at the University of British Columbia, along with others, told the committee that this system of care should include “housing, employment, social and other supports,” as well as various treatment options.

The committee added that the continuum of care should have specific goals, metrics, and timelines with transparent accountability mechanisms and regularly report results to the public.

The SSC on Health also recommended completely including people who use or have used drugs in the development and implementation of new policies and programs that impact them.

“[This includes] youth; 2SLGBTQIA+ people; Indigenous people; rural and remote residents; parents; people working in the trades, in transportation, or as equipment operators; people with mental health challenges; and people who are experiencing homelessness,” the committee said.

When it comes to treatment and recovery, the committee called for “a substantive expansion” of publicly funded, evidence-based, accredited treatment and recovery services.

Multiple stakeholders, including the BC Nurses Union, spoke of the need to improve access to treatment and recovery services, including detox and supported withdrawal. Presenters highlighted the long waitlists for these services and told the committee of the importance of providing these services immediately when a person is ready for them, referring to it as “the window of opportunity.”

It was also pointed out that more services need to be available in northern rural communities to prevent residents from having to travel long distances — sometimes in harsh weather conditions — to receive treatment.

The committee also called for new legislation ensuring regulation, standards, protocols, and evaluation of effectiveness and outcomes encompassing all treatment and recovery services.

Davies spoke of the importance of regulating treatment centres.

“[Right now] there’s no accreditation. There’s no accountability. Any Joe blow can open up a treatment center, and there’s no accreditation. That’s alarming,” Davies said.

Davies stated that the focus of the province as of late has been mainly on harm reduction, something he said is just one piece of the puzzle.

“The harm reduction piece is not gonna work by itself. We can’t fix a dead person. We’ve gotta stop the deaths, and that’s what the treatment and recovery piece does.”

However, while harm reduction is one piece of the puzzle, Burmeister said that treatment and detox can’t be the only strategy to combat the toxic drug crisis either.

“We are failing horribly when our only approach to this [crisis] is trying to make people abstinent from substance use,” Burmeister said.

In regards to the report from the SSC on Health, Burmeister said that, while the committee did an overall good job listening to people who use substances, she believes that they “epically failed” around the populations that presented to them.

“They leaned toward abstinence-based presenters. I think that some of the recommendations are weak and there’s no clear instruction on who would be responsible for the recommendations that they had,” she stated.

“But I will also say that it did in some ways put the onus kind of on the provincial government to be thinking about like an exemption 56 — how we can roll up models both medicalized and non-medical.”

Where do we go from here?

Davies said that the report has been sent to the appropriate ministries, but none of the recommendations put forth by the committee are binding.

B.C.’s Minister of Mental Health and Addictions, Jennifer Whiteside, said in a statement that Premier Eby has asked her to “accelerate” B.C.’s response to the toxic drug crisis.

“This work is urgent and will take into account the recommendations of the Select Standing Committee on Health, which received unanimous support from all parties in the legislature,” Whiteside said.

“The recommendations from the Special Committee on Health reaffirms this work as we expand life-saving services, which includes investments in prevention, harm reduction, prescribed safe supply, treatment, and recovery.”

The ministry acknowledged that separating residents from the toxic drug supply is the first step in preventing drug poisonings, stating that since the rollout of the prescribed safer supply in March of 2020, more than 14,000 British Columbians have accessed that supply, with 10,000 of those being prescribed an opioid.

In 2022, the federal government approved an exemption to remove criminal penalties for adults who possess small amounts of drugs for personal use. However, critics say this isn’t enough to make a considerable difference in reducing stigma, nor would some qualify it as “decriminalization.”

Amanda Trotter, executive director of the Fort St. John Women’s Resource Society, doesn’t believe it qualifies as such.

“It’s not really being decriminalized, as I understand it; they’re just not going to prosecute for smaller amounts,” Trotter said.

“The problem that you’ve got is that it’s not addressing the issue of contaminated drug supply, and that’s really where the main issue lies.”

Burmeister also doesn’t believe that decriminalization in its current amount will make much of a difference.

“There are these small incremental steps of decriminalization, it’s gonna take three decades at minimum with a lot of work put into the decriminalization model before it’s ever gonna reduce stigma — it’s certainly not going to reduce the loss of lives. We need more accessible safe supply,” Burmeister said.

She adds that nearly seven years into the opioid crisis, people who work in harm reduction, often those who use or formerly used substances, are being burnt out, often working with unsustainable funding.

“People like myself that work within this industry are constantly re-traumatized, losing community members while we’re trying to do everything to change drug policy, provide services, reduce harm, and people are dying around us all the time. It’s a huge burden for us to carry,” She said.

“These are health care issues — why are people who use drugs the ones who are stepping up to the plates, dealing with vicarious trauma, being harmed in so many ways, yet we continue to come to these tables, bring our own chairs, wedge our way in to be part of the conversations, and we’re still not seen as the major stakeholder in this crisis?”

Stigma surrounding substance use is still heavily prevalent

While writing this installment of our series, those we spoke to told us of the prevailing stigma that hinders people from reaching out to receive the help they need.

Charlene Burmeister added that other barriers can stop people who want to access services, including job loss, incarceration, and child apprehension.

“[This] pushes people into the shadows with substance use,” she said.

We were told that people who use substances, regardless of sobriety, are the number one stakeholder and must be adequately engaged by policymakers when looking at solutions addressing the toxic drug supply.

Both Burmeister, and Christina Chant, with the BC Centre on Substance Use, told Energeticcity that the narrative of substance users needing to hit “rock bottom” is harmful as that is not an option with today’s toxic drug supply.

“Society thinks that people who use drugs lack moral decision making, and people who may have problematic substance use, it’s their fault. Let them hit rock bottom —rock bottom today is death,” Burmeister said

“People don’t have a chance to hit rock bottom now. The drugs are so toxic that a slip-up can lead to death. So we really need to move away from that kind of thinking,” Chant echoed.

Chant added that we need to be working with people who use substances in “a less prescriptive way that honours the humanity of that person.”

In our series Code Grey, we look to decipher the current state of the health care system in Northeast B.C.

In part oneEnergeticcity.ca spoke with health officials, local leaders, and health care staff advocacy groups. In part two, we examined the history of health care in our community.

Energeticcity will delve further into possible solutions to the toxic drug epidemic, such as safer supply, in the new year.

Read the full report from the BC Legislature’s Select Standing Committee on Heath below.

With files from Fran Yanor, Northern Beat.

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