COLUMN: When will courage prevail over politics?

by Amber Streukens

On Nov. 1st, after four months of work that included hearing from nearly 1,000 voices and six years of ongoing public health emergency, the all-party Select Standing Committee on Health released their culminating report titled Closing Gaps, Reducing Barriers: Expanding the Response to the Toxic Drug and Overdose Crisis.

This highly anticipated report is the culmination of extensive consultation and deliberation by a committee of MLAs. This committee was well-positioned to make strong, actionable recommendations with respect to local and provincial responses to the toxic drug poisoning crisis that built an evidence-based continuum of care and expanded access to safer drug supplies, implementing decriminalization, and disrupting illicit toxic drug supplies.

Following engagement with a broad range of expert presentations and receiving hundreds of individual and organizational written submissions (all publicly available at www.leg.bc.ca), the committee deliberated in-camera, meaning there is no public record of these discussions.

The report's 37 recommendations amount to "just more everything." It calls for accelerating and expanding initiatives focused on reducing stigma, access to harm reduction, prescribed safer supply, treatment and recovery, connections with health care, trauma-informed mental health care, pain care, screening, prevention, and the needs of Indigenous communities, youth, incarcerated individuals, and people working in trades.

While covering a wide range of relevant and intersecting issues, the outcome of this lengthy process is disappointing to many.

The clearest call to action within this report demands that our health authorities "urgently ensure the availability of province-wide, standardized (in terms of resourcing, operating, and evaluating parameters) harm reduction services — including overdose prevention and drug checking services — and develop community-building measures to overcome local opposition."

Instead of "closing gaps" this report reads like a cursory literature review, roughly and shallowly quoting stakeholders in an attempt to represent diverse voices and explain complex, intersecting issues in digestible ways. The gap between what was heard by the committee and what was ultimately recommended in the report is huge. Recommendations aimed at "reducing barriers" point to well-documented policy failures and systemic issues, but largely fall short of innovation or immediate resolution. Overall, the recommendations put forth by this committee support the current strategy.

According to Addictions Minister Sheila Malcolmson, "Recommendations from the Special Committee on Health on the illicit drug toxicity and overdose crisis reaffirm the tools our government is using to tackle the public-health emergency in British Columbia."

Six years into a public health emergency, an average of six lives per day are lost to the unregulated drug supply in this province. In reaffirming the status quo, it would seem that, as other critics have stated in a joint letter published in The Tyee, "the sole risk the report seems comfortable in taking is the continued risk of lives lost to the poisoned drug supply."

Eight months after the release of the BC Coroners Service Death Review Panel Report, which contained much more direct and constructive recommendations, what can we expect this legislative report to change? How many more lengthy expert reports will be written before we take the action we know is needed? What will it take to allow courage to prevail over politics?

Nothing short of replacing the unregulated drug supply with safer alternatives will immediately reduce fatalities. Countless contributors echoed the need for safer supply that goes beyond the current model. By stopping short at prescribed safer supply, these recommendations do nothing to improve access for folks without a diagnosed substance-use disorder — a cohort at extremely high risk of fatal drug poisoning.

This committee took on the enormous task of reviewing numerous entangled and overlapping issues (trauma, mental health, colonization, health equity, chronic pain, addiction, drug poisoning) and returned with a range of well-intentioned upstream solutions that obfuscate the simplest underlying truth: in order to immediately reduce fatalities, the unregulated drug supply must be displaced with safer alternatives.

Amber Streukens is ANKORS' harm-reduction peer navigator.

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