What happens when a Squamish resident needs immediate help for an addiction?
The societal toll of the toxic drug supply crisis has made this question more urgent than ever.
In April, the province observed the seventh year of the ongoing public health emergency, which has claimed the lives of more than 11,800 people since the emergency was first declared in 2016.
The province reported that between January and March this year, 596 lives had been lost as a result, just about equalling the death toll for that time of year in 2022, which was 599.
So if a person is struggling with an addiction and needs immediate help in Squamish, what do they do?
According to officials with Vancouver Coastal Health, the best way to start is by either phoning 778-894-3200 or visiting the Squamish Mental Health and Addictions Services centre on 38075 2nd Ave.
“People can phone the Squamish mental health and substance use team and ask to speak to an intake clinician, and within a day or so, you would be connected with our opioid agonist therapy clinic for discussion about how you can start to make some changes in your use,” said Shelagh Smith, manager for Mental Health and Substance Use services in Squamish.
That can involve medications like suboxone and methadone. The patient would meet with a nurse and a prescriber.
If they don’t check themselves in, people can also be referred by their general practitioner or family members. The mental health team works with other agencies like Under One Roof, the RCMP, the Ministry of Children and Family Development.
Ira Roness, director of the North Shore and Sea to Sky Mental Health and Substance Use services, said that providers do everything they can to tailor the treatment to the needs of the person.
This means that treatment for addictions can look different depending on the patient’s circumstances.
Some forms of treatment include intensive therapy and group counselling.
“We have lots of services, and we want to tailor it to the needs of the individual who’s reaching out for help, and providing support to the family as well,” Roness said.
Harm reduction
Smith noted that their approach comes from the standpoint of harm reduction and is trauma-informed.
“It’s really meeting the person where they’re at. Maybe they’re thinking about discontinuing or reducing the use of substances. [It] could be that they just really need some therapy, and perhaps even a consult with one of our psychiatrists,” she said. “So it really depends where people are at, and we go from there.”
However, in speaking with some of those who work locally treating people who have addictions, there can be some significant challenges when it comes to helping people who are using toxic drugs.
Lack of detox beds
One common concern among locals working with those seeking to stop using substances is that there are no detox beds in the entire Sea to Sky.
Dr. Lawrence Klein is a local general practitioner who has experience working in the ER and serves as co-chair of the Sea to Sky Division of Family Practice.
Klein, who spoke only in terms of his personal views, told The Squamish Chief that, in his experience, there need to be more resources for severe cases where a person needs to get off a toxic drug immediately.
“At the moment, Squamish doesn’t have a true detox program,” he said. “Patients are generally treated the best you can in the emergency and then given the information and the contact number for a centralized sort of Vancouver-based detox.”
Up until last year, Klein was an emergency doctor, though he has since left that post.
“Everyone sort of thinks of the emergency department as a catch-all and a place where everything can be dealt with, but our resources there are limited as well,” said Klein.
“And, you know, in an ideal world, there would be capacity and staffing and programs in the local hospital to deal with detox and addictions. But quite honestly, that’s not really the case.”
Klein emphasized that he wasn’t out to point fingers at the Ministry of Health or other authorities, acknowledging the province’s announcement this year to fund $1 billion for mental health and addiction treatment.
“I don’t want to throw the Ministry under the bus,” he said, noting the Ministry’s intention and desire to fund detox and mental health services is clear.
However, challenges in Squamish persist.
When asked what would be on his wish list, Klein said a dedicated detox facility for the Sea to Sky Corridor would be a great asset.
“I think we have enough people in the corridor that a dedicated detox facility in Squamish, maybe serving Squamish, Whistler and Pemberton would, probably, I’m guessing, be cost-effective and certainly would probably be utilized.”
That’s just one piece of the puzzle, he said, as detox without treatment to follow isn’t effective.
He said there is a need for inpatient residential treatment facilities that are funded by the public system.
Vancouver Coastal Health’s position
In response to some of the concerns, the VCH officials, Smith and Roness acknowledged that there are no detox beds in the Sea to Sky — aside from the emergency room in Squamish General Hospital.
However, they said that mental health and addictions teams go through great effort to provide whatever help is necessary.
Both officials said that if the patient needs a detox bed, mental health and addictions team will provide transport to allow the patient to get to a bed in Vancouver.
“So again, we don’t want to leave someone alone,” said Roness. “We want to make sure that they have the resources. We’re going to provide them with that.
They also provided information about the home-based detox program.
“We do home-based detox — our OAT [Opioid Agonist Treatment] clinic is set up so that people can move from a reliance on fentanyl — everything’s laced with fentanyl … and move to alternative substances like suboxone and methadone,” said Smith.
For something like opioids, people would come into the clinic for methadone and a team can then visit the patient at home if necessary.
“So if someone needs to be visited at home or in the community, we are very capable of doing that. And that runs seven days a week,” Smith said.
They also spend time working with patients to help them come up with plans for how to move on with their lives, and this could be engagement with family, therapy, or group therapy, among other things.
“It’s not necessarily [just] the three or four days we’re detoxing someone. We’re looking at their life and helping them figure out the pathway forward,” Smith said.
He said that, to his knowledge, Squamish does have a home-based detox program for alcohol, but the criteria for that program is very specific.
Klein said the home-based help is an exciting development that is welcome in town.
However, there is a challenge, said Klein. It requires a very dedicated friend or family member to offer up their home and watch over the patient throughout the detox process. Some people with very severe addictions may not have that support network.
“But if somebody was, say, living at risk or homeless, they might very much need a program like that, but not be eligible for that specific program,” he said. “So they will be referred down to the city for a detox or medically-supported detox program. But, unfortunately, they call the number, and they make an appointment in five days or a week, and sometimes that window of desire and opportunity has now passed.”
Recovery beds available in town
VCH officials also added there are also four recovery beds available in the community. These aren’t detox beds but are places where patients can get help with starting their lives again.
These are offered through Turning Point recovery house.
By Smith’s account, the wait time can range from a couple of days to a couple of weeks.
VCH is also partnering with Under One Roof to provide three rapid-access beds, which are harm-reduction beds. This provides a space for people who are still using. Some people may try to detox in those beds, she said.
“This allows for clients to rapidly enter a safe place,” said Smith. “And sometimes the beds are full and there’s a wait, but people stay in these beds for one month, sometimes longer. It’s a negotiated tenancy.”
More hours open at the OPS?
The VCH officials also acknowledged that some in the community have been asking for Squamish’s Overdose Prevention Site to provide morning hours, as that is when many feel the urge to use.
“These are things that we look at consistently. And we want to hear feedback from the people who are using our services,” said Ronness. “If there’s a need to alter the times of any of our services, we’re going to look at that.”
Private care concerns
Concerns have been expressed by some who provide private treatment for addictions.
Nirmala Raniga, the head of the Paradise Valley Healing Center, said that one of the key issues that she’s faced has revolved around getting more beds in her facility, which is located in the Squamish area bearing its namesake.
The centre, formerly known as the Chopra Addiction and Wellness Centre, serves as a place for recovery for people struggling both with addictions and mental health issues.
This privately-run facility does not receive funding from the government, and, as a result, charges $26,000 for a four-week stay, which includes $1,200 of follow-up care.
Raniga understands well the financial burden this creates.
Raniga said this pricing was implemented as a result of post-pandemic inflation. The facility requires about 35 staff to operate, which makes it hard to cut costs.
She also does offer one community bed per month, free of charge, to people who lack the means to pay the amount.
Raniga said one of her main hurdles as a private operator has been capacity.
At one point, she said, the centre was allowed as many as 16 beds. However, government regulations have since changed, and it has forced her to cut that amount down to nine beds. Previously, people were allowed to share rooms, but now she said she’s only allowed to put in one bed per room.
This has effectively kneecapped her ability to provide more beds at a time when the toxic drug crisis continues to take more lives.
According to Raniga, the government said a concern for privacy was the reason for the change.
“All these years, we provided services to … guests with shared rooms. And now they’re saying, vulnerable people need privacy,” she said.
She acknowledged the need for privacy, but said that solitude is sometimes the last thing a person struggling with addictions and mental health needs.
“Addiction is about isolation, right?” said Raniga. “Treatment is about community and connection.”
She said that this red tape has made it hard for her and other private providers to add capacity at a time when it is greatly needed.
This inability to add more capacity has prevented her from adding any detox beds to her facility.
“Look at all the barriers we as a community create,” said Raniga. “We cannot do this, when people are dying.”
On this matter, VCH directed The Squamish Chief’s request for comment to the Ministry of Mental Health and Addictions.
In response, the Ministry offered a written statement.
“There is nothing that has recently changed in the Residential Care Regulation, which has always required single room occupancy,” reads the statement. “Licensees are able, however, to apply to the Medical Health Officer/Licensing officer for an exemption to these provisions. Each request will be considered on its own merits, and the test to be met is no increased risk to health and safety.”
It acknowledged that people living with addiction need a safe place to receive service and support.
“They need to know that the services they are considering for themselves or their loved one will put their health and safety first and provide the right level of services to meet their needs,” said the Ministry.
“In B.C., bed-based treatment and recovery fall under the responsibility of the Community Care and Assisted Living Act (CCALA) and related regulations, including the Residential Care Regulation. This legislative framework provides the minimum requirements a service must meet to operate lawfully in B.C.”
The Ministry also said that the province has prioritized strengthening governance, guidelines, and best practices for incorporating evidence-based care in the prevention, treatment, and recovery system.
It added that the province had added more than 360 new publicly-funded substance-use beds since 2017.
As of September 2022, there are approximately 3,260 publicly funded adult and youth community substance-use treatment beds throughout the province, the Ministry continued.
“Government will continue strengthening regulations and standards for treatment and recovery to ensure these services are safe, while working urgently to make more publicly funded beds available when and where people need it,” the statement said.
This article is part of an in-depth, provincewide journalistic effort by Glacier Media to examine the scope, costs and toll of the opioid and toxic drug crisis in British Columbia – a public health emergency that has taken at least 11,807 lives since 2016. If you or someone you know is in an emergency, call 911. If you need help with substance abuse, call the B.C. government's alcohol and drug information and referral service at 1-800-663-1441. It's available 24 hours a day.
