Fewer Treatment Beds and Confusion About What Remains Open
In last week’s blog, I reflected on the difference between the federal government’s effective response to the COVID-19 pandemic compared with their lack of response to Canada’s other public health emergency: the opioid overdose crisis. In this week’s blog, I argue that governments, federal and provincial, and their public health officials need to provide more guidance during the COVID-19 pandemic to Canadians negatively impacted by substance use and addictions.
The government’s lack of guidance during the COVID-19 pandemic is contributing to the closure of already-scarce addiction treatment services. British Columbia’s former provincial health officer Dr. Perry Kendall expressed “grave concerns” about reduced addiction treatment services because of COVID-19. Furthermore, a lack of public health guidance has contributed to a lack of public awareness about whether substance use services are even open to the public. For example, a Globe and Mail report found that visits to supervised drug-consumption sites in Vancouver are down from 6,000 site visits a week to 2,000. Vancouver Coastal Health’s chief medical health office Patricia Daly blamed public health messaging about staying at home and practising social distances as contributing factors for the decrease. Not coincidentally, Vancouver experienced dramatic increases in the number of opioid overdose deaths in March.
Closures and lack of public awareness has happened despite provincial governments designating substance use and addiction services as essential services. In late March, provincial governments across Canada defined essential services Canadians would rely on in their daily lives during the COVID-19 response and recovery. On their list of essential services (see, for example, BC’s list of COVID-19 essential services), provincial governments included substance use and addiction services. This was an important first step. However, the provincial government missed an opportunity to inform treatment providers and the public that not only were substance use and addiction programs still open; they also needed to explain why it was essential that these services remain open.
Accessing Addiction Treatment More Difficult
WIthout public health guidance, many treatment centres in Canada closed due to internal and external pressures. I personally know of two private addiction treatment centres that closed in March. Both described to me how locals feared that their treatment centres would bring people infected with the COVID-19 virus into their communities. To make matters worse, ownership reported how certain staff felt it was too risky, even unethical, to remain open. Many staff called in sick. Both of these treatment centres remain closed. They may never reopen; I know from personal experience how difficult it is financially when you have a full complement of staff to pay and no clients.
Publicly-funded treatment centres have also closed. For example, Saskatchewan’s main treatment centre, the Calder Centre, closed in response to the COVID-19 pandemic. A Global News story from Ontario reported the story of Liam who was discharged from the Royal Ottawa Mental Health Centre’s substance use and concurrent disorders program which closed its doors on March 26. In my research I could not identify the reasons why these programs closed. Perhaps staff refused to report to work. Perhaps medical staff were needed elsewhere to deal with the pandemic. Whatever the reason, their closure suggests that government officials deem them essential services in name only.
Finally, in places where addiction treatment is not available, residents are unable to access treatment in neighbouring provinces. A report by CBC North found that residents of Northwest Territories were being barred from attending treatment centres in BC and Alberta. Apparently, travel restrictions and fears that out-of-town patients would carry the COVID-19 virus were both factors.
Substance Use and Addiction Services Could Have Stayed Open During the Pandemic
Based on my experience at Sunshine Coast, it is possible to mitigate the risk of infecting staff and patients. In response to the pandemic, we reduced the number of beds so that each client had private accommodations. We also moved our withdrawal management unit to an offsite location to ensure newly-admitted clients are isolated for at least 5 days before joining the regular peer group. We have also hired more housekeeping staff to support heightened infection control. We have taken to driving clients from their places of residence to our treatment centre to reduce the risk of infection on air flights. Public health officials missed an opportunity to support substance use and addiction services by assuring Canadians that healthcare facilities were effectively responding to the pandemic with new policies and procedures, some of which were highlighted in a letter from BC’s public health officer to healthcare stakeholders.
We are Fortunate to Remain Open
In late March, I was involved in numerous managerial discussions at Sunshine Coast that concerned how to respond to the COVID-19 crisis. We considered whether it was best to close. We made the decision to stay open largely without any government or health authority announcements or guidance. Given the numerous challenges of the COVID-19 pandemic, we consider ourselves lucky to still be open.
Similar to the experience of our private treatment colleagues, a growing number of local residents were calling for us to close. Some of our staff thought it was unethical to stay open during the pandemic. Fortunately, Powell River mayor Dave Formosa and local representatives from the Vancouver Coastal Health Authority endorsed our decision to stay open. They understood that it was better for us to stay open than to close and take the chance that many of our clients would end up at emergency at a time when hospital staff were least equipped to treat them.
Fewer Available Addiction Services = Bad News for All Canadians
It is a loss to all Canadians when there are fewer available addiction treatment options. Had political leadership and provincial public health officers provided better public health guidance, many more of them would still be open and those that remained open would be better utilized. In the short term, more Canadians in need of addiction treatment will suffer in silence and social isolation through the COVID-19 pandemic.
Unfortunately, the pent-up demand will only worsen long waiting lists for addiction treatment that existed even before the pandemic. A 2016 CBC British Columbia story found that 75 percent of treatment centres in BC had wait lists, some up to 6 months long. A 2019 CBC Winnipeg feature from 2019 found that men in that province waited on average 52 days to enter treatment, while women had to wait, on average, 206 days. Those who have been personally impacted by addiction know how difficult it is for someone with an addiction to wait to receive treatment. Many lose hope or motivation and return to active drug or alcohol use while waiting for a treatment bed.
So, in the long term, given the lack of available addiction treatment before the COVID-19 pandemic, the negative impact the pandemic has had on substance use and addiction services, and the anticipated surge in demand for such services after the pandemic restrictions are lifted, one can only hope that provincial governments are including substance use and addiction services in their pandemic and post-pandemic healthcare strategies.
For more information on the treatment services we offer at Sunshine Coast Health Centre, please give us a call tool-free at 1.866.487.9010 or email at firstname.lastname@example.org. We are also available on Facebook and Instagram to chat.