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A fast track to addiction treatment is coming to St. Paul’s

The Vancouver hospital, a hub for drug users in crisis, will test a new model for BC pledged by Premier Eby.
St. Paul’s Hospital in downtown Vancouver has the largest inter-department division of addiction medicine of any hospital in Canada.

The downtown Vancouver hospital at an epicentre of British Columbia’s mounting toxic drug crisis will soon have a new model to improve  substance use and mental health care.

Details from the provincial government, however, remain scarce.

On Sunday, Premier David Eby vowed to  integrate services for mental health, overdose response, addiction  treatment and housing at St. Paul’s Hospital as part of his Safer  Communities Action Plan.

“We are working with St. Paul’s to create a  seamless treatment stream so when people show up at the hospital in  distress and with issues around addiction and mental health that they  can move directly to detox and into treatment,” said Eby from Queen  Elizabeth Park.

“This will be a model that we can roll out across the whole province.”

St. Paul’s, run by  Providence Health, responds to a high volume of patients in mental  health crises or experiencing drug poisonings in Vancouver due to its  proximity to the Downtown Eastside. 

It has the largest inter-department  division of addiction medicine of any hospital in Canada and has become a  hub for new models in caring for marginalized patients.

In 2016 St. Paul’s opened the Rapid Access  Addiction Clinic that provides low-barrier outpatient services for  people using substances. The hospital is also home to the Transitional  Care Centre for unhoused patients moving back to community care and the Hub, which diverts patients in need of mental health and substance use care away from the emergency room.

Demand for these services has ballooned far  beyond capacity in recent years. Wait times for referral to withdrawal  management and detox spaces for people who want to stop using drugs  start around six weeks. 

Providence estimates the number of visits  for mental health and substance use concerns including drug poisonings  has increased 70 per cent in the six years since the RAAC opened.

The Tyee contacted the Premier’s Office for  more information about how this new model will work and overcome the  capacity and resource barriers plaguing St. Paul’s now.

The request was referred to the Ministry of  Mental Health and Addictions, which said more information about the  model will be available in the coming months as the ministry works with  Providence Health and Vancouver Coastal Health.

“We know more needs to be done,  particularly to streamline access and fill gaps between services, so  that people can seamlessly move between detox and treatment services,”  wrote a ministry spokesperson in an emailed statement.

‘Nowhere to go’

Frontline workers and advocates for drug  user rights say improvements can’t come soon enough, but they need to be  done in consultation with people with living experience.

Many people who need a safe place to heal  and rest are discharged early due to capacity issues, unless they can  prove they present an immediate danger to themselves or others, said  Sarah Blyth, executive director of the Overdose Prevention Society.

“Often someone will go to St. Paul’s in an  emergency mental health situation and get medicated and tossed out  within 24 hours,” said Blyth, noting this trend has only increased as  the toxic drug supply has driven more drug poisonings.

People leave traumatized and  discouraged from accessing essential medical care for even physical  ailments like infections or injuries that can turn fatal. “How do we  expect people to get well or feel better if they have a huge infected  leg and sleep in an alleyway?” said Blyth. 

“The unintended consequences of doing nothing are what we’re seeing now.”

Gary Davison went to St. Paul’s for health  care many times when he was actively using drugs, and rarely felt he got  the care and support he needed.

But he remembers walking back to the  Downtown Eastside from St. Paul’s one rainy winter evening without any  warm clothes. The hospital had provided him a bus ticket but it was so  late transit had stopped running.

“It would help a lot of people if they  could say, ‘I am not feeling well,’ and there was somewhere for them to  stabilize and feel better,” said Davison, who has been a frontline harm  reduction worker for more than 25 years. 

“Instead you’re walking to the Downtown Eastside to sit in an alley because you have nowhere to go.”

Davison is now in recovery and takes  Suboxone, an opioid substitute therapy. He says timeliness of detox,  treatment and housing options are essential to saving lives.

“You don’t have it unless you have it when people need it,” Davison said.

On the campaign trail, Eby drew criticism  from drug users and civil liberties groups for suggesting forced treatment for people who overdose multiple times in one day. 

Blyth says the province should focus  instead on creating care that is good and welcoming for people who wish  to stop using drugs. And safe supplies of tested, uncontaminated drugs  need to be readily available to save the lives of people who can’t or  don’t want to be abstinent, she said.

Hospitals should develop care and detox  options that “make people want to stay,” said Blyth. “You don’t have to  make it mandatory if you make it good.”

She worked in the Downtown Eastside when  Eby was working as an advocate for Pivot Legal Society and directing the  BC Civil Liberties Association. Blyth says Eby’s knowledge of the  neighbourhood and the issues is unparalleled in government, and she is  cautiously optimistic he will make meaningful change.

“We have a lot of work to do, and David Eby  has a lot of work to do,” she said. “We know he’s very capable, and if  he puts his mind to it, we have faith.”