Thank you.

Good afternoon.

I'm calling in today from the unceded territories of the Musqueam, Squamish and Tsleil-Waututh nations.

Much of my work has focused on evaluating treatment for opioid use disorders, and I'd like to share some up-to-date evidence and perspectives on this topic, focusing on opioids specifically.

Broadly speaking, there are three options to choose from: outpatient pharmacological treatment, or OAT, short-term detoxification and longer-term residential care. The latter two may also include pharmacological treatment. Only one of these three options is systematically reported and available for independent researchers like me to analyze: OAT. That includes methadone, buprenorphine, slow-release oral morphine and others, prescribed in outpatient clinics and dispensed from community-based pharmacies.

As of March 2024, we had just over 24,000 people accessing some form of OAT in B.C. Unfortunately, retention in treatment has declined over the past 12 years. Although it's a complex story, most fundamentally, we haven't increased our daily dosing to match the elevated tolerance of our clients, who are now using fentanyl as opposed to heroin. More recently, doctors are now having to manage benzodiazepine tapers alongside OAT. Eliminating copayments for treatment and combining prescribed hydromorphone with OAT, as we learned serendipitously through the prescribed safer supply program, have improved OAT retention, although much more needs to be done to improve this form of treatment.

Short-term detoxification treatment in and of itself is not evidence-based care but rather a means of stabilizing and linking individuals to ongoing care after discharge. These data are held by health authorities and are not systematically linked to other provincial datasets. I was involved in a project where we were able to link these data in 2017, and the outcomes for people with OUD were poor. There were high rates of readmission to detox or ED admission, and only about 40% of people with OUD were dispensed OAT after discharge. I believe this is the only published evidence out there on detox outcomes in Canada. I urge you all to verify.

Data on specialized residential treatment facilities in B.C. are also siloed, held either by health authorities or by private for-profit clinics. We know that we have over 3,600 publicly funded treatment beds in B.C., although these are not exclusive to OUD. We know very little about the outcomes of individuals accessing this form of care in B.C. either at the point of discharge or after discharge. Tracking outcomes after discharge is important because what we've found is that transitions back into community are difficult, and it's likely that we need multiple tiers of support, including housing and other social supports, once these individuals are discharged.

What do we know about outcomes for people with OUD served by residential care facilities? Two systematic reviews were published in 2019, one by CADTH and one in the journal Drug and Alcohol Dependence. Though both demonstrated some positive outcomes, few of the component studies focused on people with OUD. The outcomes were mixed for this population, and none included people using fentanyl.

This leaves us with more questions than answers. We need to know the short-term and long-term outcomes for people who received residential care for OUD, including measurable definitions of recovery. We need to build the evidence on who benefits from these services, understand what percentage of that population is accessing services and ensure that this access is equitable, at least on geographic, ethnic and economic strata. We need to know about the staffing requirements and the level of financing needed to reach our target population. Can we hit scale? Finally, we need to continuously evaluate and adapt our approach as the needs of our clients change.

I want to emphasize here that these are not one-size-fits-all services. Through a Health Canada SUAP-funded grant, we found that perhaps the greatest unmet need was care for pregnant people with OUD. Until St. Paul's opened up a perinatal SUD ward earlier this year, there were only 13 perinatal SUD beds in B.C., and that's not just OUD but all forms of SUD. Twelve of them were in Vancouver, and there were none in the north, where OUD prevalence amongst pregnant women is 2.7 times higher than it is in Vancouver. That's coming out of a paper that's currently under review.

To be clear, no jurisdiction in North America has thus far successfully responded to the introduction of fentanyl into the illicit drug supply. Neither B.C. nor Alberta, the provinces with the highest prevalence of fentanyl in Canada, has done so. I'm a believer in evidence-based decision-making, a learning health system. That means learning from both our successes and our failures.

For the sake of the seven more people who will die of an overdose today just in B.C., I urge you to set aside your ideologies, political beliefs, and aspirations and focus on the true scope of this problem and the needs of these people. One of the constructive actions that this committee can take is to recommend—ideally, mandate—the systematic reporting of outcomes across all forms of SUD treatment, recognizing, of course, the legal complexities of doing so. We need to learn from each other to adequately respond to this persistent and evolving crisis.

I've made available to the committee each of the references used within this statement.

Thank you very much.