‘What’s happening now is not working’: Some consensus, lots of tension on addiction treatment in B.C. 

When she appeared before the Select Standing Committee on Health earlier this month, Susan Hogarth painted a bleak picture of B.C.’s toxic drug crisis, comparing hard-hit neighbourhoods to “a scene from a zombie apocalypse movie, with individuals unable to control their uncoordinated movements, stricken with flesh wounds and disease.”

“The message that I wanted to convey is that what’s happening now is not working,” said Hogarth, the executive director for Westminster House Society, an organization that provides addiction recovery and treatment programs for girls and women healing from addiction in New Westminster.

“We are missing so many opportunities to help people recover.”

Hogarth’s remarks have prompted pushback, including from Garth Mullins, a spokesperson for the Vancouver Area Network of Drug Users (VANDU), who said she presented “a very nasty view of what a drug user is.”

During her presentation, Hogarth described a situation where people “often defecate on the streets, inject drugs into their bodies out in the open and lie unconscious on the sidewalks.”

She said the way B.C. currently treats “addicted individuals” — whom Hogarth described as “intelligent, cunning and powerful manipulators” who “will stop at nothing to get what they want” — is inhumane.

People with addiction “do not need sympathetic pity and concern for their suffering or misfortunes, they need help,” Hogarth told the committee.

Hogarth is aware her comments — which she said do not apply to “all people with substance use disorder” — are “uncomfortable.”

“They might not be the popular opinion, it might not be the right language or the right wording, but you’re getting the picture,” she told BC Today. “I wanted those people on that steering committee to understand and somebody to say on record, that this is what’s happening in your poor neighbourhoods. How can you continue to let that go on? We’ve got a start naming it.”

Mullins, who also hosts and produces the Crackdown podcast, says people often use drugs for “very rational reasons,” such as coping with poverty, trauma and mental health disorders.

“We’re frequently using drugs to handle situations as best we can,” he told BC Today. “But this person just sees us as zombies, like mindless monsters. I shudder to think that this person is in any way in charge of us.”

Mullins said Hogarth’s views “seem radically out of date” with best practices for addressing problematic substance use.

“One of the reasons why a lot of people wind up using drugs problematically is because they’ve had all the control and agency taken out of their lives and that’s all this person is prescribing: a program where you’re just treated as a zombie incapable of making any decisions,” he said.

Westminster House currently operates a mix of privately and publicly funded treatment beds, as well as community care beds for people in need of longer term support. Fraser Health refers people to the public beds. Since 2020, Westminster House has received about $240,000 from the Ministry of Mental Health and Addictions.

The organization offers “a full continuum of care,” including harm reduction, according to Hogarth, and is listed as a licensed provider by the province.

The Ministry of Mental Health and Addictions did not directly respond to questions about Hogarth’s comments to the committee in the context of receiving public funding but said in a statement that “reducing the stigma of drug use is one vital part” of the province’s response to the toxic drug crisis.

“People living with addiction should receive the same dignity, respect and health-care as people who are dealing with any other kind of illness,” the statement read. “In many cases, it’s those feelings of shame and blame that keep so many people from reaching out for help.”

Mullins wants the province to increase oversight of the treatment and recovery sector to ensure funding is going to evidence-based programs.

“They’ve got to stop giving public money to people who are just continuing to shit on us,” he said.

When Nicole Luongo attended Westminster House as a 19-year-old in 2009, she was struggling with a severe eating disorder and alcohol abuse. The treatment she received at Westminster House centred on abstinence and the 12-steps, an approach “fundamentally rooted in Christianity.”

“You are told that you have … a brain disease rooted in selfishness and self-centeredness and it is kind of solely your fault — you were born flawed and it is now your responsibility to surrender to a god of your understanding to be healed,” Luongo told BC Today.

Luongo’s experience at Westminster House was not a success. She says the 12-step approach de-politicizes addiction and erases systemic factors and nuance.

“We know that rates of chaotic and compulsive drug use are elevated among marginalized groups — Indigenous peoples, racialized populations, disabled people, poor people — and the 12-steps really prevents you from incorporating that into your analysis of yourself because it’s a fully individualized program,” she said.

The 12-steps approach leaves “no room for flexibility or autonomy” for people attempting recovery, said Luongo.

“They’re designed to erode that,” she said. “You become kind of conditioned to think and speak almost clinically … and you are taught that if it does not ‘work for someone,’ it’s because they have not tried hard enough.”

Luongo spent “three years homeless on the Downtown Eastside” after leaving Westminster House. She told BC Today she entered treatment “five or six times” before completing a seven-month program and has been abstinent for years. She holds degrees in medical sociology, works for the Canadian Drug Policy Coalition and is a member of VANDU.

While 12-step programs may work for some people struggling with addiction, Luongo said they can also instil shame, fuel substance use and make it more difficult for people who fail the program to get back into recovery after a relapse.

“You are totally taught that your addiction is your responsibility to fix and when it doesn’t work, then I think use becomes more intense because it’s fuelled by this additional layer of shame that you haven’t worked the program hard enough,” she said.

Hogarth told the committee one component of an effective response to the current crisis is “holding individuals accountable to their treatment pathway, whatever pathway they choose.”

Speaking to BC Today, Hogarth said she supports harm reduction but sees “a lack of accountability to the medications that are being distributed right now to people with substance use disorder,” which ultimately harms substance users.

“People who are in need of help, they don’t need to be coddled — we have to start telling the truth to them,” she said. “This is very dangerous, you need to get help right away … Tell them the truth. If the medications aren’t working, you have got to try something else.”

But Hogarth’s stance “erases all the structural factors” that can contribute to problematic substance use,” Mullins told BC Today.

“The province may give lip service to [these factors], but don’t effectively do anything about them — even the way the province talks about stigma and decriminalization is focused on what the drug users should be feeling or doing,” he said.

Mullins also pointed to Premier John Horgan’s emphasis on “personal responsibility” when it comes to “just about every catastrophe,” including the “overdose crisis, the pandemic [and] the heat dome.”

“Of course, everybody has some agency, but you can’t erase the structural forces that are causing so much of the problem,” said Mullins. “When [Hogarth] talks about neighbourhoods looking like a zombie apocalypse? Well, that’s the housing issue, right? If people are out on the streets, you have a housing question.”

B.C. needs better data on the people accessing treatment and recovery services, according to Hogarth, and a system for assessing people’s needs early in their struggle with substances.

“We need to be able to triage right away and find out what’s going on for them so we can get them to the right service, wherever they land in that continuum of care,” she said.

“There is no current system in British Columbia to track people who suffer with the disease of addiction and substance use disorder, there’s no ability to know what treatment the person has already received.”

Knowing what types of programs people have participated in could help improve outcomes, per Hogarth.

A standardized assessment process — ideally conducted by medical professionals in hospital or clinic settings — would help ensure people are not entering facilities that may be ill-equipped to deal with issues beyond problematic substance use, such as mental health disorders, according to Hogarth.

“People aren’t being properly assessed before they show up at Westminster House,” she said.

Hogarth pushed back on chief coroner Lisa Lapointe’s suggestion that the province focus on improving oversight of the treatment and recovery sector, perhaps via legislation, saying it is “a great goal” but “will take too long.”

Mullins pointed out that treatment and recovery providers are “not required to demonstrate the outcomes and effectiveness” of their services — a point Lapointe also made during her committee presentation — while community-based harm reduction initiatives often face bureaucratic barriers.

“Every time we try to do something — going back to needle exchanges and safe injection sites, to prescribing programs now — we’re required to create mountains of evidence for it, the thresholds are very high,” he said. “For abstinence-based recovery, there’s almost nothing.”

Luongo says a lack of political will is holding back better regulation of the treatment and recovery sector.

“The government does not have the infrastructure because it doesn’t desire to regulate these treatment places,” she said.

Public indifference to people who use drugs has “allowed the government to not have regulations in place,” according to Luongo, who said there has been a shift in public understanding of what is driving drug-related deaths in B.C. in recent years.

“People are becoming somewhat more aware that the drug supply is what’s killing people, not necessarily addiction,” she said. “But people who are visible drug users, and also tend to be poor — they are simply not a population that is politically viable to care about.”

Framing treatment and recovery initiatives as a solution to the toxic drug supply is disingenuous, Luongo suggested. In doing so, provincial officials are “providing a solution to a different problem in a bid to appease the public.”

While safe supply is key to stopping deaths due to contaminated drugs, the public is “encouraged to think of all drug use as being symptomatic of addiction, and then they hear treatment and they go, OK, the government’s doing something,” Luongo said.

Mullins agreed the committee should not be focusing on treatment and recovery as a solution to the current crisis.

“This committee is looking into the toxic drug supply and the overdose crisis so it shouldn’t be concerning itself so much if people are using drugs — it should be concerning itself with people dying from drugs,” he told BC Today.

“The whole recovery industry is aimed at something that is longer term than the overdose crisis,” he added. “We need solutions that are going to save people from dying this afternoon, not something that takes years and several attempts.”

Mullins admits he’s “pretty cynical” the committee’s hearings and forthcoming report will do much to change the situation in B.C.

“I don’t want to dump on people who are hopeful about this, but I don’t think that this thing is going to magically generate information that hasn’t been available to government before this,” he said.

Governments “act like they’re spectators” to the crisis, per Mullins, framing a rising number of drug-related deaths as “a force of nature.”

He expressed disappointment, but not surprise, that no committee members pushed back on Hogarth’s presentation or the language she used to describe people who use drugs.

“Although the language is a little cruder than what government uses now, the logic behind it — of sidestepping blame and letting the responsibility fall on the drug user — that’s all too familiar,” he said.

B.C.’s government needs to take a hard look at where the evidence lies when it comes to curbing drug-related deaths, said Luongo, adding that supposed solutions not backed by data should not receive the same support proven policies do.

“It’s incredibly dangerous to ‘both-sides’ drug policy, because they’re not equivalent positions — they’re not two disparate perspectives, both rooted in evidence,” Luongo said. “One is a product of the intersections of colonialism, capitalism, imperialism, and Christianity, and the other is evidence-informed.”