B.C. to require hospitals have designated spaces for patient illicit drug use, health minister says

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British Columbia will require all of its hospitals to provide a designated space for patients with substance-use disorders to consume illicit drugs, prompted by concerns that an increase in such activity in prohibited hospital areas was putting health care workers at risk.

Health Minister Adrian Dix announced this week that the province would create a task force to standardize rules and create “active supports” to help patients manage their addictions while in care.

Some hospitals already provide designated-use spaces where staff monitor for overdoses. The Globe and Mail asked Mr. Dix Thursday whether every hospital in B.C. would be required to follow suit. “That is the purpose of the effort – not just to standardize rules,” he said.

Mr. Dix said that on any given day, hundreds of people with severe addiction issues use B.C. health care facilities. “The idea that people who are severely addicted and, say, are involved in some incident which leaves them injured and requires admission to a hospital, are going to take that moment to simply not deal with their addictions is just not correct,” he said.

“Our doctors and our nurses, and allied health science professionals, they deal with this every day. And our task is to support them.”

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The move is the latest in a province whose approach to substance use has made it an outlier in the country. B.C. is the only jurisdiction in Canada to decriminalize possession of small amounts of illicit substances, and take a provincial approach to prescribing alternatives to illicit drugs, an intervention limited to small programs and pilot projects elsewhere.

B.C. nurses have been speaking out about safety concerns related to patient drug use. BC Nurses’ Union president Adriane Gear said that while there has always been some degree of illicit drug use in care spaces, it appears to have increased since B.C.’s drug decriminalization pilot began early last year.

Ms. Gear said members’ concerns have come primarily from the north, on Vancouver Island, and in the Interior, citing as examples nurses in Victoria reporting substance use in the perinatal unit, and a nurse in the Interior reporting being exposed to substance use twice in one week.

WorkSafeBC reports have detailed concerns over drug use in patient rooms and washrooms, drug paraphernalia visible in rooms and exposure to illicit substances by inhalation.

The requirement for designated spaces could be met with resistance in some municipalities.

While Vancouver’s St. Paul’s Hospital has offered overdose prevention services on site for years, some cities have rejected them altogether.

In suburban Richmond, an effort by city council earlier this year to explore the possibility of a public supervised consumption site at the local hospital was met with raucous protest by residents before the health authority concluded that such a site isn’t needed there.

In Quesnel, where the local hospital does not have a designated space for substance use, an internal memo advising staff not to confiscate illicit substances or restrict visitors who may be dropping off drugs touched off days of heated debate in the B.C. legislature.

The task force announced by Mr. Dix, which comprises representatives from public health, each B.C. health authority and the Ministry of Health, was scheduled to have its first meeting this week. The Globe sought comment from every health authority but received no response on Thursday.

According to the Health Minister, the task force has been directed to standardize relevant policies and procedures across all health authorities and ensure consistent practices are in place in all hospitals. It will also seek to ensure “the use of drugs is specific to designated spaces within or around the facility or under specific direction of the care team of where and when unregulated drugs can be used.”

In addition, it has the task of improving training and education for staff, strengthening screening and risk assessment and ensuring “active security interventions” are taking place.

Elenore Sturko, BC United’s mental health and addictions critic, said she supports providing such patients with prescribed alternatives – such as fentanyl or hydromorphone – to use under the supervision of health care staff while in hospital.

However, she’s opposed to patients using any illicit substances on hospital grounds, citing potential behavioural issues and safety concerns arising from stimulant-induced psychosis, for example. She is also skeptical that a designated space, such as an outdoor smoking area, could be protected from predatory drug dealers.

“Of course, we don’t want people going into withdrawals and making them leave the hospital because they’re in so much pain that they can’t receive their treatment,” she said. “But there are ways of managing those symptoms of their addiction without being excessively permissive.”

Tracey Day, clinical director of substance-use and addiction services at Carrier Sekani Family Services in Prince George, said people with substance-use disorders often cannot access addiction medicine such as methadone or Suboxone, or a prescribed alternative, when admitted to hospital. As a result, many people choose not to go, despite medical need.

“They deteriorate in the community until they either overdose and die, or they become so critically ill that they end up going to hospital, where they’re unable to leave on their own accord, and then they’re in that intolerable withdrawal,” she said.

Correne Antrobus, a Victoria-based member of the advocacy group Moms Stop The Harm who regularly accompanies people who use drugs to the hospital, said those who are there without supports will often “stumble outside and use,” or leave.

“They’re so sick, and they need help, but they won’t stay because of the draw to use their drugs,” she said. “That’s what I think people don’t understand about addiction. It’s so insidious. I’m 100 per cent behind this; we need to treat this as the health crisis it is.”

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