Over the last several years, the number of opiate overdose deaths in Canada has skyrocketed. The number of deaths is especially alarming in the province of British Columbia. It is important to note that deaths related to opiate overdose have not increased because people are using more drugs or not even because more people are using drugs period. Rather, people are overdosing almost exclusively because our current illicit drug supply is being poisoned with an extremely potent opioid called Fentanyl. While this substance has been and continues to be used safely in controlled medical settings, such as for pain management during labour, its unregulated use in the drug trade has made our usual supply of street-level drugs exponentially and unpredictably more potent.
Fentanyl is also showing up in almost all types of substances including uppers and downers. And, it’s crucially important to note that despite the fact that the province of BC declared a public health emergency related to the poisoned drug supply crisis in 2016, it is without a doubt our federal, provincial and municipal drug policies that have sustained this crisis at this level for over half a decade. Despite some policy and research advancements since 2016, much remains unresolved when it comes to curbing opioid-related deaths in our province and country.
In response to high-profile opioid overdose-related youth deaths, the BC Government tabled legislation that would allow people of all ages to be detained in the hospital under the BC Mental Health Act. The Mental Health Act Amendments, Bill 22, were devised as a strategy to give healthcare clinicians time to organize services for the youth to prevent a future overdose and thus save their life. While this is a laudable goal and perhaps a reasonable strategy, in theory, it fails to account for the very real challenges such an approach would trigger. Pushing this approach forward as our provincial response to youth substance use and opioid overdose deaths seems to ignore that other options with the allotment of adequate resources were not fully explored. Nor does it seem that the youths who this piece of legislation will most impact were consulted during its drafting. Both, clear misses by the government that claims they are committed to change.
Research has shown that key pillars of effective substance use prevention and treatment programs for youth include a focus on healthy connections with at least one adult, using a trauma-informed lens, adopting a non-stigmatizing harm reduction approach, and generally “meeting youth where they’re at” both literally and figuratively. It is difficult to surmise how the idea of a youth waking up in hospital after an overdose only to be told by strangers that they will be held against their will - all too often in chaotic Emergency Departments or on adult-oriented units in the many health care facilities across the province that lack youth-specific mental health and substance use programs an spaces. The youth are essentially medically detoxed against their will, offered opiate agonist therapies that they may have no means or interest in continuing post-discharge, and told these interventions are “saving their life” and that it is “for their own good”.
It is not wrong to want to protect youth. But at what cost? Especially when the strategy involves infringing on the youth’s right to be autonomous decision-makers. In BC, under the Infants Act, a person of any age can legally consent to (and thus decline) medical treatment provided they have the capacity to understand the treatment being offered. How can we, as health care providers, reconcile this legislation (The Infants Act) where young people are empowered to make their own decisions about their health, with the potential reality Bill 22 represents? Are we saying, with Bill 22, that people who use substances lack the capacity to make their own decisions? Or only people who happened to overdose on a substance (Fentanyl) that has been allowed to absolutely take over our street-level drug supply due to policy inaction or, worse yet, harmful direct action such as shutting down safer consumption sites as is happening in Alberta?
Nurses play an important role in building relationships with youth especially those youth who are often excluded by the traditional healthcare system. Nurses work in schools, sexual health clinics, doing outreach on the streets, and in mobile harm reduction vans. We work in specialized settings using unique skill sets in ways that are unaccounted for by Bill 22. And, front and centre should be the increased barriers Bill 22 creates in trying to gain a youth’s trust because making someone feel safe, validated, and seen is much harder when they may feel trapped and mistreated within a system in which health professionals are given the power to make their decisions.
Listen to this month's episode of The Shift Change to learn more about Claire and Michelle's experience working with youth who use substances and the risks and benefits of this proposed change in BC legislation.
Resources
A report that offers an investigative look into the story of one First Nations girl in British Columbia who was let down by the healthcare system. The reported completed by British Columbia’s Representative for Children and Youth and published in 2021.
Detained: Rights of children and youth under the Mental Health Act A report released in January of 2021 highlighted the many injustices that occur with youth in the British Columbia Mental Health System.
Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act A 2019 report highlighted the many changes that are necessary in the British Columbia Mental Health Act to ensure that a human rights perspective is upheld. British Columbia Infant Act
Learn more about the provincial legislation that guides healthcare for youth.