My latest opus for the Victoria Times Colonist is a deep dive into drug treatment in BC.
It's the fifth piece in the monthly stories I'm writing for them in 2026 relevant to the homelessness crisis, and was easily the toughest so far to write. A person's individual recovery from a substance use disorder is still a fairly mystical process, and the fact that there's no real system around any of it in BC adds to the grey. And wow, so much to learn from a whole lot of informed, frustrated people.
For me, gathering the information for the piece provided such insight into the idiocy of this talk of involuntary treatment as the thing that's needed to "fix" the visible social crisis in all of our communities. People are desperately trying to get into treatment voluntarily, in fact. But there's not nearly enough supports to meet the demand, no data to demonstrate whether anything is working, and a whole lot of judgment at the locked gates to all of it that is keeping people out.
So as the sensible people have said repeatedly as cries for involuntary treatment became politically weaponized, let's put some serious time into fixing the voluntary "system" - and even defining and regulating what treatment means - before we go jumping up and down suggesting that the problem is that people don't want to get away from harmful drug use.
Here's the link to the story in the TC, which ran May 31 and has some great photos from Darren Stone. And here's the text below, but the link is better so that you can appreciate Darren's photos. I can't share those here, as I only own the copyright to the text.
It’s been a century or so since surgeon and Burnaby sanatorium owner Dr. Robert Telford was opining in the Vancouver Sun about the urgency of launching a facility in B.C. that provided treatment for “drug fiends.”
Debate had been heating up about these so-called drug fiends for a while. Fuelled by racism toward Chinese labourers in the country, opium was the new enemy. Prohibition politics were in play, and an appetite for treatment was building.
Everyone in the province had an opinion on whether to manage illicit drug use as a criminal problem or a social concern. But the commonly held view was that drug users were moral degenerates from the “underclass” who needed saving from the evil, soulless criminals selling drugs.
The world has changed hundreds of times over since then. Treatments for virtually every kind of health condition have advanced beyond anything that could have been imagined in the early 20th century. The rare studies of monkeys on methadone being done in Telford’s time have given way to grand volumes of research into every aspect of addiction, which has been understood as a health issue and not a moral failing since at least the 1950s.
But that century-old framing of illicit drug use as Good versus Evil hangs in. It dominates and polarizes the public discourse around drug treatment. It guides where government funds are spent, and stirs up vitriol in communities to the point that life-saving services can be forced to close just because the people needing them are drug users.
Addiction remains the only health issue where the views of police and politicians shape the debate around care, and where most of the public funding for the work goes to police. Canada’s Drugs and Substances Strategy has four key action areas, but the one focused on enforcement has a budget larger than all the others combined.
Telford would be pleased to know that in 2026, more treatment facilities are in everyone’s plans across the country. There’s broad agreement that more beds are urgently needed. Politicians on both the right and left claim residential treatment as the cure for what ails us, even if people have to be forced into it.
But in truth, so little about residential treatment is scrutinized and measured that an evidence-based case for it can’t be made one way or the other.
Much of the work belongs to the private sector, which doesn’t like to share what it knows. Follow-up is rare. People go in and out of B.C.’s many residential treatment centres all the time, but scarce data is collected to gauge the impact of any of it.
“I don’t even know how they’re allowed to call what we’re doing in B.C. ‘treatment,’ because there are no standards,” says former B.C. coroner Lisa Lapointe, who repeatedly raised concerns about the lack of data, strategy, oversight and regulation for residential treatment during her 10 years in office.
“And how do you treat a medical issue by funding the police?”
Treatment facilities’ effectiveness largely undocumented
Telford was long dead by the time B.C.’s first government-funded treatment centre opened at Oakalla Prison Farm in 1958. But his belief that drug users needed long-term residential programs to get them past their “maladjusted personalities” was still the dominant thinkingDecades on, we know a lot more about everything. Our health-care systems are built on data and evidence. But the effectiveness of what goes on in B.C. treatment facilities — and what happens to people after they leave — remains resolutely anecdotal and largely undocumented.
Trevor Botkin, strategic lead for trades for the Canada Men’s Health Foundation, was planning to kill himself on the day in 2019 that he went to treatment. He went through a single three-month treatment program that his mom happily paid $35,000 for, and hasn’t used stimulants since. For him, treatment was transformative.
Julian, meanwhile, has gone through treatment four times, paid for by government. But he’s back to regular drug use again because the only place he could get housing after his last round of treatment was in a converted hotel full of active drug users.
“I’m not great right now, but I’m all right. It gets a little bit easier each time I go,” he says.
Che moved into the New Roads therapeutic community for his third pass through treatment, and those 11 happy months living and working there were the longest he’d been drug-free since he was 13. But then he was moved into sober housing too close to his old haunts, and that was that.
Botkin was fortunate to have a mom able to scrounge up $35,000. Many people don’t. With so many residential-treatment services behind a paywall and the publicly funded ones overwhelmed, the first question for anyone contemplating treatment is whether they can even afford it.
The stigma that clings to illicit drug use continues to shape and limit care at every step. As one local woman noted after her own two times through residential treatment, the system of care is “set up like you have something to atone for.” Recovery from harmful drug use is hard and uncertain, and all blame for “failure” will be borne by the individual.
“This field is messy, and no one has all the right answers,” says Blake Andison, executive director of Umbrella Society for Addictions and Mental Health. “But not being able to look back and assess anything to see what’s working, the absence of a co-ordinated system of care — it just can’t be like this. It’s a complex enough issue as it is. Why are we making it so much more complicated?”
***
In practical terms, treatment for addiction encompasses everything from prescription drug regimes and trauma counselling to years-long stays in therapeutic communities. In personal terms, recovery takes so many forms and meanings that literally every person’s experience is unique.
Treatment might mean a spiritual connection to God and a lifetime of carefully guarded sobriety for some people. For others, it’s a whole lot of work on emotional regulation, help getting back to work, and a good prescription.
Some treatment centres pride themselves on following evidence and research. Others are built on someone’s personal ideology. Some run like a military operation, with points deducted if your bedsheet corners aren’t tight enough. Others are gentle and loving, with outings and events and connections that last long after the person leaves the facility.
Such different approaches aren’t necessarily a bad thing, say those familiar with the many unpredictable ways that recovery comes to people. But what’s working well isn’t really a conversation that anyone can have in B.C., because so little is being measured. And creating a measurable system for such a uniquely individual experience is a major challenge.
Twelve-step recovery programs following the Alcoholics Anonymous model no longer have the ironclad hold over treatment that they once did, but their influence and impact is still significant. Indeed, millions of people have found recovery through AA, founded in the 1930s by two men whose own experiences led them to create a volunteer system of peer support and abstinence.
But there has been a lot of other learning since then, notes Michael Egilson, who chaired all three of the coroner-led death review panels examining the devastating impact of B.C.’s toxic drug crisis.
“Think about treatments for cancer, asthma, and diabetes — how different they are today than they were 100 years ago. That’s because medicine demanded evidence, measured outcomes, and changed practice based on what it learned,” says Egilson.
“Addiction treatment has been slower to apply that same standard. Some approaches have been around for generations and largely taken on faith, with far less scrutiny than we would apply to any other treatment for any other disease.”
No one calls anyone a drug fiend in 2026, at least not out loud. But questions of moral worthiness still figure strongly in much of B.C.’s treatment services. Treatment centres are still the only B.C. residential-care facilities allowed to deny phone use to their clients, exclude people if their disability means they won’t be able to participate in mandatory chores, and use shame and blame as a programming staple.
“Sometimes good things happen in treatment, but none of it is regulated,” says Traci Letts, president of Moms Stop the Harm. Her own experiences with treatment centres while supporting her son through 12 years of harmful drug use are marred with memories of families being told that their loved ones were untrustworthy liars.
“When anybody complains about what just happened at a facility you paid $25,000 to get your child into, they tell you not to believe it because these are people who lie,” says Letts. “Even the use of the word ‘clean’ to describe someone is wrong. Nobody was every dirty.”
Long waits and massive gaps
Aside from the absence of evidence, the loose collection of services and facilities that makes up B.C.’s patchwork recovery system is also overwhelmed, especially publicly funded services. Long waits and massive gaps in the care continuum are the norm.As well, the drug that someone is addicted to often determines access to care. A government-funded bed in residential treatment is typically available only for those struggling with opioids or alcohol, the thinking being that scarce detox services need to be saved for the drugs that have the potential to kill a person during withdrawal.
That shuts out people using cocaine and crystal meth, some of whom actually start using opioids just so they can qualify for treatment.
“My drug was cocaine, but I wanted to go to treatment because I needed to understand why I kept doing things that I didn’t want to do. So I lied and said I was using opioids. But then they said I hadn’t tried other resources enough, so I still got turned down,” says Jaimee, who eventually figured her own way out by attending SMART Recovery groups sponsored by the local health authority.
That requirement to try harder before being allowed to access a publicly funded residential treatment bed distinguishes addiction services from virtually all other health care.
Cancer treatments and care for lung diseases still go ahead for people even if they continue to smoke cigarettes. Heart attacks get treated even if a person hasn’t yet committed to a healthy diet and more exercise. But treatment for addiction is still mired in stigma and an entrenched belief that people must repeatedly demonstrate their readiness.
“They’ll actually tell people that — ‘Nope, you’re not trying hard enough,’ ” says a Victoria outreach worker supporting people to access treatment.
“I’d say 50 per cent of my referrals for publicly funded treatment get turned down, either because the people have been deemed to not have tried hard enough to use other resources first, or because they haven’t been to one of the cheaper treatment centres that the Social Development and Poverty Reduction Ministry funds.”
The most visible face of addiction is on city streets. But people living homeless and in constant crisis are the least able to manage the complicated application processes, service gaps and many tests baked into the system to gauge whether they’re trying sufficiently hard.
The ongoing housing crisis adds a profound challenge. People fresh out of treatment generally don’t do well if they’re immediately moved back into places where people are using drugs, but “dry” second-stage housing is hard to come by. People living homeless can end up going through treatment only to be placed in supportive housing where drug use is permitted — or back on the street.
“It’s absurd to me that government will spend 20 to 30 thousand dollars on treatment, then return someone to homelessness,” says local addiction specialist Dr. Kelsey Roden, a founder of Doctors for Safer Drug Policy.
Deadly illicit opioid supply dials up the urgency
Eighty per cent of Canadians used a mood-altering drug in the past year — mostly alcohol, cannabis, and prescription drugs, with illicit drugs used by just three to four per cent. That rate has been stable for many years.Why a percentage of people become dependent on drugs while others can stop and start at will is still being sorted out by science. Research has confirmed genetics as accounting for up to 60 per cent of it, along with brain chemistry and environmental factors such as experiences of trauma.
But while the world waits for the final answer, the deadly illicit opioid supply has dialled up the urgency of the conversation. By the end of this year, an estimated 20,000 British Columbians will have died from the poisoned supply in the last decade. That fact and the growing crisis of homelessness across the province, so much of it layered over by addiction, has put drug treatment in the political spotlight.
Bright spots are emerging in B.C. around standardized, evidence-based forms of treatment, from new medications to a continuum of care that sticks with people long after they leave a treatment centre. Abstinence from all drugs is no longer seen as foundational to recovery. Even the most ardent 12-step treatment centres in B.C. have begun accepting the role of medications in treatment.
“There’s a lot of people just looking for a better life,” says Roden. “Abstinence doesn’t have to be the rule. If you’ve been using opioids for 50 years, you don’t have to be written off because of that. A lot of people just want to live a life that isn’t homelessness.”
The new GLP-1 weight-loss drugs are being researched for their potential to reduce cravings not just for food, but for opioids, alcohol and nicotine. The prescription drug Sublocade, a slow-release opioid injected once a month, is being used in Canada’s penitentiaries to treat inmates with opioid dependencies.
Closer to home, two physicians with expertise in drug policy and addiction — University of B.C. professor emeritus Martin Schechter and former B.C. provincial health officer Perry Kendall — have announced a new private-sector venture in Vancouver to produce inhalable diacetylmorphine, better known as heroin.
They’re seeking B.C. government support to permit the drug as a second-line treatment for opioid disorders that aren’t responding to other common opioid-based treatments such as methadone, Suboxone and Kadien.
Injectable heroin has been used in treatment at Crosstown Clinic in Vancouver since 2018 after federal permissions were secured. Schechter says the inhalable version would be significantly cheaper, and more appealing to drug users, what with the majority of opioid users shifting away from injecting.
“The medication that we’re bringing forth has been used in Europe very successfully for more than 20 years, so there is a ton of clinical experience. We know all about the safety and effectiveness of it,” Schechter said in a Globe and Mail article last month. “The government has said it wants to focus on evidence-based treatments. This is exactly what they’ve been asking for.”
On the residential-treatment front, two B.C. projects launched since the pandemic are approaching treatment with an eye to evidence-based interventions, a continuum of services, and even job training.
The Catholic non-profit Providence Health Care — which operates 18 hospitals, health-care centres and clinics in B.C. — is building out its Road to Recovery program. A new residential treatment facility is part of the plan, but for now, the focus is on aftercare for people coming out of existing treatment centres.
“A huge part of recovery is what happens after you’re outside of the treatment facility,” says Stuart Smith, who leads the aftercare team currently following 130 people who have been through treatment in B.C. “I’ve loved to see how people can come out with this after-care in place and be able to sustain their goals. Our team has been really effective in that.”
A five-year-old initiative managed by the Canadian Mental Health Association has been “a godsend,” says one local outreach worker, who counts on it for quicker access to treatment for clients who can’t afford a private bed.
People can even self-refer into CMHA’s low-barrier beds — a mix of 151 existing beds in private facilities that weren’t previously available for people who couldn’t pay, and 160 new beds.
A partnership with the Ministry of Social Development and Poverty Reduction adds a unique element to the initiative: vocational rehabilitation. To date, 58 per cent of the 378 people who have gone through the augmented treatment program are employed.
“We’re really proud of this work,” says Jonny Morris, CEO of the CMHA. “The issues are so politicized, so polarized, but this is part of the solution. And the government was very clear with us from the beginning — they want this measured, managed, and evaluated by a third party.”
The province’s own 30-bed Heartwood Centre for Women at B.C. Women’s Hospital opened in 2011, and gets high marks from women who have gone through the 90-day program. “It’s the best,” says Jen, who was preparing for her second time through.
People typically have had to make use of other services first before being accepted into Heartwood, and the expectation is that they’ve got a regional care team already in place who will continue to support them during and after their stay.
But for women with severe addictions to multiple substances and underlying mental-health issues, a stay at Heartwood can be transformative, says Kathryn Embacher, provincial executive director for adult mental health and substance use for PHSA.
“If this were my kid needing help, this is where I’d want them,” says Embacher. “Recovery is absolutely possible. We’ve got people who went through Heartwood who are now working in the field.”
Therapeutic communities provide much longer treatment experiences, up to two years. Our Place Society’s New Roads program for men has operated for eight years now, and a women’s program launched just over a year ago. Port Alberni Shelter Farm has operated long-term sober community living on a farm for women since the 1970s, and has begun the work to open a second site for men.
Such communities aren’t just the place where people live while going through treatment, they’re a major component of the treatment itself, says Cheryl Diebel, director of the New Roads program. Two-thirds of the people in the program successfully complete at least nine months to a year (though what happens after they leave isn’t being tracked). But even those who don’t make it that long are still building “recovery capital,” notes Diebel.
“Our residents tend to be people who have tried the 60- to 90-day treatment programs, and it didn’t work for them. Some have been embedded in their addiction for years,” says Diebel. “They’re typically going to have mental-health issues, criminal-justice involvement, homelessness.
“For them, it’s not good enough to just not use. They need to do emotional, spiritual and physical work — and get their taxes up to date.”
“I think expecting people to stay abstinent forever is the wrong way to think about this,” says Botkin. “What sustainable recovery actually looks like is that if someone slips up, they know how to right their own ship.
“I’ve seen it in friends who were 10, 15 years sober – they slipped, but they knew what to do. I know a guy who went through treatment 13 times. On the 13th time, he was 20 minutes in when it clicked for him.”
Not everyone will want or need residential treatment. People with jobs, pets and families can’t often fold up their lives for two or three months to move into a treatment facility, says Roden. That underlines the need for community-based recovery programs.
Jaimee has been sober for a year now, and says the sheer toxicity of the drug supply is a new motivator for her. The risk of a slipup nowadays isn’t just about feeling shame and embarrassment, it’s about death.
“I’m really testing myself when I’m down on Pandora supporting my brother, putting myself in the thick of things,” she admits. “You just don’t know what news you’ll hear out there, and all it takes is that one moment. But I’ve been down that road, and it always ends the same way. Like they tell you in Narcotics Anonymous, ‘Play the tape.’ ”
The reality of a relapse highlights the importance of all the services collectively known as harm reduction — overdose-prevention sites, clean supplies, wound care, outreach support, prescribed alternatives to the poisoned opioid supply. Such services keep people alive to fight another day and are forms of treatment in their own right, say advocates.
A shifting political mood has wrongly pitted harm reduction against treatment in the public’s mind, like it’s one or the other, says Roden. In fact, they’re both vital components of the same continuum of care.
“That’s the thing that’s perpetually on my mind right now: This narrative that puts harm reduction against treatment as if they’re not part of the same spectrum,” she says. “Harm reduction should inform all of these efforts. It belongs in all stages of treatment. It’s really sad that we’re seeing this fracturing of providers, and of people themselves. People are dying because of it. That struggle is leading to actual, measurable harms.”
Locally, medical beds for detoxing people with opioid and alcohol dependencies are the first step in the recovery process. But the number of detox beds hasn’t changed in years, says Andison, and current waits are five or six weeks. People hit that moment of change that shifts their thinking toward recovery, but struggle to sustain it through the long wait for a detox bed.
“You have to strike while the iron is hot,” says an outreach worker. “It’s so frustrating, waiting two or three months for a bed to open and then it’s [income assistance] cheque day and people lose their motivation. When people are broke and sick and ready for treatment, that’s the time to move.”
A profound lack of affordable housing for people needing to stay away from substance use makes sustaining recovery so much more difficult, says Andison.
Umbrella’s 11-bed Foundation House recovery home for men currently has a waitlist of 60 people. Everyone was excited when Cool Aid opened 20 units of substance-free housing earlier this year, says Andison, but it was at capacity in an instant.
“The appetite for recovery is there,” says Andison. “But when it’s met with so many barriers, people just say screw it. It takes so much courage to make a change. It’s crazy that we aren’t just welcoming people with open arms.”
“Our residents tend to be people who have tried the 60- to 90-day treatment programs, and it didn’t work for them. Some have been embedded in their addiction for years,” says Diebel. “They’re typically going to have mental-health issues, criminal-justice involvement, homelessness.
“For them, it’s not good enough to just not use. They need to do emotional, spiritual and physical work — and get their taxes up to date.”
Knowing how to ‘right your own ship’
Like any health problem, there will never be a single treatment for substance-use disorders. Residential treatment is one tool in the toolbox, but National Institutes of Health research has found that as many as 60 per cent of people who go through treatment will return to using substances.“I think expecting people to stay abstinent forever is the wrong way to think about this,” says Botkin. “What sustainable recovery actually looks like is that if someone slips up, they know how to right their own ship.
“I’ve seen it in friends who were 10, 15 years sober – they slipped, but they knew what to do. I know a guy who went through treatment 13 times. On the 13th time, he was 20 minutes in when it clicked for him.”
Not everyone will want or need residential treatment. People with jobs, pets and families can’t often fold up their lives for two or three months to move into a treatment facility, says Roden. That underlines the need for community-based recovery programs.
Jaimee has been sober for a year now, and says the sheer toxicity of the drug supply is a new motivator for her. The risk of a slipup nowadays isn’t just about feeling shame and embarrassment, it’s about death.
“I’m really testing myself when I’m down on Pandora supporting my brother, putting myself in the thick of things,” she admits. “You just don’t know what news you’ll hear out there, and all it takes is that one moment. But I’ve been down that road, and it always ends the same way. Like they tell you in Narcotics Anonymous, ‘Play the tape.’ ”
The reality of a relapse highlights the importance of all the services collectively known as harm reduction — overdose-prevention sites, clean supplies, wound care, outreach support, prescribed alternatives to the poisoned opioid supply. Such services keep people alive to fight another day and are forms of treatment in their own right, say advocates.
A shifting political mood has wrongly pitted harm reduction against treatment in the public’s mind, like it’s one or the other, says Roden. In fact, they’re both vital components of the same continuum of care.
“That’s the thing that’s perpetually on my mind right now: This narrative that puts harm reduction against treatment as if they’re not part of the same spectrum,” she says. “Harm reduction should inform all of these efforts. It belongs in all stages of treatment. It’s really sad that we’re seeing this fracturing of providers, and of people themselves. People are dying because of it. That struggle is leading to actual, measurable harms.”
Locally, medical beds for detoxing people with opioid and alcohol dependencies are the first step in the recovery process. But the number of detox beds hasn’t changed in years, says Andison, and current waits are five or six weeks. People hit that moment of change that shifts their thinking toward recovery, but struggle to sustain it through the long wait for a detox bed.
“You have to strike while the iron is hot,” says an outreach worker. “It’s so frustrating, waiting two or three months for a bed to open and then it’s [income assistance] cheque day and people lose their motivation. When people are broke and sick and ready for treatment, that’s the time to move.”
A profound lack of affordable housing for people needing to stay away from substance use makes sustaining recovery so much more difficult, says Andison.
Umbrella’s 11-bed Foundation House recovery home for men currently has a waitlist of 60 people. Everyone was excited when Cool Aid opened 20 units of substance-free housing earlier this year, says Andison, but it was at capacity in an instant.
“The appetite for recovery is there,” says Andison. “But when it’s met with so many barriers, people just say screw it. It takes so much courage to make a change. It’s crazy that we aren’t just welcoming people with open arms.”
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