How are we working together?
The Ministry of Health continues to collaborate and engage with First Nations, Métis and urban Indigenous organizations throughout the various components of this action., including:
Decriminalization
- Law Enforcement Implementation Working Group, which includes the First Nations Justice Council and the Health Authority Working Group (First Nations Health Authority).
- Work with Métis Nation BC to be responsive to the decriminalization engagement needs of Métis peoples and communities.
- Building Relationships in Collaboration Grants committee (First Nations Health Authority, First Nations Justice Council and Métis Nation BC).
Harm Reduction
- Support the expansion of harm reduction initiatives through planning tables, oversight committees and working groups, including the overdose prevention services’ Minimum Service Standards development core advisory table. This work includes the First Nations Health Authority, Métis Nation BC, and the BC Association of Aboriginal Friendship Centres.
- As of July 2024, the Ministry of Health initiated service planning meetings with all health authorities and the First Nations Health Authority.
Youth Culturally Relevant and Safe Services
- Health authorities, the First Nations Health Authority, the BC Association of Aboriginal Friendship Centres, the First Nations Education Steering Committee and Métis Nation BC inform the implementation planning for integrated child and youth teams.
- The Province participates in regular Indigenous Partners Committee meetings with the First Nations Health Authority, Métis Nation BC, the BC Association of Aboriginal Friendship Centres and FNESC.
- The Province participates in monthly meetings with the First Nations Health Authority to support progress of Budget 2023 investments.
The First Nations Health Authority is also a key partner in harm reduction-related toxic drug crisis response and supports the regional response team. The health authority is involved in prescribed alternatives governance committees and working groups; is a key partner in the provincial drug checking network and in expanding access to opioid agonist treatment services; and sits on the implementation and steering committees that oversee certified practice designation for opioid use disorder.
Are there challenges?
Certified Practice designation for Opioid Use Disorder/Opioid Agonist Treatment
- First Nations have identified a need to provide programming that is community-led and Nation-driven, which builds on existing strengths and values of First Nations peoples and is not directed by other’s agenda or criteria. The First Nations Health Authority is exploring development of opioid agonist therapy programming that meets communities where they are at in relation to their specific needs, goals and beliefs around substance use.
Prescribed alternatives/harm reduction
- Partner capacity to engage with multiple streams of work at varying touchpoints may impact depth of engagement achieved. Mitigation of this risk is sought via close communication with key Indigenous partners.
Youth culturally relevant and safe services
- Integrated child and youth teams support new clinical and non-clinical roles hired in 20 school district communities across the province. Capacity to fully implement integrated child and youth teams and deliver services is dependent on available labour market resources and constraints.
Decriminalization
- There are unique challenges to expanding access to harm reduction initiatives, like drug checking, for rural and remote First Nations communities. The First Nations Health Authority will be working with regional health authorities and other partners to explore ways to mitigate these challenges.
- Disaggregated data is still needed to fully evaluate the equity impacts of decriminalization for Indigenous Peoples. The Ministry of Health continues to work with policing partners to improve access to this data.
- Since the new section 56 decriminalization exemption came into effect on May 7, 2024, possession offences have increased to approximately 2022 levels (pre-decriminalization). During B.C.’s original section 56 exemption, there was a 76% decrease in possession offences in the first year of decriminalization. More data is needed to understand this trend.
Highlights
In the month of December 2024, 44 overdose prevention services and supervised consumption services reported witnessed consumption visits to the BC Centre for Disease Control. Of these, 27 reported witnessed inhalation visits.
Starting in May 2024, the Province initiated a series of pilot projects exploring increased access to nasal naloxone to priority populations, including Indigenous People. Between January and June 2024, 2,415 nasal naloxone kits were distributed to 51 First Nations communities. In August 2024, 1,600 nasal naloxone kits were distributed to 25 post-secondary institutions and 25 First Nations Mandated Institutions. 50,000 nasal kits are being shipped to 150 community sites, as well as up to 700 pharmacies for distribution to people with dexterity limits, those in cold climates, youth, and Indigenous Peoples.
The First Nations Health Authority is supporting 68 First Nations communities, First Nations health service organizations and Aboriginal Friendship Centres to access public health vending machines and care cupboards to increase low barrier and 24/7 access to harm reduction supplies.
As of October 1, 2024, the certified practitioner in opioid use disorder scope of practice expanded to include an additional opioid agonist therapy medication, extended-release buprenorphine. With expansion, these practitioners can prescribe the four most common opioid agonist therapy medications in B.C. (buprenorphine, methadone, slow-release oral morphine and extended-release buprenorphine).
Previous years’ progress
Highlights
Prescribed alternatives to the toxic supply (formerly termed ‘prescribed safer supply’) and other harm reduction efforts are part of a comprehensive package of health sector interventions to address the toxic drug crisis and function to provide life-saving interventions. As of December 2023, there are 50 overdose prevention services (OPS) and supervised consumption services (SCS) sites across all health regions, including 24 sites offering inhalation services. In 2023, three new OPS/SCS sites opened, and six sites added inhalation services.
Prescribers are able to offer prescribed alternatives according to BC Centre on Substance Use clinical guidance and protocols. Two prescribed alternatives protocols were published in August 2023, Fentanyl tablet (Fentora) and Sufentanil protocols. These documents support prescribers with standardized clinical protocols for the provision of prescribed alternatives to reduce reliance on the toxic drug supply.
The Province has also implemented an enhanced prescribed alternatives evaluation and monitoring framework under which, external contracted scientists are leading a provincial evaluation of the prescribed alternatives policy until March 2026.
$4 million allocated to the First Nations Health Authority (FNHA) to provide harm reduction grant funding to First Nations communities, First Nations health service organizations and friendship centres to lead work in community; $236.42 million over three years provided in Budget 2023 to increase services for young people, which includes funding specifically for Indigenous youth.
Funding program in development for Indigenous treatment, recovery, and aftercare services fund, $171.08 million (over three years). This includes $7 million in 2024-25 for the Orca Lelum Youth Wellness Centre in Lantzville, which will be the first in the province to offer detox services, specifically for Indigenous youth. The centre will provide 20 substance-use treatment beds that offer culturally informed care to Indigenous people aged 12 to 18 years.
Through a provincial investment of $73 million over three years in 2023, the Canadian Mental Health Association BC (CMHA-BC) launched a grant process that has funded a total of 180 substance use treatment and recovery beds, nearly double the Budget 2023 commitment to 100 beds. These beds will be added across the province over the next several months with 97 already open and serving clients as of January 2024. This funding also extends the operations of 105 existing CMHA-BC administered beds to the end of 2027. Together, the 285 beds provide quality treatment and recovery care and services with no out-of-pocket fees for people struggling with addiction challenges. People can be referred from their health-care professional or other organizations. Self-referrals are also accepted. Service providers prioritize clients based on the unique needs of their community, with a focus on expanding services for underserved populations such as those in rural and remote areas, Indigenous People, people who are or have been involved with the criminal justice system and new or pregnant parents.
Progress towards the development of tripartite MOU funded Indigenous-led treatment centres continues to be made. In January 2024, the Tsow-Tun Le Lum Society Helping House Treatment Centre in Duncan, B.C. became operational and began client intake.
In the first six months of decriminalization, there was a 76% decrease in drug possession offences and a 97% decrease of possession related drug seizures under the 2.5g threshold from the past four-year average during the same period from February to July. Reducing criminal offences of people who use drugs aims to shift people who use drugs away from the criminal justice system and towards health and social supports.
As a part of decriminalization, B.C. funded new navigator positions in the FNHA including two decriminalization ‘project managers/navigators’ to support First Nations communities in their implementation of decriminalization, engage with First Nations on decriminalization and broader harm reduction work, address emerging issues and support liaison with law enforcement. B.C. also funded five FNHA proactive outreach positions, one for each FNHA region. These roles support more local, community-level coordination and connections to care. As of November 1, 2023, 79% of RCMP officers and 98% of municipal officers have completed phase one training meant to support implementation of decriminalization. Overall compliance for frontline officers is at 88%. In September 2023, phase two police training, a health-based approach to drug possession in British Columbia, was launched.
$1 million over two years has been allocated in Budget 2023 through the Ministry of Public Safety and Solicitor General (PSSG) until 2025 for building relationships in collaboration (BRIC) grants to support First Nations, Métis, Inuit, and other Indigenous organizations to self-determine how best to work with police to implement decriminalization and shifts to approaching substance use as a health issue at the community-level. The Ministry of Mental Health and Addictions (MMHA) and PSSG has allocated $500,000 of this funding to recipients of the 2023-24 funding period.
How are we working together?
MMHA continues to collaborate and engage with First Nations, Métis, and urban Indigenous organizations on this action and throughout its varying components. Specific efforts, engagements and partners include:
- Continued development of prescribed alternatives program and harm reduction initiatives being pursued through planning tables, oversight committees, working groups and engagement workshops;
- Dialogue sessions hosted as part of prescribed safer supply service delivery framework engagement that included representatives from FNHA, MNBC and BC Association of Aboriginal Friendship Centres (BCAAFC);
- Overdose Emergency Response Centre (OERC) and FNHA work to understand needs related to overdose prevention services (OPS);
- Implementing Community Action Teams (CATs) to respond to the toxic drug crisis;
- FNHA is a key partner in supporting harm reduction-related toxic drug crisis response and participates in regional response team meetings;
- Regular meetings and working directly with the FNHA to co-develop a culturally safe and specific service mapping process with First Nations;
- The FNHA facilitates connections between the services mapping team and community on data collection protocols. An Indigenous consultant will conduct on-site consultations in each FNHA region;
- Provincial child and youth wellness framework development, including regional engagement with First Nations individuals and monthly discussion with MNBC, FNHA and BCAAFC;
- First Nations and Métis advisory table to inform provincial child and youth wellness framework;
- Engagement on development of Indigenous funding envelope includes FNHA, MNBC, First Nations and VPs of Indigenous health within health authorities;
- The Canadian Mental Health Association BC (CMHA-BC) expansion grant was developed in partnership with the FNHA to ensure that prospective applicants demonstrated how they were supporting Indigenous clients to access culture-based services, that were non-discriminatory and anti-racist;
- In addition to developing the grant, the FNHA and MNBC were part of the applicant review panel and decision-making process. In partnership with the Province, the FNHA and MNBC conducted and completed a rigorous process of selecting service operators to administer all 180 beds. The application design and adjudication process was done in full partnership with the FNHA. This included review of application requirements, particularly those relating to ensuring that successful applicants could demonstrate how their service and programs support Indigenous clients to access culture-based services. Applicants were also required to demonstrate how their policies and procedures foster an environment that is non-discriminatory and anti-racist;
- Decriminalization core planning table (MNBC, FNHA, FNJC). FNJC is a member of the law enforcement implementation working group;
- Co-developing the building relationships in collaboration (BRIC) Grants and participating in grants committee (FNHA, FNJC, MNBC).
Are there challenges?
Prescribed alternatives/harm reduction: partner capacity to engage with multiple streams of work at varying touchpoints may impact depth of engagement achieved. Mitigation sought via close communication with key Indigenous partners supporting the streams of work.
Substance use policy: Condensed timeline to deliver preliminary substance use service inventory; however, co-designing the process with the First Nations Health Authority has allowed all partners to establish realistic goals and expectations while still achieving project deliverables.
Decriminalization: Disaggregated data is needed to fully evaluate the equity impacts of decriminalization for Indigenous Peoples. The Ministry of Mental Health and Addictions continues to work with all partners to improve access to disaggregated data.
Local governments and police agencies have raised concerns about challenges with managing public drug use in the context of decriminalization. In response, the Province passed Bill 34, The Restricting Public Consumption of Illegal Substances Act. However, the Act was subject to a court challenge and injunction.
While the Act is before the courts, the Province began working with Health Canada on an update to B.C.’s s.56 exemption to prohibit public drug use, which was granted on May 7, 2024.
Highlights
On May 31, 2022, Health Canada approved B.C.’s request for an exemption under section 56 of the Controlled Drugs and Substances Act to remove criminal penalties for possession of small amounts of certain illicit substances for personal use (people will no longer face criminal sanctions if they are found to be in possession of up to 2.5 cumulative grams of drugs listed in the province’s threshold schedule). This exemption came into effect on January 31, 2023, and remains in place for three years. The s.56 exemption supports B.C.’s comprehensive response to the ongoing toxic drug crisis, including the disproportionately devastating impact on First Nations, Métis and Inuit Peoples. Decriminalization will help address these inequities, promoting pathways to supports, including culturally informed treatments and culturally safe services for First Nations, Métis and Inuit people who are at risk of toxic drug poisonings.
The Ministry of Mental Health and Addictions (MMHA) will continue to engage with First Nations, Métis and urban Indigenous communities and partners, including First Nations Health Authority (FNHA), First Nations leaders, Métis Nation British Columbia (MNBC), BC First Nations Justice Council (BCFNJC) and BC Association of Aboriginal Friendship Centres (BCAAFC) to ensure decriminalization is implemented in a culturally safe and appropriate way. As part of the pre-implementation work on this, MMHA worked with MNBC to hold a provincial town hall for Métis people. In addition, information packages were sent to all First Nations in B.C., including an invitation to upcoming town hall sessions and an offer to meet individually with any interested First Nation. This was also distributed to the First Nations Leadership Council (FNLC) and the First Nations Health Council (FNHC). MMHA partnered with FNHA to deliver five regional town halls for First Nations leadership, and MMHA now continues to meet individually with First Nations, with the support of partners from FNHA and the regional Health Authorities. Accounting for all First Nations, Métis and Inuit Peoples’ and communities’ experiences, needs and right to self-determination will continue to be a key part of implementation, monitoring and evaluation.
Indicators
- Policies/Reports developed: Developed and released a technical policy framework for the Adult Substance Use System of Care Framework in December 2022.
- Implementation project underway: Successfully applied to Government of Canada to decriminalize simple possession of small amounts of illicit drugs for personal use to address the toxic drug crisis, which came into effect on January 31, 2023, for an initial three-year period.
- Number of meetings and engagements held: Hosted five regional town halls for First Nations leadership in November and December 2022, in partnership the FNHA, and worked with MNBC to hold a provincial town hall for Métis people.
How are we working together?
Work is underway to implement the Adult Substance Use System of Care Framework and support health system transformation through continued engagement with First Nations, Métis and urban Indigenous partners. Consultation and co-operation with First Nations, Métis and Inuit partners and peoples are being pursued in a variety of ways across the four key subtasks of this action, including working groups and planning tables. A decriminalization information package was sent to all First Nations communities in B.C., to the FNLC and FNHC. Town hall sessions on decriminalization were co-developed with the FNHA for First Nations (Fall 2022) and with MNBC (June 2022). FNHA, MNBC, BCFNJC, and the BCAAFC have and continue to be members of the decriminalization Core Planning Table that has been meeting since July 2021 and to inform MMHA’s approach to engagement with partners.
Are there challenges?
Decriminalization is being rolled out in the midst of concurrent public health emergencies related to the COVID-19 and the toxic drug crisis, which are greatly impacting communities and the capacity of health and social service providers. Partner capacity to engage with multiple streams of work at varying touchpoints may delay development/implementation of project work. Mitigation sought via close communication with key First Nations, Métis and urban Indigenous partners supporting the streams of work.
B.C.’s decriminalization efforts will need to take into account the unique experiences, community contexts and rights of Indigenous Peoples throughout implementation. B.C. will need to continue to work closely with the Indigenous partners and engage with First Nations, Métis and urban Indigenous partners and communities to evaluate impacts of decriminalization on First Nations, Métis and Inuit people. This feedback will be critical to support ongoing program and policy improvements.