The B.C. government is currently working with Health Canada to urgently change the decriminalization policy to stop drug use in public and has requested an amendment to its s.56 exemption to exclude all public places. That includes a place to which the public has access as a right or by invitation, express or implied, whether or not a fee is charged for entry, and on public transit.

Importantly, the Province is working to ensure the exemption continues to apply to private residences, healthcare clinics that provide outpatient addictions services such as Rapid Access Addictions Clinics, sanctioned overdose prevention sites, including those operated by housing providers, as well as drug checking sites and to people lawfully sheltering overnight.  

The Province is also working with police on guidance to ensure that people who merely possess drugs but are not threatening public safety, their own safety or causing a disturbance, will not be subject to arrest or charge.  

In November 2023, the B.C. government passed the Restricting Public Consumption of Illegal Substances Act (RPCISA). The intention of the act was to provide law enforcement with more tools to address instances of inappropriate drug use in a variety of public places, such as parks, beaches, sports fields and community recreation areas, as well as near business and residential building entrances and bus stops. This legislation is currently being challenged in court.

Opioid agonist treatment (OAT) is a medication-assisted treatment for people who have an opioid-use disorder. OAT uses medications, such as Suboxone and methadone, to treat opioid addiction, reduce drug-related harms and support long-term recovery.

The treatment helps people who live with opioid addiction stabilize their lives, manage withdrawal symptoms and work toward recovery. It can lower the risk of drug-related harms, including hepatitis C and HIV transmission as well as fatal overdose. It can also help people stay in treatment and engage in their care.

Since 2017, the Province has been taking action to reduce barriers and expand access to OAT:

• There are approximately 2,000 clinicians prescribing OAT in the province, an increase from 773 in June 2017.
• In 2021, BC allowed registered nurses and registered psychiatric nurses to be trained to prescribe this treatment – a first in Canada. More than 280 nurses have enrolled in this training and to date, more than 170 have completed their training and are qualified to be OAT prescribers.
• In 2023, the Province made OAT free for B.C. residents with MSP coverage by adding OAT medications to Plan Z, the Province’s universal coverage plan.

As of December 2023, 24,232 people were receiving OAT – this is just over 30% of the people with a diagnosed opioid use disorder in B.C. Barriers continue to exist for some people to access OAT, including a lack of prescribers in many rural communities.

Creating a provincewide system to provide virtual access to OAT will reduce barriers for people no matter where in B.C. they live.

The Ministry of Health is developing a consistent approach to prevent illicit drug use in B.C. hospitals through universal policies, practice requirements, and appropriate enforcement approaches. Working in partnership and consultation with First Nation and Indigenous partners, health-care providers, professional associations, health-care unions, patients and communities, the actions below outline elements of a policy framework that will be implemented across all hospitals:

Action 1. Take consistent action across B.C. to prohibit drug possession, use, and purchasing of illicit drugs in hospitals or hospital sites:  

• This will be made explicit to all patients and visitors in outpatient clinics, emergency departments, and during admission to inpatient care through a single policy prohibiting street drug possession or use, along with a no tolerance policy for drug trafficking in hospitals.  
• Non-compliance will be addressed by hospital security and through an escalation process that could include discharge (with support) from the hospital and/or police involvement.  

Action 2. Improve how patients with substance or opioid-use illnesses are supported toward treatment and recovery services:

• Hospitals will expand and develop active medical oversight and addictions support to better manage patient addictions while the patient is in hospital, and improve discharge planning for post-discharge treatment in the community.
• Patients will be provided with post-discharge care and ongoing support and treatment. Hospitals will establish expedited referral pathways to community-based addictions care and treatment.

Action 3. Add in-person addiction specialists to large hospitals and virtual clinical consultation in smaller regional and rural hospitals.

• Addiction and mental-health support teams will be added in major hospital sites for immediate response and engagement with patients with severe addictions or mental-health issues. 
• These teams will also provide inpatient care management services related to managing addiction and/or mental-health illnesses while in care and be responsible for post-discharge care co-ordination related to severe addiction and or mental-health issues.

Action 4. Remain focused on a culturally safe approach to implementing change.

• Transitioning to a universal policy will be undertaken in partnership and consultation with local and regional First Nations and Métis leadership to ensure clear plans, processes and pathways are established to prevent Indigenous people from further harm and marginalization, while ensuring critical supports for Indigenous patients accessing and receiving quality and culturally safe care throughout their recovery journey.
• Treatment services rooted in Indigenous ways of knowing, being and doing are critical, alongside harm reduction and mental-health services that support individuals where they are at. The integration of cultural safety and humility and Indigenous-specific anti-racism into hospitals or hospital sites will be essential to ensure Indigenous patients receive the care and wraparound supports needed and is reflective of the region and work underway with Indigenous partners and local/regional communities since the In Plain Sight report was released. 

Action 5. Actively address unacceptable behaviour such as aggression, noncompliance with the policy, and drug dealing in hospitals through additional security.

• The safety of staff and patients is of the utmost importance. Security capacity reviews will be completed at all hospital sites to ensure adequate security capacity is available for rapid response and ensuring the safety of patients and health workers.
• Where it is deemed necessary, additional security will be added to quickly respond to any incidents involving possession or use of drugs, aggressive or violent behavior.
   

Action 6. Introduce improved education and awareness efforts to better equip and support staff facing unsafe situations.

• While the intention of the work above is to eliminate exposure to illicit substances, health-care workers will have improved training and access to the necessary protective equipment in the event of suspected exposure to the secondhand effect of drug use.
• Increased staff education will include: enhanced understanding of addictions and addiction treatment, trauma-informed care, cultural safety supports for Indigenous patients, training to manage difficult conversations, and de-escalation strategies when confronted with aggressive behaviour.

Action 7. Ensure existing overdose prevention (OPS) sites are working for people

• Existing overdose prevention sites will continue to operate.
• Use of an OPS by an inpatient will be restricted to only when expressly stated that it is permissible to do so as part of an addiction’s treatment care plan.
• The Province is currently taking action to establish minimum service standards for overdose prevention sites, as recommended recently by the auditor general to support consistent, quality care for people and a safe environment for workers. These standards will establish baseline operational and facility requirements for all provincially funded, fixed and mobile, overdose prevention services in B.C.