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Todd Kenneth at his apartment complex in Vancouver, British Columbia on Feb. 6, 2019.BEN NELMS/The Globe and Mail

For all the chaos he experienced in some 30 years of drug addiction, Todd Kenneth’s lowest moment came when it was quiet, and he was alone.

Until that point, Mr. Kenneth had interwoven the ravages of his drug use with scraps of a normal life: He worked a well-paying job. He had a bit of money. He ended each night on a mattress or couch, or in the warm embrace of a partner.

But he had none of those things when he found himself, some two decades ago, wandering a strip of Metro Vancouver’s Fraser Valley that had become a ramshackle encampment for the area’s homeless and drug-using population. Nights were spent either using drugs to stay awake or sleeping upright at a table in a drug-user resource facility, hoping he wouldn’t be robbed before sunrise.

“For the first time in my life, I had nowhere to bed down," said Mr. Kenneth, now 51. "There was not a friend that would take me in. I remember the feeling of fear and confusion, and thinking, ‘Maybe I need to go to a place and have a look at what’s going, on, because this ain’t right.'”

Mr. Kenneth phoned an access number that pointed him to the Vancouver Detox Centre, a small, 26-bed facility in East Vancouver, tucked away between some residential buildings and businesses. At 31 years old, he began inpatient treatment for his addiction to crack cocaine and methamphetamine.

More than 20 years after Mr. Kenneth first set foot in the building, the Vancouver Detox Centre is largely unchanged. On a recent winter’s day, two older men sat by a window in the facility’s modest cafeteria, drinking coffee and punctuating stories with wild gesturing of their hands. Across the room, a woman sat at a communal table, working on a puzzle. Down the hall, a handful of others watched a movie in a multipurpose room that is also used for art, yoga and acupuncture. A few slept in cramped dorms, a curtain providing some privacy.

The space functions, but it’s not ideal.

The weekly visiting and meals schedule board at Vancouver Detox.Jackie Dives/The Globe and Mail

Pending approval of a development permit, the aging detox centre will soon relocate to a large, purpose-built facility nearby. Proponents say the new building, which would include 90 units of social housing and span an entire city block, will be able to offer a full range of services that are currently scattered throughout the city.

But more than a replacement of aging infrastructure, the new building would serve as a reflection of how detoxification itself, and attitudes toward treating substance-use disorder in general, have evolved. British Columbia’s overdose crisis has changed the province’s approach to addiction, from the language used to talk about it to clinical care itself.

Drug detoxification, also called withdrawal management, has traditionally been known as an intervention during which a person stops using illicit substances and eliminates them from the body over a short period of time – a brutal period sometimes equated with going “cold turkey."

When illicit fentanyl swept the province several years ago, supplanting illicit opioids such as heroin and oxycodone and causing a dramatic surge in overdose deaths, detox had to adapt to reflect not only evolving best practices in treating opioid-use disorder, but the toxicity of a fentanyl-poisoned drug supply and its implications for those who relapse.

Keith Ahamad, a researcher at the BC Centre on Substance Use (BCCSU), co-chair of the committee that prepared the centre’s 2017 provincial guidelines on managing opioid-use disorder, and a physician at the detox centre, said people in inpatient settings such as detox facilities and jails lose their tolerance and are therefore at higher risk of overdose or death should they relapse.

For this reason, the new guidelines, which have since been recommended nationally, advise against withdrawal management alone. Instead, those with opioid-use disorder are advised to start opioid agonist therapy (OAT), also called substitution therapy, with buprenorphine-naloxone (Suboxone) or methadone. These opioid medications serve to prevent withdrawal and reduce cravings, with the intention of stabilizing a person and steering him or her away from illicit drug use.

“I think [for] the future of inpatient withdrawal-management centres," Dr. Ahamad said, "we should really change the name to ‘substance-use stabilization’ rather than detox or withdrawal, because it really is just a touch point to further treatment, rather than an isolated intervention.”

Smadar Levinson, manager of withdrawal management at Vancouver Coastal Health, in her office at Vancouver Detox on Feb. 1, 2019.Jackie Dives/The Globe and Mail

Smadar Levinson, manager of withdrawal management and Downtown Eastside rehab programs for Vancouver Coastal Health (VCH), described detox as a first step toward recovery, with the next steps dependent on where the patient is at.

“Some people want a facility that will support recovery [after detox], some people want to follow up in the community through some outpatient services,” Ms. Levinson said.

“Some people say, ‘This is my first time and I just wanted to give it a try but I’m not ready to connect to other services,’ which is fine too. We really see ourselves as part of that continuum of harm reduction. We are the beginning part of recovery.”

The new centre, which will replace both the Vancouver Detox Centre and Harbour Light Detox, will include twice as many inpatient withdrawal-management beds as the old facility (51) and 20 sobering units where police can bring non-violent people who appear severely intoxicated by drugs or alcohol – five times as many as currently available. Twenty new short-term transitional-housing beds will offer those who have just completed detox a place to stay as they transition to longer-term care.

A city-owned social enterprise program space will occupy a ground-level area, while 90 units of affordable rental/social housing will sit above.

And whereas the existing detox facility’s outdoor space is limited to an apartment-sized deck, with mismatched chairs and fencing to shield people from neighbouring residents, the new facility will include green spaces, sensory plantings and a “West Coast rock and shade Zen garden," recognizing that “connections to nature can provide relief, comfort and hope to patients in even the most difficult of circumstances,” according to a rezoning application.

At a public hearing held last month, Bonnie Wilson, director of operations for inner-city eastside and co-program lead for mental health and substance use services at VCH, showed Vancouver City Council a photo of one of the current detox centre’s cramped dorms, with several twin beds lined up head-to-foot, separated by a yellow divider.

“Because of our space constraints, we’re unable to offer the kind of privacy that people would expect when receiving a very personal and, at times, uncomfortable medical intervention,” Ms. Wilson said. “Finding a new space that is welcoming and allows us to offer care in a dignified and respectful manner has been a goal of VCH’s for a very long time.”

Council voted unanimously in favour of the project, but there were some dissenting voices from the public. Thomas Ferguson, a member of a group called Community 1st, said the building’s large-scale design doesn’t fit in the community, and that its new sobering centre “will bring intoxicated people from across this entire city” into the area.

“I’m concerned for the people who have sobered up for just four hours and then leave this facility and have to navigate Clark and 1st on foot," Mr. Ferguson said of the high-traffic intersection.

Art in the hallways of Vancouver Detox.Jackie Dives/The Globe and Mail

Mr. Kenneth went to detox several more times after first stepping foot into the Vancouver Detox Centre, his turning point coming when he secured housing and employment. Today, he lives in an affordable-housing complex in East Vancouver. He travels to Bowen Island once a month to do janitorial maintenance at a retreat centre, and he lends his voice to causes close to his heart, most recently speaking at the public hearing in support of the detox centre that helped changed his life.

He has money in savings and is happy to pay taxes. He says he’s grateful to be “in those rhythms of life again.”

What he still remembers most vividly from his first visit to detox were the simple signs of warmth and care: the smell of a fresh pot of coffee brewing, the smell of soaps and shampoos on staff members. He tears up recalling a female staffer putting her hand on his.

“It was the first time having a gentle touch in so long,” he said, his voice wavering. “Detox is more than just getting off dope. It’s like, oh my God, to have food and to have the security of knowing there will be another meal in front of you, and to have the touch of somebody who you know is doing it for more than just a paycheque.

“And then you get your first introduction to, ‘Well, there might be a way out of this.’”

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