The ongoing debate about recovery homes in B.C. is part of the broader, complex challenge of tackling mental-health and substance-abuse issues in the province, where an estimated one in five people deal with such problems each year.
One new strategy could involve a low-threshold or low-barrier methadone clinic – which gets its name because it would reduce or eliminate some hurdles patients currently face obtaining the drug as a substitute for heroin.
A low-threshold methadone clinic is among more than 20 initiatives outlined in a February paper from the Downtown Eastside Second Generation Health System Strategy. This evolving plan by Vancouver Coastal Health would streamline health services in the neighbourhood, which has about 18,000 residents and more than 20 VCH-affiliated agencies and clinics in a six-block radius.
In a low-barrier approach, methadone clients would be expected to cut back their use of heroin but not necessarily eliminate it – based on a rationale that fewer injections would help reduce the risk of blood-borne diseases, infections and other health concerns. In conventional methadone maintenance treatment, patients are expected to stop using heroin and stick to a set dosage of methadone.
The idea would be to give people who want methadone treatment what is now on offer for injection drug users at Insite – a one-stop shop where patients could get access to methadone as well as medical care and counselling.
"Essentially, what we would be trying to do is emulate the … process we have at Insite and to engage those clients into treatment," said Ron Joe, associate medical director of addiction services with Vancouver Coastal Health.
Methadone is one of the most effective medications to treat opioid addiction, and drug-use statistics suggest there are many more Canadians who could benefit from it beyond those already receiving it, Dr. Joe says.
According to the 2012 Canadian Alcohol and Drug Use Monitoring Survey, 0.5 per cent of Canadians and 0.8 per cent of British Columbians reported using heroin in their lifetime. (Those estimates were flagged with an "interpret with caution" note, as they were based on a small number of respondents).
But even if those estimates are too high, they still suggest thousands of people in B.C. and Canada need methadone treatment, he says.
"We have perhaps treated the easier half of the population and the harder half, the more difficult half are the ones who are still going to Insite or maybe not going to Insite – and we haven't cracked that nut of engaging those people into treatment," Dr. Joe said.
"So we need a specialized service to do that and that's where the low-barrier methadone site would come in."