Roughly two-thirds of British Columbians who died of an illegal drug overdose between January 1, 2016, and July 31, 2017, had recent contact with the criminal justice system, according to a death review panel report released by the BC Coroners Service in 2018. Of those, 10 per cent—or 333 people—died within their first month of release from a correctional facility.
Five new community transition teams stationed throughout the province aim to address this problem by helping people with opioid-use disorders access treatment in their communities after release from a corrections facility.
"People who are transitioning back to their communities after incarceration deserve a fresh start," said Judy Darcy, the minister of mental health and addictions. "For those with opioid-use disorder, the guidance of peer support is foundational to preventing overdose. Together with all partners, we are building a full spectrum of connected services to save lives so that people from all walks of life can find the support they need to find a pathway to hope and healing."
The teams, stationed in Surrey, Prince George, Kamloops, Nanaimo, and Port Coquitlam to begin, each consist of both a social worker and a peer—that is, a person with lived experience with drugs, the correctional system, or both.
They will work with clients for approximately 30 days following their release to connect with a community physician, fill prescriptions and access other recovery supports.
"People involved with the criminal justice system are some of society's most vulnerable," said Lynn Pelletier, the vice-president of BC Mental Health and Substance Use Services, which oversees Correctional Health Services. "They're also among the hardest to reach in the midst of this overdose emergency. Integrating correctional care with community-based care gives us an opportunity not just to prevent overdose, but also connect to health services and possibly change the trajectory of their lives by addressing some of the social and economic realities that brought them to us in the first place."
Dr. Nader Sharifi, the medical director for Correctional Health Services and the addictions lead for BC Mental Health and Substance Use Services reports that currently, about 40 per cent of people in corrections facilities are receiving opioid agonist treatment, which includes medications such as Suboxone and methadone to treat opioid use disorder.
He says people are at heightened risk when they leave corrections and no longer have access to the facility's physician.
"People with opioid-use disorder are as much as 12 times more likely to die of a drug overdose shortly after release from a correctional facility," says Dr. Sharifi. "There are barriers to continuing the treatment they start with us. Clients are facing stigma. They might have no income and no fixed address. It's not as easy as visiting the nearest doctor's office."
That's only one of the risk factors, he continues. Lowered tolerance is a danger. Another risk is the trauma associated with release.
"There are so many unknowns," he says. "They have often lost everything during their incarceration—their homes, their jobs, their families, and their dignity. Often, their social skills have eroded. Starting over again and having to navigate things such as the job market and the health system can be overwhelming—and trigger a relapse."
Andrew MacFarlane, the provincial executive director for Correctional Health Services, has spent the previous 20 years working with people with mental-health and substance-use issues, and the last five working with people on Vancouver's Downtown Eastside. He knows the importance of finding creative solutions for his clients.
MacFarlane and his team designed the community transition team project after consulting with regional health authorities and the First Nations Health Authority, and analyzing other evidence-based models across Canada.
"We learned we needed to reach beyond the walls of the correctional centres, which we're formally doing now for the first time," MacFarlane said. "We also saw real evidence of peers being an integral bridge to trusting relationships with people who use drugs. Our social workers will help clients navigate the system in a very practical way, and the peers will bring lived experience with substance use and the criminal justice system. A peer can say, 'I've been where you are. I found a way through, and so can you.' That's very powerful."
The community transition team peers have been chosen strategically—they work with community organizations throughout the province that will keep helping clients after the short-term work with community transition teams concludes.
The community transition teams began connecting with their first clients this month. PHSA hopes to scale up the project next year based on results.