Indigenous advocates optimistic about new Victoria substance use treatment facility

A new substance-use treatment facility for women and non-binary people is opening in Victoria next year. It was created in consultation with Indigenous people and groups who say more of these spaces are sorely needed in the region.

The Coastal Sage Healing Centre will open in Victoria sometime in the new year and offer six treatment beds for people to stay in during their 30- to 90-day stay, depending on the program.

“It seems that they are taking some particular interest in ensuring that this is culturally safe… following the In Plain Sight report and the level of racism that Indigenous and BIPOC community continue to experience within the healthcare system,” said Christina Kante, health team program coordinator at the Victoria Native Friendship Centre, who says the group was consulted by Island Health about the facility.

“I think that there's more of an acknowledgment within Island Health that they need to be really looking at how they're doing this in a good way, so I'm hopeful about that,” Kante said. “Women's specific treatment is much needed in the community.”

According to Kante, there are very few culturally safe, trauma-informed substance use treatment facilities in Victoria.

She said that during a meeting with Island Health, the Native Friendship Centre offered ideas on how to make the space accessible and appropriate for women, Two-Spirit, and non-binary people, how to incorporate Indigenous Elders into their support network, and the importance of having Indigenous and racialized staff members.

The result, according to Mental Health and Addictions Minister Sheila Malcolmson who shared details about Coastal Sage in November, is a space that feels like a home.

“It's got spaces for women cooking together, it's got outdoor space, the six rooms—which are private rooms—each of them is really beautifully decorated, each with a different kind of plant,” Malcolmson said. “It's got connections to nature, it's got connections to home, it's really designed as a healing house.”

Gaps in the system

Karen Mills, a Métis peer advocate for unhoused people in Victoria, has applied for a job at the healing centre, and is optimistic about its impact in the community.

The fact that patients can have up to three months at the facility is an improvement from other programs that only give people 30 days to absorb the program, according to Mills.

“I was in addiction for 26 years; I went to rehab eight times,” Mills said. “It never worked for me because either it was not long enough or it wasn’t culturally supported; it wasn’t trauma-informed, either. When you’re in addiction, it’s not just addiction, there’s a lot of things going on.”

The latest available Point in Time Count from 2020 shows that more than a third of the homeless population in Greater Victoria is Indigenous, despite making up 5% of the total population. Mills, who works with the Indigenous unhoused community, said many of them bemoan the lack of adequate treatment services for addiction.

“The system is broken when you have to wait six to 10 weeks to get into detox,” Mills said. “After their five to seven days [of detox], there's no recovery set up for them. They're back out there, and because they've had that five to seven day absence, their chances of a fatal overdose are higher. We need to stop that gap.”

Repeated studies have found that the weeks following detox can be particularly deadly because a user may lose the tolerance they previously had—so deadly that overdose is the number-one killer of people recently released from jails and prisons. In Ontario, people who had just left custody were found to be 50 times more likely to experience an overdose than the general population. Similar trends have been found in BC

There are no new detox beds coming to Victoria in addition to the recovery centre. Malcolmson did not specify whether patients would need to go through a detox program before they enter Coastal Sage.

According to Island Health, there are 33 publicly funded detox beds and 39 treatment beds across Vancouver Island, not including these six new beds coming next year.

For Mills, the new facility is welcome news, but something on a bigger scale is needed to address the current crisis.

“In reality, if we could get something like maybe three or four of those houses where it’s more than six people, where it’s got a home environment structure, maybe 20 people could go into it,” she said.

More than 1,800 people have lost their lives to the toxic drug poisoning crisis in BC in the first 10 months of this year. The toxic drug crisis was declared a public health emergency in the province in 2016—since then, 10,907 people have died from drug poisoning.

The province’s current response to the crisis has long been criticized for being inadequate. A prescription alternative to toxic street drugs is a step that advocates have been calling for, but one that is still in short supply.

In Victoria, a small number of people have access to a safe supply of fentanyl through a federally funded initiative. Island Health said they have been looking for service providers to partner with and create more safe supply initiatives, but don’t have confirmation yet.

“While the process is nearing conclusion, until contracts are signed we are unable to confirm the successful service partners or the location(s) of the new services,” the health authority said in an email. “As soon as contracts are signed, a public announcement will be made.”

Questions that remain

Though the Coastal Sage Healing Centre has been designed in consultation with Indigenous people, neither Mills nor Kante know whether Indigenous people will be prioritized for access to it.

“Access is based on clinical referral and assessment by a triage committee,” Island Health said in response to the question. “Indigenous identity and background is considered when determining priority during the assessment process.”

Another question that remains is how patients who leave the program will be supported afterwards.

The facility itself will have 12 full time equivalent staff members, including a nurse, addictions and recovery workers, an Indigenous support worker, a clinician, a cook, and a peer support worker. Once a week, a local family doctor will offer their services to the patients as well.

But once patients leave Coastal Sage, it is unclear who will be responsible for aftercare and further services.

“The client and the clinical team will be part of envisioning what the individual's hopes and dreams are for housing for safe living, for parenting; it could be anything,” Malcolmson said.

The options that are available for people recovering from substance use are not always clear to service providers themselves.

According to Kante, there is no one consolidated table or spreadsheet that shows which facilities in the region are providing what kinds of services.

“One of the things that we support community with is navigating the plethora of information that's out there because there are lots of resources within Island Health, but sometimes it can be difficult to know what the pathway to access is or what the options are,” Kante said.

“It takes a bit of work to kind of dig through what's available out there.”