Canada-British Columbia Emergency Treatment Fund Bilateral Agreement

BETWEEN:

HER MAJESTY THE QUEEN IN RIGHT OF CANADA (hereinafter referred to as “Canada” or “Government of Canada”) as represented by the Minister of Health (herein referred to as “the federal Minister”)

- and -

HER MAJESTY THE QUEEN IN RIGHT OF BRITISH COLUMBIA (hereinafter referred to as “British Columbia” or “Government of British Columbia”) as represented by the Minister of Health herein referred to as “the British Columbia Minister”)

PREAMBLE

WHEREAS, Canada and British Columbia agree that Canada is in the midst of an opioid crisis that has had a significant effect on many communities, that has claimed the lives of thousands of Canadians from all walks of life, that has had a devastating impact on many Canadian families, and the Emergency Treatment Fund is designed to augment treatment services through one-time funding in response to the opioid crisis;

WHEREAS, Canada and British Columbia agree that immediate action and collaboration is needed among governments to help reduce harms and deaths associated with problematic substance use, including opioids;

WHEREAS, the governments of Canada and British Columbia have committed to work together to further address the opioid crisis, in full respect of their respective jurisdictional responsibilities, and recognizing that the Government of British Columbia has the primary responsibility for the design and delivery of substance use disorder treatment and response services in British Columbia, the one-time Emergency Treatment Fund is intended to augment services and British Columbia will be required to sustain any ongoing initiatives as required;

WHEREAS, Canada has established a transfer payment program called the Emergency Treatment Fund to provide one-time funding to the provincial and territorial governments for the development and delivery of treatment services for problematic substance use, including opioids;

WHEREAS, Canada authorizes the federal Minister to enter into agreements with the provinces and territories, for the purpose of promptly and effectively responding to the opioid crisis and problematic substance use through the Emergency Treatment Fund; 

WHEREAS, the Ministry of Health Act authorizes the British Columbia Minister to enter into agreements with the Government of Canada under which the Government of British Columbia undertakes to use the funding provided by Canada under the Emergency Treatment Fund for the provision of treatment services for problematic substance use, including opioids;

AND WHEREAS, British Columbia is responsible for the provision of treatment services including to Indigenous populations accessing treatment services off-reserve.

NOW THEREFORE, Canada and British Columbia agree as follows:

1.0 Purpose

1.1 The Parties are committed to protecting the health and safety of all Canadians through a compassionate and collaborative approach to addressing problematic substance use. The objective is to support single or multi-year projects that will improve access to evidence-based treatment services. 

1.2 The purpose of this Agreement is to provide financial support from Canada to British Columbia to target treatment services for problematic substance use, including opioids.  This funding will support single or multi-year projects that will build on and enhance existing initiatives, capacity, and priorities.

2.0 Emergency Treatment Services

2.1 Objectives

2.1.1   Canada and British Columbia agree that over the period of this Agreement, with financial support from Canada, British Columbia will address local, regional, and system priorities to reduce opioid-related harms and deaths by further building on and enhancing British Columbia treatment services and programs to improve the availability and accessibility of treatment for problematic substance use towards achieving the objectives of:

  1. Managing acute illegal drug overdose cases by building system capacity to link people to treatment when and where it works for them;
  2. Ensuring low-barrier access to a full spectrum of evidence-based treatment for opioid use disorder including medications and comprehensive treatment and recovery services.

British Columbia’s approach to achieving these objectives is set out in its Action Plan attached as Annex 1.

2.2 Eligible Areas of Investment

2.2.1 British Columbia agrees to allocate funds provided by Canada under this Agreement in one or more of the following eligible areas of investment:

  • support initiatives that will establish, build on, or enhance existing treatment approaches;
  • encourage further implementation of innovative treatment solutions;
  • recognize the importance of broader strategies to support access to treatment services by enhancing health care providers’ knowledge of best practices. 

2.2.2 The types of initiatives for which British Columbia agrees to use the funding may include: enhancements or expansion of existing treatment approaches such as opioid agonist treatments (e.g., methadone, buprenorphine/naloxone), withdrawal management products (e.g., opioid agonist taper and alpha2-adrenergic agonists), oral Naltrexone, psychosocial treatment interventions, and counseling services; innovative treatment solutions such as wrap-around care and injectable agonist treatment; and, implementation strategies to enhance health care providers’ knowledge of best practices (alcohol, cannabis, and tobacco are excluded).

2.2.3 Treatment services specifically to address alcohol, cannabis, and tobacco are excluded from this funding.

2.2.4 Types of eligible expenditures may include:

  • Operating costs;
  • Capital costs;
  • Training, professional development and related investments;
  • Information technology and related investments; and,
  • Other costs that in the opinion of the Parties are essential for the completion of the project and achievement of results.   

2.2.5 Canada and British Columbia also agree to promote, define, and deliver innovative approaches to treatment service delivery.

3.0 Period of Agreement

3.1 This Agreement shall come into effect upon the last signature being affixed and will remain in effect until March 31, 2023, unless terminated in writing by Canada or British Columbia, in accordance with the terms and conditions set out in section 11. Funding provided under this Agreement, in accordance with section 4, will cover the period from April 1, 2018 to March 31, 2023.

3.2 Canada and British Columbia concur that the purpose of this time-limited, one-time Agreement is to help British Columbia more rapidly ramp up or otherwise augment treatment initiatives in light of the opioid crisis, and that ongoing funding for enhanced initiatives established under this Agreement are to be sustained by British Columbia.

4.0 Financial Provisions

4.1 The funding provided under this Agreement is in addition to, and not in lieu of, that which Canada currently provides to British Columbia through the Canada Health Transfer in order to support health care services within British Columbia. Furthermore, this funding is in addition to and not in lieu of those funds that Canada has already provided to address problematic substance use and the opioid crisis.

4.2 Allocation to British Columbia

4.2.1 Canada has designated the following maximum one-time amount of funding to be transferred in total to all provinces and territories under this Agreement: $150,000,000 for the period starting on April 1, 2018 and ending on March 31, 2023.

4.2.2 The final total amount to be paid to British Columbia will be calculated using the following formula:

(F –G x 500,000) x (0.33K/[N-P] + 0.33L/Q + 0.33M/R), where:

F is the total one-time funding amount available under this initiative;

G is the number of provinces and territories receiving only the minimum baseline funding (i.e., provinces and territories for which this funding allocation formula results in an allocation of less than $500,000);

K is the total population of British Columbia, as determined using the 2017 population estimates from Statistics Canada;

L is the number of apparent opioid-related deaths in British Columbia as determined using 2016 data from the Public Health Agency of Canada’s National Report on apparent Opioid-Related Deaths in Canada (based on P/T reporting);

M is the number of opioid poisoning hospitalizations in British Columbia as determined using 2016-17 data from the Canadian Institute for Health Information’s Annual Report on Opioid-Related Harms (based on P/T reporting);

N is the total population of Canada as determined using the 2017 population estimate from Statistics Canada;

P is the total population of province and territories receiving only the minimum baseline funding, as determined using the 2017 population estimate from Statistics Canada;

Q is the total number of apparent opioid-related deaths in Canada, as determined using 2016 data from the Public Health Agency of Canada’s National Report on Apparent Opioid-Related Deaths in Canada; and,

R is the total number of opioid poisoning hospitalizations in Canada as determined using 2016-17 data from the Canadian Institute for Health Information’s Annual Report on Opioid-Related Harms (based on P/T reporting).

4.2.3 British Columbia agrees to match Canada’s contribution at a 1:1 ratio, with the exception of the first $250,000 in federal funding, for which no cost-sharing is required. British Columbia’s matching contribution shall be the equivalent to Canada’s contribution less $250,000 and, as outlined in Annex 1, can include eligible expenditures made specifically for treatment related to problematic substance use as of January 1, 2016. British Columbia agrees to make reasonable efforts to ensure that previous and ongoing funding from Canada under, pursuant to, or through other programs or agreements shall not be used to match Canada’s contribution under this Agreement.

4.2.4 Based on the formula described in section 4.2.2, British Columbia’s estimated share of the amounts identified in section 4.2.1 will be $33,980,570.

British Columbia’s total contribution will be $37,760,000, to be comprised of British Columbia’s 1:1 matching contribution plus additional funds.

4.3 In this Agreement, “Fiscal Year” means the period commencing on April 1 of any calendar year and terminating on March 31 of the immediately following calendar year.

4.4 Payment

4.4.1 Canada’s contribution under this Agreement as set out in 4.2.4 will be paid within approximately 30 business days of both Parties’ signatures being affixed to this Agreement.

4.4.2 British Columbia must spend the entire amount of Canada’s contribution by no later than March 31, 2023.

4.4.3 British Columbia must spend the entire amount of British Columbia’s matching contribution by no later than March 31, 2023.

4.4.4 Payment of Canada’s contribution under this Agreement is subject to an annual appropriation by the Parliament of Canada for this purpose.

4.5 Repayment of overpayment

4.5.1 Canada and British Columbia agree that every effort will be made to ensure that the calculation of Canada’s contribution installment to British Columbia will be accurate.

4.5.2 In the event payment made to British Columbia exceeds the amount to which British Columbia is entitled under this Agreement, Canada will inform British Columbia within 30 days of identifying this error; the amount of the excess is a debt due to Canada and British Columbia shall repay the amount to Canada within 90 calendar days of written notice from Canada.

4.6 Repayment of unmatched funds

4.6.1 In the event that British Columbia does not clearly demonstrate that funds have been cost-matched to the federal funding on a 1:1 ratio less $250,000 by March 21, 2023 in accordance with section 4.2.3, including funding announced as of January 1, 2016, British Columbia agrees to repay the unmatched funds to Canada within 90 calendar days of written notice from Canada.

4.7 Use of Funds

4.7.1 Canada and British Columbia agree that funds provided under this Agreement will only be used by British Columbia in accordance with the areas for investment outlined in section 2.0 of this Agreement and detailed in Annex 1.

5.0 Accountability and Reporting

5.1 Action Plan

5.1.1 British Columbia has completed and shared its Action Plan for the years 2018-19 to 2022-23 of federal funding with Canada, as set out in Annex 1. Upon signature of this Agreement by both Parties, British Columbia will publicly release its Action Plan which:

  1. Provides an overview of the opioid crisis and treatment for problematic substance use in British Columbia;
  2. Identifies specific priority areas for investment and objectives, which builds upon the progress to date in delivering treatment services;
  3. Highlights those investments British Columbia will make in a cost-shared manner equivalent to the federal contribution less $250,000 including initiatives implemented as of January 1, 2016;
  4. Outlines the indicators and specific targets that British Columbia will use to track progress and report on annually according to their planned investments.

5.1.2 The Action Plan may be amended by British Columbia with mutual consent from Canada in a manner consistent with the spirit and intent of this Agreement if deemed necessary by British Columbia to reflect shifts in approach necessitated by changing circumstances or priorities. Such amendments will be done in accordance with section 9.1 and will be made publicly available in accordance with section 7.2.

5.2 Reporting

5.2.1 Within 90 days of both Parties signing this Agreement, British Columbia agrees to:

  1. Provide all available baseline data on the agreed-to indicators; and
  2. Describe any initiatives being undertaken in Fiscal Year 2018-2019 as outlined in the Action Plan.

5.2.2 Beginning in Fiscal year 2019-20 and by no later than October 1 of the subsequent Fiscal Year during the Period of this Agreement, British Columbia agrees to:

  1. Report to the people of British Columbia and to Canada annually on the results and expenditures of the Emergency Treatment Fund allocation until March 31, 2023. The report shall show separately the results attributable to the funding provided by Canada under this Agreement and results attributable to funding provided by British Columbia.
  2. Provide to Canada an annual financial statement, with attestation from the province’s Ministry’s Executive Financial Officer, of funding received from Canada under this Agreement during the Fiscal Year compared against the Action Plan, and noting any variances, between actual expenditures and British Columbia’s Action Plan (Annex 1):
    1. The revenue section of the statement shall show the amount received from Canada under this Agreement during the Fiscal Year;
    2. The total amount of funding used for programs and services;
    3. If applicable, the amount of any amount carried forward by British Columbia under section 4.4;
    4. If applicable, the amount of any surplus funds that are to be repaid to Canada under section 4.5 and 4.6.

5.2.3 Canada, with prior agreement from British Columbia, may incorporate all or any part or parts of the said report into any public report that Canada may prepare for its own purposes, including any reports to the Parliament of Canada or reports that may be made public.

5.3 Audit

5.3.1 British Columbia will ensure that expenditure information presented in the annual financial statement is, in accordance with British Columbia’s standard accounting practices, complete and accurate.

5.4 Evaluation

5.4.1 As per established policies and processes with respect to program effectiveness, British Columbia may evaluate programs and services receiving funds provided under this Agreement and make public the results of any such evaluations.

6.0 Long-Term Collaboration

6.1 Canada and British Columbia agree to share and release data as available, and to share knowledge, research and information on effective and innovative practices in treatment programs, to further support the development of and reporting on outcomes.

7.0 Communications

7.1 Canada and British Columbia agree on the importance of communicating with the public about the objectives of this Agreement in an open, transparent, effective and proactive manner through appropriate public information activities.

7.2 Canada will make publicly available up-to-date Emergency Treatment Fund bilateral agreements entered into with all provinces and territories, including any amendments, on a Government of Canada website.

7.3 Each government will receive the appropriate credit and visibility when investments financed through funds granted under this Agreement are announced to the public.

7.4 Canada reserves the right to conduct public communications, announcements, events, outreach and promotional activities about the bilateral agreements.

7.5 British Columbia agrees to give Canada 10 days advance notice and advance copies of public communications related to this Agreement, and results of the investments of this Agreement.

8.0 Dispute Resolution

8.1 Canada and British Columbia are committed to working together and avoiding disputes through government-to-government information exchange, advance notice, early consultation, and discussion, clarification, and resolution of issues, as they arise.

8.2 If at any time either Canada or British Columbia is of the opinion that the other Party has failed to comply with any of its obligations or undertakings under this Agreement or is in breach of any term or condition of the Agreement, Canada or British Columbia, as the case may be, may notify the other party in writing of the failure or breach. Upon such notice, Canada and British Columbia will endeavor to resolve the issue in dispute bilaterally through their designated officials at the Assistant Deputy Minister level (hereinafter “Designated Officials”).

8.3 If a dispute cannot be resolved by Designated Officials, then the dispute will be referred to the Deputy Ministers of Health for Canada and British Columbia, and if it cannot be resolved by them, then the federal Minister and British Columbia Minister shall endeavor to resolve the dispute.

9.0 Amendments to the Agreement

9.1 This Agreement, including the attached annex, may be amended at any time by mutual consent of the Parties. To be valid, any amendments shall be in writing and signed, in the case of Canada, by the federal Minister, and in the case of British Columbia, by the British Columbia Minister.

10.0 Equality of Treatment

10.1 During the term of this Agreement, if another province or territory, except the province of Quebec, negotiates and enters into an Emergency Treatment Fund agreement with Canada, or negotiates and enters into an amendment to such an agreement and if, in the reasonable opinion of British Columbia, any provision of that agreement or amended agreement is more favorable to that province or territory than the terms set forth in this Agreement, Canada agrees to amend this Agreement in order to afford similar treatment to British Columbia, if requested by British Columbia. This includes any provision of the bilateral agreement except for the Financial Provisions set out under section 4.0. This amendment shall be retroactive to the date on which the Emergency Treatment Fund Agreement or the amendment to such an agreement with the other province or territory, as the case may be, comes into force.

11.0 Termination

11.1 Canada may terminate this Agreement at any time if the terms of this Agreement are not complied with by British Columbia by giving at least 12 months written notice of its intention to terminate. British Columbia may terminate this Agreement at any time if the terms of this Agreement are not complied with by Canada by giving at least 12 months written notice of its intention to terminate.

11.2 As of the effective date of termination of this Agreement under section 11.1, Canada shall have no obligation to make any further payments to British Columbia after the date of effective termination.

11.3 As of the effective date of termination of this Agreement under section 11.1, British Columbia will repay federal funds on a pro-rated basis after the date of effective termination.

11.4 As of the effective date of termination of this Agreement under section 11.1 British Columbia agrees to return any federal funding not cost-matched by British Columbia consistent with section 4.2.3 and section 4.7.1.

12.0 Notice

12.1 Any notice, information or document provided for under this Agreement will be effectively given if delivered or sent by letter, postage or other charges prepaid. Any notice that is delivered will have been received in delivery; and, except in periods of postal disruption, any notice mailed will be deemed to have been received eight calendar days after being mailed.

The address for notice or communication to Canada shall be:

70 Colombine Drive
Ottawa, Ontario, K1A 0K9

The address for notice or communication to British Columbia shall be:

Taryn Walsh, Assistant Deputy Minister
Strategic Priorities and Initiatives
Ministry of Mental Health and Addictions
PO BOX 9646 STN PROV GOVT
1515 Blanshard St., Victoria BC V8W 9P1
Taryn.Walsh@gov.bc.ca

13.0 General

13.1 This Agreement, including Annex 1, comprises the entire agreement entered into by the Parties with respect to the subject matter hereof.

13.2 This Agreement shall be interpreted according to the laws of Canada and British Columbia.

13.3 No member of the House of Commons or of the Senate of Canada or of the Legislature of British Columbia shall be admitted to any share or part of this Agreement, or to any benefit arising therefrom.

13.4 If for any reason a provision of this Agreement that is not a fundamental term is found by a court of competent jurisdiction to be or to have become invalid or unenforceable, in whole or in part, it will be deemed to be severable and will be deleted from this Agreement, but all the other provisions of this Agreement will continue to be valid and enforceable.

13.5 This Agreement is drafted in English at the request of the Parties. Les parties ont convenu que le présent Accord soit rédigé en anglais.

SIGNED on behalf of Canada by the Minister of Health at Ottawa, Ontario this 30 day of August, 2018.

The Honourable Ginette Petitpas Taylor, Minister of Health

SIGNED on behalf of British Columbia by the Minister of Health at Victoria, British Columbia this 5 day of September, 2018.

The Honourable Adrian Dix, Minister of Health

Annex 1 British Columbia Action Plan

British Columbians continue to experience unprecedented overdose-related harms due to an increasingly toxic illegal drug supply associated with the increased presence of synthetic opioids such as fentanyl and carfentanil. Since British Columbia declared a public health emergency in April 2016, more than 2,900 people have died from a preventable illegal drug overdose.

To date, British Columbia’s cross-sector response to the overdose crisis is concentrated on essential health sector interventions and strategies for a supportive environment. Health sector interventions are focused on:

  • Ensuring sustained access to naloxone and training to administer it;
  • Supporting a diversity of community-level, low barrier services tailored to the needs of a population and/or community, including overdose prevention and supervised consumption services, housing-based initiatives, drug checking, mobile services, and strategies to reach people who are using drugs alone;
  • Managing acute overdose cases by building system capacity to link people to treatment when and where it works for them; and
  • Ensuring low-barrier access to full spectrum of evidence-based medications for opioid use disorder and comprehensive treatment and recovery services.

These interventions are underpinned by work to address social and environmental factors that have impacts on health and health outcomes, including:

  • Supporting community-level strategies that ensure ongoing psychosocial support, access to affordable housing, income stabilization, transportation, and food security;
  • Building peer empowerment and employment and involving peers and people with lived experience in the strategic development of policies and programs in the overdose response;
  • Ensuring all services are trauma-informed and rooted in cultural safety and humility; and
  • Addressing stigma, discrimination and human rights.

Continuing harm reduction efforts (e.g., providing publicly funded naloxone, establishing and operating supervised consumption and overdose prevention services) is essential to save lives, as people need to be alive in order to receive and benefit from treatment and recovery services. When people are ready, they need to be able to be reached or able to access a treatment system that provides the right services when and where they are needed.

In Budget 2017, the Government of British Columbia allocated a $322 million investment over three years to address the overdose crisis; $170 million of that funding is dedicated to enhancing treatment services, provider training, outreach, and increasing the range of available opioid agonist treatments. The Government of Canada’s contribution of $33.98 million from the Emergency Treatment Fund will be used to improve treatment and care, and contribute to improved health and social outcomes for people living with opioid use disorder through the initiatives identified in this Action Plan.

1. Expansion of Foundry

Foundry is a network of centres and e-health services co-created with health and social service partners, young people and families in communities across British Columbia. Foundry youth service centres are intended to improve access to mental health, substance use and primary care for youth and young adults in communities across the province. Foundry brings health and social services together in a single place to make it easier for young people to find the care, connection and support they need.

Health Canada funding will be used to expand treatment capacity across all Foundry sites in the province to support youth with problematic opioid use. This investment is expected to improve access to mental health, substance use, and primary care services for youth in British Columbia.

2. Injectable Opioid Agonist Treatment Expansion

Injectable Opioid Agonist Treatment (iOAT) is a key component within the continuum of care in the treatment for opioid use disorder. It is a high intensity treatment option for people with severe opioid use disorder who have been unsuccessful at reducing or ceasing their non-medical use of opioids via lower-intensity first and second-line treatment options.  (i.e., buprenorphine/naloxone, methadone). As part of plans to expand accessibility of opioid agonist treatment (OAT), British Columbia is expanding this innovative treatment option to all health regions.

Health Canada funding will be used to support regional plans to:

  • Increase capacity and reach of iOAT treatment for eligible clients;
  • Support innovative approaches to engaging patients in treatment;
  • Ensure access to iOAT in a diversity of clinical settings; and
  • Evaluate initiatives for efficacy and client outcomes.

3. Treatment Beds

As a core component of building a comprehensive system of addictions treatment and care, British Columbia is working to increase access to treatment services by improving residential treatment capacity through programs that include access to opioid agonist treatment (OAT). The goal of these expanded programs is to provide evidence-based medical and psychosocial treatment, education and support to reduce problematic substance use, improve overall health and social wellbeing, and ultimately reduce the risk of death or other harms related to overdoses and infections.

Health Canada funding will be used to fund 25 supportive residential treatment beds in the province, to provide safe accommodation and support appropriate for treatment (including withdrawal management/opioid agonist treatments), education and life-skills training, group and individual counselling, psychosocial education, and family programming.  Stays for individual clients are anticipated to be 90 days.

The following components of treatment and support are to be incorporated in funded programs to ensure effective delivery of safe and effective residential treatment for substance use:

  • Coordinated and collaborative service delivery;
  • Active involvement of significant others;
  • Client-centred, flexible approach;
  • Holistic approach to care;
  • Strengths-based model;
  • Trauma-informed practice; and
  • Evidence-based approach.

In addition to 90 days of residential treatment, clients are provided with aftercare and support for transition to home communities.  Aftercare is offered for six to nine months post-transition from the program.

4. HOPE Initiatives

British Columbia is working to address gaps in the system of care that lead to missed opportunities to connect people to treatment options for people who have recently experienced, or who are at high risk of overdose. To this end, the Province is building a system that proactively reaches out to these individuals. This includes creating referral pathways for follow-up, care planning and referrals to treatment and care from emergency departments, through first responders, and through community services. 

HOPE Initiatives will provide multidisciplinary resources to Health Regions to establish and/or expand local-level capacity to provide connections to care and system navigation support to help individuals in linking with services that are relevant, accessible and appropriate to their unique needs.  Resources will be provincially coordinated and tailored to meet the service gaps at the regional/community level, but will include one or more of the following roles:

  • Peer navigators;
  • Social workers;
  • Outreach workers;
  • Registered Nurses; and
  • Nurse Practitioners.

Provincial and regional-level planning for HOPE initiatives will engage the First Nations Health Authority to ensure engagement with First Nations Communities and the integration of culturally safe and appropriate service delivery throughout the province. This may include integrating peer navigators into Indigenous organizations.

Health Canada funding will be applied over a 3-year term to establish robust post-overdose support to facilitate community-level linkage to care for individuals at high risk of overdose (as determined by a clinical assessment of opioid use disorder, or by a history of one or more previous overdoses). Resources will be targeted toward high priority communities to support innovative approaches to connecting individuals to care, including three current public safety/healthcare partnership projects currently underway in British Columbia that seek to strengthen linkages to healthcare from police referral. 

5. Strategies to Enhance and Improve Treatment Services

In order to build capacity to treat and support people living with opioid use disorder in British Columbia, there is an urgent need to engage and support new primary and addictions care providers. This includes providing training, mentoring and fellowship education opportunities to new and existing primary care physicians, nurse practitioners, nurses and social workers throughout the Province. Sustaining capacity of primary care providers also requires resources to support practice using continuing education and access to expert consultation.

Health Canada funding will be used to support:

  • Addictions training and education (workshops, webinars);
  • Building on the network of over 75 provincial preceptors in the Provincial Opioid Addiction Treatment Support Program partnership with health authorities, BC Centre on Substance Use, and Divisions of Family Practice;
  • Quality improvement projects (e.g., healthcare collaborative, communities of practice);
  • Establishing an after-hours addictions consultation phone line for physicians and nurses;
  • Expanding the Interdisciplinary Clinical Addiction Fellowship Program to sustain an expert workforce in treating opioid and other substance use disorders in areas where there are gaps in access to care;
  • Providing consultant expertise to address barriers to access to treatment; and
  • Engaging with stakeholders and people with lived experience to inform system enhancements.

6. Enhancing treatment services across all health authorities

British Columbia has 5 regional health authorities, each with their own unique needs for treatment system enhancement within diverse urban, suburban, rural and remote communities.  There are currently inequities in the access to treatment and care related to opioid use disorder; enhancing treatment services in health authorities across the province is needed to address this gap to accessing treatment and care.

A portion of Health Canada funding will be provided to each regional health authority to work with First Nations Health Authority to enhance and expand targeted regional plans for treatment access by:

  • Providing resources to bolster continuity of care when transitioning from municipal, provincial, and federal corrections systems to community;
  • Supporting specialized substance use access and assessment teams;
  • Expanding rapid access treatment clinics that provide OAT;
  • Implementing strategies to strengthen recruitment and retention of medical addictions leadership and practitioners;
  • Expanding low barrier/high access OAT/iOAT programs;
  • Building capacity for physicians to deliver OAT and other emerging treatment; and
  • Leveraging technological solutions, such as telehealth, to expand reach of services.

7. Supportive Recovery

This initiative will ensure that British Columbians living with problematic substance use receive safe, appropriate, and supportive recovery-oriented housing while on their path to recovery. There is a need for a process by which supportive recovery homes will assess themselves against newly drafted regulations and care models being developed by the BC Centre on Substance Use to identify gaps. The funding will be used for knowledge exchange and capacity building to help bring these agencies up to “standard” in order to meet the requirements under the new regulations. Health authorities, existing service providers of supportive recovery homes, and people with lived experience will be engaged in this work.

Health Canada funding will be applied toward the implementation of a new regulatory framework related to supportive recovery residential programs.

Table 1: Federal funding by initiative
# Name of Initiative Expected Outcome/Results Performance Measuremen Expenditure Plan (in millions)
2018/19 2019/20 2020/21 TOTAL
1 Foundry

Improved mental health, substance use, and primary care access for youth in B.C.

Reporting source: Foundry Central

Reporting frequency: quarterly

Performance indicator:

  • # of youth that have accessed SU services through Foundry (in the reporting period)
  • % of youth requiring SU services who accessed them the same day of first visit

Note: indicators above may be inclusive of MH and SU

1.00 0.00 0.00 1.00
2 Injectable Opioid Agonist (iOAT) Treatment Expansion

Reduced overdose related harms due to initiation on iOAT

Reporting source: Regional health authorities (MoH)

Reporting frequency: Quarterly

Performance indicator:

  • # of  iOAT clients
  • # of new iOAT clients (in the reporting period)
2.00 0.00 0.00 2.00
3 Treatment Beds

The system’s capacity to provide OAT will be maintained to support this treatment option

Reporting source: Provincial Health Services Authority

Reporting frequency: Quarterly

Performance indicators:

  • # of unique clients served (in funded treatment beds)
  • # of unique new clients served (in the reporting period in funded treatment beds)
  • Median wait time (in days) from referral to admission
3.00 0.00 0.00 3.00
4 HOPE Initiatives

People at high risk of overdose will be identified and supported to engage with the treatment system

People at the front line of the overdose response will be able to connect those in need of care

Reporting source: BCCfE/OERC

Reporting frequency: Quarterly

Performance indicators:

  • # of people connected to OAT treatment and care
  • # of people retained in OAT care @ 3 months
4.00 4.00 4.00 12.00
5 Strategies to:

  • Enhance and support front line treatment services
  • Improve access to care for people with opioid use disorder
  • Improve post-care for people with opioid use disorder

Build capacity in primary care to create a sustainable workforce to deliver quality opioid use disorder care

Reporting source: Regional Health Authorities, Ministry of Health, BC Centre on Substance Use

Reporting frequency: quarterly/monthly

Performance indicator:

  • # and type of providers receiving addictions care training, by provider (BCCSU)
  • # and type of providers prescribing OAT, by region
  • # of patients initiated on OAT for the first time, by region
  • # of patients on OAT, by region
2.28 2.15 0.00 4.43
6 Enhancing treatment services at the Health Authority level across the province

Increased access to enhanced treatment services for people living with opioid use disorder

Reporting source: Regional health authorities, Provincial Health Services Authority, Ministry of Health

Reporting frequency: quarterly/monthly

Performance indicators:

  • # of OAT clients, by region
  • # of new OAT clients (*dispensed OAT for the first time via Pharmanet), by region
  • # of OAT prescribers, by region
  • # of new OAT prescribers, by region
4.00 3.50 3.50 11.00
7 Supportive Recovery

More British Columbians experiencing problematic substance use will be protected and receive safe, appropriate, and supportive recovery-oriented housing while on their path to recovery.

Reporting source: Regional health authorities, supportive recovery homes/service providers, Ministry of Health

Reporting frequency: quarterly/monthly

Performance indicators:

  • # of providers/staff receiving regulatory training
  • # of implementation material downloads
0.05 0.50 0.00 0.55
  16.33 10.15 7.50 33.98
Table 2: Provincial funding by initiative
BC's Matching Funding for Federal Emergency Treatment Fund 2017/18
Actuals ($millions)
Build a Network of Addiction and Treatment Recovery  
Plan G suboxone/methadone change 14.31
Slow Release Oral Morphine (SROM) 2.17
Opioid Use Disorder Treatment 9.28
Current injectable OAT services 4.53
Injectable OAT expansion   2.01
Hospital /ED Services (Other) 2.02
OAT in Correctional Facilities 0.63
Foundry Centres  1.50
Professional Education and Training 1.31
Total 37.76
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