B.C.’s first minister of mental health and addictions has been on the job for three months now. Judy Darcy has worked to create a new office within the government as the province experiences, in her words, “the worst public-health emergency we’ve had in decades”.

The NDP MLA for New Westminster said her job began with an education on B.C.’s opioid crisis. In a lengthy interview with the Straight, she recounted those experiences and discussed B.C.’s next steps responding to the epidemic.

“I went out talking to people on the front line because I wanted to hear from them, unfiltered, [about] what’s working and what isn’t,” Darcy said via phone. “I also tried, everywhere where I went, to talk to people who are living through this overdose crisis, who are themselves living with addictions or who have lost loved ones.”

When B.C.’s first NDP premier in 16 years appointed Darcy as minister of mental health and addictions, on July 18, it was the ninth consecutive month that B.C. had suffered more than 100 overdose deaths.

As recently as 2014, the average number of fatal overdoses in B.C. each month was 31.

“We cannot allow this to become the new normal,” Darcy said at a Metro Vancouver municipalities meeting on September 26.

A few weeks later, the B.C. Coroners Service announced there were another 113 deaths in September, the 10th month in a row for a triple-digit figure.

Darcy gave credit to the former Liberal government’s response to the crisis, noting it expanded harm-reduction programs beyond those of any other jurisdiction in North America. Which begs the question, where does her government go from here?

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“We need to keep doing more of what we’re already doing, more of what has been proven to work, which is harm reduction,” Darcy said. “We need to keep trying bold and innovative approaches. In the budget that we’ve just approved, there is funding for more harm-reduction sites, for more distribution of naloxone, for more training of naloxone, more support for frontline workers and first responders. There is also funding for expanding access to injectable treatment.”

Injectable-opioid-substitution therapy describes a response to an opioid addiction where a patient receives clean drugs regulated by the government via the health-care system, as opposed to buying unknown substances from a dealer on the street. The idea is to stabilize an addict’s life first, to create time and structure that allows them to then address their addiction and underlying issues.

Darcy recounted the story of a Vancouver man who spent his youth bouncing in and out of prison for crimes he committed to feed a heroin addiction. Then he enrolled as a patient at Crosstown Clinic, which operates North America’s first injectable-opioid-substitution program.

“Because of his care and treatment at Crosstown, he has his life back. He went back to school and now he’s working as a cook in the Downtown Eastside,” she said. “It’s an example of what being bold and innovative can do, to save people’s lives and give people their lives back.”

Crosstown Clinic has offered prescription heroin to a small group of select patients since 2014. Darcy said the province is now in the process of expanding access, making similar programs available at other locations.

Except, she said, in line with B.C. Centre on Substance Use guidelines released on October 11, patients won’t receive prescription heroin like those at Crosstown do. Instead, B.C.’s new injectable-opioid-substitution programs will dispense hydromorphone (brand name Dilaudid), a synthetic opioid similar to heroin.

“What the clinical experts tell me is that for most people, hydromorphone works as well as prescription diacetylmorphine [the medical term for heroin],” Darcy explained. “And it has far less regulatory barriers. It is already available and that means we’re in a position to scale it up far more rapidly.”

Darcy said exactly how these new programs will function will depend on where they’re located. She noted the guidelines describe three models for distribution, and the province could deploy all three, tailoring each program to its community and specific address.

The Crosstown model uses a stand-alone building, the primary function of which is to dispense opioid substitutes and other addictions services. A second model is described in the guidelines as “integrated or embedded”, where injectable hydromorphone is made available where harm-reduction services are already delivered; at Vancouver’s Insite supervised-injection facility, for example. The third is a “pharmacy-based” model, where injectable-treatment options are delivered in common health-care centres alongside traditional treatments such as methadone or Suboxone.

“We’ve asked all the health authorities to come back and tell us what could work in their areas,” Darcy said. “To come back by the end of the month [October] with their plans about how we can do that.”

She noted that will have to happen with an education campaign aimed at doctors and other health-care professionals who might not be familiar with injectable-opioid-substitution therapies.

Beyond B.C., Darcy said she has spoken with Canada’s new federal health minister, Ginette Petitpas Taylor, who was appointed on August 28. The two met in Edmonton on October 19 at a meeting of their counterparts from across Canada. Then they connected in Vancouver at a private meeting the following night (October 20), where their conversation focused almost exclusively on the overdose crisis.

“We are pushing the federal government on some of the regulatory barriers,” Darcy told the Straight. “We’re pushing on exemption requirements for supervised-consumption services, overdose-prevention sites, and drug checking. In all of those areas, there are still regulatory barriers.”

Since the fentanyl crisis has intensified and the monthly death tolls have remained above 100, a growing number of Vancouver service providers as well as B.C. health-care professionals have called for a discussion on decriminalization. For example, Mark Tyndall, executive director of the B.C. Centre for Disease Control, has argued that removing criminal penalties for the personal possession of drugs would reduce stigma and therefore remove barriers that prevent people from seeking help and enrolling in treatment.

But Darcy said that decriminalization is not an idea that she’s hearing receive a great deal of support at higher levels of government.

“There is not a lot of appetite for decriminalization, federally and provincially,” Darcy said. “But I think it is important to look at models elsewhere.”