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Opinion: Two-tiered health system is here – and it’s making the overdose crisis worse

"If you look a little closer the cracks in our system show, especially when it comes to substance use and addiction"
Addicts seeking immediate treatment in Canada often face being put on months-long waitlists to access care beds and other resources.

Canadians like to believe that our health care system is the envy of the world: high quality, equitable, and – best of all – free to access. If you look just a little closer, though, the cracks and gaps in our system show, especially when it comes to substance use and addiction. Those gaps reveal a two-tiered health system that is increasing overdose risk.

I see those gaps every day in my work helping people navigate the health system to get treatment for substance use. I recently spoke with a parent whose child wanted to go into addiction treatment, but the waitlist to get in was over a month long. It’s a scenario that’s way too common.

When it comes to addiction, timing is everything. Treatment doesn’t stand a chance of working if someone isn’t ready, so ensuring it’s accessible when they are ready is critical. Any delay could mean an opportunity lost – and missing that opportunity can be deadly. The toxic drug supply means a deadly overdose is always just one hit away. 

Now imagine you’re that parent who’s just learned that help for your child is so far away. With stakes this high, you’d look for any way to close that gap. That’s exactly what this parent did. They paid $5,000 to jump the queue and get their kid into treatment immediately. 

There’s not just one single waitlist though. Many treatment facilities have one list for privately paid treatment beds and another list for publicly funded treatment beds. The parents in this situation paid to bypass that public list. Seeing seven people die every day from toxic drugs is enough to make any parent with the means to do so pay out of pocket to protect their child. What choice did they have? 

Families are desperate, people who use drugs are desperate. The sad truth is some are profiting from that desperation while others are dying.

But what if you don’t have the money? Well, there’s that waitlist. There are lines for detox, lines to get into facilities. Waitlists everywhere. We tell people who use drugs to get help and get treatment and there are many people who want that help and are asking for help. They're trying and our system is failing them. If you don’t have the money for a private facility, well, then, that waitlist is the only option you have. And yet we blame the person for their addiction.

The reality is we have one system for those who can pay and another for those who can’t. What makes no sense is how little is invested in closing the gaps between two systems. Currently, funding for a single treatment bed is $35 a day. We pay more to put someone in prison for a single day, some estimate that it is three to four times more expensive to jail someone than it is to provide them with a treatment bed.

Rather than invest in making treatment more accessible, we’re funnelling people who use drugs into the prison system at a much greater cost. If we all agree that substance use and addiction are health issues why do our funding priorities say otherwise?

Treatment is only one way the two-tiered system is revealed when it comes to substance use. There are clinics that dispense opioid addiction treatments, like methadone and Suboxone, and make people pay clinic fees, often as much as $60 a month. Many used to take those fees directly from people’s social assistance cheques to prevent them from choosing to eat over getting medicine – clinics were making the choice for them. Nowhere else in our health system do we allow this kind of profiteering. 

The message to someone with an addiction: If you want help, you’re going to have to pay for it. 

For many people, paying out of pocket isn’t an option. Many people who use drugs carry a criminal record around with them for life, even if they’ve stopped using drugs. How many employers out there are hiring people with criminal records and a 15-year gap in their employment history, as I have? It doesn’t matter that if someone has been in recovery for years like I have, people carry the stigma of their substance use with them forever.

And so if you don’t have the means to pay, you’re forced to wait. If you’re forced to wait, the chances are greater that you might die. In a public health emergency, barriers to treatment and care should be removed. That we allow a two-tiered system to thrive while people die by the thousands every year is unconscionable.

The good news is the kid whose parents forked over cash is still in recovery. The bad news is most people aren’t so lucky and will never get the chance.

Guy Felicella is a Peer Clinical Advisor at the BC Centre on Substance Use. Follow him on Twitter at @guyfelicella.

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