A B.C. substance use treatment program is piloting an innovative approach to helping users kick drugs: Paying them.
The pilot, set to begin in 2024, will operate out of the Road to Recovery Program at St. Paul’s Hospital in Vancouver, and is being privately funded through a $500,000 gift from an anonymous donor.
Guy Felicella, a peer clinical advisor with the B.C. Centre on Substance Use who is spearheading the initiative, said the idea came as a reaction to proposals that would force drug users to undergo involuntary treatment.
Rather than coercing people who aren’t ready to kick drugs, he said, why not offer an incentive to people who are ready to get through he program.
“Going into recovery treatment is one component and getting off of substances is one component,” he said. “But addressing all the other social determinants of health is another, and this is that.”
Key details of the program, which Felicella said will be operated as a formal research study, are still being worked out.
But in broad strokes, it would see patients who come to the Road to Recovery clinic who are diagnosed with a substance use disorder and at high risk of overdose receive $20 per day as an incentive to stick with treatment.
Felicella said he had someone offering him financial support when he went through treatment and recovery, which allowed him to have a life outside of the recovery centre.
Having that kind of agency kept him from sitting alone in his room, he said, and allowed him to see there were good things in life outside of the street lifestyle.
“What we are trying to say is, ‘Hey, you don’t have to do that. You can do this and change your life,'” he explained.
“Giving them access to these funds potentially removes a lot of the barriers for people to go do things outside of the recovery like go for coffee or see their kids, buy some clothes, whatever it is — that part of it doesn’t exist for people who are on income assistance.”
It’s an idea Downtown Eastside resident and drug user Matt Lipka told Global News he’d be interested in trying.
Lipka, who said he worked for a decade on air ambulances, suffers chronic pain and was being treated with oxycodone. He said doctors cut him off during the pandemic, at which point he turned to drugs on the street.
“It’s difficult, it’s definitely not easy and that would help for sure,” he said of the incentive funding.
“As you can see, it’s not very great out here.”
Dr. Paxton Bach, co-medical director at the BCCSU and an addiction medicine specialist at St. Paul’s Hospital, said the pilot project will start, with 20 to 30 patients.
“We are trying to develop something that has never really been done before,” he said.
The initial pilot project is going to be small … but that is intended to help us refine our system and figure out what works, what doesn’t work, and really work towards something much more significant than that.”
Bach said the treatment program will be custom tailored to each patient’s needs, in collaboration with them.
The $20 incentive will be available for up to 90 days, but he said many patients’ treatment needs may extend well beyond that.
“We have evidence-based treatments, effective treatments for people struggling with addiction,” he said.
“But it’s a matter of finding the barriers that are preventing people from participating in these programs and breaking them down one at a time and poverty certainly represents a very significant one.”
While the idea of using incentives in drug treatment has been tried in smaller settings with more limited goals, Bach said the scope of what is being proposed has not been tried in North America.
Sarah Blyth, executive director of the Overdose Prevention Society, said money can be a major stress for drug users, making it harder for them to choose to go into detox.
“Getting people in is great. Keeping people in is great,” she said.
“We currently are working with people every day to get them into detox from OPS — anyone who wants to, we want to make sure there is no barriers to it, whether it be money, whether it be space, anything you can think of.”
The pilot will focus specifically on people with opioid use disorders, and how it proceeds will depend on the results of the study.
But Bach said he believes if the pilot is successful, in the future it could be scaled for other types of addiction.
“I think the sky is the limit for the concept,” he said.