Canada needs national standards to tackle substance use, expert says

An expert on substance use policy says there should be clearer standards for publicly funded residential addiction treatment programs in Canada.

While health and safety standards for such facilities exist, there are no overarching national standards for the quality of treatments or qualifications of those providing services, said Rebecca Jesseman, policy director at the Canadian Centre on Substance Use and Addiction.

Whether in the private system where people pay significant amounts of money, or in the public system where they face long wait times, “we’re not providing any quality guarantee,” Jesseman said.

An estimated 400 public, private and not-for-profit agencies provide residential substance abuse treatment in Canada, according to a 2015 report from the centre.

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Jesseman said she would like to see services for substance use be treated as part of Canada’s broader health-care system when it comes to funding and workforce development.

“Can you imagine going to see a heart specialist and not knowing if the individual actually had any certifications or qualifications to any cardiac specialization?” she said. “There’s no other place in the health system where this would be acceptable.”

Jesseman added that standards should focus on practices that meet minimum requirements like evidence-based approaches, paired with data collection and reporting to ensure transparency and accountability.

Historical stigma associated with substance use, as well as the fact that it is still often viewed as a moral or criminal issue, instead of related to health, contributes to the discrepancy, she said.

The best starting point would be to create standards for government-funded services, said Keir Macdonald, CEO of Phoenix Society, a B.C.-based multi-service agency that provides residential substance use treatment.

Macdonald said that in addition to funding, the federal government could play a leadership role on this task, as the sector lacks updated or common definitions even for terms, like “recovery,” central to their work.

“Where they can really help is just even helping people understand what these terms are, modernizing definitions, modernizing approaches,” he said.

Addictions and Mental Health Ontario, which represents over 200 addiction and mental health organizations, said most addiction services in the province largely evolved through grassroots organizations without a provincial strategy in place to guide development.

The body also said bed-based providers have either already put in place, or are working to implement, quality standards set by Ontario Health, an agency created by the provincial government with a mandate to connect and co-ordinate the health-care system.