Advocates propose paying most vulnerable $20/day to enter drug treatment

A former B.C. drug user turned harm reduction and recovery advocate, and an Alberta addiction physician are proposing governments pay some people to enter treatment.

Guy Felicella and Dr. Monty Ghosh said the idea of “incentivized treatment” would see those who cannot access treatment through other means – including the homeless and those living below the poverty line – be eligible for a small stipend of $20 per day to enter 90-day treatment facilities and rehabilitation services.

The $600 per month would go into people’s pockets and not towards food or accommodation costs, giving them something to work with when they leave treatment and attempt recovery.

“It’s really like looking at investing in people,” Felicella told Global News in an interview.

“We have to be better at investing in people to make recovery somewhat more attractive for people to try.”

“We’re trying to sort of challenge the notion that we need to force people into treatment services,” added Ghosh, who said the incentive process has already been tried and tested in substance use.

Contingency management, Ghosh said, is a rewards-based system with incentives to get people into certain treatment programs that has been very effective for drugs like methamphetamines, cannabis and alcohol.

“One of the big things that substance use hijacks is the reward system in the brain,” said Ghosh.

Felicella, who spent two decades fighting homelessness and heroin addiction in Vancouver’s Downtown Eastside, is well aware of how powerful a motivator drugs are.

He said he overdosed six times once fentanyl hit the streets before he found recovery through a safety net of harm reduction, compassion and suboxone, an opioid replacement treatment.

Drugs need to be counteracted with another catalyst, and Felicella and Ghosh said monetary incentives work, citing the $5 in cash that convinced dozens of Downtown Eastside residents to get their COVID-19 vaccines in 2021.

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“This is a way of giving people back their confidence and a little bit of identity that they too are part of something that’s bigger,” said Felicella.

“If we’re not addressing the other social determinants of health, then treatment is not often set up for success for a lot of people who start with absolutely nothing.”

Substance use costs Canadian society almost $46 billion a year – or almost $1,258 for every person in Canada – according to a July 2020 report by the Canadian Centre on Substance Use and Addiction (CCSA) and the University of Victoria’s Canadian Institute for Substance Use Research (CISUR). The pair believes governments can’t afford to not give incentivized treatment a trial.

“We believe that incentivization would be cheaper than the total cumulative costs that substance use has on Canada,” Ghosh told Global News.

“This includes corrections costs, justice costs, social service costs and health-care costs.”

When asked whether this is something the B.C. government has researched and/or would consider implementing in the future, the Ministry of Mental Health and Addictions told Global News in a statement: “Since 2017, government’s priority has been to build a system of mental health and substance use care that can provide treatment for people when they make the courageous decision to get help. This includes creating as many opportunities as possible for people to access the voluntary system of care.

“There is no one-size-fits all response for people who struggle with substance use. As the Province continues to expand and evolve its response to the public health emergency, a wide range of options are considered to make sure that people get the care that works for them. The government is always open to exploring new options that will prevent deaths and end the toxic drug crisis.

“As the Province implements new approaches to addictions supports and harm reduction – some of which are first in Canada – it is building evidence to further escalate the response to the toxic drug crisis in a way that best helps people who need it, when and where they need it.”

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B.C. Premier David Eby was unavailable for an interview.

Clinical psychologist and SFU Health Sciences Professor Julian Somers embraced the idea, but said incentives on their own are only part of what’s necessary – and the role of motivation is not the biggest part of what we need to fix.

“More important for many people is simply gaining access to the resources that they’ll need over time in order to overcome their addictions,” Somers told Global News.

Somers, who specializes in mental health and addiction research, said a treatment stipend would likely not help vulnerable individuals who don’t have the housing supports and work opportunities to build a new life.

Reconnecting with their families and children is also a critical long-term goal for many Indigenous people with links to communities around B.C. they’ve become estranged from, according to Somers.

“How far would $20 a day go in mobilizing that journey unless we do other things at the same time to make it possible,” questioned Somers.

Former construction worker Jory Reibin has been living on the street across from the West Hotel on Carrall Street since Dec. 1, when he said he was evicted from the single-room occupancy after 18 years as a tenant.

On Thurs., he overdosed while alone after smoking cocaine that may have been laced with fentanyl.

Reibin was resuscitated by paramedics and Vancouver firefighters after bystanders – including a Global News camera operator – delivered naloxone when they discovered him unconscious in his tent.

Grateful he survived the close call, Reibin believes $20 a day would be a great incentive to get people into treatment.

“It would give them an incentive to have an option to make a decision other than one based on survival,” Reibin told Global News in an interview Friday.

“On the street, you have very few options as far as making money – other than to hustle.”