• Fund access to community and online training opportunities
• Support the development of an integrated training network

• That act as sites of peer support and knowledge exchange
• That have capacity to consult within their communities and convey the results to policy makers and program developers
• That develop models of supporting peer organizing in rural and remote areas

• Follow best practices for peer employment - pay and employ peers appropriately for their expertise and work
• Follow best practices for peer engagement
• Use Peerology: A guide by and for people who use drugs on how to get involved
• Use Developing Peer Engagement Principles and Best Practices: A Guide for BC Health Authorities and other Providers
• Develop initiatives that facilitate collaborative dialogue and action between peers, service providers and local community organizations

• Pilot low-barrier, rapidly scalable models of distributing a regulated supply of pharmaceutical opioids to those at risk of opioid overdose due to illegal drug supply contamination.
• These may involve accessing opioids through pharmacies, mobile programs, dedicated storefronts and/or supportive housing facilities
• Allowing consumption off-site (i.e. not witnessed) will lower barriers to participation
• Pilot and evaluate the impact of stimulant substitution on the overdose crisis
• Open additional clinics based on the Crosstown model (on-site injection with intensive engagement) to provide access to supervised opioid injection
• Expand physician capacity and confidence to prescribe opiates including oral hydromorphone, long acting slow release oral morphine and injectable opioids
• Increase the number of physicians and nurse practitioners with specialty training in addiction medicine

• Develop models of drug testing feasible in rural areas
• Develop bring-home/mail-in testing programs
• Expand drug testing beyond qualitative to quantitative results on potency
• Expand drug testing to additional sites – Supervised Consumption Sites, Overdose Prevention Sites, mobile sites, health authority sites (e.g. Community Health Centres, STI clinics), and bars, nightclubs, and music festivals

• Encourage drug dealers to use drug testing programs
• Improve access of drug producers to professional-grade mixing equipment and educate them about techniques to improve homogeneity of the product

• Grower’s clubs, production on a model similar to medical marijuana, personal cultivation

• Consider a multidisciplinary approach including counselling and physical therapy
• Decrease wait times for referral services to pain clinics
• Develop a new PharmaCare plan to enable access to non-opioid pain therapies, including allied health modalities
• Enhance and evaluate access to integrated therapeutic models

• Develop incentives and expand alternative billing models to allow physicians more time to engage and manage complex patients appropriately
• Promote comprehensive pain management within the Patient Medical Home initiative of Doctors of BC
• Provide access to culturally appropriate treatments and Indigenous healing services

• Develop clinical guidelines on the treatment of chronic pain in people who have substance use disorders
• Improve PharmaNet usability to support clinical decision-making and a prescription drug monitoring program (PDMP); introduce reporting to physicians that compares their prescribing practices to the average to encourage self-reflection and behavior change (similar to reporting on antibiotic use) and evaluate any PDMP for unintended consequences

including opioids, harm reduction, mental health, substance use and trauma-informed care

Continue financial and human resources support to community-based OPS

• Ensure adequate funds are available to pay peers for their participation in a variety of roles, including program development/consultation, outreach and front-line work
• Develop site-specific guidelines addressing how to support peers in frontline OPS roles

• Integrate primary care and mental health services
• Offer scheduled primary care and mental health services at community-based OPS; scale up if successful
• Embed OPS within health authority sites
• Increase geographic scope of OPS
• Explore support for supervised inhalation in outdoor spaces
• Increase staffing on income assistance cheque days

• Build upon the existing BC telemedicine infrastructure
• Use online and smartphone video communication applications (e.g. Facetime)
• Use link smartphone actigraphy (technology which measures movement during sleep) with OPS respond where feasible (e.g. in supportive housing)

Develop a communication platform between OPS to facilitate exchange of best practices

Develop an outreach based OPS model that can be used in rural and remote areas

Create welcoming social spaces for people to use drugs together both related to and distinct from OPS

while providing the option to attend specialized clinics (offering comprehensive services, including counseling and pharmacist support) to access additional treatment. Lower barriers to access by:

• Using telehealth infrastructure to improve access in rural areas
• Improving access to medical therapy during evenings and weekends
• Expanding physician capacity for outreach and house calls

Implement legislation and policies that encourage parents to seek treatment without fear of child apprehension

Provide treatment free of charge

Increase supports to families, including counselling, education and resources

Increase supports while accessing and transitioning from treatment while using family-centered approaches

including integrated service hubs, outreach, and Indigenous healing and cultural connection services

to ensure provision of culturally safe, relevant and effective addiction treatment services

• Promote increased access to training and recruitment of Indigenous physicians
• Promote access to culture as treatment practices and indigenous healing services

• Implement minimum standards under which they must operate and ensure oversight and accountability

Increase the number of physicians with addiction medicine training through fellowships and Continuing Medical Education (CME)

• Develop incentives to encourage physicians, particularly family doctors and walk-in clinic doctors, to attend CME addictions training

Encourage uptake of existing training materials for physicians and develop new resources to fill identified gaps (e.g. people who use substances recreationally, people who use stimulants, treatment of concurrent disorders).

• Include representatives from multiple levels of law enforcement
• Ensure consistency of action and alignment with a public health approach to the crisis

Agencies engaging well with public health actions, such as Vancouver Police Department.

that addresses trauma informed care, harm reduction, substance use disorders, mental illness, cultural competency and stigma.

• Include peers in development of this training
• Deliver this training regularly as a mandatory standard
• Build mandatory case plans for people with histories of addiction, including social services, mental health services, employment and housing

through public campaigns in targeted areas.

Develop a provincial policy ending parole conditions that prevent visiting harm reduction sites (“red zones”) or carrying harm reduction supplies

Deliver evidence-based harm reduction supplies, including needle and syringe programs, inside correctional facilities

Allow people leaving corrections to carry harm reduction supplies without repercussions from parole officers and law enforcement on release

Improve treatment options and continuity for people exiting correctional facilities including pre-release planning, connection to local services and coordinated service delivery

while acknowledging that full legalization and regulation is necessary to address contamination of the drug supply.

• Ask the regulated professions to release joint statements of support for drug law reform
• Increase re-direction from sentencing to addiction treatment and social support services for minor drug offences
• Stop court ordered addiction treatment
• Provide less punitive and more flexible options

Support services for youth and parents across BC

• Standardize the connection of public health nurses to parents across the province to provide education, support and counselling
• Increase access to early screening and support for mental health in school age children

Increase access to education and programming that supports strengths-based approaches and community connectedness

• Increase access and engagement for low income children in community recreational activities
• Develop and implement substance use education for children and youth in schools focused on resiliency and skill building rather than drug harms

• Advocate and work to implement recommendations of the Truth and Reconciliation Commission
• Develop and fund practical tools and programming to support wellness for individuals and families grounded in cultural approaches

• Develop resources for people who do not meet diagnostic criteria for mental illness to support mental health and well-being

Implement coordinated social policies across departments with focus on healthy child and family development

Institute an affordable childcare plan for BC

• Introduce a minimum guaranteed income
• Provide housing to those who need it

for advocacy for people who use drugs (like the Representative for Children and Youth)

Advocate with the federal government to declare a national public health emergency

• Use lessons learned and resources from decreasing stigma around HIV, tobacco and alcohol, mental health and towards LGBTQ populations

including media, government, healthcare workers, law enforcement workers, health care students and the public

• Create non-stigmatizing language and cultural competency guides that build from existing documents
• Work with peers to develop a mandatory online training course for frontline health care providers about cultural competency and the principles of harm reduction and trauma-informed care
• Launch a public anti-stigma awareness campaign using storytelling and photo voice directed by people with lived experience

between peers, service providers and local community organizations such as the Compassion, Inclusion and Engagement initiative

• Focus on people using alone in private residences
• Explore alternative way of distributing income assistance payments to avoid peaks in overdoses
• Conduct a feasibility study of how public health leadership might facilitate access to opium on a model similar to medical marijuana
• Use data from the BC Opioid Overdose Cohort to:
  • Understand the extent to which prescription opioids and recent policy changes have fueled and supported the current overdose crisis
  • Investigate differences in risk factors for overdose, including opioid prescribing, among those with First Nations vs non-First Nations identity
  • Institute a qualitative research program to contextualize results, investigate areas of uncertainty and identify new analytic questions

including clear timelines and knowledge translation of results.

• Evaluate unintended consequences of the College of Physicians and Surgeons British Columbia (CPSBC) prescription opioid guidelines and prescription drug monitoring programs

• Build a centralized database of patients in residential addiction treatment to quantify treatment pathways and outcomes
• Collect data on possible targeted (deliberate) overdoses towards individuals
• Improve surveillance of the composition of illegal drugs

(see Child and Youth Health and Well-Being Indicators Project)