The realities of addiction treatment in Nelson and beyond - Part 3 of 3

Heather Austin, Local Journalism Initiative

Dr. Kora DeBeck of the BC Centre on Substance Use says B.C.’s voluntary addiction treatment system still has a lot of gaps.

“…Within the voluntary addiction treatment system, there are still lots of waits. It’s not very accessible and also something that the head BC coroner and our provincial health officer have highlighted multiple times is that addiction treatment is not currently regulated. We don’t know what outcomes are for folks who go into addiction treatment in BC. And so in terms of there being a robust addiction treatment system, that’s just not there…”

There are many factors that affect someone’s ability to access treatment – and what happens afterwards.

Joanne Motta, housing director at Stepping Stones in Nelson, describes what happens when people at the shelter are referred to treatment.

“We have supported quite a lot of people to go to treatment…The challenge is that sometimes what happens once they go to treatment is that we lose touch with them, so we never know if they even make it…We kind of hear, but…there is no treatment center here, so they’re going out of community, so they might be going to Kamloops, Vancouver, the Island.”

So what exactly happens when someone experiencing homelessness in Nelson wants addiction treatment?

Treatment options are varied, and scattered

Most bed-based treatment options require leaving the community.

AXIS in Castlegar offers three to five days of medically supported withdrawal management, or “detox.” Trail hospital also has inpatient withdrawal-management beds.

Nelson does have a bed-based supportive-recovery program, but Interior Health says clients must already be abstaining from illicit substances upon arrival. 

 

Chris McSpadden, Supportive Housing and Emergency Housing Manager at Stepping Stones, says that for people who need longer-term residential treatment, the options are generally outside the community. He also cites wait times as a significant obstacle. He says readiness for treatment can be highly time-sensitive, and lengthy waits can result in missed opportunities for engagement.

Lack of social supports when people return to Nelson can also complicate recovery.

Housing is part of the picture, but not the whole picture

Motta describes people at Stepping Stones being referred to treatment while simultaneously trying to obtain identification, submit BC Housing applications and secure longer-term housing.

She says the shelter works from a Housing First approach.

Research on Housing First has found general improvements in quality of life and functioning, but Housing First by itself isn’t addiction-treatment. The At Home/Chez Soi project did not show that housing alone reduces substance use.

That said, Interior Health observes it is difficult for people to consistently attend appointments and treatment when they’re unhoused.

So we shouldn’t assume that housing someone will automatically make them stop using drugs or seek treatment. But if someone does want treatment, stable housing may be an important part of helping them stay connected to care.

So what, in addition to housing, needs to happen after treatment to improve the chances of success?

After Treatment

McSpadden says that from what he has observed at Stepping Stones, supportive and recovery-oriented housing, ongoing counselling, peer support and community-based services can all influence what happens after someone goes through treatment.

Expanding on that, Dr. DeBeck says treatment can’t be viewed in isolation from other social factors.

“We need to look at treatment much more broadly in terms of how do we support someone in all aspects of their life and really often the actual substance use isn’t their key challenge. Their key challenge is how to have hope and opportunity and how to manage trauma and build connections with people.”

A look at involuntary care

Another response to the crisis has gained popularity in public discussion about street disorder in B.C.

For communities frustrated by homelessness and visible drug use, involuntary care can sound like a clear way to intervene when someone is too unwell — or unwilling — to seek treatment on their own.

In this 2025 Union of B.C. Municipalities convention interview, Mayor Leonard Krog of Nanaimo, for example, supports expanding involuntary care in his community.

“It’s very clear that there are a number of people in our streets now who need it, who should have it. Or we’re going to leave them there to die in the streets, which is what’s been happening for several years now. If a violation of rights means that it keeps you from killing yourself or perhaps killing others or hurting yourself, I’d say it’s a reasonable compromise.”

Local business owner Tanya Finley says Nelson’s Neighbourhood Network has advocated for involuntary care, although she says there need to be safeguards around who is admitted.

In a 2024 interview with Kootenay Co-op Radio, she described people she had encountered in Nelson whom she believed were clearly unwell but didn’t want treatment.

“They don’t want to go to care. We had one woman on our streets right now who is 67 years old who is kicked out of the shelter, living behind the old BC Tel building and I ask her every day can I take you? ‘No, I don’t want to go. I don’t like it there. I don’t want to be there’.”

What involuntary care actually means

In September 2025 Premier David Eby spoke at the same Union of B.C. Municipalities convention. He said the province is hearing calls from communities for more involuntary-care beds.

He pointed to two facilities already operating inside correctional institutions.

“People are getting treatment while they’re in custody and it’s working, but we need to do more.”

But what exactly is involuntary care treating?

Dr. Daniel Vigo, B.C.’s Chief Scientific Advisor for Psychiatry, Toxic Drugs and Concurrent Disorders, explains that under B.C.’s Mental Health Act substance-use disorder alone cannot be used to admit someone to involuntary care.

“Involuntary care can be different things, but what we’re doing here in BC, is medically indicated involuntary care. It’s very strict criteria in section 22 of the Mental Health Act…”

B.C. is expanding involuntary psychiatric care for a particular group of people with severe mental-health disorders. Those people might also have a substance-use disorder or an acquired brain injury. But Dr Vigo is very clear about the fact that the Mental Health Act does not allow doctors to force someone into addiction treatment unless they have an additional mental health disorder or acquired brain injury from using drugs. 

Does involuntary treatment work?

Even under these strict criteria, the results of coercing someone into addiction treatment are highly contested.

An observational study was conducted in Vancouver in 2019 around the outcomes of coerced addiction treatment. The study observed over 3,000 people who use drugs, finding no significant difference in substance-use outcomes between people who reported coerced treatment, voluntary treatment or no treatment. 

Much of the broader research around involuntary care concerns involuntary psychiatric treatment rather than involuntary treatment specifically for substance-use disorder. 

Dr. DeBeck says the evidence supporting involuntary treatment remains weak.

“Ultimately, this is not an approach that is supported by research evidence.”

And she says there is a particular risk for people who use opioids.

“It’s not a risk-free type of intervention, in particular in the context of opioid dependence because when people are not using opioids, their tolerance for opioids goes way down. And so if they do have a relapse they are much more likely overdose and die”

Dr DeBeck says there can also be significant trauma involved in the process of being coerced into treatment. The experience can leave some people reluctant to seek medical care afterwards due to a break in trust with the medical system. 

There are also ethical questions to consider around personal autonomy. Safeguards to protect people who are involuntarily detained haven’t been applied consistently. 

A 2019 investigation by B.C.’s Ombudsperson found that many forms that are essential for protecting the rights of those admitted to involuntary psychiatric care were not being completed. 

A 2026 follow-up found health authorities had made improvements, but said several health authorities were still failing to include all required forms in over 50 per cent of their patients’ files.

Very recently, In July of 2026 the BC Supreme Court found that some aspects of involuntary treatment are unconstitutional. Hospital directors, it said, were given blanket authority to make all treatment decisions on behalf of patients without first assessing whether the patient had the capacity to make those choices themselves. The province was given six months to bring the legislation into compliance. 

So involuntary care is one tool that can be used in extreme examples. But it comes with considerable challenges. 

“…we need to implement the scale-up of voluntary options that would allow us to use involuntary as last resource.”

Dr Vigo sees involuntary care as a last resort option, but not as a replacement for voluntary care and harm reduction. He also advocates for broader access to buprenorphine, a prescribed alternative that helps with withdrawal symptoms and pain as well as lowering overdose risk.

These are all important factors to consider in the continuum of caring for those harmed by the toxic drug supply. But what about addressing the drug supply itself?

I spoke with Garth Mullins, a Canadian author, activist, and methadone user at an event discussing the toxic drug crisis in Trail. He says when criminalization drives safer drugs out of the market, overdose rates increase.

“Well I think there’s places in Europe where fentanyl has not yet reached. Places that still have heroin, that still have opium, places where the overdose rate is much lower…In places where they crack down on heroin, and crack down on opium, driven those things right out of the market and they’ve been replaced with fentanyl and tranquilizers and benzodiazepines and stuff, those are the really dangerous places for drug users.”

DeBeck also points to the role criminalization plays in the crisis.

“…Criminalization and drug prohibition has been a very large failure…The kind of idea that we can (with) more law enforcement we can somehow suppress the drug supply… And not only has it not worked, but it’s actually created a lot of harms and very much the situation that we’re in right now with fentanyl…”

She says prohibition means the drugs people are consuming aren’t subject to the kind of quality controls that the law applies to legal substances.

And because people are still using drugs despite those policies, DeBeck argues that another response needs to address the immediate risk of the supply itself.

“And so I do think in order to address the crisis that we’re in right now, that we should have regulated alternatives for people from the toxic drug supply. So whether this looks like something like heroin prescription kinds of programs, they’ve had these in Europe for many decades…”

She says the goal isn’t to encourage drug use, but to reduce the immediate risk.

What does “success” mean?

There is no single measure of success when it comes to addiction treatment.

Mullins offers this perspective.

“I mean the most important thing is to not die…So we have a toxic drug supply…So the very thing we need to do is to separate people from the toxic drug supply, give them a pharmaceutical alternative. That’s what we’ve been asking for for 10 years.”

Recovery can mean different things to different people.

Some treatments — including opioid agonist therapies such as methadone and buprenorphine — have strong evidence behind them.

Dr. DeBeck says addressing addiction also means addressing the conditions in which people live.

“Addressing the social determinants and the structural determinants of health is absolutely critical. Ensuring that we have healthy communities that people feel connected, that people have opportunities… hey have some level of economic security, that they have help and support if they have trauma, that there’s opportunities for them to be connected with community. Those are all critical to drug prevention. I like the idea that drug prevention has very little to do with drugs. Drug prevention has to do with connection and with community and with opportunity and making sure that people have the options for a healthy life.”

Public discourse around addiction often uses the word “treatment” as a catch-all term. It’s easy to say someone should “go to treatment.” But as we’ve seen, there are multiple pathways, and none of them guarantees a particular outcome.

DeBeck argues that despite these treatment options, criminalization remains BC and Canada’s dominant response to the opioid crisis. 

“…We’ve had harm reduction programs on the side here and there, but our dominant response to substance use has been criminalization and drug prohibition. And so under that context, there’s really few ways that we can address and really respond to the level of death and harm.”

The question then becomes, can any treatment system we create, voluntary or involuntary, keep up with the harms of toxic drugs while the supply remains unregulated?