No physician should be punished for advocating for life-saving services during the toxic drug crisis

As a young doctor-in-training, I feel obligated to speak out against Island Health’s unethical treatment of Jessica Wilder.

On Jan. 22, Island Health placed Wilder, a Nanaimo family and addiction medicine physician, on administrative leave as head of Nanaimo Hospital’s addiction medicine service and Island Health physician lead for harm reduction and education. This action was in response to her involvement in running unsanctioned overdose prevention sites (OPSs) at Nanaimo General and Royal Jubilee Hospital. Wilder has since resigned from her positions at Island Health.

A significant number of people in British Columbia use unregulated substances – an estimated 225,000. Around half have an addiction or substance use disorder, meaning they rely on the increasingly toxic and volatile unregulated drugs. Because consuming these substances remains illegal in hospitals across B.C., the safety and care of admitted patients who use unregulated drugs is often compromised.

Criminalization pushes people to use unregulated substances into hidden places like hospital bathrooms. Others experience intolerable pain and discomfort from withdrawal and leave the hospital before their medical care can be completed. While physicians can prescribe medications for withdrawal management in-hospital, those do not always adequately address people’s needs. Moreover, only three hospitals on Vancouver Island have addiction medicine services that specialize in this complex prescribing.

The status quo in which admitted patients are denied a safe space to use substances should no longer be acceptable. Wilder and the Doctors for Safer Drug Policy call for this gap in care to be addressed by opening OPSs in all major hospitals in B.C.

OPSs are designated spaces for people to use unregulated substances with trained staff available on-site to provide emergency overdose response.

Many opposed to OPSs claim they enable and increase substance use. Some communities have protested against opening OPSs in their neighbourhoods out of concerns for public safety.

However, there is no evidence to back up these concerns. Numerous high-quality studies have shown that OPSs create no identifiable negative changes in community drug use or safety. Rather, there is an enormous body of evidence showing that OPSs save lives. Not only do they reduce overdose deaths, OPSs help connect people with addiction treatment and primary care and prevent the spread of infectious diseases like HIV and Hepatitis C.

St. Paul’s in Vancouver remains the only B.C. hospital with an OPS. About a year after opening, its OPS had more than 10,000 visits and not a single fatal overdose.

About a year after opening, St. Paul’s OPS had more than 10,000 visits and not a single fatal overdose.

On Nov. 18, the first day physicians and volunteers had set up the pop-up OPSs, police and security guards immediately forced them off Island Health property. The two pop-ups continued operating across the street from Nanaimo General and Royal Jubilee Hospital. Each site had a tent where people could consume their substances in a private, safe setting. At an adjacent folding table, volunteers offered Naloxone, sterile drug consumption equipment and other supplies like snacks, hand warmers and socks.

In response, Island Health’s Chief Medical Health Officer, Réka Gustafson, publicly stated that the health authority cannot support unapproved clinical services on its property. She emphasized that while advocacy is not discouraged, all services on Island Health property must meet regulatory, safety and clinical standards.

Leaked documents revealed that as early as September 2023, Island Health had begun planning OPSs at Royal Jubilee, Nanaimo General and Campbell River General Hospitals, only for the government to pause these plans less than a year later.

The government is responsible for ensuring that everyone in B.C. can access the care they need in a safe environment. Since B.C. declared the toxic drug crisis a public health emergency in April 2016, more than 17,000 people have died from drug poisonings. A crisis of this magnitude demands urgent action to reduce deaths.

Setting up an OPS is simple, quick, and cost-effective. As Wilder and the Doctors for Safer Drug Policy demonstrated, it requires little more than a tent and a few trained overdose responders. Yet nearly a decade into B.C.’s worst public health emergency, only one of our hospitals has an OPS. Delaying access to such an essential, easily implemented and life-saving service is not just negligent – it is unjust and dangerous.

We should all speak out against injustice, but the medical community in particular has a responsibility to fight for the rights of our patients, communities and future generations. Advocacy is recognized as a core competency by the Royal College of Physicians and Surgeons of Canada that I and other medical students must develop to become capable physicians. Our training is meant to equip us to care for individual patients as well as to change systems and policies to improve health on a population level.

Although advocacy may be recognized externally as a valuable skill, the culture of medicine tends to discourage speaking up or challenging the rules, norms and traditions. Physicians may be deterred from advocating for patients fearing reprimands from regulatory colleges, loss of clinical, research or leadership roles – as in Wilder’s case – or, at the most extreme, the revocation of their medical license.

Island Health denied that placing Wilder on administrative leave was a punitive response to her activism. In her Feb. 5 resignation letter, Wilder expressed concern that its actions will deter other physicians from speaking out, and I share the same concern.

While toxic drugs continue to kill seven people every day in B.C., it is not morally, ethically or medically acceptable to sit back and silently watch.