Opinion: The two-tier healthcare system is here — and it’s making the overdose crisis worse


“If you look a little closer, the cracks in our system are showing, especially when it comes to substance use and addiction”

Canadians like to believe that our health care system is the envy of the world: high quality, fair and, above all, free to access. If you look a little closer, however, the cracks and loopholes in our system become apparent, especially when it comes to substance use and addiction. These shortcomings reveal a two-tier healthcare system that increases the risk of overdose.

I see these gaps every day in my work helping people navigate the healthcare system to get treatment for substance use. I recently spoke with a parent whose child wanted to get into drug treatment, but the waiting list to get into it was over a month long. This is an all too common scenario.

When it comes to addiction, timing is everything. Treatment has no chance of working if someone is not ready, so ensuring it is accessible when ready is essential. Any delay can mean a lost opportunity – and missing that opportunity can be deadly. The supply of toxic drugs means a deadly overdose is always at hand.

Now imagine that you are that parent who has just learned that help for your child is so far away. With the stakes this high, you’d be looking for a way to bridge that gap. This parent did just that. They paid $5,000 to skip the line and get their child on treatment right away.

There is only one waiting list. Many treatment facilities have a list for privately funded treatment beds and another list for publicly funded treatment beds. Parents in this situation have paid to bypass this public list. Seeing seven people die every day from toxic drugs is enough to make any parent who can afford to protect their child pay out of pocket. What choice did they have?

Families are desperate, drug users are desperate. The sad truth is that some profit from this desperation while others die.

But what if you don’t have the money? Well, there’s this waiting list. There are queues for detox, queues to enter institutions. Waiting lists everywhere. We tell people who use drugs to get help and get treatment, and there are a lot of people who want that help and are asking for help. They try and our system fails them. If you don’t have the money for a private facility, well, that waiting list is the only option you have. And yet we blame the person for their addiction.

The reality is that we have one system for those who can pay and another for those who cannot. What makes no sense is the lack of investment to bridge the gaps between two systems. Currently, funding for a single treatment bed is $35 per day. We pay more to put someone in jail for a single day, some estimate it is three to four times more expensive to jail someone than to provide them with a treatment bed.

Rather than investing in making treatment more accessible, we direct people who use drugs into the prison system at a much higher cost. If we all agree that substance use and addiction are health issues, why do our funding priorities say otherwise?

Treatment is just one of the ways in which the two-tier system is revealed when it comes to substance use. There are clinics that provide treatment for opioid addiction, such as methadone and Suboxone, and require people to pay clinic fees, often up to $60 per month. Many deducted these fees directly from people’s welfare checks to prevent them from choosing to eat rather than get medicine – the clinics made the choice for them. Nowhere else in our health care system do we allow this kind of profiteering.

The message to someone with an addiction: if you want help, you’re going to have to pay.

For many people, paying out of pocket is not an option. Many people who use drugs maintain criminal records for life, even if they have stopped using drugs. How many employers hire people with criminal records and a 15 year gap in their work history, like me? It doesn’t matter that if someone has been in recovery for years like me, people carry the stigma of their substance use forever.

And so if you can’t afford to pay, you have to wait. If you are forced to wait, the chances of dying are greater. In a public health emergency, barriers to treatment and care must be removed. That we allow a two-tier system to thrive while people are dying by the thousands every year is unconscionable.

The good news is that the child whose parents forked over the money is still recovering. The bad news is that most people don’t have that chance and never will.

Guy Felicella is a peer clinical advisor at the BC Center on Substance Use. Follow him on Twitter at @guyfelicella.


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