How a B.C. doctor’s plan to treat 300 people with addictions, mental illness could tackle the overdose crisis


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A Vancouver psychiatrist says that, two decades ago, he never would have imagined the state of addiction and homelessness in Vancouver’s Downtown Eastside would deteriorate the way it has.

“I’ve been working down there since the late 1990s. No one was really predicting the level of deaths that would occur,” said Dr. Bill MacEwan, lead psychiatrist with Vancouver’s Downtown Community Court mental health team.

“The previous overdose crisis was called because of 145 people dying in one year. We’re  … outstripping that in one month now,” he told The Current‘s Matt Galloway. 

“That’s the part [that] was a real game changer that none of us thought was coming.”

Last week, British Columbia’s chief coroner announced the province had recorded 127 overdose deaths in September. That’s a slight decrease from previous months, when the province tallied 150 overdose deaths in August, 178 in July, and 183 in June — the highest monthly death toll in B.C.’s history.

The provincial overdose death toll so far this year sits at more than 1,200. That’s compared to 983 overdose deaths in 2019.

MacEwan, along with former B.C. premier Mike Harcourt and a few others, has now presented a proposal to the mayor of Vancouver and other provincial leaders to treat 300 of the most seriously mentally ill and chemically addicted citizens in the Downtown Eastside in a comprehensive new program.

B.C. Chief Coroner Lisa Lapointe. The province recorded a record-breaking number of overdose deaths this summer. And so far, the death toll for 2020 has already surpassed that of the previous year. (Michael McArthur/CBC)

“The part that’s really distressing to see is that nobody is attending to the individuals who are cycling in and out of their addiction, are in and out of homelessness, [and] the grinding poverty,” MacEwan said.

Sometimes those people aren’t admitted to hospitals and are excluded from housing facilities, he added.

“They’re just forgotten about.” 

The program he’s proposed would aim to change that, he said. 

‘This has to be done,’ says psychiatrist

If implemented, the first step in the proposed program would be for emergency room staff to call the program’s team when one such individual is discharged from the hospital, said MacEwan.

Then the program’s team would help that person through the system — finding them housing, detox, drug treatment and, eventually, addiction-free housing.

“It’s a very large program after the initial step, but this has to be done,” said MacEwan.

“It costs too much in terms of personal risk and suffering that these individuals are having.”

If we did nothing else, we would help make their lives better.– Dr. Bill MacEwan, psychiatrist

MacEwan explained that it can cost thousands of dollars each time someone who is struggling with mental health and addiction is picked up by police or an ambulance and then brought to the emergency room, where they are eventually discharged.

“There’s also the cost to the first responders we have who are excellent. They get worn down by this kind of difficulty,” he said, explaining that they often feel like they aren’t really able to help those struggling with opioid addiction.

“If we did nothing else, we would help make their lives better,” he said.

Paramedics and first responders work to save a person suspected of having a drug overdose. MacEwan says first responders feel ‘worn down’ by the issues they face in the Downtown Eastside, because they feel they can’t help enough. (Ben Nelms/CBC)

The program would be voluntary, and individuals would be identified for it through referrals by family members, hospitals or police departments.

MacEwan said it’s “a given” that not everyone referred to the program will appreciate it.

“They will need that time to understand what we’re trying to do,” he said, adding that part of building a relationship with someone means not abandoning them.

Unfortunately, there’s is still stigma around drug use and addiction in Canada. However, a lot of that stigma is internalized in the people who are grappling with addictions, MacEwan said.

People who use drugs are aware that it’s not good for them; they’re self-treating for other trauma they’ve endured, whether it’s related to mental illness, the stress of poverty or just trying to survive on the streets, said MacEwan.

“There’s so many people there who underneath all of this are decent, wonderful human beings who have other lives to tell and talk about. But they are now in the throes of their addiction,” MacEwan said.

“We have to address those individuals because we really believe that the disruption that they feel and they experience has an effect on the whole community, and not [in] a positive way.”


Written by Kirsten Fenn, with files from CBC News. Produced by Anne Penman.

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