Health-care professionals call on Manitoba government to scrap proposed addictions services bill

A group of Manitoba health-care professionals working with people who use substances wants the provincial government to abandon a bill that's garnered criticism over concerns it will create barriers for those accessing care and harm reduction services. 

In an open letter sent to the premier and government ministers, they said they have "grave concerns" about the proposed Bill 33 — the Addictions Services Act — and they want to see the Progressive Conservative government engage in community consultation now. 

"We are in the midst of an addictions and health-care crisis, with people dying as a result. Action is needed and the most impactful action will be evidence-based and community-informed," said the letter, dated March 27.

It was signed by 14 members of the Manitoba Interprofessional Maternal and Perinatal Team for Leveraging Empowerment and Services, or IMAPLES, which describes itself as an organization dedicated to advocacy, research, education and clinical care for people who use substances before, during and after pregnancy.

The bill, introduced last month, would require supervised drug consumption sites, addiction centres with beds and withdrawal-management services to apply for a provincial licence, which would spell out what kind of services can be offered.

Mental Health and Community Wellness Minister Janice Morley-Lecomte said this week it will provide people with access to safe sites as well as a "pathway to recovery."

But critics have said the bill will create barriers to treatment centres. The Opposition NDP announced Monday it plans to delay the legislation — a move NDP Leader Wab Kinew said would stop it from passing before the next provincial election, scheduled for October. 

Dr. Heather Watson is a psychosocial obstetrician gynecologist and co-chair of the interprofessional group, which officially formed in 2021 and is made up of professionals from a variety of areas, including medicine and social work, who work with people who use substances.

She says she was "tremendously relieved" to hear the bill will be delayed, and questions the rationale behind legislation governing how addictions care is delivered.

"We don't have a diabetes care act, we don't have an ophthalmology act.… It is not normally the business of the government to make care-specific legislation," she said.

"[It] just makes you a little bit kind of concerned about what the inspiration is to single out addictions medicine in this way." 

'Mortality cost'

Watson, who sees patients who use substances, said some of her concerns with the bill stem from wording around enforcement and inspection measures for addictions treatment centres, including the ability for inspectors to take photos and video. 

She worries those measures will create a barrier for people accessing care related to substance use or addiction — something she said can be a sensitive situation in a variety of ways.

"When we create barriers to care in this particular sector, there's a mortality cost to that," said Watson.

Manitoba has seen an increase in the number of overdose deaths in recent years. According to data from the province's Office of the Chief Medical Examiner, 407 Manitobans died from overdoses in 2021, up from a record 372 overdose deaths in 2020.

Preliminary numbers for 2022 up to the month of December show there were 377 drug-related deaths in Manitoba to that point.

Watson would like to see easier access to services for people who use substances across the province. 

She also wants to see more government consultation with people who work on the front lines and those with lived experience.

"This sort of top-down business of a bunch of people in a closed room who have no context, and don't really have any skin in the game, deciding what all those other people need should be out of date by now," Watson said.

Lack of consultation: doctor

Dr. Sara Matyas, who is currently doing a fellowship in addictions medicine and is part of IMAPLES, agrees that sort of consultation needs to happen when looking at how to address and improve care.

"I, for example, am a physician who's part of a group of addiction medicine specialists, and we were not even aware that this bill was in the works, let alone that this bill had been officially proposed," said Matyas. 

Community organizations like Sunshine House were also taken by surprise, she said.

"All of us assume that the government wants to … create policies that are effective and that are relevant," she said.

"We question how these policies are able to be effective and relevant if all of the experts in the field have not had a hand in … the creation of them." 

A spokesperson for Morley-Lecomte said in an email late Tuesday that at least 17 organizations that provide bed-based treatment and withdrawal management services were consulted about standards of care.

"Service providers gave feedback that was used to inform the process," the spokesperson said.

People with lived experiences were also surveyed, the spokesperson said, and 51 people provided feedback online or through guided sessions with a member of an organization they'd received care from.

Indigenous people and Indigenous-led organizations were also included in the consultation process, the spokesperson said.

Watson and Matyas said their group has not received a response to their letter from the provincial government.