A group that has been fighting to improve access to opioid agonist therapy for decades has filed a complaint with the B.C. Human Rights Tribunal.
The BC Association of People on Opioid Maintenance says monthly access fees charged by clinics that prescribe opioid agonist treatment, also referred to as OAT, are discriminatory and fly in the face of Canada’s universal health-care system.
OAT treats opioid use disorder by giving people longer-lasting drugs that don’t provide a euphoric rush but do prevent people from experiencing withdrawal. It is different from the safer supply program, which works to separate people at highest risk of overdose and death from the unregulated toxic street supply of drugs by prescribing them pharmaceutical alternatives for the drugs they use.
OAT is considered the gold standard treatment for opioid use disorder. In B.C. seeing a doctor to be diagnosed with opioid use disorder, being prescribed OAT and the medications themselves — methadone, buprenorphine, slow-release oral morphine or Suboxone — are all covered by the Medical Services Plan.
The only thing patients have to pay for is getting in the door.
Private clinics that specialize in diagnosing opioid use disorder and prescribing OAT are located across the province, said Jason Gratl, a lawyer based in Vancouver. “It is possible to get methadone or other OAT from non-private clinics but it’s systematically discouraged,” he added.
While some family doctors or emergency departments will prescribe OAT to patients for free, most family doctors are hesitant to, and emergency departments will write only short-term prescriptions, Gratl said, adding the system is set up to funnel people to the private clinics that charge fees.
Monthly clinic access fees can cost patients between $40 and $100 but generally cost between $40 and $70 per month, Gratl said.
Gratl is legal counsel for the BC Association of People on Opioid Maintenance and for Garth Mullins, who filed the complaint against the OAT clinics with the B.C. Human Rights Tribunal.
Gratl said he doesn’t want the complaint to discourage any clinics from providing these services or to get any litigants kicked out of their clinics.
“We want the clinics to continue to offer these services. They’re good services and they tend to work,” he said. They just want “to transfer costs from the patients to the public health-care system where those costs belong.”
In 2015 Gratl helped launch a similar class-action lawsuit that challenged the practice of taking OAT clinic fees out of people’s income assistance cheques. They won in 2017 and the province was ordered to pay back more than $5.5 million collected in clinic fees, according to reporting by CBC.
Gratl said this meant people on income assistance no longer had to pay clinic fees but everyone else still had to.
Which can add up to a hefty financial barrier to treatment for pensioners and “working stiffs like me,” Mullins told The Tyee, adding that people on methadone often have to choose between rent, food and clinic fees.
Mullins said he’s stepped up to be the face of the complaint because, for many people, being outed as being on methadone means you’re admitting you have a drug use problem, and that can be devastating for people because of the stigma that society attaches to drug use.
Mullins is a longtime punk and social justice advocate who has been open about his drug use for several years. He credits the security of a union job with being able to take on advocacy roles for people who use drugs.
OAT clinics are the only health-care services that charge out-of-pocket fees to patients for services otherwise entirely covered by the Medical Services Plan, Gratl said.
He added that clinic access fees are supposed to be prohibited under the Medicare Protection Act, and that collecting fees is “unlawful” under the act.
“It’s contrary to the universal single-payer health-care system that we’ve adopted throughout Canada,” he said.
Mullins has been taking methadone since 2002. That means he’s paid between $11,000 and $19,300 to be able to stay on medication fully covered by the Medical Services Plan.
“Why is it a public health-care system for everyone but us?” he said. “This is life or death medication.”
What B.C.’s Ministry of Health says
Mullins said he’s sent letters to the previous Ministry of Mental Health and Addictions, highlighting how these fees will push people away from the program, but the ministry only ever said it would “look into it,” he said.
He showed The Tyee emails he sent to then-minister of mental health and addictions Sheila Malcolmson in 2021, explaining how allowing private clinics to charge fees was pushing people away from OAT.
In a December 2021 emailed response, Malcolmson said, “Fees charged by private OAT clinics do represent a challenge for many people,” and that the ministry would review “options to reduce barriers for people seeking treatment.”
The Ministry of Mental Health and Addictions has since been folded back into the Ministry of Health.
The Tyee asked the Ministry of Health how private clinics were allowed to charge fees under the Medicare Protection Act and for any updates on work done to make OAT more accessible since 2021.
In an emailed statement the ministry said it would not comment on an issue before the Human Rights Tribunal, but it could say that, since 2020, between 22,000 and 25,000 people are on OAT in a given month. In December 2024, 23,400 were on OAT, a number that had dropped by about 100 people from the previous month.
Even though OAT is the gold standard for treating opioid use disorder, people have a really hard time staying on the medication, Mullins said.
This is due to a lot of barriers, including things like clinic fees.
“Most people aren’t on [OAT] for more than two years,” he said. “The sad thing is people die. They get off the program, do street drugs and don’t last that long.”
The toxicity of street drugs has been increasing since 2014, which is when the synthetic opioid fentanyl started being added to the unregulated supply.
Fentanyl and its analogues, such as carfentanil, are extremely potent and can cause overdose when someone doesn’t realize their drugs are thousands of or 10,000 times more potent than expected. In recent years other substances like benzodiazepines and xylazine have made their way into the supply, complicating overdose reversals.
Harm reduction strategies such as administering naloxone can work only when a person has overdosed on an opioid. Naloxone also only temporarily reverses an opioid overdose.
There have been more than 17,200 unregulated drug deaths in B.C. since the start of 2014, according to the BC Coroners Service.
Which makes it all the more urgent for people to be able to access treatment such as OAT, Mullins said.
“It’s hard to fathom why B.C. would allow this in the middle of an emergency, when fees only discourage people from obtaining the methadone they need or staying on methadone once they’ve stabilized,” Mullins said.
“It seems utter madness for the province to discourage people who need [OAT] from accessing it.”
