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This is the fifth article in the Building Hope series about the poisoned drug crisis and its impacts on Gabriola Island. Part 1 of the series can be found here.

For a list of resources and supports in relation to these subjects please visit https://ghwcollaborative.ca/poison-drug-action-table.

A staff of 20 make up Gabriola Island’s paramedic station, a mix of Primary Care Paramedics (PCPs) and Emergency Medical Responders (EMRs), including a full-time community paramedic. When requested by BC Emergency Health Services dispatch, the Gabriola Volunteer Fire Department’s first responders and EMRs also attend calls. Like any community, this emergency response team responds to a variety of cases, 24/7, including overdose callouts.

In this fifth instalment of the Building Hope series, we hear from a paramedic and a criminal defence lawyer on their experiences working with individuals with drug addictions.

In the first narrative, paramedic Brian Twaites, who has responded to numerous overdose callouts in his multi-decade career, discusses the impacts such callouts can have on emergency medical assistants and the efforts that have been made to provide mental health supports for them.

The second narrative presents insights from James Arends, a criminal defence lawyer who has represented clients with drug charges as well as other criminal charges.

Both narratives were written by Dyan Dunsmoor-Farley, based on interviews conducted by her in June and July 2025. The narratives were approved by the interview subjects prior to publication.

“It Happens Everywhere”
Paramedics on the Front Lines of B.C.’s Toxic Drug Crisis

Paramedic Brian Twaites gets a call about a possible overdose, he knows the situation could change in an instant. “Someone’s life is literally hanging by the edge,” he says. “You need to manage their airway, assess what kind of overdose it is, and administer naloxone—all in a very high-stress environment.”

Twaites, the Paramedic Public Information Officer for BC Emergency Health Services (BCEHS), worked as a street paramedic in downtown Vancouver for over 37 years. Today, he travels the province speaking about the toxic drug crisis that continues to devastate communities large and small—including on Gabriola Island, where BCEHS responded to 31 overdose callouts in 2024 alone.
Despite public perception that the crisis is concentrated in urban cores like the Downtown Eastside, Twaites emphasizes that the poisoned drug supply affects “every community, everywhere in the province.”
One of the most significant challenges in rural and island communities is that everyone knows everyone.

“When you have to deal with somebody in an unfortunate situation, and it’s someone you know, it brings an added stress,” says Twaites. “That’s true for all first responders—paramedics, fire, police, hospital staff. It makes it personal.”

In the Greater Nanaimo region both overdose response calls and number of unregulated drug deaths peaked in 2023, but showed a decline in 2024. Because Gabriola’s unregulated drug deaths are included in the Greater Nanaimo count, BC EHS can’t tell if deaths have declined on Gabriola. What is known is that calls to respond to overdoses have been increasing since 2022. It should be noted that the BCEHS calls to respond to overdoses will also include those who have taken too much prescribed medication.

The Toll on First Responders

The emotional weight of repeated overdose calls is real—and cumulative. “When it first started with the fentanyl crisis, we knew paramedics were seeing more and more tragic calls,” says Twaites. “So we built a resilience training program that all paramedics must take.”
In addition, BCEHS has developed a Critical Incident Stress Management (CISM) system to ensure timely peer and professional support. “If I went to a call and it was someone I knew, my partner—or even someone from the station—can trigger a follow-up. It’s anonymous. I’ll get a call from a trained peer saying, ‘Hey, we understand you had a difficult call. How are you doing?’” Twaites notes that overdoses are one of 11 types of call that may trigger that type of response.
The program is built into dispatch systems. Certain types of calls—especially overdose-related—automatically trigger wellness checks. “It’s a great program, and it’s expanding,” says Twaites. “There’s no stigma. It’s okay to reach out for help.”

A Crisis Evolving in Complexity

Paramedics today face an increasingly toxic drug supply. Fentanyl is now often mixed with substances like carfentanil, xylazine, and benzodiazepines, making overdoses harder to reverse and recovery less predictable.
“The synthetic opioids bind to brain receptors harder, so they need more naloxone,” says Twaites. “And now we’re not just dealing with opioids—there are sedatives on board too, making the patient much sicker. The stress level is much higher.”
This complexity demands rapid, high-stakes decision-making on every call—while working within the limitations of what is available on scene and in a rural setting.

Community Response and Naloxone Saves Lives

Gabriola Island, population 4,700, has more than 500 residents trained to use naloxone. Twaites sees this as an unequivocal success. “Naloxone kits are fantastic. I would say they’ve saved thousands of lives. If I show up and someone’s already received a dose, we’re already heading in the right direction.”
Programs like the Take Home Naloxone Program have enabled wide public access to these life-saving kits.

For Twaites, this kind of grassroots action demonstrates something essential: “It shows people care. They want to help. And that matters.”

Shifting the Culture

When asked about how BCEHS’s culture has changed over his four decades of service, Twaites doesn’t hesitate. “It’s incredible. When I started, we didn’t talk about stress. We didn’t talk about resilience. Now we have systems in place that not only support paramedics but actually check in on them.”

This shift reflects a growing awareness in emergency health services that trauma doesn’t stop when the sirens go silent. Long after a patient is stabilized—or lost—the emotional impact can linger.
“And it’s not just for paramedics,” Twaites emphasizes. “It’s for dispatchers, managers, everyone in the organization. Because everyone carries the weight of this crisis.”

ASTaR: Meeting People Where They Are

BCEHS has also adapted how it supports people who experience overdoses. One notable innovation is the ASTaR pathway—short for Assess, See, Treat, and Refer. If a patient refuses transport to hospital after an overdose, with the patient’s consent, paramedics can now refer them directly to community-based outreach and addiction support services.
“It reduces the barrier of stigma. Someone will follow up with them,” Twaites explains. “It’s just another way to help, especially for people who aren’t ready or able to go to a hospital.”
The ASTaR pathway is now active in multiple regions across B.C. and has proven effective in connecting individuals to timely support.

Ultimately, Twaites wants the public to remember the humanity behind each overdose.

“One of the things I always say when I teach is, I can’t tell you not to do drugs. That’s not going to help. But I can say: if you’re going to use, use safely. Don’t do it alone. Make sure someone has naloxone. Make sure someone is sober.”

He recalls being asked during a media ride-along how he copes with the relentless trauma.

His response was simple: “It doesn’t matter if someone is having a heart attack, a broken arm, or an overdose.

“That’s someone’s kid. Someone’s friend. Someone matters to someone.”

In communities like Gabriola, that sentiment runs deep. With more than 500 naloxone-trained residents and ongoing efforts to reduce stigma and expand education, the island is already showing what a community response can look like.

As Twaites puts it, “Community is such a powerful force. And when we come together, we save lives.”

A full list of resources provided by BC EHS is available at the bottom of this article.

“These Are People’s Sons and Daughters”
A Lawyer’s Perspective on the Drug Crisis

James Arends has practiced law for over three decades. He exclusively practices criminal defence and lives on Gabriola Island, where he frequently represents people charged with drug-related offences—individuals he believes are too often misunderstood and dehumanized.

“These are people’s sons and daughters, siblings and spouses” he says. “over the years I have had long discussions with family members incredibly concerned about their family members and the criminal charges they face because of drug use. Though I only practice criminal law, addiction issues often arise in family law and child welfare files. It’s an ever present issue.”

Arends describes a wide cross-section of clients. Some live in tents or vehicles, others in unstable housing, transient, and often homeless. Many struggle with serious mental health challenges. “Let’s say an accused has FASD, psychosis, is bipolar, or has some other mental health issue. On a day to day basis they can function acceptably and get by. But mix in an addiction to street drugs, and those same individuals spiral downward making their tenuous situation much worse. Often individuals with latent mental health issues will experience significant adverse reactions to the use of street drugs.”

He notes how quickly lives can unravel. “I had one client… He was the epitome of an upstanding citizen. He was a civil engineer. He lived with his fiancée… they had a house together. Everything was downright rosy for him. One day he was at a barbecue, and he was offered some crystal meth, and he took it… It literally ruined his life. Within a couple of years he had lost everything and was facing a penitentiary sentence.”

What bothers him most is the judgment people face when they are struggling with addiction. “The COVID pandemic really showed society’s inherent biases. No stone was left unturned regarding COVID, but why is an overweight, elderly person, with multiple health issues more important to save than a 20 year old with addiction issues? In BC, far more people have died from overdoes than COVID, but it receives a fraction of the funding and priority. I think much comes down to the common view that addictions are due to a person’s bad choices and personal failings. Addictions are a disease.”

He is critical of the lack of support services. “There’s a real shortage of programs and support for younger people and for people that are marginal and struggling… What are we doing for people with addictions? Other than PHC and a few NA and AA groups, I’m not sure what else there is on Gabriola. Resources in the Nanaimo area are stretched thin and overtaxed. It is easy for the government to have media releases, photo-ops, and express platitudes about addressing the poison drug crisis and addictions. It is much harder when they have to put actual tax dollars on the table and do something.”

“Often people feel the solution to addiction problems is harsher jail sentences. That really isn’t true as people with serious addictions aren’t going to rationally consider their actions and consequences. Getting serious about addictions treatment, community supervision, and proper support services is far cheaper than incarceration. It has nothing to do with being soft on crime, it has to do with what is best for society and the taxpayer.”

Instead, Arends emphasizes the importance of community and compassion. “There needs to be more community involvement, and there has to be a change in mindset and an appreciation that illegal drug use… affects everyone, and isn’t because the addict is a bad person.”

He often encourages his clients to seek treatment, but knows that lasting change only happens when they’re ready. “I often have conversations with clients, and discuss how they need to deal with their addictions. For some, there will be a thousand and one excuses… until they actually want to go because they realize they have to for themselves and their family.”

Despite the issues, he hasn’t lost his compassion.

“You do the best you can in order to get clients a fit and an appropriate sentence, a good outcome… If you looked at the files I deal with… people would be horrified at what my clients have gone through. They have often lived very sad and harsh lives.”

Arends believes the community has a critical role to play. “Addiction doesn’t just affect the people using drugs. It affects families, friends, neighbours, the whole community.

“And it will take the whole community to change the outcome.”

Next in the Building Hope series, two people involved with the Gabriola Commons and the HOPE Centre will share their perspectives on what they see as a compassionate response to addiction and the overdose crisis.

Community input is an integral part of this series. Please share your thoughts or questions by emailing gabriolapdat@gmail.com.

All responses will be treated as confidential and will help us gauge the impact of the series.

This series is made possible by funding from the Community Action Initiative.

Part 6 of the series can be found here.

Working with people with drug addictions: from overdose callouts to courtrooms

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