B.C. Addictions Minister Judy Darcy has no illusions about the current state of British Columbia’s recovery houses and the risk that the bad ones pose to anyone seeking safe, quality care.
Nor is she alone when she calls it “the wild, wild West.”
Anyone able to build a website and rent a house can operate a so-called recovery house. Like a game of whack-a-mole, even when inspectors try to shut down the worst ones, they spring up somewhere else.
That said, the regulations they’re supposed to enforce are so vaguely worded that it’s easier for bylaw inspectors to shut places down for garbage infractions than for failure to provide the most basic of services like food and a clean bed to people desperate for help.
Even the most deplorable ones have never been taken to court by the province, let alone fined or convicted which makes the penalties of up to $10,000 moot.
It’s taken two years, but this week Darcy — along with Health Minister Adrian Dix and Social Development Minister Shane Simpson — took the first steps toward bringing some order to the chaos and overturning years of neglect.
In two separate announcements, what they’re offering is both the stick of tighter regulations and enforcement as well as the carrot of more money for operations and training staff.
The carrots announced Friday include $4,000 grants available immediately to registered and licensed recovery home operators to offset the costs of training for staff before tougher regulations come into force on Dec. 1.
On Oct. 1, the per-diem rate paid for the treatment of people on social assistance will be raised after more than a decade without an increase. Recovery houses on the provincial registry will get a 17-per-cent increase to $35.90, while recovery houses licensed by the regional health authorities will jump to $45 from $40.
The sticks are new regulations that for the first time require things like qualified staff, which common sense should have dictated years ago as essential. Recovery houses will have to provide detailed information about what programs and services they offer. Again, this seems a no-brainer, as does requiring operators to develop personal service plans for each resident and support them as they transition out of residential care.
As for enforcement, the “incremental, remedial approach” to complaints has been scrapped and replaced with the power to take immediate action rather than waiting for a month and giving written notice to the operators.
Darcy is also among the first to admit that much, much more needs to be done to rein in bad operators whose purported treatment houses are flophouses and to provide addicts and their families with the resources they need to discern the good from the bad.
More than most, the minister knows the toll that poor funding and lack of regulation is taking both on addicts who seek help and on their loved ones. She’s haunted by meetings she’s had with the loved ones of those who have died in care and those who couldn’t get the services they needed.
“It’s the most difficult thing that I have to do and, of course, it moves me to my core,” she said in an interview following the announcement. “People say, ‘Do you ever get used to it?’ Of course I don’t. If you ever get used to it, you’re doing the wrong job.
“But I try and take that to drive me and to drive our government to do more and to move quickly and act on all fronts and having said that, there’s a lot to do. There’s really, really a lot to do.”
Among those she’s met are the two mothers of men who died within days of each other in December under deplorable conditions in two provincially registered recovery houses run by Step By Step.
It was four to six hours before 22-year-old Zach Plett’s body was found after he overdosed and died. On Christmas Eve, a 35-year-old man died at a different Step by Step house. It was two days before his body was found by other residents.
Two years before those men died, the provincial registrar had received dozens of complaints and issued dozens of non-compliances orders. Both houses remained on the registry until this summer when owner/operator Debbie Johnson voluntarily closed them.
After years of relentless advocacy Susan Sanderson, executive director of Realistic Recovery Society, was happy to host the ministers’ Friday announcement at one of its houses. She wants to believe Darcy that these are just first steps since the per-diem rate is still short of the $40 she and others lobbied for and remains a small fraction of what people who aren’t on welfare are charged — charges that can run up to $350 a day.
Having taken these long overdue and much-needed initial steps, maybe Darcy and her colleagues can take another logical next step to support working people getting access recovery who — without access to employee benefit plans — can’t afford the cost of treatment.
They shouldn’t have to wait until they’re destitute to get care, any more than someone on welfare should be deprived of help.
As of today, Karly has been clean and sober for 30 days after four years of battling addiction.
Addiction made the 17-year-old from Chiliwack vulnerable to exploitation and bullying. It disrupted her schooling, left her psychotic, suicidal, near death and unable to care for her year-old baby.
“In addiction, I never thought I could be this happy without drugs,” she said earlier this week.
“There’s obviously times when I’m feeling like I don’t want to live any more. But I realize a lot of people do care for me, and it would hurt a lot of people if I did leave.”
Up until now, Karly didn’t worry that fentanyl laced in the cocaine, crystal meth and other street drugs she’s used might kill her, as it has more than 4,000 other British Columbians in the past four years.
“Honestly, I just thought I wasn’t going to get that wrong batch. I thought I could trust my dealers. Now, I’m starting to realize the risk. I was using alone. It’s pretty scary now that I think about it.
“I could have overdosed, my poor son he would have had no mom.”
But Karly’s recovery is at risk because the B.C. government is refusing to pay for her treatment. The question of why was bounced from the Ministry of Mental Health and Addictions to the Ministry of Children and Family Development, back to addictions, then back to MCFD, and finally to Fraser Health over two days.
Friday afternoon, MCFD responded that due to privacy concerns it could not discuss the specifics of the case.
The spokesperson did confirm that the government pays for youth residential treatment. Funds are allocated by the health ministry to regional health authorities. MCFD social workers are supposed to refer youth and families to the health authority, which is supposed to do the assessments and placements.
Reached late Friday afternoon, Fraser Health said that it does not have provincial funding for youth beds at Westminster House, where Karly is getting treatment, only adult beds.
Postmedia editors and I are also concerned about Karly’s privacy and vulnerability. For that reason, we are not using her real name, or that of her mother.
On July 10, her mother Krista found Karly white-faced and barely breathing on the floor. It was a moment she had been bracing for since 2015.
Krista, who is a nurse, didn’t need the naloxone kit that she keeps at the ready. She shook Karly awake and got her into the car to take her to Surrey Creekside Withdrawal Management Centre.
En route, Karly flailed about, kicking in the glove box, banging her head against the window and screaming.
“She was in psychosis. She was not my child,” Krista said. “It took six nurses and two doctors to get her inside.”
At 9 p.m, Karly called her mom to say that if they didn’t let her out, she was going to escape, prostitute myself and get enough money to kill herself.
“I felt in my heart that she was really going to do it.”
Panicked, Krista called Susan Hogarth, Westminster House’s executive director, and begged for help. Westminster House is a residential treatment centre for women, with four designated youth beds in New Westminster.
Even though it was past midnight, Hogarth agreed to take Karly.
“We can’t not put a child somewhere,” Hogarth said this week.
The cost for treatment at Westminster House is $9,000 a month, meaning Krista needs $27,000 to pay for the three months of treatment that counsellors say Karly needs to be stabilized enough to go into second-stage care.
The crucial first month of treatment was covered using donations from individuals, and Hockey for the Homeless.
Now there are bills to be paid.
Krista’s only contact with the government has been through MCFD. A social worker helped Karly get mental health services, pre- and post-natal care and helped Krista gain guardianship of her year-old grandson last month.
It’s the social worker who told the family that the government would pay for a 10-week, co-ed live-in treatment program at Vancouver’s Peak House, but not Westminster House.
But Krista and Westminster House’s director believe a co-ed program that has no trauma counselling is not a good fit for Karly.
The only other option suggested was outpatient treatment. But Karly’s already tried and failed at that. Besides, her dealer lives two blocks from their home.
If Karly was an adult on welfare, the Ministry of Social Development and Poverty Reduction would pay $30.90 a day for her room and board in residential care.
Bizarrely, Krista said the social worker suggested maybe Karly could just wait a year and then her treatment would be fully covered.
“This is f–ing BS. I can’t wait until she’s older. She’ll be dead,” said Krista, who has had her own problems with addiction. An alumni of Westminster House, she is four years into recovery.
Concerns about how to pay for Karly’s treatment in addition to caring for Karly’s baby and Karly’s younger sister are wearing heavily on Krista. She’s had to take a medical leave from her job, and is worried about how she will pay her rent.
She’s already spent four years in a constant state of readiness in case Karly overdoses. There’s naloxone in the house. The razors are hidden because “Karly cuts, cuts.” Every time Karly took a bath, Krista stood apprehensively by the door because her daughter had threatened to drown herself.
“She is doing amazing,” Krista said. “The first time I saw her was 15 to 16 days in, and she had colour in her cheeks and they were my kid’s eyes, beautiful brown . . .
“When I brought her son to see her, her smile so genuine. I had not seen it in so many years. The smile was what I remember of her as a kid.”
Hogarth wonders why the government can’t look at the bigger picture of what Karly’s untreated addiction might cost — from more overdoses to her mother’s fragile state to the fate of her son.
Everybody, Hogarth said, deserves a chance at recovery and not just harm reduction interventions.
“Karly is not the easiest client in the world,” she said with a laugh. “But she’s worth it because we want her to go home to her son and to be able to raise him.”
For now, the non-profit Westminster House is covering Karly’s costs with donations augmented by a GoFundMe campaign organized by Krista’s friends.
But it can’t do that forever, or without more donations.
As for Karly, for the first time in years she’s thinking about a future. She won’t be ready to start school in September, but plans to go back as soon as she can for Grade 12 and then go on to study so that she can work in health care.
Nearly a year before two young man died of fentanyl overdoses in houses operated by the Step by Step Recovery Home Society, the B.C. Health Ministry had investigated and substantiated complaints that it was failing to meet the most basic standards.
Within nine days of each other in December 2018, 21-one-year-old Zachary Plett and an unnamed,35-year-old died in different houses operated by the non-profit society that has a total of five houses in Surrey.
A month earlier, inspectors had substantiated complaints at all five houses. According to the ministry’s assisted living registry website, none met the most basic standard of providing residents with safe and nutritious food.
None had staff and volunteers with the skills or qualifications needed to do their jobs. There was no counselling support for residents at any of the houses or any transitional help for those who were leaving.
Late last week, Step by Step closed its house at 132nd Street where Zach died. In a brief conversation Thursday, director Deborah Johnson said it was done “voluntarily.” She promised to call back after speaking to the other directors and staff. But that call didn’t come.
Late Thursday, a spokesperson for the Addictions Ministry said the assisted living registrar was aware that two Step by Step houses had been voluntarily closed, but was still attempting to confirm the closures.
Up until May, Step by Step had taken action on only one of the 65 substantiated complaints. It got rid of the mice at its house at 8058-138A Street in November. But it took 18 days from the time the inspectors were there before the exterminators arrived.
Despite all that, all five houses have maintained their spots on the government’s registry.
What that means is that the social development ministry has continued paying $30.90 a day for each of the 45 residents who are on welfare.
It also means that anyone ordered by the court to go to an addictions recovery house as part of their probation can be sent there.
In late May, Plett’s mother and others filed more complaints about Step by Step that have yet to be posted. But a spokesperson for the mental health and addictions ministry confirmed that they are being investigated.
Plett is incredulous. “My son died there and nothing’s been done,” she said this week.
In an email, the ministry spokesperson confirmed that no enforcement action has been taken and that there is no specific timeline for the investigation to be completed.
“The review of complaints is a complex issue that can often involve a number of agencies conducting their own investigations (which can also require a staged process),” she wrote.
“Each case is different and requires appropriate due diligence. Throughout the process of addressing non-compliance, as operators shift and improve the way they provide service, new assessments are conducted and status is updated online within 30 days.”
A senseless death
Two days after Zach Plett arrived at 9310-132nd Street in Surrey, he was dead. According to the coroner, he died between 9 a.m. and noon on Dec. 15, 2018. But his body wasn’t discovered until 4 p.m.
Plett described what she saw when went to collect Zach’s belongings.
“The house was horrible. The walls were dirty. The ceiling was stained. My son’s bed sheets were mouldy.
“His body was already taken. But the bed was soaking wet with his bodily fluids. There was graffiti on the furniture. The drape was just a hanging blanket. It was filthy.”
To add insult to grief and despair, Plett noticed that his roommate was wearing Zach’s shoes.
Worse than the state of house is the fact that Zach died in the daytime and it was at least four hours before anybody noticed.
Plett wants to know why nobody had checked on Zach? Were there no structured programs where his absence would have been noticed? Didn’t anyone wonder why he missed breakfast and lunch?
“I had no idea what it was like or I would never have sent him,” said Plett.
After battling addiction for seven years, Zach had spent the previous three months in Gimli, Man. and what Plett describes as an excellent facility that cost $40,000.
But Zach wanted to come home, despite Plett’s concerns about omnipresent fentanyl in Metro Vancouver. They agreed that he couldn’t live with her.
A trusted friend gave Plett the name of a recovery house and within a week of returning to British Columbia, Zach went to Into Action’s house in Surrey. It is a government-registered facility that has never had a substantiated complaint against it.
Because he wasn’t on welfare, his mother E-transferred $950 to Into Action to cover his first month’s stay. She was told that the staff would help Zach do the paperwork to get him on the welfare roll.
Later that day, Zach called his mother, asking her to bring him a clean blanket and pillow because the house was dirty.
Because family members aren’t allowed into the house, Plett met him at the end of the driveway to hand over the bedding. It was the last time she saw Zach.
The next day, Dec. 13, he called to say that he had been “kicked out” for “causing problems.” He told Plett that it was because he’d complained about the house and asked to see the consent form that he’d signed.
Later that day, someone from Into Action drove Zach to Step by Step’s house on 132nd Street. Two days later, he was dead.
Because of the confidentiality clause in the informed consent forms signed by all residents, Into Action executive director Chris Burwash would not even confirm that Zach had been a resident.
But he said before signing those forms, residents are given “a clear outline of the expectations of them” and “a clear description of what the rules are.”
They are told that there are no second chances if they break the rules.
“If they outright refuse to participate or outright breach our zero tolerance policies — violence or threats of violence, using illicit substances, intentional damage to facility, etc. — we are put in a position where it is impossible for us to allow them to stay. We have to ask them to leave,” he said.
Staff provide them with a list of other government-registered recovery houses and sit with them while they make their choice without any advice or interference, Burwash said. Once a place is found, Into Action staff will take them there.
Burwash emphasized that only registered recovery houses are on the list, which speaks to the importance of the governments registry. But he said it’s frustrating that operators don’t comply with registry standards since their failures reflects badly on all recovery houses.
“We absolutely support the media shining a light on the facilities that are operating below the standards that they agreed to abide by,” he said. “We are certainly not one of them.”
He invited me to visit any time.
On Dec. 14, Zach and his roommate went to an evening Narcotics Anonymous meeting. Plett found the sign-in sheet from the meeting when she collecting his belongings the following day.
“What he and Billy (his roommate) did between then and early morning, I don’t know,” she said. But another resident told her that she thought they were “using” until around 5 a.m.
The toxicology report from the coroner indicated that the amount of fentanyl found in his system was no more than what is given cancer patients for pain control. But because Zach hadn’t taken opioids for six months, his tolerance for fentanyl was minimal.
“Had he died in the middle of the night, I would never have gone public with his story. But he died in the daytime. If they’d woken him up for breakfast or tried … ” said Plett, leaving the rest unspoken.
“He wasn’t monitored. He wasn’t watched … If I had known I would never have sent him there.”
Last week, Plett had an hour-long meeting with Addictions Minister Judy Darcy and the mother of the other young man who overdosed. He died Christmas Eve at another Step by Step. His body was only discovered on Dec. 26 after other residents kicked in the door of the bathroom where he was locked inside.
“She (Darcy) was very genuine and sympathetic,” Plett said. “I don’t think she realized how bad the situation is.”
Problems left unresolved
Step by Step’s first non-compliance reports date back to an inspection done Jan. 23, 2018 at its house at 11854-97A Street in Surrey.
Inspectors found that meals were neither safely prepared nor nutritious. Staffing didn’t meet the residents’ needs. Staff and volunteers weren’t qualified, capable or knowledgeable.
On Nov. 2, they returned. Nothing had changed and more problems were found.
The house didn’t safely accommodate the needs of residents and staff. Site management wasn’t adequate. There was no support for people transitioning out of the residence.
Critically, there were no psychosocial supports to assist individuals to work toward long-term recovery, maximized self-sufficiency, enhanced quality of life and reintegration into the community. Those supports include things like counselling, education, group therapy and individual sessions with psychologists, social workers, peer-support counsellors or others with specialized training.
On Feb. 4 and March 27, inspectors went back again because of a fresh set of complaints. As of May 8, none of the substantiated complaints had been addressed.
On the same day in November that inspectors were at the 97A Street house, they also went to Step by Step’s other four houses in Surrey — 132nd Street where Zach Plett died, 78A Avenue where the other man died, 13210-89th Avenue and 8058 138A Street. Step by Step doesn’t own any of the houses, but one of it directors, Deborah Johnson, is listed as the owner of 138A Street.
Not every house had the same complaints. But all of the complaints were substantiated and there were commonalities.
None had provided properly prepared nutritious food. None had adequate, knowledgeable or capable staff. Not one house was suitable for its use.
None supported residents’ transition to other accommodation or provided psychosocial support.
Since then, there have been repeated inspectors’ visits but the last posted reports indicate that nothing has change.
The first of five guiding principles for the province’s assisted living registry is protecting the health and safety of residents. Promoting client-centred services is also on the list. But then it gets a bit fuzzy.
Others are to “investigate complaints using an incremental, remedial approach” and to “value the perspectives of stakeholders — i.e. residents and their families/caregivers, community advocates for seniors and people with mental health and substance use problems, residents, operators, health authorities and other agencies.”
But as a result of this incremental, remedial approach and seeking of stakeholders’ perspectives, there were two preventable deaths.
What more do inspectors need before the registration for these five houses is cancelled? How much more time will the province give Step by Step to bring them into compliance?
And, how much longer will the ministry of social development continue writing cheques of close to $42,000 each month to an organization that can’t even comply with the most basic standards?
British Columbia is four years into a public health emergencies that has cost 4,483 lives since a public health emergency was declared in 2016.
More than a year ago, a coroner’s death review urged better regulation, evaluation and monitoring of both public and private treatment facilities following the 2016 overdose death of a 20-year-old in a Powell River recovery house.
It’s unconscionable that the government continues to waste precious resources on substandard recovery houses, while doing so little to force bad operators into compliance. At a time when good quality services are more desperately needed than ever, the registry ought to be the place that vulnerable addicts and their loved ones can find those.
Until this is fixed, Maggie Plett is likely right to believe that Zach would have been better off homeless. At least on the street, someone might have noticed him and done something to help.
One in five Canadians lives with chronic pain, but the cries of an estimated 800,000 British Columbians are not only being ignored, their suffering is being exacerbated by regulators limiting their access to both drugs and treatment.
First, in a move unprecedented in North America, the B.C. College of Physicians and Surgeons imposed mandatory opioid and narcotic prescription limits on doctors in 2016 in an attempt to avoid creating additional addicts and having more prescription drugs sold on the street.
Physicians who don’t comply can be fined up to $100,000 or have their licences revoked.
Now, the college is setting tough regulations for physicians administering pain-management injections.
“I’m enraged,” says Kate Mills, a 33-year-old, palliative care nurse who has been on disability leave for the past 18 months. “People like me are living in chronic, intractable pain and being ignored by doctors who are either too scared or too callous to care.”
She has an uncommon, congenital condition that causes chronic inflammation near her sacroiliac joint and in her lower back, which pushes down on her nerves causing “exquisite pain” down her leg.
Her first doctor essentially fired her, refusing to treat the pain. The next one prescribed Oxycodone to help Mills through until she was able to receive a steroid injection at a clinic, which kept the pain in check for several months.
But by the time the injection’s effects were wearing off, her GP went on extended medical leave. The locum assigned to Mills refused to prescribe her any medication and told her to go to an emergency room where she was given a prescription.
After numerous ER visits, Mills finally found a doctor two weeks ago who is willing to provide medication for her between injections. But he agreed only after Mills signed a contract agreeing that she won’t sell the drugs, will only go to one pharmacy and take the drugs only as prescribed.
She is lucky, though. Her pain management clinic will likely meet the college’s new standards that were developed by an advisory panel over the past three years out of concern about patient safety.
“Increasingly,” the college says on its website, “Procedural pain management is being provided in private clinics and physician offices, but without much guidance on appropriate credentials, settings, techniques and equipment.”
The new regulations would require physicians’ offices or clinics to become accredited facilities with standards on par with ambulatory surgery centres.
That means having tens of thousands of dollars’ worth of equipment including resuscitation carts, high-resolution ultrasound, automated external defibrillators and electronic cardiograms with printout capability.
The college acknowledges that “patients do not require continuous ECG monitoring. However, the cardiac monitoring equipment must be available in the event a patient has an unintended reaction to the procedure.”
The disruption for patients will be huge, according to Dr. Helene Bertrand, a general practitioner, pain researcher and clinical instructor at UBC’s medical school.
She estimates that up to 80 per cent of the offices and clinics where the injections are currently being done won’t measure up and already wait times are up to 18 months.
When the new requirements come into force, Bertrand predicts patients will be waiting anywhere from four to seven years for treatment.
Bertrand herself will have to quit doing prolotherapy, which she has done for the past 18 years on everything from shoulders to necks to spine to ankles. That’s despite the fact she’s never been sued, never had a complaint filed with the college and has published, peer-reviewed research that revealed an 89 per cent success rate among 211 patients in her study group.
(Prolotherapy involves injecting a sugar solution close to injured or painful joints causing inflammation. That inflammation increases the blood supply and deposits collagen on tendons and ligaments helping to repair them.)
The college will not grandfather general practitioners already doing injection therapies. Instead it will restrict general practitioners to knees, ankles and shoulders. All other joint injections must be done by anesthetists or pain specialists.
For Joan Bellamy, that’s a huge step backward.
She’s suffered from chronic pain since 1983 and “undergone the gamut of medical approaches, often with excessive waits: hospital OP (outpatient), pharmacology, neurology, orthopedics, spinal, physiatry and private.”
Since 2000, she’s had multiple injections that have made a difference. But her doctor doesn’t meet the new qualifications.
“I am afraid that without her expertise … that pain will become an intolerable burden, and any search for treatment will result in inconceivable wait times and will debilitate me,” Bellamy wrote in a letter to the college and copied to me.
The near future for pain-sufferers looks grim with most physicians able to offer them little more than over-the-counter painkillers.
Ironically at a time when the provincial medical health officer and others are lobbying hard to have all drugs legalized so that addicts have access to a safe supply, chronic pain-sufferers are being marginalized. For them, it’s more difficult than ever to get what they need.
It’s forcing many of them facing a lifetime of exquisite and unbearable pain to at least contemplate one of two deadly choices: Buy potentially fentanyl-laced street drugs; or worse, ask for medically assisted dying.
Canadian governments are addicted to the revenue from alcohol DALE DE LA REY / AFP/Getty Images
With so much focus on illicit drugs and overdose deaths, it might seem that opioids are the biggest addictions problem. Far from it.
Alcohol kills many more people each year (14,800 in 2014), results in more hospitalizations annually than heart attacks and is one of the most expensive and intractable health problems.
While cannabis was legalized a year ago and B.C.’s chief medical health officer is pushing hard for decriminalization and ultimately legalization of all illicit drugs, two Canadian addictions research centres want tougher regulations to mitigate the costs and harms of alcohol use and addiction.
The Victoria-based Canadian Institute for Substance Use Research and the Toronto-based Centre for Addiction and Mental Health want a minimum price of $3.50 for a standard drink in a bar or restaurant and $1.75 for off-premise sales. They also want a national minimum drinking age of 19, which is a year higher than national minimum for cannabis. Those are just two of the recommendations in reports they released last month that look at federal, provincial and territorial alcohol policies.
The reports also calling for stricter guidelines for advertising, restrictions on manufacturers’ and retailers’ promotions on digital and social media platforms, and a federal excise tax based on alcohol content that would replace the GST.
Over the past decades, the researchers found an erosion of effective policies and regulations.
“Overall, alcohol policy in Canada has been largely neglected relative to emerging initiatives addressing tobacco control, responses to the opioid overdose crisis, and restrictions imposed on the new legal cannabis market,” their report on the provinces and territories says. In several jurisdictions — Ontario is the worst example — “customer convenience and choice are being given priority over health and safety concerns … the responsibility of governments to warn citizens of potential risks is largely absent.”
British Columbia got a bare pass at 50 per cent based on its potential to reduce alcohol-related harm, which is not good. But it’s still better than the national average of 43 per cent.
Alcohol-related harm was estimated at $14.6 billion in 2014, according the Canadian Centre on Substance Use. Productivity loss due to illness and premature death accounts for $7.1 billion. Direct health care costs add another $3.3 billion and $3.1 billion is spent on enforcement costs for this legal drug.
Tobacco was second at $12 billion followed by opioids at $3.5 billion and cannabis at $2.8 billion. But the data predate the opioid overdose crisis and cannabis legalization.
Alcohol’s costs and harms reflect the fact that 80 per cent of Canadians drink. It’s not surprising. Culturally, we associate drinking with celebrations and good times. It’s We’re bombarded with images in movies, TV and ads of beautiful people drinking and having fun.
Scarcely a week goes by that there isn’t a “good news” story about research showing that a glass of red wine might be good for your heart or that yet another populist politician is campaigning on a promise to slash the price of beer.
Yet less was made of University of Washington’s Global Burden of Diseases Study last summer that found alcohol was the leading factor in 2.8 million premature deaths in 2016 and is so harmful that governments ought to be advising people to abstain completely.
One problem is that Canadian governments are addicted to the revenue from alcohol. Liquor sales and taxes provided $12.15 billion to federal and provincial governments in 2017/18 — $1.6 billion more than five years earlier, according to Statistics Canada.
Last year, liquor consumption rose in British Columbia, which already had the highest drinking rates in Canada. There were also record sales, which meant that in addition to tax revenue, the Liquor Distribution Branch provided $1.12 billion in earned revenue, up from $1.03 billion two years earlier.
Good for taxpayers? Not really. The reports by the substance-abuse centres recommends B.C. “reconsider the treatment of alcohol as an ordinary commodity: Alcohol should not be sold alongside food and other grocery items as this leads to greater harm.”
It’s based on research done last year by Tim Stockwell of the Canadian Institute for Substance Use Research. He and his researchers found that when access to alcohol is easier, more people die.
Between 2003 and 2008, “a conservative estimate is that the rates of alcohol-related deaths increased by 3.25 per cent for each 20 per cent increase in stores density.”
Estimates have to be conservative because alcoholics’ fatalities are mistakenly counted as death from one of more than 200 other kinds of alcohol-related fatalities including car accidents, suicide, liver diseases, cancers, tuberculosis and heart disease.
What’s surprising is that more than a century after legalization, there are no federal or provincial policies aimed specifically at mitigating alcohol’s harms and costs.
The opioid crisis has been the catalyst for governments to finally think about addictions and drug-use policies and, it’s now impossible to ignore the slower moving crisis caused by alcohol abuse and addiction.
In the coming months, the B.C. health officer also plans to release an alcohol addictions report. The B.C. Centre on Substance Use recently developed guidelines for best practices in treating alcohol addiction, but the provincial government has yet to approve or release those.
Prohibition proved a failure. Yet, legalization and regulation are not panaceas either. Because even with more than 100 years of experience, there is still no jurisdiction in Canada or anywhere else that seems to have got it right.
VANCOUVER — Memories of vomiting, diarrhea and unrelenting stomach pain as he withdrew from opioids in prison had Rob MacDonald repeatedly asking for addiction treatment before he left a maximum-security facility but despite dozens of formal complaints, he says he didn’t get any help.
“I was thinking, ‘Wow, I can’t believe I’m going out onto the street with this addiction,”‘ MacDonald said recently, a week after being released on supervision from the Atlantic Institution in Renous, N.B., his fourth facility in over a decade behind bars.
MacDonald, 41, said he feared his 15-year opioid addiction would cause him to returned to crime while using illicit drugs on the outside so he tried desperately to get treatment from the federal prison service.
“I put 150 requests in, probably 70 complaints, for a 15-month period, trying to tell them, ‘Put me on it. I need it before I get out. I want to get help, I don’t want to go back into the community in a high-risk situation, I don’t want to re-offend,’ ” he said from Halifax, where he lives in a halfway house.
He said he complained to the warden and then appealed to the commissioner of the Correctional Service of Canada. One of his complaints to the commissioner was upheld but he said he was placed on a wait list because there was a limit on the number of inmates receiving treatment.
When he was incarcerated at Agassiz’s Kent Institution between 2017 and 2019 for drug-related offences and robbery, MacDonald said debilitating withdrawal symptoms had him seeking potentially deadly fentanyl-laced drugs that were smuggled into the prison.
“At least eight guys died in the 17, 18 months I was at Kent,” he said.
The Correctional Service linked MacDonald to a clinic in Halifax upon his release nearly two weeks ago and he is now prescribed the opioid substitute Suboxone. But he said he should have received the medication in prison as part of the agency’s treatment program, which also includes methadone, so he could focus on finding a construction job to get his life back on track.
Ivan Zinger, Canada’s ombudsman for offenders, said the Correctional Service has failed to provide adequate addiction treatment, programs and staff at a time when more drugs are contaminated with fentanyl.
“I think when you’re dealing with a large inmate population that has such a long history of substance abuse you should be providing an awful lot more treatment and programming in addition to opioid substitution therapy,” said Zinger, who called for the reallocation of funding to provide those services.
“It’s unclear to me why the budget has remained the same and decreased in the past when clearly the number of incidents is increasing,” he said of overdoses that caused 41 deaths between 2010 and 2018.
Zinger said programs such as counselling are provided just before offenders are released instead of throughout their incarceration.
“That’s a problem when you have a highly addicted inmate population that has a lot of time on their hands and are in sometimes difficult conditions of confinement. They will find ways to bring in drugs.”
The Correctional Service said in a statement that 66 per cent more prisoners have accessed treatment in the last two years, but a jump of 115 per cent has been recorded in the Pacific region, where the opioid crisis is most acute.
It did not respond to requests for information on whether its budget will be increased to meet the demand for more treatment.
Kent Elson, a lawyer for an offender at Joyceville Institution in Kingston, Ont., said the Correctional Service did not accommodate his client’s disability of addiction so he filed a complaint with the Canadian Human Rights Commission last November.
Elson said his 50-year-old client, who is serving a four-year sentence, had been on methadone but alleges the medication was withheld without explanation for five days when he was transferred from another facility in November 2017.
“He needed medical help and he got forced, cold-turkey withdrawal in a feces-smeared segregation cell and cruel mistreatment from guards. And it was so unbearable that he tried to kill himself three times,” Elson said from Toronto.
While Correctional Service guidelines state a doctor is required to interview offenders before they are involuntarily tapered or cut off from methadone or Suboxone, Elson said his client was not seen by a physician.
“This whole experience was incredibly traumatic and he ended up with PTSD,” he said.
“The impact on him was terrible but everybody wins if prisoners get the right treatment. Suffering from PTSD is not going to make them easier to integrate back into society.”
The Correctional Service did not respond to a request for comment on the human rights complaint filed by Elson or another from the Prisoners’ Legal Services. The B.C. group’s complaint was filed in June 2018 on behalf of offenders who accused the Correctional Service of discriminating against them.
Nicole Kief, an advocate for the group, said about 100 inmates reported three main concerns: long wait lists for treatment, being cut off Suboxone after false accusations of diverting it and not receiving addiction counselling.
“Of the people that I’ve talked to there has been a real sense of urgency, with people calling me and saying, ‘I’m worried about dying,”‘ she said.
“There’s no way to describe the enormous shock a parent experiences when you get a phone call informing you … You lose your ability to stand, and you sink into the closest chair. Your heart stops and you just can’t believe it. This terrible wave of shock goes through your entire body.”
Grand Chief Stewart Phillip took that terrible call last August from his wife, Joan. She was nearly hysterical.
“The minute I heard her, I thought, ‘Oh, no. Oh, no.’ She kept saying over and over, ‘He’s gone. He’s gone.’”
It was Aug. 7, 2018, the day after Kenny Phillip’s 42nd birthday. Their oldest son had died alone in a hotel room of a carfentanil overdose in Grand Prairie, Alta.
“I don’t think he knew that he had taken carfentanil,” his father told me. “But nobody was more well-versed in addictions and the variety of drugs available than he was.
“Having gone through so many treatment programs, he had high level of expertise. He knew everything about his addictions, the pattern and so forth. Yet he still was vulnerable to the powerful call of the addiction.”
Kenny struggled with addiction to drugs and alcohol since he was a teenager, and had been to at least half a dozen treatment programs. Still, his father said, “You’re never ready for that phone call.”
His son followed the usual cycle. Bouts of drug and alcohol use punctuated by detox, treatment and periods of recovery. His longest recovery period lasted nearly three years. But this time, his parents were optimistic that it was different.
He had graduated from the Round Lake Treatment Centre. He was working as an apprentice mechanic. He loved it. He had been obsessed with cars since he was a kid. One of the people who worked with him in Penticton described Kenny to me as “a helluva guy.”
After he died, a former co-worker designed a logo with two crossed wrenches, Kenny’s initials with the years 1976 and 2018, and had decals made up so that his friends could honour him by sticking them on their toolboxes.
Phillip says something happened when Kenny went up to northwestern Alberta, triggering his addiction. And given Grande Prairie’s reputation as a crossroads for drugs, he wouldn’t have had to go far to find them.
Northwest of Edmonton, Grande Prairie has had several recent large drug busts. In January, RCMP seized four kilos of crystal methamphetamine, 2.2 kilos of cocaine, 200 grams of heroin, about 5,500 oxycodone tablets and about 950 fentanyl tablets.
A few months earlier, guns, ammunition as well as meth, cocaine, heroin and magic mushrooms were seized in a follow-up to a July raid.
“I have first-hand knowledge,” Phillip said. “I started drinking when I was 15, and was 40-something when I sobered up. It was the hardest thing that I ever did, and I was an alcoholic not strung out on crystal meth and some of the street drugs.
“But I know that at the end of the day, it’s up to the person. The individual.”
Seven years into marriage with, at the time, three children — two daughters and Kenny — Phillip’s wife told him she was finished with the fighting, picking him up when he was drunk, and buying liquor for him. But if he wanted to carry on, he was free to go.
“I thought, ‘Free at last,’” Phillip recalled. “I lasted a month. I was downtown drinking with all my so-called buddies talking about my newfound freedom. One evening in a Chinese restaurant — nobody else was there — I put in an order and was staring at the tabletop. I just broke down. I started crying and then howling.
“The howling was coming from the soul. I was scared stiff.”
At that moment, he realized his stark choice.
“If kept going, I was going to die at my own hand. But to contemplate stopping … which at the time was like contemplating to stop breathing or stop eating because it was such an integral part of who I was.”
What had kept Phillip from suicide, he told the Georgia Strait in May 2018, was the thought of his son. “I thought he would have to grow up with that stigma.”
With the help of Joan and Emery Gabriel, a drug and alcohol counsellor and the only sober friend Phillip had, he got into treatment at the Nechako Centre and has never relapsed.
Every day, Phillip thanks the Creator for sobriety because abstinence has enabled him to take on the work he has done and continues to do as president of the Union of B.C. Indian Chiefs, grand chief of the Okanagan Nation, and as a board member for Round Lake Treatment Centre.
Phillip grieves for the “incredible, amazing young man who touched so many different lives” and for the choice Kenny made last August, knowing full well the risk he was taking in the midst of the opioid overdose crisis.
He speaks openly, and urges others to as well, because those who have died need champions to bring about change.
“I want my son’s death to be meaningful,” Phillip said. “The path forward has to be an abundance of resources to help those who are struggling with addictions. … More treatment centres, more programs, and a greater commitment from governments and society to pick up the responsibility for it.”
So far, governmental response has been “minimalist,” said Phillip.
“This notion of harm reduction is just kicking the issue down the road. It’s not dealing with getting people from an addictive state to where they are clean and sober. That’s what we need to do.”
As for cannabis legalization, Phillip said, “I just shake my head when I think of where we are at and the direction we are going.”
Ending Canada’s opioid overdose crisis will likely require much more than sophisticated drug therapies. In fact, it might mean following the lead of First Nations health-care providers and transforming how we think about and deliver medical services.
First Nations people are dying of opioid overdoses at three times the rate of the general population. Hidden in that data are Canada’s most-neglected victims — Indigenous women.
Unlike in the general population where men comprise 80 per cent of the victims, Indigenous women are as likely to overdose or die as their brothers, fathers, husbands and sons.
They are eight times more likely to overdose than other women, and five times more likely to die from an overdose.
It’s not really surprising, says Dr. Evan Adams, the First Nations Health Authority’s chief medical health officer. The terrible numbers track other devastating indicators of how their health and longevity diverge from those of other Canadians.
“A lot of First Nations women who have substance-use disorders are exploited women. They are women who are victimized by the sex trade. They’re victimized by their partners,” said Adams, who worked for five years in Vancouver’s notorious Downtown Eastside, the epicentre of Canada’s opioid crisis.
What the opioid crisis highlights for him is the endemic problem of the western medical model, where people go passively to doctors’ offices and say, “Heal me.”
“Our (First Nations) model is that the doctor gives you a chance to get better. But, you make yourself better,” he said. “It’s your family that does most of the work of helping you get better, not that doctor who you visit for 15 minutes every week, if you’re lucky.”
Unlike in the western model, healing and wellness in the traditional Indigenous way involve mind, body and spirit. For First Nations men and women to achieve wellness, Adams said they require much more than medicine.
“They need healers who can do ceremony. Maybe they need love. They need justice.
“How can a woman recover from opioid use disorder when you won’t let her see her children? It’s disgusting,” he said.
The day Adams and I met, the FNHA offices were being “swept” by a group of elders carrying cedar boughs and candles using traditional ceremonies to restore the spirits of the people who work there.
“Some people would say an elder is less trained in opioids than an addictions physician,” Adams said. “But wouldn’t it be nice to have both?”
It’s not that FNHA rejects modern medicine. It continues to expand access to opioid agonist treatments such as methadone and Suboxone, which quell cravings, making it available at all FNHA nursing stations and at four of the nine FNHA-funded residential treatment centres. FNHA reimburses treatment fees charged by private clinics and has spent $2.4 million in grants to 55 communities for harm-reduction programs.
Yet, for Adams and his staff, drug therapies are only a small part of what he calls harm reduction’s suite of services.
“Harm reduction is not just, ‘Let’s make sure you don’t overdose.’ It’s the whole person that you have to treat, not just this one aspect of the person that is craving opioids.”
To incorporate First Nations wisdom into other programs, FNHA created two peer coordinator jobs at the Crosstown Clinic in the Downtown Eastside. Its compassion inclusion initiative has engaged another 144 Indigenous people with lived experience across B.C., and its Indigenous wellness team has taught indigenous harm-reduction and wellness programs in 180 communities.
“Opioid use disorder is everyone’s business. It’s yours and it’s mine and it’s everyone around us. It’s not just the domain of physicians with 24 years of training,” he said. “Why can’t Grandma help, or a family member?”
What concerns Adams about the response to the opioid crisis that is heavily grounded in the medical model is that it could widen the gap between his people and mainstream Canadians.
Indigenous people don’t necessarily trust health providers who don’t look like them or where there is no acknowledgment of the historical trauma they have suffered and their unique experiences in the world.
That’s just one more reason why the FHNA, which is unique in Canada, is so adamant that it must transform the way health care is delivered to its people so that they are empowered to help in their own healing within their own circles of trusted friends, family and elders.
This current crisis is rooted in the western medical model. The seeds were sown by an aggressive marketing campaign by Purdue Pharma, which falsely promoted its Oxycodone as being non-addictive. What followed was an epidemic of opioid over-prescription by physicians and other health-care professionals that eventually created a demand for synthetic opioids on the black market.
With so many deaths and no end in sight, this might be the time for all of us to reconsider whether the best responses to this crisis ought to be done within a much broader context of healing and an expanded understanding of what wellness really means.
Despite increased work to combat B.C.’s public-health emergency, more people died of an overdose in 2018 than any other year on record, leading to calls to make heroin and alternatives available at the doctor’s office.
The B.C. Coroners Service said Thursday that 1,489 people died of a suspected illicit-drug overdose in B.C. last year, up from 1,487 in 2017. Most who died were men (80 per cent) aged 30-59 (71 per cent), and most died indoors (86 per cent). Fentanyl, an opioid being cut into heroin and other drugs, was detected in about 85 per cent of the deaths, up from 82 per cent in 2017.
People running overdose prevention sites and expanding access to Suboxone treatment and the overdose-reversing drug naloxone have been credited with keeping the crisis from getting worse.
But to actually reduce the death toll in 2019, provincial health officer Dr. Bonnie Henry said B.C. needs to introduce a safer supply of drugs to replace the toxic street-drug supply.
Henry said it’s important to first have low-barrier access to opioid-agnoist treatments like Suboxone and methadone for people on a path to recovery. But for some people, swapping out their fentanyl-poisoned street drugs with pharmaceutical ones needs to be a first step.
“For people who, right now, have an addiction to opioids … and are relying on this contaminated street-drug supply on a daily basis, and they’re not in a place in their lives where they’re willing or able to enter the treatment side of the spectrum, we need to have options to provide them with a safer supply than what they’re getting on the street so that they stay alive during this period of time,” she said.
“They’re at such high risk of death right now.”
Dr. Jane Buxton of the B.C. Centre for Disease Control said people should be able to seek access to a regulated, safer supply of opioids through a physician.
“Depending on who it is, we still know that going through treatment, that suits some people,” she said. “Other people, especially (those) on Suboxone, that can be life-changing. But that doesn’t suit everybody, so we have to have that variety of options.”
She pointed to a program run by the Portland Hotel Society’s Dr. Christy Sutherland, who has started 300 people on liquid hydromorphone and who last month added 50 more spots for people to crush hydromorphone pills and inject them.
When certain people who use drugs are engaged with the health system in this way, they can go on to seek treatment, food, housing and other supports, Buxton said.
“What we’ve seen in the past is that when people have a stable supply, then their life becomes more stable, then they’re able to potentially think about other treatment and being on other opioid-agnoist therapies,” she said.
“Most people are seeking drugs in the illicit market, which are dangerous, and it’s hard to be stable when that’s part of your life and things are so toxic.”
Jordan Westfall, president of the Canadian Association of People Who Use Drugs, said he found hope in the chief health officer’s comments about a safer supply.
“I think the barriers need to be reduced,” Westfall said.
He said programs like the Crosstown Clinic, which provides medical-grade heroin and hydromorphone, are crucial, but for some people the requirement that they visit clinics or nurses several times a day is too high a barrier.
Westfall added that not all people who use drugs seek recovery, and some will continue to seek street drugs to treat their own pain or feel the euphoric effects.
“We need to make sure our programs are as accessible as the street-drug supply which, for many people, is very accessible,” he said.
“You should be able to go to a physician and get a prescription for a drug, if the alternative is you buying that drug on the street and dying.”
Mental Health and Addictions Minister Judy Darcy said her ministry is working on a wide variety of evidence-based solutions to the public health emergency.
“We are going to use every tool in the toolbox,” she said. “We are not going to leave any stone unturned when it comes to safe alternatives for people to the poison-drug supply.”
Darcy said her ministry is working with the B.C. Centre on Substance Use to train more physicians in addiction and 2,100 have enrolled in a program since July.
But Darcy’s ministry must work with federal legislation that prohibits the use of controlled substances, which prevents her ministry from simply allowing doctors to prescribe heroin and substitutes at clinics, she said.
“We’re pushing the envelope within that federal context,” she said.
Jane Thornthwaite, B.C. Liberal opposition critic for mental health and addictions, said she supports making a safer drug supply available to immediately save lives, but said it must be paired with a pathway to treatment and recovery options for anyone who uses it.
“You need to have the support systems in place for these people to actually move forward,” Thornthwaite said. “If we’re not going to get to the root of the problem, then this crisis is not going to get any better. We’ll just have new people getting into the system and it could grow and grow.”
A bottle of Suboxone similar to the one nurses at St. Paul’s Hospital will be giving to patients discharged from the emergency department following an opioid overdose. [PNG Merlin Archive] Handout: Providence Health Care / PNG
Patients who visit St. Paul’s after an opioid overdose will now leave the hospital’s emergency department with a supply of addiction-treatment pills.
Providence Health Care and Vancouver Coastal Health have launched a pilot program at the downtown hospital that gives these patients bottles containing three days worth of Suboxone, provided by a specially trained addiction nurse. They will form a plan for follow-up care and get clear instructions about when to take the pills.
A nurse will direct the patients toward follow-up treatment and community resources, including the St. Paul’s Rapid Access Addiction Clinic. The free clinic provides people with immediate short-term addictions treatment and transfers them to a community care provider for longer-term rehabilitation.
Dr. Andrew Kestler, an emergency department physician at St. Paul’s and the project’s co-lead, said the program will save lives.
“People who get started on opioid agonist therapy — that could be Suboxone or methadone — live longer,” Kestler said. “We know that it reduces deaths in people who have opioid-use disorder, and we know that it reduces the need for emergency department visits.”
The B.C. Centre on Substance Use will evaluate whether the pilot program leads to a decrease in overdoses, hospital visits and deaths, and to improved engagement in care.
Patients must be in a sufficient state of withdrawal to start Suboxone, which can lead to six- to 12-hour visits to the emergency department. By letting patients take the pills with them, a common barrier to treatment is reduced for the many people uncomfortable with hospital stays, Kestler said.
Those with opioid-use disorder who visit the hospital but haven’t overdosed are also eligible for the take-home Suboxone, Kestler said.
Subxone, which contains buprenorphine and naloxone, is a medicine which can stop cravings and withdrawal symptoms, and prevent death. It is considered safer than methadone, another leading treatment for opioid addiction, mostly because buprenorphine has a ceiling effect which makes it hard to overdose, Kestler said.
Typically about five or six overdose patients visit St. Paul’s emergency department each day, Kestler said. The hospital sees 10 times more overdose patients than any other hospital in the Vancouver Coastal Health region, according to Providence.
In the first 11 months of 2018, Vancouver Coastal had the highest rate of illicit-drug death of any health region in B.C., at 37 per 100,000 people, according to the B.C. Coroners Service. Of the 1,380 people who died during that period, 408 were in Vancouver Coastal.
Kestler believes the program will prove successful and could be adopted by other emergency departments.
“We’re already sharing some of our ideas and protocols with people around the province but we really hope, with this getting off the ground and having some success, that we can pave the way for broader implementation across the province,” he said.
“I think there’s obviously interest elsewhere in Canada and North America.”
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