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Category "Drugs"

13Sep

Municipalities back Vancouver motion to push Ottawa for safer drugs

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https://vancouversun.com/


Vancouver mayor Kennedy Stewart joined Dr. Patricia Daly, Chief Medical Officer for Vancouver Coastal Health, and Vancouver Fire and Rescue Service’s Capt. Jonathan Gormick to discuss the epidemic of drug-related deaths, at a press conference in Vancouver on Friday, September 6, 2019.


Jason Payne / PNG

Local governments across Canada will press the federal government to increase access to safer drugs, and declare a national health emergency in response to the fentanyl-driven overdose crisis, after a motion by Vancouver Mayor Kennedy Stewart was passed Friday.

Stewart’s motion, drafted with his overdose emergency task force, was approved by city council in July. Coun. Rebecca Bligh brought it to a Federation of Canadian Municipalities executive meeting this week.

The motion requires the federation to call on Ottawa to support health authorities, doctors, their professional colleges and provinces to “safely provide regulated opioids and other substances through a free and federally available Pharmacare program.”

The federation will also demand that the federal government declares a national public health emergency and provides exemptions to the Controlled Drugs and Substances Act, so that cities and towns can run pilot programs which prioritize a move toward a “safe” drug supply.

Stewart said Friday that there was some division among the federation’s membership over the motion but it passed following an effective speech by Bligh. He hopes it will “shift the national dialogue toward a safe supply” during the federal election.

He wants the substances act exemptions to allow health professionals with a non-profit organization to distribute diacetylmorphine, which local research has shown can be an effective treatment for chronic, relapsing opioid dependence.

Stewart met with Prime Minister Justin Trudeau two weeks ago and told him what Vancouver needs in order to replace fentanyl-tainted street drugs with a safer, regulated supply, he said.

“It was a private conversation but I can say that I left the conversation in good spirits,” Stewart said. “I was definitely heard and that was very important.”

Stewart said front line responders are fatigued, people are experiencing multiple overdoses and suffering brain injuries, and the city and province desperately need the federal government to step up.

“We’re going to have to take it to the next level here. We’re reducing overdose deaths but overdoses are increasing. Just not dying isn’t good enough,” he said.

“It’s got to be life and hope for people.”

Karen Ward, a drug user and advocate for others who use drugs, helped with the motion and was pleased the municipalities passed it.

“If a province is a bit hesitant, the idea is that this will give a city the power to take rapid action — and individual doctors, in fact,” she said.

“It’s a necessity to have safe supply at this point because the supply has become so contaminated everywhere.”

Ward said the federation can now send a clear message to Ottawa that municipalities want the power to treat the overdose crisis “like a real” public health emergency.

“This is one way to get them to talk about it, face it squarely and acknowledge this massive disaster, and say look, we need to change our (approach),” she said.

“We need to take it as seriously as possible. It’s a health issue. It’s also a justice issue.”

According to the federal government, there have been more than 9,000 apparent opioid-related deaths across the country since 2016.

Illicit drugs killed 1,533 people in B.C. in 2018 and 538 in the first half of 2019, according to the B.C. Coroners Service.

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5Sep

B.C. government expands biosimilar drug program to Crohn’s, colitis patients

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https://vancouversun.com/


B.C. Health Minister Adrian Dix in a file photo.


Francis Georgian / PNG

The British Columbia government says it’s expanding its substitute drug program to include 1,700 patients with diseases such as Crohn’s and colitis.

Health Minister Adrian Dix says biosimilars, which are cheaper alternatives to name-brand drugs, have worked well in other countries and the province will be saving about $96.6 million to be put back into health care over three years.

Biosimilars are highly similar versions of bioengineered drugs known as biologics, and there are 17 such products approved for sale in Canada.

Bioengineered medicine is the single biggest expense for public drug plans; in 2018, B.C. spent $125 million to treat chronic conditions such as diabetes, arthritis and Crohn’s disease.

In January, the province made a three-year, $105-million investment to help low-income British Columbians get access to the drugs.

The initial program announced in May saw over 20,000 British Columbians move their prescription from the biologic to biosimilar drugs.

31Aug

Woman refuses to burn out her torch as she marks Overdose Awareness Day, crisis

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Tabitha Montgomery with free materials she’s distributing to B.C. libraries.


Francis Georgian / Postmedia News

It was during the International Overdose Awareness Day activities last year when Tabitha Montgomery really noticed it — events that had once been rallies had become vigils.

“There was a feeling that no one was listening. That it was not making a difference,” she recalled Saturday as she set up an information booth at the Vancouver Public Library.

Montgomery’s booth was one of several awareness activities happening in B.C. this weekend to mark International Overdose Awareness Day, a global movement designed to remember those who have died from drug overdoses. And to push for change.

However, some advocacy groups that organized activities in the past were noticeably absent from this year’s list of planned events.

Montgomery attributed that to burnout.

“It can be difficult to keep going,” she said. “I want to thank those who have been paving the path for so long.”

Montgomery’s father, her best friend and her daughter’s father all died from drugs. She believes the only way to end the overdose crisis is to remove the stigma and judgment around drug use and addiction and bring the issue fully into mainstream health care.

“This is a torch in my heart,” she said.

While she doesn’t represent any single group, the former director with From Grief to Action has had success asking B.C. libraries to display free books on grief and addiction in their community resources sections. She’s hoping to get the material into more libraries in the months ahead.

(Postmedia News photo by Francis Georgian)

In a statement, B.C. Minister of Mental Health and Addictions Judy Darcy recognized those who have died are “parents, children, co-workers, neighbours, partners, friends and loved ones.”

The politician said the B.C. Centre for Disease Control estimates 4,700 deaths have been averted by scaled-up distribution of Naloxone, more overdose prevention sites and better access to medication-assisted treatment, known as opioid agonist treatment.

“We have a responsibility to each other, our communities and the loved ones we have lost to keep compassion, respect and understanding at the forefront of our minds — and to continue to escalate our response,” she said.

In June, 73 people died of suspected illicit drug overdoses across the province, a 35 per cent drop from June 2018 when 113 people died, according to data collected by the B.C. Coroner’s Service.

But Montgomery said addiction is still treated like a “moral and criminal issue,” rather than a health issue.

“There’s so much misunderstanding,” she said.

Overdose awareness events were held around the world, including in many B.C. cities such as Vancouver, New Westminster, Kamloops, Kelowna, Powell River, Prince George and Quesnel.

In Vancouver’s Downtown Eastside, the Overdose Prevention Society supported the creation of a mural in the alley near its injection site. The project wrapped up with an art show.

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23Aug

Daphne Bramham: B.C. addictions minister targets province’s ‘wild, wild West’ recovery houses

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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.


B.C. Minister of Mental Health and Addictions Judy Darcy shares a laugh with Scott Kolodychuk, operations manager of Surrey’s Trilogy House One recovery home where Friday’s news conference was held.

Mike Bell /

PNG

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.

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9Aug

Daphne Bramham: Why won’t B.C. fund Karly’s addiction recovery?

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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.

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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.

But now?

“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.

“I feel like my story can help other people.”

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7Aug

Daphne Bramham: College roots out the bad, white-collar dealers, one pharmacist at a time

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When you think about shady drug dealers, it’s usually in the context of the Downtown Eastside or the Surrey Strip.

But in the last three months alone, the B.C. College of Pharmacists has rooted out some white-collar guys who were running illegal pharmacies, faking prescriptions, doling out methadone improperly, and plumping up their dispensing numbers with made-up prescriptions for over-the-counter drugs and vitamins.

While their crimes don’t have the same kind of mean-streets vibe as the illicit dealers, it doesn’t mean that the guys in white coats didn’t do some seriously bad things.

Let’s start with William Byron Sam, who is still under investigation by the college for “knowingly operating an unlicensed pharmacy.”

A complaint outcome report posted on the college’s website says “serious public risk indicators were present within the pharmacy.“ It doesn’t spell out what those serious risks are and, in an emailed response to my question about where Sam was getting the drugs from, the college refused to say.

In March, the college cancelled the licence for Garlane Pharmacy #2, which Sam was operating at 104-3380 Maquinna Dr. in Vancouver’s Champlain Heights.

(It still has two five-star ratings on Yelp! So, if it’s a legitimate drugstore you’re after, you might want to check the college’s listings.)

Sam’s problems began in 2015 with a practice review, which was followed up by a request for more information. In 2017, the college told him his conduct would be the subject of a hearing, admonishing him for failing to respond to the college after a practice review in 2015 and to a request for more information in 2016.

In May, Salma Sadrudin Damji, another Vancouver pharmacist, was found to have used a prescription pad from a medical clinic and falsified 62 prescriptions for Schedule 1 drugs, which include heroin, LSD, ecstasy and methaqualone (aka Quaalude) using three patient names and two physician names. In May, the college fined her $1,000, imposed a 90-day suspension and forbid her from owning or managing a pharmacy for three years or acting as a preceptor or mentor for pharmacy students.

Beyond that, the college says it can’t comment.

North Vancouver’s Davood Nekoi Panah provided monetary incentives to a patient, dispensed Schedule 1 drugs without an authorized prescription in unlabelled and mislabelled containers — all without taking reasonable steps to confirm the identify of the patients before giving them the drugs.

He was fined $10,000. Starting Sept. 4, he can’t work for two months and can’t be a pharmacy manager or preceptor for two years. Questions about him were also met with a no-further-comment response from the college.

Amandeep Khun-Khun has every appearance of being a good guy. From 2010 until 2012, he was on the college’s community practice advisory committee making recommendations related to community pharmacy practices. He was a preceptor for UBC pharmacy students and was quoted in UBC’s 2013 brochure aimed at recruiting other mentors.

But in June, Khun-Khun was fined $30,000 and suspended from practice for 540 days. He can only return to full pharmacist status if he passes the college’s jurisprudence exam and completes an ethics course.

The mailing address for his company, Khun-Khun Drugs, is the Shoppers Drug Mart on the tony South Granville Rise.

Over three years, the Vancouver pharmacist processed more than 15,000 false prescriptions for vitamins and over-the-counter drugs — things like aspirin and ibuprofen — on the PharmaNet records of seven individuals. But those seven people didn’t know anything about it.

Khun-Khun admitted he “directed pharmacy assistants to process transactions weekly on PharmaNet in order to artificially inflate the pharmacy’s prescription count.”

He did it even though he had previously undertaken to comply with all ethical requirements after earlier complaints.

Part of the reason Khun-Khun didn’t get caught earlier is because neither of the two full-time pharmacists working for him did what they were supposed to. The inquiry committee wrote that both of them “turned a blind eye” to what they knew or should have known was wrong.

They knew or should have known that what was happening was wrong since the transactions were done without patients’ consent and were an improper use and access of personal information.

William Wanyang Lu and Jason Wong were both working for Khun-Khun full-time. Both now have letters of reprimand on their permanent registration file and were required to pass both an ethics course and the college’s law exam or face 30-day suspensions.

Yet Wong hasn’t deleted a comment on his LinkedIn profile that while he worked at Shoppers Drug Mart he was “coached with great mentors at this pharmacy including Amandeep Khun-Khun.”

Among the others disciplined recently is Sing Man Tam. He was fined $10,000 and had a reprimand letter put on his permanent record for his “inadequate diligence and oversight” over two years related mainly to dispensing methadone to addicts to quell their cravings and minimize the effects of opioids.

Tam processed prescriptions without authorization. He also didn’t witness its ingestion, which is legally required (and the reason that pharmacists get $17 for dispensing it rather than the usual $10 for other medications).

He billed for methadone that was marked in the logs as having been “missed” and Tam delivered it without authorization by the doctor who wrote the prescription.

For the past several years, the college has received close to 800 complaints, but many of those don’t require any disciplinary action or even a referral to an inquiry committee. Its statistics cover the 12 months from March 1 to the end of February.

And while the most recent fines and suspensions may not seem to add up to much, the college is not always the final arbiter. The courts are.

In March, Richmond pharmacist Jin Tong (Tom) Li was sentenced to a year of house arrest after pleading guilty to one count of obtaining more than $5,000 under a false pretence.

The charge links back to the college’s disciplinary action in 2016 after it found that Li had submitted more than 2,400 fraudulent claims to PharmaCare between 2013 and 2014 that cost the B.C. government $616,000.

Coincidentally, Li’s pharmacy licence was reinstated as a pharmacist in October 2018, having been suspended for 540 days. He is still banned from being a manager, director or pharmacy owner or preceptor until 2023.

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26Jul

Daphne Bramham: Recovery homes’ dilemma: Trying to comply with regulations that have yet to be written

by admin

After three years of operating two registered recovery houses, in January 2016 Cole Izsak found what he believed — and still believes — is the perfect place.

But before taking possession, the owner and executive-director of Back on Track Recovery applied to the provincial health ministry to essentially grandfather his operation and transfer the registration of one of his houses to the new site.

Because Back on Track has never had any substantiated complaints, he didn’t expect any problems and, a month later, shut the registered house and opened a four-plex now called The Fortress.

The next month, Izsak closed one of the two houses that were registered by the provincial government and moved to the new compound with internal, off-street parking at 9889-140th Street in Surrey.

He still wasn’t concerned when in May, the ministry said it was putting a hold on his application while both the province and Surrey were formulating new regulations.

Since then, it is rare that any of the 40 beds — two per bedroom in each of the five-bedroom houses — are empty.

While Back on Track continues to operate the one registered house, The Fortress remains unregistered, with only two of four business licenses that it needs.

For the last 2½ years, Surrey’s bylaw inspectors have been telling Izsak that unless all four houses at The Fortress get their provincial registry, the city can’t license the houses until the registration from the health ministry comes through, certifying that services offered meet its standards of care.

In mid-May, Back on Track and its residents were told that the licenses were being revoked and the four houses would have to close at the end of July. It has since been given a reprieve, pending a decision from the provincial registrar.

“If Mr. Izsak’s registration comes through, we’ll be prepared to do our own inspections for renewal or issuance of the licenses,” bylaw services manager Kim Marosevich said this week.

In late May, after Maggie Plett first spoke publicly about her son Zachary’s death at another Surrey recovery house called Step by Step, Addictions Minister Judy Darcy told News 1130, “We’re trying to make up for lost time over the past many, many years since the scandal started to break.

“But I would expect that we will have new, stronger regulations and enforcement in place by the end of the year.”

Throughout all of this, the government has paid Back on Track the $30.90 per diem that covers the cost of room, board and recovery services for each welfare recipient living there — a rate that has remained unchanged for 16 years.

Izsak doesn’t know why the ministry has yet to make a decision on his application. The mental health and addictions ministry has not yet responded to my questions about it.

On Tuesday, Izsak gave me a tour of the four neatly kept houses. He showed me the well-supplied pantry where residents are free to take whatever food they want and as much as they want. There is also an open-air gym and smoking lounge. Every room has a naloxone kit in case of an opioid overdose, and every few weeks, residents are given training on how to use them.

The half-dozen residents that I spoke to privately — including one who said he had been in at least 20 such facilities — said The Fortress is the best. They talked about feeling safe, well-cared for, and even loved.

Izsak makes no apology for not having more set programming in the houses.

“People who are coming off the street or out of prison are not going to surrender to eight hours of programs per day,” he said. “But what they will surrender to is coming to a place like this where they are fed well, have a clean bed, a TV, and programming from 9 a.m. until noon.”

He acknowledged that there are no certified counsellors or therapists working there. He devised a recovery program called MECCA based on his own experiences in recovery that is delivered by others who are in recovery.

Izsak also said he cannot afford to hire certified addictions counsellors and specialized therapists, as they do at recovery houses where monthly rates are anywhere from $3,000 to $9,000 a month.

Right now, registered facilities don’t require that, according to the registry’s website.

What’s required is that all staff and volunteers “must have the necessary knowledge, skills, abilities and training to perform their tasks and meet the health and safety of residents.”

Far from bridling at more regulations, Izsak has a long list of his own that he would like the province to enact to weed out bad operators.

It includes random site inspections, manager-on-duty logbooks documenting what happens every two hours from 10 a.m. until 10 p.m., and a requirement that all operators provide their expense receipts.

After three recent deaths in recovery houses, Izsak is now a man on a mission.

“I want to close operations that are bad so that I’m not treated almost like a criminal because they acted unscrupulously.”

Of course, he first needs to save his own.

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Twitter: @bramham_daphne


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11Jul

Illicit drug deaths down this year in B.C., says coroner

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1May

Daphne Bramham: Alcohol, not opioids, is Canada’s biggest drug problem

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Alcohol is so much a part of our culture that 80 per cent of Canadians drink. But each year, nearly 15,000 people die from alcohol related harms.


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.

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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.

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Twitter: @bramham_daphne


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24Apr

Daphne Bramham: Decriminalization alone won’t end B.C.’s overdose crisis

by admin


A man injects drugs in Vancouver’s Downtown Eastside, Wednesday, Feb. 6, 2019. Despite significant efforts to combat overdose deaths in British Columbia, the provincial coroner says illicit drug overdose deaths increased to 1,489, just over the 2017 death total.


JONATHAN HAYWARD / THE CANADIAN PRESS

The problem with the provincial health officer’s special report recommending decriminalization of all illicit drug users  is that Dr. Bonnie Henry chose to make that her only recommendation.

Three years after a public health emergency was declared because of an epidemic of deaths from illicit opioids, B.C. still has no comprehensive addictions strategy.

It has a stunning lack of treatment services, no universal access to services, no simple pathway to what few services there are, no provincial standards or regulation of privately operated treatment and recovery homes services.

Government ministries such as health, mental health and addictions services, social development and housing remain siloed and the root causes of addiction remain largely unaddressed.

While there has been substantial investment in harm-reduction measures including overdose prevention sites, free naloxone kits (to reverse an opioid overdose), low-barrier shelters and poverty reduction, the needs are greater.

Overdose deaths have only hit a plateau – not dropped. Every day, four people British Columbians die.

Yet, Henry is adamant that decriminalization is the most important next step.

“It’s about a focus and an intent,” she said. “Instead of police focusing on requirement of the Criminal Code, it builds off-ramps to connect with services. And, that in itself, ensures those systems are built.”

The majority of those who have died of overdoses were young men using alone at home. Without fear of being arrested and with the stigma of addiction being reduced, the expectation is that addicts or recreational users would be more likely to go to a supervised injection site, use with a friend (with a naloxone kit at the ready) or call for help if they overdose.

Henry calls decriminalization “a necessary next step to stop the death toll from rising and to make harm-reduction services more readily available.”

But it’s a question whether those recreational users would do that, because many addicts say that they use alone for a variety of reasons — not least of which is that they don’t want to share their drugs or they don’t want anyone to know what they do when they’re high.

The report recommended two options for British Columbia to work around the Criminal Code provisions.

Solicitor General Mike Farnworth firmly and quickly said no to both. But he noted there are pilot projects in Vancouver, Abbotsford and Vernon where rather than charging for possession, police are linking users with services. An evaluation of those will be completed in the fall and, depending on the results, they may be expended to other communities.

Henry makes no secret of the fact that her ultimate goals for Canada are full legalization and regulation of all drugs to ensure that there is a safe supply. If that were to happen, Canada would be the first in the world to do that.

Portugal is mentioned frequently in the report and by Henry. Possession for personal use was decriminalized more than 20 years ago. But it was done only as part of a comprehensive, drug strategy.

Police still arrest anyone found with illicit drugs. They are taken to a police station where the drugs are weighed. If the amount is above the maximum limit set for personal use, they are charged and go through the criminal justice system.

If the amount is below the limit, tickets are issued and users told to appear at the Commission for the Dissuasion of Drug Use within 24 hours. There, they meet with a social worker or counsellor before going before a three-person tribunal, which recommends a plan for treatment.

People don’t have to comply. But if they are arrested again, the commission can impose community service, require that they seek treatment, impose fines and even confiscate people’s property to pay those fines.

That’s not the kind of decriminalization Henry is recommending. Instead, the onus here would be on police officers – not trained addictions specialists, psychologists or social workers — to connect users with services.

Part of the reason for the difference is that Portugal’s goal wasn’t legalization or keeping addicts alive until they chose to go treatment. Its focus was and is on getting addicts into treatment and recovery so they could resume their place in society.

Harm reduction is only a small part of the Portuguese plan. Its first supervised injection site has only recently opened. But there is free and easy access to methadone (which dampens heroin addicts’ craving for the drug) and free needles to stop the spread of infection.

These harm reduction measures are deemed to temporary bridges to abstinence for all but older, hardcore, long-term heroin users rather than long-term solutions. Of course, fentanyl and carfentanil have yet to be found in its illicit drug supply.

Its treatment services as extensive and include everything from outpatient treatment to three years’ residency in a therapeutic community during which time the users’ families are provided with income supplements.

Nothing in this decriminalization report moves British Columbia anywhere close to that kind of comprehensive system. And until we get there, it’s hard to imagine that this overdose crisis ending anytime soon.

[email protected]

Twitter: @bramham_daphne


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