John Douglas, special projects co-ordinator for the Port Alberni Shelter Society and a former mayor and councillor for the city. [PNG Merlin Archive] Submitted: John Douglas / PNG
The former mayor of Port Alberni has released a report in which he supports calls for drug decriminalization in order to protect British Columbians from overdoses and other related harm, and help them find appropriate treatment.
John Douglas, who was a paramedic for 23 years, wrote “Working Towards a Solution: Resolving the Case between Crime and Addiction” following an information-gathering trip to Portugal, and recently released it to the media.
Douglas, now special projects co-ordinator for the Port Alberni Shelter Society, explained Thursday that the paper is not a scientific analysis, but rather a “from-my-gut” exploration of what he has learned while working in the fields of social housing, mental health, poverty and addiction.
He calls for the province to engage doctors, lawyers and police, as well as the public, to make addiction and possession of addictive substances solely a health issue, under healthy ministry jurisdiction. He wants the government to develop a supply model for addictive drugs to eliminate health problems associated with contaminated street drugs.
More than 4,300 people have died of an illicit-drug overdose in B.C. since the provincial government declared a public health emergency in April, 2016. Fentanyl was detected in most cases.
Douglas recommends the development of long-term, affordable and flexible treatment communities and “health teams” to provide services. He asks the province to tell the federal government “politely and firmly” that it intends to move forward with a pilot program which is open to federal participation.
“I’ve been a politician myself — no higher than a municipal level — but I find political people, as well-meaning as they are, tend to lag behind movements, sometimes, in society,” Douglas said. “I’ve talked to so many people in the health, enforcement and legal fields that all agree (addiction) should be treated as a health issue, but the political end is lagging behind because they’re afraid of losing votes or saying the wrong thing and offending somebody.”
Douglas entered politics in 2008 as a councillor in Port Alberni and served as mayor from 2011 to 2014. After the fentanyl-related overdose crisis emerged, he helped bring a sobering centre and overdose prevention and inhalation sites to the city.
His decades of experience in health care and helping people who have addictions helped him come to the conclusion that people with addictions should be in health care, not the criminal justice system.
“With the shelter, we’re working toward researching models of therapeutic communities that could work for treatment, if and when we can get the government to start moving in the direction of decriminalization and the direction of adequate treatment for people with addictions, instead of these pathetic 30- to 60-day treatment programs that are commonplace over here,” Douglas said.
Decriminalization would apply to all drugs — even heroin and methamphetamine — but falls short of legalization, which removes prohibitions but also develops regulations for the production, sale and use of a substance (Canada’s approach to cannabis is an example).
In a special report released last April, Provincial Health Officer Dr. Bonnie Henry urged the B.C. government to implement decriminalization for simple possession for personal use.
Henry said B.C. could use its powers under the Police Act to allow the Ministry of Public Safety and Solicitor-General to set broad provincial priorities with respect to people who use drugs. Or it could enact a regulation under the act to prevent police from using resources to enforce against simple possession offences under the federal Controlled Drugs and Substances Act.
Solicitor-General Mike Farnworth shot down Henry’s proposal, saying laws around the possession of controlled substances remain federal and “no provincial action can change that.”
Douglas sides with Henry on the issue.
“I wanted to be an additional voice to echo those findings,” he said. “I agree wholeheartedly with her. We don’t have to wait for the federal government to do this.”
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.”
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.
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.
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.”
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.
The B.C. Coroners Service says the number of illicit drug deaths was down 30 per cent in B.C. for the first five months of 2019.
The coroner says there were 86 and 84 illicit drug-related deaths in April and May respectively, down from 137 and 116 for the same months in 2018.
Overall, there have been 462 illicit drug toxicity deaths in the first five months, down 30 per cent from the 651 over the same period last year.
The coroner notes that the data is subject to change and totals for 2019 will likely increase as post-mortem testing results are received, but says it is “a sign for cautious optimism.”
More than two-thirds of the illicit-drug deaths this year involved people aged 30 to 59 years, and men account for almost four in every five of all illicit-drug deaths over the same period, the coroner says.
Almost nine in every 10 illicit drug deaths occurred inside and fentanyl was detected in most (83 per cent) of the cases.
Although overall the number of fatalities is down, the number of deaths linked to carfentanil, which is reportedly 100 times stronger than fentanyl, is up compared with last year.
The coroner says carfentanil was detected in 102 of the 383 fentanyl-detected deaths this year. There were 35 carfentanil-detected deaths in 2018.
No deaths have been reported at supervised consumption or drug overdose prevention sites.
Overdose deaths linked to illicit fentanyl-laced drugs rose 21 per cent last year among First Nations people in B.C. even as there was a glimmer of hope that the crisis may have peaked among the general population.
Since the crisis began four years ago, B.C. Indigenous people have been overrepresented in the deadly count. Last year, they accounted for 13 per cent of the deaths, while making up 3.4 per cent of the provincial population.
Put another way, First Nations people were 4.2 times more likely to suffer a fatal overdose and six times more likely to suffer a non-fatal overdose than other British Columbians.
No one is suffering more than First Nations women and girls, who already have the worst health outcomes in Canada because of violence, exploitation and poverty.
They are unique in this epidemic where 80 per cent of the victims in the general population are men. Women, by contrast, account for 39 per cent of First Nations’ overdose fatalities last year and 46 per cent of the non-fatal ones.
They are bearing the brunt of marginalization, says Dr. Evan Adams, chief medical health officer at the First Nations Health Authority. Another measure of that is expected to come next week in the report of the murdered and missing women’s inquiry.
Among the reasons that he suggests for the widening gap between First Nations’ and the general population’s statistics are the effects of colonization including residential schools, the lack of social supports, childhood experiences and limited access to safe spaces and services.
The litany of dreadful statistics compiled by the provincial coroner’s office was read out Monday against the backdrop of a quilt with the names of some of the hundreds who have died. Among those names was Max, the son of the health authority’s knowledge keeper, Syexwaliya. Max died 12 days before his 41st birthday in March 2018.
“My son was just too lost,” she said. “I couldn’t do anything for him. I had to love and accept him as he was.”
Still, Syexwaliya takes heart from the statistics.
“The statistics make me feel that Indigenous people aren’t invisible and what’s brought out in the statistics and in the reports means that work is being done,” she said.
Addiction is a disease of pain — physical, emotional, mental and spiritual. Addiction piles tragedy on tragedy.
“It’s a journey of pain, a journey of suffering and a journey of seeking health services that couldn’t be found,” said the chair of the health authority, Grand Chief Doug Kelly.
Too many Canadians, too many British Columbians and too many First Nations people have already died, but Kelly said that for Indigenous people, things are not getting better. They’re getting worse, especially for those living in cities and most especially for women.
Overdose hot spots include the usual ones: Vancouver’s Downtown Eastside, the Fraser Valley, Chilliwack, Nanaimo, Victoria and Prince George. But for First Nations people, there’s also Campbell River and Kamloops.
Those stark differences mean distinct and targeted solutions are required. As Canada’s first Indigenous health authority, the First Nations authority (with its unofficial motto of “no decisions about us, without us”) is well positioned to do that.
With a goal of addressing causes of addiction, it has its own four pillars approach: preventing people from dying, reducing the harm of those who are using, creating a range of accessible treatments and supporting people on their healing journey.
The authority also strongly supports the call from B.C.’s chief medical health officer to decriminalize possession of all drugs for personal use as has been done in Portugal. (The suggestion was quickly shot down by the B.C. government, which says that could only be accomplished with federal legislation.)
Among the reasons Kelly cites are yet more terrible statistics.
Of Canada’s female offenders in federal prisons, Public Safety Canada reported last summer that 43 per cent are Indigenous. In youth detention, Indigenous kids account for 46 per cent of all admissions — a jump of 25 per cent in a decade.
Addiction is often contributing factor in the crimes committed, as is fetal alcohol spectrum disorder (although the report said there is no evidence that FASD is more prevalent among First Nations than other populations).
Because so many First Nations women are incarcerated, it means their children often end up in government care or with relatives, which only exacerbates the cycle of childhood trauma, loss and addiction.
So far, the First Nations Health Authority has spent $2.4 million on harm-reduction programs. It’s trained more than 2,430 people in 180 communities how to use naloxone to reverse fentanyl overdoses, has 180 “harm-reduction champions” and peer coordinators in all five regions.
But the biggest barrier is the one that led to Max’s death — lack of accessible treatment.
Last week, FNHA and the B.C. government committed $20 million each to build treatment centres in Vancouver and Surrey and promised to upgrade six existing ones. Kelly says that’s great. But it’s not enough. They’re still waiting for another $20 million from the federal government for construction.
Still, where will the operating money come from? That’s the next multi-million-dollar question. But it must be found.
Now that there is evidence that First Nations communities — and women in particularly — are suffering so disproportionately, ignoring them is unconscionable.
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.
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