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Category "Government of Canada"

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

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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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13Mar

Grand Chief Stewart Phillip: ‘I want my son’s death to be meaningful’

by admin

“There’s no way to describe the enormous shock a parent experiences when you get a phone call informing you … You lose your ability to stand, and you sink into the closest chair. Your heart stops and you just can’t believe it. This terrible wave of shock goes through your entire body.”

Grand Chief Stewart Phillip took that terrible call last August from his wife, Joan. She was nearly hysterical.

“The minute I heard her, I thought, ‘Oh, no. Oh, no.’ She kept saying over and over, ‘He’s gone. He’s gone.’”

It was Aug. 7, 2018, the day after Kenny Phillip’s 42nd birthday. Their oldest son had died alone in a hotel room of a carfentanil overdose in Grand Prairie, Alta.

“I don’t think he knew that he had taken carfentanil,” his father told me. “But nobody was more well-versed in addictions and the variety of drugs available than he was.

“Having gone through so many treatment programs, he had high level of expertise. He knew everything about his addictions, the pattern and so forth. Yet he still was vulnerable to the powerful call of the addiction.”

Kenny struggled with addiction to drugs and alcohol since he was a teenager, and had been to at least half a dozen treatment programs. Still, his father said, “You’re never ready for that phone call.”

His son followed the usual cycle. Bouts of drug and alcohol use punctuated by detox, treatment and periods of recovery. His longest recovery period lasted nearly three years. But this time, his parents were optimistic that it was different.

He had graduated from the Round Lake Treatment Centre. He was working as an apprentice mechanic. He loved it. He had been obsessed with cars since he was a kid. One of the people who worked with him in Penticton described Kenny to me as “a helluva guy.”

After he died, a former co-worker designed a logo with two crossed wrenches, Kenny’s initials with the years 1976 and 2018, and had decals made up so that his friends could honour him by sticking them on their toolboxes.

Phillip says something happened when Kenny went up to northwestern Alberta, triggering his addiction. And given Grande Prairie’s reputation as a crossroads for drugs, he wouldn’t have had to go far to find them.

Northwest of Edmonton, Grande Prairie has had several recent large drug busts. In January, RCMP seized four kilos of crystal methamphetamine, 2.2 kilos of cocaine, 200 grams of heroin, about 5,500 oxycodone tablets and about 950 fentanyl tablets.

A few months earlier, guns, ammunition as well as meth, cocaine, heroin and magic mushrooms were seized in a follow-up to a July raid.

“I have first-hand knowledge,” Phillip said. “I started drinking when I was 15, and was 40-something when I sobered up. It was the hardest thing that I ever did, and I was an alcoholic not strung out on crystal meth and some of the street drugs.

“But I know that at the end of the day, it’s up to the person. The individual.”

Seven years into marriage with, at the time, three children — two daughters and Kenny — Phillip’s wife told him she was finished with the fighting, picking him up when he was drunk, and buying liquor for him. But if he wanted to carry on, he was free to go.

“I thought, ‘Free at last,’” Phillip recalled. “I lasted a month. I was downtown drinking with all my so-called buddies talking about my newfound freedom. One evening in a Chinese restaurant — nobody else was there — I put in an order and was staring at the tabletop. I just broke down. I started crying and then howling.

“The howling was coming from the soul. I was scared stiff.”

At that moment, he realized his stark choice.

“If kept going, I was going to die at my own hand. But to contemplate stopping … which at the time was like contemplating to stop breathing or stop eating because it was such an integral part of who I was.”

What had kept Phillip from suicide, he told the Georgia Strait in May 2018, was the thought of his son. “I thought he would have to grow up with that stigma.”

With the help of Joan and Emery Gabriel, a drug and alcohol counsellor and the only sober friend Phillip had, he got into treatment at the Nechako Centre and has never relapsed.

Every day, Phillip thanks the Creator for sobriety because abstinence has enabled him to take on the work he has done and continues to do as president of the Union of B.C. Indian Chiefs, grand chief of the Okanagan Nation, and as a board member for Round Lake Treatment Centre.

Phillip grieves for the “incredible, amazing young man who touched so many different lives” and for the choice Kenny made last August, knowing full well the risk he was taking in the midst of the opioid overdose crisis.

He speaks openly, and urges others to as well, because those who have died need champions to bring about change.

“I want my son’s death to be meaningful,” Phillip said. “The path forward has to be an abundance of resources to help those who are struggling with addictions. … More treatment centres, more programs, and a greater commitment from governments and society to pick up the responsibility for it.”

So far, governmental response has been “minimalist,” said Phillip.

“This notion of harm reduction is just kicking the issue down the road. It’s not dealing with getting people from an addictive state to where they are clean and sober. That’s what we need to do.”

As for cannabis legalization, Phillip said, “I just shake my head when I think of where we are at and the direction we are going.”

[email protected]

Twitter: @bramham_daphne


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