Portrayed with a Red Arrows aerobatics team’s poster, British High Commissioner Susan le Jeune d’Allegeerschecque, Consul General Nicole Davison and guests had just seen the real Royal Air Force jets fly past them. PNG
STRAIGHT ARROWS: A key factor in aerial combat — literally a matter of life and death — is to be in exactly the right place at exactly the right time. Having the sun behind you helps, too. Full marks, therefore, to the Royal Air Force’s Red Arrows aerobatics team that was scheduled for a Coal Harbour flypast at 1700 hours recently. With the declining sun glistening on their red-white-and-blue tail fins, the team’s BAE Hawk trainer jets skimmed over at 5 on the dot. As they banked and climbed away, workhorse aircraft — de Havilland Beaver and Otter float planes — resumed their everyday takeoffs and landings.
Vancouver Mayor Kennedy Stewart, Chief Constable Adam Palmer, Bard on The Beach artistic director Christopher Gaze and others watched the proceedings from the Pan Pacific hotel’s eighth-floor deck. They were guests of British High Commissioner to Canada, Susan le Jeune d’Allegeerschecque, formerly ambassador to Austria, and Vancouver-based consul-general Nicole Davison. “The Red Arrows are the best ambassador our country has,” said le Jeune d’Allegeerschecque, whose married name is more common in Brussels than London. As those two cities duke it out over Brexit, the fast-flying Red Arrows might remind Gaze and especially British Prime Minister Boris Johnson of Hamlet’s “slings and arrows of outrageous fortune.” Ditto for that soliloquy’s humbling conclusion: “And thus the native hue of resolution is sicklied o’er with the pale cast of thought.”
HAPPY ENDING: Cultural organization heads sometimes roll amid a blizzard of finger-pointing, trustee bickering and other nastiness. Not at the Vancouver International Film Festival where eight-year executive director Jacqueline Dupuis announced in July that she’ll leave at year’s end. Looking as relaxed and, dare one say, glamorous as in 2011, Dupuis launched the 38th annual festival by escorting director Atom Egoyan to a screening of his Guest of Honour feature film and to a gala later. Although called “a masterful piece of subtly sophisticated filmmaking” in the VIFF program, showbiz bible Variety deemed the Egypt-born Torontonian’s picture “hopelessly muddled … overplotted and under-reasoned, hysterical and stiffly earnest.”
CONSONANTAL DRIFT: If asked to define modern-day political equivocation, habitual phrase-tangler William Spooner might have replied with a self-defence tip: “Trust in judo.” Then again, his spoonerism of voters’ “elementary affluence” would entail a mere vowel movement.
MORE AID: Dr. Peter Jepson-Young succumbed to HIV/AIDS in 1992 at age 35. CBC-TV’s weekly Dr. Peter Diaries detailed his then-almost-inevitable approach to death. Founded that year, the Dr. Peter AIDS Centre and related foundation began caring for those still living. A decade later, Nathan Fong recruited fellow chefs to launch the annual Passions gala that reportedly raised a record $220,000 recently. Executive director Scott Elliott said the centre now helps clients deal with hepatitis C and supports older ones “isolated and not participating in health care.” It will soon offer twice-weekly programs for female HIV/AIDS patients, he said.
DIRTY DISHES: Wearing a whistle-clean apron, Dirty Apron co-founder David Robertson marked the cooking school’s 10th anniversary by launching his second cookbook, Gather. Some of the 100,000 folk he’s reportedly taught filled the Beatty Street joint to buy the book and sample such dishes as sake-braised pork belly, seafood and chorizo belly and Robertson’s sensational Thai-style coconut-lemon grass braised beef short ribs.
TAIPEI TIES: There were complaints when electioneering defence minister Harjit Sajjan attended a recent gala honouring China. Not so when San Francisco-based Taiwan Tourism Bureau director Linda Lin inaugurated Maggie Sung to head our town’s new information centre for the island China claims to own. The ceremony followed Vancouver’s recent 100-event TaiwanFest that began celebrating Taiwanese culture in 1991.
BED BUDS: As the huge IDS design exhibition ran downtown, furniture designer-manufacturer Kate Duncan and curator Amber Kingsnorth staged their own fifth annual show titled Address. It occupied five-times-larger premises at Malkin Street’s Eastside Studios. As well as mature and emerging exhibitors from Pacific Northwest states and Alberta, the event welcomed newcomers from Saskatoon, Toronto and Texas. Port Alberni-raised Duncan exhibited a solid walnut bed and side tables tagged at $30,000. Calgary native Kyle Parent added a $2,100 bedspread from his ktwpquilts.com concern.
GO EAST, YOUNG WOMAN: Vancouver’s creative activities are enhanced — some say dominated — east of Main Street. The 23rd annual Eastside Culture Crawl alone will include 500 artists, artisans and designers Nov. 14-17. The latter include interior designers Annaliesse Kelly and Madeleine Sloback who, although business competitors, share chic Pender Street premises. They mount thrice-yearly exhibitions there, most recently by Mexican-born painter Miriam Aroeste and Okanagan-raised photographic artist Sandra Lowe.
TOP HAT: California-based Canadian Paisley Smith wore a simulated oil-pipeline helmet to promote her “immersive” VIFF film, Unceded Territories. Screening in a Vancity Theatre kiosk to Oct. 2, it addresses climate change and Indigenous civil rights with animated interpretations of works by Cowichan/ Syilx artist Lawrence Paul Yuxweluptun whose usual headgear is a four-feathered straw fedora.
DOWN PARRYSCOPE: Crown yourself inventively for Mad Hatter Day Oct. 6.
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.
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.
Dr. Ryan Flannigan inside VGH’s Robert Ho research building in Vancouver. Dr. Flannigan is leading a study on a new way to treat scrotum pain. Photo: Arlen Redekop/Postmedia Arlen Redekop / PNG
Males who suffer debilitating scrotal pain can now sign up for a new study using an old but reformulated numbing medication with lidocaine.
Nearly five per cent of males can suffer so much that mere walking can be painful if they have chronic pain in their testicles and scrotum, the latter of which are the sacs of skin surrounding the testicles.
Dr. Ryan Flannigan, a Vancouver General Hospital urologist who is the director of the male infertility and sexual medicine research program at the University of B.C., said that he has seen up to 100 men with chronic scrotum pain in the last six months alone. Some patients come from as far away as the Northwest Territories. But many men don’t bother to seek medical attention because, as Flannigan points out, males are generally more reluctant than women to go to doctors and more inclined to brush off medical concerns.
Flannigan, who specializes in testicular and penile abnormalities, said testicular pain is described by patients as either constant aching or episodes of sharp pain.
The scrotal pain condition occurs in a range of ages — from teenagers to men in their ’60s — but it most commonly affects those in their 20s and 30s, Flannigan said.
While conventional treatment has involved injecting a lidocaine anesthetic into the spermatic cord to help numb pain, it is temporary relief for only up to four hours. So in the new study, soon to enrol 20 patients, lidocaine will be reformulated into a polymer paste that is designed for a slow, more sustained release, over seven to 14 days.
The needlepoke through the skin at the top of the scrotum into the spermatic cord can be uncomfortable but Flannigan said he tells patients “it’s like a visit to the dentist when the freezing goes in.”
The paste, developed by a UBC spinoff company called Sustained Therapeutics (which is funding the study), will be injected into tissues, not blood vessels. Flannigan said the polymer material will “naturally break down” as it is metabolized.
Besides lidocaine-based injections, other treatments that may be tried include anti-inflammatories, steroids, and sometimes even surgery to cut nerves that are transmitting the pain. Physiotherapy can also help when the pain originates in another area of the body and is referred to the testicles.
Preclinical trials in animals at UBC affirmed the safety and proof of concept behind the intervention. Now the goal of the Phase 1 trial in humans will be to determine a safe and effective dose.
Flannigan said common causes of the condition include a blow to the testicle area, a previous infection in the area, inflammation in the spermatic cord that stores and carries sperm, and nerves pinched during hernia repair or a previous vasectomy. Pain can also be caused by enlarged veins in the scrotum, cysts, or kidney stones. The cause remains unknown in nearly half of cases.
Flannigan said men from around B.C. — or even outside the province — will be considered for the trial. To register an interest, males should contact the clinical trials unit at the Vancouver Prostate Centre or call 604-875-5675.
Dr. Kim Ch, who led a clinical trial which found that over half of patients who used a new type of hormone-reducing medication saw a reduction in their risk of cancer progression and a 33% improvement in overall survival, in Vancouver BC., June 10, 2019. NICK PROCAYLO / PNG
A new drug has helped reduce the risk of death by 33 per cent in men with prostate cancer that has spread, according to the results of an international trial led by the B.C. Cancer Agency’s Dr. Kim Chi.
The double-blind study on the androgen receptor inhibitor drug called apalutamide was conducted in 23 countries at 260 cancer centres. It involved 1,052 men whose median age was 68. The study was sponsored by Janssen, the drug company who makes apalutamide.
At two years, those taking the treatment drug in addition to their standard treatment had a 52 per cent lower risk of cancer spread or death.
Chi, an oncologist, said overall survival rate is only about five years once prostate cancer has spread beyond the prostate so new treatments are desperately needed. The percentage of patients who took the drug whose cancer did not spread was 68.2 per cent, but in the placebo group the proportion was 47.5 per cent. There was a 33 per cent reduction in the risk of death for those who took the drug.
After about two years, 82 per cent of men in the investigational drug group were alive compared to 74 per cent on placebo. Men in both groups also took standard male hormone deprivation therapy showing that combination therapy helps to improve survival. Male hormones (androgens) like testosterone feed prostate tumours and currently, men with metastatic cancer are put on hormone deprivation treatment that has been the standard of care for many decades. Apalutamide, also called Erleada, is said to more completely block male hormones.
Chi said the drug is “not toxic” and there were no significant differences in the proportion of study participants in the intervention or placebo groups who experienced side effects, but skin rashes were just over three times more common in the drug group.
The drug has already been approved in Canada for certain patients with hormone-resistant, non-metastatic cancer but Chi said now that it is showing benefit for patients whose cancer has spread, he expects the drug will be approved by Health Canada for those patients as well, perhaps later this year. After that approval, provinces will have to decide on whether to expand funding for the drug, which costs about $3,000 a month. Chi said he expects more Canadian patients will have access to it next year.
“This is a next generation, better-designed androgen inhibitor and we really need better drugs for those with metastatic prostate cancer,” Chi said.
“There’s a critical need to improve outcomes for these patients and this study suggests this treatment can prolong survival and delay the spread of the disease.”
Chi was also a co-author on another drug trial, the results of which were published in the same issue of the NEJM medical journal. The ENZAMET trial, as it was called, is on a drug called enzalutamide (Xtandi). The results of that trial were similarly favourable.
About 2,700 men will be newly diagnosed with prostate cancer in B.C. this year. More than 600 men will die from it.
Backed by a blow-up of Duomo di Milano cathedral, Ross Bonetti increased the La Dolce Vita flavour of his Italianate Livingspace store’s expansion party by straddling his two classic Vespa scooters. Malcolm Parry / PNG
CHAMPS NIGHT: Chaired by Michelle Collens and Tewanee Joseph, the B.C. Sports Hall of Fame’s recent gala was replete with memories. It couldn’t be otherwise with inductees like the 1968 New Westminster Salmonbellies lacrosse team, 1975 NFL Super Bowl winner Roy Gerela and 1977 Vancouver Whitecaps coach Tony Waiters. Also inducted were 17-season Vancouver Canucks Daniel and Henrik Sedin.
When seen in this column in 2002, the twins displayed deft passing skills. Not with the puck but with bottles of wine that then-Canucks GM and former part-time bartender Brian Burke had them serve at a benefit for Canuck Place children’s hospice. Back at the gala, rugby-star inductee Kelly McCallum heard honorary co-chair Marvin Storrow call her sport “a game of skill, not for me.” Then again, 1934-born Storrow does play hard, skilful tennis four times weekly.
MORE TWINS: Shanghai-born siblings Jim and Pat Carney shared an 84th birthday May 26. They’ll celebrate again June 28 at Pat’s induction into the Order of British Columbia. The honour likely acknowledges her years as an MP, cabinet minister, senator and best-selling author rather than early-career slogging as a Vancouver Sun reporter.
MILES AHEAD: At the Polygon Gallery, Rogers Group of Funds chair Phil Lind presented a $5,000 emerging-artist prize to movie maker Jessica Johnson. It recognized her Scotland-set 14-minute documentary, Hazel Isle. Lind also fronted a reception for regional film and television producers on Vancouver Art Gallery’s rooftop patio. No one present, especially departing VAG director Kathleen Bartels, quibbled with his assertion that “Vancouver has the best artists in Canada — by 10 miles.”
SPACEMAN: The Armoury district’s free-standing Livingspace store always had room aplenty for swish European furniture. There’s even more now that building owner Ross Bonetti has expanded the fifth floor to accommodate specific-brand showrooms. As usual, Bonetti pulled out all the stops — and his two La Dolce Vita-style Italian Vespa scooters — for a recent relaunch party. He rides the mint-condition 1969 and 1971 Sprint models around town, but not astride both as he demonstrated with them parked. Ever the showman, perhaps he’ll master Ben Hur-style riding for his next event.
PICTURES FOR PETER: Eighteen artists, from Thomas Anfield to Elizabeth Zvonar, didn’t stint when donating works for live auction at the Dr. Peter AIDS Foundation’s recent Art For Life event. Twenty-four others gave to its silent auction. With supporters filling Pender Street’s The Permanent hall, foundation executive director Scott Elliott reported $185,000 being raised.
TRANSFORMER TODAY: Imagine the wonderment of coastal longhouse dwellers when performers manipulated carved-cedar masks so that the creatures they depicted seemed alive. Something similar pertains at Sarah Macaulay’s First-off-Scotia gallery where long-established artist Lawrence Paul Yuxweluptun’s first sculpture is displayed. The mask-headed work echoes figures in Yuxweluptun’s large paintings that fetch over $100,000. Step in front, though, and the mask becomes a confusion of multicoloured pieces. The spooky change represents “the process of what drugs do, and this can happen to you,” said Yuxweluptun, who named the $45,000 sculpture Opioid Ovoid Humanoid. There’ll be four more, he added.
SUMMER WINNERS: The 11-day Indian Summer Festival will begin with its usual Roundhouse Community Centre party July 4. Revving up for that, organizers Sirish Rao and Laura Byspalko staged an Odlum Brown-sponsored banquet that reportedly raised $100,000 with the slogan: The Future Is Asian. That’s the title of a new book by geo-strategist Parag Khanna, who addressed attendees. His assertion is supported by the multinational Standard Chartered Bank’s 2017-to-2030 projection for global economies. It foresees China’s GDP rising to $64.2 trillion, India’s to $46.3 trillion and the U.S.A.’s to $31 trillion. Meanwhile, Canada, France and the U.K. lose their global top-10 positions.
ROUNDER BOUT: Old-time Howe Street flickered again on Hornby Street recently. That was when Neil Aisenstat opened Hy’s Encore restaurant’s upper room to those attending a wake for 1988 Promoter of The Year Harry Moll who died at age 83 on April 25. Although most old Vancouver Stock Exchange habitués arrived on foot, Tevie Smith pulled up in his somewhat symbolic “termite taxi,” a junk-festooned 1947 Chrysler “woody” sedan with 300,000 miles on the clock and two rescue dogs on its duct-taped seats. As for the chi-chi era, wake attendees Sonja Chopty, Renata Hofer (who flew in from Zurich), Margaret McFaul and Beverley Robinson recalled partying in the Moll-launched Sneaky Pete’s, Charlie Brown’s and Sugar Daddy’s nightclubs. Moll’s 1994-divorced wife Suzy was unavoidably out of town but still speaks warmly of him.
THE DRILL: Regarding the old stock exchange’s freebooting mining promotions, a contemporary of Moll’s once said: “Sometimes we drill the ground, and sometimes we drill the sky.”
DOWN PARRYSCOPE: Canadians and Americans wrangling over the North Pole’s ownership might recall that cheeky London journalists long ago determined principal-resident Santa Claus’s citizenship. A bewhiskered, overstuffed fellow who feasts on cookies and works one day a year would be a fellow Brit, they said.
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.
Canadian governments are addicted to the revenue from alcohol DALE DE LA REY / AFP/Getty Images
With so much focus on illicit drugs and overdose deaths, it might seem that opioids are the biggest addictions problem. Far from it.
Alcohol kills many more people each year (14,800 in 2014), results in more hospitalizations annually than heart attacks and is one of the most expensive and intractable health problems.
While cannabis was legalized a year ago and B.C.’s chief medical health officer is pushing hard for decriminalization and ultimately legalization of all illicit drugs, two Canadian addictions research centres want tougher regulations to mitigate the costs and harms of alcohol use and addiction.
The Victoria-based Canadian Institute for Substance Use Research and the Toronto-based Centre for Addiction and Mental Health want a minimum price of $3.50 for a standard drink in a bar or restaurant and $1.75 for off-premise sales. They also want a national minimum drinking age of 19, which is a year higher than national minimum for cannabis. Those are just two of the recommendations in reports they released last month that look at federal, provincial and territorial alcohol policies.
The reports also calling for stricter guidelines for advertising, restrictions on manufacturers’ and retailers’ promotions on digital and social media platforms, and a federal excise tax based on alcohol content that would replace the GST.
Over the past decades, the researchers found an erosion of effective policies and regulations.
“Overall, alcohol policy in Canada has been largely neglected relative to emerging initiatives addressing tobacco control, responses to the opioid overdose crisis, and restrictions imposed on the new legal cannabis market,” their report on the provinces and territories says. In several jurisdictions — Ontario is the worst example — “customer convenience and choice are being given priority over health and safety concerns … the responsibility of governments to warn citizens of potential risks is largely absent.”
British Columbia got a bare pass at 50 per cent based on its potential to reduce alcohol-related harm, which is not good. But it’s still better than the national average of 43 per cent.
Alcohol-related harm was estimated at $14.6 billion in 2014, according the Canadian Centre on Substance Use. Productivity loss due to illness and premature death accounts for $7.1 billion. Direct health care costs add another $3.3 billion and $3.1 billion is spent on enforcement costs for this legal drug.
Tobacco was second at $12 billion followed by opioids at $3.5 billion and cannabis at $2.8 billion. But the data predate the opioid overdose crisis and cannabis legalization.
Alcohol’s costs and harms reflect the fact that 80 per cent of Canadians drink. It’s not surprising. Culturally, we associate drinking with celebrations and good times. It’s We’re bombarded with images in movies, TV and ads of beautiful people drinking and having fun.
Scarcely a week goes by that there isn’t a “good news” story about research showing that a glass of red wine might be good for your heart or that yet another populist politician is campaigning on a promise to slash the price of beer.
Yet less was made of University of Washington’s Global Burden of Diseases Study last summer that found alcohol was the leading factor in 2.8 million premature deaths in 2016 and is so harmful that governments ought to be advising people to abstain completely.
One problem is that Canadian governments are addicted to the revenue from alcohol. Liquor sales and taxes provided $12.15 billion to federal and provincial governments in 2017/18 — $1.6 billion more than five years earlier, according to Statistics Canada.
Last year, liquor consumption rose in British Columbia, which already had the highest drinking rates in Canada. There were also record sales, which meant that in addition to tax revenue, the Liquor Distribution Branch provided $1.12 billion in earned revenue, up from $1.03 billion two years earlier.
Good for taxpayers? Not really. The reports by the substance-abuse centres recommends B.C. “reconsider the treatment of alcohol as an ordinary commodity: Alcohol should not be sold alongside food and other grocery items as this leads to greater harm.”
It’s based on research done last year by Tim Stockwell of the Canadian Institute for Substance Use Research. He and his researchers found that when access to alcohol is easier, more people die.
Between 2003 and 2008, “a conservative estimate is that the rates of alcohol-related deaths increased by 3.25 per cent for each 20 per cent increase in stores density.”
Estimates have to be conservative because alcoholics’ fatalities are mistakenly counted as death from one of more than 200 other kinds of alcohol-related fatalities including car accidents, suicide, liver diseases, cancers, tuberculosis and heart disease.
What’s surprising is that more than a century after legalization, there are no federal or provincial policies aimed specifically at mitigating alcohol’s harms and costs.
The opioid crisis has been the catalyst for governments to finally think about addictions and drug-use policies and, it’s now impossible to ignore the slower moving crisis caused by alcohol abuse and addiction.
In the coming months, the B.C. health officer also plans to release an alcohol addictions report. The B.C. Centre on Substance Use recently developed guidelines for best practices in treating alcohol addiction, but the provincial government has yet to approve or release those.
Prohibition proved a failure. Yet, legalization and regulation are not panaceas either. Because even with more than 100 years of experience, there is still no jurisdiction in Canada or anywhere else that seems to have got it right.
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