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9Aug

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

by admin

As of today, Karly has been clean and sober for 30 days after four years of battling addiction.

Addiction made the 17-year-old from Chiliwack vulnerable to exploitation and bullying. It disrupted her schooling, left her psychotic, suicidal, near death and unable to care for her year-old baby.

“In addiction, I never thought I could be this happy without drugs,” she said earlier this week.

“There’s obviously times when I’m feeling like I don’t want to live any more. But I realize a lot of people do care for me, and it would hurt a lot of people if I did leave.”

Up until now, Karly didn’t worry that fentanyl laced in the cocaine, crystal meth and other street drugs she’s used might kill her, as it has more than 4,000 other British Columbians in the past four years.

“Honestly, I just thought I wasn’t going to get that wrong batch. I thought I could trust my dealers. Now, I’m starting to realize the risk. I was using alone. It’s pretty scary now that I think about it.

“I could have overdosed, my poor son he would have had no mom.”

But Karly’s recovery is at risk because the B.C. government is refusing to pay for her treatment. The question of why was bounced from the Ministry of Mental Health and Addictions to the Ministry of Children and Family Development, back to addictions, then back to MCFD, and finally to Fraser Health over two days.

Friday afternoon, MCFD responded that due to privacy concerns it could not discuss the specifics of the case.

The spokesperson did confirm that the government pays for youth residential treatment. Funds are allocated by the health ministry to regional health authorities. MCFD social workers are supposed to refer youth and families to the health authority, which is supposed to do the assessments and placements.

Reached late Friday afternoon, Fraser Health said that it does not have provincial funding for youth beds at Westminster House, where Karly is getting treatment, only adult beds.

Postmedia editors and I are also concerned about Karly’s privacy and vulnerability. For that reason, we are not using her real name, or that of her mother.

•••

On July 10, her mother Krista found Karly white-faced and barely breathing on the floor. It was a moment she had been bracing for since 2015.

Krista, who is a nurse, didn’t need the naloxone kit that she keeps at the ready. She shook Karly awake and got her into the car to take her to Surrey Creekside Withdrawal Management Centre.

En route, Karly flailed about, kicking in the glove box, banging her head against the window and screaming.

“She was in psychosis. She was not my child,” Krista said. “It took six nurses and two doctors to get her inside.”

At 9 p.m, Karly called her mom to say that if they didn’t let her out, she was going to escape, prostitute myself and get enough money to kill herself.

“I felt in my heart that she was really going to do it.”

Panicked, Krista called Susan Hogarth, Westminster House’s executive director, and begged for help. Westminster House is a residential treatment centre for women, with four designated youth beds in New Westminster.

Even though it was past midnight, Hogarth agreed to take Karly.

“We can’t not put a child somewhere,” Hogarth said this week.

The cost for treatment at Westminster House is $9,000 a month, meaning Krista needs $27,000 to pay for the three months of treatment that counsellors say Karly needs to be stabilized enough to go into second-stage care.

The crucial first month of treatment was covered using donations from individuals, and Hockey for the Homeless.

Now there are bills to be paid.

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Krista’s only contact with the government has been through MCFD. A social worker helped Karly get mental health services, pre- and post-natal care and helped Krista gain guardianship of her year-old grandson last month.

It’s the social worker who told the family that the government would pay for a 10-week, co-ed live-in treatment program at Vancouver’s Peak House, but not Westminster House.

But Krista and Westminster House’s director believe a co-ed program that has no trauma counselling is not a good fit for Karly.

The only other option suggested was outpatient treatment. But Karly’s already tried and failed at that. Besides, her dealer lives two blocks from their home.

If Karly was an adult on welfare, the Ministry of Social Development and Poverty Reduction would pay $30.90 a day for her room and board in residential care.

Bizarrely, Krista said the social worker suggested maybe Karly could just wait a year and then her treatment would be fully covered.

“This is f–ing BS. I can’t wait until she’s older. She’ll be dead,” said Krista, who has had her own problems with addiction. An alumni of Westminster House, she is four years into recovery.

Concerns about how to pay for Karly’s treatment in addition to caring for Karly’s baby and Karly’s younger sister are wearing heavily on Krista. She’s had to take a medical leave from her job, and is worried about how she will pay her rent.

She’s already spent four years in a constant state of readiness in case Karly overdoses. There’s naloxone in the house. The razors are hidden because “Karly cuts, cuts.” Every time Karly took a bath, Krista stood apprehensively by the door because her daughter had threatened to drown herself.

But now?

“She is doing amazing,” Krista said. “The first time I saw her was 15 to 16 days in, and she had colour in her cheeks and they were my kid’s eyes, beautiful brown . . .

“When I brought her son to see her, her smile so genuine. I had not seen it in so many years. The smile was what I remember of her as a kid.”

Hogarth wonders why the government can’t look at the bigger picture of what Karly’s untreated addiction might cost — from more overdoses to her mother’s fragile state to the fate of her son.

Everybody, Hogarth said, deserves a chance at recovery and not just harm reduction interventions.

“Karly is not the easiest client in the world,” she said with a laugh. “But she’s worth it because we want her to go home to her son and to be able to raise him.”

For now, the non-profit Westminster House is covering Karly’s costs with donations augmented by a GoFundMe campaign organized by Krista’s friends.

But it can’t do that forever, or without more donations.

As for Karly, for the first time in years she’s thinking about a future. She won’t be ready to start school in September, but plans to go back as soon as she can for Grade 12 and then go on to study so that she can work in health care.

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

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19Jul

Daphne Bramham: Failure to enforce recovery house standards cost two men their lives

by admin

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.”


Step by Step recovery house at 9310 132nd Street in Surrey where Zach Plett overdosed in December.

Jason Payne /

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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.


Zach Plett.

PNG

Low tolerance

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.”


Zach Plett with his sister Cassie Plett and Maggie Plett in Manitoba.

PNG

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.

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Twitter: @bramham_daphne


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18Jul

Ian Mulgrew: Medicare expert, lawyer spar to end landmark trial

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The B.C. Government’s defence in the landmark three-year-old Medicare constitutional trial in B. C. Supreme Court is ending not with a bang but a testy, two-day courtroom sparring match involving one of its experts.

Dr. Gordon Guyatt gave as good as he got, repulsing a prolonged assault on his objectivity and left the stand Thursday having provided some last-minute fireworks but seemingly little insight on the key issue — wait-lists and the effects of constraints on access to private care in the provincial Medicare Protection Act.

“My perception is that there’s been a fluctuation of concerns with waiting lists and that governments have, to an extent, addressed things,” he said.

“Things can always get better … you have tensions — constant tensions — in every health care system in the world, and problems will never be solved.”

A specialist in internal medicine and, for almost 35 years, a health researcher at McMaster University, the argumentative Guyatt was assailed as more of an ideological warrior than a disinterested expert.

Robert Grant, lawyer for the two clinics and handful of patients behind the legal challenge over barriers to access to private care, portrayed Guyatt as a virulent opponent of the private clinics and Dr. Brian Day, the driving force behind the decade-old litigation.

Noting he had a duty to be impartial, Guyatt bristled at the broadsides aimed at impeaching his credibility.

“Given my, given that commitment, I do not see personally as relevant further pursuit of my opinions about issues beyond the issues that I’ve been asked to comment on in my deposition,” he complained.

“Thank you for that,” Justice John Steeves said. “In the meantime, just answer his questions.”

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Government lawyers vainly tried to halt the brutal cross-examination that battered Guyatt’s neutrality.

A self-described left winger who ran repeatedly as an NDP candidate, Guyatt has been a social activist for 40 years.

In 1979 he co-founded the Ontario-based Medical Reform Group, which disbanded in 2014 and was replaced by the Canadian Doctors for Medicare, which he joined.

He was also a director of the Ontario Health Coalition, an activist network, that along with its sister group the B.C. Health Coalition, is a member of the Canadian Health Coalition.

Doctors for Medicare and the B.C. coalition, under the banner of B.C. Friends of Medicare Society, have intervened in the challenge to support the government case.

Grant accused the groups of wrongly asserting Day seeks “U.S.-style health care for Canada, where people go bankrupt, lose their homes and life savings, or worse, because they can’t afford treatment when they need it.”

The B.C. coalition, he said, incorrectly claimed Day wanted a system where “international private insurance corporations run the show and patients foot the bill.”

Grant said the groups were fearmongering.

“It is an overstatement that this case could bring down single-tier Medicare,” Guyatt agreed, adding he also did not endorse the portrayal of Day and his supporters as “greedy, awful people.”

He maintained he was too busy to keep up with everything the groups did,  and distanced himself from the inflammatory rhetoric.

“The way I would put it is that we were advocates for equitable high-quality health care accessible to people without financial obstacles,” he said.

“So, specifically, as I have said previously, I believe that it is more appropriate to base care on the need — the medical need than on ability to pay — and I would like to work, continue to work, in a system where the patients I treat are treated on the basis of need rather than ability to pay.
”

“I understand,” Grant replied.

“But the point (of the trial) isn’t about what you want to do in your own practice; it’s whether or not increased private health care, and specifically private-pay surgeries, will be permitted or not. And you are opposed to increased private-pay surgeries. Isn’t that right?
”

“Yes,” Guyatt confirmed.

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Grant insisted Guyatt was a vocal opponent of Day within the Canadian Medical Association, seeing him as a “tragic choice” and “a complete disaster” as the organization’s president.

“I don’t recall active involvement in that matter,” Guyatt said, but again added such comments would be “hyperbolic.”

The Ontario specialist attacked the concept of using “benchmarks” to measure surgical waiting times — saying “not much” research has been conducted to establish what is acceptable and he suggested they were undependable tools set by “good old boys sitting around the table.”

But Guyatt has long minimized waiting lists and their ill effects — calling them “a problem that may be much smaller than we imagine” in 2004.

And he acknowledged he was not familiar with the circumstances in B.C.

“Certainly not in detail …. I do not know the details of the extent of waiting lists currently. I am sure that waiting lists remain a problem. … and that they’re not optimal … I do not know well enough to know whether it would be appropriate to characterize them as a serious problem or not.
”

The final witness John Frank, an expert on social determinants of health, took the stand later on July 18 and was to finish July 19 — day 179 of the proceedings.

“When this trial began I thought it would last up to 18 weeks (three times longer than the similar Chaoulli case in Que.),” said Day, founder of the private Cambie Surgery Centre.

“I am happy that — almost 3 years later — the witness phase is over. I am confident that the justice system will eventually grant all Canadians the same rights to protect their health that the Supreme Court of Canada granted to citizens of Que., and that the citizens of every other country in the world enjoy.”

Justice Steeves plans to hear final arguments this fall and begin deliberations in December.

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11Jul

Metro Vancouver to aim for zero greenhouse gas emissions by 2050

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Vancouver city councillor Adriane Carr.


Gerry Kahrmann / PNG

Vancouver city councillor Adriane Carr wants Metro Vancouver to reach a goal of 100-per-cent net reduction in greenhouse gas emissions over the next three decades.

On the road to 100 per cent, Carr says the region should set an interim target of reducing GHGs by 45 per cent by 2030.

Carr will be asking the regional governing body to support the 100-per-cent goal so that Metro Vancouver is in alignment with a special international report on the climate crisis.

“Scientists say that’s exactly what’s needed,” Carr said Thursday. “The world’s leading scientists issued a report in the fall of 2018 that implored governments to act with urgency. The climate is changing faster than they earlier predicted.”

Cutting GHGs by 100 per cent in Metro Vancouver requires updating the Climate 2050 Strategic Framework, which calls for an 80-per-cent reduction.

On Friday, Carr is bringing her amendment to the regional Climate Action Committee of which she is chair.

If approved, it would go to the full Metro Vancouver board for a vote on July 23.

A 100-per-cent net decrease in GHGs would bring the region into alignment with the Special Report on Global Warming by the Intergovernmental Panel on Climate Change, which provides the United Nations with a scientific analysis of climate change.

The panel’s report said if global warming is not kept to 1.5 degrees C, it could lead to more periods of drought, increased wildfires, and place entire ecosystems at risk.

To reach the 1.5-degree target, it would require “rapid, far-reaching and unprecedented changes in all aspects of society,” the panel’s report stated.

Carr admits that becoming carbon-neutral requires systemic change in Metro Vancouver.

“The first step is reaching out to the public in the development of roadmaps to get to these kind of reductions,” she said. “I’m counting on the public and stakeholders to get us to where we’re aiming to keep global warming at a level that avoids catastrophe.”

Carr pointed out that the 100-per-cent net reduction in GHG emissions recognizes that not all fossil fuels will be eliminated by 2050. What it means is that any GHG emissions by then will be offset by methods such as sequestration, a form of long-term storage of carbon dioxide by reforestation and wetland restoration.

The 2030 target of 45 per cent is important, Carr said, because it’s an interim measure which allows public bodies to assess how they’re doing over time.

Vancouver set a goal in 2010 of a 33-per-cent drop in GHGs by 2020. Part of the reason why Vancouver is now only at seven per cent, she said, is because there were no interim targets.

Climate change has already had an affect on Metro Vancouver, the Climate Action Committee report said.

“As one example, the region has been impacted by smoke from unprecedented wildfire activity in western North America in three of the past four summers,” it said. “Expected future climate impacts include more wildfire smoke, an increase in rainfall intensity by 20-45 per cent by 2050 and 40-75 per cent by 2100, and at least one metre of sea level rise.”

The report goes to say that achieving carbon neutrality requires Metro Vancouver to not only reduce GHG emissions as much as possible, but also to commit to using “100 per cent renewable fossil fuel-free energy by 2050.”

Across the country, more than 250 local governments have declared climate emergencies.

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10Jun

New drug helps extend survival rate of men with advanced prostate cancer: B.C. Cancer Agency study

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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.

The findings of the TITAN (Targeted Investigational Treatment Analysis of Novel Anti-androgen) trial which began in 2015 are published in the New England Journal of Medicine (NEJM). Results were also recently presented by Chi at the annual meeting of the American Society of Clinical Oncology.

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. 

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28May

Daphne Bramham: More needed to redress the tragic fact that Indigenous people are disproportionately victims of opioid crisis

by admin

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.

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Twitter: @bramham_daphne


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26May

Daphne Bramham: Tougher new regulations promise more agony for chronic pain-sufferers

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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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3May

B.C. couple recalls being wrongly imprisoned in China

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During the fifth month of her wrongful imprisonment in a tiny, perpetually lit jail cell in China, Julia Garratt scribbled in her Bible that she was feeling hopelessness and was longing for heaven.

Julia and her husband, Kevin Garratt, had spent 30 years in China as teachers, entrepreneurs and Christian aid workers. Then, in 2014, they were accused by the Chinese government of being spies, in retaliation for Canada’s arrest of a Chinese businessman. Julia spent six months in jail; Kevin was locked up for nearly two years.

Since then, relations between China and Canada have grown even more tense, with Canada’s arrest of Huawei executive Meng Wanzhou in December. Today, China is impeding the import of Canadian goods and there are several high-profile cases of Canadians languishing in Chinese jails.

Businessman Michael Spavor and ex-diplomat Michael Kovrig were jailed in China on Dec. 10, and experts believe it was to even the score after Meng’s arrest.

The Garratts — who share a similar story because it is now known they were seized in retaliation for a Chinese businessman’s arrest in Vancouver — have a unique perspective on how Spavor and Kovrig may be feeling five months into their captivity.


Michael Kovrig, left, and Michael Spavor.

Julie David de Lossy via AFP/Getty Images; AP

While incarcerated, the Garratts kept up their spirits by reading the Bible and writing inspirational thoughts, but also fought off despair — especially as time wore on, as it has for Spavor and Kovrig, who have now been imprisoned for 145 days.

“’If this is my new life, am I going to give up or am I going to somehow live it in here?’ I think those are the questions (we) wrestled with in an ongoing way, especially in month 4 and month 5. Because you never know what is coming the next day,” Julia said during an interview in New Westminster, where the couple now lives.

“Now that it is happening to (Spavor and Kovrig), I can totally relate to what they must be feeling and going through,” added Kevin.

Meng, who was arrested in Vancouver at the request of the U.S. government, is free on bail while waiting an extradition hearing, which could send her to the U.S. to face accusations of violating trade sanctions on Iran.

“China is likely to hold on to (Spavor and Kovrig) until Meng is released. This is the sad reality,” said Yves Tiberghien, a UBC political science professor and executive director of the UBC China Council.

It is unfortunate that Canada arrested Meng, he said in an email to Postmedia, arguing this country “became a pawn” when it detained the executive on behalf of the U.S. “(But) this point cannot excuse China’s arrest of the two Michaels and their harsh conditions. The whole situation is very unfortunate and painful.”

The men, who have been accused of stealing Chinese state secrets but have not been charged, are kept in isolation with little contact with the outside world and in cells with the lights constantly on, which some experts say is equivalent to torture.

Tiberghien believes China’s recent clampdown on importing Canadian canola seed was also in retaliation for Meng’s arrest. “It is unfortunate that such further escalation took place,” he said.

The diplomatic dispute worsened this week, with Canadian sellers of soybeans, peas and pork hitting obstacles at Chinese ports and with a second Canadian on death row for drug crimes — a sentence Foreign Affairs Minister Chrystia Freeland called “cruel and inhumane.”

Two former ambassadors to Beijing are urging Canada to take a harder stand against China but Prime Minister Justin Trudeau told reporters this week he had no plans to retaliate, saying his government is working for resolutions.


Kevin and Julia Garratt flip through the Bibles they had while jailed in China.

Today, the Garratts are saddened to see other Canadians face fear and uncertainty behind bars in China.

“There is such a human cost to all these political things. And after all the dialogue that happened back and forth between our countries over our case, I was so disappointed that another similar case erupted,” Julia said. “I was really hoping that wouldn’t happen, that (we) would have paved a new pathway to another solution to some of these political problems.”

As they reflect on their imprisonment with a remarkable lack of bitterness, the couple would like their survival and eventual release to provide encouragement to those in a similar situation.

“We would say, ‘You have to hold on to hope,’” Kevin said. “I’m hoping that maybe we offer a little bit of hope that you can get through it, although it is incredibly difficult.”

In 1984, after graduating from university in Ontario, newlyweds Julia and Kevin Garratt went to China for a “big adventure,” planning to teach English there for a year. Instead, they stayed for three decades.

“We just loved it,” Kevin said.

They thought China was a good fit for their passions for teaching, starting new businesses and providing aid to needy people.

They taught at universities, developed a model kindergarten and started a small NGO that helped to expand an orphanage.

In 2007, the Garratts, who had three children and adopted a fourth while living in China, moved to Dandong, a large city on the border with North Korea.


Kevin and Julia Garratt at the opening ceremony of their coffee shop in Dandong.

While Julia taught at the local university, the family opened a popular coffee shop that offered English-speaking nights, business dinners and talent shows.

By 2014, three of the Garratts’ grown children were studying or working in Canada, while the fourth was in university in China.

Nothing seemed amiss until that August.

When a mutual friend asked them to have dinner with a couple whose daughter was going to the University of Toronto, the Garratts’ alma mater, they agreed. When they arrived at the restaurant, the other couple said their daughter had a toothache and could not come.

“But we weren’t thinking anything sinister about it because they were friendly and nice,” Julia said.

After dinner, the Garratts rode the elevator to the lobby. When the doors opened, the lobby was packed with people with cameras, and Julia told Kevin they should leave through a side door because it must be a wedding or other event.

“But it wasn’t an event. It was an abduction,” Kevin said.

“I thought, ‘They’ve made a mistake. They’ve taken the wrong people,’” Julia recalled. “In an instant, everything changed.”

The husband and wife were taken out different doors and into waiting cars. The couple would later learn the officers who snatched them worked for the Chinese ministry of state security, which is responsible for counter-intelligence and political security.

Speaking in Mandarin, Julia asked one guard what was happening.

“He said, ‘Don’t worry, you’re safe.’ I was thinking, ‘I’m not safe,’” Julia recalled. “You have a part of your brain that is panicking and a part of your brain that is praying.”

They drove Julia to a police station and examined everything in her briefcase, from teaching documents to paper clips. It took her a long time to understand she was accused of espionage because she hadn’t learned that word in Mandarin.

She was shocked but believed they would quickly realize they had the wrong person. It was when they ordered her back into the car that she became terrified. “At this point you think: ‘China has become extremely unpredictable. I have no idea what they are going to do next.’”

Kevin was in another room, surrounded by eight or 10 “intimidating” officers with cameras.

“They’re saying we think you’re spies, and I’m thinking, ‘How can you think that?’” he said. “After quite some time, I heard Julia crying, screaming down the hallway.”

His frantic wife was yelling, “We just came to help.”

Shaken, Kevin signed a document that gave the police permission to investigate him. He had no idea what would come next or why.

The couple had never heard of Su Bin, a Chinese businessman arrested in B.C. in July 2014. Bin was arrested at the request of the United States, where he was wanted for hacking the data bases of American defence contractors to steal military secrets. One month later, the Garratts were arrested by China.

“When we were released, then I was told the reason we were taken is because Canada arrested Su Bin here in Vancouver, and China wanted to trade us for him, and that didn’t work out because he was later extradited to the U.S., and China was stuck with us,” Kevin said in a recent interview.

After being dragged out of the police station, a terrified Julia was driven for an hour to an unknown destination.

“I thought, OK this might be my last night.” she recalled. “When I was going out in the middle of nowhere, I started worrying about my family, my parents, my son, because I thought this is one of those China-makes-you-disappear things.”


Before their arrest, Julia and Kevin pose with son Peter and daughter Hannah.

SIMEON GARRATT /

AFP/Getty Images

Kevin was taken to the couple’s rented apartment, where he watched 18 officers ransack the place. They tore the sockets out of the wall, pulled photos out of their frames, and cut open a pillar in the middle of the room. They found no evidence of espionage.

At 5 a.m., the officers told Kevin to gather some clothes. He also grabbed his and Julia’s Bibles, which would become a lifeline for the religious couple during their months of isolation.

For the next 775 days, Kevin existed in a grim room where he ate meagre meals and endured hours of daily interrogation, with only occasional visits from Canadian embassy staff or his lawyer.

“There were 14 people in my cell. And the cell was not very big. So basically the beds were all together and there was a small aisle down the middle and a washroom in the corner,” he said. “There was absolutely no privacy.”

Julia’s tiny cell, where the lights were on 24/7 and she was under the eyes of two guards, was in the same facility as Kevin’s, but she didn’t know that.

“They wouldn’t give me any information about whether Kevin was alive or dead,” she said.

Seconds felt like minutes, minutes like hours.

Besides 15 minutes of outdoor time in the dark, she left her cell only to walk a few steps to an interrogation room, where she faced six hours a day of questioning.

The words in their Bibles sustained them. For Kevin, it was Romans 8:28: “All things work together for good.”


Kevin Garratt points to passages in the Bible he had while he was jailed in China.

“At times I don’t think I could see how this was going to work for good, but you think: God, I have to trust you,” Kevin recalled. “Hopelessness and hope, they battle within you.”

Julia created a calendar in the front of her Bible and every day drew a picture of something for which she was thankful, like the time the guards replaced her heavy curtains with opaque plastic when she begged for sunlight, and then cut off a top layer of the plastic when she begged to see the clouds.

“If I focused on some of the kindnesses, it really helped me in the interrogations.”

There were also dark days, which she’d mark in her “Daily Thanks” calendar with a sign for sleeping as she tried to make it through by staying in bed. “There were times I couldn’t peel myself off the floor because of the overwhelming loneliness.”


The Daily Thanks calendar Julia Garratt kept in her Bible while jailed in China.

In her Bible, which also became her diary, Julia wrote about her feelings. In month 1, she remained optimistic, writing she was innocent and safe. In month 2, she expressed surprising compassion for her female guards, who were ordered to spend day after day with her in that tiny room. By month 3, she said, “the human part of you starts to despair.” In month 4 came anger and feelings of guilt over family and friends left with little information.

In month 6, when she describes leaning on God to get through the day, Julia was released on house arrest, but still endured daily interrogations while awaiting a trial on charges that would eventually be dropped. She was allowed to visit Kevin only once, when Canadian embassy staff told her his health was deteriorating.

“My next meal will either be with Julia or Jesus,” Kevin told the embassy workers.

“They really panicked because it sounded like he was very much giving up,” recalled Julia, who fought hard to visit her ailing husband.

“I walked into that room and saw Kevin in handcuffs and he’d lost a lot of weight, and he looked extremely pale as if he was not going to be able to survive. … It was very very difficult to see him because I couldn’t do anything to help him,” she said. “I gave him messages from our family to encourage him. And said people haven’t forgotten you.”

The visit helped immensely, Kevin said. “You go back to the same cell, but you hold on to that hope that it’s going to be OK. But you just don’t know when.”

In April 2016, Kevin was found guilty of being a spy, and that September was handed an eight-year prison term. Two days after his sentencing, he was suddenly deported to Canada — to his family and to freedom.

Kevin and Julie Garratt embrace at Vancouver airport following his return to Canada.


Kevin and Julie Garratt embrace at Vancouver airport following his return to Canada in 2016.

Gilmour, Kier /

Postmedia Wire

“I think it takes some time to feel, if you want to call it, “normal’ again. But I think really from day 1 of being released and being back together, we were happy and grateful for so many people who helped us,” Kevin said.

The couple, who continue to do aid work overseas, saw a psychologist and were careful about their integration back into society. But just enjoying regular life has been cathartic, said Julia.

“All of a sudden, the sky is amazing, food is amazing, everything you appreciate in a different way. So that kind of joy has incredible healing power also,” she said.

They just wish history wasn’t repeating itself.

“We feel sadness that this is happening again,” said Julia. “As far as we know, (Spavor and Kovrig) didn’t do anything. But they are being held in probably a very similar situation to what we were.

“We would say to them: You have to hold on to hope.”

SIDEBAR

Postmedia asked Global Affairs Canada for updates on the cases of several Canadians being detained in China. This information was provided Wednesday:

Ex-diplomat Michael Kovrig and businessman Michael Spavor

Arrested Dec. 10, presumably in retaliation for Canada’s arrest of Hauwei executive Meng Wanzhou.

• Canada continues to call for their immediate release and has raised concerns with Chinese authorities.

Richmond winery owners John Chang and Allison Lu

Arrested March 2016 in China, for allegedly under-reporting the value of the wine they export to China.

• Canada is “closely following the case.” 

 Robert Schellenberg

Arrested in 2014 for drug-related charges and sentenced to 15 years in prison in November 2018. A new trial on more serious charges was ordered after Meng’s arrest and in January he was sentenced to death.

• Canada is concerned China has “arbitrarily” applied the death penalty, has sought clemency for Schellenberg, and has asked Chinese authorities to ensure his appeal of the sentence is “fair and transparent.”

Fan Wei

Sentenced to death this week for his role in a methamphetamine ring.

• Canada has asked China to grant clemency to Fan, calling his sentence “cruel and inhumane.” 

Source: Global Affairs Canada 

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1May

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

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


Canadian governments are addicted to the revenue from alcohol


DALE DE LA REY / AFP/Getty Images

With so much focus on illicit drugs and overdose deaths, it might seem that opioids are the biggest addictions problem. Far from it.

Alcohol kills many more people each year (14,800 in 2014), results in more hospitalizations annually than heart attacks and is one of the most expensive and intractable health problems.

While cannabis was legalized a year ago and B.C.’s chief medical health officer is pushing hard for decriminalization and ultimately legalization of all illicit drugs, two Canadian addictions research centres want tougher regulations to mitigate the costs and harms of alcohol use and addiction.

The Victoria-based Canadian Institute for Substance Use Research and the Toronto-based Centre for Addiction and Mental Health want a minimum price of $3.50 for a standard drink in a bar or restaurant and $1.75 for off-premise sales. They also want a national minimum drinking age of 19, which is a year higher than national minimum for cannabis. Those are just two of the recommendations in reports they released last month that look at federal, provincial and territorial alcohol policies.

The reports also calling for stricter guidelines for advertising, restrictions on manufacturers’ and retailers’ promotions on digital and social media platforms, and a federal excise tax based on alcohol content that would replace the GST.

Over the past decades, the researchers found an erosion of effective policies and regulations.

“Overall, alcohol policy in Canada has been largely neglected relative to emerging initiatives addressing tobacco control, responses to the opioid overdose crisis, and restrictions imposed on the new legal cannabis market,” their report on the provinces and territories says. In several jurisdictions — Ontario is the worst example — “customer convenience and choice are being given priority over health and safety concerns … the responsibility of governments to warn citizens of potential risks is largely absent.”

British Columbia got a bare pass at 50 per cent based on its potential to reduce alcohol-related harm, which is not good. But it’s still better than the national average of 43 per cent.

Alcohol-related harm was estimated at $14.6 billion in 2014, according the Canadian Centre on Substance Use. Productivity loss due to illness and premature death accounts for $7.1 billion. Direct health care costs add another $3.3 billion and $3.1 billion is spent on enforcement costs for this legal drug.

Related

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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28Apr

Surgery delays deepen over compliance letters B.C. government has forced on surgeons

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Dr. Amin Javer and his team perform sinus surgery on a patient at False Creek Surgery Centre in Vancouver. That is where Mr. Justice John Steeves had his sinus surgery under a contract with Vancouver Coastal Health. But the provincial government has severed contracts between health authorities and clinics that allow patients to pay for their expedited surgeries.


Arlen Redekop / PNG

Patients are waiting even longer for operations like sinus or breast reconstruction because of the latest government crackdown on private clinics and the surgeons working in them, according to affidavits filed in court.

Sinus surgeon Amin Javer says he can’t even begin to make a dent in the number of patients waiting. That’s because he only gets four operating room days at St. Paul’s Hospital a month, allowing him to handle just 12 to 16 cases monthly.

He also operated on patients at False Creek Surgical Centre. But last fall, the government ordered Vancouver Coastal Health to end its contracts with False Creek because the centre was also taking money from patients who were paying the clinic’s facility fees to get expedited surgery.

Javer was the sinus surgeon who operated on the judge in the continuing constitutional trial launched by Dr. Brian Day. The judge would not be able to get that sinus surgery today because False Creek can no longer do business with the government. Yet False Creek is the only private clinic in B.C. with the sophisticated equipment Javer needs to do delicate sinus surgeries.

Not only can Javer no longer perform publicly funded operations at False Creek, but he’s also doing fewer at St. Paul’s because, as the hospital struggles to deal with growing waiting lists, his operating room days have been cut to eight hours from 10.

He has about 300 patients on a pre-surgical wait-list and another 220 waiting for surgery. “It will take me about four years to get through my current surgical wait-list.”

He used to tell patients they’d get their surgery in 2.5 years. Now Javer, the head of the St. Paul’s Sinus Centre and co-director of ear, nose and throat research at UBC, says he has to tell them the waiting time has gone up to four years.

“There’s no outsourcing at all, so the wait-list at the hospital continues to grow. And there’s no extra time being given to surgeons at public hospitals. All that extra operating room time we were promised hasn’t happened,” he said.

Dr. Nancy Van Laeken, a plastic surgeon who performs breast reconstructive surgery on breast cancer patients, said in her affidavit that the government did not increase operating room time in public hospitals enough to compensate for the private clinic crackdown. That means that fewer surgeries are being done in B.C., she said.

Van Laeken said she has privileges to work at five hospitals but only gets four operating room days in total each month. She is willing to do surgeries 10 days a month, but can’t get more time.

“Because of the limited OR time in the public hospitals, the wait times for surgery … in the public system are very long. For example, many of my patients wait (up to) 48 months for breast reconstruction surgery,” she said in her affidavit, noting that is 42 months longer than the target.

For years, health authorities have paid several private clinics to help because of backlogs of scheduled surgeries. But most private clinics also take patients willing to pay out of pocket for expedited surgery. The NDP government argues it is illegal for clinics and doctors to take money from patients for operations covered by medicare and the government is determined to stamp out the practice.

Last fall, the government introduced so-called compliance letters. Surgeons who do any work at private clinics that have contracts with health authorities must sign statements promising they will not do medically necessary work in both the public and private systems. If they refuse, they are banned from doing publicly funded operations at those private clinics that have contracts with health authorities.

If private clinics don’t agree to the same conditions, they won’t get contracts from health authorities or could have their contracts cancelled.

There are only a few private clinics that have agreed to the terms, including View Royal Surgical Centre in Victoria and the ASC Vancouver Surgical Centre.

Javer and Van Laeken are among a group of surgeons who want B.C. Supreme Court Justice Janet Winteringham to issue an injunction to stop the province’s latest stab at clinics until the end of the Day trial, which is being heard by Justice John Steeves. Winteringham has reserved her decision.

The government’s unwavering approach doesn’t end there.

“Doctors who work at Cambie have received warnings from health authority executives that they may lose their surgical privileges in public hospitals if they continue to treat patients wishing to be treated quickly and privately at our facility,” said Day, co-owner of the Cambie Surgery Centre.

Rob Grant, a lawyer for Day, the Cambie Surgeries Corporation and other plaintiffs, calls the government’s actions “authoritarian” and counter-productive because surgeons get a limited amount of time — often only a day a week — in hospital operating rooms. Private clinics have, for over 20 years, allowed surgeons to use their excess capacity to help more patients, he said.

According to the government, the new contracting out policy has not hurt patients and “more scheduled surgeries are in fact being performed.” In the Vancouver Coastal Health region, however, the latest figures show about a third of patients who were waiting for surgery in the last nine months of 2018 were waiting for more than 26 weeks — triple the target numbers. While  86.4 per cent of scheduled operations were completed within 26 weeks, the target is more than 95 per cent.

In Fraser Health, the latest report also shows targets not being met.

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