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Category "Overdose"

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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Twitter: @bramham_daphne

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26Jul

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

by admin

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Of course, he first needs to save his own.

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Twitter: @bramham_daphne


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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.

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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.

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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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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

Mom creates program for supportive housing tenants after son’s death

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After Christine Harris’s son died slowly and alone in a Vancouver supportive housing unit, she vowed to do everything possible to ensure no other parent would have to share her pain.

She last spoke to her son, Lindsey Longe, on July 12, 2012. The 30-year-old was last seen alive by a friend on July 15, 2012. He died the next day of blood poisoning in his room at Pacific Coast Apartments. The use of illicit drugs contributed to his death, according to a coroner’s report.

Longe’s body wasn’t discovered until three days after he died, after days of Harris calling and pleading with Coast Mental Health staff to check on him, Harris said.

In recent years, Harris, an Alberta social worker, has been developing “Got Your Back For Life,” a volunteer program that pairs people living in supportive housing with a “most-trusted person” who agrees to check on them regularly.

The program is halfway through a one-year pilot at PHS Community Services Society’s Margaret Mitchell Place. About 20 residents of the 52-unit temporary modular housing complex near Olympic Village Station signed an agreement with a trusted person who might be a friend, neighbour, family member or staff member.

Together, they decide how often they’ll do health and wellness checks — it might be every day or once per week — and sign contracts with some personal information and ID photos. The trusted person can then go to building staff at the agreed-upon time, or any time they have a reason to be concerned, and ask them to check on their partner.

Harris said the program came out of discussions with supportive housing residents during an event she holds each summer in her son’s memory. She pitched the cost-free program to PHS in July 2018 and by November the trial was underway.

She praised PHS for already doing 24-hour checks at its supportive housing units but said she hopes the program helps push other housing operators to do better, too.

“(PHS is) doing it to give their tenants an extra layer of protection,” she said. “I think it’s amazing.”

Amid the overdose crisis, B.C. Housing updated contracts with supportive housing sites to require them to conduct health and wellness checks at least every 48 hours, and more frequently when deemed necessary.

But Harris believes 48 hours is inadequate. She keeps an eye on coroner reports, which recently indicated that in Vancouver 48 per cent of the people who died of an illicit-drug overdose since 2017 were in “other residences” such as social and supportive housing, SROs, shelters and hotels.

“I don’t believe that we, as a society, have done enough,” Harris said. “We need to give people the power to look after each other and this community. These people care about each other.”


Lindsey Longe, pictured here with his mother Christine Harris, was 30 when he died in supportive housing in 2012 in Vancouver.

Submitted: Christine Harris /

Vancouver

Margaret Mitchell Place resident Chris Middleton said he has a strong network of friends, family and staff who check on his well-being often, but knowing Got Your Back For Life has a “most-trusted person” regularly checking on him, too, puts his mind at ease.

“I have someone else looking out for me,” he said. “A lot of people don’t. They grow up in these buildings and they have no one that is willing to go ‘Hey, how are you?’”

Middleton believes the program is particularly good for people who might not leave their room too often, such as those who are elderly or disabled.

“It should be status quo,” he said. “Everybody would have their buddy that would check in on how they’re doing.”

The program also helps build community. When it came to Margaret Mitchell Place, it brought people together right away, said building manager Byron Slack.

“A lot of people knew each other in the building but hadn’t really congregated in the common spaces,” he said. “It was one of the first programs we brought into the building and it’s a way of empowering neighbours to be able to check up on their friends.”

Slack said staff check on residents on behalf of their loved ones whether or not they are in the program, but said the contract made between its participants, in honour of Longe, is especially meaningful.

“It’s been a really positive thing,” he said.

The program appealed to PHS because it was peer-driven and came at the height of the “prohibition crisis” behind B.C. overdose deaths, said Duncan Higgon, senior manager of housing.

It works as an overdose intervention tool, he said. For example, if partners score drugs from the same dealer, one might go back to their room, take them and come close to an overdose. With their Got Your Back For Life commitment in mind, they might be compelled to make sure their partner with potent drugs is OK.

Staff have embraced the program and it has the added benefit of engaging tenants in peer-to-peer work, Higgon said. Sometimes, tenants don’t like to ask staff for help, so an arrangement with a peer is more appealing.

“For us, that is very meaningful,” he said. “When we were presented with those opportunities, it was really exciting to trial.”

Higgon said PHS is developing trials at three other PHS modular-housing buildings. But there is potential for it to run at all 1,500 units of PHS housing. He would like to see it used to help homeless people, too.

“I really do see it as a uniquely beautiful, supportive and useful tool across a whole spectrum,” he said.

Harris believes that if just one life is saved by Got Your Back For Life, her program has done what it was designed to do.

“Lindsey, in the last while of his life, when he started hoarding, became very isolated,” she said.

“He was living in shame. To have had something that could have connected him with someone a little more tightly would have helped in many ways.”

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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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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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24Apr

Overdose crisis: BC’s top doctor wants drug possession decriminalized

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B.C.’s top doctor has unveiled a bold proposal to slow the rate of overdose deaths — by decriminalizing possession of a small amount of drugs for personal use.

Provincial health officer Dr. Bonnie Henry’s report, released Wednesday, says it is known around the world that the “war on drugs” has been a failure, and says the criminalization of non-violent people for possessing a substance for personal use does considerable harm to the person and society.

Specifically, Henry says criminalization increases communicable disease transmission, stigma and drug-related mortality. Incarceration and criminal records exacerbate drug harms by preventing future employment and travel, she adds.

“As the Provincial Health Officer of B.C., I recommend that the Province of B.C. urgently move to decriminalize people who possess controlled substances for personal use,” Henry says.

“This is a fundamental underpinning and necessary next step for the continued provincial response to the overdose crisis in B.C.”

Henry’s report, called “Stopping the Harm: Decriminalization of People Who Use Drugs in B.C.,” says that despite expanded harm-reduction activities and interventions in the province, and increased access to evidence-based treatment, an average of four people continue to die in B.C. each day due to the toxic illegal drug supply.

“Decriminalization of people who use controlled drugs is an effective public health approach to drug policy in other jurisdictions and is the most appropriate option for B.C. at this time,” Henry says.

“While law enforcement in B.C. exercise their discretion when considering possession charges, such as the presence of harmful behaviour or identified need for treatment services, the application of the law is inconsistent across communities. As such, there is a need for a provincial-level commitment to support an official policy to decriminalize people who use drugs.”

Henry says decriminalization would allow law enforcement to work with health and social systems to help connect people with treatment and other social services.

In 2001, Portugal decriminalized all drugs for personal use in response to a surge in heroin use.

Henry said there are two means by which to decriminalize in B.C. One would use provincial legislation to allow the Ministry of Public Safety and Solicitor to set provincial priorities, such as declaring a public health and harm reduction approach as a priority for police to apply when toward simple possession. The other would develop a new regulation under the Police Act that would add a provision preventing police from expending resources on simple possession offences under Section 4(1) of the Controlled Drugs and Substances Act.


Provincial health officer Dr. Bonnie Henry answers questions during a press conference about the release of the latest provincial statistics by the BC Coroners Service at Legislature in Victoria, B.C., on Thursday, February 7, 2019.

CHAD HIPOLITO /

THE CANADIAN PRESS

The report explains decriminalization as follows: “Decriminalization involves removing an action or behaviour from the scope of the criminal justice system. In the context of controlled substances, it is typically focused on possession and consumption of drugs for personal use and does not set out a system or structure for production, distribution, or sale of controlled substances.

“Decriminalization does not exclude the application of fines or administrative penalties. For example, if possession of drugs for personal use was decriminalized (as is the case in Portugal), the drug itself is still illegal, but possessing it does not lead to criminal sanctions (unless the possession is at a trafficking level).”

More to come.

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19Mar

Coroners: Carfentanil detected in 13 of 90 overdose deaths in January

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A Vancouver RCMP officer opens a printer ink bottle containing the opioid carfentanil imported from China. Drug dealers have been cutting carfentanil and its weaker cousin, fentanyl, into heroin and other illicit drugs to boost profit margins.


Submitted / RCMP

B.C.’s coroners say there were 90 suspected illicit-drug overdose deaths in the province in January, including more than a dozen in which they detected carfentanil.

The synthetic opioid carfentanil, which began showing up in B.C.’s street-drug supply in late 2016, turned up in 13 illicit-drug overdose deaths in January, according to a B.C. Coroners Service update released Tuesday. Carfentanil was detected in 35 deaths in all of 2018 and 71 deaths in the last seven months of 2017. Carfentanil is many orders of magnitude more potent, and dangerous, than fentanyl.

Fentanyl and analogs were detected in about 87 per cent of overdose deaths last year, up from 82 per cent in 2017, the service said.

Coroners also updated the total number of illicit-drug overdose deaths in 2018 to 1,510, up from the 1,489 deaths it reported last month (the numbers change as toxicology reports are completed and investigations are concluded). Overdoses killed 1,486 in 2017 and 991 in 2016.

The coroners said 90 people died of an illicit-drug overdose in B.C. in January, down from 130 deaths in January 2018, and below the 116 deaths in December 2018.

The coroners service says no one died at a supervised consumption or drug-overdose prevention site.

Most of the deaths in January were in the Vancouver Coastal Health (29) and Fraser Health (27) regions, and 88 per cent occurred indoors, including 62 per cent in private residences and 26 per cent in other residences such as social housing or hotels.

People aged 30 to 59 accounted for 76 per cent of those who died, and 83 per cent were male.

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13Mar

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

At that moment, he realized his stark choice.

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

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

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

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

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

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

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

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

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

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

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