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Posts Tagged "groups"

21Feb

Daphne Bramham: B.C. group’s call for legally regulated heroin sales is unfounded

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Desperate times call for desperate and often unfounded measures. And, that’s exactly what a new report from the B.C. Centre on Substance Use is proposing in response to the unabating opioid overdose crisis.

It wants government to immediately clear the way for “heroin compassion clubs.” These would be free-standing co-op stores staffed by health care providers selling untainted heroin — diacetylmorphine — to members at the same price or less than street heroin. It would be free to members who can’t afford it, even though the report acknowledges that the risk of street resale of prescription opioids is greatest when the drugs are free.

And that would all be possible, the report says, because of things like volume discounts and “other economies of scale.”

“It would be precisely measured and dispensed in known quantities and at relatively safe doses,” says the report that was released Thursday. The emphasis has been added.

The heroin would be in powdered form, rather than an injectable liquid, just like it is on the street except this would be untainted heroin, not heroin cut with caffeine to prevent overdoses or any other additives to bulk up the product.

Members would be able to buy a couple of days’ supply and take it home with them.

Membership would be low-barrier, a term that’s not defined in the report.

Applicants would be screened by staff members who are “health care providers,” although not necessarily addictions physicians.

The co-op’s board members would be people with “lived experience” — a.k.a. users and former addicts.

Evan Wood, the head of the B.C. Centre on Substance Abuse, says the proposal is unprecedented so there is no evidence that it would reduce overdose deaths or disrupt organized crime’s role in fentanyl, money laundering or housing affordability, which is what’s advertised on the report’s cover.

“To be fair, we are in an unprecedented situation with fentanyl and the prescription opioids overdose crisis,” Wood said. “We are in uncharted waters.”

The two main goals are keeping users alive and disrupting the evils of organized crime.

These are ambitious albeit inappropriate goals for an organization whose mandate is to “develop, help implement, and evaluate evidence-based approaches to substance use and addiction.”

Using heroin to treat users isn’t new. But every other trial or program has a treatment component whether they’re at Vancouver’s Crosstown Clinic, the PHS Community Services or in European countries.

In Europe, heroin is prescribed with the goal of stabilizing users to a point where they can get jobs, form relationships or switch to other (cheaper) opioid replacement therapies such as methadone or Suboxone. (The annual cost per patient in European prescription-heroin programs ranges from $19,000 in Switzerland to $30,000 in the Netherlands.)

But there’s nothing like this in Canada.

“I’m not aware of the existence of ‘heroin clubs’ anywhere else,” Jann Schumacher from the Swiss-based Ticino, an organization of addictions specialists, said in an email. “In Switzerland the heroin assisted therapy is strongly regulated and always under medical control.

“Our Swiss model (heroin assisted treatment) has strong evidence as a harm reduction method, in getting people into treatment and stabilizing their lives, and in reducing the illegal market.”

To qualify, Swiss patients must have at least two years of opioid dependence and at least two failed tries using other addictions treatment methods. They are only allowed to the drug in pill form and take it with them after being in the program for six months and only if it’s necessary to hold down a job.

Drug-related crime in Switzerland has decreased 90 per cent. But compassion clubs would have no effect on drug-related crimes because members would still have to find some way to buy the heroin.

As for disrupting organized crime, the report suggests that compassion clubs would be competing for sales, influencing both the demand and market for heroin.

“The establishment of a regulated and controlled supply of fentanyl-unadulterated heroin may increase demand for street heroin among persons who use street opioids and force organized crime groups to return to the provision of heroin as part of the illicit drug market,” the report says.

And since violence is criminals’ usual response to unwelcome competition, it seems likely that they will attempt to terrorize compassion clubs out of business.

What makes this proposal all the more absurd is that it is aimed only at British Columbia. Surely, low-barrier access to pure heroin would be a magnet to every opioid user across the continent, let alone Canada.

British Columbia is already the epicentre of the overdose crisis just as it was ground zero for the cannabis legalization movement that began with compassion clubs dispensing so-called “medical marijuana,” which led to an explosion in unlicensed and unregulated pot shops.

It’s also where Canada’s harm-reduction model was birthed with free needles, supervised injection sites and readily available naloxone. But it was supposed to be part of a four-pronged strategy just as Switzerland’s is — a strategy that includes access to treatment and recovery as well as education aimed at dissuading drug use.

But since 2017, the $608 million spent by the B.C. government has gone almost exclusively to harm reduction. Yet, the number of overdose deaths is still rising.

It’s clearly not working and Canadians can’t help noticing now that 9,000 are dead including more than 4,000 in British Columbia. According to an Angus Reid poll released last week, 85 per cent of Canadians want mandatory treatment for opioid addiction. Forget legalization or free drugs, decriminalization was favoured by only 48 per cent.

Although the B.C. Centre on Substance Abuse is proposing a radical and untried solution, Wood dismissed mandatory treatment as an option because it’s unsupported by evidence.

As for decriminalization, Wood said, “The problem with it is that you still leave control of the market to organized crime. The user is not criminalized, but they still have to go to the black market.”

Yet, 20 years’ worth of evidence from Portugal show that paired with assertively promoting treatment and recovery, providing universal access to those programs and enforcing drug trafficking laws, decriminalization works.

There, it not only effectively brought an end to Portugal’s heroin overdose crisis, addiction and usage rates for all drugs including cigarettes and alcohol are now among the lowest in Europe.

[email protected]

Twitter: @bramham_daphne

 


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20Feb

Anti-poverty groups say B.C.’s budget has left them hanging

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VICTORIA – Anti-poverty groups say British Columbia’s budget has left them hanging in anticipation for details outlining the minority New Democrat government’s promised poverty reduction strategy.

Finance Minister Carole James says her budget includes poverty-fighting measures, but the government’s full strategy will be announced later this spring.

BC Poverty Reduction Coalition spokeswoman Trish Garner says she’s waiting for more dollars after the small steps James took towards fighting poverty in the budget.

Garner says raising welfare and disability rates by $50 per month and adding only 200 new modular homes are not enough to help people struggling with poverty.

Canadian Centre for Policy Alternatives senior economist Iglika Ivanova says the government’s BC Child Opportunity Benefit does not come into effect until 2020 and does not go deep enough to help lift families out of extreme poverty.

Garner and Ivanova say the government’s current budget surplus situation leaves James much more room to implement poverty-reduction measures.


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21Jan

New food guide unveiled without food groups or recommended servings

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Instead of eating food from four groups, Canadians are now encouraged to follow three guidelines on: what to eat regularly, what to avoid, and the importance of cooking and preparing meals at home.

Health Minister Ginette Petitpas Taylor unveiled Canada’s new food guide on Tuesday at a market in Montreal. It was last revised in 2007.

Our decisions on what to eat and how are influenced by a host of factors from taste to tradition, Petitpas Taylor said.

“Canadians deserve an easy simple source of advice they know they can trust,” she said.

There’s no longer an emphasis on food groups and recommended servings. Instead, Health Canada recommends eating “plenty of vegetables and fruits, whole grain foods and protein foods. Choose protein foods that come from plants more often.” For instance, fruits and vegetables make up half the plate on the report’s front cover.

“It’s not about portion per se, but perhaps about proportion,” Dr. Hasan Hutchinson, director general of Health Canada’s Office of Nutrition Policy and Promotion, Health Products and Food Branch, told reporters.

The proportion approach can be incorporated into family meals and snacks, he said.

Health Canada said the guide is taught in schools and promoted by health professionals to support the goal of getting Canadians to eat well. It can also influence the foods served and sold at daycares and schools, recreation centres, workplaces and health-care facilities.

A two-page snapshot of the new 62-page guide for health professionals and policymakers includes a glass of water as the recommended “drink of choice.”

The second of three guidelines covers foods and beverages that undermine healthy eating.

Health Canada recommends eating ‘plenty of vegetables and fruits, whole grain foods and protein foods.’ (CBC)

Beverages that contain a lot of sugar — including 100 per cent fruit juice — have been associated with a higher risk of tooth decay in children, the guide said. What’s more, consuming foods or beverages with added sugars has been linked to an increased risk of weight gain, excess weight and Type 2 diabetes.

The guide also notes there are health risks associated with alcohol consumption.

The guide was prepared using high-quality scientific reports on food and health, excluding industry-commissioned reports given the potential for conflicts of interest, according to Health Canada.

Hutchinson said that when officials scanned the evidence, they were struck by aspects of the food guides in Brazil, Sweden and Belgium. Fresh, unprocessed food is the cornerstone of the Brazilian food guide.

The third guideline in Canada’s revamped guide focuses on food skills, and advises to:

  • Be mindful of your eating habits.
  • Cook more often.
  • Enjoy your food.
  • Eat meals with others.
  • Use food labels.
  • Limit foods high in sodium, sugars or saturated fat.
  • Be aware of food marketing.

“It doesn’t need to be complicated folks,” Petitpas Taylor said.  “It just needs to be nutritious, and, might I dare say, fun.”

For parents, the most important takeway is that juice and sugar-sweetened milk are beverages that should be limited and considered treats for themselves and for their kids, said Dr. Yoni Freedhoff, medical director of the non-surgical Bariatric Medical Institute in Ottawa. 

“Overall though, the most important message is cook more, use less boxes, go to restaurants less frequently, not never but less, and remember that food marketers’ job is to sell food. It’s not to protect your health, and consider that too as there are inevitable criticisms launched by the food industry about this non-industry friendly food guide.” 

The full guide says food skills should be considered within the social, cultural and historical context of Indigenous people.

“It’s quite different from the previous one because it talks about the context of eating,” said Jean-Claude Moubarac, a professor in the nutrition department at the University of Montreal who advised on Brazil’s food guide. “It goes way beyond just nutrients and food and really adopts this much more holistic approach, which is much more appropriate.”

Food loaded with sugar, salt and fat

Moubarac is pleased with most of the new Canada’s Food Guide. He said it makes it clearer to consumers to seek out fresh and minimally processed foods, and avoid highly processed foods. The food industry has three years to introduce new nutrition labels to food products detailing information such as processed sugar content.

He said one limitation is those new food labels will only be available in 2022.

“It makes me think: how will consumers be able to identify highly processed food loaded with sugar, salt and fat?”

Availability and accessibility concerns such as finances are another consideration in the guide.

Now that Canada’s new guide is released, Moubarac said, policies and programs should be set up to make healthy foods more available and less expensive to address obstacles for healthy living for people who want to eat more fruits and vegetables. He also called for teaching children how to cook in school so they “fall in love with cooking real food.”

The new guide includes a mobile-friendly version that will be continually updated with resources, such as recipes.

Health Canada is also working on healthy eating patterns for health professionals and policymakers with details on the amounts and types of foods to serve at institutions for people in different age groups and life stages.

A tool kit for for Indigenous populations is being planned.


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