A new report from the Canadian Pain Task Force is calling the issue of chronic pain a “significant public health issue” and says the health sector has a chance to overhaul how it is treated to better help Canadians.
“People living with pain have limited access to the services they require and often face stigma and undue suffering as a result of their condition,” the report reads.
Chronic pain has been recognized by the World Health Organization as a disease, and is defined as pain persisting or recurring for longer than three months, associated with significant emotional distress, significant functional disability and the symptoms are not better accounted for by another diagnoses.
It notes chronic pain more often afflicts those in populations living in poverty, Indigenous peoples and women, among others.
The opioid overdose crisis has also complicated the treatment options for those suffering from chronic pain.
The task force claims people who could benefit from opioids to manage pain are now facing barriers to obtain a prescription.
“There is a need to promote shared decision-making between health care professionals and people living with pain. Prescribing decisions must be based on the unique needs of the individual, but this is not supported by the current environment.”
The report calls for better co-ordination between the provinces and territories as a starting point.
“Provincial/territorial policies and efforts could be better coordinated to reduce duplication of effort, maximize efficiency and implementation of best practices, and ensure people living with pain have the same level of care across Canada,” the report reads.
Pain BC – an organization that looks to help those suffering from chronic pain in British Columbia – welcomed the report and its conclusions.
“This report makes Health Canada aware of what Canadians with pain have known for too long: that pain care is largely not accessible, many health care providers lack the knowledge and skills to manage pain and breakthroughs in research are hampered by lack of funding,” said Executive Director Maria Hudspith in a statement. “We hope this report lays the foundation for a national pain strategy that will improve the lives of Canadians who live with pain.”
A new report by Vancouver’s managing director of social policy and projects is recommending City Council authorize more than $1 million in child care enhancement and other grants this year.
Sixty-one new social grants totalling $1,422,864 are recommended by Mary Clare Zak in her report, which is set to be tabled at Vancouver City Council’s next meeting on July 9.
“Social grants are investments that contribute to a healthy city for all. They support non-profit community-based services that facilitate the physical, spiritual, mental and emotional well-being of people,” wrote Zak in the report.
The bulk of the funds would be split between 46 separate grants to support “licensed group child care, preschool, school-aged care and occasional child care programs serving high need families.”
The total of the 46 grants is $976,140 according to the report.The next largest line item is a grant worth more than $300,000 to support the operation of the Collingwood Gymnasium and Annex in East Vancouver.
Seven social policy capital grants would be provided to improve the “safety, accessibility, and operational needs” of non-profit childcare and service organizations, and five grants worth nearly $50,000 would be given to support start-up costs for “new or expanded childcare operations, assist with financial restructuring to address financial crises, and support innovations in early learning and care.”
The grants would be funded by the 2019 Social Policy Grants operating budget for childcare.
In the wake of the National Inquiry into Missing and Murdered Indigenous Women and Firls’ final report, attention is now turning toward whether its 231 recommendations will be acted upon.
On Monday, the national inquiry held its closing ceremony in Gatineau, Que., where it delivered its final report to government. The inquiry detailed what it found to be the root causes of the disproportionate amount of violence experienced by Indigenous women and girls and made 231 “Calls for Justice” to address them.
The inquiry’s commissioners have said the calls for justice are not merely recommendations but legal imperatives based in “international and domestic human and Indigenous rights laws, including the Charter, the Constitution and the Honour of the Crown.”
During a news conference after the inquiry’s closing ceremony, commissioner Qajaq Robinson elaborated on what it means to describe the calls for justice as legal imperatives.
“If we’re talking to access to health — for example the calls for justice that there be holistic, wraparound health services in all communities and isolated communities — that isn’t just a suggestion. It’s because the people in those communities have a right to health, have a right to those services,” she said.
“You legally have to do it. It’s not like we’re asking you to come up with a new framework to understand what you have to do. You signed it already; you’re just not implementing it.”
Commissioner Michèle Audette said the rights the inquiry is talking about seem to be respected in southern Canada.
“But when you live in my North… far, far away, there’s no protection, no services, no accessibility. And it’s still called Canada,” she said.
While the commissioners say the calls are rooted in existing legal commitments, the final report also states that “Governments are not required to implement these recommendations.”
‘These truths are piling up’
Like the Truth and Reconciliation Commission’s 2015 report, the national inquiry’s report acknowledges it will take all Canadians to assert their political pressure on institutions and governments to ensure substantive changes come about.
Cindy Blackstock, executive director of the First Nations and Family Caring Society, has been at the forefront of pushing government for equity for First Nations children in Canada.
The Canadian Human Rights Tribunal sided with the society and Assembly of First Nations in a 2016 ruling, finding that Canada discriminates against First Nations children on reserves by failing to provide them with the same level of child welfare services that exist elsewhere in Canada.
Three years later, and more than a decade since the initial complaint was filed, the case is still not resolved. There have been seven non-compliance orders issued by the tribunal since its ruling.
Blackstock says, looking at the calls put forward by the national inquiry, the most important impact the final report can have is to change the collective Canadian consciousness. In her view, governments don’t make change, they respond to change.
“All of these reports and all these truths are piling up in a way that makes it more and more difficult for people normalize the discrimination and to turn away from it,” she said.
She said key indicators that change is happening will be a shift in public attitude. She said the public should also be looking for on-the-ground, immediate investments in things like safe shelter space for women fleeing violence.
Blackstock said the calls for justice might not be legally binding, but are certainly morally binding. Still, she said it will likely take litigation to achieve the level of substantive reform for which the inquiry is calling.
Minister of Indigenous Services Seamus O’Regan said Ottawa is already taking action on the report through its national action plan to invest in housing and education on reserves and safety on the Highway of Tears.
The prime minister has also promised that the federal government will come up with a national action plan for implementing the inquiry’s recommendations, which itself is among the 231 calls for justice in the final report. The government says this action plan will be developed in partnership with survivors, family members as well as First Nations, Métis and Inuit governments and organizations.
When asked if the recommendations of the inquiry are legally binding, a spokesperson for the Ministry of Crown-Indigenous Relations and Northern Affairs wrote in an emailed statement that “the final report offered recommendations to inform concrete action,” and referred to the inquiry’s terms of reference which include making recommendations to remove “systemic causes of violence and to increase the safety of Indigenous women and girls.”
Firefighters and BC Ambulance paramedics in Vancouver take a woman who suffered an fentanyl and heroin overdose to the hospital, in January, 2018. Jason Payne / PNG
A study by the British Columbia Centre for Disease Control says the rapid harm-reduction response to the province’s overdose crisis saved more than 3,000 lives during the peak of the emergency.
Researchers looked at a 20-month period from April 2016 to December 2017 when 2,177 people died of an overdose, concluding that the number of deaths in B.C. would have been two and a half times higher.
The study gives three programs the credit: take-home naloxone which saved almost 1,600 lives, the expansion of overdose prevention services, stopping 230 deaths, and increased access to treatment that saved 590 lives.
The centre’s Dr. Mike Irvine led the research and says despite the highly toxic street drug supply, the average probability of death from accidental overdose decreased because of the services provided to keep people alive.
Mental Health and Addictions Minister Judy Darcy says the study speaks to the importance of harm reduction and the services are essential to turning the tide in the overdose crisis.
The province declared a health emergency over the crisis in April 2016 and the centre says in a news release that overdose remains the leading cause of preventable death in the province.
Irvine says their study is the among the first evidence that shows a combination of harm reduction and treatment interventions can save lives.
“It is useful information for jurisdictions considering how to respond to the overdose crisis.”
Overdose deaths increased rapidly in 2016, coinciding with the introduction of the powerful opioid fentanyl into the illicit drug supply.
Fentanyl or its analogues were detected in 87 per cent of all illicit overdose deaths last year.
Jane Buxton, the harm reduction lead at the B.C. Centre for Disease Control, says the take-home naloxone program was already in place when the crisis emerged, allowing them to quickly expand the program to help save lives.
“Since the program ramped up in mid-2016 in response to the ongoing crisis, we’ve distributed between 4,000 and 5,000 kits every month.”
Coquitlam Mayor Richard Stewart is once again calling for an end to the taxi monopoly in the Tri-Cities area and urging the province to quickly allow ride hailing services like Lyft and Uber after a local woman recounted a negative cab ride that left her feeling like a captive.
The taxi ride happened more than a week ago, but it wasn’t until Stewart wrote a post on social media titled “Held hostage by a taxi” that it started to get attention.
Gayle Hunter was taking a routine taxi ride from her home to Birchland Elementary School, where she works. Hunter, who doesn’t drive and lives with a disability that limits her mobility, said she always pays $7 for the trip, after the tip.
But, in her account, the driver failed to start the meter, and as she approached the school, she told the driver that technically, if he didn’t start the meter, she didn’t need to pay.
Hunter claims she was fully intending to pay the usual rate, but her comment sent the driver into a shouting rage.
Then, she said he turned away from her destination, despite her protest, and began to drive her in the wrong direction.
“It was essentially an altercation that resulted in her being driven against her will for some period of time, and it really angered me,” said Stewart.
“It frustrates me to no end, the length of time and the number of times we’ve had to speak with the Transportation Ministry, the Passenger Transportation Board and with this company about the behaviour of the drivers,” he said.
‘It was scary’
“Well it was, first of all, shocking, and then it was scary,” said Hunter. “It was scary. It was — and then it just made me really angry.”
Hunter said she phoned the company, Bel-Air Taxi, as the driver continued to refuse to take her to the school. She said she put the manager on speaker phone to have him tell the driver to take her to her intended destination — she says the driver continued shouting throughout.
Once Hunter got to Birchland elementary, she claims the troubling episode still didn’t end. She said the driver hurt her by aggressively ripping the cash out of her hand.
“When I got into the school, I was shaking, like I was a little — I went straight to the principal’s office,” she said. “Even today, I don’t feel safe getting into a cab.”
Hunter contacted Coquitlam RCMP to file a report, but doesn’t expect any criminal charges to arise from the incident. She also sent the company a written complaint, but said that she hasn’t heard anything back.
CBC News phoned and emailed Bel-Air Taxi for a comment, but nobody from the company replied to the request.
Manager Shawn Bowden told CTV News that he spoke to Hunter and apologized for the incident. He said the meter should have been turned on, but he added that, based on GPS records, the taxi didn’t deviate from the intended route to the school.
For both Stewart and Hunter, the incident is a reminder that, as a matter of safety and convenience, passengers need more choice when it comes to ride services in the Coquitlam, Port Coquitlam and Port Moody.
After more than three years, dozens of community meetings and testimony from well over 2,000 Canadians, the Missing and Murdered Indigenous Women and Girls inquiry will deliver its final report to the federal government at a ceremony in Gatineau, Que. today.
The report, which CBC News obtained before its official release, includes many recommendations to government, the police and the larger Canadian public to help address endemic levels of violence directed at Indigenous women and girls and 2SLGBTQQIA (two-spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex and asexual) people.
CBCNews.ca will carry the closing ceremonies live starting at 9 a.m. ET.
Beyond defining the level of violence against these women as a “Canadian genocide,” recommending official language status for Indigenous languages and a guaranteed income for all Indigenous peoples, the commissioners are also recommending sweeping reforms to the justice system and policing in this country, including stiffer penalties for men who carry out spousal or partner abuse.
“We call upon the federal government to include cases where there is a pattern of intimate partner violence and abuse as murder in the first degree under section 222 of the Criminal Code,” the report reads.
First-degree murder is the most serious of all the homicide offences. If convicted, offenders usually spend longer in prison, with fewer chances for parole.
The inquiry said that, too often, murder investigations are “marked by indifference” and negative stereotypes that result in Indigenous deaths and disappearances being investigated and treated differently from other cases — differences that result in fewer solved cases.
And when there is a reasonable chance of a conviction, the inquiry said, Crown attorneys too often are willing to accept plea bargains or reduced charges in exchange for guilty pleas in cases of murdered Indigenous women.
To that end, the inquiry calls for more “Indigenous-specific options” for sentencing, without specifying what exactly the government should change on that front. It called for a strengthening of Gladue principles in Canadian courts, a legal term that stipulates an offender’s Indigenous ancestry should be considered in the sentencing process.
“While the prosecutorial decisions … may well be justified, the frequency with which this occurs understandably raises questions in the Indigenous community, particularly when the sentences on conviction escape the mandatory parole ineligibility of 10 or 25 years on the more serious charges.”
To ensure more equitable outcomes, the inquiry said, more Indigenous judges, justices of the peace and police should be hired to ensure Indigenous voices are in positions of power in the criminal justice system. Failing that, the report said a separate court system for the Indigenous population should be established to lead to more “meaningful and culturally appropriate justice practices …”
Far too many murder cases aren’t solved and don’t make it to trial at all, the inquiry said — and that means the federal funds ought to be bolstering the ranks of Indigenous police forces across the country to ensure better investigations.
“We call upon all governments to immediately and dramatically transform Indigenous policing from its current state as a mere delegation to an exercise in self-governance and self-determination over policing,” the report reads.
“The federal government’s First Nations Policing Program must be replaced with a new legislative and funding framework, consistent with international and domestic policing best practices and standards, that must be developed by the federal, provincial, and territorial governments in partnership with Indigenous Peoples.”
The report also calls on provincial and territorial governments to improve the restraining order system by making them “available, accessible, promptly issued and effectively serviced and resourced” — to help Indigenous women stay out of harm’s way when faced with a violent partner.
Beyond facilitating access to restraining orders (or “protection orders,” as they’re often known in Canada) the inquiry is calling on the government to offer guaranteed access to financial support, legislated paid leave and disability benefits and “appropriate trauma care” to Indigenous victims of crime or other traumatic events.
Crown-Indigenous Relations Minister Carolyn Bennett would not comment on the report’s recommendations ahead of their official release.
“Out of respect for the independent National Inquiry and the families, we won’t comment on the details of the final report before then. After decades of demanding a national inquiry into missing and murdered Indigenous women and girls, families are finally getting the answers they have been looking for,” a spokesperson for the minister said.
In an interview with CBC News before the news organization obtained a leaked copy of the report, Bennett said the government accepts that the status quo isn’t keeping Indigenous women and girls safe.
She said, however, that the government already has moved ahead with meaningful reforms, including its overhaul of the child and family services regime and a de-colonizing push for greater self-government for Indigenous peoples, part of a larger fight for equality.
“The inquiry is really only a beginning. We’ve got to do the work, and we’ve got to change attitudes, and we’ve got to increase the safety of Indigenous women and girls wherever they are in this country,” Bennett said.
“Indigenous women and girls need to be safe wherever they live in this country — whether it’s in their home communities or a downtown urban centre. That’s the only way we’ll stop this national tragedy.”
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The River Rock Casino, 8811 River Rd, Vancouver, June 27 2018. Gerry Kahrmann / PNG
The Attorney General is calling for a gambler’s code of conduct at B.C. casinos after a damning report into working conditions at Richmond’s River Rock Casino.
The ministry’s Gaming Policy and Enforcement Branch made the call in a report compiled after an earlier report into dozens of harassment and violence claims made by front-line casino staff.
That earlier report, conducted by Paladin Security at the request of the B.C. Lotteries Corp., found among other things that a drunk VIP gambler slapped an employee, and then wrote them a $2,000 cheque.
It confirmed reports that an angry VIP gambler had thrown an item at a dealer, a dealer was threatened with death by a player (resulting in a 24-hour ban for the gambler) and a guest-services supervisor was assaulted.
The report stated that “according to several dealers and supervisors, verbal abuse bordering on uttering threats occurs daily, if not hourly.”
It went on to say “extra” considerations were given to VIP gamblers, including the right to keep a dealer at the table that they believed to be good luck, even if the dealer was rostered off or needed to go to the washroom.
“A number of individuals mentioned the Dogwood Room as problematic, between its combination of overwhelming bet volume, poor standards of player behaviour and complicit supervisors and managers,” the Paladin report stated. “Some suggested that if you don’t speak Mandarin, you don’t have a change to work a higher-tipping VIP table.”
The Paladin report was based on interviews with 460 of the casino’s 1,200 front-line staff.
The gaming policy branch report found that all incidents that were required to be reported to police had been reported, and there was no evidence the casino’s management or employees had suppressed reports.
It stated that between 2010 and August 2018 the River Rock Casino had sent 17,581 workplace reports to the gaming policy branch.
“When one considers the 17 alleged unreported incidents and the eight reported incidents that did not generate a (workplace report) from the same time range, the percentage of potential unreported incidents amounts to 0.142 per cent. This fact strongly suggests the (River Rock Casino), as a corporation, is paying due-diligence to its reporting requirements … ”
The branch wants the code of conduct to clearly outline the behaviour and conduct expected of all patrons (including VIPs), and clearly outlines the consequences that a patron will face if they were to be found in violation.
Jim Mann wants everyone to know that he’s more than his dementia.
He was diagnosed with Alzheimer’s 12 years ago, but that doesn’t mean he can’t be involved in making decisions about his health.
The distinction is important for Mann — and many others living with dementia. The Surrey resident is thinking a lot about consent these days after being part of an advisory committee on health care consent for people with dementia. Their report, Conversations About Care, was released Feb. 27.
Mann, 70, said professionals in health care still make assumptions about people with dementia.
He recalled an emergency room incident when a nurse yelled his name and added “patient only.”
“My wife and I stood up and walked over. Halfway there, she (the nurse) yelled again ‘patient only.’ I got up to her and said ‘my wife needs to be with me. I have Alzheimer’s.’ She turned around and looked me up and down and said ‘well, you look fine.’ “
Mann said that while the public might not always understand that dementia is a cognitive impairment not a physical one and therefore not visible, he believes that kind of language isn’t acceptable in a health care environment.
“Within the medical system, I’m sorry, you should really know this by now,” he said.
The goal of the project’s Conversations About Care report is to ensure that the legal framework in B.C. remains strong enough to protect people living with dementia as well as those named as their legal substitutes.
In 2018, about 70,000 people in B.C. were living with dementia. By 2033, that number is estimated to increase to almost 120,000.
Krista James, national director of Canadian Centre for Elder Law at the University of B.C., said the report is intended to start a conversation about the rights of people with dementia.
“I feel that we’re missing that rights-based lens that recognizes the rights of older people to make choices about what happens to them,” she said.
“Although the law is different in each jurisdiction, and this report applies specifically to the experience in B.C., we need to open up that conversation to think about the citizenship rights of older people in a health care context. It’s really urgent.”
The report’s 34 recommendations were developed through a process that included consultation with people living with dementia, family caregivers, health care professionals, and others who deal with consent on a regular basis.
James said the origins of the report came from phone calls she received from family caregivers who felt frustrated that decisions were being made without consultation.
“From our perspective, the health care consent law in B.C. is super robust and I think fairly clear,” James said.
“It says if it’s not an emergency, you need to get that prior informed consent. The care facility regulations that govern long term care don’t seem to be consistent. There is a lot more wiggle room.”
That means some physicians, licensed practical nurses and care aids don’t understand the concept of prior informed consent for non-emergency care.
“I have talked to a few people who think that if the person is in the care facility they have consented to all the care that the people who work there think is the right care for them,” she said.
“Some of the staff don’t understand they have to get consent. They confuse admission to the care facility with consent to all the meds.”
One of the report’s recommendations calls for all licensed long-term care facilities to set out rules on restraints, including chemical restraints (medications such as antipsychotics used to control aggressive behaviour).
Other big concerns include the challenge of sorting out situations where family members making decisions about care for someone with dementia can’t agree on what to do. One way to address that, James said, is to have social workers involved in helping families find a solution.
James said the report recognizes that health care providers are never going to be experts on the law.
“They’re not lawyers,” she said. “We shouldn’t expect them to be experts on the finer details of the law. They need to have support so they can properly interpret the law.”
Recommendations of the report
• Improving health care decision-making laws in B.C. by adding language to recognize that people’s capacity to make health care decisions can vary from day to day and decision to decision, and that they be involved to the greatest degree possible in all case planning and decision-making.
• Address barriers to informed consent experienced by Indigenous people and people who need language interpretation, and create financial incentives to support physicians so they can spend time to talk with patients and families.
• Create a review tribunal to allow people living with dementia to review health care decisions made by substitute decision makers.
A new report being released Thursday is expected to outline a possible model for legally regulated heroin sales.
Produced by the B.C. Centre on Substance Use, the report aims to address the ongoing opioid crisis, organized crime’s role in the drug trade and the profitability of an unregulated fentanyl market.
The report’s authors are scheduled to speak Thursday at a news conference on the proposal, alongside public health officials, addiction specialists and recovered substance-users.
Earlier this month the B.C. Coroners Service reported 1,489 people died of a suspected illicit-drug overdose in B.C. in 2018, up from 1,487 in 2017.
Most who died were men (80 per cent) aged 30-59 (71 per cent), and most died indoors (86 per cent). Fentanyl, an opioid being cut into heroin and other drugs, was detected in about 85 per cent of the deaths, up from 82 per cent in 2017.
Researchers at the University of B.C. have found that some women don’t consider cannabis a drug and believe it’s OK to light up a joint while pregnant.
The review of six U.S. studies, published in the journal Preventative Medicine, found that an alarming number of women, around one-third, don’t think cannabis could harm their baby.
That’s despite warnings from obstetricians not to consume cannabis during pregnancy and while breastfeeding, and studies that have linked pot with a higher chance of anemia, low birth weight, and stillbirth.
Although the UBC researchers analyzed U.S. data for their report, published in the journal Preventative Medicine, they say the information is relevant for health care providers in Canada, where consuming marijuana for recreational use became legal last year.
Lead author Hamideh Bayrampour, assistant professor in the UBC department of family practice, said they couldn’t find similar studies in Canada likely because of ethical issues. She said there is a need for more Canadian data on the topic.
The concern, said Bayrampour, is that many women surveyed perceived a lack of communication from their health care providers about the risks of cannabis as an indication that the drug is safe to use during pregnancy.
“This is important because if they don’t perceive harm they are more likely to use cannabis,” she said.
“What we know for sure is that we don’t know yet whether cannabis is safe to use in pregnancy, although there is evidence emerging that if a women uses cannabis their baby might be smaller than average.”
She said it would be beneficial here for health care providers to have a discussion with patients about cannabis, just as they do now with alcohol or cigarettes.
Some women surveyed said they smoked pot while pregnant to cope with an illness, such as depression or anxiety, instead of taking stronger pharmaceutical drugs, while others identified cannabis as a way to deal with the nausea of morning sickness.
“If they are choosing between cannabis and a sedative for pain they perceive cannabis as a safer choice,” said Bayrampour.
The UBC review shows pregnant cannabis users were more likely to be under the age of 25 and to have low income and education, or use other substances such as tobacco and alcohol.
In one study, women were asked about their perception of general harm associated with cannabis use, 70 per cent of both pregnant and non-pregnant cannabis users responded that they perceived slight or no risk of harm.
“I think we need to have a question specifically related to cannabis similar to alcohol. We need to provide a safe, non judgmental environment to talk about this,” said Bayrampour. “It is a great opportunity for caregivers to start this conversation and motivate and support them in their decision to quit.”
The Society of Obstetricians and Gynaecologists of Canada recommend women not use cannabis when trying to conceive, during pregnancy and while breastfeeding.
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