Game plan needed to solve addictions epidemic
B.C. wasting money on harm reduction if patients don’t get proper help to kick habit
As in many other jurisdictions, there are no regulations in B.C. for addictions treatment centres, no standards for addictions services and no requirement for outcomes to be reported or monitored.
They operate under the same legislation that regulates daycares and homes for the elderly, which means only the facilities are inspected, not the programs or services within them.
B.C. recovery homes don’t have to be licensed, although they are required to be registered if they offer three or more beds.
Some treatment facilities are accredited by third-party organizations. But, here’s the kicker: “Most homes are often short-lived business operations in rented housing,” according to last week’s report by the Death Review Panel set up to investigate British Columbia’s epidemic of illicit-drug overdoses.
The total amount British Columbia spends on treatment isn’t clear, although it spends $90 million alone on methadone and other pharmaceutical replacement therapies for addicts each year. Beyond what the government spends, hundreds of thousands (if not millions) are spent by individuals, insurance companies or employers at private facilities that charge upwards of $30,000 to $40,000 a month for residential care. (The famous Betty Ford Center costs US$3,300 a week.)
In an interview, the death panel’s chair, Michael Egilson said, “Some supportive recovery homes, somebody may have just decided to set up on their own. The exact number and how they are dealing with treatment is hard to say.”
The panel recommends that by September 2019, British Columbia develop or revise regulations for all treatment facilities and services and set standards so these facilities can be systematically evaluated and monitored.
Egilson contends that what drove this recommendation is “an acute awareness that opioid-abuse disorders best practise is certainly different from some traditional abstinence models
... Abstinence is not a desirable treatment. If a person relapses after a quick detox, there’s a greater potential for overdose death.”
This is a harm-reduction model of replacing an illicit drug with a pharmaceutical one such as methadone, suboxone or even prescription heroin — “opioid agonist therapies.”
Egilson referred specifically to Brandon Jensen, a 20-year-old who overdosed on a fentanyllaced cocktail of illicit drugs in 2016 at the Sunshine Coast Health Centre in Powell River. At the coroner’s inquest, where Egilson presided, evidence indicated that within the past three years, Jensen had spent time “at a minimum of 11 detoxication centres, recovery homes and treatment centres.”
The fact that he relapsed was hardly unique — 40 to 60 per cent of people receiving treatment do, according to the U.S. National Institute on Drug Abuse.
The unspoken suggestion in the death panel’s recommendation is the government — along with individuals, their families, insurers and employers — is likely throwing money away because most addiction programs are based on Alcoholics Anonymous’s 70-year-old, 12-step program.
But the point is we don’t know. We don’t have good data because its collection is not required. We don’t even know what kind of snake oil some of these centres are selling because none of them is properly monitored.
You can’t help but wonder why something as basic as ensuring desperate people hoping to finally kick their habit are getting the help they need has been ignored.
This is, after all, a city and a province that for nearly 20 years has been at the forefront of harm reduction with needle exchange programs, safe injection sites, methadone and suboxone treatment programs, a prescription heroin program and, more recently, free naloxone kits, free-standing naloxone stations and training for first-responders and even teachers in how to use it as an antidote for fentanyl overdoses.
We’ve gone from crisis to crisis, each one sucking up incredible resources. Currently, $250,000 a day goes into the Downtown Eastside alone for methadone treatment. This year, the B.C. government expects the number of British Columbians receiving replacement drug therapy to rise to 30,000 and then nearly double to 58,000 by 2020-21.
In 2006, when Vancouver updated its four pillars approach, it noted there were 8,319 British Columbians being treated with methadone.
By 2020-21, the province also expects to be supplying 55,000 “free” take-home naloxone kits, up from 45,000 this year.
We keep hearing about an overdose crisis, but what we have is an addictions crisis.
Solving it will require a lot more than simply reducing harm.
The more intractable problems of poverty, homelessness and abuse that are often brought on by depression, despair and other untreated mental health issues need to be addressed.
So, by all means, let’s do what we can to stop the overdoses. Let’s ensure there is evidencebased treatment available.
But let’s quit pretending. Until we deal with the root causes of addictions, harm reduction is little more than an increasingly expensive bandage.