There is a very real and deadly health crisis in B.C. from which two people died yesterday and two more will likely die today, tomorrow and the days after that.
It’s not COVID-19, and no news conference was hastily called to talk about it.
Most of those dead and dying are blue-collar guys in what should be the prime of their lives.
This is the reality as B.C. lurches into the fifth year of an opioid overdose crisis. It’s a seemingly unending emergency that by the end of 2019 had already killed 5,539 people here and more than 13,900 across Canada.
Five years in, this crisis has become normalized, with the only certainty as we face another day is that first responders are now better at resuscitating victims because, year over year, the calls have only continued to increase.
Last week, Prime Minister Justin Trudeau appointed his top ministers to a committee tasked with responding to the COVID-19 crisis. At that point, Canada had only 30 confirmed cases. Of the 21 B.C. cases, four of the patients have fully recovered.
Not to belittle the concerns about COVID-19 becoming a global pandemic, but with nearly 14,000 dead already, no committee — high-level or otherwise — has yet been struck to devise a national addictions strategy that would deal not only with opioids, but also the biggest killer, which is alcohol. A 2019 report by the Canadian Institute for Health Information found that 10 Canadians die every day from substance use, and three-quarters of those deaths are alcohol-related.
During the 2019 election, the issue flared briefly after Conservatives placed ads — mainly through ethnic media — claiming that Trudeau’s Liberals planned to legalize all drugs, including heroin.
Already beleaguered, Trudeau not only denied it, he quickly disavowed the resolution overwhelmingly passed at the party’s 2018 convention that called on the Canadian government to treat addiction as a health issue, expand treatment and harm reduction services, and decriminalize personal-use possession of all drugs, with people diverted away from the criminal courts and into treatment.
Trudeau disavowed it again this week when a Liberal backbencher’s private member’s bill was put on the order paper.
Depending on how you read Bill C-236, it’s either calling for decriminalization or legalization. Regardless, the fact that Nathaniel Erskine-Smith’s bill will be debated at least gets it on the political agenda because unless there are some major changes, Canadians are going to continue dying at these unacceptably high rates that have already caused the national life expectancy to drop.
Erskine-Smith, an Ontario MP from the Beaches-East York riding, favours a Portugal-style plan of which decriminalization plays only a small part.
But parliamentary rules forbid private member’s bills from committing the government to any new spending, so he said his bill could only narrowly focus on decriminalization.
The slim bill says charges could be laid “only if … the individual cannot be adequately dealt with by a warning or referral (to a program agency or service provider) … or by way of alternative measures.”
Erskine-Smith disagreed with the suggestion that it gives too much discretionary power to police — especially since in B.C., it’s prosecutors, not police, who determine whether charges are laid.
Still, what he proposes is quite different from what happens in Portugal.
There, police have no discretionary power. People found with illicit drugs are arrested and taken to the police station where the drugs are weighed, and the person is either charged with possession and sent to court or diverted to the Commission for the Dissuasion of Drug Use to meet with social workers, therapists and addictions specialists who map out a plan.
Since private members’ bills rarely pass, Erskine-Smith doesn’t hold out much hope for his.
It created a firestorm on social media, with some recovery advocates pitted against advocates for harm reduction, including full legalization.
Federal Conservatives also repeated their trope that drug legalization is part of Trudeau’s secret agenda.
Meanwhile, Alberta’s United Conservative government inflamed some harm-reduction advocates with the release of a report on the adverse social and economic impacts of safe consumption sites, even though it didn’t recommend shutting them down.
The report acknowledged that they play an important role in a continuum of care, but it also called for beefed-up enforcement to lessen the chaos that often surrounds them.
The committee questioned some data provided to them that suggested Lethbridge — population 92,730 — may be the world’s most-used injection site.
The committee also questioned why some operators report all adverse events, including non-life-threatening ones as overdoses, leaving the impression that without the sites “thousands of people would have fatally overdosed.”
Among its recommendations are better data collection using standardized definitions as well as better tracking of users to determine whether they are being referred to other services.
More than a year ago, Canadians overwhelmingly told the Angus Reid Institute that they supported mandatory treatment for opioid addiction.
Nearly half said they were willing to consider decriminalization. Nearly half also said that neither Ottawa nor the provinces were doing enough to ease the epidemic.
It seems Canadians are eager for change even if they’re not yet certain what it should look like. The only ones who seem reluctant are the politicians.
There was some good news in the 2019 data from the B.C. Coroners Service. Overdose deaths in the province declined for the first time since fentanyl-tainted drugs hit the streets and a public health emergency was declared in 2016.
The decrease was significant — down 36 per cent from 2018 — even though the death toll remains heartbreakingly high. As B.C. enters its fifth year of the crisis, nearly three British Columbians are dying every day.
It does mean that all of the money poured into this crisis — for naloxone kits, the training for paramedics, medical professionals and laypeople in how to use naloxone, more supervised consumption sites, and more people now on prescriptions for drugs like methadone and Suboxone to staunch addicts’ opioid cravings — is keeping more people alive.
But that’s really where the good news ends.
Alarmingly, the number of 911 calls has continued to climb.
Paramedics and other first responders took more than 24,000 calls last year, with calls spiking to more than 130 overdose alerts on “cheque days” or “welfare Wednesdays.”
Being revived from an overdose or living with an opioid addiction comes at a high cost.
Opioids affect the receptors in the brain, causing breathing to become dangerously slow, which in turn slows the heart and sometimes causing cardiac arrest. When the hearts doesn’t pump at capacity, less oxygenated blood makes it to the brain. Without oxygen, brain cells die — and they don’t regenerate.
It’s called toxic brain injury.
Within the coming weeks or months, the B.C. Centre for Disease Control will release data on the prevalence of brain injury among opioid users, including those who have been successfully restored to life with naloxone.
“We know that many hundreds of people will need a lifetime of care,” said Dr. Perry Kendall, who raised the alarm during the coroner’s news conference earlier this week. “It will be a tremendous burden.”
It’s far from the only one.
The burden carried by first responders is different and no less costly. They are burning out and checking out of the system, unable to cope physically, mentally or emotionally with the constant stress of being called to deal with all the overdoses.
This is not to say that harm-reduction measures aren’t working. No one disputes that they are keeping many people alive.
But until now, little attention has been focused on the quality of their lives, post-overdose.
Five years into the public health emergency, Chief Coroner Lisa Lapointe said B.C. still doesn’t have a comprehensive system that includes prevention, treatment and recovery.
The lack of a seamless system is particularly problematic and even deadly for people in rural areas and those coming out of jails and prisons, according to Dr. Nel Wieman, senior medical officer at the First Nations Health Authority.
The numbers back that up. The death rate in the Northern Health Authority, at 22.5 per 100,000, trails Vancouver Coastal, which has the highest rate, by a mere half a percentage point.
Regardless of where they live, Lapointe said families frequently tell coroners how their loved ones managed through detox only to come out and die while on the waiting list for a recovery bed.
The problem isn’t necessarily that there aren’t enough treatment beds. On most days, some lie empty because the government only funds treatment for welfare recipients. Everyone else has to pay their own way. And except for those with generous employee benefits, many can’t afford treatment that comes at a cost of $900-plus a day.
Lapointe also decried the lack of provincial treatment standards. Different operators have different approaches. Some aren’t evidence-based. Some are strictly abstinence-based and refuse to accept people on drug therapies such as methadone and Suboxone, even though without that, they are more vulnerable to overdose if they relapse.
Decriminalization is touted by some as the answer. Without fear of criminal charges, the theory is that people would be more willing to seek help.
They point to Portugal, where decriminalization was brought in as part of a massive overhaul of its drug treatment system.
But decriminalization has only worked there because Portugal also boosted spending on the other three pillars — prevention, enforcement and treatment.
Here, the crucial elements are missing. With a minority government in Ottawa, the Liberals already have enough problems on their plate to risk raising the controversial idea of decriminalization.
Meanwhile, most provinces, including B.C., haven’t invested enough in the infrastructure to put a Portugal-style model in place.
This week, Mental Health and Addictions Minister Judy Darcy agreed that there are enormous gaps in B.C.’s fragmented system.
When the New Democrats were elected less than three years ago, she said the drug treatment system had been neglected for so long that it was not able to cope with regular tasks, let alone a public health emergency.
The government is taking steps to fix that. But whether it’s moving fast enough is a conversation that both the coroner and chief medical health officer are pushing British Columbians to have because the lives of many loved ones depend on it.
Last year, an estimated 15,400 British Columbians were using methadone as a treatment for opioid addiction. Jason Payne / PNG
The disciplinary action taken against Diamondali Tejani paints a stark picture of the challenges that the College of Pharmacists of B.C. has had reining in bad operators.
Tejani finally had his registration suspended beginning Sept. 1 and has been forbidden from being a pharmacy manager, director, owner or shareholder in a pharmacy for two years and fined him $15,000 for what he did and didn’t do in 2016.
It was the third time he’d been disciplined. In 2012, his methadone dispensing privileges were suspended for 30 days, but there were no other details included in the college’s posting on its website.
In 2000, he was suspended for three weeks following his conviction in provincial court for tax evasion.
The cause for the most recent suspension dates back to between July 8 and Nov. 25, 2016. Tejani paid cash incentives to drug users to fill their daily dispensing orders.
As owner, manager and a pharmacist at Surrey’s Boston Pharmacy, the College also said he would have, or should have, known that a patient consultation was required every day.
That wasn’t the end of it. His staff didn’t enter or reverse daily dispense prescriptions on PharmaNet when the patient didn’t show up. Instead, they’d provide patients with missed doses and also dispensed several prescriptions without prescription labels.
Daily dispenses of methadone can be a lucrative business. British Columbia allows pharmacists to charge up to $10 for each prescription for up to three prescriptions each day. That’s in addition to the fees they collect for witnessing the ingestion of methadone.
The most recent figures show the total pharmacy costs for methadone maintenance for 13,894 patients was nearly $46 million in 2011/2012 — $40 million of which was paid by Pharmacare. Last year, an estimated 15,400 British Columbians were using methadone as a treatment for opioid addiction.
Providing methadone daily is lucrative enough that pharmacists like Tejani have actively courted business. Some still do.
Physicians, recovery house operators and recovering addicts have all told me about pharmacies offering incentives as well as threats.
The kickbacks include money to recovery house operators who insist on residents going to a particular pharmacy for their three daily dispenses and money or gifts to customers themselves.
I’ve been told about some recovery house operators threatening to evict residents unless they go to those pharmacies with their three daily scripts. I’ve heard physicians folding under pressure from patients who will be evicted unless they get daily scripts for methadone and usually a sleeping pill or an over-the-counter pain medication like naproxen (a.k.a. Aleve). Their justification? It’s better for recovering addicts to have a roof over their heads than be homeless.
The College gets those complaints. But many of the complaints are never filed because as several recovery home residents have told me, ‘Who’s going to believe an addict?’
The College’s members also haven’t always supported its actions. When the College passed a bylaw in 2013 to outlaw incentives, it resulted in a three year court battle with Safeway and Thrifty Foods who wanted prescriptions to be part of their loyalty rewards programs.
But the appellate court sided with the College and, finally, it was able to enforce the bylaws similar to what Quebec and Newfoundland and Labrador have had in place since 2008.
Still it’s fair to say that professionals’ ability to regulate themselves has been a long-standing issue here, dating back at least to a 2003 ombudsman’s report that found public trust lacking.
This April, British expert Harry Cayton filed a report to the government that recommended a new regulatory framework for health professionals that will significantly reduce their autonomy.
Instead of members electing half or two-thirds of college’s boards, the health minister would appoint them along with all the public members. All college boards would also be required to have equal numbers of professionals and members of the public.
The College of Pharmacists would be one of only five professional regulatory bodies because of its unique jurisdiction over drug schedules regulation and operation of pharmacies.
The others would be the two largest — the College of Physicians and Surgeons and the nurses. The other 15 would be lumped into two new colleges — one for oral and one for everything else from chiropractors to lab technicians to speech and hearing professionals.
Colleges would be overseen by a separate body that reports to the minister. Colleges would continue to investigate complaints, but another separate, independent panel appointed by the minister would make the disciplinary decisions.
Cayton also recommended firm time limits for each stage of investigations and the elimination of professionals’ ability to negotiate agreements/settlements late in the process.
The government is accepting online feedback until Jan. 10 Presumably after that, it will move ahead with changes.
Clearly, there are problems with the current system. But it’s an open question whether a complete overhaul will to lead to better quality services care or whether it will mean more government control and more bureaucracy.
The UGM has a long, respected record of providing supportive recovery housing for people with addictions, including this one, The Sanctuary, for women. Yet it is on a government list of “unlicensed” operators. Blame the government’s confusing and opaque rules. Jason Payne / PNG
For 80 years, the Union Gospel Mission has provided services in Vancouver’s Downtown Eastside, feeding people, providing shelter and helping them deal with addictions.
It has annual revenue of just over $22 million and assets of nearly $7 million. A couple of weeks ago, it served 2,500 people at its annual Christmas dinner.
It is one of the largest providers of supportive recovery housing for people with addictions.
For women, whose needs are greatly underserved, UGM has the eight-bed Lydia Home in Mission and 13 beds at The Sanctuary on Heatley Avenue in Vancouver.
For men, it has a purpose-built facility with 62 beds for addictions recovery, 72 shelter beds and 37 affordable housing units that opened in 2011.
The provincial government put up $12.1 million for the $29 million facility and the city waived $420,000 in development fees, which explains why former housing minister Rich Coleman and then-mayor Gregor Robertson were among the dignitaries attending.
Clearly, UGM is no fly-by-night organization.
But it’s a testament to the complexity and opacity of the B.C. government’s assisted living registry that UGM has found itself on a list on of 26 unregistered (a.k.a. illegal) facilities, which includes both supportive addictions recovery houses and seniors’ assisted living.
“We feel terrible and embarrassed about our mistake as we take regulatory compliance seriously,” programs director Dan Russell said in an email. “We believed our recovery programs did not require registration or licensing because we did not provide any prescribed services.”
When UGM learned that its recovery program “could be interpreted as a therapy program” under the Community Care and Assisted Living Act, Russell said it immediately contacted the Health Ministry, which sent inspectors on Oct. 10.
In their report posted on the ministry’s website, the inspectors listed two prescribed services that were being offered at all three houses as “psychosocial supports and medication administration.”
UGM was ordered to reduce the number of people receiving services to no more than two at each location, cease providing the services or immediately apply for registration.
UGM sprang into action, gathering documentation to meet all 30 requirements on the registration checklist. It was ready to submit the application on Nov. 20. But by then, the online application form had disappeared because of new regulations that came into effect Dec. 1.
It meant UGM (along with any others attempting to get off the bad list) had to gather more documentation to prove that it meets the new guidelines. UGM is still working on completing it, but it had hoped that its good intentions would have meant it would be taken off the list.
Among the many reasons that UGM is so eager to get off a list is that the list includes several very bad operators.
Those bad actors are the reason that after years of inaction, the province has finally taken some steps to strengthen regulations and enforcement to protect vulnerable addicts searching for help.
Vancouver Recovery Centre is one of those. Operated by Kyle Walker, four of its houses are on the unregistered list with complaints against them.
The Abbotsford News reported that neighbours of the one on Eagle Street in Abbotsford described it as a flophouse when they went to city council meeting in May to finally get it closed.It also reported that police had been called to the house 32 times between January 2017 and January 2019 for a sexual assault, a domestic dispute and threats and that residents were being charged $800 to live there.
The house was still operating despite orders from the city in April 2017 and the province in September 2018 to close.
For decades, the provincial government and municipalities have been playing whack-a-mole with scammers who promise addictions recovery services and provide only shelter.
Yet, even some government-registered recovery houses have critical failings — failings that have cost five people their lives in the past year.
Union Gospel Mission is not one of those and there are many registered and licensed houses operating to the highest standards.
Protecting them from guilt by association is why registration, licensing, regulation and enforcement are all crucial.
More importantly, a robust system and a credible registry are only ways that anyone — let alone desperate addicts and families — can determine whether a recovery house is safe or whether the best thing about it is a slick website.
Soon British Columbia will mark the fourth anniversary of a public health emergency caused by overdose deaths from a fentanyl-laced supply of illicit drugs.
The number of deaths dropped 30 per cent in the first half of 2019. But the number of times paramedics were called to deal with overdoses remains near its all-time high.
Addiction isn’t going away nor is the need for high-quality treatment and recovery services.
If ever there were a need for more harm reduction, it’s at the registered and unregistered, licensed and unlicensed addictions recovery houses in British Columbia run by operators who have no regard for residents’ health or safety.
Within the last year, five people have died in provincially registered recovery homes. Two of those deaths were in the last three months.
On Dec. 1 — years too late for too many — new legislation and regulations finally came into effect. But they apply only to operators on the provincial Assisted Living Registry and not to those licensed by the local health authorities. There is also no provision to shut down those that are operating illegally. On its website, the Health Ministry does list 26 unregistered houses that it has received complaints about. But people in the recovery community say it’s only the tip of the iceberg.
The regulations themselves are “thin,” according to Carson McPherson, the chair of the B.C. Centre on Substance Use’s recovery committee.
“They’re easy to work around. There’s no real specificity anywhere,” said McPherson.
“There are no specific requirements for level of staffing qualifications tied to prescribed services. If you’re delivering trauma-informed services, you ought to have someone qualified. But that doesn’t exist (in the regulations).”
Prior to the regulations coming into effect, the Addictions Ministry provided $4,000 grants to operators for 16 hours of staff training.
But McPherson argues that’s hardly enough. “You’re dealing with health care and life and death situations.”
Beyond that, what’s been left in place is a confusing system that’s almost impossible for recovering addicts and their families to navigate. While some recovery houses are registered on the province’s Assisted Living Registry, others are licensed by local health authorities.
Still others operate illegally, which has forced municipalities like Surrey to use their limited business licensing and bylaw enforcement systems to try to shut them down. The government provided no new tools or authority to deal with those.
Despite that, there’s plenty of catch-up work that B.C.’s assisted living registrar needs to do.
Until now under the old, so-called “progressive system,” registered operators were given multiple chances to fix problems and there were no consequences if they didn’t.
On Nov. 26, for example, it cancelled Step by Step Recovery Society’s registration. But two days later, a man in his 30s lit himself on fire and died at one of its five Surrey houses. He was the third resident in less than a year to die in one of Step by Step’s houses, which had 65 substantiated complaints registered against them.
Even now, at least one of its houses remains open. The Addictions Ministry says it has asked the city to help the remaining residents find spots at other recovery houses.
Why wasn’t Step by Step immediately closed on Dec. 1 when the legislation and regulations came into force? Because they’re not retroactive and the actions begun against Step by Step are covered by the old rules.
Also exempt from the new regulations areOptions Recovery Centre in Surrey and Reaching Out in Vancouver where the two other deaths occurred earlier this year.
On July 1, a beloved young man died at Options on 100A Avenue. The 24-year-old was the brother of a friend of mine.
Among the most cynical of Options’ substantiated failings is that it failed to even meet the legislated requirement of filing a serious incident report to the registrar within 24 hours of his death. It was only reported on Aug. 8 after complaint had been filed.
But that was the only substantiated complaint to which John Alan Murphy, Options sole proprietor, has responded.
Investigators have substantiated complaints that it fails to provide many of the key services required of supportive addictions residential care homes.
In July, investigators found that staff and volunteers are not qualified for their jobs or knowledgeable about their roles.
No help is provided for residents to work toward long-term recovery, maximize their self-sufficiency, enhance their quality of life or help them reintegrate into the community. The food was deemed not to be nutritious or safely prepared.
Two months earlier, investigators substantiated a similar list of complaints.
Unsafe meals. Unsafe site management. Unqualified staff and volunteers. No support to assist in recovery and reintegration.
Sometime in September, a resident died at Reaching Out, a house in Vancouver operated by Changing Addictive Attitudes Recovery Society of B.C.
On Nov. 25, investigators substantiated complaints about Reaching Out that are chillingly similar to those at Options.
Reaching Out failed to report the death at its facility within 24 hours. Staff and volunteers were unqualified. There is no 24-hour emergency response system for residents and staff to summon help. And investigators deemed it an unsafe place for residents to live.
To gain some modicum of credibility, the registrar needs to act swiftly to bring all of the houses into line and hope that no one else dies in the meantime.
As for Health Minister Adrian Dix and Addictions Minister Judy Darcy, they ought to draft even more sweeping changes, bolstering enforcement to ensure that illegal operators can also be rooted out.
Vulnerable people aren’t just dying on Downtown Eastside streets in the midst of the opioid overdose crisis. They’re dying in places that promise to help them attain a healthier lives.
Anyone who provides assisted living services for more than two seniors, people with mental health issues or those in recovery from addictions is required to be approved by B.C.’s assisted living registrar. Following is a list of unregistered homes by region fromhttps://connect.health.gov.bc.ca/ext/ccala/assisted-living
• 3H Wellness Society
13297 78A Avenue
• A:yelexw Women’s (Seabird Island Recovery Homes)
Late last month, a man in his 30s with a long history of addiction doused himself with gasoline and set himself on fire in the garage of a Surrey recovery house.
Two other residents went to hospital and were treated for smoke inhalation as a result of the two-alarm fire.
The B.C. Coroners Service is investigating. So is the Surrey fire department.
Self-immolation is tragedy enough. But what makes it worse is that the man’s death is directly attributable to years of appalling neglect. For two decades, B.C. failed to regulate residential addiction treatment facilities or ensure that they met even the most basic standards.
The man, who has not been officially identified, died in a government-registered treatment home where he was supposed to be monitored, supervised and helped to attain long-term recovery.
What intensifies the tragedy is that his was the third death in a year in a house run by Step by Step Recovery Society. One of the society’s five directors, Debbie Johnson, owns the house at 138A Street that was badly damaged in the fire.
Between November 2018 and March 2019, there were 65 separate breaches of the Assisted Living Registry’s regulations at the five Surrey houses that the society was operating.
Those infractions — the most recent of which were investigated in March — range from inadequate food to unqualified staff to unsafe facilities to failure to ensure residents are not a danger to themselves or others.
At the house on 138A Street where the most recent death occurred, there were 11 substantiated complaints. Only one was dealt with, according to the most recent report posted on the Assisted Living Registry’s website.
The pest control people did get rid of the mice.
But, according to the report, no action had been taken to address verified complaints about safety, about untrained, unqualified staff, and about the lack of any psychosocial supports aimed at helping people attain long-term recovery.
The society voluntarily closed two of its houses earlier this year.
But of the three still on the registry, all have substantiated complaints that haven’t been dealt with. In March, nothing had been done at the houses on 78A Avenue and 97A Avenue that were deemed unsafe for the needs of residents. Verified complaints posted in February about safety and the quality and training of staff remained outstanding.
The question that screams for an answer is: Why wasn’t Step by Step shut down earlier?
The legislation didn’t allow it. The Assisted Living Registry had no power to take immediate action to suspend or attach conditions to a registration.
Instead, all that the registry staff could do was try to work with the operator to get them to conform.
There are dozens of other niggling questions. If this were a well-staffed facility, someone might have realized that the man was struggling before he went to the garage. If it were a well-run, supportive house, it’s unlikely he would have had access to gasoline.
With better rules and oversight, those other two deaths at Step by Step might not have occurred either, and maybe other deaths could have been avoided over the past two decades.
Two decades. That’s how long B.C. went without any regulation of residential treatment centres.
That finally changed on Dec. 1 — 21 years after a previous NDP government brought in regulations only to have them scrapped in 2001 by the B.C. Liberal government that described them as too onerous.
The Liberals did promise new and improved rules in 2016 after a Surrey mom was killed outside a hockey arena by a resident of one of the unregulated facilities. But those rules were never enacted.
In 2017, a coroners’ jury recommended regulations following a 20-year-old man’s overdose death in a Powell River treatment centre. Those regulations were finally released in August 2019 and operators — including Step by Step — were given three months to get ready for the changes.
In the last four days, the registrar has cancelled all five of Step by Step’s registrations. A letter has gone to the operator. And, according to the emailed response from an addictions ministry spokesperson, the operator is “expected to begin an orderly transition of current residents to other registered supportive recovery homes.”
The email also said that Surrey’s bylaw department will work with the operator to place the remaining residents to ensure that no one is left homeless as a result of the closures.
It’s a glimmer of good news. But it all happened four days too late for the unnamed man, for 21-year-old Zachary Plett, whose family will grimly mark the first anniversary of his death at Step by Step last Dec. 15. And it comes nearly 13 months after Step by Step staff took two full days to discover the body of a 35-year-old who overdosed in the house on Christmas Eve.
“Why they had to wait to get these regulations in place is beyond me,” Zachary’s mother Maggie Plett said Thursday. “They should have been done sooner.
1998: The NDP government brings in the first regulations under the Community Care Facilities Act.
2001: The B.C. Liberal government scrapped those regulations as part of its deregulation drive, declaring the requirements too onerous.
2014: A Surrey mother is murdered outside a hockey arena by a man living at one of the unregistered houses. At the time, Surrey alone had as many as 250 flophouses purporting to offer supportive housing for recovering addicts.
2016: In the spring’s Throne Speech, B.C. Liberals promise regulations, enforcement and a public registry.
In December, Surrey council voted to require all recovery houses to have business licenses, capping the number at 55 and requiring all of them to be listed on the B.C. government’s Assisted Living Registry.
The amendments to the Community Care and Assisted Living Act were never enacted or enforced.
2018: The B.C. coroners’ review of an overdose death in a Sechelt recovery house recommended that by September 2019 there needed to be better regulations for public and private residential addiction treatment facilities, as well as heightened enforcement.
The government agreed and set up a committee to develop standards to “help ensure quality and consistency and enhance understanding of the services across the province.”
April 2019: The deadline set by the coroner for a progress report came and went, but in a letter from the Ministry of Mental Health and Addictions in May, it promised to have a final report ready for September.
August 2019: Addictions Minister Judy Darcy announces that the 2016 regulations will finally be enacted along with some additional requirements on Dec. 1. To prepare for the changes, the government offered $4,000 in grants to operators licensed by the health authorities or registered by the ALR to offset staff training costs as well as an increase in per-diem rates for residents after more than a decade of having been stuck at $35.90.
B.C. Addictions Minister Judy Darcy has no illusions about the current state of British Columbia’s recovery houses and the risk that the bad ones pose to anyone seeking safe, quality care.
Nor is she alone when she calls it “the wild, wild West.”
Anyone able to build a website and rent a house can operate a so-called recovery house. Like a game of whack-a-mole, even when inspectors try to shut down the worst ones, they spring up somewhere else.
That said, the regulations they’re supposed to enforce are so vaguely worded that it’s easier for bylaw inspectors to shut places down for garbage infractions than for failure to provide the most basic of services like food and a clean bed to people desperate for help.
Even the most deplorable ones have never been taken to court by the province, let alone fined or convicted which makes the penalties of up to $10,000 moot.
It’s taken two years, but this week Darcy — along with Health Minister Adrian Dix and Social Development Minister Shane Simpson — took the first steps toward bringing some order to the chaos and overturning years of neglect.
In two separate announcements, what they’re offering is both the stick of tighter regulations and enforcement as well as the carrot of more money for operations and training staff.
The carrots announced Friday include $4,000 grants available immediately to registered and licensed recovery home operators to offset the costs of training for staff before tougher regulations come into force on Dec. 1.
On Oct. 1, the per-diem rate paid for the treatment of people on social assistance will be raised after more than a decade without an increase. Recovery houses on the provincial registry will get a 17-per-cent increase to $35.90, while recovery houses licensed by the regional health authorities will jump to $45 from $40.
The sticks are new regulations that for the first time require things like qualified staff, which common sense should have dictated years ago as essential. Recovery houses will have to provide detailed information about what programs and services they offer. Again, this seems a no-brainer, as does requiring operators to develop personal service plans for each resident and support them as they transition out of residential care.
As for enforcement, the “incremental, remedial approach” to complaints has been scrapped and replaced with the power to take immediate action rather than waiting for a month and giving written notice to the operators.
Darcy is also among the first to admit that much, much more needs to be done to rein in bad operators whose purported treatment houses are flophouses and to provide addicts and their families with the resources they need to discern the good from the bad.
More than most, the minister knows the toll that poor funding and lack of regulation is taking both on addicts who seek help and on their loved ones. She’s haunted by meetings she’s had with the loved ones of those who have died in care and those who couldn’t get the services they needed.
“It’s the most difficult thing that I have to do and, of course, it moves me to my core,” she said in an interview following the announcement. “People say, ‘Do you ever get used to it?’ Of course I don’t. If you ever get used to it, you’re doing the wrong job.
“But I try and take that to drive me and to drive our government to do more and to move quickly and act on all fronts and having said that, there’s a lot to do. There’s really, really a lot to do.”
Among those she’s met are the two mothers of men who died within days of each other in December under deplorable conditions in two provincially registered recovery houses run by Step By Step.
It was four to six hours before 22-year-old Zach Plett’s body was found after he overdosed and died. On Christmas Eve, a 35-year-old man died at a different Step by Step house. It was two days before his body was found by other residents.
Two years before those men died, the provincial registrar had received dozens of complaints and issued dozens of non-compliances orders. Both houses remained on the registry until this summer when owner/operator Debbie Johnson voluntarily closed them.
After years of relentless advocacy Susan Sanderson, executive director of Realistic Recovery Society, was happy to host the ministers’ Friday announcement at one of its houses. She wants to believe Darcy that these are just first steps since the per-diem rate is still short of the $40 she and others lobbied for and remains a small fraction of what people who aren’t on welfare are charged — charges that can run up to $350 a day.
Having taken these long overdue and much-needed initial steps, maybe Darcy and her colleagues can take another logical next step to support working people getting access recovery who — without access to employee benefit plans — can’t afford the cost of treatment.
They shouldn’t have to wait until they’re destitute to get care, any more than someone on welfare should be deprived of help.
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.
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.
“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.
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.”
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.
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.”
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.
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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