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9Mar

Daphne Bramham: Canada’s other public health crisis also needs urgent attention

by admin

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.


Liberal member of Parliament Nathaniel Erskine-Smith (in front) pictured in 2018.

Adrian Wyld/The Canadian Press

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.

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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.

dbramham@postmedia.com

twitter.com/bramham_daphne

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25Feb

Daphne Bramham: It’s not enough to just keep overdose victims alive

by admin

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.

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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.

dbramham@postmedia.com

Twitter: @bramham_daphne

13Feb

Virtual walk-in clinics increase access to doctors in rural B.C. communities

by admin


Fort St. John resident Candace Marynuik saw a doctor through the Babylon app by Telus Health.


Submitted photo / PNG

For weeks, Candace Marynuik hadn’t felt like herself.

She might have told a doctor about her “weird symptoms,” but since moving to Fort St. John in 2017 she had been forced to rely on the local walk-in clinic, lining up in sub-zero weather before sunrise to be turned away when every space was filled.

“I hadn’t seen a doctor in over two years,” she said. “Something didn’t feel right, but I didn’t know what to do about it.”

In September, a friend suggested an app she had used to get a prescription refilled.

Within hours, Marynuik had a virtual appointment with a B.C. doctor, and within a week she had done blood tests and an X-ray. She even had a suspected diagnosis — multiple sclerosis. She would need an MRI and a visit to the University of B.C.’s MS clinic in Vancouver to confirm the diagnosis, but doctors she had never met in person connected her with the right specialists.

“I don’t know how long I would have waited (to go to the hospital in Fort St. John),” she said. “By the time I got on the plane to Vancouver, my brain was in a fog.”


Fort St. John resident Candace Marynuik saw a doctor through the Babylon app by Telus Health.

Submitted photo /

PNG

The Babylon app by Telus Health was launched in B.C. in March, at that time the only province in Canada with a billing code to pay doctors for virtual visits.

While Telus was reluctant to provide Postmedia News with information on the number of British Columbians who have used the free app so far, the telecommunications company said “tens of thousands” of people have downloaded Babylon and completed consultations. January saw the highest downloads to date, with a 30 per cent increase over December.

“The growth has been significant,” said Juggy Sihota, vice-president of Telus Consumer Health. “Some of the stories people have told us bring tears to my eyes. It’s been used by a 97-year-old who had trouble seeing a doctor because of mobility issues, someone who said the app saved their family’s Christmas (and) people in rural areas who have to drive hours to see a doctor.”

Sihota said the number of doctors registered with the app is growing, with many drawn to the system by the work-life balance it provides. Some work part-time in clinics or their own practices and take calls through Babylon on the side. Like a physical walk-in clinic, the doctors bill MSP for the consultations.

Sihota said “connected care” is at the heart of the Babylon app. While patients receive access to the doctor’s written notes, they can also play back a video of their consultation. The virtual clinic also helps them arrange the necessary tests and followup appointments.

In a short survey conducted for Telus after each appointment, 92 per cent of respondents said their main request was resolved by the end of their consultation. Asked to rate the service, they gave it an average 4.9 out of five stars, a number that hasn’t dropped since March.

The top conditions treated by doctors through the app include mental health, sexual health, skin disorders and respiratory issues. So far, more women have used it than men.

“We should all have equal access to health care,” said Sihota. “We believe technology can make our health-care system better at less cost.”


The Babylon app by Telus Health connects B.C. residents with doctors.

PNG

Babylon isn’t the only example of virtual health care in B.C.

The primary health-care strategy announced by the provincial government in 2018 included an emphasis on technology solutions. At a news conference, Health Minister Adrian Dix said technology would be used to bring health care closer to home for those in rural and remote areas through the use of telehealth services and new digital home-health monitoring.

B.C. Children’s Hospital uses technology to link specialists to doctors and patients throughout the province through 19 telehealth centres, conducting about 140 virtual appointments per month. Specialists also provide advice to adult patients through a program called Rapid Access to Consultative Expertise.

The government paid nearly $3 million for about 43,000 video-conference visits to doctors in 2015-16. The number of virtual visits rose to over one million in 2016-17.

Telus Health has recently made a push into the health-care field, buying a chain of elite medical clinics and reportedly spending over $2 billion on a variety of digital-health tools.

Some doctors have questioned whether virtual health care erodes quality of care by eliminating long-term doctor patient relationships in favour of episodic care, while also making it more attractive for doctors to work for a virtual clinic, making it even harder to see a doctor in person.

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—With files from Postmedia News

gluymes@postmedia.com

twitter.com/glendaluymes

12Feb

Daphne Bramham: Lack of addictions treatment for youth needs urgent fix

by admin

As B.C. heads into the fifth year of a public health emergency due to the high number of opioid overdose deaths, Vancouver Island still doesn’t have a single residential-treatment for youth. Provincewide, the number of youth beds and services lag demand.

For youth who do get one of those precious treatment beds, their transition back to community-based services is badly planned and poorly managed.

Had all of that been in place, 16-year-old Elliot Cleveland Eurchuk might have survived his addiction rather than being counted among the 4,850 British Columbians to have died between January 2016 and Oct. 31, 2019.

But the teen’s legacy could be — should be — that Health Minister Adrian Dix and Premier John Horgan making addictions treatment as much of a priority as harm reduction.

Recommendations from the coroner’s inquest into Eurchuk’s 2018 death released on Monday provide some direction: More acute-care beds for youths including a residential treatment centre in Victoria; more and better access to addictions services; and resources for early detection of mental-health and substance-use disorders among youth.

For more, the government ought to dig out its copies of the 2018 report from the B.C. Centre on Substance Use that recommended a “full, evidence-based continuum of care including building an effective and coordinated addiction treatment and recovery system that has traditionally been lacking.”

That report also singled out the need for youth-specific services and treatment including residential care. It also recommended “recovery high schools” where not only are drugs and alcohol are strictly prohibited, treatment and services are part of the curriculum.

Men aged 19 to 59 make up the overwhelming majority of the people who have died of opioid overdoses. But, an average of 18 youths have died in each of the past four years.

The recommendations aren’t only aimed at preventing youth from dying. They’re aimed at providing treatment to prevent their addictions from becoming entrenched.

In addition to the recommendations, the coroner’s report provides a glimpse of the other opioid crisis far away from Vancouver’s Downtown Eastside.

Related

Eurchuk knew about harm reduction services, but he didn’t get his drugs tested, didn’t go to safe injection sites, didn’t seek treatment or replacement therapies such as methadone or Suboxone.

He’d started using cannabis in November 2015 when he was 13. After injuring his shoulder wrestling a year later, he began self-medicating, buying hydromorphone from a classmate at Oak Bay High School.

In December 2016, he broke his jaw playing soccer and, after surgery, was prescribed hydromorphone for the pain. Two months later, he had the first of two surgeries on his shoulder and was prescribed another opioid, Tramacet, for the pain.

After reinjuring his shoulder that fall, Eurchuk was given another prescription for Tramacet. He was also suspended from school, accused of selling drugs to classmates.

After a second shoulder operation that October, Eurchuk got a five-day prescription for Oxycodone, followed up by a prescription for Tramacet.

In the final months of his life, Eurchuk was routinely using opioids to the point that when he was hospitalized in early 2018 for a serious infection, he got a day pass and got fentanyl and cocaine while he was out. He went into cardiac arrest in the hospital on his return.

He was home briefly in February before being readmitted under the Mental Health Act. Discharged after a week, Eurchuk was in the emergency room of Vancouver’s St. Paul’s Hospital in March because of decreased consciousness and released after a few hours.

On his final day, Eurchuk bought a two-day supply from a street dealer, used with a friend early in the evening and was heavily intoxicated by the time they parted ways. As the evening wore on, people who saw him described him as everything from fine to agitated to disoriented. He was last seen at midnight.

The teen died on the morning of April 10 at home from a heart attack, fluid in the lungs and aspiration caused by “mixed intoxication” from fentanyl, cocaine, heroin and methamphetamine.

Attempts to revive him with naloxone, chest compressions, suction and a defibrillator failed.

While the government will provide a written response to the coroner’s recommendations in the coming weeks, last summer it committed $2.4 million over three years to addictions and mental health programs.

It has opened four youth detox beds in Victoria. There are eight Foundry Centres across the province providing comprehensive supports with three more being developed.  And, this spring, a 20-bed treatment facility in Chilliwack is scheduled to open.

There is no guarantee that better acute-care treatment, earlier interventions and more comprehensive community services will save the lives of every addicted youth or that they would have saved Eurchuk.

Addiction is, after all, a chronic, relapsing condition.

Elliot Eurchuk was just a kid and there are others like him. They deserve the best chance possible to grow up to be healthy adults.

dbramham@postmedia.com

Twitter: @bramham_daphne

4Feb

Daphne Bramham: Urgent overhaul of long-term care funding and oversight needed

by admin


In 2017-18, for-profit operators failed to deliver 207,000 hours of care for which the B.C. government paid them.


AlexRaths / Getty Images/iStockphoto

Some corporate-owned, long-term care homes in B.C. are getting money for nothing, while not-for-profits may be getting less than they need for their services to be sustainable.

But the bottom line is that the losers are both vulnerable seniors and taxpayers who are footing the $1.3-billion annual bill.

To be clear, it may be unconscionable, but for-profit operators who run a third of all the long-term homes and beds in B.C. are not breaking any rules. Just as it’s fair to assume that not-for-profits, who account for another third of the total, aren’t deliberately leaving money on the table.

The problem is that the system is broken.


B.C. Seniors Advocate Isobel Mackenzie (Richard Lam/PNG)

Patients and their families have been complaining for years. On Tuesday, B.C. Seniors Advocate Isobel Mackenzie clearly set out the evidence in her report, A Billion Reasons to Care, which comes within a few months of Island Health taking over three privately operated homes.

Mackenzie’s funding review is a scorching indictment of the government’s failure to properly manage one of the largest contracting relationships it has with service providers. To some extent, Mackenzie said, the government is handing long-term care operators blank cheques.

She said the rules haven’t kept pace with the fundamental shift in government procurement policy that began 20 years ago when long-term care was contracted out to private operators who were then allowed to opt out of the Health Employers Association of B.C., which once bargained on behalf of all publicly funded, health-care employers.

Rules are non-existent, vague or not uniformly applied. Direct care hours, for example, aren’t necessarily separated out from the hours that care aides spend on food service or housekeeping. Financial monitoring is scant with no requirement for detailed or audited reports.

In 2017-18, for-profit operators failed to deliver 207,000 hours of care for which the B.C. government paid them. Were they fined? No. They got to keep the money.

Meantime, not-for-profit operators delivered 80,000 hours of care more than they were contracted to provide. Those extra hours were paid for either by lower costs in another area or by other funding sources.

It is true that all operators face a staffing crisis that Mackenzie describes as being of epidemic proportions, with nearly 90 per cent of care homes not able to meet minimum staffing guidelines.

But it’s partially self-inflicted. For-profit operators’ wage costs for each hour of direct care is lower across all classifications than the costs at not-for-profits and the homes run directly by health authorities.

Some for-profits are paying care aides, who provide two-thirds of the care, nearly a third less than the industry standard, which works out to $6.63 an hour. Part of the difference is that for-profit operators are more likely to hire part-time rather than full-time workers, which eliminates the need to pay benefits.

Raise the salaries, says Mackenzie, and workers will follow the money.

The government and health authorities should also follow the money. Rather than setting a minimum wage or requiring that all operators pay the industry standard, Mackenzie says to simply end the incentive to not deliver the care. If operators didn’t deliver 207,000 hours of care, they should have been required to give that money back.

But there are no penalties in any of the contracts. Don’t deliver and, ka-ching!, the bottom line suddenly looks a lot better as taxpayers’ money transforms into shareholder profits.

Disturbingly, Mackenzie found that contracts varied both between and within health authorities.

“All spoke to delivery of care,” she said Tuesday. “But none specified the type of care. None outlined any legal requirements to provide the care. And none had explicit penalties for non-compliance.”

Every health authority also had different reporting systems. Different ones allowed expenses to be claimed differently. There were also anomalies between the profit and non-profit operators, including for-profits having surpluses 12 times higher and profits three times higher.

The health authorities allowed for-profit operators to claim building expenses at 20 per cent of their revenues compared to the not-for-profits’ nine per cent. They also allowed mortgage interest rates considerably higher than market rates, double the depreciation rates, unexplained lump-sum payments to contractors working for affiliated companies, unspecified management fees in addition to administrative expenses that are higher than non-profits.

One concern Mackenzie has about non-profits claiming lower building expenses is that they will not be able to upgrade their facilities as they age, meet any new accessibility requirements that may be required, or expand to meet the tsunami of demand from an aging population.

It all needs to change and change quickly before even more public money is funnelled into corporate profits at the expense of vulnerable seniors who aren’t getting the care they need and deserve.

dbramham@postmedia.com

Twitter: @bramham_daphne

26Dec

Hiking for healing: UFV researcher finds nature helps anxiety among cancer survivors

by admin

After a few minutes on the hiking trail, Dr. Duna Goswami felt her stress lessen.

“It was like I was in a green tunnel. I could smell the fresh air. I could hear the water dripping from the trees,” she said.

The Abbotsford physician was one of nine cancer survivors who participated in a program designed by a University of the Fraser Valley kinesiology professor to see if nature has the ability to reduce anxiety levels.

Over eight weeks in September and October, the group met twice a week to hike in the Cultus Lake area.

Early results, based on interviews with the participants, seem to prove the oft-touted notion that nature really does soothe the soul.

“A number of them said it helped them realize how strong they were,” said lead researcher Dr. Iris Lesser. “When asked to rank their anxiety before and after the hike, we saw a drop in stress.”

There are likely several causes for that, not least of which is the experience of being in nature itself.

Lesser and her associates purposefully selected hikes that were not too difficult, but still lush and green.

“We asked participants if they thought it would be the same if they were doing a walk in the city, and they thought it wouldn’t be,” she said.

For Goswami, who finished treatments for breast cancer about a year ago, the setting made her feel peaceful.

“I might have gone hiking in the summer before, but not in the fall. It changed my view. I realized I could get outside even in the rain,” she said.

Goswami also reported several other benefits that proved common among participants. Hiking with a group of fellow cancer survivors provided support.

“Having cancer is isolating,” she said. “Even though you’re surrounded by people who want to help, it is nice to be with those who know what it is like, who understand.”

The physical exercise also brought benefits. During her treatment, which included chemotherapy, surgery and radiation, the physician felt ill and was unable to be active. For almost a year after, she still felt tired.

“I was working, but I was very tired,” she said.

Lesser said the benefits of exercise for stroke and cardiac patients are well known, but using exercise in cancer treatment is still a new field.

“We knew going in there might be several different factors at work in our results,” she said. “In an effort to untangle them, we tried to ask questions that were specific to each component.”

It appears clear that participants benefited from being in nature, as well as the social support and physical activity that hiking entailed.

The researcher was encouraged in her study by local oncologists who identified a gap in survivor care.

“They felt like patients should be better supported after treatment, but they didn’t have the time to help them navigate that part,” she said.

Lesser would eventually like to see a program for cancer survivors in the model of a support group that incorporates nature and physical activity.

In the meantime, she hopes to run another session in the spring to provide her with more data. The hikes will take place in the Chilliwack area. People can email iris.lesser@ufv.ca for more information.

gluymes@postmedia.com

twitter.com/glendaluymes

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16Dec

Daphne Bramham: Self-governing pharmacists or government? Who should keep bad health professionals in line?

by admin


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.

dbramham@postmedia.com

Twitter: @bramham_daphne

 

13Dec

Daphne Bramham:

by admin


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.

dbramham@postmedia.com

Twitter: @bramham_daphne

11Dec

Daphne Bramham: More oversight and enforcement needed at addictions recovery houses

by admin

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.

dbramham@postmedia.com

Twitter: @bramham_daphne

Unregistered supportive housing in B.C.

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 from https://connect.health.gov.bc.ca/ext/ccala/assisted-living

FRASER HEALTH

• 3H Wellness Society

13297 78A Avenue

Surrey

• A:yelexw Women’s (Seabird Island Recovery Homes)

2835 A:yxalh Lane

Agassiz

• Patricia House — Abbotsford Women’s Centre

15 Winson Road

Abbotsford

• Cozzolino Home

24990 36th Avenue

Aldergrove

• Good Samaritan Delta View Care Centre Ltd.

9341 Burns Drive

Delta

• Hope for Freedom Glory House

34641 Lougheed Hwy

Mission

• Inspire Change Wellness House

13936 — 28 Ave

Surrey

• Union Gospel Mission — Lydia Home

33170 70th Ave

Mission

• Mann Ford Recovery Center

4131 Lakemount Road

Abbotsford

• Union Gospel Mission

Men’s Recovery Program

601 East Hastings Street

 

VANCOUVER

• Night and Day Recovery Centre Ltd. (108A)

14677 108A Ave

Surrey

• The English Manor

16963 22nd Ave

Surrey

• Union Gospel Mission

The Sanctuary

361 Heatley Ave

Vancouver

• Vancouver Recovery Centre

1880 Eagle St

Abbotsford

• Vancouver Recovery Centre

2323 Southdale Crescent

Abbotsford

• Vancouver Recovery Centre — Suncrest

7822 Suncrest Drive

Surrey

• Vancouver Recovery Society

6122 168 Street

Surrey

 

INTERIOR HEALTH

• Resurrection Recovery Resources Society

Freedom’s Door #6

1340 Belaire Ave

Kelowna

• Round Lake Treatment Centre

200 Emery Louis Road

Armstrong

• Shuswap Lodge Retirement Residence

200 Trans Canada Highway SW

Salmon Arm

• The Mustard Seed

181 Victoria Street

Kamloops

• Valiant Recovery — The Crossing Point

3525-3527 Lakeshore Rd

Kelowna

 

VANCOUVER COASTAL HEALTH

• Giving Back Support Recovery (house One)

3608 Knight Street

Vancouver

 

VANCOUVER ISLAND HEALTH AUTHORITY

• Heritage Manor

1051 College Street

Duncan

• Mile Zero Sober Living

647 Niagara St

Victoria

• Oceanview Manor

468 Battie Drive

Ladysmith

5Dec

Daphne Bramham: ‘Terrible, terrible tragedy’ at Surrey recovery home should have been preventable

by admin

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.

“It’s just a terrible, terrible tragedy.”

dbramham@postmedia.com

Twitter: @bramham_daphne


Recovery house regulations timeline:

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.

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