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.
Here readying an at-home dinner for 70 art collectors and professionals, Bob Rennie later addressed building contractors on the “demographic crunch” he said will add “another Vancouver, Burnaby, New West and Coquitlam.” Malcolm Parry / PNG
CRYSTAL BALLING: Realtor Bob Rennie and his Rennie Group’s intelligence VP, Andrew Ramlo, helped Independent Contractors and Business Association conventioneers digest their bacon and eggs recently. The association president, Chris Gardner, had already told breakfasting colleagues that trade workers’ wages will increase by 5.2 per cent this year, that 54 per cent of contractors can’t obtain enough workers, and that only the Slovak Republic is slower than B.C. among 35 jurisdictions issuing building permits. Rennie and Ramlo’s “demographic crunch” projections included Canadian immigration admissions surging to 350,000 by 2021 (B.C.’s share to be 15 per cent). An aging population and climate change will be the economy’s greatest challenges, they said. Meanwhile, housing the Lower Mainland’s one million more residents by 2040 will require “another Vancouver, Burnaby, New West and Coquitlam.” And though, in constant dollars, millennials’ median household after-tax income exceeds Generation X’s and Baby Boomers’ by 32 per cent, their debt-to-after-tax-income is almost twice as high at 216 per cent. Rennie’s problem: “Twenty years from now, who’s going to be my lawyer, bring my bedpan and pay my taxes?”
GIRLY RISER: After 14 years as a global art adviser, Krista Howard has launched a physical gallery and office, Howard495, in the Railtown district. Her debut show, titled Girlie Pics, Someone Else’s History, featured work — some of it a little spicy girlie — by mostly female artists familiar to her existing clients. Catriona Jeffries’ influential gallery recently located nearby on East Cordova’s 900 block. The Monica Reyes Gallery has long operated at Hastings-at-Princess. We’ll likely see more.
HIGHER LEAH: Raised in a socialist household, Leah Costello sang in a Salmon Arm-based Hawaiian band, sought North Vancouver’s federal Tory nomination, managed Fraser Institute events, produced policy-issue videos, and founded Curious Minds Productions and the Bon Mot Book Club. The latter’s readings featured such diverse authors as former Pakistani president Pervez Musharraf, U.S. vice-presidential nominee Sarah Palin, Canadian media meteorite Conrad Black and John Cleese of the Monty Python’s Flying Circus TV series. After shelving that project, Costello married the Highland West Capital managing director and former Douglas & McIntyre book-publishing firm partner, David Rowntree. Now, as Leah Rowntree, she’s planning a podcast titled Hungry Mind, Open Heart to talk about current issues. There’s a Hawaiian song for that: I Hei Anau — How Far I’ll Go.
FREE-LUNCH DIVIDEND: Science World’s Lego-skyscrapers exhibition reminds architect Michael Green of his first job. Before designing and advocating mass-wood highrises, Green assisted César Pelli on Kuala Lumpur’s reinforced-concrete Petronas Towers. At 452 metres, the 1996 structures were the world’s tallest until 2004. Green recalls clients nixing Pelli’s original design because his tower cross-sections resembled the six-pointed Star of David. When redrawn with two more to suggest the Muslim Rub El Hizb symbol, and with further facets added, Pelli got the go-ahead. Green has given himself the same for a vegetarian-vegan book based on his lunchtime feeding of Michael Green Architecture’s 65 staff. Its second section will address how “serving food builds culture, connections and collaboration,” and a third “the financial benefits of all businesses giving lunch.” Have your cake and eat it, that is.
ART START: North Vancouver’s Polygon Gallery was packed recently when Laura Gildner received the fifth-annual Philip B. Lind Emerging Artist Prize of $5,000. “Being an artist is very hard; I admire you immensely,” Rogers Communications vice chair Lind said to prize contenders. Many feel that way about Lind, who survived a 1998 stroke to continue his 40-year guidance of communications entrepreneur Ted Rogers. Gildner’s work, Informer, contains eight life-size video images addressing viewers. Visit the Polygon gallery exhibition before March 16 to see how artists emerge.
GOOD ONE GOES: Hospital staff and patients will miss Dr. Dianne Miller who has completed 30 years as a gynecological oncologist and researcher. She received a Vancouver Coastal Health lifetime-achievement award in 2019 that recognized her “revolutionizing the care and prevention of ovarian cancer for women in B.C. and all over the world.” Miller will now spend up to three months a year teaching gynecological-cancer surgery techniques to Ugandan practitioners.
BOT BALL: Beaumont Studios founder-owner Jude Kusnierz’s recent Robot Dance Party drew participants attired in costumes that could hamper the actual dancing. Artist Noa Ben-Mazia — she goes by Noya — avoided that by creating a life-sized but inanimate robot named BroBot3E5 that, with further tweaking, may master a few dance steps for next year’s wingding.
NO DEER: Much-honoured animator Marv Newland won’t follow the Disney studio’s proposed remake of Bambi by updating his own Bambi Meets Godzilla. The Mayne Island resident and International Rocketship Ltd. founder-principal usually pooh-poohs talk of the 1969 cult-classic he made while studying at Pasadena’s ArtCenter College of Design. Newland does have a new movie, though. Containing contributions by 15 global colleagues, his Katalog of Flaws will premiere at the 20th annual Monstra Animation Festival in Lisbon, Portugal, on March 19.
DOWN PARRYSCOPE: My next column will be published March 14.
WARNING:This story contains graphic accounts of sexual violence that may be disturbing to some readers.
For 17 years, she criss-crossed Canada trying to flee the man who raped and tortured her and coerced her into prostitution and sexual slavery.
Regardless of what she did or where she went, her tormentor and the gang that he ran with were never far behind.
When she became pregnant with his child, he beat her badly enough that police were called. No charges were laid.
Over the years, he was twice arrested and convicted, but never jailed for assault or for breaching no-contact orders as part of his probation.
He spray-painted one of her homes with racist epithets, torched another and dropped off an eviscerated rat at yet another. Police were called. No charges were laid.
It all ended 12 years ago when, against incredible odds, the United States granted her asylum under the United Nations Convention Against Torture.
She didn’t have a lawyer, only two law students who with a professor’s help took it on as a class project.
U.S. Immigration Judge Kenneth Josephson relied on court precedents in concluding that domestic violence constitutes persecution, noting, “If the government is unable or unwilling to control persecution, it matters not who inflicts it.”
“There was no meaningful assistance provided to her,” he said, according to a transcription of his oral decision. He noted that she had made more than 30 attempts to get help from police and spent time in more than a dozen different transition houses across Canada and the United States.
“Obviously, Canada is a democratic, first-world country,” Josephson said. “While it is rare for a citizen of Canada to seek asylum, it is not rare to have claims presented on the basis of domestic violence.”
The judge also leaned heavily on Lisa Rupert’s affidavit describing how women are treated by Canadian police and courts. Rupert is the YWCA’s vice-president of housing services and violence protection in Vancouver.
Between 2003 and 2016, only 79 of 276 Canadian applicants were given asylum, according to the U.S. Justice Department. Because the reasons for decisions aren’t tracked, a spokesman said it’s not known how many were escaping domestic violence or gangs.
Because Rachel is still deemed by Canadian police to be at high risk, Rachel is a pseudonym. For her protection, other identifying details have been deliberately omitted or altered from the mountains of documents that she has meticulously saved over the years.
At our first meeting, Rachel insisted on one thing: “This story is not about him (the perpetrator) or the people he is involved with. … They get enough publicity for being the creepy people who they are.”
The story, she said, is about the failure of the Canadian police and courts to protect her and others like her.
Rachel is furious with Canada. She bitterly points to the country’s boast that it is a world leader when it comes to women’s rights.
“Between the RCMP and the court system, they dropped the ball and slid me down a million crevices, and then they did everything they could to cover it up.”
Now in her mid-50s, she lives at the edge of poverty in subsidized housing, scraping by on part-time and temporary work to supplement a $212-a-month disability pension from the U.S. government.
“I want the Canadian government to acknowledge what happened and repair as much of the damage as they can,” she said during one of many conversations over the past six months.
Rachel has paid dearly for her safety. It’s cost her everything she’s ever had and nearly everyone she’s known and loved.
She can never return to Canada. If she were to come even for a visit, she might be denied re-entry to the U.S. because the reason she was given asylum is that she’s at risk if she returns home.
Between the RCMP and the court system, they dropped the ball and slid me down a million crevices, and then they did everything they could to cover it up
Rachel has had to reinvent herself in a place where no one knew her or why she was there. She’s had to do it without any credentials, because her hard-earned college certificates are in her old name, and without job references because contacting Canadian employers risks having her new identity exposed.
She’s struggled with the effects of the trauma and abuse she’s endured, as well as guilt over the pain her life has caused her children.
Exile has also alienated her from Canada’s safety net, including health care, social assistance and the Canada Pension Plan.
That’s in addition to what she lost earlier when fear forced her to give up permanent custody of one of her children, cut off contact with her elderly parents, abruptly leave jobs and sell the family home she inherited from her parents in order to finance her fugitive life.
After 12 years in hiding, Rachel yearns for home. Canada Day, Canadian Thanksgiving and even Boxing Day trigger memories of happier times and thoughts about what might have been.
When she contemplated visiting Canada earlier this year, Canadian police advised her that she would be at high risk even if she only came for a few days.
The United States is the only place on the continent where she is safe. The man who hunted and abused her can’t cross the border because of his criminal convictions.
But even now, she’s extremely cautious, fearing he’ll find her again.
Meantime, her abuser has carried on. He’s served jail time for forcibly entering a home and assaulting another woman.
FATEFUL FIRST MEETING
Nearly 30 years ago, the vivacious, single, 20-something mom was singing with a band in a bar and attracted the unwanted attention of a guy who was never going to take no for an answer. It changed her world forever.
After she rebuffed him at the bar, he surreptitiously followed her home that night. The stalking had begun. He’d turn up at odd places. When she refused to go to his house for a barbecue with her child, he called repeatedly until she finally relented.
She thought that might be the end of it.
It was only the beginning.
His home was a grow-op. When she realized that, she grabbed her child and fled. He grabbed a rifle and fired a shot at her.
The phone was already ringing when she walked in the door of her home. She knew too much, he said. If she made trouble, his gang would kill her and her family.
Rachel changed her phone number, moved and quit her job. But a few weeks later, he was standing over her in her bedroom with a knife. He raped her repeatedly, pressing a pillow into her face to muffle her screams so she wouldn’t wake her child.
It went on for three days before he agreed that the child should be allowed to go stay with her father.
Over the next few weeks whenever she left the room, he went with her, carrying the switchblade knife. He began inviting some of his friends over. The more compliant she was, the more freedom he gave her. She began plotting her escape to a friend’s house in another community.
But he found out, took her car keys and her money and assaulted her. A few weeks later, he coerced her into taking him with her and the violence escalated.
He punished minor slights by locking her in the basement. In her U.S. immigration affidavit, Rachel wrote that he started humming the music from Psycho.
The RCMP report from one of the assaults that sent Rachel to hospital includes her statement describing how he wrapped a sheet around her neck and choked her before he lunged at her with a large knife.
She was thrown against a wall, thrown to the ground and kicked, according to the RCMP victim assistance supplementary report. He kept repeating that he was going to kill her.
When police interviewed Rachel about the assault, they didn’t want to hear about anything that had gone before that, she told the immigration judge. They refused to listen when she tried to tell them about how he’d coerced her into living with him, tortured and beaten her before.
Instead, they were the first of many to describe him as her boyfriend and suggest the violence was the result of her bad choices.
Although he was arrested, they didn’t detain him. They escorted him out of town as if it were all part of a Wild West movie.
It was no movie. A few days later, Rachel was released from hospital. As she was scrambling to pack the car and leave, he came out from behind the garage, grinning.
“Where are we going now?” he asked.
A month later and in another town, he beat her until she was unconscious. Once again, police weren’t interested in what had happened before, only what had happened that night.
He was charged with aggravated assault, but he later pleaded guilty to assault and was sentenced to nine months of probation and ordered to attend anger-management classes. There was no restraining order.
That night, he found her and raped her.
Within that first year, he coerced her into prostitution and made her audition for a porn film.
He also got her pregnant. When she refused to have an abortion, he assaulted her. Police came, but no charges were laid. A month after the child was born, he breached the order, robbed and assaulted her, burning her with a cigarette and punching her in the jaw.
“Strongly recommend that the accused be released only if a restraining order is put into effect,” the attending officer wrote. “No contact direct or indirect as accused harassing victim by repeated phone calls.”
Also in the report is the accused’s comment: “She’ll pay for this. She will know how this feels.”
Why police responded as they did, why he was never jailed for breaching no-contact orders and why he was never jailed at all are all questions that haunt Rachel and remain unanswered. Police don’t comment on individual cases and, aside from their decisions, judges don’t comment at all.
For 17 years, Rachel describes her life as a cat-and-mouse chase.
“I thought he’d eventually give up and move on. I didn’t think it would be a 17-year problem or that I would eventually have to leave the country,” she told me.
“I kept thinking, ‘Now, the police will do something. Now, it’s going to stop.’”
But the timeline chronicling her torment runs to eight pages. He’d breach the orders. She’d escape to a shelter and he’d find her. He’d beat her; police would be called. Only twice were restraining orders issued. He was never sent to jail.
When he couldn’t catch and assault her, he’d vandalize her home or threaten her employers. When he couldn’t find her, he’d threaten her parents.
One summer, she and her child lived off the grid in a tent bought at Zellers. When the $300 that she’d hidden from him ran out, she begged a telephone operator to find the number for a women’s shelter and put her through.
Less than a month later, her relentless and well-connected abuser found them there.
Another time and in a different shelter, a gang-connected woman wheedled her way in to deliver the message that he was watching.
Rachel relinquished permanent custody of her child from a previous relationship as a protection from the violence that permeated her life.
Later, exhausted from the threats and running, Rachel asked the child protection ministry to take the child that she’d had with her abuser into temporary care on the condition that the child’s father not be contacted.
But a social worker broke that agreement and contacted Rachel’s abuser even though his name is not on the child’s birth certificate. Because of that breach of privacy, Rachel very nearly ended up having to share custody with the man who was making her life hell.
Not only would it have meant regular contact with him, Rachel could never have got asylum in the U.S. With a custody order in place, she could have been charged with abduction if she had taken the child out of the country without his permission.
Instead, his custody attempt was the impetus for her exile.
REPEATED PLEAS FOR HELP
Over the years, Rachel has approached the Canadian government for help. She’s kept every email and letter, along with names and phone numbers of the various officials she’s spoken to.
Initially, she asked for compensation for the house she was forced to sell at below market price in 1997 to finance her fugitive life. When it sold again recently, it was for $1.4 million.
Last fall, she tried to get help accessing disability benefits under the Canada Pension Plan, which she paid into from the time she started a part-time job as a high-school student.
To get benefits, she needs a birth certificate and social insurance number. Rachel believes it’s too risky to apply for CPP under her old name, so she needs new documents.
After a flurry of email exchanges and phone calls, nothing has happened, just as nothing happened in the 1990s when Rachel begged police to give her a new identity.
Among the problems is Canada’s disjointed system, name changes and birth certificates are provincial. Social insurance numbers and CPP are federal. Each requires a separate application. Each application costs money that Rachel can ill afford.
But even before she can apply, Rachel would have to apply to be allowed to apply from outside Canada. That’s a whole other process.
For nearly 30 years, Rachel has been told there’s another problem with getting her name changed in Canada.
When she was in her late teens, Rachel defrauded a telephone company of $2,000 worth of telephone service by using a fake name.
“It was kid stuff, poor-people stuff,” she said.
She pleaded guilty and was sentenced to three years’ probation with 200 hours of community service and the requirement that she repay the money. She tried, but couldn’t manage to do all of that.
Even with the support of her probation officer, the judge refused to amend the probation order and clear the way for a later pardon, or what’s now called a record suspension. Because of her record, her only safe choice was an extreme one. Flight.
The United States gave her a waiver before granting her asylum and a new identity. Why shouldn’t Canada do that for her now?
STILL AT RISK
Rachel has lived in fear for half her life. She still struggles to accept that for as long as her assailant is alive, her life is at risk.
Violence, threats and coercion forced her into hiding, into exile and into poverty that affected not only her but her children.
Unable to return to her country of birth, she missed major milestones in her children’s lives. She is unable to visit her parents’ graves.
But among the facts of her life that Rachel finds most galling is that her punishment for defrauding a phone company of $2,000 was three times as long as any sentence her assailant ever received for nearly killing her.
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.”
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.”
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.
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.
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.
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.
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.
Holding an IUD birth control copper coil device in hand, used for contraception flocu / Getty Images/iStockphoto
Free prescription contraception is a no-brainer, according to groups advocating its inclusion in February’s provincial budget.
A cost-benefit analysis conducted by Options for Sexual Health in 2010 estimates the B.C. government could save $95 million a year if it paid for universal access to prescription contraception.
It would also promote equality, giving young people and those with low incomes the same choices as those who are able to pay for their preferred method of contraception.
“Not all contraception works for everyone,” said Dr. Teale Phelps Bondaroff, committee chair and co-founder of the AccessBC campaign. “Money shouldn’t be a factor in deciding on the best option.”
The most effective contraception is often the most expensive up front: An intrauterine device, or IUD, can cost between $75 and $380, while oral contraceptive pills can cost $20 a month, and hormone injections can cost as much as $180 a year.
But that’s a small amount compared to an unplanned pregnancy, which can have a “huge ripple effect” on a woman’s life, particularly if she is already struggling to get by, said Patti MacAhonic, executive director of the Ann Davis Transition Society in Chilliwack.
“I think it’s a gender equity issue. Contraception costs usually fall on women, and if they become pregnant that often falls on them as well.”
MacAhonic said providing free prescription contraception would also reduce some of the stigma that still exists around birth control. School-age girls trying to get a prescription without their parents’ knowledge may be prevented by a lack of money.
In May, the Canadian Paediatric Society released a position statement identifying cost as a “significant barrier” to using contraception for youth.
“Many must pay out-of-pocket because they have no pharmaceutical insurance, their insurance does not cover the contraceptives they desire, or they wish to obtain contraceptives without their parents’ knowledge,” said the statement.
The society recommended all youth should have confidential access to contraception at no cost until age 25.
But B.C. advocates want the government to go further.
AccessBC pointed to several European countries that subsidize universal access to contraception in some way, including the United Kingdom, France, Spain, Sweden, Denmark, the Netherlands, Italy and Germany. Many programs are revenue-neutral when the cost of an unintended pregnancy is considered.
In 2015, a study in the Canadian Association Medical Journal estimated the cost of universal contraception in Canada would be $157 million, but the savings, in the form of the direct medical costs of unintended pregnancy, would be $320 million.
Options for Sexual Health executive director Michelle Fortin said that while the birth control pill remains relatively cheap, women might choose another method if the cost was the same.
“If you’re a student you may have to choose between a month of food or an IUD,” she said. “Finances continue to be a barrier.”
Fortin said a petition circulated at Options clinics across the province will be presented to the health minister in advance of the budget.
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 email@example.com for more information.
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.
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