Jon,
Thank you for your article. I apologize for the length of my e-mail;
however, as this is an issue close to the heart of a number of MLAs, I thought
you should know what we have been doing.
Last year a small MLA committee was formed in frustration over the
continuing reliance by health authorities to employ their ‘harm reduction’
model of ‘best practice’ which immediately treats all opiate addictions with
methadone. The committee was formed without input from the Premier’s office or
cabinet out of frustration that huge funds are being expended on addictions
treatment without any apparent success.
We began by asking a series of questions of the health authorities
through the Minister’s office. We wanted to know wait times for detox and
residential treatment; where funded treatment is available and how many funded
beds; how much is spent on addictions versus mental health; and what tracking
systems are employed to measure success for the funds expended. The answers
were evasive and many questions were ignored.
We found that wait times are sufficiently significant as to indicate
that addicts presenting for treatment do not get that treatment when
appropriate. It is well known that when an addict is ready for treatment the
response must be immediate or the opportunity may be lost. Clearly the health
system is not responding on a timely basis.
We found
that funded residential beds are almost exclusively for harm reduction
(methadone) patients. Treatment and recovery facilities operating on an
abstinence basis appear to be philosophically rejected for funding. Abstinence residential beds either for profit private pay centers
or non-profit society operated with patient social assistance payment,
community fund raising, and in some cases a small “top-up” from the Social
Development Ministry to about 30 dollars daily.
We also found that there appears to be no tracking of patients leaving
health funded treatment. This of course means there is no way to determine how
successful the ‘best practice harm reduction’ model is performing. Without any
registry system or follow up addicts can leave one funded treatment regime and
go into another a few weeks later and there is no way of knowing that they have
relapsed. That translates to a lack of accountability for the funds expended.
To get a feel for addiction services in the Province, we visited
treatment facilities in various regions. The story was consistent throughout. Non-funded abstinence based facilities
struggled with finances but enjoyed significant success. Funded facilities were
reluctant to discuss their core beliefs but clearly many were not supportive of
the ‘harm reduction’ model. They spoke of threatened funding loss by the health
authorities should they speak publicly in non-support of the methadone program.
We spoke to some abstinence based service providers who said they at
times got patients from the health funded programs who, as part of the harm
reduction model, had been administered a variety of drugs in addition to
methadone for anxiety or depression issues.
There was a very clear difference in outlet procedures between the
funded and non-funded facilities. The health funded facilities had a specific
number of residential days allotted to each bed. Generally these were a maximum
of a 60 day stay. The non-funded abstinence based facilities generally had a 90
day and up patient stay but in most cases this would be extended if the patient
was not strong enough to continue in recovery outside.
We visited the Welcome Home
facility in Surrey which is an absolutely astounding abstinence based program.
Residents come for a minimum 2 years, learn interpersonal skills, work skills,
and life skills. They work in the PricePro store in Surrey as part of the
program. All are required to discontinue any social assistance payments they
might have been receiving. Welcome Home has a very high success
rate and receives no support of any kind from the Fraser Health Authority. We
were informed that Welcome Home had offered to assist Fraser Health in
shortening its wait list for treatment by taking any addicts that preferred the
abstinence model. We were told that
Fraser Health absolutely refused to refer anyone for treatment as they had a
philosophical bias against the abstinence model.
We also visited Portage at the
Crossing in Keremeos. It is a residential treatment facility for children.
Portage does receive funding from Coastal and Fraser Health Authorities for 42
beds. They are one of the only abstinence based programs we could find that was
funded by health authorities. We were in
receipt of a memo from Coastal Health Authority outlining a plan to cease
funding Portage as they claimed that community based treatment was more
effective for children and youth. When
we visited there were only 18 of over 60 total beds filled and Coastal claimed
there was no demand for the remaining funded beds. We were informed that
Portage had been instructed that they were not to advertise their youth service
and intake was to be through the health authority screening system. We learned
that the screening process was multi-stepped and took considerable time. There
was a belief that this was deliberately done to avoid placement thus making the
case for funding cessation.
There has
now been a new contract let with Portage that assures it remains open and we
believe it is as a result of pressure from several MLAs.
The
Ministry and the health authorities continue to claim that they support a
variety of treatment modalities including abstinence however all of the evidence
at the ground level shows this to be not the case. Abstinence based programs
are clearly not part of the current best practice definition employed by the
health authorities and as a result, funding for treatment in an abstinence
modality is not provided.
It
is apparent to those who look outside the verbiage provided through the health
authorities that addictions treatment in British Columbia is failing and there
is little or no accountability for the funding provided for that treatment.
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