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.