Pubdate: Wed, 22 Nov 2000 Source: Vancouver Sun (CN BC) Copyright: The Vancouver Sun 2000 Contact: 200 Granville Street, Ste.#1, Vancouver BC V6C 3N3 Fax: (604) 605-2323 Website: http://www.vancouversun.com/ Author: Glenn Bohn Series: Searching for solutions - Fix on the Downtown Eastside http://www.mapinc.org/thefix.htm WHEN IT'S QUITTING TIME It's almost impossible to kick heroin or cocaine without help. And help is impossibly hard to find. It takes seconds for a heroin or cocaine addict with cash to buy drugs. If the same person were to decide to try beat the addiction, it would take days or weeks to get into detox, and weeks or months to get a bed at one of the handful of treatment centres, where non-profit groups try to help addicts remain drug-free. Of all the deficiencies in Vancouver's approach to its drug problem, experts agree, the shortage of treatment facilities may be the most frustrating. The problem is worsened by the need to respond almost instantly during the rare interludes when an addict is focused on quitting. "You're dying today, your life is falling apart, and you have a window of opportunity that visits some people maybe four times in their lives," says Billy Weselowski, a former addict who co-founded a drug recovery society. "Those are rare, precious opportunities, when you don't need anyone to tell you that you're all messed up. I remember when I was 17 years old, totally out of control, and I had a moment of clarity and realized this wasn't where I wanted to be. I remember feeling that again at 25 and at 33." Then the window of opportunity closes. An addict's desire to stop using drugs wanes. And a chemically driven craving to use drugs returns, at least until the next crisis. "The desire to change is very fleeting for an addict," says Lou, 40, a Narcotics Anonymous member who says he hasn't used cocaine or heroin for 30 months. "That's the way addiction is. [Going clean] seems like a great idea one day, but it doesn't seem like such a great idea later." Detox workers say people who have to wait for a bed keep using drugs until they can get in, because it's so hard to go through withdrawal alone and without medication. What happens if they're on a waitlist for weeks or months to get into a treatment centre or house? "Let's see if you're even alive by then," Weselowski replies. Long delays in obtaining help are the rule, not the exception, according to a Lower Mainland Municipal Association report based on information from more than 200 drug-treatment, law-enforcement, health and other agencies. "The impact of these delays can sometimes be measured in terms of unnecessary deaths, deadly infections and crime," the September report states. "Many stakeholders believe that the delays caused by insufficient detox, outpatient counselling and residential treatment spaces are totally unacceptable." A Typical Scenario Here's a typical scenario: A cocaine addict prone to paranoia jumps out a window, breaks an ankle and is taken to Vancouver Hospital, where he's treated for his injury and then treated for his addiction by the hospital's chemical-dependency team. Dr. Brent Dickson says the patient might be well enough to release after one week in hospital, but would then face a six-to-eight-week wait for an out-patient clinic for drug users, or a two-to four-week wait for a bed in a support recovery home --usually a converted house where addicts live and try to stay clean. "And what do the social workers in the hospitals do when they can't find a support recovery home?" he says. "They have to find the cheapest place -- a hotel room in the Downtown Eastside, back in the same environment they came from." Dickson says many addicts tell him they have to get out of that Vancouver neighbourhood, because they can't walk down the streets without someone hawking drugs. "That's death for an addict, because you can't resist that," he says. "You have to be as far away from drugs as you can possibly get." "The System Has Failed" Dr. Ray Baker, chair of the B.C. Medical Association's addiction medicine committee and specialist in the field for 15 years, blames the wait lists on the B.C. government's alleged "mismanagement of addiction services." "I've given up trying to get people into treatment services in this province," Baker says. "The system has clogged up." According to Baker, there used to be a network of out-patient services in B.C., a continuum of services that began when a drug user was assessed and stabilized, then given appropriate treatment and followed up. "The system has failed," he says. "Residential treatment centres are full of people who come off the street and aren't ready for treatment, but there's no other place to put them." According to the B.C. government, injection drug users are not turned away if they are ready for treatment. If they can't get into a support recovery home, they are supposed to be offered counselling at an outpatient clinic or get help while staying with friends or relatives until a bed can be found. "Let me contextualize this for you, if I may," says Miki Hansen, the B.C.'s government's manager of addiction services for the last five years. Hansen says treatment is part of a process, and outpatient services will help someone work on basic things like education in the meantime. The B.C. government has budgeted more than $72 million this fiscal year for alcohol, drug and gambling abuse programs, but the money delivered to those programs drops to $58 million when things like buildings and government salaries are paid for. Eighty-five per cent of the drug and alcohol programs are provided by about 200 government-funded, non-profit organizations. Where The Money Goes On paper, this is where the money goes: $6.8 million for prevention programs; $20 million for out-patient services; $2.3 million for support recovery homes; $9.4 million for residential treatment centres (where there's more intensive counselling and treatment); $17.3 million for detoxification centres, including two in Vancouver. Hansen says there are provincial standards for addiction services, and agencies getting more than $100,000 annually must be accredited. She says there is a high level of satisfaction expressed by clients for things like the food they are given, but she cannot say how successful government or government-funded services were in keeping addicts off drugs for a specified period of time. "We don't collect relapse information," Hansen says. "At different points in time they may relapse, but that's not a failure of the treatment system or the individual. It's only part of a process, and they then get to use that as part of a learning experience and figure out ways in which they protect themselves from that kind of thing happening again." A 'Discontinuous' Continuum The need for a "continuum" of drug and alcohol services is a mantra embraced by professionals in and out of government. First, there are education and prevention programs, to try to stop substance abuse before it happens. Second come early intervention programs. Then there are detox and treatment programs. But a report this year by the non-profit Kaiser Youth Foundation says B.C.'s drug and alcohol program is poorly coordinated and fragmented. The report's indictment: "Inconsistent and under-funded education and prevention efforts. Wasted opportunities for intervention. Inadequate data collection and research capacity on which to base good decisions. Waiting lists for counselling and for treatment. "The province's [alcohol and drug services] continuum, despite the best of intentions, has become a 'discontinuous' continuum." B.C.'s addiction treatment program began in the 1950s, run by separate foundations for drugs and alcohol. In 1973, a New Democratic Party government passed legislation to create a single provincial commission for all substance abuse services, but a Social Credit government disbanded the commission in 1992 after controversy ensued over a heroin treatment program that included methadone maintenance. Alcohol and drug programs became the responsibility of the health ministry, then the labour and consumer services ministry, then the health ministry and finally, after a 1995 inquiry into the death of five-year-old Matthew Vaudreuil, it was placed under the aegis of the children and family services ministry. Except for adult drug and alcohol services in the Vancouver/Richmond health region, the children and families ministry is still in charge. And critics say adult alcoholics and drug addicts with children don't want to seek help for their substance abuse problems, because they're afraid they will lose their children. The Kaiser Youth Foundation is just one of the non-government bodies that wants Victoria to re-establish a better-funded, independent alcohol and drug commission, so the fight against drug and alcohol abuse will have a higher profile. It's the same recommendation made in 1991 by the Royal Commission on Health Care and Costs -- a recommendation that has been ignored. - --- MAP posted-by: Richard Lake