Pubdate: Tue, 25 Sep 2012
Source: Vancouver Sun (CN BC)
Copyright: 2012 The Vancouver Sun
Contact: http://www.canada.com/vancouversun/letters.html
Website: http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Authors: Phillip Owen And Evan Wood
Note: Philip Owen was mayor of Vancouver from 1993 to 2002, during 
the development and adoption of the four-pillar approach. Evan Wood, 
MD, PhD, is a senior scientist at the BC Centre for Excellence in 
HIV/AIDS and professor of medicine at the University of British 
Columbia. He is the inaugural director

ADDICTION TREATMENT SORELY LACKING

Part of Problem Is Lack of Trained Professionals; a $5-Million 
Contribution From Goldcorp Should Help Fill the Gap

Most British Columbians will recall when Vancouver's Downtown 
Eastside attracted international attention in the mid-1990s for 
rampant HIV and overdose epidemics which, in 1997, prompted the local 
health board to take the unprecedented step of declaring a public 
health emergency. At that time, HIV was spreading among intravenous 
drug users faster than had ever been documented in a developed world 
setting, and the province was recording almost one fatal drug 
overdose death per day.

After several years of collective hand-wringing by local 
policy-makers, the Framework for Action: A Four Pillar Approach to 
Vancouver's Drug Problems was adopted in 2001. It moved away from the 
failing "war on drugs" approach and towards an integrated strategy 
that placed equal emphasis on drug prevention, treatment, law 
enforcement and harm reduction strategies.

The four pillars contributed to a public health approach to drug 
addiction and enabled the creation of innovative HIV treatment and 
overdose prevention programs, such as the Insite supervised injecting 
facility. Thanks to these measures, the number of over-dose deaths 
fell by more than 70 per cent in recent years.

However, despite the fact that Vancouver Coastal Health has 
significantly increased funding for addiction treatment in recent 
years, rates of untreated drug and alcohol addiction remain 
persistently high. Thousands of Vancouverites are not receiving 
effective addiction treatment, and often end up unemployed or on the 
streets, and in hospital with costly health complications.

Why have the investments made in addiction treatment not been 
optimally effective? A fundamental road-block to success is the lack 
of trained addiction medicine specialists in the province. While 
other medical disciplines such as cardiology and obstetrics graduate 
trained specialist physicians from training programs based within 
teaching hospitals affiliated with the University of British 
Columbia, there is no such program for addiction medicine in B.C. 
Imagine being rushed to the hospital emergency room clutching your 
chest, in the throes of a heart attack, only to be seen by a 
well-meaning physician who has not been through a cardiology training 
program. While the situation seems absurd, it's exactly analogous to 
the challenge facing British Columbians addicted to alcohol and drugs.

Similar alarming circumstances exist throughout North America. A 
recent report from the U.S. National Center on Substance Abuse 
laments the fact that most Americans with addictions do not receive 
treatment from a physician at all. Rather, as in Canada, U.S. 
addictions care is usually provided by unskilled laypeople. In fact, 
only about 1,200 of the 985,375 practising physicians in the United 
States are trained in addiction medicine.

Sadly, despite the fact that addiction is linked to more than 70 
diseases or conditions and estimated to account for a third of 
in-patient hospital costs, the subject receives limited attention in 
medical school or residency training. The report's harshest criticism 
is saved for the medical community, stating that "most medical 
professionals who should be providing addiction treatment are not 
sufficiently trained to diagnose or treat it."

Fortunately, change is coming to B.C. thanks to Goldcorp Inc.'s 
recent $3-million donation to the St. Paul's Hospital Foundation, 
which aims to create Canada's first interdisciplinary medical 
education fellowship training program in addiction medicine. The 
fellowship program, which coincides with an additional $2 million 
Goldcorp gift to support an existing mental health team run through 
Vancouver Hospital Foundation, will train a critical mass of new 
addiction medicine specialists over the next five years.

The ultimate goal is to create a world-leading centre for excellence 
in addiction, similar to B.C.'s Centre for Excellence in HIV/AIDS. 
The leader-ship and work of the physicians and researchers with this 
team have contributed to a more than 85 per cent reduction in HIV 
cases in the Down-town Eastside, and the World Health Organization 
guidelines for the treatment and prevention of HIV infection have 
recently been modified based on work conducted in British Columbia.

This approach to saving lives - and millions in avoidable health care 
expenditures - is directly applicable to the problem of untreated 
addiction. Specifically, if we adequately train expert physicians and 
allied health workers to offer world-leading clinical care, conduct 
research and provide leadership, we can decrease suffering and reduce 
the enormous social and health care costs that accompany untreated addiction.

Through education and research enabled by partnerships between the 
public sector and visionary companies such as Goldcorp, British 
Columbia has the potential to take lessons learned from its response 
to HIV/AIDS and now become a world leader in the prevention and 
treatment of drug addiction. Through this approach, the province may 
one day gain international attention for its world-leading alcohol 
and drug treatment programs, rather than for the all-too-obvious 
harms resulting from high rates of untreated addiction.
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