Pubdate: Tue, 02 Apr 2013
Source: Maple Ridge Times (CN BC)
Copyright: 2013 Lower Mainland Publishing Group Inc
Author: Dr. Perry Kendall


Dear Editor,

Mr. Ferry and Mr. Robson [Harm reduction doesn't fit all sizes, Mar.
26 Just Saying, TIMES] ask why the provincial government spends so
much time, energy, and money on harm reduction services, compared to
abstinence programs.

This assertion is actually incorrect. Substance use prevention and
treatment money is not focused predominantly on harm reduction, nor
are abstinence-based treatment modalities denied funding as a
provincial policy.

In fact, the amount of money spent on harm reduction services by
regional health authorities is estimated by the Ministry of Health to
be about 1/10th of that spent overall on substance use.

One reason the government may seem to be focused on this area is that
it does attract ongoing criticism from those who favour abstinence
over other effective interventions, or who are on other grounds
opposed to harm reduction strategies.

In 2004, when the government released its planning framework for
problematic substance use and addiction, it was estimated that
approximately 120,000 British Columbians had a high probability of
alcohol dependence, another 224,000 had some indication of dependence,
and around 33,000 had a dependence on illicit drugs.

About two-thirds of the latter group were dependant on heroin, and
injection drug use had clearly emerged as an effective way of
transmitting HIV/AIDS and hepatitis C.

In 2004 there were some 8,000 individuals engaged in treatment with
methadone. The province engaged with the BCMA, the BC College of
Physicians and Surgeons, and the BC College of Pharmacists to expand
access to this treatment, and in 2012 the numbers had increased to
nearly 14,000.

Methadone as maintenance clearly has its detractors, but coupled with
adequate psycho-social supports and counselling (some of it of the
kind provided in many otherwise abstinence-based programs), it is for
many heroin-dependant persons the most effective treatment available
(I invite readers to visit the websites of either the U.S. National
Institutes for Drug Abuse or Ontario's Centre for Addictions and
Mental Health).

The stability attained through methadone maintenance, coupled with
access to antiretroviral drugs, is one reason B.C., alone among
Canadian jurisdictions, has been seeing decreases in HIV infections
through the drug injection route.

Mr. Ferry's article did raise the interesting notion that some funded
agencies, if they followed their "core beliefs," would choose not to
offer services to individuals who were receiving methadone.

However, B.C. substance use services are informed by international
clinical research, practice-based experience, and provincial
standards, guidelines, and strategic plans.

As "Healthy Minds, Healthy People: a Ten-Year Plan to Address Mental 
Health and Substance Use in British Columbia" states, the Ministry of 
Health will continue to work with Health Authorities and key 
stakeholders to ensure a comprehensive range of service options, 
including abstinence-based, clinically supported, and harm 
reduction-focused programs are available.

While much of the discourse centres around methadone, B.C.'s substance
use treatment services also use other prescribed and over-the-counter
medications that, in combination with psycho-social support,
significantly improve treatment outcomes for alcohol and nicotine 

I would like to assure readers there is no provincial policy against
funding abstinence-oriented programs. Abstinence is, in fact, the
ultimate goal of all substance use treatment.

But addictions are chronic in nature, and characterized by high rates
of relapse. When abstinence is not attained, substantial reductions in
substance use, illegal activities, ill health, and social
malfunctioning are worthy goals.

If Mr. Robson is asserting that substance use (and mental health)
programming in B.C. could use additional resources - given the extent
of the problems associated with substance use - I would absolutely

Last year, the Columbia University National Addictions Centre
undertook a ground-breaking study of addiction and addiction services
in the U.S. Among their key findings: "There is a profound gap between
the science of addiction and current practice related to prevention
and treatment."

Much of what passes for "treatment" of addiction bears little
resemblance to the treatment of other health conditions. Much of what
is offered in addiction "rehabilitation" programs has not been subject
to rigorous scientific study, and the existing body of evidence
demonstrating principles of effective treatment has not been taken to
scale or integrated effectively into many of the treatment programs
operating nationwide.

One of the report's recommendations is to bring the addiction
treatment system into the larger mainstream health care system.

I'd like to think that Canada, and particularly British Columbia, is
doing better than this.

Dr. Perry Kendall,

Provincial Health Officer
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MAP posted-by: Matt