Pubdate: Tue, 25 Nov 2014
Source: Vancouver Sun (CN BC)
Copyright: 2014 Postmedia Network Inc.
Author: Randy Shore
Page: A6


Doctor blames increasingly easy access to alcohol, which accounts for
10 times more medical costs than all other drugs combined

Hospital visits attributed to alcohol and drug abuse increased by 63
per cent in the Greater Vancouver area over just four years ending in
2013, and visits to St. Paul's Hospital in downtown Vancouver for
substance abuse increased by a whopping 89 per cent over the same
period, according to emergency room data.

And despite dire headlines about opioid addiction and IV drug use,
alcohol is driving most of the increase.

According to a national report released this weekend by the Canadian
Centre on Substance Abuse, alcohol accounts for about 10 times more
hospital costs than all other substances combined, and the number of
hospital stays due to alcohol abuse is growing three times faster than
for all other drugs combined.

Dramatic increases in hospital visits associated with alcohol abuse
appear to be in lockstep with increasing access to alcohol in the
retail market, said Evan Wood, Medical Director for Addiction Services
at Vancouver Coastal Health and Physician Program Director for
Addiction at Providence Health Care, which operates St. Paul's Hospital.

"The biggest issue in British Columbia is availability," said Wood.
"There is an excellent study that looks at how deregulation and
privatization of alcohol sales have led to an increase in alcohol-
related mortality in B. C." The study, published in the scientific
journal Addiction, found that for every 20- per-cent increase in the
density of private liquor stores, alcohol-related deaths increased
3.25 per cent.

As part of a sweeping regulatory liberalization, B. C. is set to
expand liquor sales to grocery stores and will allow government liquor
stores to open Sundays, both starting April 1, 2015. New regulations
also allow beer and wine sales at farmers markets.

"Alcohol is one of the leading causes of disease and disability in our
province, and experts have predicted that damage and costs will
increase if the status quo persists," said Attorney General Suzanne
Anton in an email interview. "That's why we made balancing health and
safety concerns a priority in the changes to our liquor laws. In fact,
over one-quarter of the recommendations in the Liquor Policy Review
are focused on health, safety, social responsibility, enforcement and

"For instance, ensuring continued restricted access to alcohol for
minors was a key consideration during the development of
recommendations coming out of the B. C. Liquor Policy Review. The
store-within-a-store model for liquor in grocery stores will restrict
minor's entry, just as the existing model does, and grocery stores
that are licensed to sell B. C. wine in-store will have designated
shelves and checkouts, helping to prevent access to alcohol by minors."

The national addiction data released Sunday also show that Canadians
increasingly find themselves in hospital as a result of abusing
opioids, cocaine and cannabinoids, such as hashish and marijuana.

Opioids - heroin, methadone and prescription pain medications -
recently passed cocaine as the family of drugs responsible for the
second greatest use of hospital resources, after alcohol. The number
of days in hospital due to opioids increased 48 per cent over the five
years between 2006 and 2011. Hospital days related to cannabinoids
rose 39 per cent, while the number of days attributed to cocaine abuse
dropped by 48 per cent.

Overall, Canadian hospital costs associated with substance abuse went
up 22 per cent over five years, from $ 219 million in 2006 to $ 261
million in 2011. Health Minister Terry Lake said last week that the
impacts extend far beyond the confines of Vancouver's Downtown
Eastside into every community, noting that one new funding initiative
for addictions focuses on mild and moderate substance abuse problems
to be delivered by St. Paul's.

Which drug inflicts the most harm varies by age, according to the
national data, with hospitalizations for cannabinoids rising fastest
for 15- to 24-year-olds and alcohol for people 45 to 64. People
between 25 and 44 stayed the longest in hospital due to opioid abuse,
while the largest increase in length of stay for opioids was among
people 65 and older.

"We know that the ' Just Say No' approach doesn't really work," Wood
said. "Rather than investing in prisons and things that make societies
worse off from a substance abuse perspective, we need to invest in
addictions treatment and other things that we know are effective."

A recent study from Columbia University found that more than 70 per
cent of people who have a chronic condition such as hypertension are
getting appropriate treatment, while only 10 per cent of people with
chronic substance abuse problems receive treatment.

"To quote the report, most people get addiction care from unskilled
lay persons," said Wood. "And most physicians, who should be
diagnosing and treating addictions, don't know how to do so. That is
certainly true in Canada and British Columbia, where we haven't
invested in training physicians in addiction medicine."

Physician training at St. Paul's - which includes Western Canada's
first American Board of Addiction Medicine accredited training program
and the largest in North America - is focused on training practising
doctors and medical students to use new, effective drugs to treat
addiction as well providing experience on the front lines, treating
patients in addiction programs and detox centres around Metro Vancouver.
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