Pubdate: Sat, 18 Jul 2015 Source: Globe and Mail (Canada) Copyright: 2015 The Globe and Mail Company Contact: http://www.theglobeandmail.com/ Details: http://www.mapinc.org/media/168 Author: Wendy Stueck Page: S1 NO GUARANTEED OUTCOMES FOR ADDICTS SEEKING HELP The system of support recovery homes in Surrey is fragmented, poorly funded and lacks regulatory oversight, Wendy Stueck reports Galven Young is a self-described reformed addict who has spent time in several recovery houses in the Lower Mainland. Now employed as a support worker at an abstinence-based recovery centre in Chilliwack, B.C., Mr. Young says he has seen many such facilities, from provincially registered ones that provide structured programs and healthy meals to unregistered homes in which illicit drug use is routine and food in short supply. But until you are in the door, it is difficult to know what to expect, he says. "The clients are people who may be looking at going to jail and so they pull the recovery card. They say, 'I'm going to go into treatment and do better,' " Mr. Young says. That outcome is not guaranteed - in part, critics maintain, because the system in B.C. is fragmented, poorly funded and lacks regulatory oversight. Support recovery homes are small residential facilities with fewer than a dozen beds that provide housing and treatment for people with addictions. An April report on support recovery homes by the Community Action Initiative, a provincial agency that funds mental-health and substance-use programs, found concerns exist about whether the facilities are registered or not. The agency also found "clients and families lack sufficient knowledge about what a registered support recovery home should offer. For example, a complaints process, fire safety measures, psychosocial programming, etc." "Unfortunately, the current system of regulation through the [assisted living registry] and per diem funding through the ministry of social development is not creating a province-wide recovery house system that individuals, families, communities, and health, social service and justice system referral agencies can trust," Mr. Lamontagne said in a letter dated May 25. Such concerns date back more than a decade. Between 1998 and 2001, the province required recovery homes to be licensed. That requirement was lifted in 2001 to reduce red tape and operating costs. That resulted in a flurry of new homes and complaints that some offered a roof and little else. In 2013, the province introduced a program that allowed recovery houses to register through the ALR. Operators that register commit to provide certain services, and become eligible for provincial funding of $30.90 a day for each client who is on social assistance, from whom they also usually collect $550 a month. Currently, 98 recovery homes are registered, and 31 registrations are in process. Under the new regime, recovery homes must register if they offer at least one "personal assistance" service, such as courses in anger or stress management, and five "hospitality" services, including meals and a 24-hour emergency response system. "Houses that do not offer this level of service - regardless of what they call themselves - are not supportive recovery homes," Ministry of Health spokeswoman Cindy MacDougall said in an e-mail. "These [unregulated] homes are bound by municipal and criminal laws." Mike Starchuk, a Surrey city councillor who is a former chief fire prevention officer in the city, campaigned last year on the issue of unregulated recovery homes. He supports the provincial registry, but wants to see more, including requirements for recovery homes to obtain a city business licence, and more resources for spot inspections. Under the current system, he says, some operators are doing the paperwork to obtain registration and meet requirements but are not necessarily following through with programming and services. "It gives the city a tool," he said. Currently, he said, some unscrupulous operators can invest enough money to ensure their buildings meet fire safety requirements and can pass an initial inspection, but then operate a home in which residents are allowed to continue using or even selling drugs while the owner collects the government money. Mr. Starchuk would like to see more resources devoted to inspections to stop such abuse. "They [the registry] really need some bodies and some help to do what they are supposed to do," Mr. Starchuk says. In spite of all the problems, many people say they had good experiences in recovery homes. Mr. Young said he benefited from his treatment at Vision Quest, as do many others. "For me, this place has saved my life," he said. "And I know I'm not the only person here who would say that." In that report, the agency included several ideas for boosting capacity in the sector, including public education on the standards and guidelines of the province's Assisted Living Registry, which regulates residences such as the recovery houses and seniors' homes. In Surrey, which has grappled with problems related to scores of unregulated recovery homes, planning manager Jean Lamontagne recommended that council support further study by the CAI to develop comprehensive provincial framework for the facilities. - ------------------------------- Low-threshold Alternative The ongoing debate about recovery homes in B.C. is part of the broader, complex challenge of tackling mental health and substance-abuse issues in the province, where an estimated one in five people deal with such problems each year. One new strategy could involve a low-threshold or low-barrier methadone clinic - which gets its name because it would reduce or eliminate some hurdles patients currently face obtaining the drug as a substitute for heroin. A low-threshold methadone clinic is among more than 20 initiatives outlined in a February paper from the Downtown Eastside Second Generation Health System Strategy. This evolving plan by Vancouver Coastal Health would streamline health services in the neighbourhood, which has about 18,000 residents and more than 20 VCH-affiliated agencies and clinics in a six-block radius. In a low-barrier approach, methadone clients would be expected to cut back their use of heroin but not necessarily eliminate it - based on a rationale that fewer injections would help reduce the risk of blood-borne diseases, infections and other health concerns. In conventional methadone maintenance treatment, patients are expected to stop using heroin and stick to a set dosage of methadone. The idea would be to give people who want methadone treatment what is now on offer for injection drug users at Insite - a one-stop shop where patients could get access to methadone as well as medical care and counselling. "Essentially, what we would be trying to do is emulate the =C2=85 process we have at Insite and to engage those clients into treatment," said Ron Joe, associate medical director of addiction services with Vancouver Coastal Health. Methadone is one of the most effective medications to treat opioid addiction, and drug-use statistics suggest there are many more Canadians who could benefit from it beyond those already receiving it, Dr. Joe says. According to the 2012 Canadian Alcohol and Drug Use Monitoring Survey, 0.5 per cent of Canadians and 0.8 per cent of British Columbians reported using heroin in their lifetime. (Those estimates were flagged with an "interpret with caution" note, as they were based on a small number of respondents). But even if those estimates are too high, they still suggest thousands of people in B.C. and Canada need methadone treatment, he says. "We have perhaps treated the easier half of the population, and the harder half, the more difficult half, are the ones who are still going to Insite or maybe not going to Insite - and we haven't cracked that nut of engaging those people into treatment," Dr. Joe said. "So we need a specialized service to do that and that's where the low-barrier methadone site would come in." - --- MAP posted-by: Matt