Pubdate: Tue, 11 Oct 2016
Source: Province, The (CN BC)
Copyright: 2016 Postmedia Network Inc.
Author: Erin Ellis
Page: 5


Health Care: Goal is to teach primary physicians how to best treat 
specific cases

As fentanyl overdoses continue to dominate headlines, the head of a
newly announced B.C. Centre on Substance Use says finding the best
addiction treatment in B.C. is notoriously difficult because there's
no single system to navigate - and science-based addiction therapy is
vastly underused in the province.

"The medical side of addiction treatment isn't well established," says
Dr. Evan Wood, who was named interim head of the new research centre
by Premier Christy Clark on Sept. 28.

Addicts and their families seeking help can face a bewildering range
of options, says Wood, who is also leader of addiction services for
Vancouver Coastal Health and Providence Health.

There are public and private recovery centres, each with their own
admission rules and waiting lists. Add to that individual counselling
or group programs offered throughout the province, many based on the
12-step program pioneered by Alcoholics Anonymous.

Wood's new job is to help increase education about addiction
throughout the health system.

"We haven't had well-organized structures for training health-care
providers in addiction care. (Until recently) we also haven't had
guidelines for the treatment of addiction disorders that would inform
primary physicians about the best approaches to take," he says.

VCH and Providence released guidelines for treating opioid addiction
in 2015 and Wood says guidelines on alcohol is expected in 2017.
According to the most recent available data released in 2006, alcohol
and cigarettes created by far the biggest drain on Canada's
health-care system.

Rather than offer the same treatment to everyone, Wood says each
substance requires a specific approach. To that end, an expanding
education program at St. Paul's Hospital in Vancouver run by addiction
researcher Dr. Keith Ahamad has provided month-long training in the
evolving field to 100 physicians and 13 year-long fellowships for
doctors, nurses and social workers over the last academic year.

They learn that Naltrexone, for instance, is a drug that blocks the
euphoric effects of opiates such as heroin - but it has also been
shown to reduce the amount of alcohol a patient drinks. (It's not to
be confused with naloxone, a drug much in the news for reversing the
effects of opioid street drugs during an overdose.)

Another medication called acamprosate can prolong abstinence from

"Particularly in the case of alcohol addictions, some of the proven
medical approaches have been greatly under-utilized," Wood says.

For opioid addictions, Wood says rapidly detoxing without being
admitted to follow-up treatment is more dangerous than taking no
action because risk of relapse and overdose is greater after a
patient's tolerance for drugs is reduced.

The 2015 guidelines on opioids also recommend a drug combination sold
under the trade name Suboxone as the preferred substitute for street
opioids because it's much less likely to cause an overdose compared to
the more regularly prescribed methadone. The idea is to avoid relapse
and gradually taper the patient off the replacement drug over a year
or more. Some recovering addicts will remain on substitutes

But many private treatment facilities won't take people unless they're
on a low-dose replacement therapy, or none at all - and some 12-step
groups frown upon it because it gives the impression that an addict
still depends on a drug to conduct daily life.

In terms of publicly funded addiction treatment beds in B.C., the
numbers are in flux. The premier promised to have 500 beds by 2017,
yet information provided by the Provincial Health Services Authority,
which oversees the majority of them, currently lists 162 available to
people with combined addiction and mental health problems.

All of the places require a referral from a doctor, a process that can
take weeks. Admission can be immediate after that.

An additional 42 beds dedicated to youth (in Keremeos, Surrey and
North Vancouver) are scheduled to open next year. And a much larger
project to replace the aging 94-bed Burnaby Centre for Mental Health
and Addictions with a new 105-bed development on the former Riverview
Hospital lands in Coquitlam is slated for completion in 2019.

The Ministry of Health says it spends more than $1.42 billion each
year in mental health and substance use services.

Connie Coniglio, director of the Burnaby centre, says an estimated
130,000 people in B.C. have problems with both mental health and
addiction, but the centre treats only those with "complex concurrent
disorders" who aren't able to function day to day. It provides the
highest level of care in the province, often after patients have had
run-ins with the law or have become homeless.

"People aren't necessarily cured by one round of treatment in our
level of care. It's often a lifetime journey," says Coniglio. "It's
not a single event that changes their lives, it's often a series of

That can include opioid replacement and psychiatric medications, along
with counselling to teach coping skills like cognitive behavioural
therapy and even spiritual awareness.
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