The Terry Project on CiTR #43: Drug Treatment (the Four Pillars Revisited, part 3 of 5)

By Gordon Katic, September 19, 2014

When somebody decides that it’s time to kick drugs, who is there to help them? In this explosive expose, we reveal a chronically underfunded drug treatment system that is dominated by unregulated flop houses, questionable pharmacists, and dogmatic providers. This is part three of the Four Pillars Revisited, our season-opening series on Vancouver drug policy, produced in partnership with The Tyee, and syndicated at the University of British Columbia, the University of Victoria and Simon Fraser University.

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The Terry Project Primer on Treatment in the Vancouver Coastal Health and Fraser Health Authority Areas

Who does all the drug treatment?

The overwhelming amount of treatment is done privately. There are about 130 beds within government-run facilities. There are 507 beds covered by government contracts within private facilities. These facilities are typically run by not-for-profit organizations.

Then rest are done privately, either as licensed beds (in the Assisted Living Registry) or as unlicensed beds. Both receive the majority of their funds by directly billing the government to take what would have been their client’s social assistance.

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What is the difference between the licensed residential recovery programs that are private and those that are publicly-funded?

Technically, they are both publicly funded. The private beds receive the majority of their funds by directly billing the government to take what would have been their client’s social assistance. However, this amount does little more than cover room and board. The licensed beds that we have listed as ‘publicly funded’ also receive generous contracts from government agencies (Vancouver Coastal Health, Fraser Coastal Health, Worksafe BC, etc) to cover specific beds, allowing those facilities to provide more programming and a higher standard of care.

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What treatment philosophy do the licensed publicly-funded beds have?

The publicly-funded beds licensed under the Community Care and Assisted Living Act receive extra scrutiny to provide a high standard of care. First, they are licensed as community care facilities, rather than assisted living facilities. For example, the former would typically have a dietician approve a meal plan, the latter would not. Moreover, these facilities are under extra pressure from the contracting government agency (usually the health authority) to provide care that aligns with the health authority’s treatment philosophy. Therefore, the overwhelming majority of them accept methadone clients.

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What treatment philosophy do the licensed privately-funded beds have?

We called every licensed facility within the lower mainland.  The treatment philosophy is overwhelmingly 12-step, abstinent-based programming that rejects the science of drug treatment. We did not call those outside of the lower mainland but still within the Fraser Health Authority, including Abbottsford, Mission, and Chiliwack. However, through scanning their websites, we can see that their treatment philosophies are likely very similar.

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How did you calculate your unlicensed beds within the City of Surrey? 

According to leaked documents obtained by The Terry Project, the City of Surrey is aware of at least 119 unlicensed recovery homes that continue to operate as of July 2014. The documents count 569 beds in 54 of the 119 homes.

Jas Rehal, Surrey’s by-law manager, confirmed the authenticity of the  documents. However, he claims that the numbers have changed since July, and Surrey is now aware of 79 unlicensed recovery homes. Rehal says that the RCMP has active investigations into 17 of those homes.

Using the average number in the 54 homes (10.54), we estimate that there are approximately 832 beds in the remaining 79 homes.

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You said that there are several stories of these unlicensed recovery homes abusing the methadone program. Why is that happening? How is it possible?

Listen to this interview with Dan Reist of the Centre for Addictions Research, who wrote a big report on the state of the methadone maintenance program. In the interview, we go over a couple potential answers. First, the system was hastily put in place when the federal government devolved it to the province, leaving the regulatory tasks to a patchwork of public and quasi-public organizations, including the BC College of Physicians and the BC College of Pharmacists, which are industry groups–not public bodies. Second, the methadone program is treated separately from the rest of the health care system, meaning not just any doctor or pharmacist can prescribe and dispense methadone. Doctors and pharmacists have to jump through hoops to become a part of the program. Some come in for the right reasons, and some come in for the wrong reasons.

In this bonus interview we talk with anthropologist Philippe Bourgois about the politically controversial option of treating opiate addiction with prescribed heroin. And we delve into methadone’s problematic pharmacology. Is this really the right drug for the job?

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I want to learn more about the state of drug treatment in BC and in Canada. Where can I do that?

Unfortunately, there hasn’t been very much written on the subject. In 2006, a Vancouver Coastal Health employee co-wrote a report [PDF – UBC only link] on treatment in Vancouver for the journal Drug Policy. However, those figures are dated. The report showed that Vancouver Coastal Health had 40 residential treatment beds, a number lower than today. In the Vancouver area, our figures are the most up-to-date and the most thorough.

For a national analysis, the best figures are from the Canadian Centre on Substance Abuse’s National Treatment Indicators Report [PDF], which found that over 150,000 Canadians accessed some sort of publicly-funded drug and alcohol treatment within a single year (including residential recovery, detox and a variety of other programs). Unfortunately, the report did not include figures for BC.

You may also want to read this report by the Canadian Drug Policy Coalition, which finds that drug treatment is an uncoordinated and patchwork system that suffers from a maze or regulatory frameworks that make for long wait times and unpredictable standards of care.

“The system of drug treatment and detoxification services is still a collection of clinics, hospitals, community agencies and private service providers developed over time in response to local pressures, political advocacy, and availability of funding and without a great deal of systematic attention to the actual needs for services.”

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What does the provincial government have to say about this?

The Ministry of Health told us that there are 2,648 community substance use beds within BC, and 1,601 in Vancouver Coastal Health. After months of reporting in the recovery and treatment scene, that number seemed extremely high to us–a wonderful surprise. However, after pestering the government for several weeks, we were able to get more specific figures, breaking the 1,601 into more specific categories.  The vast majority of those beds are low barrier housing (929), which are single occupancy residence hotels (SROs), which are not recovery programs, but notoriously poor places to live. Figures below include youth and adult beds, while the figures above are exclusively adult beds. VCH contracts 252 residential treatment and recovery beds (76 intensive, 176 supported).

Vancouver Coastal Health also administers 130 beds within government-run treatment settings, including 100 at the Burnaby Centre for Mental Health and Addictions, and 30 at BC Women’s Hospital. The Fraser Health Authority told us they are allotted 33 of the beds at the Burnaby Centre, and 5 beds at the BC Women’s Hospital. They also told us that they provide 140 beds in intensive residential treatment centres and 115 beds within supported residential settings.

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I want to learn more about the science of drug treatment. Where can I do that? 

In Drug Treatment; What Works?, a book edited by Philip Bean and Teresa Nemitz [UBC only link]. Each chapter goes over a number of different interventions that have evidence to back them, including cognitive behavioural therapy, motivational interviewing, and replacement therapies like methadone. Of particular interest is the 5th chapter, a polemic by Colin Brewer in which he rails against the abstinence-based treatment providers for being “walking placebo effects.”

“There is the natural tendency for those involved in therapeutic activity to believe that what they do is useful. People simply don’t like to admit to themselves or their patients that what they do may have no specific value or may be actually harmful. This means that enthusiasts often perceive benefit where none really exists and turn an individual or collective blind eye to adverse effects.”