Losing the drive to quit: ‘There’s no rehabilitation system at all’

Saturday, August 30, 2008

ANNA MEHLER PAPERNY

VANCOUVER — After an 18-month cocaine and heroin binge, Karmalita Joe was ready to get clean.

She had tried and failed before at detox centres around Vancouver, but the persistent urging of staff at InSite – the supervised-injection site where she says she went to shoot up “repeatedly, daily, sadistically” – prevailed. On a Friday in early July, she asked to be admitted to OnSite, the detox facility upstairs.

But the facility, which has been operating at capacity almost since it opened a year ago, didn’t have any spare beds. Come back Monday, she was told.

In the intervening two days, she was on another trip.

“When you want to quit, you need to quit now,” she said. “If you’re told you have to wait three or four days, that drive to quit … it just goes down, and addiction takes over.”

Ms. Joe was lucky: She was back at OnSite the following Wednesday, got a bed in its detox program and has graduated to its third-floor stabilization room.

“I still, for the life of me, cannot believe I was able to stay clean,” she said.

But her predicament isn’t unusual. The demand for detox and long-term treatment beds far outstrips supply across Canada. Addicts who want to kick their habit are often told to wait in line for treatment. Those with the most entrenched addictions and the least support from family, friends or the health-care system are the ones who can least afford to wait a few days for a detox bed or several weeks for a space in a long-term facility.

With the 2010 Winter Olympics approaching, the B.C. and Vancouver governments are working feverishly to clean up the city’s notorious Downtown Eastside. This week, the judge of a new community court said he hopes to sentence drug users to treatment to get them off the street. But many of those users couldn’t get into a detox bed if they tried; there just isn’t enough room.

B.C. has 176 detox beds and 326 longer-term stabilization beds, and spends about 30 per cent more on treatment than it did eight years ago. But an addict who wants to kick the habit has to wait four to five days just to get into a detox bed in Vancouver, and several weeks after detox to make it into a longer-term treatment program, according to the Vancouver Coastal Health Authority.

Other provinces are in the same boat: In Ontario, people seeking treatment in a Centre for Addiction and Mental Health facility could get into detox in a day or two, but then wait as long as two weeks after detox just to get an initial assessment appointment with a counsellor, and as much as eight weeks after that before they can enter a long-term treatment program.

It’s been like this almost “forever,” said Dennis James, clinical director of addictions programming for Toronto-based CAMH. It’s difficult to tell just how large the gap is: Waiting lists aren’t a reliable indicator because many addicts just don’t bother lining up, Mr. James said. Almost all addicts who make it through detox have tried to get into the system many times before.

Efforts are under way to remedy the shortage. B.C. is developing a 10-year plan to combat addiction, and the federal government is nearly two years into a $121-million drug-treatment funding program. But addiction doctors and researchers warn an injection of cash and even an influx of new beds will do little unless they’re part of a comprehensive system that connects recovering addicts from one stage of treatment to another, without letting them fall through the cracks and back into the vicious cycle of substance abuse.

“There’s no rehabilitation system at all,” said Gabor Maté, a doctor who works at OnSite. “There’s a patchwork, which leaves a lot of people without support.”

Addiction treatment has been ignored for a long time, says Alan Campbell, Vancouver Island Health Authority mental health and addiction services director. In B.C., addiction was bounced around from one government ministry to another for years, only falling under the Health Ministry’s umbrella in 2002.

Mr. Campbell says it’s a challenge to convince people that addiction is a disease. Although an influx of resources certainly helps, it will take a long time for those increases to show results, he says.

Victoria is more than tripling its treatment beds by April, 2009, and that will shorten the waiting list but won’t eliminate the problem, he says.

The federal government’s drug treatment program, started in April, plans to set up a $10-million abstinence-based treatment service that will provide 20 addiction treatment beds for women dealing with mental illness and addiction in Vancouver’s Downtown Eastside. The beds are set to open this fall.

Health Minister Tony Clement has criticized harm-reduction mechanisms such as InSite, arguing they do nothing to get addicts off drugs but instead help feed their habit. The federal government, in turn, has come under criticism from doctors and researchers who support InSite and say the government spends too much money on drug-law enforcement and preventive advertising campaigns rather than treatment.

A TICKING CLOCK TO STAYING CLEAN

The noise of Hastings Street is muffled outside the brightly lit walls of OnSite, where clients from the detox facility and third-floor stabilization centre, clad in pyjamas and slippers, crowd around an easel in the centre’s common room.

OnSite, which opened last September and, like InSite, is run by the Portland Hotel Society and Vancouver Coastal Health, has been full for months. OnSite manager Liz Moss says she could fill four times the beds she has now.

Portland Hotel Society executive director Liz Evans says OnSite’s clients come into the facility with a rapport already established with staff from the supervised-injection site downstairs, so mistrust and discomfort are less of a deterrent than they might be elsewhere. The Portland Hotel Society now wants to create a long-term treatment facility at a horse farm, using the animals to provide therapy for recovering addicts.

Mr. Clement’s spokeswoman, Laryssa Waler, wouldn’t say whether the government would support the proposal, but said Mr. Clement believes in “treatment that leads to full recovery.”

Ms. Moss says she prides herself on never discharging anyone from detox onto the street. She makes sure they all head upstairs to OnSite’s stabilization facility, where they get another few weeks of treatment.

If it’s full upstairs, she may let them keep their bed on the detox floor – which she admits sometimes gets her in trouble with staff wanting to free up beds – or try to find them a space at another recovery centre.

“It just gives those people a bit of extra support,” she said.

InSite supervisor Russell Maynard says the days following recovering addicts’ successful detoxification are critical to their recovery. “If you have to wait, every single day, every six hours, the probability of it not being successful is increasing,” he said.

Because most detox facilities aren’t directly connected to stabilization centres, few recovering addicts have the luxury of a smooth transition from one to the other. In Manitoba, detox and treatment facilities are run by separate organizations, and the province doesn’t collect data on how long the wait is from one to another.

“You discharge them to the street, they’re homeless – they go to a shelter. What do they do? They shoot up,” Ms. Moss said.

Although OnSite’s location brings in people who otherwise would have no contact with health care or treatment, Ms. Moss says, being smack in the middle of the city’s drug- and poverty-riddled Downtown Eastside is a challenge. On welfare days, many OnSite clients who have money in their pockets leave to buy the drugs they crave.

“It’s a big thing if we can get people past welfare day,” Ms. Moss said, adding that she tries to get clients out of the Downtown Eastside on those days. They often make day trips to the beach or the Pacific National Exhibition. “It tends to get people’s mind off of it. … Sometimes we need to get people away from those triggers.”

Susan King knows all too well what that feels like.

“I was a chronic addict; if I didn’t have a crack pipe in my mouth, I had a needle in my arm,” she said.

Ms. King has been in and out of addiction treatment since 1994. She’ll celebrate 60 days clean on Monday after her second stint at OnSite.

She motions to a man lighting a crack pipe on Hastings Street just outside the window of the café where she sits, coffee cup in hand.

“You have to get over the triggers. You have to be able to walk past someone with a crack pipe in their mouth or a needle in their arm,” she said. “It sparks something with you: ‘What do you mean, I can’t get clean here?’ You say, ‘Of course I can.’ ”

DETOX COAST TO COAST

Addiction treatment centres are full in jurisdictions across the country, which means people who want to kick their addictions have to wait in line, or give up altogether.

Detox beds Long-term beds Total beds Funding ($million) Wait time Provincial population Beds per 100,000
British Columbia 176 326 502 Two to 10 days for detox; four to 12 weeks for long-term 4,146,600 12.11
Alberta 159 260 419 $22.6 Unknown 3,153,700 13.29
Saskatchewan 112 162 274 $47.3 One to seven days for detox; two to three weeks for long-term 994,800 27.54
Manitoba 48 402 450 $22.4 Zero to two days for detox; unknown for long-term 1,162,800 38.7
Ontario n.a. n.a. 540 $123.0 One to two days for detox, three to eight weeks for long-term (CAMH) 12,238,300 4.41
Quebec n.a. n.a. 77* $27.3 Two to 12 weeks following assessment 7,487,200 1.03
Nova Scotia 66 58 124 $29.0 Unknown 936,000 13.25
New Brunswick 93 64 157 $17.6 Unknown 750,600 20.92
PEI 24 28 52 $7.5 48 to 72 hours for detox; none for long-term following assessment 137,800 37.74
Newfoundland 24 10 34 $5.6 Six to seven weeks for long-term 519,600 6.54

* Total does not include additional designated detox beds in hospitals throughout Quebec.

SOURCES: PROVINCIAL GOVERNMENTS, CENTRE FOR ADDICTION AND MENTAL HEALTH, STATISTICS CANADA

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