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    Addiction treatment—it’s complicated


    Judith Lavoie

    Victoria still has no residential treatment beds for those coming out of short-term detox—yet the new therapeutic recovery program is undersubscribed.

     

    AS VICTORIA RESIDENTS ARE FACED WITH DAILY EVIDENCE of the ravages of addiction, especially when combined with homelessness or mental health problems, there are calls for more treatment beds in the community.

    Victoria’s grim tally of overdose deaths, combined with neighbourhood crime and confrontations as people move from the Pandora Avenue and Topaz Park camps into hotels, is forcing addiction and mental health problems into the spotlight.

    In the first four months of the year, more than 60 people in the Island Health region died of overdoses, including 28 in Victoria. Last month, a public health overdose advisory was issued by Island Health as the number of fatal and non-fatal overdoses grew because of increasing toxicity of the street drug supply.

    Niki Ottosen, who hands out sandwiches to people living in Beacon Hill Park and runs the Backpack Project, which delivers backpacks filled with necessities to people in need, believes the missing piece in the program to move people into hotel rooms, in an effort to stop COVID-19 spreading through the street population, is new detox beds. No new detox or treatment beds have been announced, she noted.

     

    244323963_NikiOttosenchristmas-backpack-project.jpg.26c289e64f3fb7411bd834b7d164ac61.jpg

    Nikki Ottonsen, founder of the Backpack Project in Victoria (Photo: Backpack Project)

     

    “I’ve had to bring people to detox. It’s seven days and then they go into 30-day stabilization, but sometimes they get out of detox, after seven days withdrawing, [and] they don’t have space for you to go to 30-day detox, so then you have to go back out to wherever you were and hope you don’t have a relapse before they have a space for you,” Ottosen said. “That is the huge missing piece. We are setting people up to fail if we think we are just going to put them up in hotel rooms, or maybe get them into modular housing later, without extra supports in our community,” she said.

    Kelly Reid, Island Health director of mental health and addiction services agrees more services are needed. The goal of Island Health is to provide a continuum of care for people with addictions, but, according to Reid, the answer is not as simple as supplying more treatment beds. “It sounds like a reasonably simple question and then you dig into it and it is so complicated,” Reid said.

    People with addictions and mental health problems need different supports to create a readiness to go into treatment, he explained, and having basic needs met—whether housing, food or access to a doctor—can lead to more interest in recovery. “It’s not easy and when you are living on the street and having to work so hard to even find food and the basics of life, it is particularly hard to go through a treatment process,” he said.

    Reid believes that while replacement drug therapies and the slow move to a safe supply of drugs should help set the stage for the next step, providing a safe place to live is vital in getting people to a place where they are willing to make changes to their lives. “I really believe that when people have housing and they have nutrition and they have hope and they have social connections that they can imagine a different path forward,” he said.

    Usually people who make the decision to go drug-free can get into a detox bed within four or five days, Reid said, but, if you are not seen as high urgency, the wait can be one or two weeks.

    From there, some people go to one of the three “supportive recovery homes” in the community, including two for women and the 22-bed Douglas Street Community 90-day supportive recovery program run by the Portland Hotel Society. Such facilities offer “low to moderate supports” to newly detoxed substance-abusers as opposed to the intensive therapies offered in residential treatment programs, which are not available in Victoria. Financial help is sometimes available for people to access ones on the mainland.

    Some of those seeking recovery need to go to a fully-staffed stabilization unit for a month. Others, following their 7-day detox, simply go home and are linked to counsellors.

    Reid admits there can be a gap between programs, which is why increasing capacity is part of the goal. “We want to be able to provide treatment as soon as somebody is ready to accept it, and we are not there yet. There are still waits in some parts of the system and sometimes the opportunity passes,” he said. “In the ideal world I guess if we had a residential treatment facility in Victoria it would add to our continuum. It’s one that would be very welcome,” Reid said.

    But even available beds do not guarantee that people will be willing to complete a tough recovery program.

    New Roads, a therapeutic recovery centre in View Royal run by Our Place, offers spaces to people who have experienced homelessness, those who are leaving prison, or people who are willing to enter the two-year program as an alternative to jail.

    The 50-bed centre opened in late 2018, but currently has only about 20 residents, partially because of COVID-19 complications, but also because people are sometimes reluctant to make such a long-term commitment.

    Grant McKenzie, Our Place communications director, said persuading people to make the leap from detox into therapeutic recovery is more difficult than initially imagined. “We are dealing with a very damaged population and it can take a long time to get them to the point where they are ready to go into therapeutic recovery,” he said. Even those who enter the program, do not necessarily see it through.

    The centre accepts people who would have been sentenced to three months or more in jail, but often, after three months of getting food, exercise and sufficient sleep, they believe they have recovered and leave.

    “Within 24 hours they are back using. There’s a challenge there that we are working on, but it’s not as simple as saying ‘here’s a recovery bed and off you go,’” McKenzie said. “You are dealing with a lot of trauma and abuse and you’re trying to dig down and get people to look inward and grow,” McKenzie said.

    If people stay for two years, the chance of success is about 70 percent, but, if they stay for only three months, success rates plummet.

    Mackenzie said that in addition to services now available in Greater Victoria, there is a great need to put more resources into mental health. “We really need mental health supports where people are assessed and the medications they are on are assessed. There are a lot of people out there with undiagnosed schizophrenia or undiagnosed bipolar and they are self-medicating with street drugs,” he said.

    In addition, a growing problem is the number of people who have brain damage after overdosing and being brought back by Naloxone.

    While some people do well in a home where medications can be monitored, others would thrive in a locked institution with 24/7 supervision, said McKenzie, adding that, because of past abuses in mental health institutions, it is a difficult concept to accept.

    “It probably wouldn’t be [someone’s] choice to go in there, which is what makes it so controversial, but I really think you could save lives,” he said.

    For a list of the types of assistance the BC government provides substance users, see this site. For withdrawal and detox services at Island Health, start here.

     

    Judith Lavoie is an award-winning journalist specializing in the environment, First Nations, and social issues. Twitter @LavoieJudith

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    Addiction treatment—it’s complicated

    Complicated for sure! But it's all 'bandaid solutions', which means we'll never get a handle on the root causes. Bruce Alexander's "Rat Trap" ( https://thewalrus.ca/2007-12-health/ ) indicates that we'd have to revamp our entire social structure - which isn't going to happen - even though there are enough indicators "out there" (courtesy of the pandemic) that more than heavily suggests what we have to begin doing.

     

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