Front Burner - As B.C. overdose deaths soar, calls for fully regulated addiction treatment

Episode Date: September 9, 2020

In 2018, a BC Coroners Service panel called for provincial regulations to ensure evidence-based care at addiction recovery facilities. The panel said this system should be developed by September 2019. Now, one year later, more people are dying of overdoses than ever before, but the regulations recommended by the panel still do not exist.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem, brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. So Gemma Higgins was kind of a typical middle class teenager living in Vancouver. She made some new friends when she was a teenager, and she started experimenting with drugs when she was about 16. This is Bethany Lindsay, a colleague of mine in Vancouver. By the time she was 17, her parents realized that she was addicted to heroin.

And so they began searching around desperately for treatment for her. And they managed to get her into a facility that's specifically for treatment of use with addiction. But it was entirely based on the 12 steps of Alcoholics Anonymous. And they privileged abstinence over everything else. So when she was caught using drugs, she was kicked out of treatment. And there's that option out the window. Overdose deaths are spiking in British Columbia. The B.C. government recently committed $52 million to addiction treatment and recovery services. But there are still no comprehensive province-wide regulations on how these services are run.

So when Gemma was old enough, she got into an adult treatment center. She was 19 years old at this point, and she made it through the initial parts of the program without using drugs. And she was transferred to what's called a step-down program, which is still part of the treatment, but it's a little less stringent. Now, again, this was another 12-step program. Abstinence is everything. But Gemma somehow managed to score some drugs while she was out on an outing, snuck them back into the facility. No one checked her bags, and she used alone in her room, overdosed and died, and no one found her for 12 hours.

Today, we're talking about the calls for evidence-based care, as the number of overdose deaths in B.C. surges once again. I'm Josh Bloch. This is Frontburner. It's so tragic to think that a young person could die of a drug overdose at the very facility where she's supposed to be getting help for her drug addiction. You spoke to Gemma's mother, Karma LaRue. What did she tell you about what she thinks went wrong for Gemma in that facility in 2017 when this happened? Well, she thinks that, first of all, something went wrong in the youth facility where Gemma was caught using drugs and she was kicked out for that. Her mother says, well, why wasn't this an indication that Gemma's problem was super serious? And instead of them saying, well, you have a serious problem, Gemma's

at high risk. Let's help you find something that's going to work. They ended up shaming our family, kicking her out with no other options. And there was no other options at this point until she hit 19. Now, in the facility where she died, her mother, Karma, questions whether using these 12 steps that kind of emphasize personal defects and responsibility. Forcing her to force herself to stop and have a moral dilemma. I'm sure she felt shame and stigma. Whether that made it so that Gemma didn't feel comfortable telling anybody, I need to use. I'm going through withdrawal. My cravings are crazy. I need to use. I'm going through withdrawal. My cravings are crazy. I need to use.

And so her choice was to use alone in a locked room with nobody looking out for her. So, you know, she didn't die at home using and staying safe and getting a safe drug supply. And until she was ready, she was, you know, had no tolerance, used and died. was ready, she was, you know, had no tolerance, used and died. I understand that her mom, Karma, that she told you that she spoke to other parents who also felt like they were really let down by the treatment centers to which they sent their children. Yeah. Say in a youth treatment facility, two kids might be caught kissing and they get kicked out for that. So they lose their

chance at further treatment because they've made a relationship. There are also lots of facilities that do drug testing. And if you have a positive drug test, you get kicked out. And right now in BC, the province is really trying to increase the number of treatment beds. They're putting a lot of money into that. But as it stands right now, there aren't a ton of facilities and there's a long wait list to get into them. So if you're kicked out for having a positive drug test, that may be a window closing on getting better. And so now my big question is when they talk about opening beds up, what does that mean? What are they doing? What kind of treatment? How are they keeping people safe?

Well, I want to understand more about how these addiction facilities work in British Columbia. Who runs these centers and who regulates them? So it's a real patchwork. There are publicly run facilities. There are lots of private facilities, lots of non-profit facilities. Some of them are overseen by the BC government. And those are what's known as supportive recovery homes. So they're treated like assisted living facilities. Now, there are other homes that are overseen by the regional health authorities that we have here in BC. And these health authorities oversee what are known as community care facilities.

And now those facilities need licenses if there are three or more patients being treated. So it's kind of a confusing patchwork, as I said. And the parents that I've spoken to say it's not really clear to them which is which, which kind of facilities are regulated or overseen by the province, and which are overseen by health authorities. What's the difference between licensed and unlicensed? So they have a lot of questions. And we should say also that some of these facilities are incredibly expensive. I mean, they can cost tens of lot of questions. And we should say also that some of these facilities are incredibly expensive. I mean, they can cost tens of thousands of dollars.

Well, yeah, exactly. It's a huge range of costs. So you do have a handful that are no cost at all because they're run by nonprofits that cover it. But otherwise, they cost anywhere between about $40 a day to almost $400 a day. Wow. So you could be paying $10,000 for a month or two of treatment or as much as $118,000 for a year of treatment. So I understand that in 2018, a coroner's panel in BC called for these province-wide regulations of all private and public treatment and recovery facilities. Where did that call come from and why did it come about?

So as you mentioned, it was 2018. So that was kind of two years into the overdose crisis here in B.C. And there had already been more than 1800 people who have died of overdoses here. So the BC Coroner's Service convened a panel of experts to kind of look into what was happening and figure out the gaps that could be filled to save some lives. And so what they saw was that many of the people who had died had sought treatment in the past, and there's no system to kind of monitor the outcome of these treatment programs to see whether people are staying clean, whether they're getting better or relapsing. My name is Michael Aylson. I was the chair of the Desperate View panel.

The specific quote is that addiction treatment needs to be held to the same level of provincial regulation and standards that all other chronic disease treatment is required to meet. So this coroner's panel came up with kind of two main thoughts about how to deal with the overdose crisis. One is we've got to improve emergency response. So that's things like making sure people have access to naloxone to reverse an overdose. And BC has done pretty great at that. But they also said, we need this system of regulation that covers every kind of treatment center in BC that sets out that the treatment that they're offering has to be evidence-based and that there has to be a system to make sure that those treatments are working

so that if they're not working, you can turn around and say, okay, how do we change things? So the panel said that these regulations should be in place by September 2019. And here we are in September 2020. What does the government say they've actually achieved in this time? So they do say that they've made extremely significant progress. So I guess the biggest issue has been in these supportive recovery homes that are overseen by the province. So kind of one half of the puzzle here. What the province has done is amended some legislation so that the BC government has the power to do more inspections. They can take immediate action on complaints if there's a pressing threat to health or safety of the patients.

And they're also bringing in rules that require everyone who works at one of these centers to have at least 20 hours of training in a relevant field like counseling, for example. I mean, 20 hours of training, I saw that and that seems surprisingly low. I mean, I feel like when I got a job as a waiter, I was trained for more than 20 hours. Yeah, I think that's fair to say. Of course, when Gemma Higgins died, her mother said that many of the people who were working at that facility were volunteers with no training. They had volunteers.

It was a Saturday night, Sunday. They were watching Netflix as my daughter was dying. The next day, they saw she wasn't there, and they had to figure out how to get the door unlocked and she was gone. So 20 hours is better. But the system that the coroner's death review panel recommended, it still doesn't exist. Right. I mean, I understand that the chair of that coroner's panel says that the government has not gone nearly far enough. Exactly.

And he gives the government a lot of credit for what they've done and acknowledges that this is a really, really big undertaking to set up this system with all these different stakeholders in a short amount of time while you're also dealing with you know the reality of people dying every day that's a lot of work if you're starting to regulate something like diabetes care or cancer care i mean you just think this this really is it's a big undertaking but he says we're never going to stop losing people if we don't have a system to make sure that they're getting care that actually helps them. If we don't have regulated care, it becomes quite difficult then to determine what evidence that we're using, are things actually working, what's the quality of service that people are getting. Right. And this is, as you mentioned, the thrust of the recommendation is for regulation to ensure that programs are evidence-based. And I know you spoke to a few

people, including Gemma's mom, who really had an issue in particular with the 12-step programs. AA works for some, but because it's such a high relapse rate, let's look at different ways. What did they say they wanted to see changed and how those kinds of programs are delivered? Well, so the 12 steps is something that has been pretty dominant in addiction treatment. But every time I speak with an expert, they say 12 steps works for some people, but it doesn't work for everybody. And making it mandatory when it's not working for somebody can actually backfire. So I talked to Leslie McBain, who's the founder of a group called Mom Stop the Harm. who's the founder of a group called Moms Stop the Harm.

And she told me about how her son tried treatment before he died of an overdose in 2014. But his only option was a 12-step program. He just walked out because he said, this isn't about me, this isn't, you know, there's nothing that's helping me in this. So much more that can be done and must be done for people who seek treatment. So she says that the key is making sure that people who are in these treatment centers

have a wide variety of different options that they can keep trying until they find something that works. So it could be the 12 steps. It could be a secular alternative that doesn't involve invoking a higher power. So groups like Life Ring or Smart Recovery are some alternatives to the 12 steps. It could be ensuring that they have access to treatments like methadone, suboxone, injectable hydromorphone that can cut down on the withdrawal while they deal with therapy to kind of figure out the root of their addiction. Every single person who is addicted to a substance and wants to have treatment, wants to recover, their path is as individual as they are. Everybody has their own reasons for using drugs to feel better, to mitigate pain, whatever that pain is.

And therefore, it just stands to reason that every person needs individualized care. There are also drugs, like something called naltrexone, which is an opiate antagonist, which means that if you're using drugs and you take this pill, it will block the intoxicating effects. So you don't actually get high. And for some people, that really works to reduce the cravings over time. I know you have spoken with a BC nurse named Byron Wood, who has become a really outspoken critic of the 12-step program. And some of these critiques are stuff he's spoken about as well, specifically his concern

with this focus on abstinence and prohibition on drug replacements like hydromorphone. And they're limiting your treatment options, and they're not going to allow you to continue at that facility unless you adopt their value system and submit to what their version of recovery is. Yeah, exactly. So Byron is somebody who's spent time in treatment and was forced into a 12-step program, which did not work for him at all.

But he's seen a lot of places that will implement regular drug testing and kick people out when they're using, just like what happened to Gemma Higgins. And his concern is that when you're kicking someone out, when they're at their lowest, when they're desperate for drugs and using them again, that you're really setting them up to go back on the street and start using again with that lower tolerance. And they could be heading for a fatal overdose. It's really disappointing and it's sad, really,

because people are continuing to die. When you compare it to how COVID has been responded to, the government has immediately listened to public health officials and they've implemented immediately the things they're going to save lives and that's just not happening here. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people and I have some

startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income? That's not a typo. 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples. How would the regulations that the coroner's panel is asking for address the dominance of 12-step programs within these treatment centers? Well, ideally, they would make sure that a treatment center couldn't mandate one specific program, that you would make it clear that this is an option and here are all your other options. I know one of the issues is how people looking for a treatment facility are able to determine what its record is, to what extent it is evidence-based. And you mentioned the organization

Mom Stop the Harm, and I understand that they're actually developing this online pamphlet to help people know the kinds of questions they should be asking treatment facilities when they're considering signing up themselves or a loved one. Because people are desperate. People will pay ridiculous amounts of money and not know what kind of care their loved one's going to get. Yeah, exactly. The kind of thing that a parent could take with them, a list of questions that they can ask of a treatment facility. And Leslie McBain told me... And this wouldn't be the first time that we have done what I consider the province's work. This is what the death review panel actually asked for. Now, one of the things that is happening with the changes the BC government has made is that they are requiring recovery centers that

the government oversees to provide more upfront information. So hopefully that is changing already. BC is right now facing record-breaking overdose deaths, worse than ever before. There's 177 people died in June, 175 in July. And we've heard a lot about decriminalization, about safe supply when it comes to addressing the crisis. But how significant is this piece of the puzzle, like the treatment piece? How do those affected by this issue see this treatment piece fitting into solving the crisis? Well, you can't have one without the other. That's what I keep hearing.

You need to have those solutions like harm reduction, safe injection sites, naloxone that are keeping people alive for long enough. And then you need to have treatment for them. And you need to have treatment that works. So you just can't have one without the other. And that's what Michael Aylson of the BC Coroner's Service told me as well. They're just inseparable. Bethany, thank you so much for speaking with we end our show today. The eccentric art dealer behind a mysterious real-life treasure hunt has died. Ten years ago, Forrest Fenn said he had hidden a

treasure chest somewhere in the American Rocky Mountains. He wrote a poem with clues to tell people how to find it. It's estimated that hundreds of thousands of people tried, and at least five people died searching for it. It was only in recent months that Fenn announced the treasure had supposedly been found by someone in Wyoming. Forrest Fenn died of natural causes at his home in Santa Fe, New Mexico. He was 90 years old. We did an episode about this story back in June, when Fenn announced the treasure had been found. You can find a link to that on our Twitter feed,

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