Even before William Griffith Wilson co-founded Alcoholics Anonymous in 1935, his physician explained that addiction isn’t a moral failing, it is a medical condition.
Yet, even though most of us know people in recovery, suffering from addictions or someone who has died in the current fentanyl overdose epidemic, addiction remains a largely unspoken illness.
It’s possible that the success of AA — a society that values privacy, where surnames are not used, and where strangers seek out others like them not by asking directly about AA but by asking whether anyone is a friend of Bill W. — has paradoxically contributed to the silence.
Regardless, people suffering from addictions have long been ignored by Canada’s health system. Evan Wood, the head of the B.C. Centre on Substance Use, blames a lack of leadership and governance, a failure to properly educate health care providers, and inadequate funding.
He ruefully notes that the Vancouver Detox Centre is in the old dog pound, which is a good metaphor for the shortcomings in the addictions treatment and recovery system.
“Recovery has just been off in its own world,” Wood said. “What’s missing is a continuum.”
If there is a positive outcome from the opioid overdose crisis, he said, it’s a growing awareness that the addictions treatment and recovery system is splintered, poorly regulated and provides no continuum of care.
Over the years, various levels of governments have struggled to keep people alive with harm reduction measures that include free naloxone kits, rapid response teams and overdose treatment sites.
But having rescued them, then what?
The recovery system is chronically underfunded, with residential treatment facilities among the worst off. It’s something that Addictions Minister Judy Darcy said the government is taking a look at. But there’s no money in her ministry’s budget for it. It would have to come either from the Health Ministry or the Ministry of Social Development and Poverty Reduction — both of which have other pressing needs.
“You can’t make a go of it on $30.90 a day,” says Susan Sanderson, executive director and co-founder of Surrey-based Realistic Success Recovery Society, which runs three recovery houses for men known as Trilogy House. “It’s at least $10 a day short of what we need.”
That $30.90 is the daily fee per resident that the B.C. government pays recovery house operators, who are somehow supposed to stretch that amount to cover the cost of feeding, housing and providing recovery support to addicts fresh out of detox. It hasn’t been raised in close to a decade even as housing prices have skyrocketed and the cost of living has risen.
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Susan Sanderson runs Realistic Success Recovery Society House.
The financial crunch at Trilogy is self-inflicted — but in the best and most altruistic way. The society is committed to serving men just out of jail or recently plucked off the streets with no money, no jobs and no family who are willing or able to help them.
Many of B.C.’s 287 licensed and regulated recovery houses have a mix of government-funded beds and private-paid beds. For the private payers (including pilots, doctors, nurses, senior health authority staff and senior government officials with gold-plated extended health benefits), the cost can run as high as $350 a day.
To get government-paid care, addicts must prove they are destitute. They must be on social assistance with no assets and they have to have been on social assistance for a period of time before they qualify. In addition to getting residential care, these residents receive a “comfort stipend” of $95 a month.
“Our clientele are people who were middle-class and are no longer,” Sanderson said. “Most are guys who have gone to jail because of their drug addiction — for doing B&Es (break-and-enter thefts), low-level drug selling and doing dial-a-dope, which is feeding middle- and upper-class people in their community.
“Most have had jobs in other sectors of the economy — could be accountants, worked in TV, movies on technical side, lots of different jobs.”
If there’s an empty bed, the society will take those who don’t qualify for social assistance. But Sanderson refuses to charge them more than $30.90 a day. Their families, she said, have already suffered enough because of their loved one’s behaviour. She’s not about to send them to the poorhouse as well.
Fortunately for the clientele she serves, Sanderson is a resilient and resourceful fundraiser.
The Realistic Success Recovery Society is licensed by the B.C. government, the health authority and the municipality. This means that residents live in homes that are safe and that their recovery is overseen by certified and licensed counsellors.
But in addition to an increase in government funding for residential addictions care, Sanderson wants more and better regulation as well as enforcement.
There are shady operators — unlicensed and unregulated — who are giving everyone in the field a black eye. They’re charging for services that they may or may not provide. It’s lining their pockets, but it sure isn’t helping addicts or their loved ones.
The B.C. Centre on Substance Use has made dozens of recommendations for change in its new report, Strategies to Strengthen Recovery in British Columbia: The Path Forward.
It’s recommending tough permitting and stringent standards for treatment facilities, all backed by funding for enforcement.
As for the care provided, the B.C. Centre on Substance Use recommends a mandatory certification program for recovery residence operators, templates for municipalities on zoning and licensing of these facilities, and a policy that ensures no one is transferred from a licensed and regulated facility to one that isn’t.
There’s plenty of proof that the current system isn’t working for anybody, least of all for addicts and their loved ones.
Chasing the bad
In the Wild West of British Columbia’s unregulated addictions treatment industry, municipalities have ended up playing whack-a-mole with the bad operators who are running little more than flophouses — single-room-occupancy hotels operating under the guise of treatment facilities.
Nowhere has it been as big a problem as in Surrey, which is also home to 667 of British Columbia’s 1,572 certified residential treatment beds (42 per cent) and three-quarters of those licensed by the Fraser Health region.
In Surrey, Jas Rehl’s team has become expert at spotting the telltale signs of unlicensed addictions recovery houses — closed drapes, unkempt yards and a general air of disarray.
“In 2014, there were 250 unregulated and unlicensed recovery houses and they were causing a lot of issues in every neighbourhood and not just in one pocket area. The neighbourhoods had become complete nightmares,” said Rehl, the city’s public safety manager.
Over the past four years, Surrey’s bylaw enforcement officers have shut down more than 250 of them. But, says Rehl, as soon as they shut one down, it pops up somewhere else — not always in Surrey, but perhaps in an adjacent municipality or even further afield.
At the worst of them, Rehl says it’s almost always the same scene inside.
“There are usually about 10, 12, 15 individuals. The rooms all have locks on the doors and there’ve been lots of alterations to add more rooms,” Rehl says.
“There are no supervisors. There’s a box of cereal on the table. People are left to fend for themselves. They aren’t getting help that they need. … There’s no recovery going on in those homes. They’re using recovery as an umbrella to hide under.”
The problem is that municipalities don’t have many tools in their regulatory tool kit. But Surrey has aggressively used what it has.
Operators and property owners are fined $500 for every day they operate without a licence and another $500 for violating the zoning bylaw. They’re fined for any other violations — like too much garbage or for unsightly property. And, under the city’s nuisance abatement bylaw, every time police, firefighters or bylaw officers are called to the house, a $1,500 fee is added to the owner’s property tax bill.
Even with its aggressive enforcement, Surrey still has 10 to 15 dodgy-looking places that bylaw officers are watching closely.
Many of the unlicensed homes aren’t even safe. A recent study by Surrey’s top fire officers led by Chief Len Garis found that despite their unique characteristics and residents, recovery houses have no specific fire protection requirements. Among the study’s recommendations are that sprinkler systems be mandatory and that an in-depth study of life safety issues at recovery houses in Canada be undertaken.
Part of the reason people end up in these places is that the system is extraordinarily difficult to navigate, even for government officials. It took weeks for the provincial Addictions Ministry to respond to the Postmedia’s request for the most basic information about the number of licensed beds. The ministry had to collect the information from each of the health authorities.
There are 3,035 beds in all, including residential treatment, supportive recovery, transitional services, detox, sobering and assessment, low-barrier and supported housing.
The health authorities have lists of licensed facilities posted on their websites. But Fraser Health’s, for example, doesn’t separate addictions treatment from hospice, long-term care, community living or homes for those with brain injuries.
The Health Ministry does have an assisted living registry link on its website, but when the Postmedia tried to use it, it returned an error message saying that the page didn’t exist.
Failure to register
The sidewalk on a quiet, residential street at the edge of a pretty park in Osoyoos is littered with cigarette butts and “snoose” tins emptied of their chewing tobacco.
The RCMP stops by frequently, checking in on the residents of a house that several months ago the Brandon Jansen Recovery Foundation said it was turning into a recovery centre.
Unsurprisingly, the neighbours are concerned about an unlicensed and unregulated recovery house operating without a business licence on land that’s zoned for single-family houses.
B.C.’s Community Care and Assisted Living Act requires centres with more than two residents to be registered. Failure to register can result in a fine of up to $10,000. The act also requires supportive housing to be licensed and inspected by the health authorities.
Neither the Brandon Jansen Foundation nor the Brandon Jansen Memorial Recovery Centre is on the assisted living registry or licensed by the Interior Health Authority. The foundation’s application was rejected in November.
“If they were regulated and registered, had regular inspections, fire inspections, why would you have worries? But they have none of that,“ says Lyle Warmington, a next-door neighbour and the last guy who would oppose a properly regulated and licensed recovery home.
Because of his family’s personal experiences with addictions treatment facilities, Warmington knows a lot about the differences between good ones and bad ones.
Osoyoos’s chief administrative officer is near his wit’s end as well. Although Barry Romanko won’t comment directly on that particular house, he says municipalities are left in a terrible situation.
Because recovery houses with fewer than three residents aren’t required to register or get permits, the municipality may not even know they exist.
“We don’t know what they’re doing,” Romanko says. “And standard of care that they get? I guess it’s buyer beware.”
dbramham@postmedia.com
Twitter: @daphnebramham
Addictions:
The real fix
Day 1: Emphasis needed on treatment/recovery
Day 2: More help needed to save young addicts
Day 3: Lax rules give scammers an opening
Day 4: Moms with kids, and other underserved addicts
Day 5: Don’t just keep them alive
Methadone is making its way onto the streets
“Free medication delivery all over Greater Vancouver.”
Pharmacist Alnazir Asaria was offering that in online ads that ran until March 2017, when the B.C. College of Pharmacists suspended him, put a reprimand letter on his file and forbade him from working as pharmacist until he passed an exam on the law.
Asaria’s offences included filling prescriptions in excess of authorized quantity, filling prescriptions after their expiry date, and filling prescriptions that were missing quantity, dose or directions.
He filled methadone prescriptions to patients without complete and signed forms and witnessed ingestion logs. He gave clients methadone pills or “carries” without a physician’s authorization. He handed out methadone without adequate documentation including lack of controlled prescription program hard copy prescription and controlled prescription program prescriptions without the patient’s signature.
And, Asaria made prescription changes without adequate rationale or documentation.
For nearly 50 years, methadone has been recommended for opioid users as a means to dampen their cravings and set them on a path to recovery. And, between 2011 and 2012, B.C. pharmacists dispensed methadone more than two million times to close to 16,000 patients. Then, as now, some of that methadone is making it to the street where it is resold.
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Evan Wood, Director of the British Columbia Centre on Substance Use.
“That’s not an uncommon thing that we see in the hospital someone has overdosed on methadone that they’ve bought on the street,” Evan Wood, director of the B.C. Centre on Substance Use. He also cited a study that found methadone implicated one in four overdose deaths.
In British Columbia, Asaria was one of the largest dispensers, which is why he attracted the attention of the B.C. College of Pharmacists and the provincial Health Ministry. Together, they did an undercover investigation of 30 other pharmacists and nine pharmacies. Yee Kwok Henry Tung was also caught in the undercover investigation and was found to have put patients at risk because of his dispensing practices. In 2015, he agreed to no longer dispense methadone.
Of the others, three pharmacists were fined $15,000 each, while one was fined $5,000 and another $2,500.
Downtown Pharmacy at 348 Powell St. was permanently shut down. Native Vancouver Pharmacy at 108-50 East Hastings and its manager Mansour Djavanmard were suspended. Six pharmacies had their enrolment in Pharmacare terminated.
Because of regulations and enforcement provisions in various legislation, the good news is that pharmacists and pharmacies can be reported, investigated and disciplined. The bad news? Like all legal processes, it takes a long time and, in the interim, the misbehaviour likely continues.
By 2015, the number of times methadone was dispensed had risen to nearly three million. Between 2013 and 2015, the college received more than 130 complaints and tips about the dispensing of methadone.
Among the most serious complaints were that pharmacists were providing monetary and non-monetary inducements to attract clients, were processing prescriptions through B.C.’s computerized PharmaNet network without requiring patients to personally get their drugs, were failing to witness methadone ingestion when required by law, and, in some cases where doctors were allowing patients to take the drugs home with them, were changing prescriptions to daily dispensing, which meant higher fees for them.
The complaints led to undercover operations between 2015 and 2017 that targeted nine pharmacies. Those files are under review by the college’s inquiry committee.
During that period, another 41 pharmacies were selected for inspections based on the volume of their methadone dispensing, complaints and their geographic distribution — 13 of these inspections were in Vancouver, 10 in the Okanagan/Kootenays, five on the Sunshine Coast, four in Northern B.C. and three on Vancouver Island.
The inspections have resulted in suspensions, remedial education and pharmacy equipment improvements.
CORRECTION: An earlier version of this story had an incorrect date. Alcoholics Anonymous was founded in 1935.
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