Detox rules work well for some - so let's do it both ways
Speaking up for the rights of one group invariably means stepping on those of another, as I was reminded following my recent column on the no-smoking policy at the new detox.
An old acquaintance of mine - I’ll call her Shelly - phoned me after the column appeared to tell me I was wrong to be critical of Vancouver Island Health Authority staff for prohibiting smoking at the detox. She’d arrived for a stay at the brand-new unit last month prepared to hate the prohibition, too, but instead quit smoking - for the first time in more than 40 years.
She was proudly 28 days nicotine-free when I met up with her last week at the Pembroke Street stabilization unit, which is where people fresh from detox ideally get to stay for a month while they work out the details of a life without drugs. Shelly had gone to detox primarily to get off heroin, valium, alcohol and cocaine, but was delighted to have gotten out from under her cigarette habit at the same time.
“I brought a carton with me when I came, because the word on the street was that you could smoke in the bathroom,” says Shelly, the fourth patient through the new detox after it opened in early February. “Then they told me no. I thought, God, I’m never going to be able to do this. I was asking for the [nicotine] patch within a couple hours. But then I did fine.”
My concerns with the no-smoking policy continue - and indeed, Shelly saw a fellow patient get kicked out of detox after being caught smoking. How crazy is it to deny people urgently needed health care just to make a point about the eventual dangers of cigarette smoking? There’s also a gap a mile wide in the system for adults addicted to cocaine or crystal meth, who for the most part are not accepted at the detox.
That said, far be it from me to deny Shelly the very positive experience she had at the detox, partly as a result of not being allowed to smoke. Being in a stable, smoke-free environment - lots of support, lots of nicotine patches - was really beneficial for Shelly, who looks happier and healthier than I’ve seen her look in years.
A solution, then: A medical detox, smoke-free, for people like Shelly - people whose primary drugs are opiates or alcohol and who need the more intense medical care the new detox provides. And a different kind of detox somewhere else, one where people can get help regardless of the drug they’re addicted to and not have to give up smoking at the same time. Nothing expensive or fancy - just a practical, safe place.
Shelly’s latest journey into recovery has been an exemplary one, and worth detailing for what it says about all the things that have to come together to help those overwhelmed by addiction.
It starts with Shelly, of course, because she was the one who went looking for change. But then she had the good fortune of connecting with outreach workers from the Umbrella Society, a very savvy little peer-led non-profit that helps people with addictions and mental-health issues. Shelly had the will, but it was the Umbrella Society that showed her the way.
“Gordon Harper is a large person in my life right now,” says Shelly of the society’s executive director. “I told him that he was going to have to decide where my next move was, because I didn’t have any brains anymore.
“So he set me up with this - detox, stabilization, a recovery home for at least three months, then to Aurora [treatment centre], then back to a recovery home. I’m expecting it will take me a year to do it, but that’s OK, seeing as I’ve wasted eight years using drugs.”
Other things went right as well. Shelly got a rare 18-day stretch in the new detox, almost three times as long as most get. Then she got a bed immediately in the stabilization unit, also not typical. With Harper on her side, she just might make it through the forms, waitlists, phone calls, intake processes, hard work, meltdowns and meetings that await those trying to get help with their addictions.
Shelly says the help is there for those who reach out for it. But I know too many others lost in the fractured system to see her story as the norm. I can’t imagine why we make it so hard.
Showing posts with label VIHA. Show all posts
Showing posts with label VIHA. Show all posts
Friday, March 13, 2009
Monday, March 02, 2009
Health authority's detox rules block access for street users
We met over coffee last week, each with our own reasons for being there.
I was there to find out why the region’s new 14-bed detox unit is virtually unavailable to people from the street community. He wanted to know why the media always fixate on the negative.
We talked for an hour and a half. I’m not sure that either of us fully understood the other one’s points by the end of it all. But at least we heard each other out, and I appreciated his frankness.
As the director of addiction services for the Vancouver Island Health Authority, Dr. Laurence Bosley is an important man when it comes to addressing some of the immense problems on our streets.
Addiction certainly isn’t the only reason why people end up homelessness. But it’s a major reason for why they get stuck out there. So when the health authority opens a new detox with policies that essentially exclude most of the several hundred people with addictions on our streets, I’d like to understand why.
But first to Dr. Bosley’s point about the media, because I do get what he means. We desperately needed the new detox and seven “stabilization” beds that opened this month, and it’s a beautiful facility in a time of scarce resource.
So I understand Bosley’s unhappiness at having media hone in on two “negative” angles on the story: That the facility isn’t available for stimulant users (people addicted to cocaine or crystal meth); and that it goes against the health authority’s own addiction-treatment policy by prohibiting smoking anywhere on site.
But like I told an audience of young activists at the youth-organized Change Conference this past weekend, you don’t fix a hole in the roof by talking about the 90 per cent of it that isn’t leaking. We won’t address what’s wrong in this world without talking about the problems.
Detox is the first step in getting out from under an addiction. It’s essentially five to seven days of care and prescription-drug therapy to help people through the most immediate withdrawal effects of whatever drug they were using.
Bosley rightly notes that it’s a pretty minor step, all things considered. But it’s the first one nonetheless. None of the steps that come after - treatment; spiritual healing; finding new ways to cope; drug-free housing; new friends and places to go; the hard, hard work of staying sober - can begin without detox.
So when policies at the new detox shut out the most prominently addicted people in our region, that’s one heck of a leak in the roof. The dominant drugs on the street right now are crack cocaine and crystal meth, so the no-stimulants rule alone has huge implications. But add in the no-smoking policy for a population for whom tobacco is the sole saving grace of life, and you’ve shut out the people who most need the help.
Bosley applies a cost-benefit analysis to the issue. The health authority has a limited amount of money to spend, and unrelenting demand for all its services. It’s making choices all the time in terms of who’s getting care.
On the detox front, Bosley points out that withdrawing from heroin or alcohol can kill you, and must be done under medical supervision. Withdrawing from cocaine or crystal meth is unpleasant, but not life-threatening. VIHA’s mandate is to provide medical care, not to give away expensive beds to people who really just need a place to lie down and sweat it out.
Except people on the street don’t have a place to lie down. No bed to sleep in for five straight days, that’s for sure. No way to get away from the sellers and the users. No place to detox, and thus no way to even begin the long journey out of addiction.
Bosley also notes that it makes little sense to give someone who’s homeless a detox bed for five nights and then just release them back to the streets. On that point we definitely agree. He wonders if we try too hard to “cure” everyone, when some people’s problems simply may not be curable.
I would argue that we’ve barely tried at all in terms of the street community. The significant successes of the three VIHA-led integrated outreach teams in keeping people supported and housed this past year underline how much can be accomplished when we do get down to the business of dealing with people’s real needs.
As for smoking, Bosley says he can’t believe anyone is surprised at that decision: “That’s just good clinical care.” I guess I see it as picking your battles. What good can come of denying people care for their addiction just because they can’t quit smoking?
We met over coffee last week, each with our own reasons for being there.
I was there to find out why the region’s new 14-bed detox unit is virtually unavailable to people from the street community. He wanted to know why the media always fixate on the negative.
We talked for an hour and a half. I’m not sure that either of us fully understood the other one’s points by the end of it all. But at least we heard each other out, and I appreciated his frankness.
As the director of addiction services for the Vancouver Island Health Authority, Dr. Laurence Bosley is an important man when it comes to addressing some of the immense problems on our streets.
Addiction certainly isn’t the only reason why people end up homelessness. But it’s a major reason for why they get stuck out there. So when the health authority opens a new detox with policies that essentially exclude most of the several hundred people with addictions on our streets, I’d like to understand why.
But first to Dr. Bosley’s point about the media, because I do get what he means. We desperately needed the new detox and seven “stabilization” beds that opened this month, and it’s a beautiful facility in a time of scarce resource.
So I understand Bosley’s unhappiness at having media hone in on two “negative” angles on the story: That the facility isn’t available for stimulant users (people addicted to cocaine or crystal meth); and that it goes against the health authority’s own addiction-treatment policy by prohibiting smoking anywhere on site.
But like I told an audience of young activists at the youth-organized Change Conference this past weekend, you don’t fix a hole in the roof by talking about the 90 per cent of it that isn’t leaking. We won’t address what’s wrong in this world without talking about the problems.
Detox is the first step in getting out from under an addiction. It’s essentially five to seven days of care and prescription-drug therapy to help people through the most immediate withdrawal effects of whatever drug they were using.
Bosley rightly notes that it’s a pretty minor step, all things considered. But it’s the first one nonetheless. None of the steps that come after - treatment; spiritual healing; finding new ways to cope; drug-free housing; new friends and places to go; the hard, hard work of staying sober - can begin without detox.
So when policies at the new detox shut out the most prominently addicted people in our region, that’s one heck of a leak in the roof. The dominant drugs on the street right now are crack cocaine and crystal meth, so the no-stimulants rule alone has huge implications. But add in the no-smoking policy for a population for whom tobacco is the sole saving grace of life, and you’ve shut out the people who most need the help.
Bosley applies a cost-benefit analysis to the issue. The health authority has a limited amount of money to spend, and unrelenting demand for all its services. It’s making choices all the time in terms of who’s getting care.
On the detox front, Bosley points out that withdrawing from heroin or alcohol can kill you, and must be done under medical supervision. Withdrawing from cocaine or crystal meth is unpleasant, but not life-threatening. VIHA’s mandate is to provide medical care, not to give away expensive beds to people who really just need a place to lie down and sweat it out.
Except people on the street don’t have a place to lie down. No bed to sleep in for five straight days, that’s for sure. No way to get away from the sellers and the users. No place to detox, and thus no way to even begin the long journey out of addiction.
Bosley also notes that it makes little sense to give someone who’s homeless a detox bed for five nights and then just release them back to the streets. On that point we definitely agree. He wonders if we try too hard to “cure” everyone, when some people’s problems simply may not be curable.
I would argue that we’ve barely tried at all in terms of the street community. The significant successes of the three VIHA-led integrated outreach teams in keeping people supported and housed this past year underline how much can be accomplished when we do get down to the business of dealing with people’s real needs.
As for smoking, Bosley says he can’t believe anyone is surprised at that decision: “That’s just good clinical care.” I guess I see it as picking your battles. What good can come of denying people care for their addiction just because they can’t quit smoking?
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