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?

Best bet for ending gang violence is to remove the profit

A UVic student I met last fall when I was teaching a journalism course let me read an interview he’d done with a Vancouver gang member - a childhood friend of his.
It was an extraordinary read. Everybody’s got an opinion on why gangs have become such a deadly problem in B.C. and how we’ll get a handle on things, but it was fascinating to get a take on the issue from the point of view of a former gang member.
Like a lot of the young people caught up in Vancouver’s gang scene right now, this kid had grown up as a generally happy and well-cared-for child in a financially comfortable family. Boys emerging from impoverished, troubled childhoods are still the primary recruits for a lot of Canadian gangs, but the rise of a new kind of gang culture in Vancouver points to more complicated risk factors that we’ve barely begun to understand.
This particular young man was drawn into gang life after meeting another teen a couple years older than him who had it all going on: Money; cars; girls; drugs; stature among his peers. The older teen asked the boy if he wanted to earn a little money selling marijuana to his secondary-school classmates.
Within months, he was making more money than he’d ever imagined. He’d also undergone a transformation among his peers: From the quiet kid at school who nobody noticed, to the one whom everybody wanted to hang out with.
He had a cool car, lots of girls interested in him, and access to the best drugs. Heady stuff when you’re an invincible 16-year-old.
Neither this boy nor anyone he worked with in the gang seemed to worry too much about running afoul of the law. So I’d counsel that we think twice before assuming that more policing and tougher jail sentences will solve Vancouver’s escalating problems. Things are always much more complex than that.
The boy was eventually invited to be a truck driver for the gang, moving drugs back and forth over the Canada-U.S. border. The older teen he’d first met continued to be a mentor of sorts, even inviting the boy to room with him for a while after he fought with his parents over the source of his lavish new lifestyle. The parties at the new place were non-stop.
In his eight years in the business, he never got caught. He made a ton of money. The only reason he even left gang life was because guys above him in the hierarchy started getting killed by rival gangs, and he knew his time would be coming soon if he didn’t get out. He’s back at university now, studying to be a pharmacist.
A word like “gang” has a great deal of emotional charge, but at its essence a gang is an organization that’s in the business of buying, selling or producing something that’s illegal.
The product can be just about anything; I remember reading a few years ago about U.S. gangs who specialized in hazardous waste, because there was a lucrative business at that time in illegal dumping. Here in B.C., it’s mostly drugs, the trade of which we are superbly placed to handle due to our long coastline, proximity to the U.S., and sophisticated network of marijuana operations.
Were the product anything but illegal drugs, the B.C. government would be bragging about the runaway success of a local industry. Like it or not, it’s an immensely successful industry, albeit one in which murder is an acceptable corporate strategy for resolving rivalries and personal slights.
Gangs exist because many, many people in the mainstream community want to do illegal things, and go looking for someone to provide it. So either we’re going to have to stop buying anything illegal, or we’re going have to make more things legal in hopes of cutting into gang profits.
We obviously don’t want to be legalizing every criminal activity. But it seems to me we could make significant progress by starting with drugs and sex. Decades of bad law haven’t done a thing to curb demand or supply of either of those products, so it’s not like we’d be abandoning a winning strategy.
It’s the buying habits of the mainstream community that fuels gang activity. Any real solution has to involve making gang life less profitable.
Yes, we also need enforcement, and meaningful tools for understanding the small segment of privileged, middle-class boys who end up attracted to the egocentric and anti-social world of gangs. But we’ll get to the root of the problem only by taking the money out of it.

Any more lean years for non-profits a potential disaster

The lesson that lingers the most for me from my three years of heading up a non-profit is how very hard you have to work just to keep the doors open.
Whatever else may be happening on a given day, the one constant for anyone running a non-profit is the endless hustle for money. Barely a moment went by in my time at PEERS Victoria when I wasn’t working at least a dozen different angles to make sure we’d have enough money to keep going.
And that was in the good times. In bad times - well, I guess we’ll see. Nationally, expectations are that as many as a fifth of Canada’s 60,000 non-profits will close as a result of the economic downturn. Small non-profits walk a razor edge when it comes to survival, so that number sounds frighteningly accurate to me.
Non-profits rely almost exclusively on governments, investment-rich foundations and generous citizens for their funding. None of those groups have much interest in spending at the moment.
That’s a scary development for a sector that generally lives by the seat of its pants even in boom years. It’s an equally scary development for what it will mean for the tens of thousands of British Columbians who rely on the myriad services and programs run by non-profits. B.C. agencies are awaiting Tuesday’s provincial budget with particular trepidation, as the province provides the bulk of their funding.
“How do you do the work you do if you don’t have any profit?” a UVic student once asked me after I’d told her PEERS was a “non-profit.” The label is fairly baffling, I agree, and “not-for-profit” no better.
What’s possibly worse for the sector is that both terms call to mind a kind of begging state, a place where there’s never any money to be had . That’s certainly how it is for a lot of small non-profits, but you know what they say about how a label can hold you down.
Essentially, the sector does the work of government - most importantly, the human-service work essential to a civil society. The private sector doesn’t set up shop unless it can turn a profit, so a typical western democracy like Canada turns to non-profits to do all the other work that would otherwise go undone.
That’s the reason why it’s PEERS and not a private business providing outreach on the local prostitution stroll. It’s the reason why poor people in the downtown are fed and cared for by non-profits, and why the work of holding families together is mostly done by neighbourhood houses and other small agencies.
The people who need those services don’t have the money to pay for them, which means the work is all cost and no revenue. That’s the kind of service that’s either going to be provided by the non-profit sector or not at all.
British Columbians count on a very long list of non-profit-run services to be there when they’re needed. Sexual-assault counselling; programs for children with disabilities; job training and placement; legal advice; support for troubled teenagers; seniors’ care; on and on - were it not for all the work done by B.C. non-profits, this province would be a much sicker, sadder and less productive place.
But it’s one thing to be thankful for the work of non-profits, and quite another to fund them with any kind of consistency. Unstable funding that rarely keeps up with cost-of-living increases has been the norm even under governments professing interest in looking after vulnerable citizens, but has become much more of a problem in the past decade as governments moved to reject responsibility for the social health of citizens.
In B.C., those shifting ideologies placed the non-profit sector firmly on the outside looking in during the economic boom. Having gone hungry for several years now, many are in poor shape to withstand whatever might be coming now that the economy has collapsed.
Obviously, we need to be worried in B.C. about lost construction jobs and dried-up industrial contracts, because that’s where the recession has shown its face first. But there’s big trouble on the horizon that will rock the non-profit sector as well, at a time when it’s weak from years of underfunding and facing even greater demand for services due to the crashing economy.
Perhaps it’s the nature of the work - not nearly as visible as a broken arm or a cancerous lung, not nearly so easily measured as a graduation certificate or an overcrowded classroom. But it will be our grand mistake if we underestimate the importance of keeping our non-profits in fighting shape for the hard work that lies ahead.

Nothing equal about treatment of men, women in 2009 federal budget

In theory, we’re all equals in Canada. But just follow the money in the 2009 federal budget for proof of the flaws in that argument, notes an Ontario academic.
Equality looks great on paper, which is why Canada has a Charter of Rights, wide-reaching human rights law, and its signature on just about every feel-good global declaration of oneness that’s out there. We’ve been particularly passionate in our calls for equality between men and women.
But there are the warm and fuzzy things that we tell each other, and then there’s reality. A gender analysis out of Queen’s University of the most recent federal budget is a sobering reminder of just how far Canadian women continue to lag behind men economically.
The analysis was done by Prof. Kathleen Lahey, a law professor with a speciality in tax. Twenty years ago when she took her first look at whether tax laws affect men and women differently, she was stunned to discover that women were routinely “overtaxed and underbenefited.” Virtually every tax analysis she’s done since then has reaffirmed that for her.
Canada’s 2009 budget demonstrates the problem. With its emphasis on tax cuts and rate improvements for those at the higher end of the income scale, its “stimulus” measures bypass 40 per cent of Canadian women, says Lahey. They simply don’t earn enough to benefit.
Women will also miss out on much of the new money for infrastructure projects earmarked to help Canadians weather the recession, adds Lahey. The industries that will benefit primarily employ men; just seven per cent of Canada’s construction and trades workers are female. (Read Lahey’s analysis at http://www.progressive-economics.ca/2009/01/31/gender-analysis-of-budget-2009/)
Many of the issues Lahey identifies in her analysis are applicable to anyone in a lower income bracket. But women are more likely to be in that category than men, and so end up disproportionately affected.
The average income for women in Canada is just $27,000 a year, compared to $45,000 for men. The disparity is even more noticeable among single-parent families, with single moms and their children living on little more than half the income that single dads earn ($30,900 versus $58,300).
The budget made improvements to Employment Insurance benefits, but not in a way that helps women, says Lahey. Since 1996, people working less than 35 hours a week don’t qualify for benefits. That shift hit women significantly harder than men, because women do more part-time and seasonal work. The most recent enhancements improve things for those who qualify for EI - three-quarters of whom are men - but do nothing to help more people get benefits.
Flat taxes like the new carbon tax and provincial sales taxes also hit women harder, notes Lahey. A five per cent goods and services tax may sound like equal treatment for all, but such taxes in fact have a much greater impact on people with less spending power.
Why do women consistently earn less than men in Canada? We must have dissected that issue at least a thousand different ways by now, and once believed the answer was simply to push enough women through the various glass ceilings and discriminatory hiring practises getting in their way.
But the issue is more complex than that. Women are the ones who bear children, and are most likely to be the primary caregiver when children are small. We make different choices around the kind of work we do.
The jobs that women do also tend to pay less than traditional male jobs.
We could argue for years about why that’s so - and we have. But none of it has brought us closer to rectifying the situation. We may talk a good game about getting down to the business of “equal pay for work of equal value,” but the concept terrifies government and employers.
As for encouraging women to do more of the kind of work that pays well - men’s work, in other words - well, it’s good to try. We certainly need more women at the top. But all our efforts to get them there are for naught unless we can do something about the many women who crack the glass ceiling only to realize they hate everything about their new life.
Sexist tax policy can only make things worse, says Lahey. She thinks it’s time for women to “get over their dislike of tax policy” and learn enough to fight back.
“This is systemic,” Lahey says. “The direct spending and tax cuts in the federal budget simply reinforce inequalities between men and women.”

When the telemarketers call, let it ring

In the recent furor over telemarketing and the use of the new do-not-call list for nefarious purposes, I’ve yet to see mention of the most obvious solution to the problem: Quit buying from random strangers who call you up uninvited.
There’s nothing wrong with doing business over the phone. It’s handy to be able to use the phone to bank, order products, report your stolen credit card, start and stop subscriptions, or any number of other useful services that have become part of the consumer landscape.
But an out-of-the-blue sales pitch from a stranger who bought a list somewhere with your home phone number on it - well, that’s a whole other thing. I hate being rude to people, but I’ll hang up on a telemarketer without hesitation. A particular pox on the companies who think I’m stupid enough to stay on the line for their taped sales pitch.
If they’re motivated to keep calling, though, that has to mean that at least some of the people they’re calling are buying. No company would run a telemarketing operation if they didn’t think they could make money at it.
So it’s us consumers who actually have all the power when it comes to doing something to stop telemarketing. As the potential buyers - “prospects,” as we’re known in the industry - we could wipe out the whole ugly business simply by refusing to be part of it anymore.
Telemarketing is part of the “telephone call centre” industry, which has exploded in the past decade in Canada and around the world. That’s the result of a deregulated telecommunications industry and a massive expansion in cheap data-transmission capability.
Most of the work of the sector takes place in call centres, like the xxx West Corp. facility in Central Saanich. Canada has become something of a global hub for call centres, in fact. A 2007 research report into international call-centre trends found that three countries had a disproportionate number of them: Canada; India; and South Africa.
Borders don’t matter when business is done by phone, and up until recently Canada’s favourable dollar and weak regulation made it a choice location for call centres under contract with U.S. companies. Provinces with chronically high unemployment have been more than happy to welcome American-owned call centres to their communities.
Twenty years ago, 20,000 Canadians worked in call centres. Today, there are 155,000, including untold thousands calling up people like you and me in every corner of the world.
Most of that commerce doesn’t have anything to do with unwanted phone solicitations, of course. Typically, only 20 per cent of a call centre’s phone work involves “outbound” calls - the ones that drive us nuts (22 per cent in Canada). Still, that’s a whole lot of unwanted phone calls when you consider they can come into your home from any call centre in the world.
Polls into how we feel about telemarketing typically find 90 per cent of those surveyed ranting about the practise. In the weeks leading up to the introduction of tougher telemarketing laws last fall, two-thirds of the Canadians polled said they were planning to register their phone numbers on the federal do-not-call list.
The Canadian Marketing Association, a staunch defender of telemarketing, admitted to the CBC last year that the practice is “by far and away the leading source of calls and complaints” the organization receives. The CMA has even had to step up security at its front entrance.
Canada’s new legislation adds some additional layers to the discussion, starting with a number of exemptions that let certain groups - political parties, charities, opinion pollsters - keep phoning even if someone is on the do-not-call list.
Then there’s the problem of the list itself, as reported in the news last week. Telemarketing firms need access to the no-call list to know who not to call, but that means they’ve now got your number. How handy.
Companies risk a $15,000 fine for calling people on the list. But how will Canada enforce that when calls can originate from anywhere in the world? How long before a “listings broker” gets their hands on all those verified phone numbers - a golden find in the telemarketing industry?
And yet the solution is so simple. If we refuse to buy from telemarketers, they’ll quit trying to sell that way.
Yes, it makes things a little tougher for the charities and businesses that rely on phone solicitation, as it tars everybody with the same brush regardless of whether they deserve. But so it goes.
Don’t feed the beast. Flex your muscle as a consumer and just hang up.