Background Paper on Treatment Needs in Vancouver, July 1998

[ Appendix 1 ] [ Appendix 2 ] [ Appendix 3 ]

Background

Effective public policy and programs for addressing drug and alcohol problems can have immediate and far-reaching effects, not only in reducing substance abuse and improving health, but also in making our communities safer, lowering our taxes, improving workplace productivity and reducing health care costs. By "treatment" we mean the broadest sense of the word - a continuum of care that begins with education and prevention to appropriate care, and continues on to support the recovering addict in training for work, completing school, finding housing and restoring families.

Over the last decade, many reviews and assessments of service needs have been conducted. The recommendations put forth have focused on: responding to the growing problem of injection drug use in the urban core; delivering more effective treatment for people with addiction and mental health problems; providing better access to detoxification and treatment services; and placing greater emphasis on effective prevention and health promotion. However, most of these recommendations have yet to be implemented, while deaths from illicit drug use rose again in Vancouver. From January to the end of June, 1998 Vancouver had 116 illicit drug deaths, up from 78 in the same period in 1997.

In 1997, the Vancouver Regional Office of the Ministry for Children and Families (MCF) and the Vancouver/Richmond Health Board jointly sponsored a review of Alcohol and Drug Services in Vancouver. The review, in which the City's Social Planning Department participated, recommended a restructured program model and organizational structure and action plan to address the systemic barriers that exist in Alcohol and Drug Services in Vancouver, and to establish a more responsive, community-based system.

On June 29, 1998, MCF released a "Report on the Status of the Implementation of the Recommendations of: The Review of Alcohol & Drug Services in Vancouver". While progress in developing a number of areas has started, such as contractual reform and the "sobering centre", two major themes continue to hamper a full response to the Review:

• First, continued "central control" of MCF Addictions Services by Victoria means Vancouver Region is not free to manage its own system.
• Second, is insufficient resources. The report states "the impact of the lack of adequate resources cannot be overstated. The simple fact is: there is not enough of anything, there are waiting lists for everything and we are chronically under-serving many. There is not only a need for more of the same, but new and innovative approaches need to be developed to attend to emerging trends and issues".

Economic Costs

A May, 1998 U.S. study estimates that the annual economic costs of alcohol and other drug abuse is $246 billion U.S. According to the study, alcohol abuse and alcoholism resulted in $148 billion or about 60% of the costs, while illicit drug abuse and dependence accounted for the remaining $98 billion, or 40%.

According to a comparative national study from the Canadian Centre on Substance Abuse using 1992 data, British Columbia had the highest per capita illicit drug-related costs in Canada. Direct law enforcement costs alone were in excess of $57 million in B.C. that year. When other costs such as health care, workplace loss, productivity loss, prevention and treatment are considered, B.C.'s illicit drug-related costs exceeded $207 million and alcohol costs exceeded $938 million for a provincial total of $1.145 billion or $332 per capita. The costs do not include the costs related to property crime by illicit drug use, nor are transfer payments such as welfare benefits to people included. More than 34,000 people are behind bars in Canada, 4,588 in B.C., and another 113,000 are in non-custodial (full and day parole, statutory release) care in Canada. Fifty percent of federal offenders report on admission that they were either under the influence of alcohol and other drugs during the time they committed their offences or that drugs were a major factor. More than 35% of offenders used cocaine or heroin in the six months prior to arrest.

In April, 1998 a U.S. study sponsored by Physician Leadership on National Drug Policy comparing more than 600 research articles, plus original data analysis, showed that drug addiction treatment is effective and that it works as well as other established medical treatments for illnesses such as diabetes, asthma and hypertension. The study noted that while reduced health costs are impressive, the most dramatic return is the effectiveness of treatment in reducing the occurrence and costs relating to crime. From a business perspective the study found that drug treatment reduces crime by 80%; for every dollar spent in drug treatment, seven dollars are saved in societal and medical costs; and drug treatment helps society's health, reducing the spread of AIDS and hepatitis.

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Call for Action in Vancouver

What we are doing no longer works. As stated before, there is not enough of anything, there are waiting lists for everything and we are chronically under-serving many. Filling prisons or our hospital beds with substance abusers does not make any public policy sense. Expert estimates of crimes committed by the average drug addict range from 89 to 191 a year. At the conservative end, successfully treating and training just 5,000 drug addicts would eliminate 500,000 crimes a year.

Staff have gathered information from across North America and Europe, including Seattle and Portland. Staff visited Portland and found that Portland has developed a continuum of services focussing on treatment for drug and alcohol addiction and housing. The model that they developed acknowledges the importance of providing access to adequate treatment resources and considers stable housing an essential part of the treatment process. Central City Concern operates transitional supportive housing that people can access as they come out of detox programs, drug and alcohol-free permanent housing for those moving on from transitional supportive housing or other residential treatment programs and traditional low income SRO housing. As the treatment/ housing continuum has evolved, they have added other program components that acknowledge the link with gaining meaningful employment as part of the process of becoming healthy and programs that provide ongoing and highly accessible outpatient services.

After all the reports that have been written, it is now time to make a heavy investment in treatment for the drug and alcohol abusers who have few options to get off the streets and the cycle of addiction. Staff have put forward a draft program of immediate and longer term needs. Staff believe we must immediately add: (see Appendix A1).

1. 50 detox beds
2. 40 residential support/recovery beds
3. Increase methadone clinic spaces by 500 and start the process to provide accessible counselling and job training programs
4. 100 units of alcohol and drug-free long term housing (see Housing Plan recommendation 4.2).
5. A regional strategy for drug-related services throughout the Lower Mainland.

Longer term expansion is needed in Prevention, Counselling, Treatment, Detox and Residential programs. In addition, other solutions need to be linked to treatment expansion such as housing, job training and criminal justice initiatives.

The Provincial agencies responsible for health and drug treatment need to provide Vancouver with a system of care that really delivers "treatment on demand". When we do, the streets will be safer, our health care costs will be reduced, and the cost of law enforcement will be lower.

[ Appendix 1 ] [ Appendix 2 ] [ Appendix 3 ]

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