Sober N Clean

BACK in 2003 many residents of Vancouver reckoned that an answer had finally been found to the worsening hard-drug problem in the liberal-minded city’s Downtown Eastside district. A reformist city council, borrowing a European idea, opened the first supervised heroin-injection clinic in North America. It was set up as a research experiment, with a three-year remit (since twice extended). The idea was that giving addicts a safe place to inject themselves would remove them from crime, disease and other risks, and make them more amenable to treatment. The Liberals who were then running the federal government agreed, and blessed Insite, as the project is called, with C$1.5m (then worth $1.1m) and a vital exemption from drug laws.

Five years on, Insite has proved a disappointment to many in Vancouver. It has also become the object of partisan conflict. The Conservative federal government of Stephen Harper dislikes the project. A committee set up to advise it on the issue found that only about 500 of Vancouver’s 8,000 addicts use Insite each day, and fewer than 10% of those use it for all their injections. It found no clear evidence of any increase in treatment, nor of any fall in HIV cases. It did estimate that the project might have saved one life per year but found that overdose deaths were still about 50 a year among addicts. Crime continues unabated as addicts steal to feed their habits, something which frustrates the local police. The government therefore proposed to allow Insite’s legal exemption to lapse when it expired in June.

Many health workers thereupon sprang to Insite’s defence. They are convinced that the project’s “harm-reduction” approach can work. In May they gained an order from a justice of British Columbia’s Supreme Court to stop the federal government from closing the clinic. In a radical ruling Justice Ian Pitfield found the federal law prohibiting the possession and trafficking of drugs to be unconstitutional and said that closing Insite would deny addicts access to a “health-care facility”. Allowing the clinic to stay open, he gave the federal government a year to amend its anti-drug law. The federal government promptly appealed against the ruling.

Health care in Canada is a provincial matter. Last month Quebec stepped into the drug debate. Its public-health director announced that he was considering plans for supervised injection sites in Montreal and Quebec City. This seems to have made things even stickier for the federal health minister, Tony Clement.

This week Mr Clement restated his opposition to Insite. “Allowing and/or encouraging people to inject heroin into their veins is not harm reduction, it is the opposite,” he said while attending an international conference on AIDS in Mexico City. He wants to focus instead on treatment and prevention. But he has remained silent as to whether the government would grant any request from Quebec for exemption from drug-prohibition laws. Mr Harper’s hopes of turning his government’s minority status into a majority at the next election depend on winning seats in Quebec. So the future of drug policy in Canada may turn on a political calculation.
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source: The Economist, http://www.economist.com

Ottawa is determined to shut down Vancouver's safe-injection site because it's necessary to "draw a line" about which public health measures are acceptable, Canada's Health Minister says.

Tony Clement said that while the government supports needle exchanges as a legitimate intervention, providing a site to facilitate the injection of illegal drugs is going too far. He also invoked the slippery-slope argument.

"There are already people saying injection sites aren't enough, that true harm reduction is giving out heroin for free," the minister said.

"You have to draw the line somewhere and we feel we're drawing the line in a place Canadians are comfortable," Mr. Clement said in an interview in Mexico City, where he is attending the 17th International AIDS Conference.

Mark Townsend, a spokesman for the PHS Community Services Society, which helps run Insite, Vancouver's safe-injection site, called the notion "depressing silliness."

He said supervised injection sites provide better care for addicts and increase their likeliness to attend detox, so it makes little sense to throw support behind needle exchanges as a legitimate intervention.

"There's really little difference between needle exchanges and supervised injection sites, except for in a supervised injection site, there's a nurse there," Mr. Townsend said. "If you overdose, you don't die."

Earlier in the week, the World Health Organization issued a new guide for countries on how to best tackle the epidemic of HIV-AIDS that strongly endorsed a broad array of harm-reduction measures, including safe-injection sites.

Mr. Clement said that it is up to each country to decide what measures are appropriate, and "it's not my job to kowtow to orthodoxy."

The minister said intravenous drug use and its role in fuelling the epidemic of HIV-AIDS requires a mix of prevention, treatment and enforcement and he's convinced Canada has the balance right.

"I believe I'm on the side of compassion and on the side of the angels."

But Carolyn Bennett, the Liberal public health critic, balked at that suggestion, saying Mr. Clement "opposes supervised injection sites yet says he supports needle exchange, which makes no medical sense."

She said the Conservative government's stand is driven by ideology, not compassion, and accused Mr. Clement of "embarrassing Canada" on the world stage.

At the Mexico City conference, Canada has also been under fire for what some call its paltry contribution to the fight against AIDS, both domestically and internationally.

Julio Montaner, a Vancouver physician who heads the International AIDS Society, told Mr. Clement that Canada should be ashamed that it is not contributing as much, per capita, as its neighbour to the south.

Last week, U.S. President George W. Bush approved a plan to spend $48-billion (U.S.) over the next five years on AIDS programs.

Currently, Canada invests a fraction of what the United States does: $550-million over the past three years on HIV-AIDS programs abroad. In Mexico, Mr. Clement announced an additional $45-million in funding.

"I acknowledge that it's not $45-billion but it's commensurate with Canada's abilities," the minister said.

Mr. Clement said Ottawa is spending $84.4-million on AIDS programs this year, the highest amount in its history.
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source: The Globe and Mail, http://www.theglobeandmail.com

WHO WOULD have thought that cavalier lending practices in the U.S. Sunbelt would damage the second-largest industry in British Columbia?

No, I’m not talking about forestry and lumber. I’m talking about dope. BC Business magazine reckons that marijuana production in B.C. contributes $7.5 billion and 250,000 jobs to the province’s GDP — second only to construction, and more than forestry.

Most of the product is exported to the United States. The RCMP estimate that marijuana is being grown in about 20,000 B.C. homes, not to mention sizable farms in the Interior and large-scale commercial operations in former warehouses and industrial buildings. One academic study concluded that if marijuana in B.C. were legalized, the province would see $5 billion in additional legal business activity and could collect $2 billion in taxes.

The ranks of British Columbia marijuana producers have also broadened remarkably. Cannabis cultivation is no longer the exclusive preserve of organized crime, though organized crime certainly continues to thrive in the fetid netherworld of prohibition. Today, however, marijuana production has become a sideline for thousands of otherwise law-abiding middle-class citizens.

As a recent BBC report put it, "Much of the revenue derived from B.C. Bud, as the cannabis crop is known, goes on paying college fees, perhaps buying a second car or making that holiday to the Caribbean just a little bit more affordable." As a result, "the trade is so large that the police in B.C. are faced with an impossible task."

Indeed they are, and the job is getting harder. The RCMP drug section in Greater Vancouver once employed more than 100 officers; it’s now down to 60. The number of tips they receive about grow-ops has also fallen, from 615 in September 2003 to 207 last December.

Does that mean that the number of grow-ops has fallen? Probably it has, says Tony Emery, a leading cannabis advocate and leader of the B.C. Marijuana Party.

For one thing, the rising Canadian dollar has hurt the competitiveness of B.C. Bud, just as it has hurt filmmakers, the forest industries and furniture manufacturers.

In addition, the downturn in the U.S. economy has induced many Americans to try their hand at growing their own pot. Marijuana plantations have been turning up in the national forests, while laid-off workers and homeowners facing foreclosure have been converting their basements and spare rooms into grow-ops. Even a tiny operation using only a couple of high-intensity lights can earn $20,000 a year for the owner — in cash, and tax-free.

"It certainly is enough to tide people over, no problem," Emery says, "and two lights are not going to get you into trouble, either."

So there you have it. Predatory and foolhardy lending practices in the United States lead to a wave of foreclosures. Wary consumers stop buying. Workers get laid off. Desperate for cash, the victims of the downturn try their hand at illicit agriculture. At the same time, the rising loonie makes B.C. Bud less competitive, so Canadian growers find their markets contracting.

What’s so striking about this story is that it really is not a story about crime and the law. It’s a business story, and almost all accounts of the situation treat it that way. In theory this whole industry is illegal, but in practice it’s so big that the police can’t even begin to control it. Any serious attempt to enforce the law would require an army of police officers and gobble up so much public money that governments would almost have to abandon such other concerns as health care and education.

So the business is completely unregulated and the only controls on it are the controls the market itself imposes. As with any business, unfavourable market conditions affect the industry. Adverse exchange rates and increased competition drive prices down and eliminate marginal producers.

Nevertheless, the market is huge and hungry. It reaches into every social class and every age group, though a recent study from the University of Alberta apparently revealed that marijuana is particularly popular among educated, middle-class Canadians. Do they wish to break the law? Probably not. But do they think this law deserves to be obeyed? Obviously not.

In short, the law has essentially made itself irrelevant. If anything, the law benefits the business. To a large extent, the industry is profitable precisely because it is illegal. All entrepreneurs take risks, but if the risks include jail time, only the boldest entrepreneurs will enter the business — and they’ll demand a premium for the extra risk.

The net result of our irrational drug policies is that we enrich the criminals and criminalize ordinary citizens. We control tobacco and alcohol far more effectively than we control any illegal drugs. If those are the results we want, these policies are perfect.
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source: The Chronicle-Herald Nova Scotia, http://thechronicleherald.ca/TheNovaScotian

Kids from drug-infested homes often start their lives in the bottom of the ninth, down by five runs and with two strikes against them.

Their odds aren't good.

We've gotten a glimpse into that world in recent days, most graphically in the story of Jessica Kasten -- the Wausau woman convicted of letting one of her children die of suffocation as she slept off a methamphetamine bender.

Her parents, who spoke at length with a Gannett Wisconsin Media reporter, said Kasten's own upbringing in a home rife with drugs and alcohol didn't give her a good start in life.

Kasten's story has been revealing to many of us. But it comes as no surprise to police and social workers, who see such tragedies unfolding all the time.

They've had enough, and they're trying to do something about it.

Until recently, authorities had no standard procedure for dealing with kids from drug homes. The dwellings they would encounter were squalid or, even worse, toxic with residue of chemicals used to make drugs.

Police would show up and take parents to jail for dealing or using drugs. Children would be sent off to a relative's house, and everyone would get back to work -- until the next bust, when the same cycle would begin all over again.

Now, an encounter with a drug home automatically kicks a special procedure into gear.

The Drug Endangered Children Program, developed by the Marathon County Sheriff's Department, ties together 15 area police agencies, social workers and two hospitals, all dedicated with giving kids from drug homes a chance.

As soon as police know children are involved in a drug home, they begin building two cases -- one to prosecute the parents and another to help the children.

"Officers are trained to look for how close chemicals are to where kids eat and sleep, to test clothing for chemicals for child neglect and abuse charges," Marathon County Sheriff's Department Capt. Tom Kujawa said. "When the kids get to the hospital, doctors are trained to look for chemicals on their skin and in their systems. A lot of times, you would put kids with a brother or grandparent or whatever, and it would turn out they were cooking drugs, too. So now, we have a whole checklist we go through to make sure we get them to a safe environment."

Often, Kujawa said, children must leave behind everything they own because it's all contaminated with drugs. So police give them backpacks of clothing, toiletries and blankets that are knitted by church groups and -- of all people -- male prison inmates.

The Sheriff's Department started the Drug Endangered Children program about three years ago, when methamphetamine first started appearing.

Now, it's being adopted around the state -- and being put to more use than ever.

In May, authorities used the system when they raided a Wausau-area meth house and removed three children, ages 5, 7 an 14.

"Without intervention, they have zero chance," said Kujawa, who was leader of the county's drug enforcement unit when the program began.

"Kids need an opportunity to be kids, and we cheat them out of life," Kujawa said. "Some of these kids, 5, 6, 7 years old, the kids are raising the parents because of the addiction. It's just sad."

It is sad. But thanks to this program -- the first of its kind in Wisconsin -- some of these children are getting a new chance at life.
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source: Wisconsin Info, http://www.wisinfo.com

New regulation bans tobacco use in programs for other dependencies

By now, most people understand the dangers of smoking and the benefits of a tobacco-free environment — but it never hurts to make the point again, and what better entity to do so than the state and what better time to start than the present?

On the anniversary of the Clean Indoor Air Act, the commissioner of the New York State Office of Alcoholism & Substance Abuse Services announced a proposed Tobacco-Free regulation for all programs funded or certified by her office — no tobacco use in any facilities, any grounds under provider control or any vehicles owned, leased or operated by the programs.

That places New York in a group of states that require all of their chemical dependence prevention and treatment programs to become tobacco-free. The new regulation took affect July 24.

Commissioner Karen M. Carpenter-Palumbo presents a compelling argument for the need: Up to 92 percent of the chemically-dependent population smokes, even though the overall state average is 18.2 percent. Research shows that those in chemical dependence treatment programs are more likely to die from a tobacco-related illness than from alcoholism or drugs.

The new regulation should be a direct benefit to the 110,000 New Yorkers within the Alcoholism & Substance Abuse Services system on any given day — but the state-funded agencies must also work to ensure that the new tobacco- free environment in those programs does not deter new or current clients.

Part of treating addiction is treating nicotine, said K. Michael Cummings, senior cancer research scientist and director of the Tobacco Control Program at Roswell Park Cancer Institute. More and more, Cummings said, experts find that people who are still smoking also tend to have other “comorbidities,” substance abuse problems and, possibly, mental health issues such as depression.

The percentage of those in New York state and nationally who smoke is declining, but those who do smoke tend to have fewer resources to quit — so if the state is investing funds to help people end their cocaine, alcohol or heroine addiction, nicotine addiction also should be treated.

This is a shift from the mind-set of years ago in the treatment field, when forcing clients to give up cigarettes was taboo. The belief was that quitting tobacco would have an adverse affect on getting addicts to quit alcohol or drugs. There have been enough studies completed now to suggest that is not the case, as Cummings said, adding that he hasn’t seen evidence that people will forgo substance abuse treatment because they can’t light up a cigarette indoors.
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source: The Buffalo News, http://www.buffalonews.com

Ten years ago, a small group of people frustrated by the rising cost of treating addiction decided to try to turn back the clock.

Managed care was eroding the Minnesota Model, the residential treatment programs that made the state the place to go to get sober. Hundreds of treatment centers around the country were closing as insurers tried to cut costs. The survivors, such as the famed Hazelden Foundation, were under pressure to show clinical results. They added medical staff, pushing prices beyond the reach of many.

The little group tried a different path.

They eschewed the clinical psychiatry and pharmaceuticals embraced by the rest of the industry, going back to the roots of the treatment movement: a full month's residence, surrender to a higher power and support from a community of former addicts.

"We went in a direction nobody was going -- simpler, more affordable," said John Curtiss, a longtime Hazelden executive who left to start the new venture.

They called it "The Retreat."

Now housed in a former nuns' retreat in Wayzata's Big Woods, it offers a one-month residential program for about $4,000, about one-seventh of what Hazelden charges. Its outcomes are comparable to that of other major centers, with 50 percent of those who come through abstaining from alcohol and drugs for 12 months afterward, Curtiss said.

Ten years after its inception, The Retreat hasn't exactly reversed the course of American addiction treatment, which continues to get more expensive. But it has thrived and spawned similar centers in Sioux Falls, S.D.; Auckland, New Zealand; and Hong Kong.

"The Retreat is a model for the nation of affordable treatment that works," said U.S. Rep. Jim Ramstad, a recovering alcoholic and longtime national advocate for better access to treatment. He is a regular volunteer at the Retreat.

Making access affordable

On a recent morning, two dozen women gather in a sun-filled room to study the "Big Book," the bible of Alcoholics Anonymous. Young and old, they bend over the volumes, pages heavily underlined.

Ralph C., a bearded, bow-tied volunteer, is talking about spiritual surrender.

"Is it possible that there is a power that has more horsepower out there?" asks Ralph C., who uses just his first name in line with AA's philosophy. "Am I beginning to suspect it's not another man who's going to fix this? Or a counselor or a drink?"

Quit trying to play God, he tells them.

They are among the few who have managed to get affordable help on the road to recovery. Many others never do. In 2006, 23.6 million people age 12 or older needed treatment for addiction, but only 2.5 million, or 10 percent, got it, according to the U.S. Department of Health and Human Services.

Cost is often a barrier -- with most programs charging $30,000 or more for a month-long stay. Not all insurance covers treatment, and not all centers accept insurance.

The Retreat draws half of its patients from Minnesota, the rest from as far away as India and Australia. The average age is 38 and most have college educations.

The program isn't for everyone. With no clinical staff, the typical client is medically stable and highly motivated. Eighty percent have been through previous treatments.

"We wanted to create a dignified, safe place to go, away from the burning house of addiction," Curtiss said.

If they're suicidal or otherwise need medical help, the Retreat refers them to Hazelden. Other centers in turn refer patients here.

"They have a niche," said Ron Hunsicker, president of the National Association of Addiction Treatment Providers. But the fact that the program hasn't been copied by many suggests its clientele may be limited, Hunsicker said. More addicts are showing up for treatment these days needing medical care.

But William Moyers, executive director of Hazelden's Center for Public Advocacy, differs. "I believe the Retreat is the future of recovery," he said. "It's crucial to replicate it." There is a need for cheaper alternatives for those who relapse, he said.

It was the Retreat, Moyers said, that inspired Hazelden to start its Lodge program in 2002, a nonclinical retreat on its Center City campus.

Letting go of insurance

Curtiss was a patient at Hazelden in the 1970s and returned as a counselor. He worked his way up to vice president of Hazelden's national operations, overseeing multibillion-dollar expansions into New York and Chicago.

In the early 1990s, health insurers, anxious to cut costs, were scrutinizing chemical dependency programs. As insurers insisted on medical diagnoses, addiction centers duly produced them.

"You want to see pathology? We'll show you lots of pathology," said Curtiss, describing the mood of the day. As centers hired more medical staff, costs went up further.

Others were uneasy.

"We were going down the wrong path, trying very hard to make alcoholism into a mental illness," said Dr. George Mann, former director of treatment at St. Mary's Hospital in Minneapolis, now part of Fairview Health Services.

Mann, Curtiss and others began meeting to discuss solutions. In 1998, with a grant from the Johnson Institute, they opened a facility with 20 beds in the old Pillsbury mansion in Minnetrista. Curtiss staffed and furnished it for the grand sum of $177,000.

The Retreat didn't register as a treatment center. Instead, it is regulated by the state Department of Health as "board and lodging." It has grown into an 80-bed campus in Wayzata and runs 54 sober living beds in St. Paul for program graduates.

Over the decade, about 3,500 clients have come through the monthlong program, a third of those with financial help provided by donations. The center doesn't have contracts with insurers.

Stoked by volunteers

In any month, 250 volunteers lead chapel services at The Retreat, drive patients or teach the "Big Book." They not only help keep costs down, they form a vital safety net of recovering addicts.

Alcoholism is "not a disease where people bake casseroles and come over," said Dee L., a volunteer wearing a business suit and pearls. A client three years ago, Dee now returns often to tell her story. She does it as much for herself as for them: "This is how I stay sober."

Even board members continue to work for free. The top executive, Curtiss, is paid $140,000 a year.

An early volunteer at The Retreat was Andrew Zimmern, host of the Travel Channel's "Bizarre Foods."

Zimmern left New York City and checked into Hazelden in 1992, in his words: "a homeless, alcohol- and drug-addled wreck." He credits Hazelden for saving his life. Luckily for Zimmern, his former business partner had continued to pay his health premiums, so insurance covered his treatment.

After he left, Zimmern became concerned that too many people couldn't afford the same. So he volunteers at the Retreat.

"We all know recovery works at its simplest," he said, "when one alcoholic talks to another."
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source: Minneapolis Star Tribune, http://www.startribune.com

The email arrived out of nowhere. It was from friends I'd lost touch with and it said Brian had died.

"He died in the hospital Tuesday night," it said and "he'd been in poor health for awhile" and "he had heart problems."

So I emailed back, said I was sorry to hear about Brian and mentioned that my daughter had died of cirrhosis of the liver two years ago.

So they emailed back and said that Brian's deteriorating health was alcohol related.

"Little by little, he lost his ability to walk," they said.

I try to picture my former drinking buddy, all six-feet-four inches of him, unable to walk and can't do it.

Instead, I see him at the pub table. I see us all at the pub table, drinking too much, laughing, drinking some more and going to work hungover the next day

I see him dumping a beer all over a guy who joked about the little bald spot on the back of his head. At 28, he hated that bald spot.

I listen and I can hear one of us, him, me, you, order another round.

Then, we drifted away, to other jobs, to other towns.

Some of us kept drinking, some of us didn't.

I did. Until one day, after a couple of blackouts, I knew it was time to quit. I did that, too.

I guess Brian didn't. He kept on drinking. More and more.

For whatever reason. Those of us who have drinking problems can never adequately explain to a non-drinker why we continue in that cycle. Maybe there is no explanation.

Drinking to excess is of course, older than Allah, more common than high gas prices and every bit as dangerous as crystal meth. It's just that booze usually takes a little longer to rip a life apart than does meth or cocaine.

And it is that ordinariness of drinking, that "sure I'll have another beer" of it that makes it so socially acceptable.

We tell ourselves that Uncle John likes to drink a bit too much or that our sister Jennifer seems to be getting into the martinis earlier in the afternoon. We may even mention the fact to John or Jennifer, get rebuffed and tell ourselves to forget it.

And then, one day John or Jennifer -- or my daughter, or Brian -- is rushed to a hospital emergency department.

As I look back on my daughter's drinking, my own drinking and Brian's, I wonder if we're so concerned about drugs that we forget -- or minimize -- what booze can do.

Blessed are those who can have one or two glasses of beer or wine or whatever and get a trifle tipsy now and again. If I could do that, I'd start drinking again tomorrow.

But I and, according to Health Canada, some 4.5 million problem drinkers in this country cannot.

Excessive drinking is not attractive or amusing, especially as it continues year after year.

It is instead, debilitating, dangerous and in any number of cases, lethal. I know that, so does my daughter. And now Brian knows it too.
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source: Edmonton Sun