Harm Reduction Forums – Session 1

By James Breckenridge. I attended the January 22, 2013 public forum on harm reduction at Matsqui Centennial Auditorium, where local service providers were sharing their experience with those using illegal drugs and getting members of that population to take the first step, treatment, on their long journey to recovering their lives.

A copy of the information about the speakers handed out at the forum is appended at the end of this commentary.

Disclosure: Readers should know that I support harm reduction. This support of harm reduction comes from 1) years of experience with, and listening to, those dealing with addictions (whether legal or illegal; involving drugs or not) and mental health issues. 2) a willingness to hear what they want to say, rather than insisting on hearing what I want to hear. 3) an open mind so that one hears what is actually being said, especially when what is being said does not support what you believe to be the reality (or want the reality to be) and requires changing your mind. 4) an understanding that because it is an issue that involves human beings there is no single solution and that addressing the issue will involve messy, uncomfortable choices. 5) an acceptance of Tradition 1: “Our common welfare should come first; personal progress for the greatest number depends upon unity”. Will harm reduction have negative consequences for someone? Yes. Given that this is a matter involving humans it can be assumed there will be negative consequences. Whether the negative consequences affect 1 individual or 1 – 2% of the individuals involved we cannot know. What we do know is that any policy/program will negatively affect an individual or individuals. Either we do nothing or we accept reality and act on “…progress for the greatest number…” As uncomfortable as it may be, in making decisions when every policy will have negative consequences for someone – policies involving human beings – one must look at the forest rather than individual trees.

The forum started with a brief overview of the history of the bylaw preventing harm reduction; that it was passed in 2005, that in 2010 Fraser Health requested a review and change of the bylaw and that forum(s) in 2013 were being held as part of City Council’s review of the bylaw.

If City Council wants to squander millions of taxpayer dollars subsidising a professional hockey team, squander $300 million taxpayer dollars to fix a ‘problem’ that is not a problem or give $17.5 million to the Y when the only benefit of that profligate spending is to ensure Council’s work load stays light enough they do not have to return to meeting every week – BAM, it takes only months. But on a matter of health care for an unpopular health care issue for an unpopular group of citizens it takes years – three so far – to make a decision.

A person involved in politics and around in 2005 shared the information that Fraser Health came in demanding rather than seeking to work together. Fraser Health’s behaviour got Abbotsford City Council’s nose out of joint and Voila – the bylaw preventing harm reduction health care was passed. Health policy based on tit-for-tat; both sides deserve (fill in the blank) for behaving like children.

While discussing harm reduction we need to be very clear it is a health care policy. While it provides benefits in getting people into treatment and recovery it is not about treatment or recovery – it is about health care.

Having government – in this case Abbotsford City Council – deciding who will receive health care and what type of health care they will receive, is not a slippery slope I have any interest in venturing out onto. Especially when the specific health care denied is denied to specific and unpopular set (group) of people.

Warm Zone – Women’s Resource

Dorothy Henneveld: “Harm reduction keeps all of our health safer.”

Michele Giordano: “You cannot help a dead body.” Michele also raised the point that, if your goal is to truly help people to recover their lives, you need to provide support, not to judge and condemn.

Erica Thomson: “Harm reduction kept me alive until I could become the person I am today.” She spoke of how intimidating the system was for her and how building a trust relationship with street nurses and other front line workers allowed her to ask for their help in seeking treatment and recovery.

Kinghaven

Milt Walker: “the most important thing is getting them in the door.” Mr. Walker also raised several other important points to keep in mind: 1) know the person, the individual, is important; 2) you need to care about where the individual is going – and you must make sure they not only understand but KNOW that you care; 3) never give up; 4) there is always an opportunity, the possibility, to change these lives; 5) need to help/support them coming to care/like for themselves.

Life Recovery.

Tim Williams spoke of the need to help individuals “deal with deep inner issues that have them using” and the fact that those abusing substances are the “most vulnerable and hurting people in the community.”

After all of the local service providers had been given 10 minutes to address the audience the floor was opened for questions.

Brian Gross, the Executive Director of Impact Youth Substance Use Services, spoke of how clients are afraid they are going to get a lecture and not the support and help needed to recover their lives. He raised the important point that a spectrum of services is needed because there is no one way that works.

James Fairbanks (Kinghaven) spoke of how individuals are not forced to go to Kinghaven for treatment. Now if he meant people were not grabbed off the streets, hauled to Kinghaven (or other treatment facilities) and held behind bars……then he is correct – people are not forced to Kinghaven (or other treatment facilities). But what about court choices of treatment or jail, of employees who either go to treatment or lose their job, or parents who have to go to treatment to keep or get back their children, or individuals who have pressures other than their desire for recovery that drive them to a treatment facility?

One can be ‘forced’ to treatment in a variety of ways or from a variety of external pressures.

The question is how does this affect, or does it affect, what is required for these individuals to make it through treatment. More importantly how does this affect what these individuals need to do to succeed in finding recovery?

Kinghaven’s opening 10 minute statement included the information that Kinghaven had, over its 42 years of existence, provided treatment to tens of thousands (25,000) of individuals. What wasn’t asked or addressed is how many of these individuals had found recovery through their time at Kinghaven.

According to long term members of AA in Abbotsford only about 3% are sober and in recovery at the end of their first year; and that the 3% continues to decline over time. In interviews Dr. Gabor Maté, sought after as a speaker for his expertise in addiction, spoke to the fact that in his practice in the downtown east side of Vancouver a 5% success (individuals still in recovery) was outstanding.

The problem is not Kinghaven per sae. Kinghaven does an excellent job at what its role really is – getting individuals sober. Do I wish there was more emphasis placed on the fact that Kinghaven is about getting sober and that individuals face the need of years of work to find and stay in recover after they leave Kinghaven? Yes, but without the community based supports and resources to help individuals seeking recovery I can understand why this is not something Kinghaven (or other treatment programs) focus on. Without those supports and resources in place, focusing on the reality that recovery involves a long term commitment, can well be seen or considered as pointless.

As James Fairbanks (Kinghaven) noted: “Drugs are not the problem, it is the underlying emotional and mental issues.”

On that point Michele Giordano (Zone) pointed out that the problems that drive people to use drugs as a (poor choice of) coping mechanism took a long time to develop and because of this there is no quick easy fix – it requires time, a long time, to deal with this (these) problem(s).

Erica Thomson (Zone) raised the point that addressing issues and supporting recovery is complicated by the reality that people are so diverse.

When she stepped up to the microphone Gerda Peachey asked/raised/shared several points and shared that she cared for these individuals.

Love and caring come without conditions or restrictions; caring and love require the letting go of judgement. As Mother Teresa noted, if you judge people, you have no time to love them.

Gerda spoke of how women she was driving from jail to their destination, who had drug addiction issues, all told her that harm reduction is wrong. – told Gerda what it was she wanted to hear. It is no surprise to me, nor should it surprise anyone else when someone in your car, someone you are providing a ride they need, tells you what you want to hear. This is why I cited an open mind and willingness to hear what is actually being said as important factors in my arrival at a support for harm reduction.

While harm reduction can, and will, have negative consequences for a limited number of individuals, we cannot allow that to prevent us acting to the “greatest good”.

Listening to Gerda speak of her conversations with these women, experience had me wondering what the fate of these women has been, how are they faring now?

Gerda then spoke with passion about going after the criminals who profit from our decision to have an illegal drug trade.

However this is an entirely separate discussion and has no place in a discussion about harm reduction. I say no place in the discussion because the focus of harm reduction is the health of the individuals; of keeping individuals alive until they find their way into the pursuit of recovery and providing a gateway for them to enter into the pursuit of recovery.

When addressing issues that involve people I always try to keep in mind the words of Brazilian writer Paulo Coelho “We can never judge the lives of others, because each person knows only their own pain and renunciation. It’s one thing to feel that you are on the right path, but it’s another to think that yours is the only path.”

Once you fall into the trap of thinking yours is the only path, you vision narrows to the point you see only what agrees with your point of view, failing to see either flaws with the ‘supporting evidence’ or the portions of the ‘supporting evidence’ that in fact do not support one’s ‘only path’; ‘only path’ thinking can cause you to misunderstand or miss the point of issues such as harm reduction; ‘only path’ denies the complexity of issues, ignoring the reality that when addressing an issue where human beings are the central component there is no ‘one size fits all’; the ‘only path’ serves the wilful denial of uncomfortable realities or truths one does not want to see.

Tim Williams (Life Recovery) cited the “Bruno Study of Montreal” as proof positive against harm reduction. He did not refer to any of the reviews of the Bruno Study that challenged the study or its conclusions. Michele Giordano (Zone) was quick to point out that there many studies that show the efficacy of harm reduction.

I would like to recommend “How to Lie with Statistics”. It is a book written by Darrell Huff in 1954 presenting an introduction to statistics for the general reader that is so well written that many introductory statistics courses use it as a text book.

In a world where statistics are thrown around as ‘proof’ or ‘evidence’ of every and anything, the understanding of statistics and what it means (doesn’t mean) and can do (or cannot do) is invaluable for anyone who is confronted with statistics as ‘evidence’ or ‘proof’.

Reading this book will not only give you an understanding of statistics, it will have you taking statistics offered as ‘proof’ or ‘evidence’ with multiple grains of salt. It will also arm you with an understanding of the questions one should be asking or considering.

Statistics can be a useful and powerful tool. But as Mark Twain noted in stating “There are lies, damned lies and statistics” statistics are not only subject to misuse but are often misused.

Consider: we all know that if you flip a coin 100 times you should get 50 heads and 50 tails. So, you flip a coin then flip it again and continue until you have flipped the coin one hundred times. Should you have 50 heads and 50 tails? Did you impart the exact same amount of energy, the same angle of launch to the coin in every flip? Not very likely for a human being, I certainly not only don’t but can’t.

The use of statistics as a tool for understanding complex human behaviour issues is an area rife with problems, inaccuracies and misinformation – even where the best of intentions are present.

I did find Tim Williams (Life Recovery) constant statement that Life Recovery’s program is about abstinence, implying those who support harm reduction are against abstinence or that harm reduction and abstinence are mutually exclusive, you can have harm reduction or abstinence but not both, disturbing.

Harm reduction is a health issue, an issue about keeping people alive and providing a gateway to treatment and (hopefully) recovery. The only connection harm reduction has to treatment and recovery is keeping people alive and healthy enough to be able to move on to treatment and recovery when they are ready to do so.

Abstinence is part of treatment and recovery. My brother John made several trips through different treatment facilities and programs.

The major factor in my moving to Abbotsford was my brother’s need to attend the 6:40 AM meeting at the Alano Club as a key part of his continued abstinence; a key he found during/after his last (needed) trip through Kinghaven. The importance of that key was demonstrated by the fact that attending the 6:40 AM meeting as a key part of his recovery action plan, helped John be successful in recovery and abstinence, for over a quarter century, until his recent passing.

Experience and personal family history make me fully aware of the importance of abstinence. It also makes me aware of how important surviving until someone is ready to do the work to be able to sustain abstinence is. My brother survived until he found abstinence as part of ongoing recovery. Our cousin Terry died in his early twenties, of health issues, before he found recovery – at an age before that at which my brother found recovery (and abstinence).

Yes, abstinence is important in recovery. Living long enough to find recovery is more important. As Michele Giordano (Zone) was quoted stating earlier: “You cannot help a dead body.”

Mr. Williams (Life Recovery) also stated that there is no need for needle distribution or exchange because illegal drug injection users could simply walk into any pharmacy in Abbotsford and purchase a supply of clean needles.

Reality check: Perhaps Mr. Williams can walk into any pharmacy and purchase a supply of clean needles? The only clients I am aware of who can purchase a supply of clean needles at pharmacies in Abbotsford are those who have a prescription for insulin. A quick survey of people in the audience would have shown Mr. Williams the reality that walking into a pharmacy to purchase gets you a refusal and request to leave, not a supply of clean needles. Just as an afterthought: even should pharmacies be willing to sell clean needles to anyone requesting them, would it not be against Abbotsford’s harm reduction bylaw for them to do so?

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I raise an uncomfortable thought for Mr. Williams to consider.

Despite Mr. Williams oft repeated assertion that Life Recovery was about abstinence, listening to Mr. Williams description of the Life Recovery program leaves one thinking that the program is not about abstinence but about substitution. Instead of the individual continuing to use an illegal substance to deal, more accurately to avoid dealing in a constructive way, with whatever the underlying issues that have them abusing drugs to cope, Life Recovery substitutes religion as the coping mechanism – a socially acceptable substitution in the manner of a workaholic.

Substituting Religion for the drug abuse in the same manner that an addiction to Methadone is substituted for an addiction to Heroin; the addiction to methadone being socially acceptable as it involves a doctor’s prescription.

Wilfully ignoring the facts that 1) if you take away the methadone the individual will either have to purchase methadone on the street (yes methadone is part of the drug trade – as are many prescription drugs) or score and use heroin; 2) some individuals user heroin so they can get onto methadone – getting their drug fix of pharmaceutical grade drug paid for by the government; 3) methadone is suppose to be used short term to withdraw from narcotics use, not for year after year, decade after decade, generation to generation usage; 4) that methadone has harsh physical side effects on the human body; 5) every clean, abstaining heroin addict I have met who had the misfortune to have experienced methadone, states with passion that if anything should be illegal it is methadone.

To the gentleman who was concerned about needles and condoms in his yard. There is no solution to this matter. Or perhaps that should be there is no neat, tidy, quick or easy solution to this type of issue. Of course the major roadblock to addressing these issues is the self interest of politicians who benefit from the status quo and seek to avoid the negatives that come with leadership on issues such as these, the self interest of the special interests that benefit from our current policies and the voters who have demonstrated their unwillingness to set policy rationally based on fact, not belief, or to demand that policy and programs be designed around what is known rather than what is believed or ‘that’s the way we do it’.

I would note that surveys show a decline (up to 50% in some cases) in the number/amount of needles etc dropped on the aground after the implementation of a harm reduction program. The only practical advice I can offer for the short term is a sharps box (for used needles) and a garbage can (used condoms etc) in a location that permits and/or encourages using them. That and protecting yourself with the purchase of puncture proof gloves.

To the gentleman whose voice conveyed the pain involved in losing not stuff, which can be replaced, but items (heirlooms) with memories and emotions attached which are irreplaceable, all I can say is that this type of loss is one of the numerous negative consequences of continuing our current policies of using the legal system to fail miserably to address what is, at its root, a medical issue. Assuming your assumption that you were robbed by someone seeking money to purchase drugs is correct.

Governments, society, voters ignore the reality that the drug trade is pure capitalism, capitalism gone feral. In ignoring or denying the capitalistic reality of the illegal drug business we ignore the consequences that flow from it being capitalism gone feral. More importantly, we ignore what economics tells us is the approach we should be taking while continuing to pursue policies that economics (and human nature) tell us will not succeed as we suffer the negative consequences economics predicts will flow from our chosen course of action.

Policies we continue to pursue despite the decades of evidence as to the failure and futility of these policies; policies pursued out of fear, misinformation, superstition and myth, wilful ignorance and special interests who reap economic benefits from the continued support of these policies that are not simply unsuccessful but add to the problems and issues.

Three final thoughts on the forum.

There was a great deal of irony in the fact that the most disruptive individual at the forum was someone abusing the legal drug alcohol. Alcohol – the drug that is legal by our choice, yet causes more harm and destruction than the few drugs we have chosen, no accepted, as illegal do in total..

There was also a great deal of irony in the fact that the best example of the time and support needed to deal with drug addiction from Michele Giordano (Zone)was her (and many others) addiction to nicotine (cigarettes), her struggle for abstinence and the part drug maintenance therapy (the patch) now plays in trying to withdraw from nicotine (cigarettes). In an aside about nicotine, a study published in the Lancet medical journal that assigned values to drugs (legal and illegal) based on the harm done to the individual and the harm done to society, nicotine placed between cocaine (on the low side) and crack cocaine.

During the afternoon prior to the forum I ran into an old acquaintance who was bright eyed and bushy tailed in his sobriety. Who made the surprising statement that he attributed his wellness to a car accident. The trauma of the accident led him to cognitive therapy to deal with the trauma. As part of the process of dealing with the trauma he found it necessary to deal with “…the underlying emotional and mental issues” [ James Fairbanks (Kinghaven)]. It took time and hard work but he felt that this time and hard work was what was responsible for his state of wellness. He also felt that this type of hard work and investing the time it takes were necessary for everyone who wants to get solidly onto the road to and into recovery.

Hmmm. A bicycle/car accident and a badly broken leg got someone i know sober. A traumatic car accident got someone else I know to invest the time and hard work required to deal with the issues and find wellness. Rather interesting treatment plan suggested by those outcomes n’est pas?

Speaker information

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Public forums about harm reduction

Matsqui Centennial Auditorium, Abbotsford BC

MODERATOR

Dr. Adrienne Chan is the (Acting) Associate Vice President of Research and Graduate Studies, and a Professor in the School of Social Work and Human Services at the University of the Fraser Valley (UF. For over 20 years, Dr. Chan has worked as an instructor, researcher, and community and adult educator in the areas of diversity, equity, harassment awareness and prevention, anti-racism, multiculturalism, and social justice.

She has been teaching and conducting research at UFV since 2004 and has a Doctorate from the University of Kent at Canterbury, England. She also holds a Bachelor of Arts in Psychology and a Masters of Social Work. Dr. Chan has moderated a number of debates and forums on social development topics.

JANUARY 22: LOCAL SERVICE PROVIDERS
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Women’s Resource Society of the Fraser Valley! Warm Zone

The Women’s Resource Society of the Fraser Valley fWRSFV) is a respected non-profit society that provides innovative programs and partnerships to address issues of domestic violence in Abbotsford and Mission. WRSFV provides emergency shelter with a transition house in Abbotsford and in Mission, a first stage house (Penny’s Place for women in active addiction), second stage housing (Santa Rosa and Christine Lamb residence) outreach, emotional support, advocacy, referral, individual counseling and support groups for women, children and youth who have experienced violence in Abbotsford and Mission. WRSFV also runs a police-based Victim Services Program embedded with the Mission RCMP, as well as a social enterprise women’s boutique, Fronyas.

The Warm Zone began six years ago recognizing there was no service for street engaged women. It serves women who have significant barriers in accessing health and protective supports because of addictions, mental health issues, and barriers associated with living in poverty. The program not only addresses basic needs, but also fosters social inclusion through public awareness events, workshops, art shows, advocacy and supported referrals.

Dorothy Henneveld is the Executive Director of the Women’s Resource Society of the Fraser Valley, a respected non-profit society providing vital community housing including the Christine Lamb residence, shelter support with two transition houses, and outreach and counselling services to women and children who have had or are currently experiencing violence in the Abbotsford and Mission communities. Dorothy has a Masters in Counselling Psychology.

Michele Giordano is the Coordinator of the Warm Zone, which provides support to women who are often active in their addiction, living with mental illness, and who may be working the sex trade. Michele has worked for Women’s Resource Society for seven years, and holds a Masters in Criminal Justice from the University of the Fraser Valley, and her thesis is called: “Exiting Prostitution Programs – What Works?”

Erica Thomson is from Vancouver Island where she attended high school. She then completed three years towards a liberal arts degree at Capilano College and Malispina University. Ms. Thomson suffered from a drug addiction during these years. Her life as an addict has helped her understand the struggles and barriers addicts face in their daily lives, and provides her with the passion and commitment to help others who experience similar struggles. She works as an Outreach Worker at the Warm Zone. Erica has completed her certification in Concurrent Disorders through the Centre of Addictions and Mental Health (CAM H) and continues with her university education attending the University of the Fraser Valley’s Social Work program. She is on the Board of Directors for Pacific Hepatitis C Network and Positive Living of the Fraser Valley.

Kinghaven Peardonville House Treatment Centres

Kinghaven has been providing addiction service to men for 41 years. Peardonville House has been providing addiction service to women and children for 25 years. Both facilities are funded by Fraser Health Authority and both are licenced by Community Care Licensing. Both facilities practice a modified harm reduction model in that they provide methadone maintenance programming and clients are not automatically discharged for using drugs. Both facilities also offer stabilization and transitional living programs for the most chronically addicted as well as detox services under the auspices of Fraser Health’s Riverstone detox program.

Milt Walker has been with the organization for 30 years in various roles, most recently as the Executive Director since 2000. He is a member of Fraser Health’s Substance Use Steering and Planning Committee as well as a member of the Abbotsford Social Development Advisory Committee. He is responsible for all aspects of the day-to-day operation of Kinghaven and Peardonville House.

James Fairbanks is the Clinical Director and has been involved in the addiction recovery field for a number of years as a counsellor and clinical supervisor. Prior to joining Kinghaven in 2010 he was on staff at Maple Ridge Treatment Centre for 8 years. He is responsible for all clinical aspects of the program, supervision, and training of clinical staff and over-site of client’s individual treatment plans.

LIFE Recovery

LIFE Recovery Association is a Christian residential drug rehabilitation center for women. Since opening in 1999, approximately 1100 women have been through our program. At LIFE Recovery a high percentage of our graduates continue to live in freedom and remain sober upon leaving the home.

Our house is located at 2693 Braeside Street and has the capacity for up to 18 women. Our mission is to be a safe, structured and supportive environment for women who have decided to replace a lifestyle of drug and alcohol abuse for freedom from addiction.

LIFE Recovery strives to:

• Provide a safe, caring and Christian home for recovering drug and alcohol addicts • Provide therapy (group and individual) and other rehabilitation services

• Introduce or re-introduce residents to the 12 Step program (M and NA)

• Introduce or re-introduce residents to the Word of God and to Christian beliefs and principles

• Provide follow-up service and an after-care program

• Help with transition and re-integration into society and the local church, after completion of the program.

• Be a place where graduates may return for love, understanding and support.

LIFE Recovery helps women achieve and maintain a substance-free state and improve their overall quality of life. We provide residents with a warm, family-like atmosphere as they travel the road to recovery. Qualified, compassionate and experienced staff and volunteers are called to minister to our clients in truth and love.

Patricia Watson is the Executive Director of LIFE Recovery. She has a Bachelor of Arts in Business Management and a teaching diploma in Information Technology. Her role is to oversee the staff and programs of LIFE and reports to the board of directors. She has a strong desire to see women coming into freedom and recognizing their value and significance. Patricia has been involved in the non-profit sector for many years and is married with 2 adult Sons.

Tim Williams is the Board Chairman of LIFE Recovery Association. He has served on the boards of several non-profit organizations and corporations. Tim is originally from Australia and moved to Abbotsford 12 years ago. Apart from Tim’s business, corporate and family interests, he devotes a significant amount of his time volunteering with and for drug addicts and prisoners. He has been a pastor of Northview Community Church as well as the Executive Director of LIFE Recovery immediately prior to Patricia Watson being hired.