Pubdate: Tue, 09 Aug 2005
Source: Medical Post (Canada)
Copyright: 2005 The Medical Post
Contact:  http://www.medicalpost.com/
Details: http://www.mapinc.org/media/3180
Author: Matt Borsellino
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)

ADDICTION MEDICINE IN B.C. BUOYED BY POLITICAL SUPPORT

Addiction Expert Finds Western Province Has A Very Different Take On Drug 
Abuse Than Ontario

VANCOUVER | It's been more than a year and a half since Dr. David Marsh 
left Ontario to become a key player in the development of strategies to 
handle Vancouver's drug abuse problem, but it didn't take him that long to 
discover the importance of addiction medicine in British Columbia.

His title is simple: "physician leader of addiction medicine" with 
Vancouver Coastal Health, the local regional health authority, and 
Providence Health Care, the umbrella organization for the city's Catholic 
hospitals, including St. Paul's. His duties, however, are not.

Dr. Marsh is responsible for clinical leadership and strategic planning for 
addiction services provided by a complex acute care and community-based 
health-care organization with an annual budget of more than $2 billion and 
catchment population of 700,000.

But he's doing it in a province where drug addiction is perceived 
differently, he told the Medical Post recently during a conversation at a 
downtown coffee shop blocks away from Vancouver Coastal Health's headquarters.

It was shortly after arriving in Vancouver that Dr. Marsh noticed addiction 
medicine seemed to have what he called "a lot more political weight" in 
British Columbia than in Ontario. Earlier this year, Vancouver Mayor Larry 
Campbell unveiled the last of the city's four-pillar drug strategy focusing 
on harm reduction, treatment, enforcement and education/prevention.

B.C.'s family doctors also seem more open to talking about patients with 
addictions than their Ontario colleagues, Dr. Marsh added. They recognize 
more readily that addicts often develop long-term health problems and need 
quality care.

"There's more support organizationally and more of a willingness here to 
invest in innovative programs," he said. "Drug user advocate groups have 
had sustainable funding for a significant time and can successfully put 
faces to the problem for the mayor's office. Ontario hasn't had the kind of 
year-to-year funding they've had here.

"One of the biggest reasons is the visibility of the problem on the 
downtown east side. Lots of people here believe there's more people with 
drug abuse problems in this area than anywhere in Canada. I don't believe 
that's true, but the popular impression and myth is that the problem is 
worse here, and with the Olympics coming (in 2010), I don't think 
strategies set up to deal with the problem are going to be allowed to 
evaporate."

Dr. Marsh pointed to results of a November 2004 national survey on the 
prevalence of use and related harms by Canadians of alcohol and other 
drugs. The study ranked B.C. seventh of the 10 provinces in incidents 
involving harm caused by drug abuse over the past year (see chart).

The study, which stresses the use of illicit drugs can have negative 
impacts for the drug user, also found that living in New Brunswick and 
Newfoundland and Labrador is "significantly associated with lower rates of 
lifetime harm," than provinces with much higher rates, like B.C. and Alberta.

A number of historical factors--such as the relative smallness of the 
neighbourhood, how close people live together there, the broad income gap, 
as well as other factors Dr. Marsh said "have nothing to do with drug 
use"--contribute to the unenviable image of Vancouver's downtown east side.

"This is an opportunity to do some clear, concrete things over the next 
five years," he said. "It's what made the job attractive. The research 
environment here encourages collaboration and new thinking to combat 
addiction problems in the downtown east side."

As for the cost of drug addiction, it's virtually impossible to calculate, 
Dr. Marsh said. It has been estimated there are as many as 90,000 injection 
drug users across Canada. Results of one 1992 study, often repeated, pegged 
the cost of addiction at $9.5 billion for tobacco, $7.5 billion for alcohol 
and $1.7 billion for illicit drugs. Dr. Marsh said those costs have risen 
with the prevalent use of a number of other drugs, especially cannabis, 
over the past 13 years.

While there are signs problems associated with addiction are getting 
worse--at least in part because of more instances of public disorder caused 
by increases in crack smoking, which carries higher risks of psychotic 
behaviour--there is also reason for hope, he said.

Overdose deaths in Vancouver fell to fewer than 50 in 2003 from nearly 200 
in 1998. Waits for detox services have shrunk to a matter of days, whereas 
they used to be as long as six weeks. And there are now as many as 8,000 
patients registered in B.C.'s methadone maintenance program, up from just 
1,000 in 1995.

Since coming to Vancouver, Dr. Marsh has collaborated on several projects 
with potential impact on clinical services for addicts, and his work has 
targeted ways to streamline delivery of such services into community-based 
facilities.

One program, Hywire, examines delivery of HIV and youth addiction services 
through a computer simulation of how patients gain access to withdrawal 
management. Another initiative, the Urgent Response Team, looks to deliver 
community-based services rather than have patients go to hospital emergency 
rooms.

Dr. Marsh is also lead clinical investigator locally for the North American 
Opiate Medication Initiative, which is testing whether heroin-assisted 
therapy benefits people suffering from chronic opiate addiction who have 
not benefited from other treatments, such as methadone.

Dr. Marsh, a graduate of Memorial University medical school in St. John's, 
Nfld., is also president of the Canadian Society of Addiction Medicine, 
which has about 250 members, up 30% over three years. The group, which will 
soon open a new membership category for non-physicians and scientists, 
plays host to an annual scientific conference at the Coast Plaza Hotel at 
Stanley Park here Oct. 27 to 30.
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MAP posted-by: Jay Bergstrom