People in Pain: It's Time to Update Our Teachings and End the Stigma of Mental Health and Addiction A recent Simon Fraser University study showed expensive services in Vancouver's Downtown Eastside do not result in improvements in mental health or legal problems for residents of this notorious neighbourhood, often called Canada's poorest postal code. To ask, however, why many in the DTES do not get "better" is like wondering why patients keep dying or being sick in our hospitals, despite all the health care dollars expended on treatment, or why, despite repeated treatment, mentally ill people keep getting readmitted to psychiatric wards. [continues 646 words]
As a Western-trained doctor, I have long been aware of modern medicine's limitations in handling chronic conditions of mind and body. For all our achievements, there are ailments whose ravages we physicians can at best alleviate. In our narrow pursuit of cure, we fail to comprehend the essence of healing. Thus the popularity of ayahuasca, the Amazonian plant medicine that many Westerners seek out for the healing of physical illness or mental anguish or for a sense of meaning amid the growing alienation in our culture. [continues 464 words]
IT IS ALWAYS big news when a celebrity is stricken dead by a substance overdose. What never makes the news is why such tragedies happen. The roster of drug- and alcohol-related show-business deaths is ever expanding: Janis Joplin, Jimi Hendrix, Elvis Presley, Keith Moon, Kurt Cobain; in the recent past, Heath Ledger, Michael Jackson, Amy Winehouse, Whitney Houston; and, most recently of all, Cory Monteith. A complete list would, of course, include many others. The popular media gathers around the famous dead like vultures around a cadaver, picking their stories clean to feed the public appetite for intimate and irrelevant details. What friends did Cory spend the evening before his demise? How does his girlfriend feel back on the set of Glee, the TV program where Monteith found stardom? [continues 1142 words]
Licia Corbella implies that Vancouver's supervised injection site (Insite) is a place where drug seekers can "score" heroin or other substances. I worked as the physician at this facility for two years and I can assure Corbella that Insite is not a place for drug dealing - - that happens on the street in Vancouver, Calgary and every major city. Insite's demonstrated benefit is to diminish the harm from drug use, not only by resuscitating overdosed clients, as Corbella mentioned, but also by significantly reducing the transmission of HIV, hepatitis C and other deadly diseases, thereby saving lives and multiple millions of health care dollars. [continues 63 words]
Mr. Clement impugns the ethics and morality of physicians who support (or, as I do, work with) supervised injection. His statement introduces an element of rancour into a painful, complex debate already characterized by too much emotion and a lack of dispassionate inquiry. The minister may legitimately, if shortsightedly, question the specific harm reduction practice of supervised injection. But he ought to resign if he cannot tolerate disagreement without personally attacking health professionals who, under challenging circumstances and with no help from his government, are attempting to relieve suffering of which he seems to have no understanding. Vancouver [end]
Canada's Health Minister urgently needs an education in harm reduction. Announcing his intention to shut down Insite, the supervised injection facility serving drug addicts in Vancouver's Downtown Eastside, Tony Clement told the House of Commons health committee that "supervised injection is not medicine; it does not heal the person addicted to drugs." Mr. Clement got one thing right: Supervised injection does not heal addiction. It is, however, completely in line with accepted medical practice. Consider other areas of medicine. Prescribing inhalant medication to open airways and reduce lung inflammation in smokers also does not "heal" nicotine addiction: It only saves lives and improves quality of life. Similarly, quadruple bypass surgery in overstressed type-A business executives does not heal workaholism; insulin does not cure people whose eating patterns and sedentary habits have triggered diabetes, and intestinal bypass surgery in relief of morbid obesity does not cure food addiction. But all of these medical interventions are harm-reduction measures. [continues 436 words]
The official U.S. response to the free heroin trial about to begin in Vancouver is predictably negative. A spokesman for John Walters, director of the White House Office of National Drug Control Policy, calls it "an inhumane medical experiment." "I would bet any amount of money the U.S. has exerted extreme pressure on Canada to abort this trial," Alex Wodak, a prominent Australian addictions researcher, has said. He should know: U.S. opposition helped to abort a heroin trial in his country. It is to Ottawa's credit that Canada has resisted similar pressure from the Bush administration, whose addictions policies owe more to narrow moralism than to science, compassion or insight. [continues 638 words]
Drugs Don't Cause Substance Abuse, Emotional Pain Does, Says Gabor Mate, Who Works With Addicts Addictions always originate in unhappiness, even if hidden. They are emotional anesthetics; they numb pain. The first question -- always -- is not "Why the addiction?" but "Why the pain?" The answer, ever the same, is scrawled with crude eloquence on the wall of my patient Anna's room at the Portland Hotel in the heart of Vancouver's Downtown Eastside: "Any place I went to, I wasn't wanted. [continues 1010 words]
