This is the second of two articles regarding information about treatment -- what it is and what it isn't' and the different formats that describe treatment. The series is written by East Kootenay Addiction Services' Executive Director, Dean Nicholson. The article below does not necessarily reflect the views and opinions of East Kootenay Addiction Services.
As a new story seems to come out daily about the fentanyl problem and what’s being done to address it, it would be understandable if many people were confused about what services and programs are available to assist people with substance use problems. This article will outline some of the major components and approaches to substance use treatment and how they relate to the current fentanyl problem.
Firstly, it must be said that not everyone who is experiencing a problem with substances such as alcohol, marijuana, cocaine or fentanyl is necessarily ‘addicted’ in the strict clinical term. Substance use falls along a continuum from ‘no-use’ through ‘social use’ through ‘problematic use’, and finally ‘dependent or addicted use’. The type of services that could help will depend on where a person’s use falls on the continuum and what changes they want to make.
Secondly, substance use problems are no longer viewed as a ‘stand-alone’ issue. It is generally recognized that most people who struggle with substance use problems also have other concerns, such as depression or anxiety, housing and financial problems, relationship problems etc. It is not enough to deal with the substance use; to make lasting change people often need support in a number of areas of their lives.
With this being said, what are the different components of substance use treatment? At East Kootenay Addictions Services (EKASS) we believe that treatment starts as soon as someone contacts us. Reaching out for help means treatment has begun. After that there are various services that a person could become involved with depending on their situation.
Withdrawal Management: Often referred to as ‘detox’ or a ‘dry out center’. Withdrawal management assists people in the initial physical withdrawal that they may experience as they stop using substances. This could take place at home with outside support, in a withdrawal management center such as Ponderosa House in Cranbrook, or at a local hospital when other medical complications might be present. People are usually only in a withdrawal program for 5-10 days, depending on the substance, although some substances may take longer to taper off of. There is no cost for approved withdrawal management services.
Outpatient Counselling: Outpatient counselling is often the first type of treatment that people access. People are seen by a trained substance use counsellor who assists them in identifying the problems they are having, developing goals, implementing strategies and connecting them with other services that may be helpful. At EKASS we see people at our offices, but can also meet people at other locations if that is easier. There are no costs for people to access outpatient counselling at provincially funded mental health and substance use offices.
Residential Treatment Programs: This is what most people think of as ‘treatment’ although in reality it is just one type of service. Residential Programs can run from 6 weeks up to 3 months or more. The programs offer group counselling in a secure live-in environment. In B.C. some programs have been accredited and some have not. Being accredited means that the program has been thoroughly reviewed by an outside evaluator and that the treatment program, the facilities, the staff and the policies all meet an accepted level. All residential treatment programs have a cost for the user. If a residential program is run by an accredited not-for-profit society and has an agreement with the Ministry of Health, then a number of beds will be subsidized as $40.00 per day beds. People usually access these beds through a referral from an substance use counsellor. For people on Income Assistance the program costs are usually covered. Non-subsidized beds in not-for-profit programs typically run around $120.00 per day. People can access these beds without a referral from a substance use counsellor. Private for-profit residential programs can cost upwards of $15,000 per month. The philosophy of treatment at residential programs generally falls into one of two approaches: 12 Step Programs and Holistic Programs. The main difference between these approaches is the emphasis on the 12 Step or Minnesota Model of recovery. Both types of programs use group counselling as a primary counselling strategy. Aboriginal residential programs will usually include aboriginal healing practices as well. Helping people find the program that is the best match for them is part of what an substance use counsellor does when working with a client. Residential programs have waitlists, but these can vary from a few days to a number of months, depending on the program.
Harm Reduction Programming: In one sense all substance use programming aims to reduce the harms associated with using. In a more specific sense though, in relation to the fentanyl crisis this can refer to two types of programming: Opioid Replacement Programs and the Take Home Naloxone Program.
Opioid Replacement Programs: are programs that help someone get off of opioids like heroin, morphine, fentanyl etc, by replacing them with another opioid, such as Methadone or Suboxone. The purpose of going on Methadone or Suboxone is to prevent the person from going into withdrawal. Avoiding the pain and sickness associated with withdrawal from opioids is usually the primary reason people keep using. By having a regular dose of Methadone or Suboxone a person does not go into withdrawal and does not have to engage in the kinds of behaviours that will allow them to keep using. People are able to stabilize their lives and begin to work on changing other problem areas. When they are on the proper dose, people do not experience a ‘high’ from Methadone or Suboxone. There is a lot of monitoring that goes with the program. In the early stages people often have to get their medication each morning at a pharmacy. They will have meetings with the prescribing physician every two to four weeks, and they will be required to provide urine samples to show that they are not misusing other opioids. Despite some of the restrictions these requirements place on a person, research shows that people on an Opioid Replacement Program are less likely to relapse and go back to using. This means they are at less risk of overdose than people who try to quit opioids on their own. Furthermore, when people are maintained on an Opioid Replacement Program they are able to create stability in their lives and began working on other concerns to further improve their well-being. Although any doctor can prescribe Suboxone after a short on-line course, one of the biggest barriers for people getting on to an Opioid Replacement Program is the lack of prescribing doctors. At EKASS we operate a weekly Telehealth Clinic in which our clients have access to a prescribing doctor in Kamloops.
Take Home Naloxone Program: The Take Home Naloxone Program was developed in large part in response to the fentanyl crisis. Naloxone or Narcan is a drug that when taken helps to reverse an opioid overdose. Naloxone has been around for decades and has been used by paramedics and hospital emergency departments. In B.C. the Take Home Naloxone Program has sought to get Naloxone kits into the hands of people at risk for opioid overdose. Kits are available at a wide range of locations and eligible people can receive a free kit after taking part in a short training program. At EKASS we have been dispensing kits for nearly two years, and there are many other locations in the East Kootenay where people can receive free kits.
This article has described some of the common components of addictions treatment in British Columbia. For more information about services offered through EKASS please visit our website at www.ekass.com or call us at 1-800-489-4344.