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.

This is the first 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. 

Over the past number of months there has been a lot of media focus on the fentanyl crisis in B.C.  Many of the stories have talked about the lack of treatment, or the wait for treatment, often with the subtext that if people could have gotten treatment than the problem would have been solved.  But what exactly is ‘addictions treatment’ and how does it work?

We typically think of ‘treatment’ as some kind of intervention that brings about a ‘cure’ or an end to the problems we’ve been having.  Antibiotics are a good example.  We are sick with an infection, we do a treatment of antibiotics which kills the bacteria, and in a few weeks we are back to our normal health.  Dealing with addiction problems is very different.   Addictions treatment does not provide a ‘cure’, nor does the problem go away.  ‘Treatment Centers’ are programs where individuals typically stay for 2-3 months.  These programs provide structure, opportunity for group and individual counselling and support, education, safety, regular food and social connection.  But despite what certain programs might say, they cannot provide a ‘cure’ to addiction.  Any program that promises to cure someone of their addiction is selling a bill of goods.

Why isn’t there a cure for addiction or substance abuse?  Addiction and substance abuse are basically brain disorders.  People use substances for a variety of reasons, but one of the main reasons is because they like the way substances make them feel, at least in the beginning.  Our brain is designed to turn behaviours that we do repeatedly into habits.   The thinking part of our brain doesn’t have to be involved as much, and a deeper part of our brain controls the behaviour.  Think of driving a car – when we first learned we had to pay attention to every single thing we had to do – braking, accelerating, signaling etc.  After a few months we could do most of that without actually thinking about it.  Much of driving had become habitual.  The same thing happens when we use substances.  If we use a substance enough times our brain develops a habit for using, or for using to feel a certain way.   We don’t have to think about how to use, a deeper part of the brain makes it happen.   If we use certain substances long enough, the brain actually goes through physical changes, so that the substance use is regarded as essential to feel a certain way.  As a person progresses from social use to habitual use to addicted use, the amount of choice and control that the person has over using decreases.  When a person has developed an addiction, there is a part of their brain that will control their behaviour and compel them use the substance even when they know it is harming them or that it could kill them.  

The good news is that the brain is remarkably able to rewire itself.  New habits can be learned to replace old harmful habits.  But just as it takes time to develop a habit or an addiction, so too does it take to develop new ways of behaving.  The reality of addiction is that there is no simple way to change a brain.  Even when people want to stop using recovery is a long-term process, often with many setbacks, that requires a lot of effort.  Factor in that many people are ambivalent about changing or stopping their use, and the process becomes even more difficult.  Difficult doesn’t mean impossible, but it does mean that there is no simple ‘cure’, no ‘treatment’ that can be imposed on someone that will make their brain automatically change.  

As a culture we have come to believe that there should be quick fixes.  We don’t like to be uncomfortable or to suffer.  We have a society built around instant gratification.  This expectation is part of what fuels people getting in to trouble with substances, and then it becomes part of what fuels people having unrealistic expectations about recovery.  Does this mean there is no hope?  Absolutely not.  Every day at East Kootenay Addiction Services we see people who are learning to reorganize their lives, develop new skills and move away from addiction towards happy and fulfilling lives.  And what makes those people successful?  They have come to recognize that there isn’t a quick fix.  Life requires ongoing effort and focus, whether that is recovering from an addiction, having a family, or building a career.  Accepting that recovery is a process and not a cure has allowed those people to work realistically and productively towards better lives.

If you are feeling uncertain about the upcoming holiday season, that is OK.  Realize that recognizing you are feeling indicates you are self-aware.  That is fantastic!  Here are some ideas to help you navigate through the next month whether you are up-to-your-eyeballs-busy or feel you have way too much time on your hands.  You don’t have to be a Grinch, a Santa or a saint. Just begin to be more self-aware of what is happening as it is happening.  Starting today, why not spend at least part of this season being with yourself in ways that renew and strengthen your health.  So many of the problems we experience arise because we are ‘somewhere else’ in our mind, rather than in the moment.  Give yourself and your loved ones the gift of presence.
 
 Use the count down to the end of the year as a way to honour and celebrate what you have.  Notice your thoughts right now as you read these words.  Do you tend to think of the negative or the positive?  Congratulations!  You just gave yourself the gift of being more self-aware.  There are many ways to celebrate what you have.  Use my ideas or come up with some of your own.  There are many suggestions on how to be more in the moment day to day.  You might find ideas on-line or in the library. They don’t have to cost money.  Instead of shopping why not try investing in your relationships by spending time and focused energy?   You might choose to write in a gratitude journal.  Or what if you chose to eat one of those famous Christmas oranges slowly and mindfully?  
 
 Set a timer and give yourself 10 – 20 minutes.  You will have to slow right down. Start by looking at the orange (you can use any piece of food), even before you pick it up.  Then hold it and feel its bumps or smoothness, its coolness or warmth.  Look at how the light and shadow play across its surface.  Really look at it.   Marvel at it being here in your hand. Imagine the factors and people that contributed to this marvelous fruit and you coming together.  So many circumstances supported this event: the fertile soil on planet earth, sunlight from 150 million kilometers away, rain from the atmosphere, someone planted a tree and cared for it through the years.  First cultivated in China in 2500 BC, we are benefitting from centuries of human labour and knowledge. Eating them creates energy and life in our bodies through the amazing processes of ingestion, digestion and elimination.  You may have eaten other oranges, but never this one.  This one sitting in your hand right now is unique unto itself.  There are millions of oranges in the world very similar to this one.  You, in this moment with this particular fruit on this day, in this year are completely distinct.  It is a unique and precious circumstance.    
 
 I invite you to relish in all it means to be alive!  Embrace the gift of stopping what you are doing and giving yourself some space from everything else.   For a few minutes every day completely BE with the process of appreciating, examining, smelling, feeling, listening and tasting.
 
 A million miracles are held within the fruit, within you and within the process that brought you together.  Ahhhhh.  Slowing down and appreciating the wondrous nature of life helps us to live in joy and gratitude.

With all the talk about the Fentanyl crisis, the term Harm Reduction is often raised as an approach to deal with the problem.  Many people are unclear what Harm Reduction means and this article hopes to provide some clarification.  Harm Reduction refers to an approach to dealing with substance abuse, where the primary focus is to reduce the harms associated with using substances, rather than the focus being on stopping the use of substances.  This doesn’t mean that stopping or reducing use is not a goal, just that it is not the first goal. Often Harm Reduction is associated with programs like needle exchanges or safe-injection sites; programs in which people continue to use substances but are encouraged to do so in safer ways.  These are definitely Harm Reduction approaches but Harm Reduction casts a much wider net.  Too often in the past Harm Reduction approaches were contrasted with Abstinence approaches, with the two approaches being seen as polar opposites and opposed in principle.   From the Abstinence side, Harm Reduction was often characterized as supporting or encouraging substance use.   For some people on the Abstinence side, people on an Opioid Replacement Program like Suboxone or Methadone (which is one of the best ways to support people to get off Fentanyl) could be criticized for still being addicts because they were still using a drug.   In fact, Abstinence is also a Harm Reduction approach, as is responsible social drinking, as are needle exchanges.  

 

A problem with the debate around Harm Reduction is that historically society’s focus on drug and alcohol use as been on the behavior itself – on the using.  If using is the problem, then not using is the solution.  This is further entrenched by then making using illegal and with the consequence that users become criminals.  A Law and Order approach, or a War on Drugs approach, is the natural outcome.  In Canada, about 70% of all Federal dollars that go towards substance use problems, goes to the law enforcement side, including the RCMP, the courts and correctional services.  Only 30% goes to prevention, education, treatment and research.   Law and Order and Abstinence-only approaches limit the ways we can respond as a society.

 

Perhaps a good analogy is driving.  We all know that one of the major causes of death in Canada is motor vehicle accidents.   If we took a similar approach to driving deaths as we do to substance use, we would make all driving illegal, ban automobiles and motorbikes, and arrest and charge people caught using motor vehicles or involved in the production or sale of motor vehicles.  Clearly this is not an approach that anyone would support, even though we could all agree we would like to reduce motor vehicle deaths.  So what do we do?  We create a wide range of Harm Reduction programs to try and reduce the likelihood of motor vehicle accidents while allowing people to continue driving.  Programs like seat belt laws, graduated licensing systems for new drivers, standardized traffic rules, maximum speeds, improved car design etc. etc.  We don’t view driving as a criminal matter but as a public health concern and we create policies and programs accordingly.  At the same time, we take a Law and Order approach to certain behaviours associated with risky driving, such as speeding or driving while impaired, but we accept that people are going to drive.  Harm Reduction in the area of substance use is just the same.  If we accept that people are going to use substances (and in any given year over 80% of Canadians 15 or over will use a substance) then it makes more sense to develop programs and approaches that discourage unhealthy use, encourage responsible use, and provide means for people who have more serious problems to reduce negative consequences so that they can hopefully be in a place to make healthier choices.  At the same time, there is a role for a Law and Order approach in areas such as trafficking, unregulated drug production and inappropriate public use.

 

At East Kootenay Addiction Services, we view substance use, abuse and addiction as both a personal and a public health problem, rather than as a criminal problem.  Our aim is to provide services that reduce the harms that use can cause, whether that is by supporting someone to quit using altogether, to use in a more responsible and less harmful way, or to help them improve other areas of their life that their use may be impacting.  If we consider substance use as a personal and public health issue, then the goals for intervention can change, as can the types of interventions that are used.  This is what Harm Reduction means and research shows that programs coming from this approach are more effective in creating overall healthy change for people using and for communities as a whole.

What does your procrastination dragon look like?

There are many times when I don't want to do something. The list of errands sits on my desk reminding me of what I need to so and that I am avoiding it. It takes more energy to avoid doing errands than it takes to just do them.   I spend time and energy fighting and negotiating internally with myself. ‘Should I do it now?  No, I think later is better.’ Then I ignore the list only to have the internal fight again 3 hours later as I re-encounter the reminder.  
 
 I repeat the cycle over and over losing energy as I do.  I struggle internally (disappointment in the moment with the moment as it is:  There are errands to be done).  I feel badly about my previous decision to procrastinate (regretting the past).  I know I will have to face it again if I don’t deal with it now (worrying about the future).  I know that I will feel better if I do take action and still I decide not to (lack of focused will and reverting to unconscious habits).  
 
 Sometimes even eating or urinating can feel like a bother.  Life is struggle.  This is a fundamental truth. Ask your intestines if they work and struggle to digest food.  Or ask your teeth and jaw if they have to move and work to grind up food.  When I accept that I need to do things that I don’t necessarily want to do then I have started on the road to growth and healing.
 
 When I step out of the internal dialogue of, “I want to”, “I don’t want to” and just do what needs doing in the moment it is like slaying the dragon in tales of old.  Some days it takes that much effort.  Every day we have the opportunity to be dragon slayers in our lives.  
 
 I invite you now as you read these words, Stand up! Hear the call to arms! Slay the 2 year old self-centered dragon who thinks he/she shouldn’t have to do something because it is a bother.  
 
 How, you ask?  
 1. Accept that there are many things in life we don’t want to do.  An adult (warrior/hero) does what needs to be done, when it needs to be done to the best of her/his ability.
 2. Find a way to make it interesting by investigating it closer.  Notice the dissenting voice.  What or who does it sound like?  Where did you learn that one?
 3. Realign the internal view from ‘I don’t feel like it’ to a more holistic view.  ‘I don’t feel like it and I am going to do it anyway’.  Given this is what is going on inside, what can I learn about myself and the nature of being human in these circumstances so that I can grow to be a more capable adult (hero/heroine).
 
 Take away contemplations:
 
 What is the nature of that which decides not to do something?
 What is the nature of thinking that an errand is a bother?

We live in a world that promotes thinking as a superior function.  Many education systems value abstract learning above others. Most people are trained when they’re young to identify with their thoughts. To be mindful sounds like it is an activity that only happens in the head. When we make efforts to train ourselves to pay attention to sensations in the body, we can stop living just in our heads and live more fully in our whole being. Being aware of the body is an important part of living well and mindfulness practice.
 
 1. The human body is an astonishingly wonderful composite!  We often take what it does for granted.  We tend to notice our body when it hurts or isn’t working well.  At these times we may get frustrated, angry and impatient. Most often the body works without us having to notice it.  Noticing the body is a wonderful way of practicing appreciation for the incredible gift that is the body. Every breath, every heart beat is an amazing miracle. And this is true even when we feel sick or sore. Being aware of the body moment by moment helps us remember the amazing feat that we call our body.
 
 2. Being in our bodies more fully allows us to experience the joy of living.  When we stay stuck in conceptual thoughts the vividness of being in a body and experiencing the senses can be dulled and feel distant.  When we practice mindfulness we are practicing being open to the full experience of being alive. That includes joy and sorrow.  We can’t have one without the other.  To fully taste the cool sweetness of a drop of dew licked from a blade of grass, to fully immerse ourselves in the experience of a dragonfly in sunlight, to feel as if for the first time a rain drop falling from the sky and landing on our skin.  These are just a few examples of the amazing experiences possible if we are fully in the body in the moment.
 
 3. The body is always in the present “now” moment.  When we feel the wind blow across our skin we are experiencing that sensation in the present moment.  Bringing our attention to the sensations in the body means we are placing our attention in the here and now.  The body is not in tomorrow.  The body is not in yesterday.  In this way the sensations of the body and the activities of the body can be useful anchors to bring us to now.   Being in the now brings us out of thoughts of the future and past. Out of thoughts such as “what if…” and “I wish…”  The body remains firmly in the present and is an excellent touch stone for bringing our minds to the present as well.
 
 4. Paying attention to the body allow us to feel grounded.  The body has a mass and is firmly established on the earth thanks to gravity.  Our minds are less solid and can be more like the wind, blowing here and then there:  Sometimes gently and at other times like squalls.  As we practice paying attention to the body in the moment we become more aware of the weight of the body on the earth.   This paying attention to the body can stabilize the windy tendency of the mind to zoom off in uncontrolled ways that can feel distracting and agitating.  Being mindful of the body we are helping our energy ground and be directed.

 5. We live in the physical body, lets get to know it better.  Lots of times we try not to live in our bodies.  We do this by ignoring how it feels or wishing it was different than it is. The body experiences itself and life by feeling physical sensations.  The more we are familiar with these the better we will cope with them as they arise.  The body is our home whether we like it or not.  When we open ourselves to the reality of the experience of our body as it is now, not how we would like it to be, we have a better chance of accepting what is happening with more joy and ease.  Being in the body in the moment, moment by moment invokes a state of calm that doesn’t depend on things being pleasant.

Adapted from
http://www.mindful.org/meditation/mindfulness-getting-started/

In March 2019 East Kootenay Addiction Services Society (EKASS) conducted the ninth Adolescent Drug Use Survey. The region-wide survey, first undertaken by the Agency in 2002, includes all students in Grades 7 – 12 in the East Kootenay. The survey is conducted every two years to monitor changes in drug use patterns, attitudes and behaviors amongst East Kootenay adolescents. The next survey will be circulated in April 2021, with the results of that survey available by the end of May 2021.

See the report below for the EKASS Drug Use Survey 2019 results.

Adolescent drug use survey report 2015 (544 KB) 

This is the third article in a series regarding changes to marijuana legislation in Canada. 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. 

Here is the title of a research article published in the January edition of the journal Cerebral Cortex by researchers at Western University:  Adolescent Cannabinoid Exposure Induces a Persistent Sub-Cortical Hyper-Dopaminergic State and Associated Molecular Adaptations in the Prefrontal Cortex.

Now, if you’re like me and never read the journal, Cerebral Cortex, this title probably sounds like a strange foreign language.  In fact, I’m showing this as an example of the kind of research that it is trying to determine the potential positive and negative effects of marijuana use on teen brains.  As the Canadian government moves towards legalizing marijuana one of the big concerns is going to be the potential impact on adolescents.  Both the previous Conservative government and the current Liberal government said they wanted to limit teens’ access to marijuana and protect them from marijuana’s risks.  The two governments had very different ideas about how this could be done, but that’s the topic for a different discussion.  

What is important to realize is that quality research on the risks and/or benefits of marijuana use is relatively scarce, and the research that is being done that helps to shed some light on how marijuana may affect teens tends to be published in obscure specialist journals with intimidating titles like the one above.  Most people don’t access this kind of information.  What people might find when they look for information is sites on the Web, YouTube or Blogs.  Some of these sites may be very good and based in good research, while many are little more than personal opinion sites masquerading as expert testimony.  For the average person it can be very difficult to sort through.  

At East Kootenay Addiction Services we routinely hear teens talking about a website they found which says marijuana is perfectly safe, while concerned parents talk about a site they found which says marijuana is the worst drug ever used.  ‘Seek and ye shall find’ could be the catch phrase for the Web, as you are bound to find a site that will affirm your beliefs.  So how to sort through all of this?  On our EKASS website we provide links to Canadian and International websites that we believe provide the best balanced information on substances and substance use.  Check these sites out as a good starting place for more accurate information.  

As for the study I mentioned above –it found that giving heavy doses of marijuana to young rats created lasting behaviour and brain changes which resembled those found in people with schizophrenia.  They did not find these changes in adult rats exposed to marijuana.  The implication being that heavy marijuana use in teens may cause more significant damage than in adults (at least if you’re a rat).  

In the next article I’ll talk more about some of the research findings of the potential impact on teens of marijuana use.  Stay tuned.

This is the second article in a series regarding changes to marijuana legislation in Canada. 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. 

Marijuana Myths
 

As the federal government begins the process of moving towards legalizing marijuana, East Kootenay Addiction Services Society is presenting a number of articles to generate discussion about marijuana and what changes to marijuana laws could mean.  This article will look at some of the common beliefs about marijuana and separate the myths from the facts. 

Marijuana is the most popular illicit drug used worldwide.   Because of its popularity, and in part because of the push to change the legal status of marijuana in Western countries, there are many statements made about marijuana in the media and on the internet that sound factual but may not be accurate.

Truth:  People often use this argument when comparing marijuana to man-made chemical drugs like Ecstasy, Crystal Meth or Fentanyl.  Just because marijuana grows out of the ground doesn’t make it automatically safe.  There are lots of plants that can kill or cause serious illness.  Marijuana naturally has a large number of active compounds which can affect everything from brain function, development of the fetus, and lung functioning.  Marijuana today is often grown in controlled settings with fertilizers and other chemicals to increase the productivity.  These chemicals aren’t at all natural.  Remember that all substance use has potential risks and no drug is perfectly safe.
 
Myth 2: Marijuana is a gateway drug.  If you start smoking marijuana you’ll move on to harder drugs.

Truth:  This one is mostly a myth.  Most people who try or use marijuana don’t go on to use other drugs.  There is nothing in marijuana that automatically makes people want to try other drugs.  It is true that most people, who report using drugs like cocaine, or opioids or amphetamines, also report that they used marijuana before they started these drugs.  That doesn’t mean marijuana caused them to use those drugs.  After alcohol, marijuana is typically the first drug that young people experiment with if they are going to experiment.  There can be many reasons why a small group of people will progress from using marijuana to using other drugs.  They can include genetic vulnerabilities, personality factors, history of trauma, and environmental factors.  It is true that if young people smoke marijuana they have a greater chance of being exposed to people using other drugs, but it does not mean they will automatically use them.

Truth:  It probably is true that no one has actually overdosed by using marijuana.  It doesn’t seem to affect the body that way.  That doesn’t mean people haven’t died while under the influence of marijuana through motor vehicle crashes and other accidents caused because people’s judgment, coordination and motor control were impaired by marijuana.   Marijuana also acts to increase the effects of other drugs.  People who use marijuana while using alcohol, cocaine or other drugs could be at greater risk from overdosing from those drugs.  Just like alcohol, there are safer times, places and ways to use marijuana, and there are ways which are riskier.
 
Myth 4:  Marijuana is not addictive.

Truth:  Marijuana is addictive, both physically and psychologically.  Some of the confusion around this belief arises because of confusion with the word ‘addiction’.  A better word might be dependency.   One of the reasons people often don’t recognize marijuana dependency is that it is often not as obvious as alcohol or cocaine dependency, where the negative problems tend to be more obvious and show up earlier.  Regular use of marijuana can cause dependency in which people experience a strong need to use marijuana in order to feel o.k.  This can be accompanied by increased use, more thought and time spent focussed on using, using at times and places that would not be socially appropriate, and using despite having negative consequences.  Withdrawal symptoms can occur when someone has been using heavily for a period of time.  These can include irritability, anxiety, difficulty falling asleep, lack of appetite, restlessness, depression and occasionally abdominal pain.  A recent report suggested that marijuana users have a 16% risk of developing dependency.  This was slightly lower than alcohol (23%) or cocaine (21%) but still means that one out of six people who use marijuana could be at risk for developing a more serious problem.

There are many other mistaken ideas about the risks and benefits of marijuana use.  Unfortunately there is no shortage of websites and blogs talking about marijuana, many of which sound authoritative but which give information which may be inaccurate or flat-out wrong.  The following Canadian organizations all have excellent websites which offer factual, research-based information on the risks and benefits of marijuana:

Canadian Centre on Substance Abuse
http://www.ccsa.ca/Eng/topics/Marijuana/Pages/default.aspx

http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/Cannabis/Pages/default.aspx
 

Centre for Addiction Research of British Columbia
http://www.heretohelp.bc.ca/factsheet/safer-cannabis-use-marijuana-hash-hash-oil

This is the first article in a series regarding changes to marijuana legislation in Canada. 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. Discussion for Changes to Marijuana Legislation

The Liberal Government has stated they intend to move towards legalization of marijuana.  What does this mean and what issues need to be considered?  In 2015 the Canadian Centre for Substance Abuse (CCSA), along with partners from the public health, substance use treatment and the law enforcement communities, took two fact-finding trips to Washington and Colorado to talk to stakeholders about the experience of legalizing marijuana in those two states.  The CCSA is Canada’s only national agency dedicated to reducing the harms of alcohol and other drugs on society, informing policy and practice, and improving services for those affected by substance use disorders.  Two weeks ago the CCSA released a report on their findings.  In their report the CCSA identified a number of recommendations based on the Colorado/Washington experience. 

Marijuana, or cannabis, is the most widely used illicit drug in the world.  Although the usage rates have been dropping over the past 15 years, Canada still has some of the highest rates of marijuana use, particularly amongst adolescents and young adults.  The CCSA Report recommended that movement towards legalization identify a clear purpose to drive the overall approach.  The principle rationales that are usually raised for legalizing marijuana are that it would help to reduce the role of organized crime, it would reduce the significant negative impact of criminal charges for recreational users, and it would improve product safety and generate tax revenue.  Furthermore, by shifting the understanding of marijuana use from it being a criminal problem to it being a public health issue, it allows for more effective prevention and education activities, as well as greater regulatory control over access and marketing.

By talking to their counterparts in Washington and Colorado the CCSA delegation learned that the regulatory framework must:
 1. Reconcile the medical marijuana markets and the retail markets.
 2. Control product concentrations and product formats.  This was necessary to ensure consistency in the types of marijuana products sold and the concentrations of active ingredients in the products.
 3. Prevent commercialization.  This can be achieved through taxation, rigorous federal regulation and monitoring, and strict controls on advertising and promotion.
 4. Prevent use by youth.  This can be achieved by controlling access, having mandatory age limits on use, and by investing in effective health promotion, prevention and education campaigns for both youth and parents.

Two concerns that were identified consistently were the need to educate youth about the potential negative consequences of marijuana use, and the risks associated with marijuana use and driving.  Over the coming months East Kootenay Addiction Services Society (EKASS) will be contributing articles to local papers to provide information on these points.  We at EKASS believe that robust public dialogue on the legalization of marijuana informed by accurate information will be important as the government moves towards making these changes.

For more information or to submit questions or comments please contact Dean Nicholson at [email protected].

East Kootenay adolescents more likely to be physically active but also to be vaping 

McCreary Centre Society today released the East Kootenay regional results of the 2018 BC Adolescent Health Survey. The survey was completed by over 38,000 of the province’s Grade 7–12 students, including all three school districts in East Kootenay. Results showed that East Kootenay youth remain more physically active than youth across the province, including 24% who participated in extreme sports on a weekly basis, compared to 9% across B.C. Also, local youth were more likely than their peers across the province to have met Canadian physical activity recommendations.  
  
However, mental health and vaping rates provide some cause for concern, as McCreary’s Executive Director Annie Smith explained: “A quarter of East Kootenay youth had seriously considered suicide and almost one in five who needed mental health services did not receive them. This is obviously worrying as were the findings that 29% had vaped with nicotine in the past month.” 
  
Smith went on to say “The local results for East Kootenay also confirm what we see across the province in that youth who have supportive adults in their family, school and community report more positive mental health and are less likely to engage in risky substance use, and that gives us some clear direction as to how we can support young people growing up here.” 
  
Positive local trends included increases in East Kootenay youth reporting feeling connected to their community, having an adult in their community they could turn to for help when they had a problem, and decreases in local youth binge drinking. 
  
A copy of the report, Balance and connection in East Kootenay: The health and well-being of our youth, can be obtained at www.mcs.bc.ca.  
  
The report is now available at www.mcs.bc.ca. 
  
A Power Point presentation is also available at www.mcs.bc.ca.

This month marked a policy change in BC which permits select grocery stores to sell alcohol. This post originally appeared on the Centre for Addiction and Mental Health blog, however, while this blog is from Ontario, many of the points are now relevant to BC. In the last few days we have heard about plans to permit the sale of beer and wine in grocery stores in Ontario. For the most part, media reports have made no reference to potential health and safety risks associated with the proposed changes. You would have thought that the reporters were talking about changing the distribution of milk or orange juice in Ontario. What about the possible increase in alcohol-related incidents or negative impact on vulnerable populations — is that not relevant to the discussion?

 Alcohol is a drug with a long list of well demonstrated harms associated with its use. How it is sold, marketed and priced impacts the rate of alcohol-related problems. International research over many decades has shown repeatedly that if more alcohol is sold and appropriate checks are not in place, then more harm can be expected. These harms include a range of health and social problems impacting not only the drinker, but others in society. They contribute to the already high costs of alcohol-related hospital care (chronic and emergency), criminal justice responses, and productivity losses. 
 Currently in Ontario there are about 1,800 places where alcohol can be purchased to be consumed elsewhere, so-called ‘off premise’ outlets. This includes LCBO regular stores, LCBO Agency Stores, Ontario Winery, Beer Stores and a few others. According to media reports, the contemplated changes would add about 400 new outlets – 100 new Agency stores and 300 large grocery stores that would sell beer and wine. This is a 22% increase in outlet density.
 
Canadian and international research has indicated that an increase in alcohol outlet density is associated with a wide range of acute and chronic problems. While there are many international examples to support this conclusion, a recent one from British Columbia is timely: researchers found that after an increase in private liquor stores (higher density) there was an increase in liver cirrhosis cases.
 
Once 300 grocery stores have a green light, will not the thousand or so others also lobby for the same access? What about convenience stores? We know from the examples of Alberta and BC that privatization of alcohol sales can result in more relaxed enforcement of laws pertaining to underage purchases – as well as higher mortality rates from suicide and other alcohol-related causes. The proposed plan is a very risky one. An alternative strategy should be developed in consultation with public health experts.
 
 The challenges of eliminating Ontario’s deficit are likely substantial and will require innovative approaches and exemplary decision-making. As the provincial government attempts to raise revenues and “modernize” the sale of alcohol, it should focus on strategies that can achieve that aim without increasing the risk of alcohol-related harm. Possibilities include:

Para-MethoxyAmphetamine

An ecstasy user would like their pills to contain just one active ingredient - MDMA (3,4-methylenedioxy-N-methylamphetamine). But because banned drugs are unregulated, they can contain other drugs, and sometimes no MDMA at all. Currently, ecstasy  is at times, reportedly containing the drug PMA instead of, or as well as MDMA. Several deaths linked to PMA have occurred recently. PMA brings on effects at lower doses and much less ‘forgiving’ drug than MDMA. Technically speaking it has a steeper dose-response curve, so the amount that could send your temperature, heart-rate and blood pressure soaring dangerously is not much more than the amount you need to feel it at all. People have reported very unpleasant or dangerous reactions after just a single pill or even less.

Have a look at this harm reduction poster for more information about the differences between MDMA and PMA and how to reduce your harms. 

March 16 - 22nd is Brain Awareness Week, a global campaign to increasepublic awareness of the progress and benefits of brain research. In recognition of the week, EKASS has created a list of resources which highlight the ways in which brain research has added to our understanding of addiction, its prevention and treatment.