DETOX UNIT FINE, BUT NOT FOR STREET ADDICTS

We met over coffee last week, each with our own reasons for being
there. I was there to find out why the region's new 14-bed detox unit
is virtually inaccessible to people from the street community. He
wanted to know why the media always fixate on the negative.

We talked for an hour and a half. I'm not sure either of us fully
understood the other's points by the end of it all. But at least we
heard each other out, and I appreciated his frankness.

As the director of addiction services for the Vancouver Island Health
Authority, Dr. Laurence Bosley is an important man when it comes to
addressing some of the immense problems on our streets.

Addiction certainly isn't the only reason why people end up homeless.
But it's a major reason they get stuck out there. So when the health
authority opens a new detox unit with policies that essentially
exclude most of the several hundred people with addictions on our
streets, I'd like to understand why.

But first to Bosley's point about the media, because I get what he
means. We desperately needed the detox spaces and seven
"stabilization" beds that opened this month, and it's a beautiful
facility in a time of scarce resources.

So I understand Bosley's unhappiness at having media hone in on two
"negative" angles: That the facility doesn't accept stimulant users
(people addicted to cocaine or crystal meth) who want to quit; and
that it goes against the health authority's own addiction-treatment
policy by prohibiting smoking anywhere on site.

But as I told an audience of young activists at the youth-organized
Change Conference last weekend, you don't fix a hole in the roof by
talking about the 90 per cent of it that isn't leaking. We won't
address what's wrong in this world without talking about the problems.

Detox is the first step in getting out from under an addiction. It's
essentially five to seven days of care and prescription-drug therapy
to help people through the most immediate withdrawal effects of
whatever drug they were using.

Bosley rightly notes that it's a pretty minor step, all things
considered. But it's the first one nonetheless. None of the steps that
come after -- treatment; spiritual healing; finding new ways to cope;
drug-free housing; new friends and places to go; the hard, hard work
of staying sober -- can begin without detox.

So when policies at the new detox shut out the most prominently
addicted people in our region, that's one heck of a leak in the roof.
The dominant drugs on the street are crack cocaine and crystal meth,
so the no-stimulants rule alone has huge implications.

But add in the no-smoking policy for a population for whom tobacco is
the sole saving grace of life, and you've shut out the people who most
need the help.

Bosley applies a cost-benefit analysis to the issue. The health
authority has a limited amount of money to spend and unrelenting
demand for all its services. It's making choices all the time in terms
of who's getting care.

On the detox front, Bosley points out that withdrawing from heroin or
alcohol can kill you and must be done under medical supervision.
Withdrawing from cocaine or crystal meth is unpleasant, but not
life-threatening. VIHA's mandate is to provide medical care, not to
give expensive beds to people who really just need a place to lie down
and sweat it out.

Except people on the street don't have a place to lie down. No bed to
sleep in for five straight days, that's for sure. No way to get away
from the sellers and the users. No place to detox, and thus no way to
even begin the long journey out of addiction.

Bosley also notes that it makes little sense to give someone who is
homeless a detox bed for five nights and then just release him back to
the streets. On that point we definitely agree. He wonders if we try
too hard to "cure" everyone, when some people's problems simply may
not be curable.

I would argue that we've barely tried at all in terms of the street
community. The significant successes of the three VIHA-led integrated
outreach teams in keeping people supported and housed in the last year
underline how much can be accomplished when we do get down to the
business of dealing with people's real needs.

As for smoking, Bosley says he can't believe anyone is surprised at
that decision: "That's just good clinical care."

I guess I see it as picking your battles. What good can come of
denying people care for their addiction just because they can't quit
smoking?