Open Letter to the Government of British Columbia:
BC Needs an OPIOID ACTION PLAN
Since April, 2016 when the epidemic of opioid overdose deaths was declared a ‘Public Health Emergency’ by the Provincial Health Officer for BC, a new government has been elected. A Ministry for Mental Health and Addictions has been created with a Minister appointed to lead the development of a response to the opioid issue with a $325 million budget.
The causes of this epidemic are complex:
Large numbers of individuals and families with inadequate income, housing, food, employment, social supports, etc. who are living with hopelessness, stress and despair and dying more frequently from opioids, other drugs, alcohol, tobacco and violence.
The promotion of opioids by pharmaceutical companies for pain relief and the willingness of physicians to prescribe them, coupled with inadequate resources for mental health, addiction treatment and non-opioid pain relief.
Opioid and other substance use as self-medication for relief from stress and the effects of physical, emotional and sexual abuse.
Street drug supplies in which fentanyl and analogues are ubiquitous and inconsistently mixed so that lethal doses are unavoidable. Fentanyl was detected in 80% of recent overdose deaths in BC.
While not all people who use drugs come from a background of deprivation, opioid addiction frequently begins and ends in desperation: homelessness, poverty, unemployment, crime, chronic poor mental and physical health, chronic physical and emotional pain and an untimely death. Therefore the broad issues of poverty, homelessness, food security, education, early childhood and youth development, employment and the other social determinants of health (SDOH) must be addressed in the plan.
We recommend a public health approach to this challenge: a comprehensive review of the issue and the generation of strategic interventions addressing the multiple causal factors.
In BC, we have a crisis: in Europe a rate of 2 overdose deaths/100,000 population /yr. is considered ‘a major crisis’ 1, the US is considered to have the highest overdose death rates in the world2 at about 20/100,0003; BC is at 31/100,0004 and Vancouver at 57/100,0004, about4-5 overdose deaths/day. (Vancouver is the epicentre for Canada; in the US, hotspots like Virginia have death rates as high as 90/100,000). “BC continues to experience unprecedented…overdose deaths and more action is needed”5.
Now we need a BC OPIOID ACTION PLAN to urgently address this crisis based on the following:
Destigmatize & decriminalize drug use and addiction – people dependent on drugs should be treated with the same dignity and respect as patients suffering from any other chronic illness requiring clinical care (e.g. diabetes, heart disease), regardless of race, gender or age.
Security – Provide people who are dependent on opioids with pharmaceutical opioids as part of the medical treatment of opioid addiction so they don’t have to self-medicate with illicit street drugs contaminated with toxic ingredients; and they are brought into a comprehensive, secure and supportive therapeutic clinical setting as described below.
Economics – it is cheaper to treat opioid addiction with appropriate clinical care and SDOH supports than to leave patients untreated, leading to much higher expenditures related to crime, violence, policing, courts, jails, prison, ambulances, ER visits, hospitalizations and so forth. Some estimates calculate about $35,000 per patient/year for treatment vs. as much as $100,000 per patient/yr. left untreated.
Coordinated action will be needed by all levels of government (federal, provincial and municipal) with/by Health Authorities:
The following actions are presented to be consistent with the 4 Pillars in the new Canadian Drug and Substances Strategy6 :
Pillar 1: Prevention
Given that opioid addiction is a ‘disease of despair’ coordinated action is needed by all levels of government to address the SDOH (poverty and homelessness, etc.) and socioeconomic inequity through strategies with legislated goals, budgets and timelines.
Pillar 2: Harm Reduction
Many of these actions have been initiated but need expansion:
Make Naloxone more available: ‘take home’ supplies and the expanded use of nasal spray format (for first responders uncomfortable with injections).
Explore and evaluate drug checking programs to establish the evidence for drug checking as an intervention to prevent overdoses and deaths.
Expand the availability of supervised consumption (injection) services (SCS) for those continuing to use illicit street drugs.
Explore, legislate and institute permanent Overdose Prevention Service (OPS) models, especially in settings which do not have the resources for full SCS.
Expand the availability of non-opioid pain care services (non-opioid medications, myofascial release treatment, etc.)7.
Pillar 3: Opioid Addiction Treatment
Develop comprehensive, integrated opioid addiction treatment centres staffed with addictions specialists that include:
Baseline care with options for injectable or oral pharmaceutical opioids, including Suboxone, methadone, diacetylmorphine (heroin), hydromorphone (Dilaudid) and oral slow release morphine. Experience has shown that for most patients, Suboxone or methadone will meet their needs, but for a small minority these other options are required. Oral opioid antagonists such as naltrexone may also be considered. As these medications will be prescribed by physicians with addictions training, clinical judgement will ensure that the most cost-effective and appropriate medication will be prescribed.
This approach is recommended for several reasons:
The provision of pharmaceutical opioids in a therapeutic setting has been shown in a number of jurisdictions to virtually eliminate infectious diseases (hepatitis and HIV) and overdose deaths related to opioid use (as patients are no longer consuming illicit street drugs contaminated with toxic materials such as fentanyl or infectious agents).
To maximize the goal of replacing the toxic illicit drug market as the primary source for people not yet in addiction treatment, pilot and evaluate several low threshold Public Health Access to Safer Opioids programs delivered through a wider array of points of service including clinics, community health centres and harm reduction programs.
When pharmaceutical opioids are widely available, the criminal street market is largely eliminated and much public expenditure avoided.
And when brought into a secure, supportive therapeutic setting these patients can be supported with SDOH interventions, counselling and so forth as below.
SDOH supports for individual patients: income, housing, food, social support, education and others.
Integrated primary health care for treating co-morbidities (mental illness, chronic pain, hepatitis, HIV, cardiovascular disease, diabetes) and other addictions (alcohol, tobacco).
Counselling and psychosocial supports (e.g. 12 steps) and supportive residential care to enable transition from opioid treatment with heroin, hydromorphone, etc. to methadone or Suboxone and, when possible, to abstinence.
Training and education for employment such as peer counselling or as appropriate to past education, training and work experience.
For some, eventual abstinence and return to family, community and work.
Pillar 4: Enforcement
Possession of small amounts of drugs for personal use should be decriminalized. Treating people as criminals contributes to their ongoing stigmatization and leads to social isolation and solo drug use without supportive peers and access to naloxone and other emergency measures and thus contributes to the epidemic of opioid deaths. Decriminalization can be implemented more quickly through local police procedural change and does not need the lengthy legal and legislative processes to achieve legalization of opioids.
Opioid addiction treatment should be made available in all Corrections facilities.
The development of pain care and opioid addiction treatment teams will take some time and budget and will be best developed through a ‘collective impact’ approach at the local community level with funding from the Ministry for Mental Health and Addictions. Many of the Harm Reduction actions can be implemented quickly and help to immediately save lives. Developing poverty reduction and homelessness strategies will take more time but are of paramount importance to the long term solution of opioid addiction.
The above actions need to be supported by a better system of data collection, linkage, analysis, sharing and reporting, that allows the tracking (anonymous) of the therapeutic progress of patients (as has been done for HIV patients) so that the effectiveness of therapeutic interventions can be assessed. This will be critical to an evaluation plan that includes clinical outcomes, destigmatization measures and cost-effectiveness of programs to drive continuous quality improvement.
We are encouraged by the steps already taken by the BC and federal governments and BC Health Authorities and stand ready to assist in any way to quickly develop and implement an OPIOIDACTION PLAN.
Respectfully,
Dr. Gord Miller, President
Public Health Association of BC
Trish Garner, Community Organizer
Poverty Reduction Coalition
Adrienne Montani, Provincial Coordinator
First Call: BC Child and Youth Advocacy Coalition
Donald MacPherson, Director
Canadian Drug Policy Coalition
Seth Klein, Director
Canadian Centre for Policy Alternatives – BC Office
Judy Willows, Board of Directors
Community Legal Assistance Society
Benita Ho, Chair
DTES Neighbourhood House
References:
7 Countries That Beat an Overdose Crisis. Anderson, K. and Smith, A. The Fix, May 19, 2017.
America Leads the World in Drug Overdose Deaths: data from United Nations Office on Drugs & Crime, June, 2017
US National Center for Health Statistics data, June, 2017.
Illicit Drug Overdose Deaths in BC. Coroners Service, Sep 7,2017
Responding to BC’s Opioid Overdose Epidemic. Ministry of Mental Health & Addictions, Sept., 2017
The new Canadian Drugs and Substances Strategy. December 12, 2016
Guideline for opioid therapy and chronic non-cancer pain. Busse, JW et al. Canadian Medical Association Journal, May 8, 2017.
Do you want to work for a great organization that is all about promoting the mental health and supporting the resilience and recovery of people experiencing mental illness and addiction? Are you a self-motivated individual with broad-based executive leadership and management experience who possesses great interpersonal skills, is very passionate about helping others and has personal experience and affinity for addiction and mental health treatment? Are you an authentic and collaborative leader who builds rapport quickly and has a bias for action?
If your answer is yes to the above questions then keep on reading!
CMHA, BC Division has an exciting opportunity for an energetic, solutions-focused, strategic leader to oversee the effective functioning of the BC Division office and its progression through growth and change. Under the direction of the Chief Executive Officer, you will ensure the development of a three year operational plan and compliance with the risk management plan. In addition, you will actualize the vision, mission, mandate, and values of the Association through effective planning and implementation of the priorities established by the Board of Directors. You will also act as a professional advisor to the CEO on specified aspects of the Association’s activities and provide effective liaison between the CEO and the Leadership Team and between the CEO and Provincial CMHA Branch Executive Directors.
What you will bring to CMHA:
We are looking for someone with knowledge associated with CBT evidence-based programs within a self-management context, along with knowledge and skills to work with individuals and groups with varying perspectives and in the area of cross cultural mental health. You will also have experience working within a federated model.
Demonstrated excellence in overseeing multiple projects, strong verbal and written communication skills and excellent relationship building skills are all necessary.
You will have experience in areas such as resource development and media relations, human resources, conflict resolution and negotiations and have the ability to manage and negotiate projects with external partners and/or funders.
Located in downtown Vancouver, we offer a flexible work environment along with a competitive salary and benefits package. There may be occasional periods where work outside normal office hours is required in order to meet program requirements.
Application process
We will consider applications from interested candidates who submit a resume and cover letter describing how you meet the qualifications outlined above. We regret that only short-listed candidates will be contacted to schedule an interview. Please submit in Word or PDF formatno later than 5 p.m. on Friday, November 17, 2017 to human.resources@cmha.bc.ca.
CMHA, BC Division is committed to our workforce reflecting the diversity of the communities within which we work. As such, we encourage applications from persons with disabilities, members of visible minorities, First Nations, Inuit, and Métis people, people of all sexual orientations and genders, and others who may contribute to the diversity of our staff. Personal experience with mental illness and or addiction, either through self or a loved one, is an asset.
Located on the unceded territories of the Coast Salish Peoples.
Farm to School BC (F2SBC) is a school-based initiative that connects K – 12 public, First Nations, and independent schools, communities and local farms, with a goal to ensure that children have access to fresh, local and sustainable foods while at school. Farm to School BC has three core elements: 1) healthy local foods; 2) hands-on learning and; 3) school-community connectedness. The program is supported by the Province of British Columbia and the Provincial Health Services Authority and administered by the Public Health Association of BC (PHABC). Farm to School (F2S) activities may differ by school, but are always directed towards a common goal- more healthy local foods on the plates, minds and bellies of all students.
Does your school want to (but not limited to):
Purchase new refrigeration system for cooking or preservation?
Start a salad bar?
Buy equipment to support sustainable school-based agriculture practices involving school gardens, micro green system, or other forms of cultivating food?
Take students out on field trips to your local farmer’s market, farms and other agriculture-based settings to educate students about our local food environment?
Plant native plants, build medicine wheels, harvest traditional foods, and connect with elders and knowledge keepers?
Demonstrate willingness to partner and collaborate with the local organizations, and community members to strengthen the F2S Team (see question 8).
Commitment to a working team of at least 3 people to build and expand the Farm to School program at your respective school.
Exclusion criteria
If you are currently holding another active Farm to School grant, you are not eligible to receive this grant (i.e., Farm to School Grant 2016, Farm to Cafeteria’s Salad Bar Grant).
Applications must be received no later than Friday, December 1, 2017 at 11:59pm PST. Schools will be notified about the status of their application by Wednesday, December 20, 2017. Please direct any questions you have to prov.manager@farmtoschoolbc.ca.
The National Manager will lead and manage the quality and growth of the national CMHA flagship program Living Life to the Full /Vivre sa vie, pleinement: an evidence-based community course that teaches skills to build resilience currently offered by CMHA affiliates and approved partners across Canada.
Most of your time will be taken up by:
Business planning and development, including:
Developing and implementing a three year business plan
Ensuring budgeted revenues are met or exceeded, and that mechanisms for the reporting of sales and the assessment of royalties are managed in a timely manner
Leading the preparation of funding applications, and securing new affiliates and partners.
Liaising with key stakeholders for information sharing and program development
Quality assurance and improvement:
Identifying unique approaches and methods to deliver the program and ensure ongoing program fidelity and accountability.
Review and update the facilitator training curriculum
Facilitate discussion and information sharing by the growing community of practice of course facilitators and identify needs and gaps
Promotion and marketing
Ensure program successes and needs are regularly communicated to CMHA fundraising and communications staff to incorporate into fundraising appeals and donor communication
Seek opportunities to promote the program through various media, and through presentations at strategic meetings and conferences.
Oversee the transition of a fully bilingual website (livinglifetothefull.ca and an enhanced vivresaviepleinment.ca) to the national platform
Training
Offer and lead regular facilitator training workshops in different locations across the country
Explore, build and market an option to train new facilitators online
Manages and supports regional and national initiatives
Work with funders and affiliates to oversee delivery of the program to specific populations
What you bring to the role:
You will have a Masters degree in a relevant discipline, along with a minimum of 5 years experience in a comparable program/project management role. You will also have experience in the non-profit sector, ideally in a health or mental health context. A background or clinical experience in delivering psychoeducation interventions is an asset, but not required.
In addition, you will have:
Superb written and verbal communication skills in both official languages, and in a Canadian context (mandatory)
Excellent project/program management skills, facilitation and training skills
Experience in business/resource development and marketing, with confidence in sourcing funding;
Excellent customer service, and the ability to work in a complex environment with complex relationships
Cross cultural experience, ideally in a health or mental health context
Knowledge and network mobilization, such as through communities of practice
Ability to take direction and supervision as well as experience in supervising others.
Internet, web/videoconferencing and software skills in MS Office
Knowledge of principles of cognitive-behavioural therapy an asset
Personal experience with mental health issues, either through self or a loved one, is an asset in this position
Working conditions
This is a regular full time management position, with a 37.5 hour work week. Flexibility to travel and to work non-core hours relative to assignments is required.
Located in downtown Vancouver, we offer a flexible work environment along with a competitive salary and benefits package.
How to Apply
We will consider applications from interested candidates who submit a resume and cover letter describing how you meet the qualifications outlined above. Please submit in PDF formatno later than October 31, 2017 to human.resources@cmha.bc.ca.
For more information about this role and the Living Life to the Full Program, please visit our website at www.cmha.bc.ca
We regret that only short-listed candidates will be contacted to schedule an interview.
ABOUT CMHA
At the Canadian Mental Health Association (CMHA), we are all about promoting the mental health of all and supporting the resilience and recovery of people experiencing mental illness and addiction. Founded in 1918, the Canadian Mental Health Association (CMHA) is a national charity and nation-wide leader and champion for mental health.
CMHA, BC Division is committed to our workforce reflecting the diversity of the communities within which we work. As such, we encourage applications from persons with disabilities, members of visible minorities, First Nations, Inuit, and Métis people, people of all sexual orientations and genders, and others who may contribute to the diversity of our staff.
Located on the unceded territories of the Coast Salish Peoples.
Time Frame: November 1, 2017 – June 30, 2018 (or as soon as possible)
Contract Fee: $ 52,800 – 61,600
Hours: Based on deliverables, approximately 30-35 hours/week
The Vancouver Early Years Partnership (VEYP) is one of the Children First Learning initiatives developed by the Early Childhood Development (ECD) Branch in 2013 and is funded by MCFD to support communities to identify and develop an integrated and comprehensive model of ECD service delivery for children from birth to 6 years old and their families.
The VEYP is hiring an early years community developer for an 8 months to coordinate day-to-day operations and implement community planning. Position may be extended.
Deliverables
Under the direction of the VEYP Steering Committee and the MCFD Director of Operations, the Contractor will coordinate VEYP projects and day-to-day operations as outlined in the VEYP Strategic Plan and annual work plan. These deliverables, based on the strategic priorities, include:
Support: A sustainable infrastructure to support the early years sector
Coordinate and support the VEYP Steering Committee
Coordinate and support the development of up to 2 early years place-based planning initiatives
Develop and implement a plan to support/liaise with neighbourhood early years tables
Attend meetings as the VEYP liaison
Provide or sub-contract secretarial support for meeting minutes, meeting packages, etc.
Produce reports and perform other administrative duties as needed
Connect: Meaningful engagement between and across the early years sector
Develop and implement a low-barrier city-wide early years sector learning and networking opportunity
Nurture and build community and partner relationships where appropriate, including the Early Years Centre, neighbourhood early years initiatives and funding and research partners
Develop and initiate communication tools to inform and connect early years partners, including quarterly newsletter on promising practices for parent education and e-announcements for early years practitioners
Identify and initiate opportunities for collaboration
Participate in relevant early years committees and initiative
Educate: Increase awareness and a deeper understanding of the importance of the early years
Provide leadership and support to a committee to plan and promote 2 (two) free professional development opportunities
Create and support an Action Team to develop a strategy to support the sector with parent education
Research: Early years work informed and guided by research and innovation
Develop a plan and partnerships for knowledge acquisition, knowledge development and implementation of knowledge sharing and translation
Act as Vancouver’s EDI Community Trainer; provide training and support
Required Qualifications and Experience
Demonstrated experience in community development and project management
Understanding of place-based planning
Experience working collaboratively with diverse stakeholders to support early childhood development
Ability to promote a shared leadership approach
Strong knowledge of the early years field; knowledge of the early years sector in Vancouver as asset
Strong networking skills and ability to build trusting relationships
Bachelor’s degree and/or equivalent in community development, social work, early childhood
Self-starter with strong administration and organizational skills
Effective written and verbal communication skills
Knowledgeable and efficient with computers and social media
Current and valid BC driver’s license and access to a vehicle required
Home office required
Flexibility regarding availability required (work may include occasional evenings and weekends)
TO APPLY
Please submit your resume and a cover letter outlining your experience and qualifications to: Kim Adamson – Chair – Vancouver Early Years Partnership – kim.adamson@gv.ymca.ca – by Friday, October 20 , 2017 at noon.
Harvest4Knowledge is a pilot project taking place on the unceeded territory of the Songhees and Esquimalt First Nation. The project is funded by the Ministry of Health and Horner Foundation, and administered by Farm to School BC through Public Health Association of BC (PHABC) to bring native plant and traditional food knowledge into the minds, hearts and bellies of children and youth. Selected schools in School District 61 (SD61) that meet our eligibility criteria will receive grants to plant native plants, build medicine wheels, harvest traditional foods, and connect with elders and knowledge keepers. This project will promote opportunities for students to eat traditional foods in their classrooms, lunch or breakfast programs. Finally, the Harvest4Knowledge will continue to build regional and provincial Farm to School Network, bringing Indigenous ways of knowing into the network through a community of practice and working alongside local First Nations communities.
Position Summary:
The contract is for $7,000 which includes GST and start from November 2017 to June 2018, with the opportunity for renewal for the 2018-2019 school year. In this position you will report to Capital Region Farm to School Hub Animator, the Lkwungen Harvest4Knowledge Coordinator will support grant recipient schools in creating native plant gardens, medicines and opportunities for students to eat traditional foods in their classroom. The Lkwungen
Harvest4Knowledge Coordinator will place Songhees, Esquimalt communities and selected schools at the centre of all they do, believing that sustainable solutions are only ever developed when the support of a local community is strongly evident. The Lkwungen Harvest4Knowledge Coordinator will be a change agent in the community, building bridges within the community, among different communities and with the organizations and institutions that are impacting the community. The Lkwungen Harvest4Knowledge Coordinator will invest in relationships that
will form the solid foundation for future partnership development.
Essential Duties & Responsibilities:
Coordinate the acquisition of signage for all selected school native plant gardens and medicine wheels
Work with Sarah Rhude, District Aboriginal Art and Culture Facilitator to acquire plants for and other infrastructure to support the creation of native plant gardens and medicine wheels.
Support the development of signage that will be in Lkwungen and English
Communicate with Songhees and Esquimalt elders and knowledge keepers about the project and connect them to the project when appropriate
Support selected schools in developing a program plan for their project.
Check-in with selected schools to discuss successes and challenges and to address additional needs or concerns.
Provide verbal and written updates as requested
Attending meetings and other duties as requested by Capital Region Farm to School Animator
Qualifications
Education and/or experience working with Aboriginal communities and youth.
Ability to navigate complex relationships and competing organizations and community needs
The ability to share knowledge or connect with elders and knowledge keeps about Coast Salish plants
An understanding of community development and Songhees and Esquimalt community protocol and the ability to build cultural safety
Demonstrates the ability to work independently and as a team player
Leadership style and work ethic that promotes collaboration, inclusivity, creativity, open communication as well as independent decision making
To Apply:
Submit your resume and one page cover letter of why you would be the ideal candidate for this position to Aaren Topley, Capital Region Farm to School Hub Animator at capitalregion@farmtoschoolbc.ca.
Application Deadline:
Monday, October 23rd, 2017 at 11pm.
Priority will be given to applicants who are members of the Songhees and Esquimalt First Nation.
