Big price tag, or big waitlist: addicts face barriers no matter where they turn in Manitoba

Two months after her daughter, Lisa Erickson, died of a suspected carfentanil overdose, Carol Ward still wonders if a private recovery clinic could have saved her daughter's life.

"She told me, 'mama, if you can get me in there, I'll go there, but I am not willing to detox at Health Science Centre ... I'll die doing it,'" recounted Ward.

About five years ago, Erickson went through medically assisted detox to get off opiates at the Addiction Unit at Health Sciences Centre. Ward said her daughter first became addicted to prescription opiates while in hospital more than a decade ago, and continued to be prescribed a high dosage of morphine up until her death.

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Ultimately, Erickson relapsed after getting clean, but she was willing to go through detox again if the right supports were available. Ward saidher daughter believed the public system was ill-equipped to deal with the potency of her addiction. Having moved on to an even stronger drug, Ward saidher daughter was terrified of the withdrawal.

"She told me flat out before she died, her drug of choice was carfentanil mixed with morphine. Well, carfentanil, it's such a strong drug what is the intensity of that withdrawal? That needs real, specific, medically assisted detox," said Ward.

HSC is one of two detoxification units in Winnipeg available through the public system, and the only place that provides medically assisted detox. Given its current criteria, it's unlikely that Erickson would be a candidate for one of its 11 beds which its medical director describes as being for the "sickest of the sick."

"Most of our admissions would be for individuals who are experiencing significant medical withdrawal symptoms from alcohol, which is medically dangerous if not managed carefully," said Dr. Marina Reinecke, medical director of the Addictions Unit at HSC.

The other option for detox would be Main Street Project where addicts are kept comfortable by staff but with little medical support. Clients stay in a dorm-styleshelter environment.

'Serene,' but private clinic not a spa

For Erickson, Aurora Recovery Centre was much more appealing.

Nestled on the shores of Lake Winnipeg, the private facility combines medically assisted detox with a 30- to 45-day recovery program.

"It's a very serene place. I think it's a place where people find comfort and they know everything is there. They don't have to hop from this place to this place and they don't have to talk to this person and this person in all different places all over the city," said Ward.

The facility is split into three wings: one for medical detox, and two residential wings that separate the men from the women. Some of the highlights of the facility include a swimming pool, a fully equipped gym, yoga room and sweat lodge.

While the space looks more resort than recovery centre, CEO Paul Melnuk says it's no spa.

"They're here for the purpose of recovery and recovery takes a lot of work. They have full days. Wake up is seven in the morning and they go to bed 11 at night, and we keep them pretty busy throughout the whole time," said Melnuk.

Clients spend roughly 45 hours per week in group therapy and another three hours in one-on-one counselling. Each client has two counsellors, one with a focus on addiction and the other on psychology.

"Every addict has to deal with the disease of addiction but there's also co-occurring mental health situations in virtually everybody who walks in the door. The approach we've taken is to give them the best of both," said Melnuk.

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The cost for 10 days of detox and 30 days of residential recovery is $18,000 a small price to pay, saidMelnuk, who is a recovering addict himself and whose son has also struggled with addiction.

"I understand how difficult it is on a family, how difficult it is to watch a child destroying themselves. What I would rather do is take out a mortgage on my house to provide my child with the help that I cannot provide," said Melnuk.

Aurora's capacity is 70, and there is currently no waitlistto get in. However, the cost of private addictions servicesis unattainable for many, and so they must turn to the public system for more affordable options.

Addicts face wait times, other barriers in public system

One residential program option in the public systemis the Anchorage programrun by the Salvation Army. If a client is on employment and income assistance, the program is free, otherwise the cost is $1,050 for 30 days.

The Anchorage program provides daily group counselling as well as one 30-minute counselling session each week. Because Anchorage is a Christian organization, the program also includes mandatory chapel and spiritual classes. Art therapy is offered once a week, music therapy twice a week, and an outdoor recreational activity is planned for every second Friday.

The view is challenging.

Located in one of Winnipeg's most notorious neighbourhoods for drug and alcohol abuse, the Anchorage program is surrounded by addiction.

"We have negative influences. When you walk in the front door there are people smoking, people using. It's hard to convince them to abstain from those influences," said Priyanka Kumar, program manager for Anchorage.

Another challenge is the co-ed environment. While men and women sleep in separate dorms, it is difficult to separate them during the day, and all programs are co-ed.

"We don't allow relationship-building here because you are not focused on your recovery, but we see that a lot. That's why our long-term goal is to have a separate program for men and women," said Kumar.

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The capacity for Anchorage is 56 beds for men and women, 20 of which are reserved for Corrections Services Canada (CSC). Some of CSC's clients receive treatment and attend programs while others stay as a condition of their release.

High demand for the program means waits of more than 30 days to get in.According to Kumar, the intake worker receives up to 100 messages a day from people wanting to secure a bed. Once the intake worker reaches a client, the average wait time is two to three days for an assessment, and then 20-25 days to get into the program.

Despite the challenges, those who make it into Anchorage are often successful. According to Kumar, 80 per cent of the program's clients make it to the end of the 30-day program, and many stay on. A client who is looking for additional help with housing and employment can stay up to 90 days.

Residential support vs. outpatient programs

For both Kumar and Melnuk, providing clients a havenfrom negative influencesis essential for recovery, but the Addictions Foundation of Manitoba (AFM) claims that a small percentage of addicts actually require a residential program.

"90 per cent of AFM's clients access non-residential treatment services, and many of them find that to be really effective," said Jennifer Faulder, a spokesperson for AFM.

One of AFM'soutpatient programs is amethadone clinic where patients receiveopiate replacement therapy,a treatment meant to stabilize clients.Reinecke said that while some addicts may seek immediate detoxification, stabilizing on methadone first yields better results.

"These patients just statistically don't do well staying clean, even if they go straight into a treatment program. We find that over time their cravings become overwhelming and they experience prolonged psychological withdrawal symptoms ... so most patients with opiate addiction who detox will eventually relapse," said Reinecke.

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Based on Reinecke's recommendations, a path to recovery for someone such as Erickson would likely start at HSC's opioid assessment clinic. The current wait time for that clinic is two to three months. Once assessed, thepatientwould be put on methadone and encouraged to seek other general recovery support while they wait for availability at either a residential recovery program or another outpatientprogram.

Wait times for outpatient programs in Winnipeg are also lengthy. For example, the Laurel Centre, which specializes in addiciton services and counselling for survivors of childhood sexual abuse, hasa two- to six-month waitlist for its group programs and a 30-month wait list for individual therapy.

Cost to Canadians on the rise

According to the Canadian Centre on Substance Use and Addiction, costs associated with addiction and substance use are rising. For example, hospitalizing people with substance use disorders cost $267 millionin Canada in 2011. That's up 22 per cent from 2006.

As someone who has seen the ultimate price of addiction, Ward saidthe problem will worsen until all three levels of government invest in services as well aseducate the medical community and the general public on where to get help.

"The system isn't working. It's not linking together properly and even hospitals aren't aware of all the treatment programs out there. They're going to have to start putting it on the radio, putting it on TV, making advertisements they make advertisements about people texting and driving all the time ... so why don't we start advertising where you can go to get help?"

When it comes to helping a loved one with an addiction, Ward saidnot to give up.

"Search out any programs you can find, for one. Don't listen to everybody who says there's nothing we can do, because there has to be somewhere and someone out there who can do something," she said.

Help in navigating publicly-funded addictions services in Manitoba is available through the Manitoba AddictionsHelpline:1-855-662-6605.

An online navigational tool is also provided by ManitobaAddictionAgenciesNetwork: mbaddictionhelp.ca.

If you have comments or concerns about addictions services in Manitoba, contact kim.kaschor@cbc.ca.