The trouble with PChAD (The Protection of Children Abusing Drugs Act in Alberta)

Jason Luan, the Associate Minister of Mental Health & Addictions for the current UCP government of Alberta made an announcement on January 23rd, 2020 opening a $9.1-million safe house to replace a temporary PChAD Protective Safe House that has been serving the local community of Red Deer, since 2006.  

At first glance this appears like good news, but there are many problems with the PChAD model. The Protection of Children Abusing Drugs (PChAD) Act is an Alberta law that took effect on July 1, 2006. The process allows parents, or a legal guardian, to petition the court for a Protective Court Order for their child to be taken INVOLUNTARILY to a “Protective Safe House” for detoxification, stabilization and assessment. The court order is for an initial 10-day period with an option to increase that stay by another 5 days if parents are willing to go back to the court to apply for the extension.

I cannot begin to explain how trying the PChAD process was for myself and my then 16 year old daughter Zoe. After an emotional disclosure of circumstances with an AHS counsellor, I was given a requisition to present to Alberta Law Courts to secure a hearing with a judge in a family courtroom. The courtroom is filled with family court cases and you are sworn before the judge to speak about your child and explain the circumstances that have led you to this desperate point of involuntarily admitting your child. Others in the courtroom are listening to your situation and the atmosphere is incredibly intense. The judge in my case, made me feel very uncomfortable and I felt that his questions were derogatory. I was made to feel like I was a horrible parent as I tried to explain my child’s situation and addiction in order to receive the court order. This procedure was like nothing I had experienced before and I felt completely victimized. Once the judge granted the court order then I was instructed to connect with the Protective Safe House to secure a bed and advised that I generally had 24 hours to get my daughter to the safe house either voluntarily (ideal, but not always possible) or to involuntarily transport her to the safe house. In my daughters’ case we had to coerce her and have the police escort her there.

She was extremely angry and felt very violated by what we had done. To be honest I felt just as angry and violated by the system myself. Detox was very difficult and dangerous for her as is with most people going through it. The staff at the safe house was pleasant, although they wouldn’t give us a lot of information citing privacy issues. We tried to visit her, but she didn’t want to see us. I thought about applying for the extension for another 5 days, and hoped to get some kind of input from staff to see how she had done over the 10 day detox, but that didn’t happen and they couldn’t divulge any information to me so I was in the dark about what to do. When Zoe finally agreed to see me, she begged and pleaded with me not to apply for the extension, so I didn’t. After 10 days, she was released in my care with a treatment plan that was not shared with me, again for privacy issues. The staff told me that Zoe would have to share the treatment plan with me. Sadly, my husband and I brought her home knowing that the 10 day detox process had not been successful. She left in the middle of the night while we slept and met up with another youth that she had met in the protective safe house during their stay there together. They were both arrested the next day trying to steal liquor from a liquor store in the town where the other girl lived. This was my daughters first arrest and created a lot more problems for her moving forward from this experience. In the end, two PChAD court orders failed my daughter. She died on November 7, 2016 from fentanyl poisoning less than 4 months after she had turned 18.

The evidence (https://www.cmaj.ca/content/190/41/E1219 clearly demonstrates that involuntary treatment does not work. The reality Is that adolescents also have rights and forcing them into institutions against their will, will only produce more harm than good.

In June, 2018 The Office Of the Child and Youth Advocate released a 52 page investigative report to the then NDP government in Alberta entitled: INTO FOCUS: CALLING ATTENTION TO YOUTH OPIOID USE IN ALBERTA. The report investigated 12 youth (1 of which was my daughter) who had access to the PChAD program, not only once, but several times. All 12 of these youth died.

Several recommendations were made in this investigative report including the following with regards to PChAD.

Recommendation 5: The Ministry of Health should undertake a review of the Protection of Children Abusing Drugs (PChAD) Act and its policies, so the related services better meet the needs of young people and their families.

The OCYA investigation and its recommendations were lost in the 2019 election and change of leadership in AB, and it’s a shame because the youth in this report who slipped through the cracks DESERVE BETTER, and the youth who have died since and their desperate families deserve better.

More access to a program that is flawed and has failed youth and their families is NOT helpful.  Before any more support is given to PChAD, a review should be conducted of the act and its policies. The current UCP government has set up review committees on a variety of other things, since taking office – a review of the PChAD act should be a priority before putting youth into a dangerous situation.

Minister Luan, I ask you how many more youth do Albertan families have to bury before the PChAD order is reviewed and the recommendations are implemented?

Angela Welz - Zoe’s Mom

Zoe - Age 14

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"The Day" by Jenny Churchill

Jenny’s son Jordan Wakelam

"The Day"...2 years ago today my beautiful boy died of a fentanyl overdose.

His friend drove him to a guy's house and waited in the truck. Jordan came out and within 2 blocks, he was nodding out. "He didn't know".

His friend drove to a fast food place and Jordan could barely stand-up while waiting in line. "He didn't know".

His friend dropped him off at another friend's house; he stumbled out of the truck. "He didn't know".

Jordan walked in the house and said he felt sick. "She didn't know".

He went to the bathroom and stayed there for 3 hours. "She didn't know".

She heard him snoring; she thought he was sleeping; he was dying. "She didn't know".

When he stopped snoring, she attempted to open the door but his body was against the door. "She didn't know".

She eventually got the door opened and saw that he wasn't breathing. "She didn't know".

She called 911 and attempted to save his life. "She didn't know".

He died on that bathroom floor.

"They" didn't know the signs of an overdose.

The young man came to our home a few days after Jordan died with a half-dead orchid he picked up from Safeway. He was hysterical; he was beyond sorry; he truly didn't know. I believe him.

The young woman came to our home a few months after Jordan died. She cried and asked for forgiveness. She truly didn't know. I believe her.Jordan was in recovery for 3 months. These two young people were friends from high school that Jordan reconnected with during his recovery journey. They had no knowledge of what an opioid overdose looks like.

PLEASE take every opportunity to share the signs of an overdose. I lost my son and will remain heartbroken forever. The young man and young woman will spend the rest of their lives feeling the emotional pain of "not knowing".

#NaloxoneSavesLives,

#KnowTheSignsOfAnOverdose,

#ImissMySonSoMuch

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Exposure - after my son died

By Kym Porter, Medicine Hat Alberta

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Exposure

The Visit

Cop at the door
Cop at the door
Wonder what he’s here for
Run away, run away
Then don't have to hear him say
…Dead

The Blanket

A covering, a protection, a shelter, a gesture of kindness
She came downstairs and placed one over my son, thinking him
asleep.
her not knowing he was leaving soon, as he lay on his living room floor with fentanyl poisoning his veins, stopping his heart, starting our loss.  And even so, I am grateful.

Leaving

Did a bird sit on your shoulder and sing for you as you left this earthly place?
Did he  take away any fear you might have had for your leaving?
Was the song sweet and short and strong?
Did he help pull you up from your collapse?
Is he there with you still?
What is the new song he sings?

The Last Touch

When they finished your autopsy, did one of them rest their hand on your body in a tender gesture?
Did the attendant who pushed you into the fire for  your cremation say a gentle good bye?
Were you more than just a fentanyl overdose to any of them?
I wonder.

The Morgue

I went to the morgue. You were purple and still. I did not expect that. You looked relaxed. Your arm was up over your head. I keep remembering that. I wasn't allowed to touch you. Two security guards stood and watched, their thoughts, perhaps, on dinner.

Your Last week-

Thinking to your last week on earth.
You didn't know
We didn't know
What was it like?
You were here on your last day alive
Did you feel safe
Did you feel loved
You were busy texting a deal
You left quickly,
You had money and a need
Kevin saw you last, he drove you home
What was your last meal
Did you feel the end was near
Where are you now

Dear Neil

I saw a fellow get out of a truck with a dog today. I knew it had to be Rod.   I had never met him. He said at work they talk about you everyday. He asked how I am doing.
I said goodbye and then cried and cried. I didn't want to let him walk away. I felt like I was with you.  He said, the dog ate your lunch. We laughed.
Love Mom

Exposed

my grief has rubbed me raw
all my vulnerabilities are exposed
all my judgements
all my jealousies
all my unkindness’
so difficult to live with
knowing i have such thoughts

Words

Sometimes my words sound so reasonable- I’m unsure whether I mean them or not.

Letter to the City of Medicine Hat

There is an Adirondack chair in my backyard.
It faces a memorial garden I have planted for my son.
I never seem to be able to sit in the chair and face that garden.
My son, Neil, was 31 when he died alone of a fentanyl overdose two years ago in Medicine Hat.
He was my first born, my only son.
He grew up playing sports, reading comics, going camping and he also lived with a substance use disorder.
He graduated from Monsignor  McCoy High School, attended MHC and worked as an Emergency Medical Technician as well as at a home for people with disabilities, did construction work and at the time of his death, was employed by the City of Medicine Hat. He was a generous soul, always looking out for the less fortunate. He had many friends as he was easy going and had a wonderful sense of humour. People were drawn to his kind and thoughtful ways. He had his own apartment and an extensive book collection. He loved a good steak and a big glass of milk. He hugged you when he met you. He also struggled for years with  mental health issues and with his addictions. At the time of his death, he was seeing a counsellor and a psychiatrist. He had attended a detox program. He had overdosed numerous times and was always found in time to be saved...until he wasn’t. He hid his health needs from most as he lived with immense shame. He left behind a village of people trying to help him.  My son was ill. His illness did not make him a person to be feared, it made him vulnerable and in need of appropriate support.. 
As citizens of Medicine Hat, I believe we have a responsibility to be ‘the village’ for the vulnerable in our community.
Signed,
Another grieving mom

The Teaching...

Tough love

The Learning

Death

The Lesson

Don't trust in the teaching

Dreams -

I had planned on recording my dreams after you left.
I started a dream journal. I told myself I would be diligent for a year.
I was but my dreams weren't and so the journal sits naked at my bedside.

letting go

do not get fooled into thinking letting go is for the living.
letting go is for the dying
once gone, we are sometimes told to let them go.
they are already gone, there is nothing to let go of.
We, the living, on the other hand, must hold on.
We must hold on to them as they are a part of who we are.
To let go would be to be fooled.
A slight of hand offered but not to be accepted.

Police notes

Your son is not the first, nor will he be the last to die of a fentanyl overdose in this community
He belonged to a Sub culture
No one tells you your son overdosed previously because of foip. They are afraid of losing their jobs
And so instead we lose our children.
He was somebody's someone.
My someone
My first born
My son

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In an effort to help politicians and policy makers understand the human cost of the overdose crisis and why we urgently need to preserve and expand life saving harm reduction measures, including supervised consumption services, #MSTH leadership member Kym Porter has publicly shared the following excerpts from her private journal she wrote following the death of her son Neil.

In defense of supervised consumption SCS in Alberta

By Dr. Elaine Hyska, re-posted from Twitter (January 21, 2020) with permission.

This is a response to Alberta Premier Jason Kenny’s stance against supervised consumption services (SCS) and his claim that in the past few years investments in AB were only in harm reduction and treatment was ignored.

MSTH would like to thank Dr. Hyska for this detailed and evidence based analysis that provides important context to the discussion on the fate of Supervised Consumption in Alberta.

#ABleg #ABpoli #ABhealth #SCS

Since 2017 Alberta heavily invested in new *treatment, prevention AND harm reduction* programs. Now in 2019, OD deaths are steadily declining. Cutting effective interventions could undo this progress and put more lives at risk . [The premiers position is stated in this article by Global News].

Between 2015 and 2019 the # of Albertans engaged in (gold standard) medication treatments for opioid use disorder grew from ~4200 to ~11,000; and AHS added 4000 new treatment spaces across the province. {See AHS infographic]

The province also opened 7 community-based supervised consumption services, which have collectively supervised over 307,793 visits with 0 deaths and 4587 overdoses reversed as of Sept. 30 2019.

Note the SCS stats below exclude visits and overdoses for 2 other SCS: a hospital-based service in Edmonton and Red Deer's (provincially funded) overdose prevention site.

Further, almost 200,000 naloxone kits have been dispensed to date by community-based harm reduction service providers, pharmacies, AHS, and other sites.

These investments were made on the best available evidence, which tells us that the most promising strategies for averting overdose deaths at a population level are 1) naloxone kits, 2) treatment w/ medication, and 3)supervised consumption services.

Collectively, these 3 strategies have been estimated to have *averted 3030 overdose deaths* in British Columbia between April 2016 and December 2017 [See Research article by Irvine and others, 2019). You can see from the results of study below, that SCS (or overdose prevention sites) contribute a smaller but still significant proportion of deaths averted. It is thus very distressing one of the few strategies shown to save lives could be defunded in Alberta.

Beyond these 3 interventions, the previous government funded community-led prevention efforts, reductions in inappropriate opioid prescribing, and introduced long overdue consumer protections for people seeking care in private residential addiction treatment facilities.

Their overdose response plan was expert-led (by the MOERC, which (full disclosure) I Co-Chaired alongside the province's Chief Medical Officer of Health. You can read all 32 recommendations implemented here:

The new gov't has announced funding for 4000 new treatment spaces. Details are still to be determine, but this appears to be new residential treatment spaces, which though helpful for many w/ addiction, are not very effective for treating opioid use disorder or reducing deaths. In fact, some evidence suggests that periods of abstinence associated with short-term residential treatment and detox programs can actually increase someone's risk of overdose death (due to decreased tolerance and high rates of relapse).

Every overdose death represents a friend, family member, or neighbour. With so many loved ones grieving across Alberta, I hope the current gov't will recognize the value of saving lives and reconsider the wisdom of cutting these services.

The Decade that Changed My Life Forever

By MSTH co-founder Petra Schulz

This was the decade that changed my life forever. Losing my youngest son Danny (25 years young) to fentanyl poisoning after trying to help him deal with problematic substance use, without the right tools and knowledge.

This was the decade when I learned that people who use drugs, like Danny, don’t make bad choices and that I am not a bad mom. Instead I learned that we have seriously flawed and harmful drug policies that have caused thousands to die from substance use related causes in Canada.

This was the decade when I learned about #harmreduction and it’s role in saving lives and building relationships. Too late for Danny, not too late for others. We need ready access in all provinces. #RecoveryWorks as long as we have harm reduction.

This was the decade when the most tragic event in my life led me to the best people. My MSTH co-founders Leslie McBain and Lorna Thomas, all the other great advocates in #MSTH and the many harm reduction friends locally, nationally and globally. You give me strength and hope.

The next decade must be the one that brings change. We are losing a generation & the dying needs to end. We need #safersupply, and decriminalization, ultimately legal regulation. We stand in solidarity with our allies to end the #WarOnDrugs, a war on the people we love. Happy New Year!

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