BC Centre on Substance Use Should Only Sponsor Evidence Based Conferences
The BCCSU is sponsoring the Recovery Capital Conference of Canada, which features physicians who use a “grossly unlawful and blatantly discriminatory” approach to treating employees with subsance use problems.
The British Columbia Centre on Substance Use (BCCSU) is a government funded organization with a mandate to develop, help implement, and evaluate evidence-based approaches to substance use and addiction. With support from the Province, the BCCSU is tasked with helping transform substance use policies and care, by translating research into education, training and evidence-based clinical practice guidelines.
The BC Ministry of Mental Health and Addictions refers to the expertise of the BCCSU to help inform public policy.
The BC College of Physicians and Surgeons, and other professional colleges in BC develop their registrant clinical practice guidelines for the treatment of substance use disorders by deferring to the expertise of the BCCSU.[i]
I find it extremely troubling then, that for the third year in a row, the BCCSU is sponsoring a conference whose guest speakers include physicians[ii]who use what a Vancouver lawyer has argued is a “grossly unlawful and blatantly discriminatory” approach to treating employees with substance use problems.[iii]
The Recovery Capital Conference is an annual conference taking place in New Westminster BC, on Sept 5 & 6, 2019. The conference is hosted by the Last Door Recovery Society, a faith based residential addiction treatment centre in metro Vancouver.[iv]
Promotional material for the conference claims that it will feature leading international researchers, clinicians, and policymakers who will provide evidence-based clinical knowledge gained through decades of care. This year the conference has expanded across Canada.
According to their website, the Recovery Capital Conference is targeted at physicians, occupational health leaders, human resources managers, health care policy makers, therapists, psychiatrists, psychologists, interventionists, residential treatment centre management and clinical teams, students, union leaders, community leaders, disability management coordinators, professional regulatory bodies, insurance carriers, labour relations specialists, employee assistance program providers, labour lawyers, safety committee members, union representatives, nurses, social workers, people with lived and living experience and families. A two-day ticket to the conference is six hundred dollars.
Health care professionals can receive continuing education credits for attending the conference. In past years the BC Minister of Mental Health and Addictions, Judy Darcy, has attended the conference, presumably to gather information to help inform public policy. The BC Centre on Substance Use is a “Title Sponsor/Partner” of the conference.[v]
The schedule of this year’s Recovery Capital Conference includes workshops on “Recovery Capital in the Workplace”, “Recovery Capital in Health Care” and “Workplace Monitoring”. The physicians who will be conducting these workshops are among a group of BC physicians who practice what they refer to as “Occupational Addiction Medicine.” They work in the private health care system and get referrals from employers who have concerns about an employee’s substance use.
The physicians assess employees for substance use disorder, make addiction treatment recommendations and determine if, when and under what conditions an employee can work.
Referrals are made to these physicians for people who work in construction, the trades, transport industries, government jobs, legal professions, health professions (including nurses and physicians) and other occupations that are considered “safety sensitive”. The treatment and monitoring recommendations that are made by these physicians are then enforced by the employer with the threat of job loss if the employee does not fully comply.
After diagnosing an employee with a substance use disorder, these physicians demand that the employee attends a prolonged 12-step abstinence-based inpatient addiction treatment centre, through the private health care system.
After completing an inpatient program, the physicians require that employees submit to a 2–5 year (sometime longer) medical monitoring agreement that requires complete and indefinite abstinence from all psychoactive substances, including when employees are not at work. Over the counter medications and medications prescribed by the employee’s primary health care provider for pre-existing psychiatric conditions are often not allowed. This is enforced through regular random biological testing.
The physicians demand that employees attend daily 12-step meetings, work with a 12-step sponsor, and complete a written series of the 12-steps.
Employees are required to attend private medical monitoring clinics that track their compliance with all of the treatment recommendations. These clinics are owned by the physicians and charge $400-$1000 per month to attend. [vi]
The physicians do not allow employees to undergo treatment or monitoring through the public health care system. If employees do not comply with all of these recommendations the physicians will deem them “unfit to work,” and they will likely lose their job.[vii]
The physicians mandate the same standardized treatment and monitoring regime regardless of the severity of the employee’s substance use problem and regardless of whether or not the employee’s substance use has impacted the work place. Even employees with no previous work performance issues, who voluntarily approach their employer asking for help regarding their substance use outside of the workplace, can end up with the same mandated treatment and monitoring conditions after being referred to one of these physicians.[viii]
Sometimes the mere suspicion of an employee having a substance use problem results in the physician mandating them into a multi-year treatment and monitoring agreement, costing the employee tens of thousands of dollars.
The physicians claim that an employee is not safe to work unless they comply with all of these recommendations. However, these assumptions are not supported by research evidence with respect to the relationship between people with substance use disorders and work place safety, and instead are based on stereotypes, stigma, and a misunderstanding of people with substance use disorders.[ix]
A systematic review of these standardized treatment and monitoring regimes showed that they are unsupported by scientific evidence, and that the existing studies examining them were of poor methodological quality, and were marred by conflict of interest.[x]
The physicians don’t allow for evidence-based interventions based on public health approaches such as, client centred collaborative care, brief interventions, harm reduction, moderation management, pharmacological treatments, or trauma informed care. Professional counselling and peer support groups such as SMART Recovery are not allowed as alternatives to 12-step meetings. Employees are not allowed to attend public residential treatment centres operated by the provincial health authorities. Employees are not allowed to attend outpatient treatment as an alternative to 12-step inpatient programs.
The physicians refuse to prescribe Opiate Agonist Treatments (OAT) for employees with opioid use disorders who work in safety sensitive occupations.[xi]This is despite the fact that OAT is the 1st line treatment for opioid use disorders, and failing to prescribe this medication puts a person with an opioid use disorder at increased risk for relapse, overdose, hypoxic brain injury and death.[xii]Research shows that people on a stable OAT dose, are not impaired and do not pose a safety risk to the workplace, even in a health care setting.[xiii]
A 2019 op-ed in the New England Journal of Medicine states that denying OAT to health care professionals who have opioid use disorders, is bad medicine, body policy, and discriminatory.
As well as refusing to prescribe OAT, the physicians do not prescribe any other pharmacological treatments despite the fact that there are highly evidence based medications for substance use disorder that are available to all other citizens through the public health care system. For example, Naltrexone and Acamprosate are evidence based medications for the treatment of Alcohol Use Disorder. However these physicians do not prescribe these medications to employees.
Treatment recommendations from the employee’s primary health care provider are often ignored or outright rejected by the physicians.[xiv]
When treating people who work in safety sensitive occupations, these physicians deny their patients the right to make their own health care decisions and use an outdated, one-size-fits all, unscientific and coercive approach. The physicians refuse to alter their treatment recommendations even if the patient finds that the treatment is not working for them and they would prefer another approach.
This is despite the fact that there is a large body of scientific literature that suggests that no one treatment approach for substance use disorders has demonstrated effectiveness for all patients. In fact, one of the most significant factors relating to the effectiveness of the program has to do with the patient’s relationship with the treatment provider. Refusing to allow other evidence-based treatment options will negatively impact the patient’s potential recovery.[xv]
“Furthermore, “Informed consent” is the most fundamental right of a patient to make their own health care decisions. This right is protected by law under the Health Care (Consent) and Care Facility (Admission) Act. These physicians claim that they are only giving treatment “recommendations”, but they use the threat of job loss to coerce employees to follow one particular “treatment” approach. This strips employees of their right to consent to treatment.
The BCCSU’s own treatment guidelines state that when treating individuals with substance use disorders, physicians should give them a menu of evidence-based treatment options to choose from. So, it is troubling that the BCCSU would sponsor a conference, knowing that a group of physicians speaking at the conference deny their patients the right to make their own health care decisions and force them into an outdated and harmful model of care- a practice that I have been trying to put an end to for the last 5 years.
The physician’s insistence that their patients attend 12-step programs is problematic. A 2006 Cochrane Review, the world’s most highly respected evidence-based medicine review group, reviewed studies going back to the 1960s and found that “no experimental studies unequivocally demonstrated the effectiveness of Alcoholics Anonymous or 12-Step approaches for reducing alcohol dependence or problems.”
Another study showed that when a person is coerced into attending 12-step programs, it can be harmful to the person and make their substance use problems worse.[xvi]
The 12-step programs originated in the 1930’s for white, middle-class, heterosexual, fundamentalist Christian, men with alcohol use disorders. The program is therefore not appropriate for a large segment of todays population. Many people view some of the core principles of the 12-Step program to be harmful, such as “admitting powerlessness” and taking personal responsibility for every negative event in ones life. This can be particularly harmful for women, LGBTQ2 people, racialized groups, survivors of abuse, and people who have been traumatized by religious organizations. There has been documentation of sexual predators using 12-step meetings as a hunting ground to prey on vulnerable women and girls.[xvii]
Twelve Step programs are based on religious principles that conflict with the core values and beliefs of many people in society. As a result, in the United States it is unlawful for a government actor such as a court, a prison, a parole officer or a government employer to mandate a person to attend 12-Step programs if they object for religious reasons.[xviii] However in British Columbia, this happens all the time.
Next year the BC Human Rights Tribunal will decide whether the Vancouver Coastal Health Authority violated the Human Rights Code by firing me from my job as a nurse after I refused to attend religious 12-step meetings. Addiction and legal experts from across North America have sent letters to the Tribunal supporting my case, and condemning the approach used by the physician whose advise my employer relied upon- the same approach used by the group of physicians speaking at the Recovery Capital Conference.
Not only does science not support the efficacy of 12-step programs, scientific literature does not support the notion that everyone who experiences problematic substance use must achieve complete abstinence in order to function effectively in their lives.[xix]
All of this calls into question the rational for these physicians continuing to force employees into 12-step abstinence-based programs, and the BCCSU giving its tacit approval of this practice
When questioned by the CBC about this practice, Senior Deputy Registrar of the BC College of Physicians Dr. Galt Wilson, stated that 12-Step abstinence-based treatment is the “community standard” used by physicians in BC to treat people with substance use disorders who work in safety-sensitive occupations. Dr. Wilson did however admit that there is a lack of scientific evidence to show that 12-Step programs are effective.
After the College of Physicians dismissed a complaint that I filed against a physician for forcing me to participate in a 12-step abstinence based treatment regime as a condition of continued employment, the Health Professions Review Board, an administrative tribunal that provides independent reviews of decisions made by professional colleges in BC, reviewed the College of Physicians decision.
In their decision, the Health Professions Review Board had concerns about how the College of Physicians determined that 12-step abstinence-based programs are the community standard:
“it would have been helpful had the inquiry committee discussed…what it meant by the term “community standard” and how it concluded that standard is “well established.”[xx]
Dr. Charlotte Ross conducted a PhD study(2018) through the Department of Health Sciences at the University of Simon Fraser, that examined the experiences of nurses who were subjected to the mandated treatment and monitoring approach that the physicians speaking at the Recovery Conference use.
Some of the nurses in the study found the treatment and monitoring to be abusive, to have an adverse effect on both their physical and mental health, and to actually exacerbate their substance use problems. If the nurses asked to follow an alternative evidence-based treatment regime, this was refused and they were chastised for being “non-compliant” and “in denial” of their addiction.
Nurses felt that being required to attend and pay tens of thousands of dollars to medical monitoring companies owned by the referring physicians, was a conflict of interest.[xxi]
Numerous complaints have been filed to the BC College of Physicians regarding this conflict of interest, all of which have been dismissed. The Health Professions Review Board reviewed one of these complaints and ruled that the physicians must at minimum inform their patients of their financial interests before referring them to companies that they own, or to other health care providers whom they are in business relationships with. The Review Board ordered the College of Physicians to issue a citation against the physicians if they did not agree to these conditions.
The financial toll of having to pay tens of thousands of dollars to the physicians medical monitoring companies has led to some nurses having to drop out of the program and leave the nursing profession. Because of the monitoring costs, some nurses couldn’t afford to pay their rent, and became homeless.[xxii]
Despite their outdated and harmful approach to addressing substance use in the workplace, this group of physicians who are speaking at the Recovery Capital Conference, are recognized as experts by all levels of courts and tribunals in BC. They are on provincial and national advisory boards, in positions of power with medical boards, health authorities, hospitals, universities and editorial boards of scholarly journals. They are regular presenters at workshops, conventions and conferences nationally and internationally. They consult with employers and unions to help them develop their substance use policies. Because of this, the outdated and harmful approach used by these physicians to address substance use in the workplace has become the norm in BC.
One of the physician speaking at the Recovery Conference consulted for the Interior Health Authority (IHA) to help them develop their substance use policy.[xxiii]
The Hospital Employees Union (HEU), which represents about 8,000 workers in BC, filed a complaint against IHA, arguing that the workplace substance use policy that the physician helped create, was unreasonable and violated the BC Human Rights Code.
The HEU argued that IHA made stigmatized assumptions and stereotypes about employees with substance use problems, denied them the right to consent to treatment, and singled them out for discipline without considering their individual circumstances. The HEU also argued that the policy forced employees to arbitrarily submit to a particular “treatment” regime (12-steps), imposed unreasonable financial burdens on them, reached beyond the confines of the workplace and intruded upon the private, personal and medical lives of employees.
In November 2018, an Arbitrator agreed that the Interior Health Authority’s approach to addressing substance use in the workplace was unreasonable and ordered them to overhaul their policy. Yet the physicians speaking at the Recovery Capital Conference continue to use this approach to treat employees with substance use problems.
Jonathan Chapnick, a lawyer who represented members of the Hospital Employees Union in their grievance against IHA, argued in a 2014 Paper for the BC Continuing Legal Education Human Rights Conference, that these approaches to substance use in the workplace are
“grossly unlawful and blatantly discriminatory. They are not evidence-based, nor are they reasonably necessary or demonstrably effective. Rather, they are rooted in pervasive stereotypes and misconceptions about employees with addictions, and are resulting in the further stigmatization of an already-marginalized population of workers. They are also extremely invasive of personal privacy and bodily integrity, and obscenely intrusive into medical autonomy and self- determination.” [xxiv]
In her PhD study, Dr. Charlotte Ross found that these approaches to substance use in the workplace for nurses
“do not allow, let alone emphasize interventions based on current public health approaches, instead they are entrenched in outdated understandings of substance-use problems as moral failing. Abrogation of the nurses’ basic rights to choose and to ethical, high- quality health care is wholly unsupportable. Nurses must be offered a choice of individualized treatment options based upon current scientific evidence. The accredited publicly funded treatment services already in existence and deemed appropriate for the public should be incorporated into The Program.…Potential and actual furthering of corporate imperatives, power imbalances, dual relationships, and conflicts of interest were rife in The Program” [xxv]
The archaic approach used by these physicians is affecting people working in construction, the trades, transport industries, government jobs, legal professions, health professions and people working in other “safety- sensitive” occupations. These physicians are denying employees the right to make their own health care decisions, refusing to use evidence-based approaches to addiction treatment, causing harm to employees physical and mental health, putting employees at risk for fatal overdoses, inflicting great financial hardship upon employees, and threatening their ability to continue working in their chosen professions.
The BCCSU is supposed to set the standards for best practices in treating substance use disorders in BC. The BCCSU has a mandate to help transform public policy so that it aligns with current scientific research. By sponsoring a conference, that showcases physicians who use this outdated and harmful approach, the BCCSU is giving its stamp of approval to an unscientific, grossly unlawful and blatantly discriminatory approach to addressing substance use in the workplace. The BCCSU is signalling to physicians, employers, unions and professional colleges, that it is acceptable to continue these outdated and harmful practices.
Unless Dr. Paul Farnan, Dr. Paul Sobey, Dr. Ray Baker and Dr. Jennifer Melamed are removed from the speakers list at the Recovery Capital Conference, the BC Centre on Substance Use should immediately withdraw its sponsorship of the event.
[i]Email from the office of Adrian Dix, BC Minister of Health
[ii]Dr. Paul Farnan, Dr. Paul Sobey, Dr. Jennifer Melamed, & Dr. Ray Baker are speaking at the conference. I have learned about the approach that these physicians use to treat people who work in “safety sensitive professions” from nurses who been treated by them, from the lawyers of patients who have been treated by them, and from the following online legal decisions that document their treatment approach:
Seaspan ULC v International Longshore & Warehouse Union, Local 400, 2014 CanLII 83893 (CA LA). (Dr. Sobey & Dr. Farnan) https://tinyurl.com/y59f4bts
K.G.P. v. D.B., 2004 BCSC 1733 (CanLII). Schuetz (Re), 2011 LSBC 21 (CanLII). (Dr. Farnan & Dr. Hedges) https://tinyurl.com/yydhj5om
Government of the Province of British Columbia v British Columbia Crown Counsel Association, 2019 CanLII 51802 (BC LA). (Dr. Melamed) https://tinyurl.com/yyc9tw99
British Columbia v. B.C. Government and Service Employees’ Union, 2002 CanLII 52883 (BC LRB). (Dr. Baker) https://tinyurl.com/y2xz28ta
City of Vancouver Board of Parks and Recreation v Canadian Union of Public Employees, Local 1004, 2011 CanLII 91477 (BC LA). (Dr. Baker) https://tinyurl.com/y34s67h4
J.P. v. J.L.S., 2005 BCSC 1383 (CanLII). Gayman (Re), 2012 LSBC 12 (CanLII). (Dr. Baker) https://tinyurl.com/y6rtlqj5
Gayman (Re), 2012 LSBC 12 (CanLII). (Dr. Baker) https://tinyurl.com/yynh8wh3
Health Employers Association of British Columbia v. Hospital Employees’ Union, 2010 CanLII 39411 (BC LA). (Dr. Hedges) https://tinyurl.com/y3jjyku9
This is a quote from a podcast that one of the physicians did- Dr. Ray Baker: “The evidence for 12-step efficacy is greater than any pharmacological treatment out there. “ at 08:14 https://aabeyondbelief.org/2018/06/13/episode-93-dr-ray-baker-the-science-of-addiction-and-recovery/
Dr. Donald Hedges is the physician that demanded that I participate in a 12-Step abstinence-based treatment and monitoring program or be fired from my job as a nurse. In addition to performing Independent Medical Exams (IME) for employees who have been identified as having substance use problems, Dr. Hedges is an “Addiction Physician” at the Last Door treatment centre, the faith based 12-step society that is hosting the Recovery Capital Conference.
[iii]Chapnick, Jonathan. (2014) “Beyond the label: Rethinking workplace substance use policies”. Conference paper: BC Continuing Legal Education Human Rights Conference, Vancouver. page 8.1.40
[iv]The Last Door Recovery Society is an addiction treatment centre in New Westminster BC that uses the faith based 12-Step philosophy as its foundation. Their website states that they are a “A Community that inspires recovery founded on the principles of compassion, trust, faith, integrity, diversity, fun and unity”.
[v]The BCCSU is listed as a “Title Sponsor/Partner” of the Recover Captial Conference. According to the conference website, a title sponsor has donated at least $20,000 to the conference. The Conference is hosted by the Last Door 12-step Recovery Society, and is sponsored by five other 12-step Recovery Centres. The Province of British Columbia, the Canadian Centre on Substance use and Addiction, and the St. Pauls Foundation are also listed as sponsors. There are no experts from the BCCSU speaking at the conference this year.
[vi]The for-profit medical monitoring companies that these physicians own, and require their patients attend, are also sponsors of the Recovery Capital Conference. Web searches and Board of Director documents show that Alliance Medical Monitoring Company is owned by Dr. Paul Farnan & Dr. Ray Baker, and Precision Medical Monitoring Company is owned by Dr. Jennifer Melamed
*After this article was published, the Managing Director of Alliance Medical Monitoring contacted me to inform me that Dr. Farnan and Dr Baker are no longer shareholders in Alliance Medical Monitoring Inc. According to the Central Securities Registrar, on April 15, 2016 Dr Farnan and Dr Baker each transfered 100 shares of Alliance Medial Monitoring Inc. to Sage Counselling and Addiction Services Inc. It is unclear what connection, if any, Dr Farnan and Dr Baker have with Sage Counselling and Addiction Services Inc. Janice Johnson, the Managing Director of Alliance, is also one of the owners of Sage Counselling and Addiction Services.
[vii]Ross, Dr. Charlotte A. (2018). An Institutional Ethnography of Substance-Use Practices Among Nurses and Related Management Intervention Practices in a Province in Western Canada. (Unpublished doctoral dissertation). Simon Fraser University, Burnaby, British Columbia, Canada. Chapter 4.
[viii]Ross, (2018). Chapter 4.
[ix]Chapnick, (2014). page 8.1.40
[x]Urbanoski, K. A. (2014). Workplace policies for employee substance misuse: An analysis of Interior Health Authority’s policy. Vancouver, Canada: Substance Use Disorder and Vancouver Coastal Health Authority’s substance Use Policy.(Cited in Ross. 2018)
[xi]Ross, (2018). Chapter 4.
[xii]A guideline for the clinical management of opiate use. British Columbia Centre of Substance Use (BCCSU)
[xiii]Braquehais, M. D., Fadeuilhe, C., Håkansson, A., Bel, M. J., Navarro, M. C., Roncero, C., … Casas, M. (2015). Buprenorphine-naloxone treatment in physicians and nurses with opioid dependence. Substance Abuse, 36(2), 138–140. https://dx.doi.org/10.1080/08897077.2014.996698
[xiv]Ross, (2018). Chapter 4.
[xv]Riest, Dan. Canadian Institute for Substance Use Research.
[xvi]Kownacki RJ, Shadish WR. “Does Alcoholics Anonymous Work? The Results from a meta-analysis of controlled experiments”. Substance Use and Misuse. Nov 1999;34(13):1897–1916)
[xvii]Brown Elizabeth. The Culture of Alcoholics Anonymous Perpetuates Sexual Abuse. Vice. Nov. 10, 2017.
[xviii]Inouye v. Kemna, 504 F.3d 705, 705 (9th Cir. 2007)
[xix]Dawson DA. Recovery from DSM-IV alcohol dependence: United States, 2001–2002. Addiction 2005;100:281–92. Sobell LC, Cunningham JA, Sobell MB. Recovery from alcohol problems with and without treatment: Prevalence in two population surveys.American Journal of Public Health. 1996;86:966–72.
[xx]Health Professions Review Board File: 2016-HPA-211(b)
[xxi]Ross, (2018). Chapter 4.
[xxii]After the Canadian Broadcasting Company wrote a story about my experience in the workplace substance use program for nurses, I was contacted by almost 20 nurses who had gone through the same experience. Many had to pay tens of thousands of dollars to medical monitoring companies in order to return to work. This was a great financial hardship, and because of this, some lost their housing or had to leave the nursing profession.
[xxiii] “In the Matter of an Arbitration Under the Labour Relations Code RSBC 1996 C.244 Between Interior Health Authority and Hospital Employees Union” page 8. Dr. Paul Farnan approached the Interior Health Authority and recommended that they develop a workplace substance use policy. He acted as a consultant to help them develop the policy:
[xxiv]Chapnick, (2014). page 8.1.40
[xxv]Ross, (2018). Chapter 4
Further Reading:
Simmons-Duffin, Selena. “For Health Care Workers with Addiction, Why are Treatment Options Limited?” NPR. Sept. 6, 2019. https://tinyurl.com/y4jl9a33
Glaser, Gabrielle. “The Irrationality of Alcoholics Anonymous” The Atlantic. April 2015. https://tinyurl.com/zwmwymg
Getlen, Larry. “How Alcoholics Anonymous Lied to the American People.” New York Post. April 13, 2019 https://tinyurl.com/yxlzekp3
