21st century drinking in BC: more convenience, more government revenue and reduced harms?

On Friday January 31, 2014 the BC government endorsed all 73 recommendations contained in John Yap’s landmark review of liquor laws with the stated goal of modernizing BC’s approach to managing alcohol. Modern drinking in British Columbia will mean consumers are able to purchase and consume more types of alcohol and in more places. Bars, nightclubs and restaurants will be able to compete aggressively on price by offering happy hours; Canucks fans will be able to consume hard liquor while watching a game; festivalgoers will be able to purchase alcohol and wander freely as they drink it; shoppers will be able to buy alcohol with their groceries and parents will be allowed to bring their children into pubs.

The government heralds these and other measures as a way to free businesses and charities from cumbersome, out of date regulations. Interestingly, the media release is relatively silent on an encouraging swathe of other recommendations in the report that, while less politically appealing, make BC’s approach to alcohol also more responsive to health concerns. Mr Yap clearly heard the messages delivered during the review by individuals and groups concerned with health and safety, including those summarised in the CARBC submission.

We congratulate Mr Yap on his acknowledgement that alcohol is a major health issue and not just a matter for the economy, for tourism and government revenue. His very first recommendations concern the need to communicate the serious health effects of alcohol more effectively to British Columbians along with active promotion of the national drinking guidelines. The report even mentions the word “cancer”. This is critically important: at the present time the BC Liquor Distribution Branch has absolutely no mandate to acknowledge, address or monitor the health and safety consequences of the product it so efficiently distributes across our province. It will now be required to collaborate with health experts to design educational materials and, more importantly, consider how to price the many thousands of its alcoholic products so that: a) they are not too cheap and b) their price reflects their degree of potential harmfulness i.e. alcoholic strength.

Perhaps wisely, the government press release has not trumpeted the recommendations on alcohol pricing. It has used only cautious language stating rather timidly that the BC Liquor Distribution Branch should “consider” setting minimum prices according to the ethanol content of drinks and whether they are at “an appropriate level”. Such policies, while possibly the most effective available to government to reduce alcohol-related harm, are undoubtedly not quite as popular as the introduction of happy hours and less red tape for small business.

For the past eight years CARBC has been collecting and reporting indicators of alcohol consumption and related harms across 89 local areas of the province as part of the Alcohol and Other Drug (AOD) Monitoring Project. When Mr Yap’s report asserts that in 2011 there were 20,542 alcohol-related hospital admissions and 1191 alcohol-related deaths, those estimates were calculated by the AOD project team. They were also the basis of research published in the American Journal of Public Health identifying the significant positive impacts of minimum alcohol prices on BC hospital admissions. This same paper also identified negative but smaller impacts on hospital admissions from the increased availability of alcohol associated with the large increase in private liquor outlets that occurred between 2002 and 2006.

On the basis both of local and international research, if the government proceeds with only the more popular recommendations in the report, the net effect will be upward pressure on levels of alcohol consumption and increased harms. If the key recommendations for higher minimum prices based on ethanol content are fully implemented, the net effect will be reduced alcohol-related harms and increased government revenues. Maybe this is what 21st century drinking should be: more choices, more responsibility, more convenience and more financial incentives to produce, promote and consume less harmful products. Perhaps also more funds for treatment and prevention. We at CARBC will continue to watch and hope that the easier and popular policy changes will not be implemented in advance of those which are less popular but more effective in terms of protecting health and safety. Either way, we will observe and report the outcomes as they unfold.

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Authors (left to right): Tim Stockwell, Dan Reist, Kara Thompson, Gerald Thomas, & Kate Vallance

Five numbers that will change how you think about drug overdoses

Drug overdoses get a lot of media attention when a celebrity passes away, be it Cory Monteith, Michael Jackson or Anna-Nicole Smith. However, there is little discussion about how to ensure that people who use drugs live to see another day so that they can seek treatment if and when they choose to. Through the five numbers below, we share with you a harm reduction approach that educates people on how to prevent, recognize and respond to opioid overdoses.

308.

That’s the number of people who died in British Columbia in 2013 because of illicit drug overdoses. Opioids, such as heroin, morphine and codeine, suppress breathing which can  result in severe brain damage, and even death, due to lack of oxygen. We can reduce the number of accidental overdoses by educating the public on the factors that increase the risk of overdose, such as mixing drugs and alcohol.

 85.

That’s the percent of illicit drug overdoses that happen in the company of other people. Helping others learn to recognize the signs of overdose, and teaching them what to do in the case of an overdose, will increase the likelihood of being able to prevent death from overdoses. 

1.

That’s the number of minutes it takes for naloxone to start reversing the effects of an opioid overdose. Naloxone is a safe, prescription-only medication that has been used for decades by paramedics and in emergency departments to reverse the effects of an opioid overdose. Naloxone can restore normal breathing within 1-5 minutes of administration, but the effects may wear off in 30-90 minutes and the overdose may return. Naloxone cannot be abused, does not cause a high, and has no effect on the body if opioids are not present. We can prevent accidental overdose deaths by equipping people with naloxone and training them on how to respond to an overdose.

911.

That’s the number to call as soon as possible. Calling 9-1-1 is the first and most crucial step in overdose response. Medical attention is important even after naloxone is used. The effects of naloxone wear off and overdose may return, especially since some opioids (such as methadone and fentanyl) can last in the body for a long time. Naloxone only works for opioid overdoses and has no effects on other drugs or alcohol that a person may have taken; although removing the effects of the opioids helps in a multi-drug overdose. Medical professionals are trained to handle such situations.

55.

That’s the number of lives that have been saved by take-home-naloxone kits in BC since August 2012. The kits are distributed as part of the BC Take Home Naloxone (BCTHN) program, an initiative of the Harm Reduction program at the BC Centre for Disease Control that aims to prevent unintentional deaths due to opioid use. At participating sites, clients learn how to prevent, recognize and respond to an overdose, and eligible participants are prescribed a take-home-naloxone kit. After 17 months, BCTHN operates in 35 sites across BC, from large urban hubs such as Vancouver and Surrey, to smaller rural centres such as Cranbrook, Campbell River and Fort St. John. Nearly a thousand people have been trained including staff and volunteers at health and social service agencies, as well as friends and family members of someone who uses drugs. Over 600 kits have been dispensed to clients who use opioids and various resource materials are being developed to assist community partners increase the reach of the program.

For more info, visit towardtheheart.com/naloxone

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

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Authors: Ashraf Amlani (left), Harm Reduction Epidemiologist, BC Centre for Disease Control, and Jane Buxton (right), Harm Reduction Lead, BC Centre for Disease Control