This Vancouver hospital is transforming addiction treatment

The firehose of news from America can feel like a lot these days. If you're trying to figure out what to make of it all, we got you. I'm Katie Simpson. And I'm Paul Hunter. We're correspondence here in Washington. Working just around the corner from where much of the action is taking place. Two blocks from the White House. And that's the name of our new podcast. For top notch analysis of US politics from a Canadian perspective, find two blocks from the White House every Wednesday, wherever you get your podcasts. Including YouTube. This is a CBC podcast. Sorry, my, my bus. No apologies necessary. I was actually a minute late too. Hi, how you doing? Good. How are you? Good to meet you. Good to meet you as well. I'm Dr. Brian Goldman. This is White Cop Black Art. And that's Jamie Ramsey. A young woman I've come to Vancouver to meet. Thank you so much for doing this. You're welcome. Happy to. Jamie has dark eyes. Medium-like brown hair parted in the middle. A practical leather shoulder bag at her side, and this. I'm currently 25 now. So I've always kind of drank since I was young, like since I was 15. But it started to get pretty bad. For the last, I guess, six, seven years, I've been in this really bad cycle of, you know, binge drinking from 9 a.m. until I pass out for five days straight and then having incredible withdrawals and just really bad anxiety attacks and just really having trouble getting out of that cycle. Jamie's smart comes from a middle-class background and she's also a binge drinker on a tenuous path to recovery. And she's not alone. In Canada and other developed nations, young women are the fastest rising group of people who binge alcohol. As an ER physician, I find this alarming because I see it all the time where I work in Toronto. They also see it here at St. Paul's Hospital where I've come to visit. I felt helpless to prevent patients like Jamie from coming back again and again, like a revolving door. That's what happened to her. I ended up calling an ambulance three to four times and was taken to St. Paul's or any sort of ER, I guess. And, you know, I was having hallucinations. I was in a very dire state of like withdrawal and there would be someone beside me that has a cough or like a common cold or a broken leg. And I didn't feel like it was the right place for me to be. I just didn't really feel comfortable. A lot of the doctors and nurses around didn't really take what was going on with me on an empathetic level. Like they didn't really understand how to treat me. In the ER, treating people with alcohol use disorder is our bread and butter. Yet we seldom get the kind of pointed feedback Jamie just told me, mostly because we seldom ask. But they did ask here at St. Paul's Hospital. And the result is a new program that's doing things differently and getting better results. It's called Road to Recovery or R2R. We'll hear a lot more from Jamie later in the show. Now, let's meet one of several passionate physicians behind the program. Nice to meet you, Jim Persons. Oh, welcome. We're here. We're here. Yeah, and lovely. Hi, my name is Paxton Bach. I am a addiction medicine physician here at St. Paul's Hospital in downtown Vancouver. So, historically, what we've had in British Columbia and I think in many parts in Canada has been not much of a system as a whole. Not much communication, coordination, and fluidity such that patients have had to navigate this on their own. And they have to put in enormous amounts of effort in trying to figure out where they need to be next, how to get there, what weightless to sign up for. There have been so many cracks that they can fall through. So, we're trying to build the system where they get to focus on themselves and their health needs. And the system will take care of the rest of it. Part of the power of what we have in the Road to Recovery Unit is a whole variety, different kind of pathways into the system. And that's sort of the whole point of this. We'll take this here with the stairs. The elevators here are maybe the oldest elevators in Vancouver. I know what that's like. I'm gonna, I'm gonna miss anything. So, with this hospital, but the 60-year-old elevators is not here. The R2R program started here at St. Paul's, a hundred-year-old hospital where we're taking the stairs because the elevators are often out of service. The hospital will be moving to new digs in 2027, but that hasn't stopped Bach and more than a dozen doctors who treat addiction here from innovating. R2R was built to handle not just people with alcohol use disorder, like Jamie, but high needs patients who frequently smoke and inject fentanyl and other synthetic street drugs, yo-yoing, from intoxication to withdrawal and back again. For patients, the prior system was fragmented and hard to access, especially at a time when they were too sick to jump through hoops. Bach has stories, lots of them. So, I remember seeing this young individual. He'd been on methadone, he'd been really well. At that point, he was seeking, he wanted to get back on his methadone, he wanted to access detox. In order to do that, he would historically have to start a methadone clinic, call various withdrawal management services. He wanted to go to treatment. That would be separate applications. He had to fill out. All of this was on him. He was 19 years old. He was homeless. He was dealing with an active substance use disorder and a presphere infection. He's sick. He's sick. So, we were able to start up on methadone clinic. One of our peers was able to take him down in the emergency room to get any biotics or his infection. We were able to find him a shelter bed. We were able to help him make phone calls to withdrawal management services. We were able to do a lot for him, but objectively, so many places he could still fall through the cracks. He had to go to the emergency room. He had to wait. He had to go to the pharmacy, he had his antibiotics. He had to get to a shelter. He had to get back to us for his methadone. He had to wait in the wait list for a withdrawal management facility. He didn't have a phone. So, contacting him to let him know when his time was ready at a detox facility. All of these were opportunities for him to fall through the cracks. And that was with pretty wraparound care. Like, we were providing him a level of service that was not really available in most places. And still, it was so obvious how many opportunities they were there for the plan to fall apart. There are three ways to gain access to R2R. Through the ER, a toll-free line called access central or a walking clinic. From there, clients can move to the new 25-bed R2R unit, where withdrawal is managed and a full team helps with addiction, housing, work, and family support. So, contrast that with what we can do now, where I would actually be able to walk down, meet him in the emergency room, ask him if he wants to come into the hospital, take him right upstairs to our unit, provide him the medical care he needs, start him on the medications he needs, connect him with social work, connect him with whatever downstream services he needs to here in this moment in hospital, and keep him here in a hospital bed or in a transitional bed, right up into the time when his name is called for the next step, so that he doesn't have to actually take care of the logistics and can focus on his own care. Well, that's what we can offer now through this program. It sounds like a small thing, but again, it's- No, it's not. You can get people a detox bed and nothing else after that. And even that, I would be impressed if you could get somebody detox bed within 24 hours. We make people work really, really hard to access treatment for substance use disorders. We make them work much harder than we would in any other area of medicine, and we see people falling through the cracks because of it. Your model is heart care, isn't it? Yeah, it's an allergy that I like to provide, so I'm an internist by training, so I worked in hospitals for my entire working life. If somebody, anyone in Canada, was to start experiencing crushing central chest pain, immediately people around them recognize that this is a sign of a heart attack. That's because we've been taught that. We've been taught that since we're very young. That's part of the prevention scheme is that we all understand kind of what the warning signs are. We call 911, we speak to a highly trained operator, and ambulance is on its way within minutes filled with their own highly trained individuals, and that individual started a medication before they even get to the hospital. Once they arrive at the hospital, you have this incredible team, which is assembled day or night to provide them with an angiogram and a stent, and all of the medications and all the care they need within minutes. We take this system for granted, that this is what happens when you have a heart attack, and quite realistically, if somebody was to overdose, and nearly die in most settings, they'll get given maybe some knock-in and a phone number, and ask to call and make an appointment the next day, or sometime that week, depending on when they can see them to access life-saving care. And that is the extent of the care that you'd be provided. What's at stake for that client who has to make all those phone calls and hope that they can get some place? This is a life-threatening condition, especially in the current air and the current environment of the toxic drug crisis, and we know how often people who are dying of overdose deaths have contacted the medical system in the days or weeks prior to their overdose death. We know that those contacts are happening frequently, and those are touch points and opportunities to try and link somebody to care, and we know we're missing that. And so how do we take advantage of those opportunities? How do we make sure that people have the care that they're looking for when it's in the time and place when they're looking for it? What can you do today for a client so that they might not die tomorrow? That is the forefront of my mind whenever I'm talking to patients. How do I keep you alive until tomorrow? There's a lot of physical discomfort, a lot of psychological vulnerability, and a lot of past experiences with the system that may not be kind. There's a lot of people who have interacted with the medical system or other systems in the past and not had particular good experiences, so we're really conscious of trying to make this a very safe environment for people. Helping to create that safe environment are pure support workers with lived experience, including people who come from indigenous backgrounds. People like Angie Thompson. Going into the hospital in Chiloweco a couple of times for an overdose, and they just said, "Yeah, she's just a junkie." You know, we don't give you meds that you want. There's nothing that we could offer drug seekers. They said that to my face. Yes. Angie Thompson's official title at St. Paul's is Indigenous Wellness Liaison. She's worked here for more than a decade. Starting as a peer support worker before becoming a certified drug and alcohol counselor. Angie's been in recovery for 27 years. Oh, so you know my language? I know Code White. Okay. I know Code Blue and Code White. I know Code Brown. When Roach and Recovery started up in 2023, she jumped at the chance to join the team where nearly half of the clients are indigenous. I speak of my own experiences, what it was like for me, because I used to be a downtown junkie homeless. So I give them that a little bit of an experience too, to give them hope. And they just like, "Look at me." And it was like, "Why do you are a downtown junkie?" Yes, I was. And the changes that I've made and the changes I'd like to help them go through by providing the emotional support. And at that moment, when you tell them you've had lived experience, what impact does that have on them, do you think? Because I'm Indigenous and a woman and a mother, that it's a huge impact with them. Because if I can do it, they have chances that they can do it as well. Angie was once on a similar journey to which clients can relate. She had run-ins with the law and lost her kids. She ended up in a women's recovery house. How different is this program? Huge. Everything that they have to offer here now is way better than when I had back then. I had no idea that they had detox. I had no idea that they had peer support. Today we have Indigenous Wellness Liaison that is supporting from hand over to hand over. At times myself, I would hang onto their hand. If they're in emergency, I'll go down and get them and bring them into detox. And they're really thankful for that. That really appreciative of the patients. I've heard all about the program, the standpoint of managing empty talks and opioid agonist therapy and addressing the socioeconomic determinants of health, and all that kind of stuff that I've been told that there's this Indigenous piece. And you're about that. So why don't you tell me what you bring? What I bring into this is I'm a translator. Doctors and nurses, when they're asking the patient's questions, the patients have no understanding about all the drugs like suboxone, methadone, gabapentin. Doctors are asking if you can give them a urine test. So they can figure out what you're on and what you're coming off of. So they help you with your detox and withdrawal. We know you start yourself because I've been there, done that. So we would like to make sure your meals give you more on your meal tray or we have vitamins or we have the doctors that are wanting to take you in for TCT scan. Because there's some other things that we like to know. I would wait probably the second or third day then I'll start offering them traditional foods, which is salmon, bison, seaweed, and the last one was ginger ale. It's traditional. And they love it because it brings them back. And then we also have sharing circles. They get in touch with their culture, how they were brought up. And they start remembering their names, remember their language. They start remembering the sacred space. They start remembering a lot of stuff. So they feel safe when I bring them to the sacred space. You're trying to teach people to love themselves? Yes, yes, it's not easy. Not for indigenous people, it's not easy. No, not easy. But with the help of people like Angie Thompson, it is possible. First year data from R2R shows that a great proportion of indigenous people are able to stick with the program. I feel good about doing what I'm doing. So I'm going to do what I need to do for myself. I want back to school. Got a good job. Good team. I love my life today. I have six grandchildren. Never dreamed of having not. But today I have six grandchildren. Yeah. What do you wish Canadians could know about the work you're doing here? I want everybody to know that we are all human. The trauma that we've been through, the reserves that they put us on. We need more treatment centers for the indigenous people. We need more detox for the indigenous people. We need more homes for families to go to where it's safe, cultural wise. Well, now they do know. So Angie Thompson, thank you so much for speaking with me. Thank you. Thank you for having me. Angie works with Dr. Paxton Bach and the other physicians to make indigenous clients feel safe. How unusual is a unit like this? There is nothing like this to my knowledge anywhere in North America. In North America. To my knowledge, especially at this scale, that provides that same kind of fluidity and that same continuity. I think that what we're doing here is a really important service for our community. But more than anything, it's proof of principle. We'll be right back. Hi there, Steve Patterson here, host of the debaters. The show or Canada's top comics take on the world's most important questions. This week, we're asking, is Shawarma the best late-night food? All right, time to wrap this up. Listen, wherever you get your podcasts. You're listening to Waco Black Art. This week, a new program in Vancouver called Road to Recovery provides seamless access to treatment for clients with alcohol and drug addiction. Since the program's launch in September 2023, 1,200 people and counting have had withdrawal management. B.C. plans on rolling out the program throughout the province. At the top of the show, we heard from Jamie Ramsey, who was 25 and struggling with binge drinking. A recent Canadian study found rising rates of severe alcohol liver disease, particularly among women between the ages of 18 to 40 and at a rate faster than in men. I met Jamie at St. Paul's Hospital near the Rapid Access Addiction Clinic or RAC, an outpatient walking clinic for people with alcohol and drug use disorders. Hi, my name's Jamie Ramsey. Right now, we're at the St. Paul's Hospital near the RAC clinic to talk about addictions and the Road to Recovery program. Tell me about your own personal journey with alcohol, how it progressed. So, it started to take a toll around the last year. The binge drinking and the actual addiction, not really serious. I was mixing it with my SSRI medication, which is very dangerous. But I started to get worried that I was going to have a seizure. And I would start to, like, on day five if I was having really bad withdrawals, my body would seize up in, like, really bad panic attack states. But it was also dizzy spells where I would kind of block out and, yeah, really, really scary health. Actually did lose consciousness. Oh, yeah, yeah, several times, yeah. Before you entered the RAC clinic, you had come to the emergency department a few times in alcohol withdrawal. What were those visits like? I just kept asking for attention because I'd be sitting there for hours and hours. And I was having really bad hallucinations and, like, paranoia. What kinds of hallucinations did you have? It kind of feels like there's bugs all over your body. And I was kind of hearing whispers, like, kept hearing people whispering around me. And I knew it wasn't real, but it feels really, really real when you're going through it. And so I kept pulling, you know, nurses and doctors aside. And I was trying to keep my voice down because I didn't want to free people out either. And what was the reaction? They said, "Oh, someone will be with you." And it was just, you know, just very much put to the side. And then finally, when I was seen, they're busy. And they say, "Oh, yeah, you were drinking." And then they would give me an out of hand. And then they check you out. And they go, "Okay, see you later." And they don't, you know, they know. Until the next time. Until the next time, yeah. You didn't see a social worker. You weren't plugged into a withdrawal program, a detox program, or an alcohol recovery program of any kind. Were you given places to call? No. Resources, not. No, nothing. Now check zone? Nope, not a thing. It can't be saved? Nope. Wow. Yeah, I didn't even know those things existed. I had no idea. Like, and that happened three to four times. I would show up to the ER. Same thing. You came to the RAC clinic. Yes. How did that come about? So, I think around the fifth time I'd called an ambulance. And this time I was really seizing up on the floor. I was just really, really scared for my life at this point. And so I called an ambulance. And I'd been drinking for about, I think, seven days at this point, day to night. Like, just the minute I wake up from passing out waste that I would start drinking again. And just the cycle continues. And the ambulance picked me up. And the paramedics said, you know, I think there's a clinic called the RAC clinic. And I'd never heard of it. She was like, well, it's connected to St. Paul's, which is the hospital route right now. And I was like, oh, okay. And she's like, would you like to go there instead? And I was like, I don't know. Like, I just really want to be seen by a doctor. I'm just really scared for my health. Like, I guess I could come after. Because I didn't really know the way it worked or the system. And she was like, okay, well, to make you feel better, we'll take you into the ER, we'll get you checked out, whatever. And then we'll have them take you up to the RAC. And as soon as, and this was like the quickest hospital experience I've ever had. So like, every other time I probably waited about eight to nine hours. And I came in and because they knew I was going to the RAC, they, you know, check my vitals within the first, like, 20 minutes. And I was good to go. And a doctor, I think it was a doctor, came down. That was, that worked at the RAC. And just immediately his whole persona was so different than what I was used to. And he just was immediately very empathetic. He also pulled me aside. Like, tell me a little bit what's going on. I know it's probably very personal and hard to talk about. But like, we need to know kind of what's going on. And so I told him everything. And he just was super respectful. And he was like, all right, follow me. It took me up stairs, like two flights of stairs up to the RAC, which I had no idea was there. And this visit was like immaculate. So I think I was there for about four hours. In that time, I saw a doctor, a social worker, a psychiatrist. I'm pretty sure. And I saw another, I think, just a counselor as well. And people were constantly checking on me. Were you having hallucinations at that time? Yes, I was. And so they were cognizant of that. And they were asking how they were. And yet, they were just reassuring you. Totally. So when the doctor took me up the stairs, he's like, so just so you know, the waiting room here is going to be very different than the ER. You know, all these people are here for addictions. And you know, we don't know what they're coming down off of. We don't know what state of mind they're going to be in. But that, to me, was very comforting to hear because I was like, well, that's perfect, because that's exactly where I'm at. And I, you know, it's just a lot more comforting to know you're surrounded by people that know exactly what you're going through. He just was like, yeah, I've been there. I've been there. I'm like, you know, 20 years sober. And yeah, I know what it's like. How do you feel when you heard that? Amazing. I felt I just wanted to cry. Like, I just was like, ah, that is just like the most comforting thing. And he's like, it's going to be the roughest few hours of your life. And it's going to, it's going to suck. And he's like, but you just got to go through it. And you're going to be fine. And like, you came to the right place. You're doing the right thing. And every single person, counselor, social worker, every person that came up to me was like, you're in the right place. You did the right thing. And we're proud of you. So what else happened during that first visit? They said, okay, so we're going to prescribe you with Gabba Penton, which is it helps with the withdrawal come down. And I'd never taken it before. And they were like, we're going to give it to you. And we're also going to monitor you as you take it. So I took the Gabba Penton. I was monitored. It helped really just relax me and get me through all the withdrawals. So they said, we're also going to prescribe you a knell checkstone. And we're also going to cover the cost of it. And then I also told them I was on my SSRI. And they said, we're also going to cover the next cost of that for you. Because they also knew that I was just like, terribly unemployed at this time, was having an awful financial crisis as well. They just, they were just checking all these boxes for me within two days. Like a total one step. Oh yeah, like it was crazy. And they made sure they were like, we're going to, we're going to hold you till you feel like you're good to go. But they were just keeping an eye on me. They were monitoring me. And they also, I left with about 10 pamphlets of meeting groups to go to, of free counseling or affordable, you know, group therapy. So they walked you through the aftercare? They walked me through the aftercare. They made the phone calls, you know, they, and they just were like, if you, if you need someone to hold you accountable, we can have someone message you and make sure that you make it to that meeting that you need to go to. Helping people like Jamie keeps Dr. Paxton Bach and his colleagues going. When they've been through this system over and over and over and over again in the past, the, the, I've had people break down in tears and start crying in that moment, when I can just walk them upstairs with one of our peers and take care of it. Transform it up for you too. Absolutely. It's, it's those, those stories, um, particularly in people who have had such challenges in the past that really, I think, keep us going, knowing that if we continue to offer people, the right kind of supports that we can, we can have an incredible impact. What keeps you up at night? I lay awake at night thinking about patients that I saw that day. I lay awake at night thinking about patients that I've got to know in the past that I haven't seen recently. I lay awake at night thinking of all of the opportunities that we have that we are not taking advantage of to make the system better and I lay awake at night thinking about all of the noise and the distraction that's taking away from our ability to adopt these solutions that we know work. There's opportunities there to do better and we're seeing the fruits of that right here, even in the early stages of the road to recovery program. Dr. Paxton Bach, thank you so much for speaking with me. It's my pleasure, Brian. Thanks for coming. There was one more thing I wanted to ask Jamie about her treatment so far. My training says that relapses a common part of recovery. Do you have a personal experience of that since being part of this program? Yeah, absolutely. I have a lot of addiction within my family as well. So I've been dealing with that. Yeah, I've had I have had a couple relapses since going through all this and it's been difficult because it obviously is, it's a very shameful feeling, especially when you feel like you're getting on the right track. I come back to the rack. It's been way, way less severe when I do relapse. Like I haven't had any insane, insane withdrawals. So you can just show up? Yeah, and that's what's so lovely too is that when I like any time I've come back, they're always encouraging. They're like, please come back. We want you here. Like you're not a burden to our system. You're not clogging our system. We want you here. Come back. They're actually involved with road to recovery beyond being a client. So you're kind of a peer advisor. Yeah, I would say so. Could you ever see yourself as a peer counselor? I would love to do that. Yeah, it's something I've always thought about doing and now that I'm kind of in this area of my life that I'm dealing with all this. It really interests me. Yeah. I know you've had your challenges. Life is a struggle. It's an ongoing struggle just as you're struggling with alcohol use. Yeah, yeah, it is. Right now I'm still trying to find a job. So I'm trying to kind of get my routine back. But I'm doing better. I've definitely cut down alcohol. I've been a lot healthier. I've been happier. But it comes in waves. So you try to find support where you can and talking to people that are going through hard times really helps as well. So you know, having those groups and stuff is really, really helpful. Well, Jamie Ramsey, I want to thank you for spending some time with me and talking about your own personal journey. And I wish you strength. And I hope you continue on that journey towards a happy ending. Thank you very much, Brian. I appreciate it. And it was very nice to talk about all this as well. Since I spoke with Jamie a few months ago, she has found work as a server. But she started drinking again. She wanted to share that with us so that people entering treatment understand that relapse is a big part of the disease. Jamie plans on heading back to the rapid access addictions clinic. It's a reminder that the aptly named road to recovery is as much about the road as it is about the hope for destination. I wish her well. That's our show this week. If you'd like to comment, email us at [email protected]. Whitecoat Black Art was produced this week by Jennifer Warren with help from Stephanie Dubois at Sameer Chabra. Our digital producers Ruby Blisa, our senior producers calling Ross. I'm Brian Goldman and I'm proud to bring you stories from the Canadian side of the gurney. See you next week.