Ten years ago, when I first investigated resources for supporting addiction medicine in British Columbia, the provincial government library, then in the Ministry of Labour, was in boxes in a basement in Victoria. As journal issues were received, they were put in a box and, when the box was full, it was taken to the basement. Dedicated staff, who had followed the library from its home in the Alcohol and Drug Commission, did actually retrieve items occasionally. This library has since been passed from ministry to ministry. Right now, it is in boxes in transit from the Ministry of Children and the Family to the Ministry of Health Services. Those familiar with addiction medicine will recognize the library’s problems. Addictions have been a political football for many years with various factions supporting, for example, enforcement, treatment, prevention, the disease model, and harm reduction. As new factions gained the fore, so provincial addiction services moved, bringing along the library. The latest reorganization of BC’s health care system reduces centralized addiction services and shifts responsibility to the five large geographic regions.
More recently, the necessity for collaboration across geographic boundaries and between various provincial ministries and levels of government has been recognized. Both the Lower Mainland Municipal Association report leading to this column, Regional Action Plan to Reduce the Harmful Effects of Alcohol and Drug Abuse (www.cnv.org/Committees/LMMA_DSC/LMMA_Action_Plan.pdf) and the 2001 Report of the Auditor General of Canada (see Chapter 11 “Illicit drugs; The Federal Government’s Role”; www.oag-bvg.gc.ca/domino/reports.nsf/html/0111ce.html/$file/0111ce.pdf) acknowledge how crucial is the need for coordination and balance. This column describes various resources now available to those in BC working in addiction medicine. It suggests a more coordinated approach is needed, and may be coming, specifically for knowledge about addiction medicine.
Some BC groups have successfully adapted to the changes in the substance abuse field. These organizations include the Kaiser Foundation (www.kaiserfoundation.ca; (604) 681-1888), which supports prevention initiatives and produces an annual directory, and the Alcohol-Drug Education Service (www.ades.bc.ca; (604) 874-0903), which has recently produced materials for school-based prevention activities tailored to various grade levels.
The BCMA Council on Health Promotion has been active through two subcommittees, the Addiction Medicine Committee and the Tobacco and Illness Committee. Most readers will know of the fine work of the Physician Support Program, [(604) 742-0747]. The BC Doctors’ Stop Smoking Program (www.bcdssp.com; (604) 638-2946) continues to provide materials and advice for physicians in supporting their patients in smoking cessation.
The College’s Methadone Program authorizes physicians to prescribe methadone and approves patients to receive methadone. Education is an important component. Three introductory workshops and one advanced workshop are held each year. The College also sponsors a number of chronic pain workshops and has information on its web site (www.cpsbc.ca) about chronic non-malignant pain management and about benzodiazapenes. For more information, contact the College at (604) 733-7758.
For dual diagnosis, mental health sources, such as MHECCU (Mental Health Evaluation and Community Consultation Unit, UBC Department of Psychiatry; www.mheccu.ubc.ca; (604) 822-7727) should also be consulted.
The provincially funded Prevention Source BC (www.preventionsource.bc.ca; Lower Mainland: (604) 874-8452, toll free 1 800 663-1880) provides publications to support prevention activities.
The Kaiser Foundation Directory of Addiction Services in BC is available in print on request from the foundation or on the web at www2.vpl.vancouver.bc.ca/dbs/kaiser/home.html. The Alcohol and Drug Information and Referral Service (Lower Mainland: (604) 660-9382; toll free: 1 800 663-1441) is available 24 hours a day, 7 days a week. For gambling, call the Problem Gambling Information and Referral Service (toll free: 1 888 795-6111).
For information on important Canadian organizations, contact us or visit our web site under Hot Links—Substance Abuse. Notable are the Canadian Centre on Substance Abuse and its National Clearinghouse on Substance Abuse and Ontario’s Centre for Addiction and Mental Health.
The Medical Library Service has a strong collection in substance abuse treatment. Recommended is the American Society of Addiction Medicine’s Principles of Addiction Medicine (2nd edition, 1998). Texts general and specific (e.g., dual diagnosis) covering all points of view are available for loan on request—free return postage. I note also a chapter on alcoholism by Dr Ray Baker of Richmond in the 2002 edition of Conn’s Current Therapy just published.
Many documents, especially government publications, are available on the web as well as in print. MLS can loan copies of the Treatment Improvement Protocol (TIP) series of 37 texts from the US Center for Substance Abuse Treatment’s Substance Abuse and Mental Health Services Administration, or they can be viewed full text at www.treatment.org/Externals/tips.html. A smaller Canadian series of best practice publications is available in print from MLS or full text on the Canadian Drug Strategy web site at www.hc-sc.gc.ca/hppb/cds-sca/cds/publications/index.html under “Treatment and Rehabilitation.” A large number of publications are available full text from the Drug Policy Alliance, formerly the Lindesmith Centre. A subject listing, including “Pain,” “Maintenance—Methadone,” and “Marijuana—Medicinal,” may be found at www.lindesmith.org/library/subject.html.
Finding journal articles
Addiction is a significant medical problem and, as such, is well represented in the MEDLINE database. Specialized databases include the Alcohol and Alcohol Problems Science Database (ETOH), online at etoh.niaaa.nih.gov; the University of Minnesota’s DrugInfo, online at druginfo.lib.umn.edu; and the CORK database, online at www.state.vt.us/adap/Cork/SectionDatabaseSearch.html. These databases can be accessed by skilled librarians at MLS or, for those in the mental health field, via Riverview Hospital Library (www.bcmhs.bc.ca/default2.asp?level1=Riverview+Library; (604) 524-7576). For Ministry of Health Planning staff, Ministry of Health Services staff, and regional public health staff, the Ministry of Health Services Library (www.hlth.gov.bc.ca/library; (250) 952-2196) can be contacted. It will soon have a good collection on addictions.
A BC centre for advancement of addiction knowledge and practice
And there is hope. The March 2001 document, Weaving Threads Together: A New Approach to Address Addictions in BC (www.kaiserfoundation.ca/ATG_Final_Report.pdf) proposes a British Columbia Centre for Advancement of Addiction Knowledge and Practice, incorporated as a society. The centre is described in a section titled “Evidence-based decision making.” Called for is “a provincial resource… to provide the service providers and decision-makers with information to guide best practice, strategic planning and policy development.” For those working across BC in addiction medicine, such a centre is needed to coordinate and strengthen existing resources with stable, unbiased services and collections. The evidence is recorded in the multidisciplinary research literature, both in print and, increasingly, electronically. It is hoped that the new centre will include a library dedicated to gathering, organizing, and providing access to this literature for BC. A fund of $10 million has been allocated by the provincial government to start this centre.
—Jim Henderson, Director
Medical Library Service, College of Physicians & Surgeons of BC
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