Joan Gadsby's Letter
to Lillian Bayne
July 17, 2000
Market-Media International Corp.
4507 Cedarcrest Ave., North Vancouver, BC, V7R 3R2, Canada
Phone: (604) 987-6064 Fax: (604) 987-6063
July 17, 2000
Ms. Lillian Bayne
Regional Director General
West Health Canada
Room 235
757 West Hastings Street
Vancouver, BC V6C 1A1
Fax: (604) 775-8716
Dear Lillian,
Re: Consulting Proposal - Strategic Action Plan Benzodiazepines (Tranquillizers and Sleeping Pills) - Health Canada
Further to our meeting on July 6, 2000, also attended by Lorraine Cameron, Regional Coordinator, Status of Women Canada, and as requested, this letter outlines my consulting proposal to develop an integrated and detailed strategic action plan for Health Canada to address the serious and continuing problem of benzodiazepines.
As discussed and as you aware, these drugs are very addictive legal drugs prescribed by doctors beyond established guidelines with very significant and adverse short and long term side effects.
This long standing major health issue has considerable socio-economic and political implications in Canada and internationally, which costs millions of dollars and affects the quality of life of hundreds of thousands of men and women (of all ages), who become "accidental addicts".
In 1981, Health and Welfare Canada published a guidebook, "It's Just Your Nerves" and in 1982 published and distributed a lengthy document entitled "The Effects of Tranquillization: Benzodiazepine Use in Canada" (which I referred to in our meeting) both expressing considerable concern with benzo use in Canada, extent of use, inappropriate prescribing, contraindications and serious side effects etc.
Regrettably, since these publications were produced and distributed, Health Canada (whose mandate is to protect the health and safety of Canadians) and other stakeholders have done minimal to address the issue of misprescribing, misdiagnosis and mistreatment surrounding these drugs, which has reached epidemic proportions in Canada.
Note: I discussed this latter publication in May this year with Monique Begin, former Health Minister for Canada in 1982, who is astounded at the lack of action after almost 2 decades.
I. Background
There are 4 elements of the benzodiazepine problem (i.e. Valium, Librium, Dalmane, Restoril, Serax, Ativan, Rivotril etc).
Unnecessary prescribing beyond a short term if at all (2-4 weeks is stipulated in guidelines dating back to the early 70’s and 80’s) and 7-10 days by Health Canada.
Serious and often dangerous side effects including paradoxical agitation, increased behavioural disinhibition, impaired new learning, cognitive impairment, decreased short and long term memory, impaired psychomotor functioning (leading to accidents and/or falls), rage, suicidal ideation, creation of psychiatric symptoms i.e. appearance or worsening of depressive symptoms, dementia, floppy baby syndrome, emotional anesthesia, unintentional overdoses, toxicity, addiction and cross addictions to alcohol and other drugs.
The severity and extended duration of withdrawal effects, both acute and protracted lasting up to 2 years or more (depending on years of use).
The potential for organic brain damage and potentially permanent cognitive impairment. Research has shown that 52% of patients on therapeutic doses of benzos long term suffer a gradual intellectual deterioration.
Unfortunately, most recipients of these prescriptions and repeat prescriptions for years are unaware of these deleterious effects on their lives and their families trusting in their doctors to "do no harm" and thinking they need these drugs to help them stay calm, to cope or to sleep.
The serious implications of prescribing these legal drugs beyond short term and for intermittent use only has been known for over 2 decades. (Reference various research papers included in my book "Addiction By Prescription" which is internationally endorsed by experts.)
As in the rest of Canada, in British Columbia, we have a significant problem with not only seniors (23% of whom receive repeat prescriptions for years - 27% on the North Shore) but an estimated 10% - 15% of the population from young teens to all ages are prescribed these drugs, with two thirds being prescribed to women. All of this has been identified and documented in extensive Canadian and provincial research, including concerns expressed by the Chief Medical Health Officer for British Columbia who strongly recommended an awareness campaign to address the issue, the British Columbia Auditor General in his report on appropriate drug utilization, the Women’s Health Bureau etc.
A research report released in May 1999 revealed that in 1997, benzo prescriptions continued to surpass all other prescriptions for women exceeding cardiac drugs, anti depressants and estrogen. The question this all raises is WHY is this continuing?
The high cost to our socio-economic system with indiscriminate prescribing and usage of these drugs includes career devastation, family dysfunction, workplace safety, productivity losses, car accidents, falls, lost years of peoples lives, lost lives, costs to the legal and justice system, social welfare costs, emergency admissions, detox facilities and increased overall costs for healthcare and other addiction counselling professionals.
How has this been allowed? Pharmaceutical companies as you know, have spent millions of dollars over the years marketing and promoting these drugs, and physicians regrettably have bought in. Many of these doctors have been slow (or in denial) in upgrading their knowledge, or have been resistant to change.
The Pharmaceutical Manufacturers Association of Canada, in an extensive public relations article in the Globe and Mail in April 1997 acknowledged this and that there is "...an urgent need to educate the medical profession" with "...some of the worst problems of inappropriate prescribing occurring with well established medications such as benzodiazepines - tranquilizers".
My commitment to this project as you are aware, stems from personal experience when after the death of my son from a brain tumor in 1966 I was prescribed benzos for over 2 decades by my former family doctor. It was not until shortly after I nearly died of an unintentional overdose February 1990 that I found out the ramifications and serious effects of these drugs and went through a harrowing protracted withdrawal for 2 years. In the past decade I have completely rebuilt my physical, mental and emotional health at considerable cost to my life, my family, career and financial security. (This horrendous experience has cost me more than $1.4 million to date in lost income and assets.) My life today, 10 years off the drugs is tenfold what it was.
II. Project Objectives
To develop an integrated and detailed strategic action plan for Health Canada which is multi stakeholder focused i.e. government, consumers, doctors, pharmaceutical companies, pharmacists, and other healthcare professionals.
Specifically, to reduce prescribing of benzos (a) to existing repeat and long term users and (b) to limit the duration of use (in accordance with short term guidelines) to potential new users who may be prescribed these drugs.
To identify obstacles to reduced usage of these drugs with specific solutions by stakeholder groups.
To encourage positive partnership solutions amongst the key stakeholder groups.
To investigate and report on policies regarding these drugs and practices providing recommendations for remedial action - short term and long term.
To increase awareness of the serious adverse side effects of these drugs amongst consumers who can then make informed choices. Educational and preventative materials and tools to be recommended and to be developed (in the second phase of the project - implementing the strategic action plan).
To liaise with and obtain concurrence amongst key medical and healthcare professionals who recognize the problem and who are working to address the issue (i.e. Therapeutics Initiative, chemical dependency doctors, the Canadian Medical Association, the Colleges of Physicians and Surgeons etc.) and to develop realistic, phased in solutions to doctor education directed at changing doctors’ prescribing habits.
To develop a training program and educational workshop on benzos for Health Canada and other stakeholders for implementation across Canada.
To identify private sector and alternative funding opportunities to develop and implement the benzo awareness program (i.e. corporate community, pharmaceutical manufacturers, non profit organizations and foundations.)
To illustrate leadership and commitment to addressing this problem.
To identify other government collaborative opportunities for funding and to implement the strategic action plan (in the second phase of this project initiative).
III. Project Methods
Approximately 90% of the salient research (nationally, provincially and internationally) I have already investigated and documented regarding benzos and the roles of the various stakeholders over the past 9½ years. Further meetings and interviews with key people and organizations are anticipated and will be part of the strategic action plan. The project will be consensus building oriented amongst the key stakeholders and an Advisory Committee will be organized representing all stakeholders. To maximize the effectiveness of the strategic action plan key Health Canada contact personnel will be identified who have a commitment to addressing the problem. Their input will be encouraged and reflected in the strategic plan.
IV. Potential Problems
Resistance to change, Medical Community feeling threatened.
Budget restrictions.
Lack of commitment and leadership to resolving the problem.
("Turf" protection).
Time constraints.
Medical expertise to assist existing long term and other users of benzos during the withdrawal stage is limited.
Treatment and detox facilities for benzo withdrawal (which is documented to be worse than heroin or cocaine) are limited.
Resistance to change, Medical Community feeling threatened.
Note: All of the foregoing potential problems will be addressed openly and collaboratively and with consensus building techniques amongst the key stakeholders in the process of developing the strategic action plan in order that "win/win" solutions can be achieved.
Development of the strategic action plan on benzodiazepines requires stakeholder "buy in" and a commitment to implement the resulting conclusions and recommendations in a timely, planned and phased in manner to ensure that the momentum for change is not lost or that the report is not put on the shelf.
V. Project Product
A detailed and integrated strategic action report with Executive summary, Conclusions and Recommendations identifying tangible and realistic solutions to the problem by individual stakeholder groups will be produced.
Detailed recommendations of awareness building and educational tools will be developed and implemented (primarily in the second phase of the project).
A coordinated, comprehensive strategic plan of action with recommendations for monitoring change and progress towards achieving identified goals to resolve the problem will be included in the report. Consultant will make a presentation of the report’s conclusions to Health Canada upon completion and to other stakeholders as requested.
VI. Benefits of the Strategic Action Plan
A blueprint - i.e. for every $1 spent on education an estimated $6-$8 can be saved in future costs.
Millions of dollars in the socio-economic system can be saved i.e. in health, addiction, social welfare, justice system, in the work place (refer to high costs list page 2).
Savings in expenditures in the future for addiction services including treatment.
Health consumers focused on wellness and health promotion and making informed choices. Improved quality of life for hundreds of thousands of people.
Sourcing of not only public sector funding but private sector and alternative funding.
Costs to the Federal Government and other agencies/organizations caused by usage of these drugs i.e. job loss, family dysfunction, floppy baby syndrome, social welfare and violence will be reduced.
Positive public/private sector partnership solutions to this long standing problem amongst the key stakeholders will be developed, acknowledged and addressed.
Leadership shown by Health Canada will benefit other Federal Government Departments financially (i.e. reduced costs), the financial health of the economy as a whole and will serve as a model Canadian program for implementation across Canada.
VII. Why Select Joan Gadsby as Project Consultant
20 years of diversified senior business experience in strategic marketing and planning, economics, public affairs, communications and issues management with 4 of Canada’s largest companies.
Public sector experience - 8 years as Director of Planning and Development for the BC Liquor Distribution Branch.
President/Owner of Market Media International Corporation which provides with senior contract executive associates consulting services in strategic marketing and planning, government relations, communications and issues management to a wide variety of private and public sector clients.
Former elected poll topping Councillor, North Vancouver District for 13 years.
Considerable years of experience and participation in health related activities i.e. Lions Gates Hospital, North Shore Health, Centre of Excellence Women’s Hospital, National Health Forum, Vancouver Board of Trade Health Committee task force, BC Alcohol and Drug Education Service Board.
Recognized authority internationally on benzodiazepines and a presenter at an international conference at the University of London, School of Economics scheduled for September 13, 2000 with other international authorities on the subject.
Have conducted and assembled extensive Canadian and international research over the past 9 ½ years on this subject.
Have presented to the House of Commons Standing Committee on Health in Ottawa on this subject April 1997.
Have established significant contacts with all the key stakeholders in this field - in Canada and internationally.
Have developed 2 initiatives (awareness building vehicles):
A Television Documentary "Our Pill Epidemic" - the shocking story of a society hooked on drugs for which I was co-executive producer and research consultant which aired on British Columbia 8 times and nationally on CTV. Co-executive producer was Jack McGaw former of CTV's W5 investigative program. This is also available in video format (Note: In 1997 the B.C. Ministry of Women's Equality provided a $5000 grant to help market and promote the documentary/video to create awareness of the problem) and B.C. Pharmacare allocated $20,000 of the $175,000 production budget. (I put in personally $50,000). The Federal Government's participation was requested but no money regretfully received.
A book "Addiction By Prescription" - one woman's triumph and fight for change which I wrote and which has just been released by my publisher - Key Porter, Toronto. My book is internationally endorsed by experts in the field and my recent national publicity tour (to Halifax, Ottawa, Toronto, Calgary, Edmonton, including Vancouver, Victoria) has received excellent response and support by all media and continues to be an awareness building vehicle for all key stakeholders. (costs to me personally $100,000).
My personal experience (as a survivor) and my commitment and passion to effect greater awareness and systemic change regarding the misprescribing, misdiagnosis and mistreatment surrounding the usage of tranquillizers and sleeping pills.
VIII. Project Costs and Timeframes
Estimated cost of developing an integrated strategic action plan for benzodiazepines which is multi stakeholder focused as outlined is $100,000 including an estimated $10,000 in expenses.
This estimate is based on a projected timeframe of 1 year to complete upon approval of the project. A detailed 1 year timetable of specific tasks to be performed in 3 month intervals is available for your perusal.
It is strongly recommended that the project scope be approved in its entirety and be multi stakeholder focused rather that just directed at consumers, doctors, etc.
Regarding consulting remuneration, 1/3 is payable on authorization to proceed, 1/3 at mid point or 6 months into the project and 1/3 on delivery of the final report. (3 copies to be provided).
Note: The development of the strategic action plan on its own will go a long way to creating awareness of the need for change in the prescribing and usage of these drugs. The second phase of the project will be the implementation of the strategic action plan for which costs will be developed.
Lillian, I would be very pleased to discuss this project proposal with you further to incorporate your thoughts or add to the terms of reference for the project. I am confident however that your leadership and commitment to this project at this stage will produce significant results in terms of cost effectiveness, savings and improvement in the quality of life of thousands of Canadians addicted to these drugs.
You indicated in our meeting that your budget for Alberta and British Columbia does not include money for this kind of project focused on education, health promotion and wellness and action which is somewhat surprising to me. You advised however that you would take my proposal to Health Canada in Ottawa to determine funding possibilities and for a decision.
I would be pleased to present further on this significant issue of benzodiazepines using the presentation materials I gave at the Building Bridges Conference in Victoria at the end of April this year entitled "Benzodiazepines - Time for Action - An integrated Approach to Positive Partnership Solutions to a Long Standing Serious Health Epidemic".
As I communicated to you, I have previously written and/or discussed my initiatives surrounding benzodiazepines over the past 10 years with former Health Minister David Dingwall, Minister Allan Rock, Minister Paul Martin, Minister Sheila Copps and Hedy Fry, Secretary of State, Status of Women. I have also met with various staff members of public service in Health Canada over the past 6 years.
Most recently I discussed the issue and the need for a strategic action plan with Senator Lucie Pépin in Ottawa on my May publicity tour for my book. June 29th I met again with Hedy Fry who continues to be supportive of the need for change and my efforts in that direction. She also has indicated that she will contact Health Minister Allan Rock, stressing the importance of an action plan addressing the issue.
Lillian, this is a very real problem which requires Health Canada's commitment and leadership as many hundreds of thousands of people's lives continue to be lost and/or devastated needlessly by these insidious drugs. The "Time For Action" on a strategic plan is now!
I look forward to your early favourable response to my proposal. Together we can make a difference!
Sincerely,
Joan E. Gadsby
President
cc: Ms. Lorraine Cameron
Regional Coordinator
BC and Yukon Region Status of Women
Fax 666-0212
cc: Hon. Hedy Fry
Secretary of State Status of Women
Fax 666-0114
Attachments:
Press Release and Video Jacket - TV Documentary "Our Pill Epidemic"
Press Release - "Addiction By Prescription" and Book Cover
Resumé and Former Councillor re-election brochure
Press Clipping - North Shore News Friday, January 21, 2000
Prescribing Benzodiazepines: Time for Reappraisal - Statistics and Adverse Effects
Adverse Side Effects of Tranquilizers and Sleeping Pills
Note: Media clips and television excerpts from my recent national publicity tour are also available.
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