Joan Gadsby's Letter to
Gretchen Brewin
June 12, 2000
Market-Media International Corp.
4507 Cedarcrest Ave., North Vancouver, BC, V7R 3R2, Canada
Phone: (604) 987-6064 Fax: (604) 987-6063
June 12, 2000
Honourable Gretchen Brewin
Minister, Children and Families
Parliament Buildings - Room 28
PO Box 9057, Stn Prov, Govt.
Victoria, BC, V8W 9E2
Fax: (250) 387-9722
Re: Consulting Proposal - Strategic Action Plan Benzodiazepines (Tranquillizers and Sleeping Pills)
Dear Madam Minister,
Thanks for the opportunity of meeting with you and Mike Corbeil in Victoria Tuesday, June 6 on the subject of benzodiazepines - very addictive legal drugs prescribed by doctors beyond established guidelines with serious short and long term side effects.
This is a long standing major health issue with considerable socio - economic implications in this province (and elsewhere 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".
As requested, this letter outlines my consulting proposal to develop an integrated and detailed strategic action plan which is multi stakeholder focused to address this problem which has reached epidemic proportions. As you are aware, this subject crosses Ministerial boundaries (i.e. Addiction, Health and the Attorney General) but primarily falls in your area of responsibility (education and treatment for addictions).
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 anaesthesia, 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.
Regrettably, 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 has been known for 2 decades. (Reference various research papers included in my book "Addiction By Prescription" which I gave you which is internationally endorsed.
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% of the population from young teens to all ages with two thirds being prescribed to women. All of this has been identified and documented in extensive 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 British Columbia 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 oestrogen. 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, 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.
My commitment to this project as you are aware, stems from personal experience when after the death of my son from a brain tumour 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. 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 which is multi stakeholder focused i.e. consumers, doctors, pharmaceutical companies (who have publicly acknowledged the problem) pharmacists, government 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 liase with and obtain concurrence amongst key medical professionals who recognize the problem and who are working to address the issue (i.e. BC Therapeutics Initiative, chemical dependency doctors, BC Medical Association, College of Physicians and Surgeons) and to develop realistic, phased in solutions to doctor education directed at changing doctors' prescribing habits.
To develop a training program and workshop on benzos for British Columbia and its various regions for implementation at the regional level throughout the province. (Also for use with all stakeholders).
To identify private sector and alternative funding opportunities to implement the benzo awareness program provincially (i.e. corporate community pharmaceutical manufacturers, non profit organizations and foundations.)
To illustrate leadership and commitment to addressing this problem.
To identify federal 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 (provincially, nationally 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 inter Ministerial contact personnel within the provincial government 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 (denial, apathy, ignorance) Medical Community feeling threatened.
Budget restrictions.
Lack of commitment and leadership to resolving the problem.
Potential lack of inter Ministerial cooperation.
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.
Note: All of the foregoing potential problems will be addressed openly and collaboratively and with consensus building techniques 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 client and other stakeholders upon completion.
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 Ministry of Children and Families caused by usage of these drugs i.e. job loss, family dysfunction, floppy baby syndrome, social welfare and violence will be reduced.
Positive partnership solutions to this long standing problem amongst the key stakeholders will be developed, acknowledged and addressed.
Leadership shown by the BC Ministry of Children and Families will benefit other provincial Ministries financially (i.e. reduced costs) and will serve as a model for a Canadian program and for other provinces.
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 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 I will be presenting at an international conference at the University of London, School of Economics September 13, 2000 with other international authorities on the subject.
Have conducted and assembled extensive British Columbia, Canadian and international research over the past 9½ 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 BC, 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. This is also available in video format (note: In 1997 the Ministry of Women's Equality provided a $5000 grant to help market and promote the documentary/video to create awareness of the problem) and Pharmacare allocated $20,000 of the $175,000 production budget. (I put in personally $50,000).
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 (including Dr. Jim Wright, Therapeutics Initiative Head, UBC) and my recent national publicity tour 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 and 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.
Madam Minister, 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 approving 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 British Columbians addicted to these drugs.
When in Victoria last Tuesday I noted that British Columbia's Tobacco Reduction and Prevention Strategy supported by the Ministry of Health has had $6.5 million allocated to it in this fiscal year. These prescription drugs are a different matter since the end user/patient consumer takes these drugs on the advice of their doctor.
I look forward to your early favourable response to my proposal. It has also occurred to me since this is an inter Ministerial issue that there may be a opportunity to present jointly to relevant Ministers, to interested Cabinet Ministers and to the Premier on this issue. My presentation at the Building Bridge Conference in Victoria 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" is a one half hour visual presentation.
I know the Premier is interested in this subject matter from the impaired driving perspective caused by benzos. Previous conversations on this subject matter I have had over the past few years with other Cabinet Ministers whose portfolios have changed include Sue Hammell, Joy MacPhail, Andrew Petter, Paul Ramsey, Gordon Wilson, Joan Smallwood and I was told last Tuesday that Jenny Kwan was also interested.
Please advise on whether a presentation to your Cabinet colleagues is possible.
Again, thank you for your consideration of my proposal. Together we can make a difference!
Sincerely,
Joan E. Gadsby
President
Attachments:
Press Release and Video Jacket - TV Documentary "Our Pill Epidemic"
Press Release - "Addiction By Prescription" and Book Cover
Résumé and Former Councillor re-election brochure
Press Clipping - North Shore News Friday, January 21, 2000
Prescribing Benzodiazepines: Time for Reappraisal -Statistics and Adverse Effects
Note: Media clips and television excerpts from my recent national publicity tour are also available.
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