Standing Committee on Health

In December 2018, Pine River Institute CEO Vaughan Dowie and Clinical Director Victoria Creighton attended the House of Commons Standing Committee on Health to discuss the impacts of methamphetamine use in Canada. You can listen to entire hearing online here and access the entire transcript here.

 
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     My name is Vaughan Dowie. I'm the CEO of Pine River Institute. I'm here with my colleague Dr. Victoria Creighton, who is our Clinical Director. 

We thought that the best contribution we could make to the committee's deliberations is to talk to you about the importance of adolescent treatment services, particularly residential treatment for youth in need of service for addictive behaviours. To provide you with context, let me tell you a bit about Pine River Institute.

    Pine River Institute is a residential treatment program for adolescents with addictive behaviours and, frequently, other mental health concerns. We serve a population of adolescents between the ages of 13 and 19. We are mandated to accept both girls and boys from across Ontario. Our main campus is located just outside of Shelburne, Ontario, about 100 kilometres northwest of Toronto. We operate 36 beds, 29 of which are funded by the Ontario Ministry of Health and Long-Term Care. For those 29 beds, we have a wait-list of more than 200 youths.

    Our program is unique in Canada. All our students begin with the wilderness phase of the program, either in Muskoka or Haliburton, depending on the time of year. We're now in the Haliburton time of year. They then move to our campus. After a time there, they spend increasing amounts of time back in their home communities to practise what they learned in the program.

    After transition from the residential program, we offer aftercare support. Our program works not only with the youth. Family involvement in the program is a requirement of admission. We require our families to be engaged in the program through workshops, retreats and regular parent groups over and above the work they will do with their child.

    Pine River is involved in ongoing research. In particular, since our inception 12 years ago, we've invested in ongoing outcome research. We track a number of indicators, particularly those involved with substance use, school or workplace engagement, contact with the legal system, hospitalizations and other crisis indicators such as running away. We track these indicators pre-admission and after discharge and every year thereafter until the youth turns 25 to measure whether the change that takes place is maintained. We publish these results annually as a way to inform our funders, potential clients and other stakeholders of our outcomes. I have brought a few copies of the most recent report with me if anybody would like a copy.

    Pine River's clinical philosophy centres on trying to increase the maturity of the youth who we see. We believe that the youth in the program have delays in maturity. This can be caused by trauma or other obstacles. We define maturity to include a future orientation; a social ethic; emotional regulation; the ability to be autonomous and not be part of a puppet relationship, either as a puppet or as a puppeteer; empathy; plus, a lack of narcissism. Often these elements are also described in some literature as part of “healthy emotional intelligence”.

    The Pine River program has a variable length of stay. By that, I mean that unlike other programs in the sector with a fixed time for treatment—21 days, 90 days, four months, whatever—we allow our students to complete the treatment at their own pace. Our average length of stay is about 14 months.

     As for substance use, the majority of our students are polysubstance users. They will use whatever is available. We do ask about the drug of choice. The number one drug of choice is cannabis, but of interest to this committee for the purposes of this hearing, we ask parents prior to admission what substances the youth is using, and the results for methamphetamine were the following.

     In 2015, 2% of our parents reported meth use for their child. In 2016, again it was 2%. In 2017, it was 5%, and in 2018, it was 16%. Contrast that to our students' self-report of what they are actually using: in 2015, it was 18% for meth use; in 2016, 53% reported meth use; in 2017, the number was 22%; and, so far this year, we're at 16%.

    We take from that a couple of conclusions. First, generally speaking, the use of methamphetamine has been much greater than suspected, even by parents who are really concerned about the behaviour or the habits of their kid. Second, while the numbers seem to fluctuate with our clientele, it's a significant factor in the drugs they choose to use.

    As the committee tries to integrate the various perspectives regarding the issues that arise out of methamphetamine use in Canada, here are the take-aways we'd like to leave with the committee.

     One, it is imperative to invest in services for young people in order to address the underlying issues as soon as possible. Not only is it the right thing to do, but it makes good economic sense.

     We work with the DeGroote School of Business at McMaster University to look at the social return on the investment made in the youth in our program as a result of government funding. The answer was somewhere between seven and 10 times return on investment. I've also brought copies of that report if anybody would like to have it.

    There needs to be a significant expansion of accredited residential resources aimed at youth. Our waiting list of over 200 speaks eloquently about the lack of quality resources for youth in this age group. Very often, governments hesitate to invest in residential programs because it's the most expensive end of the continuum, but working with youth who are abusing substances is so important because, as time goes on, the problems become more ingrained, thereby making change in their lives and brains more difficult. This approach is as important—if not more so—for methamphetamine as for any other substance.

    Public education should always be a component of any substance use approach and should provide real and believable information about the impact of the substance to young people. Otherwise, we rely on word of mouth and bad information that often minimizes potential harms.

    We commend the committee for its interest in this important subject. The complexities of the issues that are linked to meth use and abuse require a multi-faceted response. Within that response, we ask the committee to remember the need for effective youth treatment services as part of our national approach.