Pubdate: Fri, 15 Jun 2001
Source: National Post (Canada)
Copyright: 2001 Southam Inc.
Contact:  http://www.nationalpost.com/
Details: http://www.mapinc.org/media/286
Author: Yvonne Berg
Bookmark: http://www.mapinc.org/find?136 (Methadone)

FORMER ADDICTS OFTEN DENIED TRANSPLANTS

'Subtle Disdain'

JEFF OSTOFSKY: Methadone "saved my life, my marriage, my sanity."

Like thousands of other Canadians on methadone, Jeff Ostofsky beat back his 
powerful addiction to heroin and the miserable, lawless lifestyle that came 
with it. For eight years, he has led a normal, productive life.

But he and the majority of other methadone patients who caught hepatitis C 
from dirty needles are often denied liver transplants, something many of 
them will need to survive as the relatively new illness takes its toll, say 
addiction physicians.

Some former addicts have died after being ruled ineligible for livers to 
replace theirs, which have been ravaged by hepatitis C, even though 
methadone itself does not affect the success of a transplant, the doctors 
say. They blame medical ignorance and the attitude that people who had 
illicit drug habits are undeserving.

"Our people, who are perceived as the authors of their own misfortune, are 
often getting the dirty end of the stick when the health resources are 
meted out," said Dennis Long, who runs a methadone program in Toronto.

Attitudes are changing in the system and the majority of transplant 
programs will consider methadone patients. But, faced with a severe 
shortage of available organs, a significant minority still rule out former 
junkies as recipients, experts say.

"It would be a shame if people who could benefit from a transplant that 
might save their lives are denied that care simply because of a medication 
they are taking," said Dr. David Marsh of the Toronto-based Centre for 
Addiction and Mental Health.

One methadone patient died after being turned down for a transplant by 
Toronto General Hospital, a recent article on the issue in the centre's 
Journal of Addiction and Mental Health reported. Married, with a small 
child, the patient had tested drug-free for eight years and had "a long 
life ahead of him," a centre doctor said in a letter of complaint to the 
hospital.

Mr. Ostofsky, 43, was hooked on heroin for 18 years, committing numerous 
crimes to feed his habit. Methadone, he said, has "saved my life, saved my 
marriage, saved my sanity." But he fears the kind of service he will get if 
his hepatitis C becomes severe.

When doctors learn he's on methadone, their attitude is "a subtle disdain, 
an unspoken contempt," said the 43-year-old, now a public health worker.

Dr. Marsh said as many as 80% of the 15,000 Canadians on methadone have 
hepatitis C, a virus that inflames the liver, sometimes causing irreparable 
harm. And 30% to 50% of hepatitis C patients eventually will need a 
transplant to survive, he said.

Methadone is a synthetic narcotic that is effective in getting addicts off 
heroin, and keeping them off it with few side effects.

However, a study published in the Journal of the American Medical 
Association this year found that less than 60% of transplant centres accept 
patients who are on methadone.

Dr. Michael Lester, a Toronto addiction physician, said a patient of his 
died 1 1/2 years ago after being ruled ineligible for a transplant because 
of his methadone treatment.

"This was a highly functioning guy who tried very hard to get himself a 
liver transplant," he said. "He was told 'You have to get off methadone 
first,' which he couldn't really do. The methadone was keeping him off 
drugs and he was doing well because of it."

Toronto General Hospital recently changed its policy about offering 
transplants to methadone users with advice from the addiction centre, said 
Dr. Gary Levy, director of the General's transplant program.

The British Columbia Transplant Society, though, says it "strongly 
encourages" patients to be off methadone before they get a transplant, said 
Sally Greenwood, a society spokeswoman.
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