Pubdate: Thu, 15 Nov 2001
Source: Kitchener-Waterloo Record (CN ON)
Copyright: 2001 Kitchener-Waterloo Record
Contact:  http://www.therecord.com/
Details: http://www.mapinc.org/media/225
Author: Brian Caldwell

CLINIC RULES MAKE ABUSE RARE, MD SAYS

Control Of Pain Prescriptions Looser

The chairman of a body that oversees methadone treatment programs in 
Ontario is worried they will be unfairly blamed for dozens of overdose deaths.

Dr. Graeme Cunningham, chairman of the Methadone Governance Committee of 
Ontario, said legitimate questions are being asked about possible diversion 
of the powerful narcotic from clinics where it is prescribed for people 
addicted to heroin and other opiates.

But he said he is confident the treatment programs, subject to stringent 
guidelines and controls set by the Ontario College of Physicians and 
Surgeons, will stand up to scrutiny by the provincial coroner and police in 
at least six communities, including Waterloo Region.

If there are problems, they will have to be addressed, but "we've got a 
good system in place," said Cunningham, an addictions expert at the 
Homewood Health Centre in Guelph.

Dr. James Cairns, deputy chief coroner of Ontario, has said he is concerned 
that a dramatic increase in methadone overdose deaths since 1996 coincided 
with the rapid expansion of treatment clinics.

Methadone-related deaths shot up from nine a year to 64 between 1996 and 
1998, and have remained alarmingly high ever since. During the same period, 
patients receiving the synthetic substitute for heroin soared to more than 
6,000 from fewer than 1,000.

Cairns said one possibility is that methadone prescribed to addicts is 
making its way to a black market on the street. The drug can kill users who 
have not built up a tolerance to it.

His concern is shared by Waterloo regional police, who investigated the 
overdose deaths of two Kitchener young people this summer and have urged 
tighter controls on the drug.

Cunningham acknowledged that even one overdose death is "one too many."

But he said methadone-maintenance programs have saved dozens of heroin 
addicts, while stabilizing the chaotic lives of thousands of others.

If black market methadone is a problem, Cunningham said, it is likely 
getting on to the street after it is prescribed for chronic pain by doctors 
who aren't under the same stringent controls as clinics.

Cheap, long-lasting and effective, he said, the popularity of methadone as 
pain medication has grown by leaps and bounds, with 160 doctors in Ontario 
now approved to prescribe it for that purpose, up from only a handful two 
years ago.

And -- unlike doctors in addiction programs, who must receive special 
training and are subject to regular checks by the college -- Cunningham 
said physicians using it for pain are routinely "rubber-stamped" by Health 
Canada.

"My thesis is, it's on the pain-management side of things that methadone is 
being misused," he said.

"They don't have to be audited, they don't have to keep a registry of 
patients. They're just there."

Officials from Health Canada could not be reached yesterday to respond to 
his criticism.
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MAP posted-by: Beth