Pubdate: Sun, 16 Nov 2003 Source: Victoria Times-Colonist (CN BC) Copyright: 2003 Times Colonist Contact: http://www.canada.com/victoria/timescolonist/ Details: http://www.mapinc.org/media/481 Author: Jody Paterson, Times Colonist ADDICTED TO A MORAL MINDSET The scope of B.C.'s drug problem really sunk in for me last week when I learned that almost 10,000 British Columbians are registered methadone users. Wow. And those are just the ones who have made it onto methadone, a synthetic opiate that quells cravings for heroin and morphine. Add in at least 12,000 more injection-drug users buying heroin and cocaine at the street level, not to mention uncounted thousands addicted to drugs that don't require needles, and B.C.'s numbers are downright alarming. What are we doing about it? More than most, I suppose: Two-thirds of all the methadone prescribed in Canada goes to British Columbians, and we've got the country's only safe-injection site. But in real terms, not much. We're still a long way from shaking off the moral mindset that taints the way we treat addiction. Every day in this province, in this country, in this world, people do injury to themselves in the pursuit of pleasure. And whether it's a teenage street-racer who crashes his car, an obese 45-year-old who has eaten her way to Type II diabetes or a cigarette smoker whose habit has finally caught up with him, we'd rightly be aghast if our health-care system provided anything less than high-quality, non-judgmental care. Addiction is the notable exception, however, particularly when it involves street drugs. Compromise your health and happiness through illicit drugs and you'll find yourself begging for help from a scornful community, and one that feels no guilt about dramatically different health-care standards. B.C.'s 38-year-old methadone program is a case in point. Even those who have used methadone for years can't buy more than a week's worth of the drug in advance, and most face having to make daily trips to the pharmacy to buy one dose at a time. If that interferes with people's ability to hold down a job, travel or just get on with their lives, too bad. While methadone is covered under Pharmacare, it's free only to those on income assistance; everyone else will pay the $3,600 annual fee up front just like any of us. But the average prescription-drug user can buy dozens of pills at a time and pay a single dispensing fee. Those on methadone ante up every day, including $7 or more for a dispensing fee charged each time a pharmacy hands over a cup of methadone. Few of us have doctors who would try to punish us by withholding our medicine, but that's a constant threat for methadone users. If they don't have the money for their methadone, are caught with other drugs in their system or even just rub a clinician the wrong way, they can be cut off. The College of Physicians and Surgeons, which administers the program, recently ramped that up by making it harder for methadone users to switch doctors. The college has also cautioned doctors against prescribing morphine to tide people over while they wait to be accepted into the methadone program, which means addicts either have to keep using heroin or get by with no medication for two weeks while their application is processed. Should they choose the latter, they could end up denied entry to the program, as happened last month to local actress Sheryl Fjellgaard. Fjellgaard died of an apparent overdose trying to boost her heroin levels enough to qualify her for methadone. Yes, methadone is an addictive and potentially dangerous drug. And yes, the occasional user does manage to outfox the system and sell their supply. But how often? As noted by the national Institute of Medicine in a 1995 report, the current level of regulation "puts too much emphasis on protecting society from methadone and not enough on protecting society from the epidemics of addiction, violence and infectious disease that methadone reduces." People make mistakes, and ending up addicted is certainly one of them. But until we're prepared to withhold health care to everyone whose lifestyle choices cause them harm, let's quit the finger-wagging and get on with the important business of making people well. - --- MAP posted-by: Richard Lake