Pubdate: Sat, 25 Feb 2006 Source: Toronto Star (CN ON) Copyright: 2006 The Toronto Star Contact: http://www.thestar.com/ Details: http://www.mapinc.org/media/456 Author: Jessica Leeder And Kevin Donovan, Staff Reporters Bookmark: http://www.mapinc.org/heroin.htm (Heroin) Bookmark: http://www.mapinc.org/find?136 (Methadone) Bookmark: http://www.mapinc.org/rehab.htm (Treatment) METHADONE PIPELINE SHUT DOWN A husband-and-wife team of pharmacists has been ordered to shut down a controversial methadone pipeline servicing 2,000 drug addicts across Ontario. The Ontario College of Pharmacists, which issued the order yesterday, is scrambling to find local pharmacists in a dozen cities and towns to supply the patients before a March 13 deadline. On that day, Kitchener-based pharmacists Wing and Sue Wong must stop shipping boxfuls of medication to a chain of methadone clinics, called Ontario Addiction Treatment Centres (OATC), where the drug is given out by non-pharmacist clinic staffers. The clinics service 4,000 methadone patients; the Wongs supply half of them with the potentially lethal drug. The Wongs plan to go to court to challenge the order. In a statement issued late yesterday, they claimed the college's order will have "a devastating effect upon thousands of patients, many of whom will be unable to obtain methadone from alternate sources. This is because many ... patients live in remote or isolated areas which do not have community pharmacies that dispense methadone. ..." A recent Star investigation found that the college has been aware of the shipping scheme since at least 2003, but has been slow to act. "We are putting the patients first," said deputy college registrar Della Croteau. "When we move to restrict a pharmacist's practice, we must take care of the patients." College officials believe the Wongs' pipeline is endangering patients. Over the last two years, the Wongs have ignored several college warnings requiring them to stop the practice. College rules state that, for safety reasons, all drugs must be dispensed to patients in person by licensed pharmacists in accredited pharmacies. Part of a pharmacist's entitlement to payment for dispensing methadone, according to college rules, involves not only measuring out a patient's dosage but counselling him or her each day and watching the patient ingest the narcotic drink. If the Wongs don't comply with the order, the college could revoke their licences. If they comply, they can still directly dispense methadone in their three pharmacies. In their statement, the Wongs said there is "no legal foundation" for the orders from the college. "The manner in which methadone is dispensed by Mr. and Mrs. Wong, and administered by the Ontario Addiction Treatment Centres, is safe and effective. It involves specially trained regulated health professionals at every step of the process." Improper dispensing of methadone can have fatal consequences. An Ottawa man died last year when an untrained staffer at an OATC clinic accidentally gave him another person's dose, which was 10 times the amount he could handle. The methadone in that clinic was shipped from a Hanover pharmacy partly owned by the Wongs. In their statement, the Wongs said neither was involved with dispensing medication in that case. Several investigations, including one by the Ontario coroner's office, are looking into the death. Over the last five years, the Wongs have built a virtual monopoly on methadone prescriptions at Ontario Addiction Treatment Centres in numerous cities, including North York, Newmarket, Woodbridge, Brampton, Vanier and Hamilton. Shipments to Owen Sound, Guelph and Ottawa came from partner pharmacies co-owned by the Wongs in Hanover and Guelph. Other pharmacists licensed to dispense methadone in many of those cities told the Star they virtually stopped dispensing the drug once the Wongs took over the market. Now, those local pharmacists are being asked to start dispensing methadone again. Methadone is a synthetic narcotic usually taken in liquid form mixed with orange drink. Generally, it blocks the high addicts get from heroin and opiate-based painkillers, such as morphine. It is used to wean addicts off the drugs and stops them from experiencing cravings and withdrawal symptoms. Patients who start taking methadone are often dependent for years -- and even life. OATC is the biggest chain of methadone clinics in Ontario. The clinics are a partnership led by two Richmond Hill doctors, Jeff Daiter and Michael Varenbut. Calls for comment were not returned yesterday. Daiter, who has refused interviews over the past two months, has told the College of Physicians and Surgeons he receives no financial benefit from his relationships with pharmacies. The Star found the agreements the clinics have with the Wongs are both lucrative and controversial. Among the allegations: as part of the agreement, OATC patients are required to sign contracts stating they will allow their doctor to choose their pharmacist. In interviews with clinic insiders, the Star found that OATC gave the Wongs their pick of which clinics they would service. In exchange for a guaranteed slate of daily methadone patients, pharmacists make financial investments in the clinics, and purchase medical software supplied by a company owned by Daiter and Varenbut. The pharmacists' college has been investigating the OATC/Wong relationship since 2003 and recently referred the Wongs to a disciplinary committee (the pharmacists' college has no jurisdiction over the doctors). No hearing date has been set. - --- MAP posted-by: Beth Wehrman