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.
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MAP posted-by: Beth Wehrman