Pubdate: Mon, 03 Apr 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, Kevin Donovan
Bookmark: http://www.mapinc.org/find?136 (Methadone)

PROVINCE TO PROBE METHADONE MISUSE

Task Force Formed After Star Stories

Problems With Drug Distribution Found

The Ontario government is launching a task force to fix serious 
problems in the province's methadone dispensing system.

The task force, launched following an ongoing Toronto Star 
investigation, will include senior representatives from the Ontario 
Health Insurance Plan, the provincial coroner's office, and the 
colleges that regulate doctors, pharmacists and nurses. It will 
report directly to Ontario Health Minister George Smitherman. The 
task force will be told to quickly come up with clear-cut policies on 
how the potentially dangerous narcotic should be safely administered 
to patients and how it should be regulated. It will also probe 
whether the methadone for addicts program is being used as a profit 
centre for some doctors, rather than for the benefit of vulnerable patients.

Methadone is a federally sanctioned, synthetic narcotic used by 
addicts who are trying to wean themselves off heroin and opiate-based 
painkillers.

Recently, the Star reported that a group of clinics that treat one 
third of Ontario's 14,000 methadone patients are billing OHIP for 
expensive urine tests that are rarely used for patient care and 
running the tests through an unlicensed laboratory. Many of its 
doctors are being paid for treating patients they never see, the Star found.

In addition, the clinics have a controversial relationship with a 
Kitchener pharmacist who gets exclusive rights to supply methadone 
and other drugs to the clinics. In return, the pharmacist makes 
financial investments in the clinics and purchases medical software 
sold by its founders, both practices that are frowned upon by regulators.

The doctors are part of the Ontario Addiction Treatment Centres 
(OATC), a chain of 24 clinics that is owned by Drs. Jeff Daiter and 
Michael Varenbut, both of Richmond Hill. The pharmacist is Wing Wong 
of Kitchener.

All three have denied any wrongdoing, either in brief interviews with 
the Star or through their lawyers.

Meanwhile, the Ontario Provincial Police are investigating the 
doctors' schemes and the provincial coroner's office is looking into 
two deaths related to the clinics.

An inquest may be called into at least one of those deaths.

Chief Coroner Barry McLellan and others have confirmed they will be 
on the task force, which is expected to make recommendations within 
three months.

"It will be an adviser to the minister on a number of quality issues 
around methadone programs," McLellan said. His office is probing two 
deaths at the Ontario Addiction Treatment Centres and an inquest may 
be called into one or both of the deaths. One person died from a 
risky procedure called rapid opiate detoxification. Another died when 
clinic staff mixed up his methadone dose and gave him 10 times what 
his body could handle.

Rocco Gerace, registrar of the Ontario College of Physicians of 
Surgeons, will also sit on the task force, as will the registrar of 
the College of Pharmacists, Deanna Williams. A spokesman for the 
Ontario College of Nurses was unable to confirm that college's 
involvement, but nurses are an important part of the methadone system 
since they typically hand out the doses in clinics like those run by 
OATC. Health Canada, which also has a role in methadone control, will 
likely have input. Other key members will be supplied by OHIP, the 
provincial health insurance plan that pays for most of the treatment.

In its investigation, the Star found that the methadone program has 
been allowed to grow virtually unchecked since the federal government 
downloaded responsibility to the provinces in 1996.

Back then, only about 300 people in Ontario took the drug. Today, 
14,000 addicts take the daily drink and the various medical colleges 
that are supposed to tightly regulate it instead turned a blind eye 
to controversial and potentially dangerous practices.

A confusing array of rules attempt to govern methadone, and they 
frequently change. For example, the college of pharmacists recently 
laid a series of disciplinary allegations against pharmacist Wing 
Wong in Kitchener. The college alleged that he was not properly 
dispensing the methadone since he was sending thousands of 
prescription bottles by courier to the OATC clinics across Ontario to 
be handed out by nurses. Wong was being paid by the Ontario Drug 
Benefit Plan as if he was personally dispensing methadone and other 
drugs, when he was simply shipping them out the door. Other 
allegations against Wong relate to overcharging dispensing fees, 
sloppy record-keeping and prescription labelling, and the manner in 
which he obtained a monopoly on OATC patients.

Wong was told to stop shipping methadone by March 13.

Just a few days after that deadline (following numerous calls by 
concerned OATC patients to the College of Pharmacists), a new 
"interim" policy emerged that effectively allows Wong to keep 
shipping provided OATC doctors get a special federal exemption 
permitting them to delegate the dispensing of methadone to a 
"qualified person" such as a nurse.

The College of Pharmacists says it still plans to proceed with the 
disciplinary action against Wong and his wife, also a pharmacist.

The task force will delve deeply into the business of methadone. The 
Star found that OATC doctors had discovered they could bill OHIP for 
a myriad of tests that were often not used for patient care. While 
OATC founders claim they are key to the well-being of patients, 
numerous experts and the College of Physicians and Surgeons disagree. 
Still, the testing and high payments continue.

The Star has learned that OATC is running thousands of tests weekly 
in its Woodbridge clinic. The technician who performs the test is not 
a provincially qualified lab technician and the lab machines are not 
subject to quality control rules that govern proper labs in Ontario.

Ministry of Health officials won't discuss the case.

Another issue for the task force will be whether a doctor should be 
allowed to bill OHIP for treatment (testing urine) of patients they never see.

Many of these issues are being explored by the OPP, which executed 
three search warrants on OATC clinics last November.

The Star has tried to obtain these warrants but OATC lawyers are 
opposing the Star in court, stating that revealing the contents of 
the warrants would tarnish their client's reputation. No charges have 
been laid.

Today, at a court hearing in Newmarket, lawyers for the OATC will 
seek a hearing date to have the warrants "quashed," which would 
effectively end the criminal investigation.

The OPP and the Crown attorney for Newmarket are opposing the application.
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MAP posted-by: Beth Wehrman