Pubdate: Wed, 28 Feb 2007 Source: Peterborough Examiner, The (CN ON) Copyright: 2007 Osprey Media Group Inc. Contact: http://www.thepeterboroughexaminer.com/ Details: http://www.mapinc.org/media/2616 Author: Sylvia Sutherland Note: The author is a writer, journalist and former mayor of Peterborough. Sylvia's Side A DRUG DOCTORS CAN'T GIVE Canadians have three things upon which they can depend: death, taxes and constitutional barriers. Take the situation with methadone. In what other country would the dispensing of methadone by doctors become a constitutional issue? Methadone is a synthetic narcotic, first developed in Germany in 1937 as a pain killer that would be easier to use during surgery than morphine and potentially less addictive post-op. It was brought to the United States in 1947 by Eli Lilly and Company and marketed under the trade name Dolophine. Since the 1990s, its best known application has been in the treatment of narcotic addiction. It is also used to manage chronic pain because of its long duration of action and low cost. It is rigorously well-tested, and is safe and effective for the treatment of opioid withdrawal and dependence when carefully monitored by a physician. When it is unmonitored it can, like any narcotic, be deadly. While the drug is cheap when prescribed, it has a street value of upwards of $20 for up to 100 milligrams, and $25 to $35 for anything more than 100 milligrams which will give people with a strong tolerance to opioids a nice high. It's a dangerous practice though; if a person who does not have a tolerance to opiates takes a dose of methadone intended for someone on a maintenance program, they will quickly overdose. In Canada, methadone falls under the Controlled Drugs and Substances Act, a piece of federal legislation. Physicians who provide methadone maintenance treatment must obtain a special exemption from Health Canada. Last January, the College of Physicians and Surgeons of Ontario approved a policy establishing parameters for physicians wishing to delegate methadone administration to patients within a multidisciplinary care setting. To facilitate this, Health Canada has created a new class of exemption, called a "delegation exemption." It allows exempted physicians to delegate the act of methadone administration to other qualified health professionals. But there is a sticking point. Health Canada insists that only pharmacists can dispense methadone. Physicians, regardless of the circumstances, cannot. Dispensing is a controlled act which physicians are legally entitled to perform under Ontario's legislation. But methadone is a narcotic, and therefore under Health Canada's jurisdiction. So, while Ontario allows doctors to dispense drugs, the federal government says not methadone. You have to wonder why Health Canada is so adamant that only pharmacists can dispense this drug. To a cynical eye, it looks like a bit of a power trip. There appears to be little thought given to the patients who rely on a proper dose of methadone at the proper time. There are times, for example, when patient safety may be compromised due to a risk of withdrawal or overdose. This is the first of only three circumstances under which the College of Physicians and Surgeons is proposing that physicians should be able to dispense individual doses of methadone to a patient without a pharmacist. The second is if, in the physician's clinical judgment, a new or modified dose is necessary to avoid patient withdrawal or overdose. The third is if no pharmacist is available within a reasonable period of time. There are situations when a patient has missed three or more consecutive days of dosing and requires stabilization to prevent further withdrawal. In other cases a doctor may witness a patient vomiting a dose. In the case of a pregnant woman this could compromise the well-being of her fetus. None of this seems to matter to Health Canada. Under its new delegation exemption policy, a doctor cannot under any circumstance dispense methadone. If a patient dies as a result, whose responsibility will that be? Has Health Canada asked itself that question? - --- MAP posted-by: Elaine