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?
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MAP posted-by: Elaine