Pubdate: Wed, 13 Feb 2008 Source: Vancouver Courier (CN BC) Copyright: 2008 Vancouver Courier Contact: http://www.vancourier.com/ Details: http://www.mapinc.org/media/474 Author: Mike Howell DOCTORS PAN MAYOR'S 'ADDICTION SUBSTITUTION' PLAN CAST Program Criticized For Eyeing Crime Reduction Mayor Sam Sullivan's proposed drug treatment plan for up to 1,800 addicts is "a poorly conceived strategy that has negative consequences," according to 14 doctors who had their letter published in the most recent edition of the B.C. Medical Journal. The doctors point to a statement on the Chronic Addiction Substitution Treatment (CAST) website that says substitution therapy is a means of reducing the addict's impact on public order and public health until durable solutions are reached. "This is not health care, nor is it likely that it represents the goal of addicted patients," they wrote. "Does this mean that the chances for recovery for addicts is so small that the only option is to be 'safely and ethically' managed through the CAST initiative with its stated primary goal being 'to significantly reduce crime and disorder in Vancouver by 2010?'" The mayor's CAST plan calls for medical doctors to prescribe legal drugs to up to 1,800 addicts in an effort to reduce or end a person's addiction to hard drugs. The plan, which is to involve five trials, has yet to be approved by Health Canada. "We believe that the widespread introduction of safe housing, a regular family doctor and social supports are the cornerstones in the management of patients with addictions," the doctors' letter continued. "The positive effects of these interventions are well researched and well documented." Another concern is that housing, counselling and access to a family doctor may be tied to participation in the mayor's treatment program. "What will happen to study dropouts?" the doctors said. "Will they lose their doctor/home/social supports? If we begin to base our decisions on social quietude versus sound medical principle, can we in all good conscience claim to follow the tenets of the Hippocratic Oath and keep our patients free 'from harm and injustice?'" Dr. Ray Baker, the former chair of the B.C. Medical Association's committee on addiction medicine, is one of the doctors who signed the letter. Baker designed and implemented the addiction medicine curriculum at the University of B.C. medical school and directed the program for five years. Baker said the doctors wrote the letter because they felt their perspective wasn't being heard. He said the letter reflects clinicians' experience with addictions as opposed to research scientists. "What's being advocated and promoted [by the mayor] does not represent the opinions of expert clinicians in the field," Baker told the Courier. He said the city's Four Pillars drug strategy has focused too much on harm reduction. Treatment is one of the pillars but it is woefully inadequate in the city, where the open drug market continues to thrive, he added. "Those of us who work in the trenches are still absolutely frustrated by the lack of treatment resources in all of B.C., but specifically in the Vancouver area," Baker said. CAST supporters, doctors David Marsh and Michael Krausz, wrote a letter to the B.C. Medical Journal in response to the letter published by Baker and his colleagues. It has yet to be published but the Courier obtained a copy. In the letter, Marsh and Krausz point out that the best studied treatment available for addicts is methadone. But, they said, not all addicts respond to methadone and that is why the CAST plan is worth implementing. Marsh and Krausz, who are working on CAST proposals, assured that access to housing and treatment services will not be exclusive to CAST participants. "For example, over the past year the municipal and provincial governments have announced several initiatives that will significantly expand access to supportive housing in Vancouver and while CAST participants will be able to avail of these services, access will not be limited to CAST participants." As for the critics' concerns that novel medications cannot be evaluated until access to support services is available to all, Marsh and Krausz wrote that "then we would still be limited to treating hypertension with diuretics while working to expand dietary and exercise programs." They said the primary goal of CAST is to improve addicts' health. - --- MAP posted-by: Derek