Pubdate: Fri, 16 Mar 2012
Source: Enterprise-Bulletin, The (CN ON)
Copyright: 2012, Osprey Media Group Inc.
Contact:  http://www.theenterprisebulletin.com/
Details: http://www.mapinc.org/media/2267
Author: Kristen Smith

ADDICTION NEEDS TREATMENT, NOT STIGMA

When a methadone clinic opens in a community it often brings with it a
stigma.

Jeff Daiter, the chief medical director of Ontario Addiction Treatment
Clinics, which recently opened a Collingwood location, says that
stigma is the result on an unfortunate misunderstanding about addiction.

The OATC has been offering methadone clinics in Ontario since
1995.

Daiter says addiction is a disease and suggests there's a discrepancy
in attitude between diseases occurring 'above and below the
shoulders.' He says people seem to attach the idea of weakness to
addiction and mental disease, and consider it less socially acceptable.

Methadone is used to treat addiction and dependency on opiates and
opioids. Opiates are derived from the opium poppy, such opium and
morphine, or are derived from the poppy and chemically altered, such
as heroin. Opioids include opiates, but also include synthetic drugs
with morphine-like affects, such as OxyContin, Demerol, Percocet.

Methadone, an opioid itself, alleviates the symptoms of opioid 
withdrawal, and the appropriate dose stems the chronic craving for 
them. It also diminishes the effect of other opioids. The appropriate 
dose is supposed to last for about 24 hours.

While methadone can be used to relieve pain, it most commonly holds a
harm-reduction role for people with an opioid addiction.

Daiter says the people using the First Street clinic want
treatment.

"This is a small cohort who are seeking help," said Daiter. "It's
unfortunate for people trying to get care to be faced with this dilemma."

Steve Lucas, whose name has been changed to conceal his identity, has
been in a methadone treatment program for more than a year.

Lucas developed a dependency after being prescribed Percocet, and then
OxyContin. He held a prescription for four years until his doctor
retired, and ing it for four more years.

Lucas says he had built up a tolerance. Without a prescription, he
started selling his things in order to buy drugs and got into trouble
with the law.

He says the people in the program aren't heroin junkies -they're the
people getting help.

"We're the people who serve your food, pick up your garbage, the
people who build your home," said Lucas, adding there is no
stereotypical user -- anyone can become addicted to opioids.

Until OATC Collingwood opened last month, the closest OATC clinics
were in Barrie, Owen Sound, and Alliston.

The Mental Health and Addiction Services of Simcoe County also offers
a methadone program in Barrie, and a half-day satellite clinic in
Wasaga Beach.

Addiction counsellor Kim Bray says the wait list for the Wasaga Beach
clinic, which opened a year ago in the South Georgian Bay Community
Health Centre, was between nine months and one year.

Daiter says many people were travelling from the Collingwood area to
other OATC sites for methadone treatment.

"It's our hope to always treat people in their community," said
Daiter, adding bringing a clinic to Collingwood is reducing the
patient's travel costs, which are subsidized by the province.

"There'd be enough people in any community to make a clinic
worthwhile," he said.

Lucas travelled daily to Owen Sound until he earned take-home doses,
then weekly until he transferred to the Collingwood location.

"(Methadone treatment) actually saved my life. This has given me a
chance to get back into society," he said. "Being addicted to
something like this is the worst, helpless feeling."

He says once someone makes the decision to seek treatment, they want
to start immediately, not sit on a waitlist.

Patrizia Di Pietro, drug enforcement police officer for the
Collingwood and The Blue Mountains OPP, says a dependency can develop
in "just about anyone," and generally requires medical
intervention.

Di Pietro says the opioids her unit has seen most are oxycodone
tablets, Fentanyl patches, morphine tablets, and heroin, of which
heroin is the only nonprescription drug.

She says "opioids and addiction are apparent and affecting people in
Collingwood," adding drug abuse of any kind, legal or illegal, is a
problem for police.

"I would add that the reason that opioids are sought is because of the
physical dependency that it causes for its users," she said.

Daiter says for every dollar invested in Methadone Maintenance
Treatment (MMT), which is funded by OHIP, the community sees a savings
of about $7, though crime reduction, fewer emergency room visits, and
patients returning to work.

MMT is often cited as reducing criminal behaviour, and Di Pietro says
buying prescription medication illegally is expensive. Oxycodone can
be purchased for about a dollar a milligram, with an 80mg tablet
costing between $50 and $80.

"Because of the physical dependency ... and depending on how much one
needs to avoid the negative withdrawal affects, in some cases, users
will commit crimes to support their addiction," she said, adding a
methadone patient will be monitored by a doctor.

Lucas says withdrawal is excruciating.

"It's the most god-awful thing you can ever imagine," said Lucas. "It
feels like you got run over by a transport truck."

He says methadone stops the withdrawal so the patient doesn't have the
urge any longer.

If a methadone program is followed properly, Di Pietro says, the
patient will not have to purchase illegal drugs, or commit crimes in
order to find enough money to purchase drugs.

David Jensen, spokesperson for the Ministry of Health and Long-Term
Care, says methadone is safe, if properly applied.

"When it's applied by physicians who are properly trained it is safe
and effective-- the ministry fully supports methadone clinics," said
Jensen. "It's considered a gold-standard treatment for opioid addiction."

OxyContin, one of the most commonly abused opioids, was removed from
the Ontario Drug Benefit program on Feb. 29. (ODB recipients can
receive coverage for its replacement, OxyNEO, for one year if they
made a claim prior to the delisting date.)

OxyNEO is touted as less likely to be abused, as is more difficult to
crush.

Experts have suggested the move to pull funding will see a rise in the
abuse of other opioids still on the market, while others have
suggested it might put a strain on addiction services.

"(The ministry) is putting together a group of addiction and health
experts and they will provide advice on short and medium-term
interventions to ensure that people have access to any treatment they
might need," said Jenson.

He says the ministry will also be coordinating with Local Health
Integration Networks to respond to any increase in people seeking
addiction treatment in response to the drug being removed from the
market and identify any gaps in treatment that might exist.

Jensen says the ministry has a narcotics strategy to prevent overuse
of opioids, including a database being implemented next month, which
will allow pharmacists to monitor client history across pharmacies.

"It is a huge challenge and one that we're taking steps to address
through the strategy," he said. 
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MAP posted-by: Richard R Smith Jr.