Pubdate: Wed, 25 Jul 2012
Source: StarPhoenix, The (CN SN)
Copyright: 2012 The StarPhoenix
Contact: http://www.canada.com/saskatoonstarphoenix/letters.html
Website: http://www.canada.com/saskatoonstarphoenix/
Details: http://www.mapinc.org/media/400
Author: David Hutton

DOCTORS SAY METHADONE PROGRAM GRIDLOCKED

Saskatoon's methadone program is gridlocked, according to a number of 
concerned physicians.

The lack of addictions counsellors to support recovering addicts and 
the small number of physicians able to prescribe methadone means 
patients who aren't HIV-positive or pregnant are being turned away 
too often, the doctors said.

"The capacity has never been adequate to meet the need," said Dr. 
Peter Butt, head of methadone assisted recovery services, the 
Saskatoon Health Region's program.

"When we add the explosion in (needle) drug use, compounded by the 
explosion in HIV-AIDS to the fact we weren't keeping up to begin 
with, it's a struggle. The tragedy here is that some of the people 
we're not able to provide service to ... are at very high risk of 
becoming HIV-positive."

Methadone is a synthetic opiate that can be used to help wean people 
off addictions to heroin, morphine or other opiates.

The health region's treatment program, started in the late 1990s, is 
designed to help addicts through withdrawal. There are around 800 
people in Saskatoon in the program, including those at a community 
clinic run by Dr. Brian Fern, the first doctor in the city to 
prescribe methadone.

The health region program is run by a committee made up of a doctor 
who writes the prescriptions and treats patients and an addictions 
counsellor who screens and counsels applicants.

The health region is turning down 44 people on average per month from 
the methadone program and doesn't maintain a waiting list, officials said.

Dr. Morris Markentin, who practices at the West Side Community Clinic 
and is one of four active Saskatoon doctors with an exemption to 
prescribe methadone, said he turned away 27 people last week looking 
to start the program.

Markentin said methadone is not the "cure-all" and must be prescribed 
in conjunction with addictions counselling and detox services, 
especially for those with a long history of sexual abuse facing deep 
emotional anguish.

"It's not just writing a prescription and sending the person out the 
door," Markentin said. "If you don't offer a full package and just 
want to prescribe methadone, then we might as well put it in vending 
machines in the street. They're using because they have underlying 
issues and if you don't deal with the underlying issues, you can't help."

Tracy Muggli, director of mental health and addiction services for 
the health region, said there has been a problem recruiting 
physicians to prescribe methadone since the program's inception.

The health region is talking to the provincial government about the 
need for more addiction counsellors, which is the most pressing 
issue, Muggli said.

"We're trying to work together to find some ways to (help)," she 
said. "If there was a simple solution we probably would have already done it.

"A lot of this is about additional resources and there's many 
competing challenges."

There is also work being done to recruit more physicians to take on 
methadone patients who are stable, Muggli said.

"A big part of it is debunking myths and doing some education," she said.

"These aren't evil people. These are people who live all over the 
city. They live in Lakeview, they live in Briarwood, they live everywhere.

"Part of it is trying to dispel some of the myths and helping people 
know that taking on these patients is not going to be a negative. You 
could see somebody eventually complete the program. There are many 
people on (the) methadone program who are fully employed."

Butt said around 25 per cent of patients in the health region program 
are stable and could be shifted to doctors in the community willing 
to obtain a methadone exemption.

The shift would allow the core program to focus on patients with higher needs.

Many patients are being admitted to detox or addictions programs or 
being prescribed other drugs. But a comprehensive approach is needed, 
Butt said.

The HIV rate in Saskatchewan is more than twice the Canadian average. 
The lack of resources to deal with addictions increases the risk, Butt said.

Dr. Ryan Meili, who practises at the West Side Community Clinic, 
which began prescribing methadone in April, is calling for an 
inner-city centre that has a spectrum of addiction services under one roof.

"Right now, there's no capacity to take anyone else (in the methadone 
program) except people who are pregnant or HIV-positive," Meili said.

"It's a messed up thing where you've got people who need help and 
say, 'I want to get off drugs,' and we want to reduce harm and 
basically we're having to say to do them, 'Wait until you get HIV and 
then we can help.' It results in us sending a pretty mixed message 
that we're not interested in reducing harm. We're only interesting in 
taking care of you once you've got it."
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MAP posted-by: Jay Bergstrom