Pubdate: Sat, 15 Jun 2013
Source: Telegram, The (CN NF)
Copyright: 2013 The Telegram
Contact:  http://www.thetelegram.com/
Details: http://www.mapinc.org/media/303
Author: Barb Sweet
Bookmark: http://www.mapinc.org/find?136 (Methadone)

METHADONE SUCCESSES WORTH IT: DOCTOR

The rate of success is poor, the nature of the work often frustrating 
and the paperwork required under new rules is daunting.

But the reward is the amazing transformation of those who are helped 
by methadone, says Dr. Jeff White, who has been administering the 
program as part of his family practice for several years.

Methadone -- which reduces drug cravings and opiate withdrawal while 
blocking euphoria -- is used to treat addiction to opiates like 
OxyContin. Doctors who administer methadone maintenance therapy must 
obtain a special exemption. There are only a handful who provide the 
service in the St. John's area.

The success rate for patients staying clean after they have completed 
the program is about 20 or 25 per cent, White estimated.

"That's disconcerting. That's not a lot from all the effort that (the 
patients) have put in coming back and forth for three years," he 
said, adding it's just one form of addiction treatment.

"I will be the first to admit most people are not doing well."

While some doctors may fear taking it on in their practices, he said 
the more who provide the service, the more the wait times get reduced.

"We need the help," said White, whose partner in practice of a year, 
Dr. Chisty Joseph, also accepts patients.

White has about 330 patients and Joseph about 65-70.

The wait time is two months. They accept two new patients a week and 
White said half of Joseph's patients are his old clients who relapsed.

Extensive new standards for treating opiate addiction with methadone 
were drawn up by the College of Physicians and Surgeons of 
Newfoundland and Labrador and came into effect in May.

That means more paperwork and responsibilities for the doctors who 
prescribe it.

The standards are meant to make the program safer, particularly when 
it comes to carries -- the doses certain patients are allowed to take 
with them from the drug store as opposed to drinking them in front of 
the pharmacist.

Since 2009, drug screening has detected methadone in 11 deaths, 10 of 
which were overdoses, according to recent numbers supplied to The 
Telegram by the province's chief medical examiner.

About 60 per cent of those deaths were of people who weren't on the 
methadone program.

The only way to make the program completely safe is to do away with 
the carries, White said.

"It would make my life a lot easier. Carries is probably the most 
onerous task I have now, trying to figure out who should get them and 
how many," he said, adding obviously sometimes doctors are wrong in 
picking who to trust with the carries, because they are getting on the street.

"But is that fair to the other people working and trying to get 
ahead? Trying to make a life, which is what the whole program is 
about anyway? No matter what program, there are going to be flaws."

White said carries are the only practical way to treat patients whose 
work moves them to different locations.

He defended the program when it comes to weaning off patients -- 
about half of his clients are on lower doses than they were two months ago.

White tells patients upfront it's a two-year process -- one to get 
stable and one to wean down.

But he said he has some patients in their 10th year on methadone who 
are reluctant to leave it.

"They don't think they can. Whenever the topic is brought up, I am 
shut down and fair enough, they are hell of a lot better than they 
were 10 years ago," he said.

A few will never come off the program, White speculated.

It's all individual for addicts -- some people attend long-term 
recovery centres, or go through the multitude of programs in prisons, 
but wind up faltering, he said.

White said he was drawn to the methadone practice about seven years 
ago when he read a story in The Telegram about a couple who lost 
custody of their children to drug addiction and were faced with 
travelling to central Newfoundland for treatment because there wasn't 
anyone in St. John's administering methadone at the time.

He was looking for a change and went to Toronto for the training.

White joined the newly opened Opiate Treatment Centre in 
Pleasantville around 2006, but left there after a year because he 
said he disagreed with a policy of making patients wait until an 
addictions counsellor is available. That policy, he said, lengthened 
the centre's wait times because there just aren't enough counsellors.

White admitted his feelings about being involved in administering 
methadone have wavered at times and he's softened or hardened views 
based on discussions with other doctors across the country.

Patients are kicked off the program if they use profane language, 
threaten staff or continue to abuse drugs.

"It's not done lightly. You have to somehow make an impression they 
can't have the same lifestyle they had while on methadone," he said.

"If I feel this person is unsafe, I got to do my part and eliminate a 
portion of their problem. If that means stopping their methadone, it 
means stopping their methadone."

White said his answer to addicts anxious about the length of the wait 
time is that the people ahead of them on the list have put in their time.

"To (those waiting) it seems like an eternity. It seems like end of 
world," he said.

He credits pharmacists and group therapy organizations like Turnings 
with their work in addictions treatment.

"There are a lot of people trying to help," he said. "I am just one of them."

Meanwhile, the wait time at the Opioid Treatment Centre in St. John's 
is at least three times as long as White's -- about six to eight months.

There are currently 71 individuals who are waiting for treatment at 
the centre, according to Eastern Health.

Two physicians work there on a part-time basis, along with two 
addictions counsellors, a nurse, a licensed practical nurse and a pharmacist.

An Eastern Health spokeswoman said the wait list is based on the 
doctors' caseload.
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MAP posted-by: Jay Bergstrom