Pubdate: Fri, 20 Nov 2015
Source: Globe and Mail (Canada)
Copyright: 2015 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Geordon Omand
Page: S2

METHADONE FEES NECESSARY, DOCTOR SAYS

Controversial charges might not be collected from the best sources, 
physician argues, but counselling costs have to be covered

Methadone-dispensing fees that are the focus of legal action in 
British Columbia must be charged to secure crucial support services 
for recovering addicts, a doctor from Vancouver Island says.

Dr. Jane Clelland said while the province pays for physicians and 
drugs, public money doesn't cover counselling, which she called necessary.

Counselling is also a service supported by the B.C. College of 
Physicians and Surgeons.

"They don't expect you just to see the patient, they expect you to 
provide a program," Dr. Clelland said in an interview about the 
medical-licensing and regulatory body.

"The clinic is supposed to help rehabilitate the person and get them 
a normal life and you're not going to do that only with methadone."

The treatment program has come under scrutiny after a proposed 
class-action lawsuit was launched against the province over the 
$18.34 additional fee automatically taken from the cheques of addicts 
on income assistance.

The fee agreement referenced in court documents is $60, which is 
reduced by $41.66 through a government-provided Alcohol and Drug 
Supplement. The remaining money is drawn from a client's monthly 
support allowance, according to documents filed this month in B.C. 
Supreme Court.

"I can see why this Pivot Legal Society thinks it's wrong to take 
money from these patients, and I agree," Dr. Clelland said. "But 
unless the whole system changes, if they just take away that money, 
then there's basically no way to run these programs."

Pivot is a legal advocacy group that works on behalf of marginalized groups.

The legal action was launched by representative plaintiff Laura 
Shaver, who is addicted to heroin. She said she signed a 
government-drafted agreement "unwillingly and under duress" to 
authorize the deduction of money from her welfare cheques.

"In my view, it's the wrong way to do it," said Dr. Clelland, 
describing addiction care in B.C. as "disjointed" and "a bit of a mess."

"If they're going to fund, this I don't understand why that money has 
to come from the patient. I don't understand why [the government] 
doesn't pay the $60."

Health Minister Terry Lake said the government is reviewing the way 
it delivers opioid-dependence services with an eye to modernizing and 
improving the program. He said the added fee was also under review 
but wouldn't say if it would be scrapped.

"Halfway through 2016, I think you will see significant changes in 
the way methadone and opioid addiction is treated in the province of 
British Columbia," Mr. Lake said.

There are 16,457 people in B.C. enrolled in the methadone-maintenance 
treatment program, and about two-thirds of them receive income 
assistance. PharmaCare pays more than $44-million annually for the 
program, a government statement said.

The college authorizes 528 doctors to prescribe methadone for 
opioid-dependence treatment, though the Ministry of Health revealed 
only 363 actively prescribe the drug.

Deputy registrar Ailve McNestry said the college's expectation that 
doctors offer clients additional services not publicly covered is 
based on solid research and best practices.

"A very important component of the treatment of any substance-abuse 
disorder is counselling," said Dr. McNestry. "I think most addictions 
physicians would say it wouldn't be an appropriate program if the 
patient didn't have access to counselling."

While no legal requirement exists, she said there is a "fairly clear 
expectation" on doctors that counselling services are provided.

Dr. McNestry also raised the issue of access to addictions treatment, 
highlighting the concentration of methadone-licensed physicians in 
the Lower Mainland and on southern Vancouver Island and their dearth 
in rural and northern regions.

"They're not properly distributed," she said, adding that it mirrors 
the situation in other medical fields. "It's the same reason why you 
don't actually have a neurosurgeon north of Kamloops."
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MAP posted-by: Jay Bergstrom