Pubdate: Wed, 16 Mar 2016
Source: National Post (Canada)
Copyright: 2016 Canwest Publishing Inc.
Author: Tom Blackwell
Page: A1


Sandra Thorkelson sees them huddled outside the addiction clinic
opposite her bank in North Bay, Ont., and knows a surprising number

They are patients on methadone treatment, though some admit to
Thorkelson their daily dose of the synthetic opioid is more for
pleasure than therapy.

"I honestly don't think it's a way of treating themselves," said the
resident of Corbeil, just outside North Bay. "It's seen as a cheap, or
free, high."

Whether motivated by medical need or not, Thorkelson' s acquaintances
are among a fast-growing army of Canadians undergoing a once-rarefied
treatment - and provoking debate among experts and

The number of patients on methadone has soared in recent years,
climbing in Ontario alone from 3,000 in 1996 to more than 50,000,
almost four times the per capita rate in the U.S.

The cost has burgeoned as well, with the Ontario Health Ministry now
paying $156 million a year to support the program. B.C. has seen a
similar jump - the numbers almost doubling to 18,000
opioid-maintenance patients in seven years - and though statistics
elsewhere are scarce, anecdotal evidence suggests methadone use is
growing countrywide.

Alongside it has risen a mini-industry, with one company boasting 57
methadone-maintenance clinics - serving more than 10,000 patients daily.

The trend is a striking reflection of what an addictions specialist
calls the "public health crisis" of prescription-opioid abuse.
Methadone was once used exclusively for heroin addicts; most patients
today are hooked on medicines from oxycodone to fentanyl, often after
a doctor prescribed one of the painkillers.

But some critics question whether the pendulum has swung too

"It's kind of absurd to put a 21-year-old who has maybe played with
OxyContin and hydromorphone for a year or two =C2=85 on lifelong methadon
maintenance," said Benedikt Fischer, a scientist at Ontario's Centre
for Addiction and Mental Health. "All of a sudden the biggest opioid
problem may actually be the maintenance treatment."

He stressed that methadone remains an important treatment. But Fischer
and colleagues co-wrote a commentary in a substance abuse journal
recently that suggested trying such options as detox and behavioural
therapy first.

There is another issue, too. The first-line "opioid maintenance
treatment" in most of Canada is methadone, though another
opioid-maintenance drug, suboxone, is considered six times less likely
to cause overdoses. Methadone itself was a factor or cause in an
average 108 deaths yearly in Ontario from 2011-14, the chief coroner's
office says.

Vancouver Coastal Health recently announced a shift to suboxone as the
first choice - as is the case in the U.S. - but it is largely alone in

Ontario's Liberal government is sufficiently concerned about the
issues that Dr. Eric Hoskins, the health minister, recently set up a
"methadone task force," charged with overhauling the system, he
revealed in an interview.

The minister has already cut the fee that is paid to doctors for
methadone urine tests to $15 from $29, sparking outcry from addictions

Hoskins told the National Post the evidence of suboxone's greater
safety is convincing. But he also wants his task force to recommend
ways the program can do more than just dole out methadone to patients
who sometimes have an array of health and social problems.

"Many, many of the individuals aren't getting the additional support
they need or getting plugged into community mental health programs,"
said the minister. "We have an opportunity to really be bold here, and
look at reforming in a substantive way our entire approach."

But some experts caution against pulling back on methadone

Even Fischer and his colleagues argued 20 years ago for making
methadone more available - and that was before the
prescription-narcotic epidemic began, noted Dr. David Marsh, medical
director of the Ontario Addiction Treatment Centres. The chain owns 56
clinics in Ontario and one in Manitoba.

"The number of overdose deaths (from opioid painkillers) are close to
or higher than deaths from motor vehicle accidents," said Marsh. "It
seems an odd time to say there's too much treatment available =C2=85 We
need as many effective treatments as possible."

He also stressed that the College of Physicians and Surgeons does
regular audits to ensure physicians prescribe the therapy to those who
truly need it.

Like heroin or oxycodone, methadone is itself an opioid, satisfying
cravings but helping injection-drug users avoid disease-spreading
needles, and providing stability that can allow users to lead a normal

Julie Bruneau, a University of Montreal addictions expert, questions
any drive to ratchet back methadone's availability, saying wait lists
are still long in Quebec.

Three decades of evidence points to opioid-maintenance therapy as the
most effective answer to opioid addiction, she said.

Bruneau does question why methadone is the first choice in much of
Canada, when suboxone is safer, and could be administered by family
physicians without the cumbersome routine of regular urine tests and
daily visits.

She and Fischer are part of a new trial funded by the Canadian
Institutes of Health Research that will compare the benefits and risks
of methadone and suboxone.

Back in North Bay, meanwhile, Thorkelson said some patients have told
her people need only show up at a clinic, test positive for a
prescription opioid, say they're addicted - and be virtually assured
of getting methadone treatment indefinitely.

Her allegation could not be independently verified, but she said she
has four or five acquaintances on methadone, as well as others hooked
on prescription opioids.

"What blows my mind is that I live in a fairly small community," she
said, "and it seems so pervasive here."
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MAP posted-by: Matt