Doctors say methadone program ‘gridlocked’
Saskatoon’s methadone program is gridlocked, say 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 say.
“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 say.
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, says he turned away 27 people last week looking 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 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.”