Home > All Posts, All things MAT, Family and Friends, NIMBYism > Methadone patients demand ethical treatment from Ontario College of Physicians and Surgeons « Toronto Social Justice Magazine

Methadone patients demand ethical treatment from Ontario College of Physicians and Surgeons « Toronto Social Justice Magazine

http://johnb98.wordpress.com/2009/02/17/methadone-patients-demand-ethical-treatment-from-ontario-college-of-physicians-and-surgeons/

When 50-year-old Tracy Thacher needs her medication, she has to consume a white, crystalline powder dissolved in orange juice, under direct observation by a pharmacist. She has to submit to random urine screening and attend her doctor’s office as required, despite having taken the drug for almost fifteen years.

“All we’re asking is that we’re treated like other patients,” said Thacher at a rally Friday outside the office of the College of Physicians and Surgeons of Ontario (CPSO). “We want our doctors to be able to practice using their own discretion, not rules made up by a different group of people.”

But Thacher’s a methadone patient, one of approximately 22,000 in Ontario.

“Methadone is a dangerous drug because of the significant potential for fatal overdose in patients who have not previously taken the drug. It is also highly susceptible to illegal diversion. Dispensing the medication in orange juice helps to prevent diversion and injection”, wrote the CPSO in a statement issued the day before the rally and posted to their website.

Methadone maintenance treatment, which prevents opioid withdrawal and reduces or eliminates drug cravings, was first developed in the 1960s. For many years, Canadian regulations around the prescription of methadone were so restrictive that few doctors offered the treatment. People who wanted methadone treatment often had to wait months or years. In the 1990s, the need to reduce the harm of drug use was more clearly recognized, and changes were made to make it easier for doctors to provide methadone treatment.

In their statement, the CPSO wrote that “the methadone maintenance treatment (MMT) program of the College of Physicians and Surgeons of Ontario (the “CPSO”) was initiated in 1996 after Health Canada devolved responsibility for the administration of a methadone program for the treatment of opioid dependence to the provinces. The CPSO administers Ontario’s MMT program on behalf of the Ministry of Health and Long Term Care.”

Under the direction of the CPSO’s Methadone Committee, which was created in 1999, the program developed Methadone Maintenance Treatment Guidelines for use by the medical profession in the treatment of opioid dependency. The CPSO also administers the application and assessment processes of physicians and recommends to Health Canada the names of physicians for consideration of an exemption to prescribe methadone. Health Canada makes the final decision on whether to issue a physician an exemption to prescribe methadone. The MMT program also offers support and information to patients and physicians.

According to the CPSO, most people who are prescribed methadone are being treated for dependence on opioid drugs, such as heroin. With methadone, a person is kept free of withdrawal symptoms for 24 hours with a single dose, whereas a person who uses heroin to avoid withdrawal must use three to four times a day.

The CPSO claims that from 1996, when the CPSO became involved in administering the methadone program in Ontario, methadone-related deaths dropped from 4.2 (per 1,000 patients in treatment) in 1996 to 1.7 (per 1,000 patients in treatment) in 2000.

This is why, wrote the CPSO, attendance at a pharmacy and urine drug screening, along with frequent office visits are important.

“There’s no other drug where that’s necessary,” said Thacher. “It can totally disrupt your week if you work because you’re bound by the hours of your pharmacy. Not only that, the CPSO gives the doctors rules. They don’t allow the physician to treat you the way he sees is fit. He should be able to say, ‘I think you’re stable enough for me to give you a prescription for a month.’ But it can’t happen.”

Thacher said she finds it humiliating when a temperature strip is put on her urine to make sure it just came out of her body. “We’re seeking treatment,” she said. “We’re not going there to scam them. We’re going there to get help and they’re treating us like we’re on parole. It’s like (we’re wearing) “liquid” handcuffs.”

Despite the criticism, the CPSO insists that “there are relatively few rules, but they were developed to protect patients and the public. The MMT guidelines tell physicians what to do to achieve the best outcomes for patients.”

“I know people on parole that don’t have the rules that we do on methadone,” said Thacher. “It should be left to the discretion of the physician what kind of treatment you need.”

As a result, Thacher said half the patients enrolled in the methadone treatment program are discharged for violating the rules or leave the program voluntarily because they can’t deal with the standards, putting them at risk of serious harm or death. Others, whose health would improve from methadone treatment, choose not to seek treatment in the first place.

Methadone patients are also outraged over the CPSO’s practice of turning their “guidelines” into rules. This practice forces Methadone Maintenance Treatment (MMT) patients to, among other things, disclose to the CPSO personal information, including their names and other identifying private information, as a condition of receiving methadone treatment.

But the CPSO wrote that they only collect the most basic information from MMT patients, including name, city of residence, gender, date of birth, OHIP number, treating physician and episodes in treatment in order to maintain a centralized patient and physician registry as mandated by the Agreement with the Ministry.

However, methadone patients said that maintaining a registry is illegal and further said the CPSO uses this data not simply for statistics but in research publications – without their specific and  informed consent, a charge the CPSO flatly denied.

In spite of a “flawed” program, Thacher’s chosen to remain with methadone treatment because she said “it’s far safer than using illegal drugs and ending up back on the streets”, adding “I have a very good doctor who really tries the best he can to help me.”

An addict for twelve years, Thacher began using heroin and other opiates in her early 20’s. “My life was totally unmanageable,” she said. “I was in and out of jail. It was not a good life at all.” Back then, there weren’t a lot of treatment options available for heroin addicts. “I sought treatment,” she said. “But there were two or three year waiting lists to get on methadone.”

Raffi Balian, Project Coordinator at South Riverdale Community Health Centre, remembered how difficult it was for addicts in 1992 to access a methadone treatment program. “There were only a few physicians,” he said, “and there were long waiting lists.”

But now, Balian has to convince patients to enter and remain in methadone treatment programs because it’s so difficult for them to maintain jobs or some sense of normalcy in their lives while in treatment. The constant trips to the pharmacy and their doctors has made it, he said, “almost impossible for people to get on and stay on methadone,” putting them at much higher risk of contracting HIV, Hepatitis or other infections.

Dr. Philip Berger, Chief of Family Medicine at St. Michael’s Hospital in Toronto, said the CPSO’s rules are regulating patients instead of doctors. “That’s not their business or the mandate they’re given by government,” said Berger, standing on the front steps of the CPSO.

In some circumstances certain rules can create hardships for patients, many of whom have to visit their pharmacy daily, including Sundays, to obtain their methadone. But the CPSO has a rule, said Berger, which prohibits a doctor from giving a “take home” prescription for those people living in rural Ontario, whose pharmacy is closed Sundays, leaving many without their medication.

“There is no other situation where the CPSO has a rule that makes patients sicker and sends them into withdrawal,” he said. “That is outright discrimination based on where someone lives and their disability.”

Before filing a formal complaint, Berger wrote to the CPSO outlining his concerns. Four and a half months later, the CPSO responded with a letter, he said, “failed to address many of the concerns I’d raised.”

So last October, Berger filed a complaint with the Ontario Human Rights Tribunal and the Information and Privacy Commissioner with a request, he said, “to stop discriminating against the most motivated addicts, seeking treatment in the province.” He’s still awaiting a decision.

In Berger’s opinion, methadone treatment should be operating like it does for any other drug in the province.

“There are equally or more dangerous drugs routinely prescribed for which the CPSO does not conduct mandatory audits on the charts of patients or constrain them to “severe” rules,” he said, “like peeing in front of strangers, drinking their medication publicly in front of a pharmacist or not getting their drug on a Sunday because the pharmacy is closed.

“To what other groups of patients would that ever happen?”

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