© Barb Sweet photo
Dr. Jeff White
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 â which reduces drug cravings and opiate withdrawal while blocking euphoria â 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. Johnâs area.
The success rate for patients staying clean after they have completed the program is about 20 or 25 per cent, White estimated.
âThatâs disconcerting. Thatâs not a lot from all the effort that (the patients) have put in coming back and forth for three years,â he said, adding itâs just one form of addiction treatment.
âI will be the first to admit most people are not doing well.â
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.
âWe need the help,â 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 Josephâs 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 inâMay.
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 â 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 provinceâs 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.
âIt 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,â he said, adding obviously sometimes doctors are wrong in picking who to trust with the carries, because they are getting on the street.
âBut 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.â
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 â about half of his clients are on lower doses than they were two months ago.
White tells patients upfront itâs a two-year process â 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.
âThey donât 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,â he said.
A few will never come off the program, White speculated.
Itâs all individual for addicts â 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 wasnât anyone in St. Johnâs 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 centreâs wait times because there just arenât enough counsellors.
White admitted his feelings about being involved in administering methadone have wavered at times and heâs 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.
âItâs not done lightly. You have to somehow make an impression they canât have the same lifestyle they had while on methadone,â he said.
âIf 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.â
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.
âTo (those waiting) it seems like an eternity. It seems like end of world,â he said.
He credits pharmacists and group therapy organizations like Turnings with their work in addictions treatment.
âThere are a lot of people trying to help,â he said. âI am just one of them.â
Meanwhile, the wait time at the Opioid Treatment Centre in St. Johnâs is at least three times as long as Whiteâs â 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 doctorsâ caseload.