Methadone successes worth it: doctor

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Barb Sweet
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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 — which reduces drug cravings and opiate withdrawal while blocking euphoria — 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. John’s area.

The success rate for patients staying clean after they have completed the program is about 20 or 25 per cent, White estimated.

“That’s disconcerting. That’s not a lot from all the effort that (the patients) have put in coming back and forth for three years,” he said, adding it’s just one form of addiction treatment.

“I will be the first to admit most people are not doing well.”

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.

 

 

“We need the help,” 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 Joseph’s 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 in May.

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 — 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 province’s 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.

“It 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,” he said, adding obviously sometimes doctors are wrong in picking who to trust with the carries, because they are getting on the street.

“But 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.”

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 — about half of his clients are on lower doses than they were two months ago.

White tells patients upfront it’s a two-year process — 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.

“They don’t 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,” he said.

A few will never come off the program, White speculated.

It’s all individual for addicts — 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 wasn’t anyone in St. John’s 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 centre’s  wait times because there just aren’t enough counsellors.

White admitted his feelings about being involved in administering methadone have wavered at times and he’s 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.

“It’s not done lightly. You have to somehow make an impression they can’t have the same lifestyle they had while on methadone,” he said.

“If 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.”

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.

“To (those waiting) it seems like an eternity. It seems like end of world,” he said.

He credits pharmacists and group therapy organizations like Turnings with their work in addictions treatment.

“There are a lot of people trying to help,” he said. “I am just one of them.”

Meanwhile, the wait time at the Opioid Treatment Centre in St. John’s is at least three times as long as White’s — 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 doctors’ caseload.

 

bsweet@thetelegram.com

Organizations: College of Physicians, Opiate Treatment Centre, Opioid Treatment Centre Eastern Health

Geographic location: Newfoundland and Labrador, Toronto, Pleasantville

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  • Virginia Waters
    June 15, 2013 - 20:51

    ".. some patients in their 10th year on methadone who are reluctant to leave it" - i.e. from one crutch to another. I think I agree with 'Sometimes'. Perhaps our efforts to minimize the pain and suffering associated with 'getting clean' or 'drying out' are contributing to the high rate of relapse. Is it possible that the stark memory of a painful rehabilitation unassisted by methadone or other drugs would help addicts more in the long term? When we look at the enormous costs and grief for families and society that accompanies addictive drugs, we have to ask whether it is time for a two pronged approach. The first step is to take the manufacture and distribution of pot out of the hands of criminals and assign responsibility for it to the liquor commission. (Yes, I realize that alcohol is addictive - but one battle at a time please.) That will free up an enormous amount of money and energy that can be redirected to the interdiction of harsher drugs. The second step is to make treatment of addicts mandatory under law. For those for whom voluntary treatment doesn't work, incarceration would be necessary. The latter would be outside the prison system unless the addict is found guilty of crimes other than the possession of addictive drugs. I don't insist this is the only solution, but I think it is high time that we considered other strategies and therapies. The current system simply doesn't work.

  • Sometimes
    June 15, 2013 - 08:16

    Sometimes I wonder if society is better off to put these people in a room for as long as it takes for the drugs to wear off. Withdrawal is rough, really rough. I wouldn't wish it on anybody. Crime has escalated because of drugs. Needles are left out in the open. People are getting killed. Some time of being sick may make them think seriously about going back on drugs.