Time to recognize role of private addictions clinics
Centres key to battling opioid Crisis, Alan Brookstone says.
We are in the midst of a crisis. People are dying daily. They are young, middle-aged, and occasionally elderly. They die on the streets and in their homes, from the hotels of the Downtown Eastside to apartment condos and family homes in the suburbs. They are dying from opioid overdoses. Needlessly.
It’s not that great efforts haven’t been made to reverse this calamity. Governments have funded a variety of interventions. We’ve seen the establishment of supervised injection sites, emergency clinics in the DTES, clinics that provide injectable opioids, the wide distribution of life-saving naloxone kits, the relaxation of the prescribing requirements for methadone and suboxone and prescriptions of other opioids for injection such as hydromorphone.
Different interventions are being studied and the data are published in scientific journals. There is media coverage on a daily basis on these efforts and the rising toll in spite of them. Apart from decriminalizing all drugs and providing them in regulated outlets, what else can be done to avert this tragedy?
One successful approach has been operating under the radar. Methadone clinics have been saving lives for decades. These non-government clinics are located in most urban and suburban municipalities and in some remote towns. They are staffed by skilled and dedicated workers who provide a safe and welcoming environment for patients.
The physicians prescribe opiate agonist therapies, mainly methadone and suboxone. They see their patients frequently and often attend to their other medical needs. They bring expertise from their regular practices in family medicine, psychiatry and other specialties.
The clinics also employ counsellors who help with access to treatment, housing, employment and social services along with counselling aimed at remission. The program prevents overdose deaths. Informally polling our colleagues, we find the loss of an actively enrolled patient is an exceedingly rare event.
This program supporting thousands of opioid users appears to be overlooked. Given the urgency, it is remarkable nobody is seeking to study our model to measure and understand its effectiveness and expand its reach.
Our patients become healthier, have fewer emergency room visits, commit fewer crimes and begin to become productive members of society. All this happens after they stabilize on therapies that remove the physical need to find and pay for their next fix.
The process can be long and arduous, with frequent setbacks. A trust relationship, which develops slowly, is an essential foundation. We recognize this is anecdotal data that needs to be validated with research, yet, as far as we know, no such research is underway. Why not?
Our clinics operate on shoestring budgets. Patients on social assistance are funded through a modest monthly payment from social services. Those who are employed are asked to pay a similar amount and, if they cannot, are rarely turned away. Ours is an efficient model. It is hard to imagine a government-run clinic would operate on a lower overhead cost per patient.
A significant barrier to access is the cost of prescriptions. Most patients are required to attend their pharmacy daily where the costs become prohibitive if not covered by pharmacare. Patients who are marginally employed or who want to enter the workforce can be thwarted by the high pharmacy costs.
We have recently established Addiction Care Clinics of B.C., an organization that will provide a vehicle for the non-government methadone clinics operating in more than 30 communities. We have much to offer in the areas of patient care, prevention and research. More can be done to provide wider access to our life-saving model of care. We look forward to sharing our unique knowledge and expertise, on behalf of our patients, in those places where policy, program and research decisions are made.
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