Methadone counsellors swamped
Data suggest SHA’S 11 counsellors have huge lists of clients, opposition says
There are hundreds of patients on opioid substitution therapy for every addictions counsellor dedicated to them through the Saskatchewan Health Authority (SHA), according to provincial data the NDP called “abysmal.”
It is unclear whether the numbers — which came through an Opposition request to the Ministry of Health — reflect actual caseloads for counsellors, but a leading expert said they seem close.
The opioid substitution therapy program provides methadone or Suboxone to patients to treat addictions to powerful drugs like heroin and hydromorphone. As of spring 2019, there were 3,715 patients receiving those treatments in Saskatchewan.
At roughly the same time, there were only 10 addictions counsellors and one social worker employed through the SHA to provide services to patients on opioid substitution therapy, according to the Ministry of Health.
Most of the patients were in Saskatoon, Regina and Prince Albert. Simply dividing the number of patients by the number of counsellors in each city gave caseloads of 195 in Regina, 200 in Prince Albert and 400 in Saskatoon.
Dr. Peter Butt, an associate professor in the University of Saskatchewan’s College of Medicine who also prescribes opioid substitution therapies in Saskatoon, said that reading of the numbers provides an accurate picture of the reality on the ground.
He said addictions counsellors are “stretched very thin.”
“The question is, are people really getting in the face time that they can benefit from, and I would say no, in many cases they’re not, simply because of the complexity of the care required,” he said.
Butt said counsellors have to deal with a wide range of overlapping needs well beyond addictions, from housing issues and HIV care to probation and parole. While many patients might be stable and require little support, he estimates that roughly a third require substantial assistance. Butt added caseloads in the opioid substitution program are “far above” the 50 or so patients other SHA addictions counsellors support.
Health Minister Jim Reiter responded to the data by pointing out that some of those patients are getting treatment through private practitioners, not the SHA. He also explained that the SHA has other addictions workers, who might also assist the patients receiving opioid substitution therapy.
“Those aren’t the only addictions counsellors out there, and not every person seeking addiction counselling is in that program,” he said. “Just because there’s not a counsellor specializing in that doesn’t mean there’s not assistance.”
According to the information his ministry provided to the NDP, there are 175 full-time equivalent positions in the SHA’S outpatient addictions treatment services.
The SHA was not immediately able to clarify what the actual caseloads of dedicated counsellors are in the opioid substitution therapy program, given the uncertainty over the supports provided by other addictions workers.
Reiter said the budget next spring will put “a lot of emphasis on mental health and addictions.” He also told reporters to expect legislation on opioids next week.
“The problem’s been growing across the country and not decreasing, so obviously we need to provide more supports,” he said.
“We have a mental health and addictions problem and we’re going to continue to make it a priority.”
But NDP mental health and addictions critic Danielle Chartier said front-line addictions workers have told her their caseloads are “out of control.”
“How do you provide care to folks when you’ve got 400 people on your caseload?” said Chartier.
“What I know is people on the front lines need the resources to provide the care to folks who are living with addictions issues, and those resources are not there right now.”