Boots-on-ground doctor calls for more clinic help
Dr. Patricia Mark wants to stand on a mountain top and scream until the government funds addiction clinics properly and pays for the medication used to treat opioid addiction.
But until that happens, the addiction-support physician at Nanaimo Regional Hospital will keep her boots on the ground, treating addicted patients at the hospital, at AIDS Vancouver Island’s methadone clinic in Nanaimo and in jails across the province.
“I have never known such a marginalized, discriminated and judged group of patients in my long and adventurous career. It’s truly dreadful,” Mark said. “I’ve seen a lot, and heard a lot of what gets people into addiction in the first place. And nobody wakes up in the morning and says: ‘I think I’ll be a drug addict.’ Nobody.”
The fentanyl crisis has its roots in physicians overprescribing heavy-duty painkillers for minimal pain, Mark said. When OxyContin, used as a street-based substitute for heroin, was discontinued in 2012, highly concentrated fentanyl pills and powders flooded the market.
Young people, curious about drugs, have been sidetracked into the misery of addiction just by trying the new dangerous and highly addictive drugs, Mark said.
“So before they know where they are, they are absolutely caught.”
Entrenched and marginalized drug addicts are also caught in addiction that stems from horrifying child abuse and childhood trauma, Mark said. Their psychological pain is so dreadful, they take drugs to numb it.
Mark has heard stories from men in jail who were started on heroin at six or seven years of age by their parents, who then rented them out for sex.
“I visited a woman in prison who was seven when her father started her on heroin, then raped her a few times and sold her out for group sex with men,” Mark said. “These people are too damaged. It makes it very difficult for them to ever recover. When something like that happens to you when you are seven or eight years old, you’re done.”
The good news is that doctors are having success treating opioid dependence with methadone. They’re having even more success treating people with Suboxone, a much safer medication.
“There’s a big push to get as many people onto opioid substitution therapy as possible in the jails,” Mark said.
Mark is on the committee governing opioid treatment guidelines in B.C. She said the provincial government should develop an all-party committee to look at funding for opioid-dependence treatment.
At the methadone clinic where she works, patients pay $65 a month for treatment. The clinic employs a nurse and a counsellor and provides the full spectrum of care. “It’s not fully funded and it should be,” Mark said. “If you’re on welfare, the government pays $55, but the patient still has to pay $10 out of his $600 monthly payment. It’s even more difficult for the working poor who pay $12 to $15 a day for methadone or Suboxone. It doesn’t sound like a lot. But it’s a huge burden when you make $14 a hour and you’re trying to feed your children and keep a roof over your heads.”
Instead of paying for medication, some addicts exchange favours for heroin, said Mark, who is treating two 16-year-olds who are selling sex on the street to support their drug habit.
“The street worker is screwing her dealer or middling — getting heroin from the dealer to the client — and getting a little bit for themselves. This is incredibly damaging. It’s paying in kind for heroin.”
Other patients try to get by, taking their medication every second day. It doesn’t work.
Mark said the government could provide immediate help by supporting the clinics and paying for medications.
“It’s so basic. Make sure they can get their medication without the horrifying choices they have to make in terms of their kids’ food and rent. So I don’t have to treat patients who say they can’t afford it and are back using.”
Health Minister Terry Lake said the government has done a lot of work on the opioid substitution program and the new frontline treatment in most jurisdictions will be Suboxone.
“What you will see is more and more people have access to opioid substitution programs and it is covered on a sliding scale under PharmaCare,” Lake said. “This switch in the new approach to opioid substitution program, I think will eliminate a lot of concerns about barriers to treatment.”
Although the province has promised to provide 500 addiction-treatment beds in 2017, treatment beds generally don’t work, said Mark. She has seen families bankrupt themselves spending thousands of dollars to send a son, or daughter to a treatment centre.
“More beds is not the answer. Stuff them in a bed, then what are you going to do with them? We need boots on the ground, handson patient care — because they are pretty sick from other things like septic joints and heart-valve disease.
“You just don’t treat the addiction. This is a person. A real live human being. It’s somebody’s son. It’s somebody’s mother. It’s somebody’s daughter, sister, brother.
“These are the people who serve you at the grocery store, at the petrol station, the woman who teaches your child at Sunday school. They are real people and they are not bad people.”
The government should also continue to support housing options for the homeless. A lot of addicts don’t have anywhere safe to live. They’re couch surfing or staying in crack houses, or other desperate places where people pay $500 a month in rent and everybody uses drugs.
“You have no chance on God’s green Earth you’ll ever be able to come off hard drugs if other people around you are using,” Mark said. “If you’re a drug user or have been a drug user and you see a rig or the heroin, the spoon and the heat, you will use even after 10 years, it’s that powerful.”
People don’t understand addiction, the compulsion to use, Mark said.
“And, therefore, something you don’t understand, you denigrate. It’s a very judgy world out there. But when someone in the family struggles with this problem, they have a really rude awakening to the sheer dreadfulness of this.”