The departure of a local doctor to work in Nanaimo has left many Duncan methadone patients with limited options.
John, whose name has been changed in this story for privacy reasons, said that after Dr. Mark Greenspoon left the Canada Avenue Clinic, he was told by the clinic he would have to register with the new Nanaimo Clinic and commute there to get prescriptions because the other doctor in Duncan authorized to dispense methadone is not accepting new patients.
“The one doctor that’s left here [Dr. Peter Gooch] already has a full list and then the clinic said they’re trying to get a replacement,” John explained. “But shouldn’t that kind of be done before? Shouldn’t they have their ducks in a row?”
Methadone and other opiate substitutes are used for those who have developed an habituation to opiates of some kind. It masks the significant withdrawal symptoms they would otherwise experience and allows individuals to remain capable of daily activities without turning back to opiates.
John said he had major back problems, was prescribed strong opiate-based pain pills and then developed a dependence on them.
“I was going in for [pill] refills all the time, so they kind of forced me on methadone. I never wanted to go on methadone though,” John said, adding “It’s a long story.”
John said he was coming off a “huge” amount of pills. “You’re trying to come in there to get off the drugs, you know,” he said.
John requires a methadone prescription once per month and said Greenspoon last wrote him a prescription in mid-March. Commuting to Nanaimo is not something John is keen about, but he will do so if necessary, something he said many of the patients worse off than him won’t be able to do.
“I know a lot of these patients don’t have cars. They’re junkies, right,” John said, adding that the situation will affect many others who went to Greenspoon for methadone, not just him.
Providing enough resources for those facing opiate addiction is a challenge and currently not working as well as it could on the Island, according to Central Vancouver Island Medical Health Officer Paul Hasselback.
“It’s one of the issues that we’re relatively under-serviced for in many parts of the Island. So Duncan and the Cowichan Valley isn’t unique in that sense,” Hasselback said. “Maybe we should be rethinking what our approach to opiate substitution is in the province so that we can make this more available,” he added.
Last available statistics provided by Hasselback showed 61 methadone prescribers on the Island, a figure that he believes is still fairly accurate. In terms of patients receiving opiate substitution, the last statistics Island Health had available were for 2012-13 and showed approximately 2,800 patients on the Island who were having opiate substitution.
“That was growing fairly constantly at about 10 per cent per year,” Hasselback said.
In terms of opioid pills, though, Hasselback granted here can be issues, despite their legitimate use to treat chronic pain.
“They may be very necessary to carry them through very difficult times in their lives, but unfortunately weaning them off of those drugs can be difficult without the use of some sort of substitute like methadone,” he said.
Methadone may only be prescribed by physicians who’ve taken a special training program on the Mainland offered bi-annually, and distribution of it carries strict guidelines. One major roadblock to more physicians taking the short training program is that being able to dispense methadone can limit the scope of their medical practice.
“If somebody else came in right now and could prescribe they’d probably have a full-time practice just prescribing methadone in Duncan. Many physicians prefer a bit of diversity,” Hasselback said. “So other physicians are reluctant to sort of advertise themselves as providing it as a service. So there’s a balance there. It’s not just because people aren’t willing to get training, but it becomes a much longer practice-style commitment that few physicians seem to be engaged in lately.”
Hasselback also spoke to Duncan’s committee of the whole on Monday, April 4 about a variety of substance issues, including the increasing deaths from alcohol and growing prevalence of availability of potentially lethal opiate-based drugs like fentanyl.
“With the increase in illicit drug — particularly overdose — deaths, as well as changes and information on increases in alcohol-related morbidity and mortality, that kind of prompted me to put a focus this year on substances in general,” Hasselback explained.
A message from the Canada Avenue Clinic said the search for a new methadone-dispensing doctor is ongoing.
“Dr. Gooch, who owns the Canada Avenue Clinic is, I believe, trying to recruit another doctor. However, he won’t be available. He’s out of the country until probably about April 12,” said the message from Leigh Forrest, a counsellor at the clinic.
Greenspoon did not respond to request for comment by press deadline.