DOCTORS PAN MAYOR'S 'ADDICTION SUBSTITUTION' PLAN

CAST Program Criticized For Eyeing Crime Reduction

Mayor Sam Sullivan's proposed drug treatment plan for up to 1,800
addicts is "a poorly conceived strategy that has negative
consequences," according to 14 doctors who had their letter published
in the most recent edition of the B.C. Medical Journal.

The doctors point to a statement on the Chronic Addiction Substitution
Treatment (CAST) website that says substitution therapy is a means of
reducing the addict's impact on public order and public health until
durable solutions are reached.

"This is not health care, nor is it likely that it represents the goal
of addicted patients," they wrote. "Does this mean that the chances
for recovery for addicts is so small that the only option is to be
'safely and ethically' managed through the CAST initiative with its
stated primary goal being 'to significantly reduce crime and disorder
in Vancouver by 2010?'"

The mayor's CAST plan calls for medical doctors to prescribe legal
drugs to up to 1,800 addicts in an effort to reduce or end a person's
addiction to hard drugs. The plan, which is to involve five trials,
has yet to be approved by Health Canada.

"We believe that the widespread introduction of safe housing, a
regular family doctor and social supports are the cornerstones in the
management of patients with addictions," the doctors' letter
continued. "The positive effects of these interventions are well
researched and well documented."

Another concern is that housing, counselling and access to a family
doctor may be tied to participation in the mayor's treatment program.

"What will happen to study dropouts?" the doctors said. "Will they
lose their doctor/home/social supports? If we begin to base our
decisions on social quietude versus sound medical principle, can we in
all good conscience claim to follow the tenets of the Hippocratic Oath
and keep our patients free 'from harm and injustice?'"

Dr. Ray Baker, the former chair of the B.C. Medical Association's
committee on addiction medicine, is one of the doctors who signed the
letter. Baker designed and implemented the addiction medicine
curriculum at the University of B.C. medical school and directed the
program for five years.

Baker said the doctors wrote the letter because they felt their
perspective wasn't being heard. He said the letter reflects
clinicians' experience with addictions as opposed to research scientists.

"What's being advocated and promoted [by the mayor] does not represent
the opinions of expert clinicians in the field," Baker told the Courier.

He said the city's Four Pillars drug strategy has focused too much on
harm reduction. Treatment is one of the pillars but it is woefully
inadequate in the city, where the open drug market continues to
thrive, he added.

"Those of us who work in the trenches are still absolutely frustrated
by the lack of treatment resources in all of B.C., but specifically in
the Vancouver area," Baker said.

CAST supporters, doctors David Marsh and Michael Krausz, wrote a
letter to the B.C. Medical Journal in response to the letter published
by Baker and his colleagues. It has yet to be published but the
Courier obtained a copy.

In the letter, Marsh and Krausz point out that the best studied
treatment available for addicts is methadone. But, they said, not all
addicts respond to methadone and that is why the CAST plan is worth
implementing.

Marsh and Krausz, who are working on CAST proposals, assured that
access to housing and treatment services will not be exclusive to CAST
participants.

"For example, over the past year the municipal and provincial
governments have announced several initiatives that will significantly
expand access to supportive housing in Vancouver and while CAST
participants will be able to avail of these services, access will not
be limited to CAST participants."

As for the critics' concerns that novel medications cannot be
evaluated until access to support services is available to all, Marsh
and Krausz wrote that "then we would still be limited to treating
hypertension with diuretics while working to expand dietary and
exercise programs."

They said the primary goal of CAST is to improve addicts' health.