PRESCRIPTION DRUGS A HIT ON THE STREET

More Doctors Raising Concerns As Police Try To Tackle The Illicit Sales

EDMONTON - As medical director of an inner city health clinic, Dr. Mat
Rose can't afford to be naive when it comes to addictions to
prescription drugs. Almost every day, he gets patients requesting
potentially addictive painkillers such as OxyContin or Ms-Contin.

"In our situation, you can't be naive and you can't pretend to be
naive," says Rose, who has worked at the Boyle McCauley Health Centre
for almost nine years.

"You have to know about substance abuse, you have to prescribe
carefully."

For his patients, this might mean getting small amounts of medication
dispensed at a pharmacy, so as to limit the temptation to binge.

Some of Rose's patients must visit a pharmacy every
day.

For Rose, these steps are a regular part of his practice and he
expresses surprise more doctors don't do the same thing.

It's a message, however, that organizations such as the College of
Physicians and Surgeons of Alberta (CPSA) is trying to get out, as
more doctors raise concerns about addictions to prescription drugs and
police forces try to tackle the illicit sale of the drugs on the street.

In Edmonton, the police service, RCMP, CPSA, the Alberta College of
Pharmacists, and other organizations, started a working group last
fall to address the problem.

While experts generally agree that prescription drug abuse has long
been an issue, some believe it is becoming a greater concern in cities
such as Edmonton.

The drugs posing the most problems could easily be found in any
medicine cabinet. These include opioids -- morphine-like drugs such as
Ms-Contin, OxyContin and Percodan -- and benzodiazepines, such as Valium.

While some of the drugs are abused by middle-class people in
established neighbourhoods, others end up on the street where a 200-mg
dose of Ms-Contin might sell for $50 or a Percocet pill might be
traded for a cigarette.

Dr. Janet Wright, the CPSA's assistant registrar in charge of
prescribing practices, says these drugs are "very useful" but doctors
must remain vigilant -- and educated -- in order to spot patients who
might abuse the drugs themselves or try to get a supply to sell to
others.

"(Doctors) are not saying 'I'd like to be a drug supplier,' but they
may inadvertently find themselves in a position where they need more
education, more training, more tools," she says. "They're saying, 'I
didn't realize,' or 'I didn't know,' or 'I didn't quite know how to
manage that.' Helping physicians have the tools to be able to address
this sensibly and to give them advice, I feel very strongly that
that's the way to go."

Rose -- who gives presentations to fellow physicians on addictions and
the use and abuse of prescription drugs -- says many doctors are
constrained by time and a lack of experience in dealing with substance
abuse problems. Doctors need to ask straightforward questions about a
patient's history of drug use and carefully weigh the potential
benefits and risks of prescribing a drug that could become addictive.

"Physicians are pressed by time, multiple demands and they're
ill-equipped to deal with patients who might have substance abuse
problems. So it's easier to write a prescription and pretend there's
not a problem," he says.

Rose acknowledges that working in an inner-city health clinic means he
encounters more drug issues than the average family physician. Often,
people who have been "dumped" by other doctors for substance abuse end
up at the Boyle McCauley Health Centre because no one else will take
them as patients.

Rose believes the interconnections between potentially addictive
drugs, social problems and addiction problems are so complex that only
a portion of physicians should be allowed to prescribe some drugs,
with patients getting referrals to those doctors.

"I think in an ideal world, because this can be such a thorny problem,
you should have a proportion of physicians, probably a tenth of
physicians, who would be adept at managing opioids and benzodiazepines
medications. It means they'd have a good understanding of chronic
pain, substance use and abuse and anxiety disorders," he says.

He is doubtful, however, that that plan might ever
materialize.

Pharmacists such as Mohib Samnani, who often serves clients from the
Boyle McCauley Health Centre, says the controlled amounts of
medication prescribed by doctors such as Rose can help both physicians
keep track of their patients, but can also help patients better
understand the drugs they're using.

"It enables patients to know how to use their medications," says
Samnani.

In the near future, better computer systems will allow doctors and
pharmacists to quickly check on what drugs have been prescribed to
what patients, says Wright from the CPSA.

Currently, prescriptions to some prescription drugs are kept track of
through a system that can take time and effort to access.

Wright is also hopeful her organization's new partnership with police
will help shed light on exactly where people are obtaining illicit
prescription drugs.

"It doesn't all come from doctors prescriptions," Wright says. "It
also comes from across borders and from being stolen."

For their part, police acknowledge that the illicit sale of
prescription drugs is an ongoing concern in the city.

"There are locations in the downtown core that on any given day, at
any time you can purchase illicit prescription drugs for an inflated
price, without any questions asked," says Det. Guy Pilon, from the EPS
drug unit.

He notes that many of drug sellers legitimately require prescription
drugs for medical ailments, but sell what they can to dealers in order
to make some extra cash.

"A lot of addicts who do that use that to supplement their income,"
Pilon says. "It's a means of income that they use to pay rent."