ADDICTED TO A MORAL MINDSET

The scope of B.C.'s drug problem really sunk in for me last week when
I learned that almost 10,000 British Columbians are registered
methadone users.

Wow. And those are just the ones who have made it onto methadone, a
synthetic opiate that quells cravings for heroin and morphine. Add in
at least 12,000 more injection-drug users buying heroin and cocaine at
the street level, not to mention uncounted thousands addicted to drugs
that don't require needles, and B.C.'s numbers are downright alarming.

What are we doing about it? More than most, I suppose: Two-thirds of
all the methadone prescribed in Canada goes to British Columbians, and
we've got the country's only safe-injection site. But in real terms,
not much. We're still a long way from shaking off the moral mindset
that taints the way we treat addiction.

Every day in this province, in this country, in this world, people do
injury to themselves in the pursuit of pleasure. And whether it's a
teenage street-racer who crashes his car, an obese 45-year-old who has
eaten her way to Type II diabetes or a cigarette smoker whose habit
has finally caught up with him, we'd rightly be aghast if our
health-care system provided anything less than high-quality,
non-judgmental care.

Addiction is the notable exception, however, particularly when it
involves street drugs. Compromise your health and happiness through
illicit drugs and you'll find yourself begging for help from a
scornful community, and one that feels no guilt about dramatically
different health-care standards.

B.C.'s 38-year-old methadone program is a case in point. Even those
who have used methadone for years can't buy more than a week's worth
of the drug in advance, and most face having to make daily trips to
the pharmacy to buy one dose at a time. If that interferes with
people's ability to hold down a job, travel or just get on with their
lives, too bad.

While methadone is covered under Pharmacare, it's free only to those
on income assistance; everyone else will pay the $3,600 annual fee up
front just like any of us. But the average prescription-drug user can
buy dozens of pills at a time and pay a single dispensing fee. Those
on methadone ante up every day, including $7 or more for a dispensing
fee charged each time a pharmacy hands over a cup of methadone.

Few of us have doctors who would try to punish us by withholding our
medicine, but that's a constant threat for methadone users. If they
don't have the money for their methadone, are caught with other drugs
in their system or even just rub a clinician the wrong way, they can
be cut off. The College of Physicians and Surgeons, which administers
the program, recently ramped that up by making it harder for methadone
users to switch doctors.

The college has also cautioned doctors against prescribing morphine to
tide people over while they wait to be accepted into the methadone
program, which means addicts either have to keep using heroin or get
by with no medication for two weeks while their application is
processed. Should they choose the latter, they could end up denied
entry to the program, as happened last month to local actress Sheryl
Fjellgaard. Fjellgaard died of an apparent overdose trying to boost
her heroin levels enough to qualify her for methadone.

Yes, methadone is an addictive and potentially dangerous drug. And
yes, the occasional user does manage to outfox the system and sell
their supply.

But how often? As noted by the national Institute of Medicine in a
1995 report, the current level of regulation "puts too much emphasis
on protecting society from methadone and not enough on protecting
society from the epidemics of addiction, violence and infectious
disease that methadone reduces."

People make mistakes, and ending up addicted is certainly one of them.
But until we're prepared to withhold health care to everyone whose
lifestyle choices cause them harm, let's quit the finger-wagging and
get on with the important business of making people well.