FORMER ADDICTS OFTEN DENIED TRANSPLANTS

'Subtle Disdain'

JEFF OSTOFSKY: Methadone "saved my life, my marriage, my sanity."

Like thousands of other Canadians on methadone, Jeff Ostofsky beat back his
powerful addiction to heroin and the miserable, lawless lifestyle that came
with it. For eight years, he has led a normal, productive life.

But he and the majority of other methadone patients who caught hepatitis C
from dirty needles are often denied liver transplants, something many of
them will need to survive as the relatively new illness takes its toll, say
addiction physicians.

Some former addicts have died after being ruled ineligible for livers to
replace theirs, which have been ravaged by hepatitis C, even though
methadone itself does not affect the success of a transplant, the doctors
say. They blame medical ignorance and the attitude that people who had
illicit drug habits are undeserving.

"Our people, who are perceived as the authors of their own misfortune, are
often getting the dirty end of the stick when the health resources are
meted out," said Dennis Long, who runs a methadone program in Toronto.

Attitudes are changing in the system and the majority of transplant
programs will consider methadone patients. But, faced with a severe
shortage of available organs, a significant minority still rule out former
junkies as recipients, experts say.

"It would be a shame if people who could benefit from a transplant that
might save their lives are denied that care simply because of a medication
they are taking," said Dr. David Marsh of the Toronto-based Centre for
Addiction and Mental Health.

One methadone patient died after being turned down for a transplant by
Toronto General Hospital, a recent article on the issue in the centre's
Journal of Addiction and Mental Health reported. Married, with a small
child, the patient had tested drug-free for eight years and had "a long
life ahead of him," a centre doctor said in a letter of complaint to the
hospital.

Mr. Ostofsky, 43, was hooked on heroin for 18 years, committing numerous
crimes to feed his habit. Methadone, he said, has "saved my life, saved my
marriage, saved my sanity." But he fears the kind of service he will get if
his hepatitis C becomes severe.

When doctors learn he's on methadone, their attitude is "a subtle disdain,
an unspoken contempt," said the 43-year-old, now a public health worker.

Dr. Marsh said as many as 80% of the 15,000 Canadians on methadone have
hepatitis C, a virus that inflames the liver, sometimes causing irreparable
harm. And 30% to 50% of hepatitis C patients eventually will need a
transplant to survive, he said.

Methadone is a synthetic narcotic that is effective in getting addicts off
heroin, and keeping them off it with few side effects.

However, a study published in the Journal of the American Medical
Association this year found that less than 60% of transplant centres accept
patients who are on methadone.

Dr. Michael Lester, a Toronto addiction physician, said a patient of his
died 1 1/2 years ago after being ruled ineligible for a transplant because
of his methadone treatment.

"This was a highly functioning guy who tried very hard to get himself a
liver transplant," he said. "He was told 'You have to get off methadone
first,' which he couldn't really do. The methadone was keeping him off
drugs and he was doing well because of it."

Toronto General Hospital recently changed its policy about offering
transplants to methadone users with advice from the addiction centre, said
Dr. Gary Levy, director of the General's transplant program.

The British Columbia Transplant Society, though, says it "strongly
encourages" patients to be off methadone before they get a transplant, said
Sally Greenwood, a society spokeswoman.