DOWNTOWN EASTSIDE ADDICTS GROW TIRED OF FIGHT FOR PRESCRIPTIONS

Vancouver resident Lee Wiebe knows what it's like to endure perpetual
agony. Wiebe, who is on the board of the Vancouver Area Network of
Drug Users, suffers from chronic pain caused by an inflammatory
arthritis known as ankylosing spondylitis. Despite being prescribed
100 milligrams of morphine daily for pain management, he says he is
constantly struggling with physicians to have his much-needed
prescription filled.

"I have troubles with the doctors at the clinic," Wiebe told the
Georgia Straight at the VANDU office on Hastings Street. "One of them
said to me that he didn't feel comfortable prescribing me morphine."

Why would a doctor deny a patient the medication he requires in order
to function? "It's because I'm a drug addict who lives on the Downtown
Eastside," Wiebe said.

As a member of the VANDU injection-support team, Wiebe spends most of
his time aiding and educating other drug users in the community. He
said he often walks for hours picking up needles and talking to people
on the streets despite suffering constant pain-sometimes so
debilitating he's confined to his bed for days. However, on other
occasions, he can't even travel to other areas of the city because
doctors won't fill his morphine prescription. Instead, he must go to
the same Downtown Eastside clinic and be watched by a pharmacist as he
takes his morphine each day. Wiebe claimed that this is
discriminatory.

"It pisses me off," he said. "I'm made to feel like a criminal, and
it's not going to change the way I would do drugs. It's just a ball
and chains since I can't leave the city." This type of discrimination
against drug users seeking pain medication is nothing new to Amy
Salmon, a researcher at the Women's Health Research Institute and the
UBC School of Population and Public Health. Salmon conducted a study
of drug users from the Downtown Eastside who tried to get medication
for their chronic pain. It found that physicians were "overwhelmingly"
turning away known drug users and not treating their chronic-pain conditions.

"The training that physicians are provided when navigating and
negotiating with drug-seeking patients is often set up to
systematically filter out people who use street drugs, people with
addiction, or people with suspected addictions from being seen as
anything other than drugs-seeking," Salmon told the Straight in a
phone interview.

This type of disconnect between patient and doctor is what health
researcher Melanie Spence and lawyer Katrina Pacey from Pivot Legal
Society would like to see corrected. Spence and Pacey, who spoke with
the Straight at the Pivot law offices, explained that more
communication is the key to establishing trust between drug addicts
and their doctors.

"Everyone here has a pain story," Spence said, referring to those
living in the Downtown Eastside. "We're trying to design a workshop
with an eye to try and build better relationships between physicians
and the people at VANDU who use those services."

They hope that this awareness-raising initiative will help mend the
"broken relationship" between doctors and their drug-addicted
patients. They would also like physicians to understand that these
addicts have legitimate health issues that can result in their demise
if left untreated.

Dr. Gabor Mate, author of In the Realm of Hungry Ghosts: Close Encounters
With Addiction, told the Straight in a phone interview that, addicted or
not, if people have pain it needs to be taken care of. He went one step
further and suggested the legal system with regard to drugs is "irrational"
and needs an overhaul.

"Part of the problem is the system itself; the whole problem is that
drugs are illegal," he said. "Therefore, people who are addicted have
to resort to sometimes illicit measures to get them, which sets up the
whole problem with pain relief because the doctors don't know what to
do very often."

Mate added that most people have trouble getting narcotics prescribed
by their doctors, but he emphasized the rigorous scrutiny and
suspicion that addicts go through when they require pain medication.
"There is less trust and communication," he said. "They [drug addicts]
are more easily dismissed because of their low socioeconomic
status-they become marginalized."

"Addicts tend to get the short end of the stick because they are often
accused of manipulation and diversion when it comes to legitimate pain
needs," he said. "That's how the system works."

Both Pacey and Spence acknowledge the complexity of the issue and
understand that doctors don't want to exacerbate a person's addiction
or contribute to the potential diversion of prescription drugs into
the street market.

Pacey said that these are "legitimate concerns", but she added that
she and Spence worry that Downtown Eastside doctors act as if they are
just treating a community of drug users without thinking on a
patient-by-patient basis. "Physicians take an oath that says they'll
provide the best care that they can to the person that is presenting
before them," Pacey said. "We're concerned that operating on
assumptions of who addicts are and what they'll do with a certain
prescription may be influencing doctors' decision-making as opposed to
what is the best possible care they could give to this person and what
will make them as healthy and safe as possible."