HEAVY-HANDED RULES HARM METHADONE TREATMENT

Something extraordinary happened at a recent conference of Ontario
doctors who use methadone to treat people addicted to heroin and other
drugs.

The usually well-behaved and deferential physicians booed and jeered
their licensing and regulatory body - the College of Physicians and
Surgeons of Ontario - and they were joined by patients and other
health-care professionals.

The unprecedented public derision erupted during an attempt by the
college to justify its targeting of these doctors with special audits,
and for singling out methadone patients for invasive monitoring. The
outburst was the culmination of 13 years of increasing resentment, and
will hopefully herald bold new opposition to the unfair regulatory
system that burdens these doctors and their vulnerable patients.

Methadone is a legal substitute therapy for patients addicted to
opioids, such as heroin, and prescription narcotics like OxyContin.
Taken orally - dissolved in orange juice - it has negligible euphoric
effects. Patients are usually on it for life, and those who stay on it
experience substantially reduced rates of death and diseases like HIV
and hepatitis. They also engage in much less criminal activity.

The 280 Ontario physicians who prescribe methadone are among the most
heavily regulated doctors in the profession. They are subject to
frequent audits to ensure compliance with rigid methadone guidelines.
True, the issuing of this drug has been marred, in the past, by
isolated cases of physicians relying on underqualified staff, and
overbilling by performing too many tests. These problems were
highlighted in a series of Toronto Star investigative stories. Such
abuses, however, were a rare exception rather than the rule.

Only methadone patients must disclose personally identifying
information to the college as a condition of receiving treatment. Most
are unaware that their names are entered permanently into a college
registry. The college provides information from the registry, and from
the physician audits, to researchers who publish on the methadone
program - all done without the knowledge or consent of either patients
or physicians.

The drawbacks of this heavy-handed regulation aren't restricted to
inconvenience, or even undue invasiveness. It actually harms people's
health. There is solid evidence that Ontario's methadone-related death
rate has risen, despite introduction of the college's methadone
program in 1996. Contrary to what's claimed on the college's website -
that this death rate fell from 4.2 fatalities per 1,000 patients to
1.7 by 2000 - a more rigorous examination of the data shows that under
the college's watch, the rate actually rose, from 1.4 deaths per 1,000
to 1.7.

In its communications, the college continues to wrongly maintain that
there has been a "marked improvement in patient safety" since 1996. On
the same website, the college correctly notes that studies show
methadone patients are more likely to die if they stop receiving this
drug than if they were maintained on treatment. But the college stops
there - failing to mention a 2005 study on methadone patient retention
rates (using the college's own data) showing that 50 per cent of
patients who enter methadone treatment in Ontario have left the
program at the two-year mark. The college's heavy regulation does
nothing to keep these people in treatment and is more likely to drive
them away. That puts patients at higher risk of drug relapse, harm and
death - hardly the "marked improvement in patient safety" that the
college claims.

Meanwhile, ironically, the college pays far less attention to the
harmful and fatal consequences of prescribing drugs that are at least
as dangerous as methadone, such as morphine and OxyContin. The college
also has no equivalent system for monitoring physicians prescribing
such medication, or for controlling their patients.

No wonder methadone physicians are agitating to be unshackled from a
regulatory system that controls every aspect of their professional
judgment and drives patients out of treatment.

The college's motto is "Quality Professionals, Healthy System, Public
Trust." For methadone patients and their physicians, the college has
failed on all three counts.

Dr. Philip Berger has been prescribing methadone to addicts for 18
years. He and a patient have lodged a complaint against the College
with the Ontario Human Rights Tribunal.