METHADONE TREATMENT EXPERT FRUSTRATED WITH POLICY MAKERS

SAINT JOHN - Medical ethicist and epidemiologist Tim Christie is at a
loss to understand why government seems unwilling to redistribute
resources that would see an additional 382 addicts receiving methadone
to help them kick their habit.

"It makes no sense at all. I don't know why they won't do it," he
said.

"I've engaged them in dialogue and they will not respond to reason and
they won't respond to the evidence."

Christie is one of the authors of a report that contends Ridgewood's
addiction treatment model costs $2,845 per patient per year, compared
to the uptown clinic's cost of $935 per patient per year. The uptown
clinic is located at St. Joseph's Community Health Centre and has been
open for nearly one year.

Christie said if the uptown model was followed at Ridgewood, 743
addicts could receive treatment with no new money required.

The difference, he said, is the cost of paying social workers on staff
at Ridgewood and the number of physician hours logged.

Up until recently, it was mandated by the province that addicts in the
methadone treatment program must receive counselling in addition to
their medicine which, when administered once a day and in adequate
doses, can usually suppress a heroin or Dilaudid addict's craving and
withdrawal for 24 hours.

But new scientific data says that, while counselling is useful, that's
not where resources should be concentrated,

"The literature says it's better to give people methadone only, than
nothing," Christie said.

"As a result of investing all our resources in counselling, we have
these huge wait lists."

According to the report, more than 80 per cent of resources dedicated
to the Ridgewood program are directed at providing psycho-social
counselling and administration. That program's annual budget is
$541,000; $442,000 for staffing and $99,000 for physicians who spend
66 hours a month treating addicts at Ridgewood.

Alternatively, at the uptown clinic, 86 per cent of resources are
directed at providing methadone; no resources are allocated to
structured psycho-social counselling and the site spends only $20,000
annually for 12 hours a month that physicians spend there.

The total annual budget for the uptown methadone clinic is $160,000
and it treats almost as many people as Ridgewood, he said.

During its first five months, 171 addicts were in treatment at the
uptown clinic and 190 at Ridgewood.

Christie, who is a member of the uptown methadone clinic's steering
committee, spends all of his time pouring over scientific evidence and
studying ethics and is frustrated at the response he is getting from
government and health officials.

"They have not been willing to change anything," he said. "I've
explained to them the cost-effectiveness of the uptown methadone
clinic and how much cheaper the uptown methadone clinic is and how, if
we changed the way we deliver the service, we could treat more people
within existing resources.

"They said they are not willing to change the model at
Ridgewood."

He also wants to make it clear that the way the program is delivered
is not the fault of the people at Ridgewood.

"They are doing the best they can but the people in charge of policy,
decision-making and resources are not responding to reason. The
front-line workers are just doing what they're supposed to do."

Health Minister Mary Schryer did not respond to interview requests and
Sue Haley-LaJoie, director of addictions and mental health services
for the Horizon Health Network, declined to comment on Christie's
report but said that counselling is "right up there" as a means of
treating addicts in the facility's specialized opiate treatment
centre. "Based on Health Canada's best practice guidelines,
counselling is one of the better ways in which to treat opiate
addictions or any addiction."

She said Health Canada recommends both counselling and
methadone.

"Will people do better with just methadone alone? Certainly. They
can't do any worse when they're out there with nothing and they're
using. Would they do even better than that with counselling along with
that? Absolutely."

Julie Dingwell, executive director of AIDS Saint John, was a big
proponent of setting up both the Ridgewood program and the new one at
the uptown clinic.

"We know there are hundreds of desperate people. We figure there are
500 or 600 more people who might access methadone, if they could," she
said.

People who come to the uptown clinic and need counselling get it, she
said.

"There are other agencies in the city that provide counselling and we
should be utilizing those services."

She believes that if more investment was made in nurse practitioners,
as opposed to social workers, more addicts would be treated and
medically stabilized.

"I've stopped calling it addictions treatment. It's life-saving
medicine," she said. "People have died on wait lists in the last few
years."

Saint John Harbour MLA Ed Doherty says he "feels strongly" about the
need for both programs.

"There are a number of people who have gone through the Ridgewood
program who have been extremely successful. They, in fact, do require
the counselling and have been able to get off the opiates as a result
of the counselling. What works for one doesn't necessarily work for
others.

"Nurse practitioners are not providing the intensive counselling and
programming that the social workers do at Ridgewood."

The Tories' health critic, Rothesay MLA Margaret-Ann Blaney, believes
it would be wise to follow Christie's lead.

"We need to be mindful of what the expert advice is and if somebody is
in the field and has done a comprehensive analysis, we need to look at
that.

"If changes need to be made, then they should be made. Common sense
needs to prevail. We don't have unlimited dollars, so let's utilize
them the best way we possibly can."

Christie, meanwhile, has no intention of giving up the
fight.

"Methadone is the most studied drug in the history of
pharmaceuticals," he said.

"This is not speculation. This is absolutely clear - if you give
people methadone and nothing else, it will reduce the drugs they take
in treatment, retain them in treatment, stabilize their lives and
reduce drug-seeking behaviour. The list is very long.

"For the past four years, I've been trying to reason with people and
provide them with evidence on which they can make informed decisions.
I've done that consistently and I'm going to keep doing that. This is
not something that will go away."