ADDICTS AT RISK IN DRUG SCHEME

'Is This Going To Kill Me' Patient Asks Shortly Before Dying From Overdose

Pharmacist Says His Methadone Program Is Both Legal And Necessary

Thousands of addicts in a government-sanctioned treatment program are
being put at risk by pharmacists who provide drugs in a scheme the
Ontario College of Pharmacists describes as "disgraceful" and "unprofessional."

Pharmacists Wing and Sue Wong have for years been shipping boxes of a
highly controlled synthetic narcotic called methadone to a network of
drug treatment clinics used by people who are weaning themselves off
street heroin and opiate-based painkillers. The clinics, called
Ontario Addiction Treatment Centres (OATC), service 4,000 patients
and the Wongs' pharmacies supply roughly half of those clinics.

When the daily shipments reach the clinics, unqualified staffers --
typically nurses who don't have special methadone dispensing licences
- -- administer the methadone. According to the Ontario College of
Pharmacists, only pharmacists and doctors are allowed to dispense the
sometimes-lethal drug.

The arrangement between OATC founders and the Wongs' three pharmacies
in Kitchener, Hanover and Guelph is both lucrative and controversial.
The pharmacies make financial investments in the clinics in exchange
for a guaranteed slate of OATC methadone patients in numerous towns
and cities across Ontario. The Wongs also get numerous extra
"dispensing fees" -- many of them daily instead of the standard
weekly or monthly prescriptions -- for additional medications
methadone patients often require.

These deals are at the heart of a series of allegations brought
against the Wongs this week by the college that regulates
pharmacists. Much of the revenue the Wongs earn is paid by the
Ontario Drug Benefit Plan, a provincial system that supports people
who cannot afford the full cost of medications.

Improper dispensing of methadone can have fatal consequences. The
provincial coroner's office is investigating the October death of
Wade Hatt, a 41-year-old OATC patient and father of two. Just months
away from beating a painkiller addiction, Hatt was mistakenly given a
methadone dose that was 10 times his normal amount. The medication
had been shipped from one of the Wongs' pharmacies.

"Is this going to kill me?" Hatt said worriedly to an OATC nurse
after he realized he had been given a major overdose of the drug.
Experts say Hatt should have been sent to an emergency room, but the
nurse instead sent him home and told him to go to hospital only if he
got unusually sleepy.

The Wongs are alleged by the college to have broken numerous federal
and provincial rules and regulations governing the safe dispensing of
methadone. For example, they charge the full fee pharmacists are
allowed for dispensing drugs, but since they never see the patient
they don't discuss the treatment and potential side effects -- all
duties of a pharmacist.

'I will give them your phone number and you can deal with the addicts'

They are also alleged to have violated conflict of interest
guidelines that guard against financial agreements between
pharmacists and doctors, and are alleged to have engaged in
"disgraceful, dishonourable or unprofessional" acts. The charges,
which have not been proven, are to be heard at a college discipline hearing.

In a recent telephone interview, Wing Wong defended his practice and
told the Star that non-pharmacists should be allowed to give out
methadone at medical clinics because patients have more points of
access and a higher chance of success.

After being confronted by college investigators last summer, Wong
told them that the scheme helps provide a valuable service. To stop
it, he said, would overwhelm and literally sicken desperate patients.

"I will give them all your number and you can deal with the addicts.
You will have 2,000 starving patients on your doorstep," Wong and his
counsel told the college.

Wong told the Star it would be a mistake to shut down his system.
"These people who are being treated are being jeopardized by the
college," he said.

Methadone is a synthetic narcotic usually taken in liquid form mixed
with orange drink. Generally, it blocks the high addicts get from
heroin and opiate-based painkillers, such as morphine. It is used to
wean addicts off the drugs and stops them from experiencing cravings
and withdrawal symptoms.

Sometimes called "liquid handcuffs," the once-controversial
medication must be taken daily, seven days per week. Although
patients are often dependent for years -- or even life -- treatment
experts say methadone helps reduce death rates, illicit drug use and
allows addicts to move on with their lives. Use of the drug in
Ontario has skyrocketed since 1996, when provincial health
authorities pledged to make the treatment widely available.
Pharmacists and doctors were encouraged to go for methadone training
and apply for special federal licences needed to obtain authorization
to prescribe and dispense the drug.

But a confusing set of rules and regulations govern the dispensing of
methadone. While the Ontario College of Pharmacists says only doctors
and pharmacists are authorized "under federal regulation" to dispense
methadone, the Wongs and OATC have for years been advocating for
their system, in which doctors and pharmacists can delegate the
dispensing rights.

The college has periodically warned the Wongs (the pharmacy college
has no jurisdiction over doctors) to stop. It was not until this week
that allegations were brought against the pharmacist and his wife. A
handful of other pharmacists supply other OATC clinics in the same
manner, but they are not facing disciplinary action.

At 5 p.m., Purolator picks up hundreds of methadone doses at the
Wongs' Kitchener store

The Wongs get a virtual monopoly on prescriptions because OATC
patients are typically asked to sign a contract directing them to the
pharmacist their OATC doctor chooses. Patients in Ottawa, for
example, receive medication measured out by the Wongs' staff in
Hanover. It is shipped to Ottawa by courier and then dispensed to
patients by a non-pharmacist, usually a nurse. The Wongs' pharmacy
then bills the province, even though a pharmacist never spoke to the
patient, a key safeguard when dispensing any drug.

As part of a broad investigation into the business of methadone
treatment, Star reporters and a photographer recently witnessed
workers at the Wongs' King St. pharmacy in Kitchener measuring out
hundreds of methadone doses and packaging them as part of a large
order. The store, with its sparsely stocked shelves and aisles strewn
with boxes of empty prescription bottles, seemed more like a storage
and shipping centre than a conventional pharmacy.

Working in a mini-assembly line, pharmacy staffers mixed powdered
methadone concentrate with water in large brown glass jugs. Next,
they pumped the clear liquid into hundreds of small prescription
bottles that appeared to be labelled with patients' names. They also
packaged other medication to be sent with the shipments. Pharmacist
Susan Wong was overseeing the process. The prescriptions they were
filling had been sent electronically by OATC doctors.

At 5 p.m. each day, a Purolator courier truck pulls up to the front
of the store and the driver hauls away loads of large boxes filled
with the tiny prescription bottles. The boxes are then delivered to
OATC clinics in various cities, including Lindsay, Newmarket,
Woodbridge, Brampton, North York, Vanier and Hamilton. Shipments to
Owen Sound, Guelph and Ottawa come from partner pharmacies co-owned
by the Wongs in Hanover and Guelph.

At OATC clinics serviced by the Wongs, patients line up every day at
a pharmacy "depot" to get their methadone drinks and other
medications. The Wongs are in effect operating small pharmacies
across Ontario without having to pay the high overhead, such as the
professional salary of a pharmacist, required to support a
traditional pharmacy.

When Wade Hatt took his fatal overdose, he was just months away from freedom

Wade Hatt, who died last October, made it his routine to go to the
Ottawa clinic depot for his dose each day around 2 p.m.

A night shift deliveryman determined to beat his addiction, Hatt
usually went with his 37-year-old girlfriend, who declined to be
interviewed. Although the woman was further behind him in the
treatment program and required a higher amount of medication, the two
were making an effort to get their lives on track. They would line up
together each day and wait for the clinic staffer to retrieve
prescription bottles filled with pre-measured medication from the
clinic fridge.

The methadone had been measured out in Hanover. At the clinic,
staffers mixed the clear liquid with orange drink to make it taste better.

Although he was never into street drugs, Hatt developed an addiction
to the prescription painkiller Oxycontin -- known on the street as
"hillbilly heroin" -- around the time of his divorce. "He never
touched drugs up until then," a family member said. "It was so
strange." Hatt was a former bus driver and actor who once dreamed of
being a stuntman. He and his former wife raised two sons but Hatt
lost touch with them when his addiction started.

Hatt considered quitting cold turkey, but instead opted for the
methadone program that he hoped would help him slowly end his
addiction. He joined the OATC methadone program with his girlfriend.

Making daily appointments kept him from working full time, the family
member said. "His life was on hold. He had to go there every day."
When the OATC clinic opened in Ottawa, Hatt began working again. His
live-in girlfriend also had a stable job; Hatt began his difficult
push to get off methadone altogether.

When he took his last swig of the orange-flavoured juice last
October, he was mere months from freedom, the family member said. "I
thought 'Oh, this is a godsend to get him off.' Then this happened."

Hatt's family wants to know why the clinic made the mistake. The
death is being investigated by the provincial coroner's office, the
College of Pharmacy and the College of Physicians and Surgeons. A
source close to the investigation said that a nurse at the OATC
clinic gave Hatt the 150-milligram dose intended for his girlfriend.
Although normal protocol -- including that posted on OATC's website
- -- states that overdose victims are to be sent to hospital, Hatt was
told to go home and watch for unusual drowsiness.

The clinic nurse told Hatt's girlfriend to monitor him closely
because he might appear sleepy. Frequent checks throughout the night
revealed a snoring Hatt. But by morning, he was dead.

Staff at the OATC Ottawa clinic and the Hanover pharmacy said they
could not discuss the case.

Dr. Jim Cairns, Ontario's deputy chief coroner, said this week that
his office is investigating "what role the clinic played in his death."

'Dr. Daiter and his colleagues at OATC... have acted honestly and
professionally'

Since November, the Star has sought comment from OATC and its
founders, Dr. Michael Varenbut and Dr. Jeff Daiter. Both doctors have
refused requests for interviews about specific allegations. In a
brief interview Varenbut said, "We are not doing anything wrong."

David Porter, a lawyer who represents Daiter, gave the Star a written
statement: "Dr. Daiter and his colleagues at the OATC are dedicated
and conscientious physicians providing exceptional patient care. They
have conducted themselves honestly and professionally in every aspect
of their practice. Any review of the practices of Dr. Daiter and the
OATC would conclude that these are honourable, conscientious doctors
who have acted honestly and professionally in delivering necessary
medical services to the public."

The College of Pharmacists has no jurisdiction over methadone
doctors, who are governed by the College of Physicians and Surgeons of Ontario.

A source close to the Wongs said they have been warned about their
methods by the college several times over the past two years. But in
recent years, courier runs have become more frequent, and work more
frenzied, as the number of patients it serviced ballooned.

In September 2004, all pharmacists across Ontario were issued a
blanket warning stating those who "involved their pharmacies in
special arrangements with some methadone clinics" were to stop
shipping drugs and allowing unqualified clinic staffers to administer it.

That same month, OATC founder Dr. Jeff Daiter wrote to his own
college describing how the pharmacy depots work. OATC staffers
sometimes acted as "employees" of the pharmacy, he said, adding: "The
pharmacy depot inside the clinic is rented by the pharmacy and as
such, the pharmacy has trained staff to operate it."

Daiter has told his college that OATC doctors receive no financial
benefit from the pharmacy arrangement, which he says is convenient
for methadone patients.

Methadone dispensing is a lucrative business when done at high
volumes. At about $4 per daily prescription of methadone, the Wong
pharmacies have an earning potential of close to $3 million in
revenue for daily doses to their 2,000 OATC patients. On top of that
are the additional prescriptions OATC physicians write. Methadone
patients often require drugs such as anti-depressants, and stool
softeners to counter the side effects of methadone.

The Wongs and other pharmacists who supply OATC patients purchase an
expensive medical software program called Toxpro that is sold for
thousands of dollars by the OATC founders. A source with knowledge of
the business relationship between the Wongs and OATC said that large
cheques were sent by the Wongs to the software company, owned by
Daiter and Varenbut. Other cheques were paid by the Wongs to OATC.
The source believed the cheques are payment for the software and
renting depot space in the OATC clinics.

Other pharmacists OATC tried to recruit have told the Star that they
were asked to make a variety of payments to OATC in return for the
incentive of a monopoly on patients.

Part of a pharmacist's entitlement to payment for dispensing
methadone, according to provincial rules, involves not only measuring
out the patient's dosage but counselling him or her each day and
watching the patient ingest the medicine.

At the Ottawa clinic yesterday, a nurse who spoke to the Star by
telephone said they were continuing to give out methadone to
patients. No pharmacist was on duty and no doctor was there for the full day.