LET'S COME TOGETHER OVER METHADONE

City emergency room physicians hate methadone programs and, some would
argue, with good reason. Emergency departments are the only resort for
those seriously afflicted, be it with cardiac problems, trauma,
psychosis or overdose. The obese diabetic smoker who lands in cardiac
bed one has systematically resisted all attempts to effect some
therapeutic change. The unrepentant addict who has been accepted into
a methadone program but continues to use all available chemicals,
arrives comatose into the acute room, only to flee the scene
post-Narcan. Both have rejected appropriate medical care, thus costing
the system big-time, never mind frustrating the overworked folks in
emergency.

Do I hear diatribes against cardiac cripples who soak up nearly
infinite resources? Not often. But there is a barely concealed anger
and hostility towards addicts in most ERs. Why? Well, let's consider
that hoary old chestnut: communication.

There are few ER docs nowadays who cut their teeth in the trenches of
general practice. Not only have they little or no experience in the
field, but most of them wouldn't know a GP if such an animal were to
parachute into their local Starbucks.

In city hospitals, GPs are now extinct. There is little contact
between GPs and ERPs, no consultation, no exchange of information. As
far as most city ERPs are concerned, GPs are an inept and useless
group of overpaid underproducers who can't manage their patients'
chronic illnesses, leaving them to pick up the pieces. Indeed, given
the subset of non compliant humanity which fetches up in ERs, they
might be forgiven for feeling this way.

But when it comes to addicts, especially those addicts on methadone,
the sense of outrage escalates, for few ERPs understand methadone
programs, in which most of the prescribers are GPs. In city ERs, there
is no methadone physician to call. The perception is that methadone is
just another drug peddled by physicians duly licensed to do so.
Without physician to physician contact, mythologies flourish.

The experience can be different. I have a methadone licence for both
opiate addiction and analgesia. I will confess up front that it has
taken me years to become good at using this medication as part of a
program to benefit my opiate addicted patients. I am even more careful
when I use it for analgesia for this is an unforgiving drug, given to
depressing respiration in ridiculously small doses.

I work in a mid-size city where virtually all GPs have active hospital
privileges. Together with my methadone prescribing colleagues, I
respond to calls from ERPs or psychiatrists in order to assist
physicians attending addicted patients. As a group, we meet regularly
in each others' homes. We are available for methadone patients, as we
are for our frail elderly or our cardiac patients. They all need our
help. We do not judge.

What of methadone patients who only end up in ERs with surgical
symptoms or intercurrent disease? These are success stories. They work
with us to stabilize their illness (oh yes, addiction is an illness),
achieve safe housing, more education, jobs and more.

Yes, the methadone program works. It works for many people. Nothing
works for everyone, not in heart disease, not for cancer, not for the
addicted.

So for those who take issue with the benefits of methadone, one of the
world's most studied medications, remember this: There are men and
women in your life who are on methadone: the oil delivery guy, that
nice check-out woman packing groceries, the government office clerk,
the manager of a thriving local business, your daughter's Sunday
school teacher.

Just like our cardiac patients who exercise, watch their diet and stop
smoking in order to improve their lives and minimize ER visits, our
committed methadone patients will seldom darken ER doors. They manage
their lives at varying levels of function. Many are invisible in their
communities.

Just for a moment, let's imagine a world where methadone physicians
and ERPs communicate regularly, share clinical information, consult
and discuss. Patient care would improve. All physicians would learn.
Frustration and anger would diminish.

What's to lose?

- - Patricia Mark is a family physician in Nanoose Bay, B.C.