MDS SEEK CLINIC FOR AREA DRUG ADDICTS

Heroin and morphine addicts in Sault Ste. Marie area need local methadone
maintenance treatment, say doctors and the Centre for Addiction and Mental
Health.

The Health Ministry urges establishment of such a service here, and a
spokesman for the local CAMH says it might ease demands on the city's
physicians and the hospitals.

Dr. David Marsh, clinical director for addiction medicine of CAMH in
Toronto, and Wade Hillier, from the College of Physicians and Surgeons of
Ontario, visited the Sault Monday to promote development of a local clinic.
Marsh said recent advances prove methadone maintenance treatment (MMT) is
"the most effective treatment we have for opioid addiction," such as heroin
and morphine.

Health Canada loosened the guidelines in 1996 for how many patients a
physician can take on for MMT and dropped its requirement to screen and
approve prospective patients for treatment.

"Now it's up to the doctors to decide. That helped the expansion (of MMT)
in Toronto," Marsh said.

"Before 1996, there were people on waiting lists to get treatment. Since
then there's been a dramatic increase in the number of doctors prescribing
because of those changes in guidelines."

CAMH established a training course for doctors in 1996, followed by a
course for pharmacists and counsellors. Last year the centre published a
client handbook, and hopes to issue a manual for counsellors this year.

Hillier said The College of Physicians and Surgeons of Ontario got on board
roughly at the same time, because Health Canada "watered down (the
responsibility) and passed it down to the province."

The result is an uneven availability of treatment from province to province
- - British Columbia and then Ontario were the first to establish private
practice clinics - but also from region to region.

While the number of people on MMT has increased five-fold in the last five
years in Ontario, addicts in Algoma District have no local recourse. The
closest clinic is in Sudbury.

At the same time, a recent University of Toronto study shows that HIV
prevalence in injection drug users surpasses 15 per cent in Northern
Ontario - higher than the provincial average - and is growing at a more
rapid pace than in the rest of the province, Marsh said.

"That makes it even more important to help injection drug users in these
communities . . . Methadone maintenance helps prevent the spread of HIV in
injection users."

The push to establish methadone treatment locally is spearheaded by a local
committee of health care providers, including CAMH, the Algoma AIDS
Network, Algoma Health Unit and Addiction Treatment and Prevention Services
of Algoma.

The committee is partly a result of a directive of the Ontario Substance
Abuse Bureau, an arm of the provincial health ministry that funds addiction
treatment centres such as CAMH.

The Methadone Strategic Working Group, a provincial committee of consumers
and service providers, followed up in May with a report advocating the
availability of more methadone treatment to counter the "crisis" across
Ontario.

Mike O'Shea, committee chair and program director for the local CAMH
office, says the health community has shown greater interest. About a dozen
local physicians were expected to attend Monday to learn how to get an
exemption to prescribe methadone.

Two doctors with such exemptions would be good for Algoma District, with up
to four optimal, O'Shea said. But he warned that prospect is still far from
a certainty.

"It's partly dependent on interest from the medical community, the
availability of trained physicians . . . and funding. Funding is a big if.
Physicians in the community are saying things are critical already - there
are waiting lists for GPs and no doctors to staff the emergency department
(at night.)"

But Marsh said diverting opioid addicts from general practitioners and
emergency rooms can actually ease local demands.

Studies show untreated opioid users access health providers an average of
twice a month and create about $5,000 in health costs per year - money that
could be used for MMT.

"On the one hand, this might be a good time. This could divert people for
treatment who don't have it right now."