CLINIC RULES MAKE ABUSE RARE, MD SAYS

Control Of Pain Prescriptions Looser

The chairman of a body that oversees methadone treatment programs in
Ontario is worried they will be unfairly blamed for dozens of overdose deaths.

Dr. Graeme Cunningham, chairman of the Methadone Governance Committee of
Ontario, said legitimate questions are being asked about possible diversion
of the powerful narcotic from clinics where it is prescribed for people
addicted to heroin and other opiates.

But he said he is confident the treatment programs, subject to stringent
guidelines and controls set by the Ontario College of Physicians and
Surgeons, will stand up to scrutiny by the provincial coroner and police in
at least six communities, including Waterloo Region.

If there are problems, they will have to be addressed, but "we've got a
good system in place," said Cunningham, an addictions expert at the
Homewood Health Centre in Guelph.

Dr. James Cairns, deputy chief coroner of Ontario, has said he is concerned
that a dramatic increase in methadone overdose deaths since 1996 coincided
with the rapid expansion of treatment clinics.

Methadone-related deaths shot up from nine a year to 64 between 1996 and
1998, and have remained alarmingly high ever since. During the same period,
patients receiving the synthetic substitute for heroin soared to more than
6,000 from fewer than 1,000.

Cairns said one possibility is that methadone prescribed to addicts is
making its way to a black market on the street. The drug can kill users who
have not built up a tolerance to it.

His concern is shared by Waterloo regional police, who investigated the
overdose deaths of two Kitchener young people this summer and have urged
tighter controls on the drug.

Cunningham acknowledged that even one overdose death is "one too many."

But he said methadone-maintenance programs have saved dozens of heroin
addicts, while stabilizing the chaotic lives of thousands of others.

If black market methadone is a problem, Cunningham said, it is likely
getting on to the street after it is prescribed for chronic pain by doctors
who aren't under the same stringent controls as clinics.

Cheap, long-lasting and effective, he said, the popularity of methadone as
pain medication has grown by leaps and bounds, with 160 doctors in Ontario
now approved to prescribe it for that purpose, up from only a handful two
years ago.

And -- unlike doctors in addiction programs, who must receive special
training and are subject to regular checks by the college -- Cunningham
said physicians using it for pain are routinely "rubber-stamped" by Health
Canada.

"My thesis is, it's on the pain-management side of things that methadone is
being misused," he said.

"They don't have to be audited, they don't have to keep a registry of
patients. They're just there."

Officials from Health Canada could not be reached yesterday to respond to
his criticism.