Increase in methadone good news for addicts

By GLORIA GALLOWAY The Canadian Press

TORONTO It's the teenagers that bother pharmacist Komal Khosla the
kids who show up at his midtown methadone clinic with a $400aday
habit and needle tracks beneath their highschool jerseys.

"When you get a 45yearold heroin addict, that makes sense," he says,
taking a break from the business of keeping junkies clean. "When you
get a 17yearold, it doesn't."

Fortunately, in the summer of 1997, Khosla and his physician
colleagues have easy access to methadone, used to help addicts kick
their habit by alleviating the symptoms of withdrawal.

Incredible difference

That wasn't true before the spring of 1996, when the federal Bureau of
Drug Surveillance decided it didn't need to approve each addict for
methadone and instead allowed provincial colleges of physicians to
license doctors to prescribe the drug.

Two years ago, Canadian addicts could expect to wait years before
receiving methadone treatment. Today, they can walk into a doctor's
office and walk out with a prescription.

Addiction therapists say the change has made an incredible difference
in the lives of thousands of heroin users across the country.

In a day when every shared needle holds the possibility of AIDS and
when nearly 300 people overdose annually in British Columbia alone,
methadone literally means the difference between life and death.

The old system was terribly bureaucratic, says Bruce Rowsell, director
for the drug surveillance bureau, who was largely responsible for the
policy change. And it was limiting.

In Ontario, for instance, there were just 800 spots in methadone
programs for an estimated 20,000 heroin addicts.

Although there are no statistics on how many have swapped heroin for
methadone since the change, there's no doubt the numbers have
increased dramatically, says Rowsell.

The new system not only makes methadone more available in the big drug
centres of Toronto and Vancouver, it also means smalltown doctors can
prescribe it.

"We had cases in Western Canada where people were travelling a couple
of hundred miles to obtain treatment," says Rowsell.

In one respect, methadone treatment exchanges one addiction for
another. "But you're replacing their heroin with a pharmaceutical
preparation where the quality is known," says Rowsell.

Patients on methadone are generally free of hallucinations. It's far
cheaper than heroin $5 to $20 a day compared with $400 so they're
not forced to steal to support their habit. And there's no sharing of
needles.

"The number of people on methadone is increasing and that is a good
thing," says Dr. Doug Gourlay of the Addiction Research Foundation.

Although methadone is an addictive substance, says Gourlay, the drug
programs lure addicts into counselling. Eventually, they may beat the
dependency.

They may also live for decades with a methadone addiction which
poses a new set of ethical problems for people like Khosla. Is it
right to turn teenagers into methadone junkies?

On the other hand, he asks: "Do we send them back to the streets until
they catch HIV and then bring them back in?"

Khosla is a strong advocate of the new system. But he sees potential
for abuse.

`Not a bad thing'

"Two years ago no one could get a licence (to prescribe methadone),"
he says. "Today, anyone can get a licence. That's not a bad thing. But
there must be quality assurances."

Some doctors who aren't trained at addiction therapy have been
dispensing the drug without considering alternative treatments and
without proper assessment and counselling, says Khosla.

"It was far too tightly regulated ... and we've done a massive swing
in a year. I think we need to fall somewhere in the middle."

That being said, Khosla says it's better methadone is too available
than not available enough. "Even if too many people are getting on it
... (the change) was still needed because the bottom line is we don't
want deaths out there."