The Prince Albert methadone clinic where Lanre Egbeyemi worked has about 400 patients. He figures there are 10 times that many people who need treatment for crippling addictions to a host of potent opioids — and aren’t getting it.
“There are probably 3000, 4000 patients that are addicted. They can’t get in,” he said.
“The clinic is not accessible to the people that need it.”
When Egbeyemi first started practicing in Canada, he was shocked: The Nigeria-trained family physician had never seen people prescribed long-acting painkillers outside a hospital or palliative setting. In his Saskatchewan practice, he inherited patients who’d been on heavy doses of opioids for years.
“It was shocking,” he said.
“The effects of these types of practicing and prescribing are still in the community.
“We see it every day: People have been prescribed these things for 20 years, 25 years. They can’t go off.”
And when addicts want to get clean, the resources simply aren’t there.
“Demand for addiction treatment continues to far outstrip supply,” said Evan Wood, Canada Research Chair in Inner-City Medicine and director of addiction services for Vancouver Coastal Health.
Canada has 158 doctors across the country certified by the American Board of Addiction Medicine, seen as the best form of evidence-based addiction medicine training. Seventy-eight per cent of them are in B.C. and Ontario, the only two provinces where that training’s available. New Brunswick, Newfoundland and the three territories have none.
Edmonton’s opioid dependency program is actually treating 150 fewer patients than it was two years ago; the Calgary program has a three-month waiting list.
“We’ve made massive discoveries in how to prevent and treat addiction,” Wood said.
“But we haven’t seen those research findings translated into improved care.”
Instead, people struggling to kick addictions face lengthy wait times, limited access to the most effective treatments and detox-heavy programs whose relapse rates can top 90 per cent. People struggling to quit one addiction can find themselves taking a host of psychoactive drugs that don’t work.
“It’s something family physicians can and should be doing. But because we haven’t had a national strategy, it’s been neglected in the medical schools,” Wood said.
“We’ve got a lot of catch-up to do.”
At a campaign stop in Markham Tuesday morning, Conservative leader Stephen Harper announced new initiatives to combat drug abuse, including additional resources for RCMP clandestine drug lab teams and a hotline for parents worried about their kids’ substance use.
But while Harper emphasized the importance of treatment during his remarks, the photo op didn’t include a promise of more resources to treat Canadians in the grip of addiction.
But there remain huge gaps between what scientists and researchers have found to work and what policy-makers want to fund.
One example is the awareness campaigns and hotlines the federal government has funded: A 2011 study by the B.C. Centre for Excellence in HIV/AIDS found that many anti-illicit-drug Public Service Announcements do little do dissuade drug use; in some cases, they had the opposite effect, and “significantly increased intention to use drugs.”
And even as the federal Conservatives pledge to beef up funding for enforcement,studies suggest intensive drug-law enforcement doesn’t actually lessen drug-market violence: On the contrary, it can worsen it.
On the other hand, there has been ample empirical evidence indicating harm reduction efforts such as InSite, Vancouver’s supervised injection site, prevent overdoses, violent crime and the spread of blood-borne illnesses and help get people into treatment without increasing the incidence of illicit drug use.
The federal government has been adamantly opposed to InSite, however, fighting it unsuccessfully in court and then bringing in laws intended to discourage the spread of similar facilities elsewhere in Canada.
The Tories have slammed statements from Liberal leader Justin Trudeau and NDP leader Thomas Mulcair supporting, in theory, more supervised injection sites.
“The data’s mixed” on InSite’s efficacy, Harper said Tuesday morning.
Is it, actually?
Not really. When asked for this mixed data, a spokesperson for the Conservative party pointed to studies that found InSite resulted in “one life saved per year, on average” and didn’t deter or decrease drug use.
OnSite, the rehabilitation clinic attached to InSite, was overwhelmed with clients in the years after it opened. Same goes for what treatment facilities exist across the country.
It’s not that addicts aren’t seeking out treatment: It just isn’t there when they need it.
“Ninety per cent of [addicts] will seek treatment with methadone or suboxone if it’s seen to be readily accessible,” says Hakique Virani, an addiction medicine and public health specialist in Edmonton.
“If it’s not seen to be readily available, they’ll stop seeking it out.”
Virani figures Alberta has treatment spaces for about one tenth of the people who need it.
“It’s a question of science, and what works.”
And what works, if you’re hooked on heroin, OxyContin, Fentanyl, Hydromorph Contin or any other opioid, is methadone or suboxone maintenance treatment.
“We’ve shown time and again we can counsel people ’til the cows come home, but we really can’t get anywhere without agonist maintenance treatment,” Virani said.
“A lot of it has to do with the antiquated ways that our health authorities, particularly in Alberta, approach these problems,” he argued.
“We treat everything like a moral issue and not like a medical issue. In this case, we’re dealing with a medical problem that has medical solutions.”
In the meantime, addictions that go untreated get worse. People spiral downward, use more harmful drugs in more dangerous ways. They lose jobs, family, commit crimes to feed addictions.
“We have to treat those people,” Virani said.
“There’s no question about it.”