By Gemma Hunt – special to SaultOnline.com
Opioid dependency continues to plague Americans, with an estimated 1.9 million people in the United States having substance abuse disorders linked to prescription opioid pain relievers and 586,000 addicted to heroin. Drug overdose is the leading cause of accidental death in America, with 47,055 overdose deaths taking place in 2014. Of this figure, some 18,893 deaths were linked to prescription medications, while 10,574 were linked to heroin. Between the years 1999 and 2008, the overdose rate rose fourfold and in 2012 alone, a staggering 259 million prescriptions were written for opioid drugs – an amount which, according to ASAM.org, is large enough to provide every American adult with their own bottle of pills.
In order to counteract this dangerous trend, a new private methadone clinic opened recently in Sault Ste. Marie. The clinic, called The Road to Recovery, is the fifth founded by Dr. Brian Taylor, a family doctor who has worked to curb opioid dependency in his patients for seven years. His other clinics are in Bradford, Barrie and Midland, Ont. and Thunder Bay, Ont. He decided to open his new branch in Sault Ste. Marie, not because prescription medication abuse is particularly high in our area, but simply because the epidemic affects all areas in Canada. Moreover, since the economy continues to lag, it is feared that the loss of jobs and ensuing tension could possibly result in higher addiction rates.
Staff will be treating addictions to substances such as heroin, oxycodone, morphine, etc. Dr. Taylor has stated that he will conduct monthly visits to the Clinic, attending to his patients afterwards via secured videoconferencing sessions. The clinic itself will be staffed by two registered practical nurses who have been specifically trained in the administration of methadone and suboxone.
Concerns have been raised regarding the safety of establishing a methadone clinic in the city centre (the Clinic is located at 332 Queen St. East). However, Dr. Taylor notes that rather than inciting crime, the clinic will actually work to reduce it. Patients wishing to rely on the service simply need to present a valid health card; the doctors treating the patient will be paid via OHIP, the Ontario Drug Benefit Program, or a health care provider. The staff will first have to assess the patient, to see whether they are opioid dependent. They will later determine whether methadone or suboxone is the treatment of choice.
Some members of the media have alleged that Suboxone is as powerful or even more so than methadone, though in reality both have been used successfully. As a general rule, Suboxone seems to benefit those with a short history of addiction the most. Sometimes, patients start on Suboxone yet, if their cravings continue, their doctor may prescribe methadone. Dr. Taylor notes that patients who are working are generally prescribed suboxone, while those who have various mental conditions may do better on methadone, because it has stronger sedative effects. He added that all his patients are required to submit urine samples twice weekly, so that staff can determine which drug (or combination of drugs) they are taking. Only patients who have shown that they are stable will be able to take home doses.
Dr Taylor has noted that most patients simply walk in from the street, eager to find a way to halt their addiction. Most remain on the program for around a year. The main aim is to reduce the cravings and withdrawal symptoms, which occur in the first weeks after quitting drugs. After that, patients are considered on maintenance for a year.
Over the past 40 years, methadone has come to be recognized as the gold standard in opiate addiction treatment. Detoxification without medical aid has a 5-10% success rate, compared to the 60-90% rate of methadone maintenance. Studies have shown that old-style treatments (which focused on cold-turkey detoxification and incarceration) have failed to solve the problem. Critics of methadone treatment fail to understand that patients prescribed the drug do not actually experience a high; therefore, the idea is that they not get addicted to methadone itself. Moreover, they fail to take into account the structural changes caused by opioid exposure. These changes have been shown to persist for years after quitting drugs. Because these changes cause such as high relapse rate, doctors are now stressing the importance of relying on medications such as methadone and buprenorphine.