Thank you, Mr. Lobb, and congratulations on your appointment as chair.
Welcome to the committee members as well.
Thank you very much for inviting me this afternoon to be part of this experience and to share with you my knowledge and my passion for addressing the needs of patients in light of prescription drug use and pain management.
Just over five years ago, I was challenged to become a volunteer in a methadone clinic. I had never given any thought to working with those people before, but it changed my life. I knew that changes needed to be made to the model that existed for methadone treatment for addiction, and my master's was in decision-making modelling, and I came up with a new model just over five years ago. It was a multidisciplinary best practice evidence-based model.
In September 2010 when the CPSO came out with their recommendations in their “Avoiding Abuse, Achieving a Balance” paper, I felt vindicated that in fact what we were doing was of benefit and could be taken to a larger model, not just in my own little community, but to other communities around.
There was a 2007 task force report that was written on methadone that stated that there were four under-serviced areas in Ontario, and Halton, where I lived, was one of them. I couldn't believe that people in Halton, which seemed to be an upscale kind of place, would not be able to get the kind of medical care they needed and deserved.
So I birthed Wellbeings and built it on a Field of Dreams kind of vision: build it and they will come, and they did come. It wasn't without a lot of fanfare at the beginning because I was almost publicly lynched in 2008 and 2009 when people said, “You're not bringing those addicts to our area, we don't want those people in our community.” Little did they know that they are, as Ms. Cooper says, your mothers, your fathers, your kids, your aunts, and your uncles. They are just regular people we know who have to cope on a daily basis with living in pain and who might suffer from addiction, and as a result they may also have mental health issues.
I have assembled a slide presentation that you can see behind you if you like, and there is also a set of notes there as well. I thank very much Marc-Olivier who helped me to do the French translations for everything. Thank you very much.
If you have any questions afterwards or later on, please feel free to ask me. I'd be happy to answer them.
We have two Wellbeing clinics presently, one in Hamilton and one in Burlington, and we hope to be opening a third very soon in January, because we have over a one-year wait-list now for people who suffer in pain. We're actually on the short end in the Hamilton area for people to get some help within a year as opposed to other funded hospitals where people can wait several years to get help.
In terms of addictions, the physicians who work in Wellbeings clinics see people within 24 to 48 hours. Sometimes we see people who just walk in the door. Our model is not that of a walk-in clinic, but if somebody walks in and there's a doctor available, they will get the help and the attention they need because we do know from the addiction side of the model that when people are in that pre-contemplative mode, when they know today is the day they really need help and they come and ask for it, you can't turn them away. You can't say you'll see them in three weeks' time because it may be too late in three weeks' time.
The physicians who work in our clinic are remunerated by OHIP. The clinic is funded by moneys the doctors pay to me—a percentage to me—and is also funded as part of my philanthropic entrepreneurialism, because the model that exists in Ontario does not fully fund a best practice evidence-based model, unfortunately.
I have been working and trying to bring it to that level. I'm happy to report that last year we helped over 1,100 families, and I think we're actually saving the Ontario government tens of millions or hundreds of millions of dollars. I've asked just for a percentage of that so we can roll this out in lots of other communities, but we know it's really making a significant difference in people's lives.
The analogy I'd like to make to you about addiction and mental health is one where people shouldn't have to let others know why they are going to see their doctor. People should be able to go and see their physician in a private atmosphere, in one of respect, and one where they are well treated, and there's compassion and good clinical management.
As a result of that, I thought to myself that if I were to open an erectile dysfunction clinic, and I hung a big shingle outside that said “Erectile Dysfunction”, I don't know how long I would have to wait for people to walk in my door, but I could imagine that it would take an awfully long time. Erectile dysfunction is one of the symptoms we have as part of addiction because when people are addicted, they find they are not able to have sexual relations.
But nobody should know why you go to see your doctor. When people walk into the Wellbeings model, they could have just hurt their shoulder and they're coming in for a pain treatment. It could be that they're coming to see the psychiatrist or the addiction doctor as well. We have people who come on a Thursday when all three areas are covered, as well as having our case manager who is a local RN who was given to us from the ADAPT program. A person could literally spend hours there seeing all the people they need to see. We hope to be able to get people functional again, get them out of pain, first of all, so we can work on titrating their medications to lower what they're taking or get them off everything, and to make sure they have a good outcome in their mental capacities as well.
Imagine if you were hurt in a car accident five years ago and you're still suffering and you can no longer go to work and your wife is on your case because you're not bringing in any money and your mortgage is due and your car payments aren't being made. It can be overwhelming for people and they need help in all these areas. Those are the areas we have to help them in.
I saw that Dr. Buckley gave his disclosures, and I'll give one now and another in a few minutes. One is that I receive no remuneration whatsoever from this. My work there is completely voluntary. My staff are amazing because, first of all, they haven't gotten a raise in five years—because my CFO says I can't give them one and she knows what the money situation is—and second, because we have a group of people who care passionately about helping others and want to make the model work. So to that end, I have to give a lot of credit as well to the people who work in this model. We're a kind of Doctors Without Borders, except we're local. This is happening in our community.
I really want to be the Maytag repairman. I want to have no one who suffers from pain. I want no one to have any addiction issues, and I don't want anyone to have to have any mental issues whatsoever. So our model works as a success model when nobody gets to come to us anymore.
One thing I'd like to talk about in terms of a national strategy for pain and addictions is the work of the CCSA and the Canadian Pain Society. They both have national strategies, and I know you've heard from other members before. I've read your minutes, so I'm not going to spend any time on this. I just want to emphasize that you should keep up the good work and ensure that we have national strategies for pain and addiction. You have endorsed national strategies for cancer as well as mental health, and I will tell you that pain and addiction are inextricably interwoven with cancer and mental health. They can't be separated. So please give serious consideration to your continued funding of the CCSA and the Canadian Pain Society in developing a national strategy. We can be world leaders here, and I think it behooves us all to do what we can for people in our community.
The International Association for the Study of Pain came out with a statement in 2011 that said that access to pain management is a fundamental human right, and it is. There are no cookie cutter solutions for people. If you have 100 different people you could have 100 different solutions for their pain management, for their addictions. We see a lot of polysubstance abuse in addictions. So it may be that there is an opioid addiction—which is the reason a person may come to Wellbeings, because we really only focus on opioid addiction—but we also find in urine drug screens things like cocaine and alcohol and THC, and all kinds of other things. There's a whole lot of things that people will do for self-medication because they're in pain in most cases, and whether that's a mental pain or a physical pain—because they all come out in somewhat the same manner lots of times—we need to help them get well.
The most important thing here, I think, is that patients need timely access to care. Imagine that you hurt yourself and your body should heal itself in a month or so but it doesn't and it continues to get worse. Say you were in a car accident and six months or a year down the road, you're still suffering in pain. You can no longer go back to work. You can't do these things.
Are we surprised that people are addicted to the pain medications that their physicians wrote for them and continue to titrate up because the pain medication no longer seems to do the job? The pain got worse. I'm not blaming physicians. We need to work together to make sure that people have timely access to care. Ms. Cooper mentioned that as well.
Government decisions on health funding should be driven by science and reasoning, not by scare tactics and community uproar. Opioids can be effective pain relievers for some period of time for some people who have chronic pain, but there are lots of alternative things that need to be done as well. The other thing that we do at Wellbeing are trigger point injections. A physician receives $8.85 for each trigger point injection and is restricted to doing four as a maximum.
For example, I may have an anaesthesiologist who's doing pain management, and a patient may go in for 20 minutes and get four injections . That's four times $8.85. Physicians should be well remunerated for what they do. If there is a simple and elegant solution to a problem like a trigger point injection, we should use it. We should be looking at the easiest ways to treat things first.
Our first medical director did a study on knee replacements out of Queens University, and 55% of the people, after receiving pain treatments, did not get their knees replaced. The people really only wanted to get rid of the pain. They didn't want new knees. They just wanted to be out of the pain. There are things we can do, but the model that exists right now may not support that. It takes a lot $8.85 injections.