I'm going to be very brief. I'm Dr. Durnin and I work in addiction throughout this city, including with Lorinda. I'm going to ask the committee, based on previous comments that you've heard, for four actions.
Number one, you have to have a public campaign to address the stigmatization. I see it with doctors, nurses, counsellors, other addiction patients. I see great ignorance throughout this province and this country about what addiction actually means, what methadone treatment means, and I emphasize proper methadone treatment or Suboxone treatment, where indicated, for opiate-addicted patients.
Our patients feel incredible shame, and heaping public perception and comments from those who ought to know better, or who don't know, increases the burden incredibly on these patients in getting better. Hazelden, one of the premier treatment centres in the U.S., and recently Bellwood, a major treatment centre in Ontario, have within the last two years acknowledged the need for chronic opiate-agonist therapy in selected patients, rather than complete detox. These decisions are based on clinical evidence, and nobody should be stigmatized for choosing that option with their doctor. We would never endure this stigma for any other chronic disease.
Secondly, I'm asking that you consider return-to-work programs that specifically take into account the needs of patients with addiction disorder. I will remind you that these patients are often young, able patients and they would otherwise be contributing to your tax bases instead of sucking resources from it. Their needs are very different. They have lost their skills. They may not be able to return to their former work, if they had it, and they're now faced with working menial tasks with long hours. Part of their requirements include return to recovery activities as part of what they do. In my experience, they often risk losing their jobs because they have to leave work to come to my office, to go to AA meetings, to do urine monitoring, etc. They are fragile. They need your help and they need to return to work successfully to give them back their dignity.
As part of this, I am asking that you consider funding for all opiate therapy when it is indicated, in the proper setting, because our patients are usually financially challenged in their early stages, and they need that help to get back on their feet. This also helps me as a physician to ensure that it is properly prescribed and properly administered. You're well aware that there's a lot of abuse of the system out there and part of what is happening is due to the fact that my patients cannot afford their medications, especially in early recovery.
Thirdly, I'm asking you to consider benzodiazepines. They are dangerous medications. This is a class of sedative-hypnotics that is pervasive in our society. It not only includes Valium and Xanax, etc., but also the so-called “Z” drugs, zopiclone, which are commonly used as sleeping aids. They are used chronically for sleep and anxiety. When they're used, at best, it is usually for the short term, other than in certain mental health diagnoses. They cause memory impairment, falls, sedation, and particularly in combination with opiates or alcohol, overdose and death. They're extremely habit-forming, and my patients hate getting off them and they resist me all the way. I'm asking for increased regulation for this class of medication, such as duplicate prescription or triplicate prescription, as currently exists for opiates. Doctors need to be aware and accountable for what they are prescribing for these patients in this respect, because these medications are widely, widely abused.
The same arguments apply to Tylenol 3, and tramadol, etc., which are not currently regulated by triplicate prescribing, and for Tylenol 1, which my patients buy over the counter. It contains codeine. They take too much of it and they kill their livers.
Lastly, I'm going to speak about chronic pain control issues. It's a real issue, and the fact that it's a difficult issue to deal with doesn't mean that family doctors shouldn't be dealing with it. However, as you've heard from other speakers, they only have opiates in their armamentarium. There are tools out there; you've heard about them already. I'm asking not only that access to these tools be improved, but I'm also asking that family doctors be better reimbursed for taking the time to do this. You must remember that family doctors get paid per patient. If family doctors take the time to deal with these patients, who are some of the most taxing and exhausting we deal with, then they are financially penalized for taking that step.
I'm asking you to also improve the access to alternative measures, which include counselling, physiotherapy, cognitive behavioural therapy, etc., as per Dr. Kahan's suggestions—and you'll be talking to him later. I don't believe that family doctors should be absolved from caring for these patients, but these patients definitely need increased care.
Finally in closing, I'm going to draw your attention to the placement criteria of the American Society of Addiction Medicine, which are some of the tools you may find useful in guiding your decisions. It talks about where an addict is at this point in time, and I note the comment from Dr. Peter Selby, from your earlier speakers, of the right treatment for the right patient at this particular point in time, because our patients' needs change over the continuum.
I'll stop there. I'm sorry. I've been very fast.