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Question: I developed an addiction to prescription pain medications after being in a car accident several years ago. I am now in treatment for drug addiction. I am getting methadone as a substitute for the opioid painkillers. My life is going well. I live and work in the Maritimes and have a chance for a better job in Ontario. But how can I find an Ontario doctor who can continue with my treatment? Without knowing I can keep getting methadone, there is no way I can move to Ontario. Is there a group or organization that has a list of addiction-treatment doctors?
Answer: It makes a lot of sense to line up your medical care before switching provinces. As I am sure you are well aware, there is a lot of stigma around the issue of drug addiction and it’s not always easy finding a doctor with expertise in treating the condition.
Your best bet is a relatively new website called opioidrecovery.ca. It contains a wide range of valuable information for Canadians living with opioid addictions. But most important, for your purposes, it also provides a doctor-locator function.
You simply type in your address or postal code into the locator tool and up pops a map showing the nearest doctors and clinics specializing in the treatment of opioid addictions.
The website has been several years in the making, says Dr. Joel Bordman, an addiction-treatment physician who played a key role in its development. It was officially launched in June 2014.
“Patients had no idea where to get help. There was a real need for this type of website.”
Addiction doctors, he explains, often work in isolation, separated from the rest of the medical establishment. They don’t tend to be integrated into teams of family doctors. Just as there is a stigma around the patients, the doctors are sometimes painted with the same brush. Some critics see them as enablers of bad habits by providing patients with access to methadone or similar opioid substitutes. They prefer to see themselves as being engaged in a process of harm reduction – better methadone than a harder narcotic. And over time, with proper medical support, some patients will be able to wean themselves off the opioid substitutes completely.
When patients get into trouble with highly-addictive pain medications, their family physicians may not know where to refer them for help. To make matters worse, the prescribing habits of some physicians – such as giving too high a dose of a drug – can contribute to patients becoming addicted to painkillers. And the patients may feel they have no place to turn for assistance.
Dr. Bordman, working with like-minded colleagues, began to make plans for a website about three years ago. However, they lacked the resources to do it on their own.
They ended up getting financial support from Reckitt Benckiser Pharmaceuticals Inc., the maker of Suboxone, a drug used in the treatment of opioid addictions.
Dr. Bordman says the money is provided without any strings attached and the company doesn’t control what is put on the website. “I personally approved of all the content,” he says. “The most important thing is that there is information out there for patients, families and doctors.”
Others who participated in the creation of the website also say it is free of drug-company influence.
“I needed to be personally assured that they [Reckitt Benckiser] had given the money in an unfettered way,” says Wayne Skinner, deputy clinical director in the ambulatory care and structured treatment program at the Centre for Addiction and Mental Health in Toronto.
Mr. Skinner was asked to be part of an expert advisory panel for the website. Before accepting the task, Mr. Skinner says he was “satisfied that we were not just marionettes with the drug company acting as the puppeteer – those strings do not exist.”
Addiction specialists, who are not directly connected to the website, generally agree that it appears to be a valuable source of unbiased information.
“What I like most is the educational features of this website,” says Dr. Sharon Cirone, an addiction-medicine physician who practices in Toronto. “It has videotaped vignettes from patients and their family members about opioid recovery,” she added.
Mr. Skinner, who is also an assistant professor in the department of psychiatry at the University of Toronto, envisions that the website will evolve over time. He would like to see it act as a forum in which patients and family members can share their insights and experiences with opioid addictions. “Hopefully it will have an empowering effect for the clients and families so they are making their best choices around how to deal with these issues.
Of course, those are plans for the future. You have a more immediate need — finding a doctor who can help you continue with your methadone treatments when you move to Ontario. The website’s doctor-locator tool should serve that purpose. You do not need a referral from your family physician, or a specialist, to book an appointment with one of these doctors. Provincial health insurance should cover the cost of the visits. (There will be a three-month period in which your former province will pick up the tab before your Ontario health coverage begins.)
It’s important to note that the website doesn’t actually endorse the physicians in its registry. The doctors have voluntarily put forward their names to be included in the Canada-wide database of physicians who treat opioid addictions. But they are not systematically checked out and scrutinized by the website, although they must confirm they’ve got a medical license and have some experience treating patients with opioid addictions.
“I can’t say if someone is a good doctor or a bad doctor,” says Dr. Bordman. That’s a judgment call you will have to make for yourself.
However, there is one additional source of information that you may find useful. It’s the website of the College of Physicians and Surgeons of Ontario (CPSO) – the body that regulates the province’s doctors.
“We have a section [on the website] called The Public Register that provides details about the Ontario doctors,” says Kathryn Clarke, senior communications coordinator at the CPSO. By using the site’s doctor search function you can learn a lot about each of the physicians “including their practice address, their educational qualifications, their specialty and any disciplinary findings we have on them,” she explains.
Unfortunately, the CPSO website doesn’t include addiction medicine as a separate category in its breakdown of specialists. (That’s partly because the doctors who do this work come from a variety of different disciplines, including internal medicine and family medicine.)
So that means going on the opioidrecovery.ca website is really the easiest way for you to get a list of doctors who treat your condition.
But at least you can use the CPSO website to confirm that a doctor is in good standing with the college and hasn’t broken any of its rules.
Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families, relying heavily on medical and health experts. His blog Personal Health Navigator is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Email your questions to AskPaul@sunnybrook.ca and follow Paul on Twitter @epaultaylor