Tuesday, August 19, 2008

The Conservatives and Insite

Tony Clement continues his attack on the safe injection site on Vancouver's East Hastings Street by now attacking the ethics of the doctors who have the termerity to support the continued operation of the site. Here is a little sample of Mr. Clement's thoughtfull and insightfull words: "The supervised injection site undercuts the ethic of medical practice and sets a debilitating example for all physicians and nurses, both present and future in Canada." he also added the clever comment of: "junkies and pushers don't belong near children and families. They should be in rehab or behind bars." Hard to argue with that now isn't it -- but wait, do we actually have rehab here in Canada?

In my previous life as a lawyer in Toronto I had the privilege of assisting a number of physicians dealing with problems with alcohol and drugs. In some cases, these were very severe addictions and the College of Physicians and Surgeons had to intervene, not just to protect the public but also to protect the doctors themselves.

Becasue of this, I saw what treatment for drug addiction could look like if properly supported. These doctors, despite in some cases taking staggering amounts of drugs or alcohol, were surprisingly functional. They did not look like the ghostly addicts that are seen on East Hasting Streets with hollow eyes and track marks on their arms. What was also remarkable was the extent to which even if their personal lives were a ruin, their professional skills were intact -- in not one case that I dealt with was there any allegation or evidence that a patient had been injured or mistreated.

The most astounding part of the story though is what happened after discovery and intervention by the College (usually triggered by a warning by a colleague). As these people were doctors and generally had access either to good health insurance coverage or personal resources they could afford excellent and intensive medical treatment and generally pursued it. This did not mean a drop-in to a therapist now and then for a bit of chit chat -- this meant serious 30-60 day admission in inpatient facililities like Homewood Health Centre in Guelph.

These doctors would receive multi-disciplinary treatment that included medical care, nursing care, psychotherapy, physical therapy and occupational therapy. They would receive guidance on the issues that had led them to addiction and the patterns that could lead them back into trouble. They would be given the help to re-organize their professional lives (in some cases it is inappropriate to return to certain specialities -- anesthetists for example are particularly at risk of relapse as are intensivists and emergency room doctors). After leaving hospital they would be given further follow-up treatment and extensive support to put in place mechanisms to prevent relapse. The College would also provide very strict monitoring programs (random drug testing, supervised practices and mandatory medical reporting for example) to ensure public safety

This treatment was successful in every case I saw. These doctors returned to the profession as healthy productive members of society with their addictions under control. But this treatment was expensive and the facilities available for such treatment limited. The reality most addicts face is that the availability of such rehabilitation is a fantasy. No province supports or funds such treatment and the federal government certainly has no intention of putting any funds into providing that kind of care for addicts who are not blessed with incomes north of $200,000.

The other thing that came home to me in seeing these doctors go into treatment and fight to stay in treatment was the importance of having something to come out to. These doctors had homes and families. They had networks of friends. Moreover, the College made it clear that addiction was not a professional death sentence -- treatment would allow them to salvage their careers provided they could prove that the public was not at risk. All of this drove these men and women to succeed at their treatment. The reality we offer the people on East Hastings is nothing -- we label them junkie and pusher and then marginalize them leaving them in poverty, without jobs and in many cases without families. The best people like Tony Clement will offer them is a good hard shake of the finger saying that either they should be "in rehab or behind bars".

The joke in Canada though is that we do not offer rehab. The treatment I just described is expensive (but likely far less expensive than a week in ICU for someone doomed to die). It is also treatmentg that is being offered to people that the conservatives and many members of the general public despise -- "junkies and pushers." Not people who are deserving of the taxpayers dollars in the minds of many.

But, this treatment, if given the proper support can work -- I have seen it work and so have many in the medical profession. We give our doctors a hellish choice -- we say to them treat these people as best you can but then do not let them offer the treatments that work. So what should doctors do then -- Tony Clement would have them walk away and leave these people to rot in jail or on the streets. Tony Clement would have the doctors stand aside and let these people get AIDS, HEP-C, TB and the whole range of nasty (largely antibiotic resistant) infections that destroy these people's bodies and minds. Instead the doctors have said, "well if you won't give us the tools to treat, at least let us reduce the harm." This is what Insite is all about -- true it is not treatment for addiction but it does help these people at least have a chance to some day get to treatment without the whole range of wasting diseases that afflict the impoverished drug addict. For Tony Clement to question the ethics of these doctors -- as he did at the recent CMA conference -- is a joke.

The final part of the joke is that Mr. Clement is part of the government that killed one of the initiatives that in the long term (perhaps in this generation but not by the next election) could have addressed the other side of the equation -- the problem of giving the people on East Hastings something to come out of treatment to. Aboriginal people make up a very large percentage of the victims of drug abuse on East Hastings. Before they were the victims of drug abuse though they were also victims of poverty, poor education and broken families. They have few job skills and no job prospects. Often they have no real family to turn to. The Kelowna Accord was designed to start addressing this -- to set aside the ideological and legal disputes over ideas like rights and sovereignty and to work together to address educational deficits, health problems, unemployment and poverty. Sadly the Tories decided they were not interested.

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Anonymous said...

Two weeks ago I was in the emergency at Mt. Sinai for pneumonia. I overheard the floor nurse saying that that they don't look after drunks there. I did feel like seeking out the person who was discriminated against and doing a little grandstanding, but I was too sick. When you have the chance to put these people in their place it feels so good to do it. Tony Clement is truly an ass. Just doing what he's told. Any chance you can write about the proposed changes to the food and drug act?

David P. Janes said...

Ummmm ... a hyper-motivated class of people with everything to look forward to are comparable to junkies because of wot now? Having the privilege of knowing someone who has become a crackhead recently, I'm relatively certain that it's because it's the most frickin awesome thing going on his life and resistance to rehab has a lot to do this. Still, sample size of one and all that.

It's good to know that the $5 billion that the CPC so-evilly canceled was going to be push over the top which was going to solve whatever ails 'em. Or was it the next $5 bil after that? Someone should bring that up next election.