City of Vancouver works to prevent methadone abuses
JANUARY 23, 2012 | BY SCOTT BERNSTEIN
There is no question that the Methadone Maintenance Therapy (MMT) program in British Columbia is failing many of the people who rely on it to stabilize and treat their addictions to injection drugs. Nearly 12,000 people in BC rely on MMT to manage their dependence on heroin and other opioids, and it is an internationally recognized, highly effective and safe treatment for opioid dependency. But in Vancouver we’ve seen some serious problems with the access and distribution of methadone that ends up hurting many of our clients in serious ways, including putting their housing at risk. <!--break--> Because many residents living in SRO hotels do so out of necessity and suffer from addiction issues, they are often vulnerable to coercion and to abusive practices around methadone access.
Take the recent example of the problems at the Wonder and Palace hotels. On June 30, 2011, a committee of Vancouver City Council considered recommendations by their staff that council authorize legal action in relation to the Wonder and Palace hotels in order to bring those buildings into compliance with City By-laws. At the open council session to debate the recommendation that injunction proceedings be started, councilors heard that the conditions in both of these buildings had deteriorated significantly and posed health and safety risks to tenants. Councilors also heard from a large contingent of Downtown Eastside (DTES) residents who described the horrific conditions of the Wonder and Palace Hotel [Pivot lawyer Doug King has been working with several tenants of these hotels to bring damages claims at the Residential Tenancy Branch].
Residents of the hotels described the unsanitary conditions in the rat and cockroach infested buildings. Another tenant spoke about how two tenants had been instantly evicted within the last few days and both were living in temporary shelters. Tenants described their fear of retaliation from the landlords because they came forward to council.
Some tenants who were on MMT also described how they were forced to have their prescriptions filled from a particular pharmacy affiliated with the landlord or face eviction. The tenants described many alleged incidents of methadone fraud and abuse that prevented access to MMT.
As a result of these council meetings and the input from affected DTES residents, council not only approved the legal route to getting injunctions, but also struck two working groups: one on SROs and the other on “Preventing Methadone Maintenance Therapy Abuses in the Downtown Eastside.” The goal of the methadone working group: investigate the issues through multiple-stakeholder involvement and recommend to council policies or by-law changes that the City might use to mitigate these problems and prevent future abuses.
On January 10th, I attended a full-day workshop on MMT organized by the City, Vancouver Area Network of Drug Users (VANDU), BC Association of People on Methadone (BCAPOM) and other community organizations. This workshop was attended by around 80 people representing community members and organizations, the province, the federal government, City of Vancouver, and the colleges of Pharmacists and Physicians & Surgeons. The workshop’s goal was to identify the roles that the City can consider, in collaboration with other stakeholders, to help address MMT issues in the DTES. Dr. Penny Ballem, City Manager for Vancouver, gave a welcome and overview of MMT. The workshop then had a panel presentation on several issues, followed by three breakout sessions where attendees could participate in small discussions about: 1) getting a prescription from a physician; 2) pharmacies and dispensing; 3) social/psychological/emotional supports; 4) links between housing, MMT and welfare; and 5) prisons/jails/parole and MMT. The breakout sessions were summarized to the group as a whole and Dr. Ballem made closing remarks.
I was asked to present the municipal legal landscape of MMT on the panel. Because prescription of MMT is regulated by the College of Physicians & Surgeons and distribution is regulated by the College of Pharmacists, there is not necessarily a strong role that the City can have in curbing abuse. I did suggest that the City could play an important role in coordinating and documenting abuse claims, in advocating for access to all studies and all information that is available (which has to date not been fully disclosed by the province) and it might take a more active role through business licensing. For now, there are no specific requirements for pharmacies around business licensing in the by-laws, but there certainly could be. Stronger measures could be taken to deny pharmacies licenses when their are findings of fraud or coercive practices, for example.
We are anxiously awaiting the report from the workshop, which should summarize the contributions from the participants. The next steps of the working group are to meet in February and evaluate the results from the workshop. I am optimistic that the City will be able to take some positive steps to curb the abuse to the MMT system. This, in large part, is because of the courage and willingness of people on MMT to describe their experiences on the program.
[Photograph: Danny Lawson/PA Archive/PA Photos - Guardian UK]