Family doctors should learn to treat addiction, not shun patients: scientist

B.C. Centre on Substance Use’s Dr. Evan Wood said efforts underway to change addiction medicine image

Leslie McBain whose son died following an opioid addiction talks to reporters at a news conference regarding the impact of opioid overdose on Parliament Hill, in Ottawa on Thursday, Nov. 17, 2016. (Fred Chartrand/The Canadian Press)

Leslie McBain whose son died following an opioid addiction talks to reporters at a news conference regarding the impact of opioid overdose on Parliament Hill, in Ottawa on Thursday, Nov. 17, 2016. (Fred Chartrand/The Canadian Press)

Family doctors should be on the front lines of addiction treatment but many are unwilling to learn about substance use even as a national overdose crisis worsens, says the head of medical education at Canada’s largest mental health teaching hospital.

Dr. Peter Selby, in the addictions division of the Centre for Addiction and Mental Health, said stigma and discrimination prevent physicians from getting training to treat vulnerable patients who have become addicted to opioids such as heroin or those prescribed for pain relief.

“It comes from this core lack of understanding and training around helping people with addictions as a medical condition,” Selby said from Toronto. “It’s still seen as something bad that people do.”

Selby said it’s no longer acceptable for doctors to say they don’t know enough about addiction treatment, which he added should be integrated into primary care so patients can be screened and switched to medications, such as methadone and suboxone to reduce withdrawal symptoms.

“You’ve got a whole core of established physicians in Canada who refuse to accept patients with addiction, will not provide the evidence-based treatments,” Selby said. “And that leads to significant consequences, like overdoses and deaths.”

Health Canada said 2,816 people died across the country in 2016 of suspected opioid overdoses. Between January and March 2017, the latest figures available, there were 602 fatalities. British Columbia alone recorded 1,208 deaths between January and October this year, up from 683 fatalities during the same period in 2016.

READ MORE: Recovery centre operator said neighbours bought property ‘in haste’

READ MORE: B.C. overdose deaths surpass 1,200

Leslie McBain said her son, Jordan Miller, feared he’d become dependent on oxycodone that was prescribed for a back injury and sought help. McBain accompanied him to see a doctor, who she said unleashed a torrent of anger when the issue of addiction came up.

“The doctor blew up,” said McBain, a founding member of a group called Moms Stop the Harm, which supports about 300 families across Canada as they deal with the death of a loved one who has overdosed.

“I’ve never seen a professional person lose their temper like that. It was ugly. I was just sitting on the sidelines in the office and I thought, ‘My son came in here with his courage in his hand to say I need help and the doctor’s yelling at him.’”

Overdose deaths by city
Infogram

McBain said she and her husband got their son into detox in B.C. on their own. But she couldn’t find a counsellor, psychiatrist or addictions specialist to help him afterwards as he endured two months of painful withdrawal symptoms.

That’s when Miller relapsed and “doctor shopped” at walk-in clinics, she said, getting more prescription drugs to ease the agony. McBain’s only child died of an overdose at age 25 in February 2014.

“Very little has changed,” McBain said about stigma against substance users. She said progress toward recognizing addiction as a chronic and relapsing condition has been slow among doctors.

However, colleges that regulate the medical profession have created more awareness and offered continuing education for physicians who are interested in learning about addiction, said McBain, who also advocates for families through the B.C. Centre on Substance Use.

Dr. Jeff Sisler, executive director of professional development and practice support at the College of Family Physicians of Canada, said some doctors do shun patients struggling with addiction, which is considered less attractive, complex care.

“But the clinical demands and the societal pressures for doctors to manage this better is being felt,” he said.

The college has been focusing on linking doctors with mentorship networks to get the support they need, he said, noting that family physicians in Ontario are connected with specialists online, through texts and via phone calls.

“It’s a long-term relationship with regular family doctors and people with more expertise to provide information tailored to the person and also to encourage them, to give them confidence, to address some of the worries that family doctors have about these complex patients,” Sisler said.

“We’re actually trying right now to get other provinces to offer similar networks.”

Dr. Evan Wood, director of the B.C. Centre on Substance Use, said efforts are underway to change the image of addiction medicine from an unattractive discipline to one that’s rewarding because patients can dramatically improve their health with treatment.

“We want people to understand that it’s one of the most exciting areas in medicine right now,” he said. “Colleagues of mine are talking about the development of new medications, new interventions that are coming forward in the substance-use context.”

He said 25 doctors applied this year for four fellowship spots in addiction medicine within the Vancouver Coastal Health region and funding is needed to allow more physicians to specialize in the discipline as part of a focused competency so they can lead clinical programs around the province.

The B.C. Centre on Substance Use is also trying to identify medical students early in their careers if they show an interest in working with substance users, Wood said.

“But it doesn’t address the fundamental issue that if it takes twice as long and you get paid half as much you’re not going to get enough altruistic physicians who are going to take this on.”

Wood said doctors may need incentive payments to treat addiction because starting someone on suboxone, for example, can take three hours on the first day. Physicians are already paid extra for methadone treatment as well as other chronic conditions, including diabetes and high blood pressure.

Doctors of BC has proposed higher fees for treatment of opioid use disorder, and the association said in an email that it, along with the Medical Services Commission, which manages the Medical Services Plan for the government, will decide early next year whether physicians can bill for more money.

Family doctors will need to lead the effort to treat addiction with support from specialists, the same as for other health concerns, Wood said.

“That’s the opportunity in front of us now, if we go about this in a thoughtful way.”

Camille Bains, The Canadian Press

Like us on Facebook and follow us on Twitter.

Just Posted

As part of the province’s strategy to combat the opioid overdose crisis, take-home naloxone kits have been distributed throughout the province. (Courtesy of Gaëlle Nicolussi)
Vancouver Island could be at its worst point of overdose crises yet: medical health officer

Island Health issued overdose advisories for Victoria, various communities in the last two weeks

The conservation service confirmed they do not relocate cougars from settled areas but that euthanasia is not necessarily the fate for an animal in the Fanny Bay area. The hope is that the animal will move on to wild areas. (File photo)
Woman hopes cat-stalking Fanny Bay cougar can avoid euthanization

Conservation officers do not relocate the animals from Vancouver Island

A B.C. Centre for Disease Control map shows new COVID-19 cases by local health area for the week of April 11-17. (BCCDC image)
BCCDC says fresh COVID-19 cases down in most Island Health areas

Nanaimo sees its fewest new COVID-19 cases since mid January

Police executed a search warrant at the Devils Army Clubhouse on Petersen road in Campbell River on August 10, 2017.
Murder trial: Victim left to conclude out-of-court settlement on the day he disappeared

Trial of Richard Alexander in death of John Dillon Brown continues in B.C. Supreme Court in Victoria

Nanaimo RCMP say a man was injured while pouring gunpowder on a backyard fire in Harewood on Wednesday, April 21. (File photo)
Nanaimo man hospitalized after pouring gunpowder onto backyard fire

RCMP investigating explosion in Harewood also came across a still for making alcohol on the property

Canadian Prime Minister Justin Trudeau and United States President Joe Biden smile as they say farewell following a virtual joint statement in Ottawa, Tuesday, February 23, 2021. THE CANADIAN PRESS/Adrian Wyld
Trudeau pledges to cut emissions by 40% to 45% by 2030, short of U.S. goal

Trudeau announced target during a virtual climate summit convened by U.S. President Joe Biden

MLA Shirley Bond, right, answers questions during a press conference at Legislature in Victoria, B.C., on February 19, 2019. THE CANADIAN PRESS/Chad Hipolito
Former B.C. gaming minister says she wasn’t told directly about dirty cash flowing to casinos

Shirley Bond said Thursday civil forfeiture, gang violence and gambling addiction were also major concerns in 2011

RCMP Constable Etsell speaks to tourists leaving the area at a police roadblock on Westside Road south of Fintry, B.C., Thursday, July 23, 2009. THE CANADIAN PRESS/ Yvonne Berg
B.C. police say they take ‘exception’ to conducting roadblocks limiting travel

Asking the police to enforce roadblocks exposes officers to further risk and possible COVID-19 infections, says federation president Brian Sauve

Tofino residents expressed frustration over a recent post by Long Beach Lodge owner Tim Hackett that falsely claimed all residents have been vaccinated. (Westerly file photo)
Resort owner apologizes for suggesting Tofino is safe to travel to

Long Beach Lodge owner Tim Hackett apologizes to community and visitors

BC Hydro released a survey Thursday, April 22. It found that many British Columbians are unintentionally contributing to climate change with their yard maintenance choices. (Pixabay)
Spend a lot of time doing yard work? It might be contributing to climate change

Recent BC Hydro survey finds 60% of homeowners still use gas-powered lawnmowers and yard equipment

Journal de Montreal is seen in Montreal, on Thursday, April 22, 2021. The daily newspaper uses a file picture of Prime Minister Justin Trudeau dressed in traditional Indian clothing during his trip to India to illustrate a story on the Indian variant of the coronavirus. Paul Chiasson/The Canadian Press
Montreal newspaper blasted for front-page photo of Trudeau in India

Trudeau is wearing traditional Indian clothes and holding his hands together in prayer beside a caption that reads, ‘The Indian variant has arrived’

Victoria’s bylaw restricting sheltering in parks won’t apply to those who accept indoor housing when it comes back into effect on May 1. (Black Press Media file photo)
Victoria bylaw restricting sheltering in parks won’t apply to those who accept indoor housing

The bylaw banning daytime camping in public parks will be reinstated on May 1

Provincial health officer Dr. Bonnie Henry arrives for briefing on the COVID-19 situation, B.C. legislature, Oct. 26, 2020 (B.C. government)
B.C. sees 1,006 COVID-19 cases Thursday, ‘alarming’ 502 in hospital

Vaccine bookings for people aged 60 and older set to start

Most Read