jun 25, 2013 - legislative assembly

PRINCE EDWARD ISLAND LEGISLATIVE ASSEMBLY

Speaker: Hon. Carolyn I. Bertram Published by Order of the Legislature

Standing Committee on Health, Social Development and Seniors

DATE OF HEARING: 25 JUNE 2013 MEETING STATUS: Public LOCATION: POPE ROOM, COLES BUILDING, CHARLOTTETOWN SUBJECT: PRESENTATION ON PEI METHADONE MAINTENANCE TREATMENT PROGRAM COMMITTEE: Bush Dumville, MLA West Royalty-Springvale

Richard Brown, MLA Charlottetown-Victoria Park Olive Crane, MLA Morell-Mermaid Sonny Gallant, MLA Evangeline-Miscouche Gerard Greenan, MLA Summerside-St. Eleanors Robert Mitchell, Charlottetown-Sherwood Hal Perry, MLA Tignish-Palmer Road COMMITTEE MEMBERS ABSENT:

none GUESTS: PEI Methadone Maintenance Treatment Program (Dr. Don Ling) STAFF: Ryan Reddin, Research Officer and Committee Clerk

Edited by Hansard

Health, Social Development and Seniors 25 June 2013

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The Committee met at 3:00 p.m. Chair (Dumville): All right, I’ll call the meeting to order. If I can get somebody to grab that – oh, Hal, could you grab that door on your way by? Mr. Perry: Sure. Chair: Please and thank you. I’ll just ask for approval of the agenda before we start. Mr. Perry: So moved. (Indistinct) Chair: Okay. Dr. Ling, I’d like to welcome you here today. It’s good to see you, and thank you for coming and appearing before the committee today. All I would ask is – your presentation, it can be however you prefer. If you prefer to go right through your presentation and questions after or whether you prefer to have questions asked during your presentation, it’s up to you. All I ask is before you start, for the Hansard, that you state your name for record. Dr. Don Ling: Thank you, Mr. Chair. Start now? Chair: It’s all yours. Dr. Don Ling: Dr. Don Ling, medical director of the PEI Methadone Maintenance Treatment Program. First off I’d like to thank this committee for issuing the invitation to come and appear before you, because it’s an opportunity that I relish and I would like to share my experience with you over the past nine years or so with our program that has now evolved into a significant program here in PEI. If I could, as far as the questions go, I don’t mind questions at any time and feel free to interject. I have a little bit of a – I put together a bit of a presentation. I have some points I wanted to share and some things I wanted you to learn a little bit. I’m not sure how much you’ve had. I did see a transcript of your meeting when the minister, deputy

and director of mental health and addictions were here, so I had a chance to look at that. You’ve got some grounding there, and I expect you’re early in your hearings, so maybe I have a good chance to share some experience here. Personally, just to give you a background on myself, I’m an Islander. I grew up on PEI and went away to school, of course. I graduated medicine in Dalhousie 40 years ago this year, in 1973. Was in the military, went through on the military plan, so that kind of explains a little bit probably of where I am today. I had four years as a military physician in CFB Chatham, and during that time in the early 1970s alcohol was a significant issue in the military. It was nice. I got a chance, with some other physicians, to spend a week at the Donwood Institute up in Toronto to learn their programming. It was a very valuable experience for me, and I think it had tuned me in a little bit to this disease which has grown in prevalence over the years, especially where I work now. So that was Donwood. I then, after military, came back and I was a family physician at the Polyclinic for about 20 years until I answered the call to government and served for eight years with government in the department of health as the provincial medical director, director of medical services, and enjoyed that immensely. Then – it was funny – it was during that time in that seat on Garfield Street that I became aware of a problem in PEI, that we had people that went away to federal incarceration and they got – in 2001, I think it was, the federal Corrections Canada introduced methadone treatment to the system. We had Islanders going away with opioid problems and got on methadone treatment off-Island, Dorchester, wherever they happened to be, but could not come back to PEI on release because there was nobody to pick up the prescribing for them. I became aware of that in the medical operation at Garfield and I said: That’s not very good. We’re not very friendly or welcoming to our own. I started to do some work on it and to check into it and met with a few patients around that time who were lobbying the minister, and so became more aware of this issue which, when I left practice in 1996 it wasn’t a big deal. There


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was a little bit of action but it wasn’t a big thing. We were careful about our opioid prescribing at the Polyclinic and the after-hours clinic, but it wasn’t the situation it is today for sure, but it grew over those years. Around the time I left government – just before I left – I got involved with the addiction treatment facility because there was a need there, and I took to the work. I enjoyed it over there. I was doing some other things after I left government but that was my favourite, and that’s what I then started to peel away some other things and focused there entirely after a few years. We started our methadone program – I started treating some individuals myself in 2004 – and we started our program. Government gave us a social worker over there in the fall of 2004. That’s where the methadone program started. I’ve been a member of Canadian Society of Addiction Medicine since around that time. I think I joined in 2003 or 2004. I was on the board from 2005. I served as president of the Canadian Society of Addiction Medicine from 2008 to 2010 – I was pleased to be able to bring our annual meeting, our scientific conference, to the Delta here in 2010 – and currently sit at the immediate past-president, but that’s soon to be finished. But I’ve had a wonderful run with that organization too. Now that’s me, so let’s talk about why I’m here. It’s not because of me, it’s because of opioid addiction. The word epidemic, I’ve seen it referenced, and that’s a word that’s been put to it by the Centers for Disease Control and Prevention in Atlanta, so they’re much bigger than we are, but they’ve used that word. I had a presentation in 2010 I think, or 2011 – 2011, maybe – at the American society meeting, and somebody from the CDC in Atlanta gave an address and used epidemic, and that’s kind of where it started because it has been escalating rapidly. The saddest thing about this disease – and it is a disease, it’s a brain disease. Any addiction is a brain disease, but opioid addiction, as opposed to our previous experience with alcohol, it’s hitting a younger people. That’s a significant change

from – and it’s changed things at the detox centre. We’ve had this trending down in age. Very quickly, it’s an extremely destructive disease and it leaves people with desperate lifestyles. After you’ve been opioid addicted for a few years you don’t really have much of a life anymore. You live and people will tell you, and if you ever get any of the addicts in here they’ll tell you, that really because of the nature of the medicine, the drug, it has a half-life. They use Dilaudid or hydro-morph or OxyContin. They prefer to get the ones that are meant for 12 hours of treatment if you swallow them because they’re kind of layered up, they release slowly in the gut. But they crush them down and they get the bigger bang. But they have a half-life of two to four hours. It means that about after four hours they get this level, it goes down, and so they start to experience withdrawal symptoms at about six, eight hours – 12 it gets bad. They know within that first day, after they become addicted, they know what withdrawal is like. It’s terrible and they live in fear of it. It increases anxiety tremendously. They live this desperate life. No sooner have they got their fix then they’re preoccupied with: How can I get the money or the pill for my next fix? That’s as far ahead as they can see. It’s a horrible existence. You don’t have to work around this disease very long before you – you really sympathize with where they’re caught. This is not willful behaviour. They’re a prisoner of this disease. They don’t get a chance. At the detox they come in there – and in 2006, I think it was, we introduced methadone withdrawal because they weren’t lasting more than two days. They’d come in, they’d get into withdrawal, they’d use a bit of medication that didn’t help them very much, and they’re out the door. They made for short stays. When we introduced methadone withdrawal, which is really a six-day treatment – we’ve refined it now to six days – that keeps them comfortable. They get time out. They come in, they’ve had a horrible life, they’re probably at the end of everything, and they come in and they get a peaceful week. We keep them eight days. We give them methadone 10-10-10 for three days, then we


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give them 10-10 for a day and we give them 10 for a day and we give them 5 the last day. That’s six days of methadone. They’re comfortable, it addresses most of them. Very few can’t then stay. We encourage them to stay two more days and we encourage them to make plans. Where are they at with this disease? Do they really want to change? Not everybody does. Some of them want a break, but the majority want to change. Some don’t come to see us, they just keep on going. That’s fine. There’s no law against it. You can be an addict, that’s up to the individual. But we give them time out, then they go out and, really, it’s very few that would stay clean for even a week. After that detox admission, if they go out without treatment, which most of them do, it’s just a few days, usually, before they relapse. Some get a couple of weeks in, but that’s the exception. The other thing about opioid addiction, it is a family – you can appreciate the desperation of these lives. Pills are expensive. A Dilaudid pill – I meant to go to the pharmacy – it wouldn’t cost a dollar on a prescription, it wouldn’t cost 50 cents, a Dilaudid pill. It sells for $25 on the streets. So you can see the challenge here. How do they get their pill? You can see the challenge of the people that get prescriptions. They’re worth a lot of money. They sell their scripts, they fill them, sell the pills. The saddest thing is there’s diversion taking place on these powerful prescriptions from, seriously, older people that may have liberal prescribing but they’re not using all the pills. They’ve got rather aggressive relatives in the household. These pills are worth a lot of money, and some families actually depend on some of the business income. We’ve had a patient or two that gave testimony to that, that there was a prescription for the dad for a painful back or whatever, a lot of pills, but a lot of them were being sold around. Sad part of it, but it’s a huge business. It’s a family disease. When you have one of your children caught up in this, because of the desperation and the need for the pill to keep from being sick, they do whatever it take, and usually you wrong the people closest to you, you steal from them. You’ve heard stories, I’m sure, where families get ripped off because that’s all they can do. That’s either steal from a

store, which might put you in jail, or take something out of the house, whether it’s a computer, laptop, whatever and pawn that, and you’re good for a day. That’s about it, but it’s never over. The other thing about opioid addiction that’s a bit different from the alcohol, with alcohol addiction when the individual is using usually you can tell because there’s impairment with the substance use. With opioid addiction it’s the other way around. The dysfunction comes when they’re in withdrawal. When they’re fixed they’re normal, they operate. Different. It’s a bit unusual. That’s how it’s a little unique too. What else did I have? The risk of addiction, by the way, it’s a chronic disease, addiction is. Not everybody has the same susceptibility or risk, but it’s anywhere, depending on who you’re reading or whatever, between 10 and 22%. Some people say it’s as high as 22. There’s a lot of factors into it. We all have some genetic factors. Let’s face it, you go into a family history you’ll find some alcohol in the background, in some families stronger than others. The environmental factor, in my mind, is extremely important for the young person growing up. If you grow up in a dysfunctional family where substance use is a main part of the dysfunction, your risk of becoming an addict is high. We see that. I have a number of families where we have more than one member of that family in our treatment program. It stands to reason, I guess. An interesting thing. Another presentation I happened to hear at one of our meetings was: How do you assess risk for this addiction disease? One of the quickest questions people most vulnerable to – if you’re going to prescribe opioids, for instance, ask them: Do you smoke? If you smoke you’re high risk, increased risk. Smoking’s an addiction. Most people, if you ask them how much beer they drink, they’ll probably lie to you if they’re trying to get a prescription. But if you ask them whether they smoke or not they usually answer honestly. You usually can tell, there’s maybe tell-tale signs, too, so that’s a – for somebody like myself, trying to assess a situation, but that’s for the on-call doctor who gets caught late on a Friday afternoon


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covering for his colleague and gets this petition or request for an opioid prescription. Now, let’s see. Opioid disease. Oh yeah, I wanted to talk – the detox trending. I talked about the youth thing a little bit. I know that when the minister was here, and others, they talked a little bit about the trending, and I dug out some information I had there today, and it’s rather powerful. Detox, okay, here, I’ll summarize it. The trends. We had a 10-year run, spreadsheet, 10 years with stats and admissions. You may have seen some of it. The trends over those 10 years: female admissions went from 21% to 35%. So females, that’s a trend, female involvement. They’re using the facility more. Average length of stay 10 years ago was three to four days, average about four days. Alcohol was a five, six day stay, other things. Now the average length of stay – it was down last year, in the last complete year, to around five point – it’s around six days. We’ve trended from an average length of stay from four to six. One of the things that impacted on that, as I mentioned before, the opioid addicts when they were coming in 10 years ago or eight years ago, they weren’t staying very long. It kind of impacted on the average length of stay. Now they tend to stay through the course. So we’ve got an average length of stay that’s up. In the methadone inductions, which – a few years ago we used to keep them longer to get them started on methadone. We’ve now shortened that down quite a bit. We actually get them on methadone quicker now. When we bring somebody in to induct them, to start them on methadone treatment as opposed to withdrawal, it’s actually a shorter stay usually than a withdrawal stay. The withdrawal stay, I said, is about eight days on average – we try and encourage it – but for an induction we’ll get them out of there in five or six, and it’s a whole different future for them, too. Opioid admissions 10 years ago: 6% of the total admissions. Last year: 54%. Significant. Wow. Significant. Big. And it’s trended every year over those 10 years, just kept going like this. Ms. Crane: (Indistinct) the age (Indistinct)?

Dr. Don Ling: Don’t have the age numbers. Stats aren’t perfect. Ms. Crane: No, sure, but from your own experience, is at a younger – Dr. Don Ling: Yeah, that’s what I’m saying with the opioids, that we got a younger, yes, younger. Ms. Crane: So that’s really significant when you look at (Indistinct). Dr. Don Ling: Yeah, the opiates, and it’s here, it’s a table that you can easily have access to. What’s the other one I want, the other trend here? Yeah, it passed alcohol. Alcohol was always the major reason for admission until 2010-2011. That’s where opiates went above alcohol and stayed above since. The interesting thing – and I know that this came up when the minister and the delegation were here – that last year there was a bounce back on alcohol and there’s a bit of a factor for that. They introduced a new triaging or scoring system, and alcohol got priority. Alcohol’s a very dangerous drug. It’s the most dangerous drug to quit all of a sudden. Alcohol has more medical complications than any of the other products. Alcohol can kill you in acute consumption as well. You can overdose on alcohol and die, and we hear of people that do that, but stopping – if you’ve been using that substance regularly for a while and you stop it all of a sudden outside, you can have serious medical issues. Alcohol is the most dangerous drug. Opiates are dangerous only that you overdose, take too many. When you stop them all of a sudden it’s miserable, but you don’t die. Alcohol, you might. They introduced a scoring system over there. The alcohol problems got scored higher, and so alcohol had a bit of a bounce back in admissions. What has happened, though, (Indistinct) concerned whatever the substance is. If you have frequent, four, five, six admissions a year, you almost become an enabling – you’ve become part of that lifestyle. There’s really very little work oftentimes being done by the individual as far as recovery goes, and they just keep bouncing back.


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I think we’re trying to address that a bit over there now and it’s evening out again a little bit. They’re trying to get a little more fair, I think. Ms. Crane: (Indistinct) question (Indistinct)? Chair: Doctor? Olive Crane. Ms. Crane: Just a quick question. When you were referring to the alcoholism, is that patient at admissions getting older or is it a younger person as well? Dr. Don Ling: On the alcohol? Ms. Crane: Yes. Dr. Don Ling: Yeah, I haven’t done the regular detox work for the past four years. Actually, I do coverage and I’m around. I focus mostly on opiates in that time. I really couldn’t give a fair answer to that question. Certainly we see many of the returnees, but the younger people, to my experience, tend to use – it’s not that they wouldn’t have started with alcohol, most do, but their problems develop around the pills. Yeah, that’s usually what they then identify as the reason they’ve come. Mr. Brown: (Indistinct) methadone, over the last 10 years, how many people on it? Let’s say, six or seven years ago to now, or – Dr. Don Ling: Yeah, thank you, that’s good. We should get into that, probably. We started in 2004 and we had nine, I had nine people in treatment, when the social worker came – I was going to talk about our resourcing – and we now are at 237 or 238. That’s been going up every year, there’s more been inducted. We used to try to get two a month into our treatment program. Now we try to get four a month, four or five. I go away a little bit in the wintertime so it doesn’t proceed quite as quickly when I’m away, but we’re probably adding 50 a year, I expect now. I expect it’s that. Actually, the last couple of months since I’ve been back it’s lots of action, and – just to talk a little bit about who we treat – sorry. Chair: The Chair recognizes Sonny Gallant.

Mr. Gallant: Thank you. For someone to get into the methadone program, they have to go through you? Dr. Don Ling: No – Mr. Gallant: Your office? Dr. Don Ling: No, not me personally, but they – usually, if they phone in, and many will phone in, we encourage them to start with a detox admission if they haven’t been to detox. If they come to detox and they’re an opioid user, they’ll usually be – and they want treatment, which they just have to tell the nurse that’s what they’d like, to have methadone treatment – they’ll usually be interviewed by one of our staff on the program. We call it a screening, just to get their history, and then they’re advised to follow up with a counselling service in their region. That’s the avenue in. One of the good things, we have a provincial committee or table that we come together once a month. There’s a big request list, but we single out 10, 12, 15 names, whatever it is. We have the different representatives there and we talk about the individual cases and try to make selections. Mr. Gallant: There would be somebody in different locations, like in Prince County, say, in Summerside. Dr. Don Ling: We have five centres. Mr. Gallant: Five centres, okay. Dr. Don Ling: We have a West Prince centre in Alberton. Summerside, Charlottetown, Montague. Montague, Souris are the same personnel but there’s two centres there. Mr. Gallant: So someone from your group would assess that individual. Dr. Don Ling: If they come to detox, yes, and we encourage that, mainly because our program is not a simple program. Some people think everybody should have methadone, I guess. I mean, everybody should have the opportunity if they’re serious about changing their life, but not everybody is able to probably have success if they’re not focused on that change, which


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means they have to do some things. We value, for instance, the ability to keep appointments. Our program, for three months, has weekly meetings, and every day to the pharmacy. It’s not an easy ticket. You get inducted to methadone, first of all you come to detox. We usually do it as an inpatient. Not always, but usually. Then you go out and you go every day to the pharmacy for three months and you drink your drink at the pharmacy in front of the pharmacist, and every week you come to what we call a group meeting for three months, and your urines are tested every week. You’ll see the physician frequently during that time, not every week. Then after three months, if in fact you’ve had perfect results and your urines have all been good, you’ll probably get one carry on a Sunday so that you don’t have to go to the pharmacy on a Sunday, and then you’ll come back and see the physician probably a month later. If everything’s holding together you’ll probably get a second or third single carry on a Wednesday or something. So, over the next few months, if everything stays good and you do all what’s recommended, you can get up to five or six carries a week. It means you go to the pharmacy once a week, if you’ve done perfectly, and you drink in front of the pharmacist. You have a box that locks and they put five or six more doses in it. If it’s five, it’s usually you go Saturday, on a Wednesday or something, but if you’re working or going to school and you can’t get there during the week, well, you go in on Saturday, and they get six bottles put in that box, they lock it up, you take it home, and every day you take one of your drinks. We’re concerned about the diversion of methadone on the street, which is no small issue. Some of it’s from our patients too. We were not naïve to think that everything’s perfect in our world, so we’ve encouraged the pharmacies, and most now are getting what we call tamper proof bottles which have kind of a double cap to them. You have a liner. Once you screw it in to place if you open it, it has to break this under liner, this orange inner seal and if we do a call back, we call it, we ask them to bring their bottles back into the pharmacy after they have four left that shouldn’t be opened, and if any are

open, we take away their carries. We’re moving into that area with more vigor now. Methadone is a very useful drug used properly, but it’s a very dangerous drug used improperly. So people out there, we’ve have deaths, not so much in our program, but we had one death here a few years ago where a hard-nosed addict who wasn’t on methadone, used other things, got a bottle of methadone, drank it down, and he was found dead in his apartment. After that, we had some inside information on that, and that’s the type of medicine it is. Chair: Doctor, Chair recognizes Hal Perry. Mr. Perry: Can you go back again just on entry into the program? Just a little bit more elaboration on it. Let’s say I’m a user from Tignish. How do I go about getting into that treatment program? Dr. Don Ling: You’ve two ways. You could present yourself to the Alberton hospital addiction centre there and declare your intention, if that’s what you wanted, or you come to detox and they could help you get the detox. Mr. Perry: So if I go to the addiction centre and say: I want some help. What transpires from there on in? Dr. Don Ling: Normally there’d be a detox admission. If you’re going to meet any of the program people it would be at the provincial addiction facility. Mr. Perry: You have to meet with the detox. Dr. Don Ling: Be admitted to detox. Mr. Perry: Admitted to detox. What about if you want to just get on that program right away, you don’t want to wait a week, let’s say? Dr. Don Ling: That probably wouldn’t happen. Mr. Perry: It wouldn’t happen. If you go into the detox and you complete detoxification, then what’s the next step? Dr. Don Ling: You’d meet with – and they could give you some advice about the


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counselling. We strongly encourage that first you follow up with the counselling service at Alberton, for instance, and keep appointments. Then we would – at the monthly meeting – see how that case was doing, and it may become one of their highest recommendations for that area. Mr. Perry: When you guys decide who’s getting into the program is it done on – is it a priority? How do you guys base it? Dr. Don Ling: It’s really on compliance and readiness for change, I guess, and that’s where the meetings come in. We know they’re going to have bad urines. We do that urine test because there are certain substances that become a problem if you’re going to use methadone. The clear opioid addict is the preference. If it’s poly-drug, other drugs may become a worry and you have to address that issue with that patient. Mr. Perry: Would some of those patients be discouraged with this process of getting to that point of where they’re actually on the program? Dr. Don Ling: Oh, I expect they would. Mr. Perry: Is there any way of improving that? Dr. Don Ling: Like I say, not everybody is ready for methadone treatment. It may increase the risk of trouble and that’s why we try and take some time to see if they’re able to comply with the program requirements which are (Indistinct). Mr. Perry: Right now, what is the average – how many people are actually on the waiting list? Dr. Don Ling: I think it numbers around 80 right now. Mr. Perry: Eighty? Dr. Don Ling: Yeah. Mr. Perry: Okay. Is that high, low? Dr. Don Ling: The waiting list, it’s hard to use that as a barometer. We had a larger waiting list a year ago, but many of the cases hadn’t been heard from for a significant period of time. They had declared they

wanted treatment at one stage and months had gone by and nobody had any contact. We’ve now got an active wait list which means there’s been contact with the system in the past six months. Mr. Perry: By the individual – Dr. Don Ling: Yeah. Mr. Perry: – on the waiting list? Dr. Don Ling: Yeah. Mr. Perry: How long will that waiting be, the average time? Dr. Don Ling: To get into treatment? Mr. Perry: Yeah. Dr. Don Ling: As you can see, if the wait list is 80 long and we get maybe 50 into treatment a year, it can be significant. Mr. Perry: So it’s discouraging for those individuals. Dr. Don Ling: It is. But some are more ready than others, that’s I guess what – Chair: Chair recognizes Gerard Greenan and then Olive Crane. Mr. Greenan: Yes, Dr. Ling. Those Islanders who moved away or people who come to the Island that are on methadone, when they return to the Island or if they’re on a program in another province, how do we treat that (Indistinct)? Dr. Don Ling: That’s called a transfer. Unfortunately, we don’t treat it with open arms. I guess we’d separate that a little bit too. We have a few ground rules around accepting a transfer request. Number one, they should be in treatment for a minimum period of time and with reasonably good results. Because if you don’t have requirements like that, we’ve got people running over to Moncton or somewhere else, getting on treatment in a physician office and expecting to come back to our program. Unfortunately, our capacity isn’t such to accept that. If it’s somebody who’s been away and is working and gets a transfer back


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for a legitimate reason, a job, we’d look at that very seriously. I mean, that needs our support. Mr. Greenan: So each case is done – Dr. Don Ling: Each case is unique, yeah, it depends on the circumstances. Like I say, our capacity trying to get people off our waiting list into treatment, we’re not encouraging that. But we would look at individual worthy cases. We have taken transfers (Indistinct) say that. Chair: Olive Crane. Ms. Crane: Dr. Ling, I have a couple of questions. When you started your presentation you mentioned a little bit about the history of the program and you mentioned about some of the federal inmates that were not able to come back to the province at the time without the methadone program here. Had you, or has addictions, ever utilized any of the work the federal addiction centre that was completed in Montague? Was there ever a relationship there?, is one question. I also remember in 2006 when I first became elected you came and did a presentation. After you left there was a big discussion on people wondering about can you really treat someone’s that addicted with another drug. People have sort of in their mind a fixed idea of the old AA program, you had to be totally clean. I guess my question around that: Is there still less stigma, and where are we at with that when there’s so many more people requiring the help? The third part of that question is: There was a mental health addiction review done last year, and did you participate in that process? Dr. Don Ling: Number one was the centre in Montague. The only significant connection I personally had was at meetings where they would make presentations and I would speak with individuals and we’d see some of their statistical – they did stats from Corrections Canada, they dealt, and some of it was rather interesting. But officially, between our centre and theirs, I don’t think there was much – I wasn’t in charge of anything, but I don’t recall.

Ms. Crane: I was just curious when you said there was such an increase with the number of women because they had done quite a bit of work on Native addictions and female addictions. In terms of, then, the stigma, is that still there? Dr. Don Ling: It is. It’s slowly decreasing a bit, but that was huge back in 2004. Ms. Crane: Yes. Dr. Don Ling: I do understand it. I wish, personally, we had a drug like methadone to use for alcohol problems. I wish we did. That’s where a lot of the resistance has developed because that’s a tough battle, alcohol. There’ve been different medications promoted but nothing has been very perfect. It’s a tough fight. It looks like an easy ticket when you’re using methadone for opioid addiction, but it’s not quite that easy. I think that community is slowly adjusting to the usefulness of this particular medication and realize – because those that are broader-minded, I guess, or more open-minded, know that if you suffer from addiction disease and you can find your way to a successful recovery road, that’s valuable, and I think people would respect it. It works for them, that’s good, their life is back on track and that’s a good thing. I think it’s easing a little bit, but it’s large. Ms. Crane: Very good. The mental health addiction – Dr. Don Ling: The mental health. Yes, I think I had one little interview somewhere along the line there. I go away in the winter at the wrong time when a lot of this work is being done. I tend to miss some of these things which irritates me when I come back, but it’s my own doing. I think I did get interviewed once on that but I kind of forget. What was I going to talk about next? The questions that stem from anything I talk about, that’s great, we can develop it. I’m not sure. I have a little more time or – Chair: Just as much time as you need, Doctor.


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Dr. Don Ling: Oh, you’re very kind, Mr. Chair, thank you. Chair: I’m sure you didn’t want to hear that one, did you? Dr. Don Ling: No, I got some things I want to share with this committee, and – Chair: We’d love to hear it. Dr. Don Ling: Okay, I think I talked about – I want to talk about the results of our program because they’re quite impressive. That’s what has kept me going. I can honestly say at the outset that – I told you why I sort of came to this work. There was a need, and I became aware, and there was nobody else doing it, and I’m a great guy to get into things new, I seem to like the challenge. But anyway, the results after nine years, this is in a nutshell: for 100 patients we take into our program, 60 do great, perfect recovery – abstinence, powerful stuff – 60 of 100. Twenty tend to get bogged down in marijuana. Our objective in our program is abstinence. Marijuana’s a big deal. We work a lot on the marijuana patient. We don’t always have success and that restricts them. I talked about the carry doses. If they’re marijuana-positive, and like I say, almost 15 or 20% tend to get bogged down there, they at most get to carry a dose from the pharmacy once or twice a week. That’s quite restrictive. Then there’s another 15 or 20% that struggle, but that’s powerful stuff. If you worked in alcohol recovery they’d be outstanding numbers. That’s what encourages. My experience with this – and I started from the ground with no real experience – has been very professionally rewarding. Lives that are in the dumpster, all of a sudden back in a productive way, kids back in mothers’ care, people back to work or school. It’s just powerful stuff, and they just go along normal life. I see them three times a year (Indistinct) else. They go to the pharmacy once a week. They’re out there with jobs. I think I have that information for you, too, about how many go back to work, but it’s very powerful, the work in the program. It’s very encouraging, and I think when we started

over at the addiction centre in 2004, there was a lot of skepticism right in the centre. An Hon. Member: (Indistinct). Dr. Don Ling: I wasn’t warmly embraced. I was doing my own urine collections initially that summer, I remember. They let me work out of the office and they were very good that way, but nobody was there to do anything. I saw the patients, collected the urines, sent them off, but then the social worker came and we had a little team of two there for a while, and now we’ve grown. The centre itself, it’s now very nicely accepted. I can honestly say working there has been – now nobody looks at you askance because you’re working with methadone, and the counsellors come to us, they advocate for cases, nurses on the detox unit put in a little bit of a pitch for somebody they think is worthy and doing well, and so it’s great to see. The centre itself has really come along. It’s been a little slower at Prince County, but what’s helped there, and we’re moving forward, is three years ago I started going there one day a week to see – we had a travel problem. To get people from Prince County to come down and see us at Mount Herbert when they didn’t have a car, and probably didn’t have anybody (Indistinct), it was tough, and so a lot of no-shows. We had a lot of phone calls. They couldn’t get there. Some didn’t call. They just didn’t get there. I looked at it for a while and said: Maybe I’ll go there. It was a lot of people. Prince County had a big-time problem. Summerside was the biggest problem centre in PEI. An Hon. Member: (Indistinct). Dr. Don Ling: Very large, very big opioid problem, no needle exchange. Summerside was a cesspool in this disease, and so I started going there, and so the no-shows disappeared, because the – as opposed to the PATF, we’re out of town, you need a taxi ride or hitchhike or something, but the Prince County Hospital you can get to. You can walk to it, it’s not that far, and so we didn’t have very many no-shows and it was great.


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I’ve had a very pleasant experience up there, and over those three years got closer to the nurses and the counsellors in particular, and so now they feel like these are their patients. They’re out of that centre. They do all the work there. We have a group. We started a group there. Instead of having to come to Mount Herbert and do the group, now we do groups in Summerside once a week, do all the urines there, see the physician there. It’s worked out wonderfully, and it has helped that centre, much like the PATF a few years before them, appreciate the role that this program has and how it helps people. So it’s been encouraging. Chair: Doctor, Richard Brown. Mr. Brown: Yes, Doctor, I remember nine years ago or something when we were having the committee meetings and I was bringing up methadone, and back then a lot of people thought: You’re just a drug dealer then, no help. I’m quite impressed by the recovery. So you’re saying 60% of the people that you treat on methadone recover. That’s a phenomenal rate. We’ve been hearing – the last couple of people that have been in were saying, and there’s a general consensus out there, that: There’s a 77% relapse rate so why should we even care? That’s the general thought that was out there for a while. Dr. Don Ling: I think, Mr. Brown, that was the relapse rate from the Strength Program, wasn’t it? Am I wrong? Mr. Brown: No. Ms. Crane: Well, there’s two. The Strength Program has a relapse rate as well, but – Dr. Don Ling: We’ll talk about that in a minute. Mr. Brown: Yeah. So at 60%, and there’s 20 having a problem with marijuana, and there’s 15. But you can work on the 20 and recover a lot of the – like, my opinion is that you don’t always get them on the first shot. Second, maybe third, and then you say: Maybe they’re in the 15% bracket, their long-term solution. So out of the 20, would you pick up a couple on the second or third try –

Dr. Don Ling: Yeah. Mr. Brown: – or the fourth try, or – Dr. Don Ling: Some conquered the marijuana. Mr. Brown: And then what about the 15, the chronic? Dr. Don Ling: Well, there’s value. They’ve probably been a needle user, and there’s value if they’re not using the needle anymore. They may be dabbling in drugs, they may use cocaine periodically, they may have an alcohol issue. Some do, which is dangerous with methadone. We monitor closely and they don’t get much privilege, and we use the carry privilege as the carrot to try to address these issues, and it does help, and some get serious about it and – the first patient I actually put in treatment, I happened to see him here a day or two ago. In 2000, I think I sent him over – I wasn’t inducting at the time in 2003 – anyway, I sent him over to Halifax and he got on treatment and I picked it up back here as a prescriber. He didn’t get much privilege, but here this past year he’s had his best year. That’s a long time, and he’s struggled with some different things, and it’s been wonderful to see. Mr. Brown: Just one or two other quick – you’re the medical director of methadone. Dr. Don Ling: Methadone program. Mr. Brown: Okay. Who’s the medical director of addictions? Dr. Don Ling: Dr. Dada. Mr. Brown: Dr. Dada, okay. So he’s in charge of – Dr. Don Ling: Mental health and addictions. An Hon. Member: Mental health. Mr. Brown: Mental health and addictions. Do other provinces have just a medical director of addictions? Like, an overall person who can say: Where are our addictions, where are our problems? Because I know we link mental health with addictions, but I think there’s a dividing line


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there. I’m no doctor so I’m not proclaiming to be any expert by no means. Do other provinces have like a czar in charge of addictions to say: Your job is to bring down our addiction rates, to see what we can do in those terms or – Dr. Don Ling: I expect. I’m not up to date on all that, but we’re small here and I guess that’s why we get caught up in joint responsibilities. Mr. Brown: I’d sort of more – I’m not trying to promote you, but I’d (Indistinct) not only the methadone program but addictions in general. You’re just not methadone, are you? Do you look into – Dr. Don Ling: I’m just methadone, yeah. Mr. Brown: Okay. Dr. Don Ling: I’m a contract guy. I’m not an employee. I’m on a contract. I’m semi-retired. I didn’t mention that at the outset. I only work three days a week. Mr. Brown: Suboxone. Dr. Don Ling: Suboxone. Mr. Brown: There was a discussion about it, federally approved, you’ve been in the paper. An Hon. Member: (Indistinct). Mr. Brown: Other people have been in the paper. What’s the problem? Why don’t we have it? Dr. Don Ling: Well, we do have it. Why isn’t it paid for, I mean that’s the – we have it. We have a few patients on it. Actually, we had it covered on special authorization for – with methadone, methadone can affect your heart. A very small percentage of people can get heart irregularities from methadone, and when we discover – and I’ve had one or two patients, I guess, one I know in particular, who – you identify that problem, and then you apply and you get covered for Suboxone, and she’s been on Suboxone. But Suboxone could be used a little more liberally. Not all the time, I like methadone. I’ll be honest with you. Methadone is a very good drug for most of these cases –

Mr. Brown: Sixty percent. Dr. Don Ling: But the younger – Suboxone is a little different drug. It’s a little safer drug. That’s why I like it for younger people. It’s a little lighter a drug, I guess we’ll call it. Still potentially dangerous if you don’t use it properly, but methadone’s a heavy drug. Suboxone’s a little lighter drug, and when you’ve got a youngster, 18, 20 years old, it fits them a little better sometimes, especially if they’re involved with the Strength Program. I’ll be honest with you. To deal with the younger addict, one who’s less than 20, is a large challenge. In our program we reserve our active medication treatment probably for those that are plugged into the Strength Program, or headed for Strength, to support them so that they have a good experience at Strength. That’s how we best can help. I think it’s extremely important for many of those young people to have their physical discomfort addressed with a drug like Suboxone so that they can focus on that eight-week program. Mr. Brown: When you prescribe Suboxone does it get refused? You as a medical doctor say: This young person should have Suboxone. Are your overriding it? Dr. Don Ling: Yes. Unless there’s a special reason for it and it’s very few. Mr. Brown: Who overrides you? Dr. Don Ling: It’s controlled by the provincial pharmacy. They pay for drugs and they have rules around what they can approve. Most of our Suboxone for young people, for instance, we’ve had a couple recently that their families were able to pay the freight. So it’s worked out. Mr. Brown: Thank you. Chair: Chair recognizes Robert Mitchell. Mr. Mitchell: Yes, Doctor, just on something you just stated there a couple of moments ago. If there was a young user, two side-by-side users, one that seems to be having some success in the Strength Program but a new youth, the focus become on one rather than the other? Is that what


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you said? The Strength Program person would receive the methadone and maybe the person wouldn’t? Am I clear on that? Dr. Don Ling: Yes. We feel that the chances for real change or success in a young person who is not connected strongly to counselling service and focused on a rehab program like Strength is probably low. The chances of success are not real high. If that individual is not willing to take that kind of a step you’re probably not going to do very well. We’ve got limited capacity, so we try to go where we can do the most good, I guess, is what I’m saying. Mr. Mitchell: The parent probably would fully understand that, that they have to do some more work before they would (Indistinct). Dr. Don Ling: They would get counselling to that effect, I would hope, yes, either from our own program, if they got to meet with us, or from the youth side of things. We meet with the youth people. They know our philosophy, I guess we’ll call it, and they would hopefully share. Mr. Mitchell: I guess my other question would be, a parent involved, is there a considerable amount or is it basically the young person’s on their own, left out there hanging and if you decide they’re not getting it, then they’re left. Dr. Don Ling: Parents usually try to fix it for a while by doing different things which often times turns out to be more enabling than anything else. That’s where the counselling can kind of help the parents sometimes because it’s a desperate situation. The parents have to have firm rules about what’s acceptable and what’s not, and if that individual – if they’re along the road to an opioid addiction and they’re still living home, I mean, you have to be careful about things. Oftentimes the parents cover up a lot and don’t want the ugliness to come through, I guess, of the disease. But they come to a breaking point where they have said: No, I can’t take it anymore, because the whole family becomes troubled. That’s the saddest part. Then you hope – and as you know, some of our youth go away to the New Brunswick residential program, Portage, others get involved with local

counsellors and get aimed towards Strength, and everybody is assessed. There’s a recommendation made. Some come through the detox unit. Then we get to meet them over there and get to see what their readiness for change might be. I know some voices have said: No matter how you get them to treatment, forced them to treatment or whatever, the results, they’re not the same. Any of us, if we’re pushed, we push back usually. In addiction you have to make that decision for yourself. They talk about surrendering or admitting that you haven’t got the solution. So many people caught up in this disease go along, they figure that – they rationalize, they figure they can make things right or it just won’t happen again. DUI, for instance. Any of us could get a DUI, let’s face it. We’ve had long lives and there’s times when after the event you say: I don’t think I should have driven the car home last night. You know, when you’re young. Anybody can get one DUI. You get the second DUI, you got a problem. Simple as that. Chair: Olive Crane. Ms. Crane: I’m curious again. Back in 2005-2006 when we talk about youth addictions and the problem on PEI, people would often stop me and say: It’s not really youth addictions, it’s substance abuse. When you look at where we’re at today, do we have a high number of young people that are truly addicted or is there still a significant population within that population that has a substance abuse problem? Dr. Don Ling: There’s a spectrum there. Ms. Crane: Yes. Dr. Don Ling: There’s a combination. Ms. Crane: I’m just curious (Indistinct). Dr. Don Ling: It’s frightening though how many of our youth are using opioids every day by needle in significant amounts. That’s addiction. Their lives are – Ms. Crane: Is that under 20, too? Is it people 20 to (Indistinct) we’re talking about or is it just –


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Dr. Don Ling: We talk about youth. I think the Strength Program, I think 18 to 24 or something. But 18, let’s talk 18 to 22. We see a lot of young people around the 20 mark, they probably may or may not have finished high school, usually haven’t, dropped out. After over those two, three years, they’ve got a significant habit on their hands. Nobody starts out thinking that’s what they’re going to end up at. They start out at parties where we used to drink some beer or marijuana was coming out in my youth and you might have a joint or two. I mean, that was what the experimentation was. Now they go to parties and they do pills. If you’re in that 10 to 20% who are vulnerable to it, you do that for a few weekends and then all of a sudden you’re doing it on Wednesday and you start – you don’t feel so good if you don’t get the pill and it only takes a year or two and you’re doing it every day. It starts out innocent enough, they’re just at the party with their friends and they’re doing pills. They start to sniff them because they get a bigger high. They don’t know what lies ahead. By the time we get to see them it’s not willful behaviour anymore, it’s long past that, they’re trapped. Ms. Crane: Do you think we need to have more treatment spaces at Mount Herbert? At one time people thought we needed a youth addiction 24-hour facility here. People would argue against that saying: Portage had a really good model. But Portage usually stops taking people at 21. If more people here are having issues especially around the 20 year, are we now at a time that we should be considering a 24-hour facility for the province or how does that work from your experience? Dr. Don Ling: Again, age can play into it a little bit here. Portage, I wasn’t sure what their – Ms. Crane: I think they go to 21. Dr. Don Ling: That sounds good. If you got somebody less than 20 and you can get them to Portage, which is an abstinence-based program, no medications, fine, see how they do. That’s something to try. We’ve had lots of young people go through Portage, come back and have (Indistinct) we get to know

them, we get involved with them and they do quite well with medication support. The one point I would make is that the detox unit is not great for the youth, let’s face it. Ms. Crane: There’s only two beds there, right? Dr. Don Ling: There’s two dedicated beds. They can take more in. There’s a male-female wing. It’s not a great environment with somebody with the disease for 20 years or 10 years, whatever, older. The conversation is not always positive and you can’t control it. It would be nice to have more of a youth centre for that sort of thing. Whether you keep them there a long time – I know the Strength Program, they have a house out in Cornwall, I think. It’s nice to have that capability and to put them into safe housing. Eight-week rehab program they have. It’s a great program and a day program, works out quite well. Again, where I feel we can make the best help to that is to have medication support. I think if you hear from – hopefully you’ll hear from the manager of that Strength Program, Sean Morrison. Hopefully he’ll get to talk to you during your deliberations here and he can share some statistics. I’ve talked to Sean, that’s why I’ve come to my conclusions. Number one, most of the kids they take into the program are opioid problems. Number two, they have a significant casualty rate – in other words, leaving in the first week or two. But with Suboxone you’d probably kill that. You’d probably have kids that would get through it for the eight weeks, and then hopefully you’d have Suboxone go on for another six to 12 months at least. In other words, give them a – as long as they stayed connected to their program. If they divorce from it and don’t do so well, maybe it’s not the right time. We can pull away the medication slowly. Do it slowly. That’s where I’d like to support the Strength Program. Mr. Brown: So your conclusion is we should be using Suboxone out at the Strength Program? Dr. Don Ling: I think it should be –


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Mr. Brown: We’ve got medical people saying we should use it and we got some bureaucrats saying we shouldn’t use it. Dr. Don Ling: It’s a money issue. I spent enough time on Garfield Street to know the challenges. I’ll tell you, treasury department gives you a pretty rough ride. Mr. Brown: Yeah. Dr. Don Ling: It can be brutal sometimes. When you’re in the health department and you’re in the room with the Treasury Board and they’re banging away at you, it’s not pleasant. They try to stem it. It’s a money issue. But in health you have to decide what’s important and you have to commit and say: That’s what we’re going to do and I’ll go to battle for that. You pick a hill and you go and you die on that hill and that’s what you’re going to get. Be prepared to die, you don’t die. If you’re that serious about it – Mr. Brown: (Indistinct). Dr. Don Ling: You come out with a few bruises, but as long as you get what you went for, it’s okay. Mr. Mitchell: What if you have the proper people supporting the direction you’re going? It makes it much simpler, for sure. Dr. Don Ling: Yeah. I’m pretty sure Suboxone is going to be supported here soon. I’m pretty sure. Mr. Brown: Oh, it’s a no-brainer. Dr. Don Ling: You people can probably help the process. Mr. Brown: We are all right. Dr. Don Ling: Basically you sit in influential seats. Mr. Brown: I don’t know about that. Dr. Don Ling: It has to be used properly. I have to be honest with you, there’s a lot of people think if you throw around more methadone or more Suboxone, you cure all this problem. No, it isn’t that simple, doesn’t work that way.

Mr. Brown: No. Chair: They have to earn it. Dr. Don Ling: What’s that? Chair: They have to earn it? Dr. Don Ling: You have to have a patient that’s willing to do the work themselves. The drug doesn’t fix anybody. Matter of fact, it can raise their risk for death or illness. You got to be careful. The patient has to be going that way. Mr. Brown: A few years ago we were looking at some legislation, when I was in opposition, that, like, the parents were being told he’s 18 or she’s 18, you can’t have any information and that. There was some legislation throughout the country that was being passed at the time that sort of took the privacy act and said: Look, parents and children, we’re going to ease up on it a bit. I’m being told by parents that to get information is extremely hard. I can see the privacy act, but once a child, always a child in the mother’s or father’s eyes. I think you guys are taking a kid and all of a sudden it’s like: You have no more control, you have no more say, and there’s a disconnect there between the family. I know in the old AA program the family was quite involved. It seems nowadays, according to privacy, that person becomes an adult and you have no authority over that person and we have a privacy act, therefore you step aside. Dr. Don Ling: Just to share our experience in our - most methadone programs, you sign your life away. You sign releases that we can talk to whomever we think is important to this case. Mr. Brown: Okay. Dr. Don Ling: I came across this once when I was doing detox. We at detox used to get them to sign that we could send information out at the end of their admission to their family doctor. We were using methadone withdrawal. One individual refused to let this go to the family doctor. I said: Hey, in that situation we’re not going to use any methadone. If this information can’t be


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shared and we can’t communicate with important people here, we’re not going to take an active drug and help you with your withdrawal. You can go through it bare bones here. That’s not in the spirit of good medicine. You can’t treat in isolation, you have to know the whole story. If you’re here being treated for opioid addiction and you’re getting your prescription from your family doctor to accent or make your situation worse, I mean, you have to share information. That doctor has a right to know. Mr. Mitchell: Is that standard policy now? Dr. Don Ling: I hope so. I don’t know, I’m not working in the detox unit any more. That was something I came up with at the time. I said: Hey, we’re not going to do all we can do here if you’re going to refuse (Indistinct). Mr. Mitchell: The same thing if any doctor admitted you to the QEH, your family doctor knows pretty near immediately. So I’m (Indistinct) – Dr. Don Ling: If they said: No, you can’t talk to my family doctor. What would they do out there? They would have a hairy and say: Hey, we want the proper information here. We got a Drug Information System now that helps a lot, too, of course. We go on the computer and you can see all the drugs that were prescribed, etc. It circumvents that kind of problem. But no, you don’t treat in isolation, it’s your health. Chair: Chair recognizes Hal Perry. Mr. Perry: Thank you, Chair. We talked a lot about addictions and the treatment of addictions. But from your experience, what do you recommend for the province taking a proactive stance on this, on addictions prevention? Dr. Don Ling: Prevention. Mr. Perry: Does it all come down to education or – Dr. Don Ling: Education’s important and that’s where the youth thing comes in. I know that we have a presence in the schools. I know we have youth counsellors out there. Of course, my experience is mostly with

opioid problems which seems to be the flavour of the day for sure. Sometimes the best message is carried by individuals who have come through the process. We try and encourage that. I’m not sure. I’m not involved with the youth program so I don’t know. I know I had one of my patients in – for instance, here’s something I can share. I had one of my patients in the other day who’s done extremely well, wonderfully well, as a matter of fact. He’s now at university and aiming for med school which is tremendous, and is on the dean’s list. Just a fantastic story. He’s got a brother that’s involved with the Strength Program, and he was out there as sort of a parenting, as a support type. One of the counsellors there got the – and he shared his story a little bit I guess. They wanted him to come back and talk to the Strength Program again, which is wonderful to hear because he’s young enough, he can bring a great message, he’s been there, done that. That has impact. I go up there, they wouldn’t listen to it, but he could go there and tell his story, and hopefully more of that will happen. Mr. Brown: Yeah, I think it’s like the AA program. Dr. Don Ling: Yeah, similar. Mr. Brown: When you get your peer group telling you, like, you know, down to nothing, had nothing, drunk, but I worked my way through it, there’s a light beyond the tunnel, some people say: Okay. You’re a little too old for them out there, the Strength – Dr. Don Ling: That’s what you’ll see. Mr. Perry: (Indistinct) the ones that are already in through that program that have an addiction, but I’m talking prior to that, to prevent an addiction, to prevent youth or even adults from getting addicted to opioids or what have you. Dr. Don Ling: Just what you’re doing is a help. You’re bringing more awareness to this problem. That’s why I was glad to see your committee was going to do some work and I was happy to come to it. I hope you keep talking to people and hopefully – I’m


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not sure who’s here from the media – but hopefully you’ll get some exposure and some thoughts will be shared, and public awareness. Because that’s what I was going to talk about. There’s an attitude issue, and I think Ms. Crane referenced that about stigma, etc., and that does exist in the public and with employers, around our program in particular with employers, and unfortunately with physicians. We’ve got a battle right in our own – many physicians don’t want to address this issue. They feel, I don’t know, they’re second-class citizens. Because you have addiction disease you’re not worthy of – Mr. Brown: Everybody on Prince Edward Island is one or two relatives away from a problem. Anyone that says they’re not is lying. Mr. Greenan: They’re not an Islander. Mr. Brown: What? Mr. Greenan: They’re not an Islander. Mr. Brown: And they’re probably the one. Ms. Crane: But Doctor, that’s part of the issue too, in the school system, is often someone’s missing time, and people should be asking some questions, right? I think that’s what Hal’s getting at, especially as our populations are getting younger, and then people are dropping out, and it’s a whole combination. Dr. Don Ling: All you can do is more education and that’s where counsellors come in. Sometimes people that have been there, they can still identify with the younger crowd. I mean, they might listen to that story. We see that come through all the time. Whether it’s somebody who’s had a brain injury or whatever, they come through, they speak to school assemblies, and it impacts, whether it was related to drunk driving or whatever. Mr. Brown: Has the school board ever said: Let’s get all the school counsellors and have you in? There is a problem. The schools are saying there’s a problem. I don’t know what unit of the English school board or the

French school board is doing about it, but have they not said: We’ve got a problem here and maybe we should get all our counsellors together and maybe we should have some of the experts in for a day or half a day, one hour, to go over this? Have they asked you? Dr. Don Ling: I don’t think so, not that I’m aware of. Mr. Brown: Maybe that’s a suggestion the committee could make to the school board. Mr. Mitchell: Or one of these people, the 60% of successful recovery. Dr. Don Ling: We’ve lots of examples that could speak to people, that’s correct. Mr. Brown: Good. So you’re willing to go to the – if they all got together and – because we’re learning quite a bit here today (Indistinct). Mr. Greenan: (Indistinct) association. Mr. Brown: Oh, is there a counsellor association? Chair: One more question for Hal Perry. Mr. Perry: I hate to go back to this again, but it’s again for an addict to get treatment. When they go again to one of these addiction centres – I know you said they want to get them through the detox program first. A lot of these individuals are petrified to go through the detoxification for that low. They’re petrified of that low so they’re turned – they want treatment but they don’t want to go through that detoxification. Is there any meaning to what I’m saying? You don’t see that? Dr. Don Ling: No, I don’t. Mr. Perry: You don’t think people get turned off by that, they’re scared of that low? Dr. Don Ling: Scared of the low? Mr. Perry: Yeah. Dr. Don Ling: What’s the low?


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Mr. Perry: If they’re an addict, right, and they’re using drugs and you want them to detoxify, all right, there’s going to be a low period. They could be fearful of that. Dr. Don Ling: We use methadone. If it’s opioids that the drug issue is with we use methadone. Like I say, after the second day, by the second day they’re fairly comfortable. Mr. Perry: But if they get to that point. Dr. Don Ling: Well, it’s not that tough. Mr. Perry: What do you think turns them away from wanting to do the detoxification? Dr. Don Ling: They may not be ready for change. Mr. Perry: Why would they be there in the first place, I guess? Dr. Don Ling: Well, who knows? There are other factors. Mr. Perry: Another thing that’s disturbing to me is the fact that the waiting list is like a year and a half. Dr. Don Ling: That’s why I say don’t focus too much on the waiting list. Those that want to make the change will impress the people they’re seeing. They’ll rise up more quickly. It doesn’t go: You have to wait for 59 others to get treated. It doesn’t work that way. You look at the whole group and you start picking who seems most ready. Mr. Perry: But someone can remain on that list for quite some time, too, and not receive. There are individuals that can fall through the cracks, too. Dr. Don Ling: Yes, for sure. I couldn’t deny that. Mr. Brown: Some would say (Indistinct) you know, and then never go check up on it again. To get you off my back, put my name on the list. Mr. Perry: But to get to that point they have to go through, apparently, the detoxification part of it.

Dr. Don Ling: I can share this with you. This is interesting. Couples out there – the woman gets pregnant, comes in – and by the way, if you’re opioid addicted and you’re with child, if you’re pregnant, you are priority, you get treatment like that. You’re offered it. If you don’t want it you don’t get it, but we strongly encourage it because it’s the best way to get a good outcome with that baby, to have the baby come out in a healthy state. Mr. Perry: But would that encourage individuals to become pregnant? Dr. Don Ling: Possibly. Mr. Perry: Is there another avenue? Dr. Don Ling: (Indistinct) doing that. Mr. Mitchell: (Indistinct). Dr. Don Ling: That’s right. Some of those pregnancy cases don’t do as well. They come in so quickly without the preparation work that we sort of encourage. It’s a 50-50 thing. Some do wonderfully well and I’ve got some recent examples, just superb. The woman then gets on treatment, goes through, has the baby and stays clean and does well, and she’s got the boyfriend, the partner, who may or may not live there. Child and family usually swoop around. Often times that guy – and I can think of four or five cases right now – that guy might say certain things. The woman’s in good recovery and she wants to be a mother and is doing a nice job, and this guy is using. If he’s around too much there’s problems for that woman because the risk is higher when you’re in the middle of it. But we do a lot of chatting and the mother then starts to tell buddy: Look, if you’re going to do this you can’t be here, we got to separate. That’s a common story that I encounter. That’s a guy who probably puts his name on the list. When I meet with that mother I’ll say: Look, we’ll find Johnny, you should get him to go to detox or get him to see a counsellor, get him to do some things. If he tells you he’s clean and you’re suspicious about it, get him to go see the counsellor and get a urine test done just to confirm it. Because she may have carries at this stage. I’ve encountered that. Carry doses of methadone going home


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because she’s earned them, and here’s her love interest who’s sick with withdrawal. He knows that the treatment, the solution, is right there in that bottle, so he can get her in trouble by sharing the methadone. It can be an ugly situation. We get nervous if he’s too close to the scene and still active. He may be just putting up a front, for instance, that: Oh yes, I want to get treatment. But he’s not doing anything to show that he’s serious about treatment. The best she can do is probably keep him at a distance. Chair: Olive Crane. Mr. Mitchell: (Indistinct) say if that’s the family situation, do you both get treatment? Dr. Don Ling: That’s a good question, good point. We actually give some priority to the partner of a successful patient with a child, but they have to do a couple of things positive to get to advance. They can’t just be saying one thing and doing another. That doesn’t impress too many. But you’re right, that’s a person we’d like to get into treatment. We tell that mother, when the mother comes in to treatment pregnant, we say: We’ll offer you methadone – because we’re treating the baby, basically – and if you do well and want to stay on treatment, it’s yours. But if you don’t do very well it could be taken away after the baby’s born. We’re treating the baby initially. If they do well we say: Look, if you do well and you want your partner who is struggling out there, like, encourage him to do these couple of things and we’ll give him special consideration because you’re trying to be a family unit, which we value, and we’ll try to support that. Mr. Mitchell: So it does occur. (Indistinct) long as they do those couple of things they can be off and running. Dr. Don Ling: Yeah, does help. Chair: Chair recognizes Olive Crane. Ms. Crane: Out of your 200-plus patients that are on methadone, how many ladies would be pregnant and out of those ladies,

how many would – would they be connected to child and family, like, with the – Dr. Don Ling: They’re all, I think. Ms. Crane: Okay. Dr. Don Ling: Everybody who comes in to our program pregnant, probably child and family are involved – Ms. Crane: Involved, okay. Dr. Don Ling: – because of the illness. We probably do – it’s a good question. We should have those numbers available for you. I know we do six or eight pregnancies a year, I would expect. It might be a little more. I’m sure we have at least half a dozen a year. Some women may try to get pregnant to get treated. They get desperate. It’s a tough life. The cracks, Mr. Perry, you’re right. We’re not perfect. We don’t get all the best cases. I mean, we do the best we can, but other people out there used other ways to get our attention and more power to them. For instance, an addict out there who’s using street methadone, we don’t condone diversion of methadone, we’re nervous about it, but we don’t look askance or penalize anybody who’s been able to get street methadone to manage their situation. It’s a credit to them, actually, although we’d like to stop the supply because it’s not right. But that’s a credit to them. They’re actually trying to manage things the best they can. Chair: So, one more? Ms. Crane: Just one more, and I promise, no more after that. On the other side of the opiates, I mentioned about the stigma of a physician or what used to be there in terms of the treatment part. Where are all the pills coming from? My question is: Do physicians recognize how easy it is for people to be addicted to the opiates? Do you know what I’m trying to get at? I’ll give you a real example. Kids get wisdom teeth out, and before they even have any pain they’re given the prescription for


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20 or 30 opiates and that drives my blood pressure through the roof. Dr. Don Ling: Just a year and a half ago I was in consultation with the dental board. A gentleman I happened to know quite well phoned one day with this on his plate. He’s their registrar of their college or whatever they call it. I put up together a page or a little letter and I sent it to him and he circulated it to dentists with that advice. Our own college has tried to share the same type of information with their membership. I think slowly - and this awareness helps too – dentists and doctors read the paper and know what’s going on. The more we talk about it and talk about the dangers that are there and the problems there are, they start to, then, modify a little. They say: Maybe I have to pull back. This has been strongly encouraged, and it’s a national scene too. It’s in the medical journals and things like that. There’s lots of attention going to it, but that’s where this is going to help. Yes, there’s too much liberal prescribing. Nine years ago when our program started I was convinced that all the opiates in PEI were just diverted from local prescriptions. It’s not that case now. There’s importation going on. It’s a big business. You got a big business. People are going to do business. Coming in from Montreal, I expect, through Moncton, whatever. It’s coming across the bridge. They’re apprehending some of the caravans that come in or some of the supply, but that’s just some of it, but it’s being imported. Chair: Doctor, I want to thank you very much for being here today. We’ve allowed an hour. We’ve taken up your time for an hour and fifteen minutes. Is there anything you’d like to summarize for the committee? We have the media here. Teresa Wright is back there. Anything that you wish to say to bring attention to this? Dr. Don Ling: In fairness, I’m here as an individual but I’m part of a team. I’d like to say that, just so there’s no misunderstanding. At the PATF we have a workforce now in this program of 5.2. We have a full-time nursing office with two nurses, equals 1.4 nursing strength. We have a full-time nurse lead. We have a full-time social worker. We

have a full-time addiction worker who’s wonderfully important to our urine. We do a lot of urine checks and this individual, so – and we have other physicians. I’m the primary physician for our program, and I was going to say I have the majority of our patients, but we have two other physicians at the centre and they each have some patients. We’re unfortunately losing one this summer, but there’ll always be more than one physician involved, too. I wanted to share that, Mr. Chair, that I’m here speaking for this program, but I’m only one person involved with this program. I guess that’s the other thing – oh, if there’s anything that would help in addiction recovery, to opiates in particular, housing. There’s very little safe housing. When people return to where they live with the problems around them, it’s hard. It would be nice – we have some recovery homes. We have, let’s see, 22 male beds and six female beds. Not enough female beds. As I said, there was a trend towards female, especially in opioids, and we only have six beds at Lacey House. We need more. Safe housing is critical to recovery, a safe environment, and that’s – yeah. Ms. Crane: Just – can I make a quick comment, just on that. With the Doctor, it’s not a question – Dr. Don Ling: All right. Ms. Crane: It’s something he may find helpful. I don’t know for some of your patients that are on social assistance, but you used to be able to make a really good argument if someone needed to live over a rent ceiling. So if Richard is a single person and he is on assistance, the rent ceilings are really low, which causes people to live in environments that are really poor. You used to be able to – as part of that group that you’re working with – make a case with the department, and in some cases if they knew Pete was really trying his best, to make allowances for that. Not everybody knows that. I don’t know if that is still the practice but that’s something we could really recommend. Especially some of the stories you’ve talked about that became really successful, if that’s something that would help.


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Dr. Don Ling: That was one thing – that would be nice. Actually, they’ve cut back on travel support, which has been tough on us. An Hon. Member: Who? Ms. Crane: Social services? Dr. Don Ling: Social services, yeah. Oh yes, one last thing, Mr. Chairman, just to tell you how valuable this program is for returning to normal lives. I have 186 of the patients. Working or full-time: 63 now. Working seasonal: 27. Ninety of the 186 are working, many of them self-supporting. Nine are disabled so they’re unemployable. Five of my patients currently involved with maternity or child care, and four are in school or Strength. If you look at that, the return to working, 56%. It’s powerful stuff. And you can imagine, when they’re in the midst of this disease their life is a shambles. They’re usually up in court for stealing, etc. They don’t hold a job. There wouldn’t be three that I’ve treated that had a regular job when they come into treatment. Most of them are hanging by a thread of those three. That’s powerful stuff, the recovery rate and the fact they get back to regular lives. Social service department should thank us a lot for taking them off their rolls, but they don’t see it that way. We want these taxi rides out to do urine tests at the PATF and they object to that. Ms. Crane: But maybe that’s some of the area that this committee can help with. As the pressure is going on social assistance to – those that are getting treatment – Dr. Don Ling: I do apologize. One last shot. Detox admissions. I just went into the chart room before I came out here today. I said: I want to do some research. We had one guy who’s been in treatment now for a long time. He had 74 admissions to detox. He got inducted in December of 2006. He had alcohol issues, too. He subsequently had seven admissions, but since 2009, no admissions to detox, and in solid recovery. Mr. Brown: So he had 74?

Dr. Don Ling: Seventy-four. He’s had a total of 81. Seven came after his induction, but nothing for the last four years. Powerful stuff. Another girl was only – he was in his forties when he was inducted – this girl, 28 when she was inducted. She had 13 admissions to detox, was inducted in October of 2007 six year ago, no admissions since, doing great. Another young lady had six admissions all in one year in 2007. We inducted her in December of 2007. She was 24 years old. Nothing since. She actually excelled at a program she took at Holland College and she’s mothering a couple of kids. Another young man working at one of our local (Indistinct), he had eight admissions. He was 21 when we inducted him, one of the younger ones, May of 2008. Perfect since, no admissions. And another gentleman who had some mental health issues, who we worked with the McGill Centre on because it was a bigger challenge, and he had seven admissions to detox. He was 25 when we inducted him in February of 2008. No admissions since, and he’s now living out in the community doing wonderfully well. Mr. Brown: I never believe people that sort of wrote people off pretty quick. I believe if you give people a chance, one or two or three times – 74, that’s pretty good. Mr. Mitchell: That’s a lot, yeah. Mr. Brown: That’s a success. That tells you – like, the people that come in and say: They’re repeat or 77%, so forget them. There’s a person that got their lives back, there’s a lady that got their life back. That’s what government’s all about, I think, giving people a second chance and not just throwing them out. Dr. Don Ling: I apologize for taking extra time, but I get passionate about this stuff. Some Hon. Members: (Indistinct). Chair: No, this is what we want. Dr. Don Ling: These poor people, the people in the midst of the disease, don’t


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really have much of a voice. Nobody wants to give them a stage or listen to them, and they’re so beat up themselves anyway they’re unable to do it. They’re crushed, but they come back, and it’s nice to see. Mr. Brown: That’s why we were saying we’re going to have some of our meetings in camera because we want to hear from those people. Dr. Don Ling: Yeah. Mr. Brown: We don’t want them to be – we don’t want to deny anybody from this committee, and if some people don’t like holding it in camera, tough luck. Dr. Don Ling: If you have any trouble finding people, call us and we’ll encourage a couple to come forward. Chair: Dr. Ling, if you care to – if the committee would like to have you back, would you be willing to come back? Dr. Don Ling: What do you think? Chair: I think so. If you think of anything else that you would like the committee to hear, or you could send in a confidential report to the clerk, and it could be part of our report when we report to the Legislature this fall. Dr. Don Ling: I thank you for this opportunity. Mr. Brown: Thank you, doc. You’ve been great. Chair: It’s been a great meeting. All right, meeting is adjourned for one minute – Research Officer and Committee Clerk: Oh, no (Indistinct) Chair: One minute. Research Officer and Committee Clerk: (Indistinct) thought you were going to adjourn – Chair: No, no, just for one minute. Some Hon. Members: Recess.

Research Officer and Committee Clerk: Recess. Chair: A recess for one minute. [Recess] Chair: I’m getting some consensus here that the people have to go and that we would put off the showing of the video to our next meeting. Is everybody in agreement? Some Hon. Members: Agreed. Chair: One other thing I want to ask you – we just put the video off to another meeting. Ms. Crane: Okay. Chair: What is the committee’s preference? I know this is a very important topic, and the Legislature has written out that we’re going to hold most of our meetings starting in September, in the fall, because we want to give everybody the opportunity to come before us. But two months seems like an awful long time. If the clerk has some feedback of people that want to appear during July and August, would the committee be in favour that we could line up people that voluntarily want to get before the committee as soon as possible? Would all committee members – Ms. Crane: Just one comment on that. There’s some of us going out of province for conferences and I’d really like to attend (Indistinct). Chair: We will make sure that we don’t interfere with any conferences. We’ll check with people if a meeting can be pulled off. Will everybody be in consensus that rather than wait two months, that could possibly be some meetings? Some Hon. Members: (Indistinct). Sonny Gallant: Can I also just add to that? If there’s a possibility that one person on this committee can’t meet I’d like that we not meet. If you’re going out of province – let’s say somebody takes two or three days’ holidays and the rest of the group can meet, I think we should all be in consensus that we


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can meet because this is important to all of us. I don’t think one person – Chair: All right. Is the consensus of the committee that all committee members want to be here for all meetings? Some Hon. Members: Yes. Chair: Okay, all right? So moved. You got that, Ryan? Research Officer and Committee Clerk: Yeah. Chair: Anything to bring up before I ask for adjournment? Hearing nothing, we’re adjourned. Thank you very much. Wonderful meeting. The Committee adjourned

jun 25, 2013 - legislative assembly

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