Reluctance by family doctors to treat people with an active drug addiction in Cape Breton means some people have to travel to Halifax for methadone treatment on their own dime.
The shuttle ride costs them about $140 for a return trip.
People with opioid use disorder can receive care through the opioid recovery program. Once those clients become clinically stable, the goal is to transfer them to their family doctors.
But in Cape Breton, there's no one to accept them as patients.
"So far, we don't have any doctors here in Cape Breton who are actually willing to or able to take on those stable folks from our specialized opioid treatment program here with the health authority," said Sharon MacKenzie, acting director for mental health and addictions in the eastern zone for the Nova Scotia Health Authority.
MacKenzie said the problem is unique to Cape Breton.
She pointed out, though, that the island does have a strong clinical team of doctors, nurses, social workers and outreach workers who provide care through the opioid recovery program.
Too complex and time-consuming
Christine Porter, executive director of the Ally Centre, which operates a clean needle exchange in Cape Breton, knows of a couple of people who are making the trip to Halifax once a month.
On each trip, the patients see their physician, who writes a prescription for them to take to the pharmacy. They have to visit the pharmacy twice a week and then return to Halifax once a month to see their doctor and renew their prescription.
Porter said doctors can be reluctant to take on such patients.
"I mean, I can't speak for all of them, but from my experience and from people I've spoken with and our research certainly tells us that they don't want to deal with the complexities of drug addiction or substance use disorder within their practices," she said.
MacKenzie said there are a few reasons why there is a shortage of doctors in Cape Breton willing to accept those patients. First, Health Canada requires doctors to get a special exemption to prescribe methadone.
"That can be a bit of a barrier for some family physicians that are busy and can't get that education or the exemption," MacKenzie said.
"There may be a belief, too, that the clients and the patients are too complex and time-consuming and can't be managed adequately in their private practices," MacKenzie said.
"And I think that stigma plays a role in all of this, not only within in Cape Breton but provincially, nationally."
To make matters worse, about 20 per cent of the people in the specialized clinic do not have a family doctor to be transferred to once they stabilize.
Provincial wait-list reaches 214
The Nova Scotia Health Authority says the current wait-list for treatment on the island for people with opioid use disorder is about 62 days. Sixty-eight people are waiting for service.
The wait-list has decreased in recent months. In March, people waited about 96 days before they got into the health authority's specialized opioid recovery program.
MacKenzie said that number pales in comparison to other parts of the province.
"The current provincial wait-list is about 214 waiting and they wait, on average, up to 104 days for treatment," she said in a recent interview.
Recent increased funding from the province added 80 spots for people in Cape Breton to access services.
Porter said the wait-list could have been cleared up long ago if primary-care physicians took on patients who are stabilized on opioid-replacement therapies such as methadone or suboxone.
The wait-list for treatment started shortly after Cape Breton got a methadone program in 2004 following the deaths of 22 people in one year due to Oxycontin overdoses, Porter said.