A Nova Scotia doctor has lost her privileges to treat opioid users at an inpatient detox unit in Pictou because she refuses to prescribe methadone, or what she calls a "medical monster."
Dr. Cathy Felderhof said people need more options, including long-term counseling, when trying to overcome their addiction other than resorting to the controversial synthetic opioid.
"It's taken the spotlight off of some of the root causes [of addiction]," said Felderhof of methadone.
A CBC Nova Scotia investigation has learned the Nova Scotia Health Authority shut down treatment for opioid users at the Pictou withdrawal unit last spring, after learning Felderhof had been operating without methadone for two years. The facility continues to treat people who are addicted to alcohol and other drugs.
No methadone policy
Felderhof, who has been a physician for 42 years, said the unit was upfront with patients about the no-methadone policy.
"Those who chose to come to Pictou detox came there because they didn't want methadone." - Dr. Cathy Felderhof
"When they came in to be withdrawn, we provided them with what we call codeine-Valium protocol, and they would give them reducing doses of those medications over a period of five to seven days," she said.
"Those who chose to come to Pictou detox came there because they didn't want methadone."
The Nova Scotia Health Authority declined several opportunities to comment. However, in December, the health authority's head of addictions told CBC the withdrawal unit was not following "accepted practice."
"It was safer to keep that unit running, but not for that particular target population," said Linda Courey at the time.
Courey said opioid users in Pictou County were being referred to the detox facility about 120 kilometres away in Springhill. At the time, Courey also confirmed to CBC the health authority was shifting away from inpatient detox for opioid users and putting more people on long-term methadone therapy.
Methadone is currently used both as a short-term treatment to help stave off discomfort or pain during withdrawal from opioids, and as medicine to ease cravings in people who have already gotten off the drugs.
Success on methadone
Shayne Nelson, 26, credits methadone for saving his life five years ago. In 2012, he spoke with CBC about his battle with opioids.
"Some people have a stigma towards it and I don't think of it any different than getting Champix [a prescription medication] to stop smoking than having to take a drink every morning to stop being a junkie," he said.
Nelson said he is taking his recovery on methadone "one day at a time."
"Thinking about five years or three years or even one year time, it kind of scares me to come off [methadone] and know I don't have a crutch, per se, to help me," he said.
Longer care needed
Although his outlook falls in line with the Nova Scotia Health Authority when it comes to methadone, Nelson agrees with Felderhof that people deserve more choices.
"Detox, I find there's a major flaw in it to begin with. You can't get anything out of two weeks," he said.
"It should be at least 30 days to come off and plus to try to get some of your thought process ... in gear again before you're sent back out on the street."
Felderhof concedes that for some people, methadone is the best option. However, she argues it should be a case by case basis.
"I think the more options that are available is always a healthy way to approach a problem," she said.
"I think as soon as somebody tries to control a program and says this is how it has to happen, that's not healthy."