Fly-in addictions doctor says fast action is key to addressing opioid crisis
Need for addictions services great in 'every nook and cranny' of Newfoundland and Labrador
It is 9 a.m. on a Wednesday and people are lined up at Dr. Todd Young's addictions clinic in Marystown, N.L., even before he arrives.
Shane Murphy is one of Young's first patients in this town of about 5,000 people. When he became severely addicted to opiates prescribed for dental pain, he had trouble getting help.
Murphy finally got an appointment at a clinic in St. John's, 300 kilometres away, but could not afford to make the trip several times a month, often in treacherous winter conditions.
"You're dealing with a person who is falling apart because of what the addiction is doing to them," Murphy says. "If they've got to fight for help, what are they going to do? Go back to the pill bottle. That's easier."
Young's new local clinic has been a lifeline, Murphy says. "It's in my own hometown. No one else ever offered this."
Murphy's predicament is not unusual in Newfoundland and Labrador. To avail of treatment, people often have to travel long distances to clinics in larger centres such as St. John's or Corner Brook.
Even after they get an appointment, the wait list can be a year or more before they're seen.
Young is changing that by travelling regularly to smaller communities and offering local clinics that focus on starting treatment as quickly as possible. He uses a combination of telemedicine and on-site clinic visits to treat his 525 patients.
"When someone who has a substance use disorder is asking for help, they need to be getting easy access to that help in days — not weeks, not months," Young says.
"We've tried to simplify access. We've got a rapid access program where patients from the time of referral … can be started on treatment within five days."
Young has stirred controversy in Newfoundland and Labrador. He was sanctioned by the provincial College of Physicians and Surgeons after admitting at a hearing in 2015 to having had sex with a former patient and to inappropriate conduct with another. He was allowed to resume his medical practice in 2016 but was denied hospital admission privileges by Central Health, triggering protests from his patients.
His hospital privileges were reinstated in September 2018, but he has continued to work with patients through a growing network of satellite clinics in small towns.
In addition to the family practice that he started in his hometown of Springdale several years ago, over the past year the doctor has expanded his opiate addiction services to include monthly clinics in Clarenville, Harbour Breton, Marystown, Pasadena, St. Anthony, Stephenville, and St. John's.
Deaths and hospitalizations due to opiate poisoning are on the rise in Newfoundland and Labrador.
Even though doctors in this province write more opiate prescriptions per capita than in any other province in Canada, many are unwilling to treat the resulting addictions.
The Newfoundland and Labrador Centre for Health Information reports that the number of opioid-related deaths in the province almost doubled from 18 in 2016 to 33 in 2017.
Hospitalizations involving opioid poisoning increased from 57 to 84 over the same time period.
"It's amazing, actually — [in] every nook and cranny, every small town, people are exposed to opiates," Young says.
Marystown is one of seven clinics that Young recently opened on the island in order to meet the demand for opiate addiction treatment, primarily in rural areas where the need has increased in recent years.
"Since Dr. Young came in the picture, for any addict who wants help there's no barriers now," Murphy says.
'That's someone's son or daughter. They deserve to be respected."- Dr. Todd Young
But travelling long distances to his new satellite clinics in far-flung communities was taking away too much time with patients. So Young recently bought a Piper Navajo six-seater plane to help him and his team get to patients faster.
That team now includes an addictions counsellor and a nurse, as well as a pilot.
"When I did the math, it made sense. To drive to Marystown today, for example, would have been at least seven hours, weather permitting," Young says.
'I got my life back on track'
Kimberley Boland, 25, is among the 44 patients Young sees today in Marystown. Boland had been addicted to opioids and other drugs since she was 15.
"Just being around friends, they'd say, 'Try this, try that' … and then I just couldn't get away from it.
"It was a very hard road, to the point that I didn't want to live any more," Boland says.
I didn't want to live any more.- Kimberley Boland , 25.
She tried to get treatment several times, but the lack of services near her hometown meant every attempt ended in failure. Then she met Young.
"When I first seen him, I started crying, and he said, 'Don't go getting discouraged, because everything will be OK.' And nobody says that to you when it comes to addiction. Nobody. But he did, and it makes a huge difference," Boland says.
Boland's impetus for finally kicking her addiction was her four-year-old son. She lost custody of him when he was six months old, but getting treatment means she is well enough to be a full-time mom.
"I got him back now. I got my life back on track … I'm doing school now, like, I got my life back, my friends, my family."
A matter of respect
Young's reason for wanting to treat people with addiction is simple.
"These are people, good people, and they deserve to have their disease treated just like anybody else," says Young, whose philosophy includes removing stigma from addictions treatment.
"If I was to say, 'Sorry, I don't take diabetics,' people would have a problem with that. And they should have a problem with that."
All of his patients are someone's son or daughter who got off track and are looking for a way to restart their lives, he adds.
"I'm not going to be able to help them to the full extent that I can do so if they don't feel comfortable and respected."
Nicole Skinner, 22, is another of his patients. She became addicted to opiates when she was just 15.
When she sought help from one of the province's big clinics a couple of years ago, Skinner was put on a waiting list of about a year-and-a-half. She decided to try Young's clinic in Springfield and was given an appointment in two days.
Skinner has now been off drugs for two years, she says.
"It completely changed my life, this program."
She is an animal lover, and Skinner and her partner have set up a cat rescue shelter in Marystown, where she is a patient at Young's satellite clinic.
"I can't even think about going back to the way it was before … I only encourage people to get help and to try and make their lives better, because it [life as an addict] is no way to live at all."
Testing enhances patient accountability
Young's approach to treating drug addiction also means holding patients accountable.
He has implemented on-the-spot urinalysis, which tests for oxycontin, cocaine, amphetamines, barbiturates, and other drugs. It also tests for addiction medications — methadone and suboxone.
Tests sent to a laboratory can take three to four weeks. But with on-the-spot testing, Young says he can tailor the patient's treatment to where they are in their recovery on the day he sees them.
"A lot can happen in four weeks."
By using this system, Young knows at each appointment whether his patients have used drugs they should not be using, and whether they are taking their addiction medication.
Patients feel proud when their test proves they are sticking to the program, Young adds.
"They're honest people, because they've gone through a time where they've lived a lie and they're tired of that, and they enjoy the honesty."
When he began treating addictions, Young had no idea about the scope of opiate addictions in Newfoundland and Labrador. And the difficulty some people had finding medical help.
In addition to doctors who refuse to treat patients addicted to drugs, some pharmacists refuse to dispense methadone and suboxone.
Many pharmacists in the towns where he has set up clinics have come on board, but in the health care system overall there is much room for improvement, Young says.
"My vision would be that every physician, every family physician in particular, and every nurse practitioner … would be prescribing, that they would all be part of the solution for patients who have substance abuse disorder."
Young has heard the criticism in some quarters that treating people with addictions is a waste of money. He argues that getting people healthy benefits everyone in society.
"It does save us all money in the end, and lives," he says.
"What costs taxpayers is crime, is incarceration, is secondary disease … those are significant costs to our system."
Treating addiction goes beyond the patient, it extends to their family, their support system and their community, he adds.
"That's someone's son or daughter. They deserve to be respected," Young says.
"Everybody has a story, and I think as you go through life yourself you kind of take a few knocks sometimes, and with those you appreciate the battles that other people have."
It completely saved my life, this program.- Nicole Skinner, patient
Young has already set his sights on starting two more addictions clinics in Labrador in the coming months.
For his part, Shane Murphy doubts that he would be alive today without the treatment he is getting from Young.
"He will see to it that you get your life back on track if you are wanting to help yourself ... Dr. Young has helped me so much, and I'm going to continue to see him until my life is where I want it to be."
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