Family doctor of the year says treating addiction is 'uplifting'
A lack of training, bias against addiction holds doctors back, says Dr. David Martell
A family doctor in Nova Scotia, who is also among the few addiction medicine specialists in the province, is being honoured as one of Canada's top doctors of the year.
"It's humbling," Dr. David Martell said at his clinic at Fishermen's Memorial Hospital in Lunenburg.
Martell will receive a family physician of the year award in honour of Dr. Reg L. Perkin, from the College of Family Physicians of Canada, at a ceremony Friday in Halifax.
The distinction recognizes doctors who provide exceptional patient care, contribute to the health of their community and dedicate themselves to the education of future doctors.
Martell, the 45-year-old grandson of a fish plant worker from Cape Breton, is something of a rarity in Nova Scotia.
Of 2,500 practising doctors, only 85 are able to prescribe methadone for opioid addiction. That lack of addiction training holds many doctors back, he said, adding that it's improving.
The other big reason, he said is stigma.
'It never happens'
Patients with addictions often find themselves judged, and may receive poor treatment even though "as family doctors, we're not supposed to judge anybody," Martell said.
"People are told you have to get sober, get clean before we can do anything for you," he said.
"That's problematic in that it never happens. People just continue to deteriorate sometimes."
Martell said he believes psychotherapy counselling, along with medication, is important for successful treatment.
"These patients that I've helped have been uplifting," he said. "Rather than them being a burden on my practice, they enhance my practice."
'Really good doctor'
Of 1,400 patients at his clinic, Martell treats 40 people for addictions, like David Iyoupe.
The 55-year-old drinks methadone every day. A roofing accident in 2009 left him with back pain, and then he became addicted to morphine and other opioids.
For a while he was a without a family doctor.
"I was scared," Iyoupe said. "What am I going to do? Back on the street buying opiates or go to the emergency room."
He said he's fortunate Martell took him on, who he calls a "really good doctor." Martell takes the time to talk to patients to understand where they're feeling pain and whether the medication is working, Iyoupe said.
"Now I don't even take a regular strength Tylenol," he said.
Martell also has started prescribing an alternative that is described as safer but more expensive than methadone. Suboxone, which is a combination of buprenorphine and naloxone, is only covered in Nova Scotia for patients under 25.
About 255 patients in Nova Scotia filled a prescription for the drug this year, according to the prescription monitoring program.
That's less than one per cent of the number of patients who have filled prescriptions for methadone.
Ontario recently announced it will expand access to the drug as part of its first comprehensive opioid strategy.
Doctors part of the problem
Doctors have been blamed for over-prescribing opioids, creating the crisis that's plaguing the country. Martell said he was a part of that problem.
"For sure, definitely I was," he said.
He thinks he was sold "a bill of goods" about opioids that are instead "truly dangerous," he said.
'Wonderful' to see change
Five years ago Martell treated his first patient for pill abuse. That patient marked the start of his interest in addiction medicine.
The patient "did magically well" on methadone, Martell said. Others may need months of treatment before it's effective. Some may be at risk of abusing it.
Martell said this patient has gone on to become employed, married and a father.
"It's been a wonderful thing to see."