Downtown gets another methadone clinic

Subject to a building code inspection today, Sault Ste. Marie's second private methadone clinic is expected to open its doors next week.

Dr. Brian Taylor's Road to Recovery Health Clinic has already started registering opioid-dependent patients, three-quarters of whom are walking in off Queen Street without physician referrals.

This will be Dr. Taylor's fifth methadone clinic.

He'll follow the model he's successfully used at his two locations in Barrie, and others in Bradford and Midland.

"There's a thousand reasons why people get involved with opioids," says the Toronto-based family physician.

"It's not just because people want to get high. That may be the end result. They may start off [with] knee pain, given Percocets by their buddy. And it just escalates from there. It's very easy to become addicted to these things."

The new clinic is at 332 Queen Street East, between Mann Florist and the Ministry of Children and Youth Services.

That's just half a kilometre from the existing Ontario Addiction Treatment Centres (OATC) methadone clinic at 500 Queen Street East.

Opposition

Earlier this year, Marnie Stone at Stone's Office Supply Inc., Terri Williams from Body First and Jill Zago from Stonehouse Wines were expressing concern about what they saw as problems with OATC's location and clientele.

Mayor Christian Provenzano has also spoken out about downtown crime, but Police Chief Robert Keetch cites data showing that both calls for service and violent crime occurrences downtown declined from 2012 to 2015, while calls involving theft, shoplifting and mischief "did not vary significantly" between 2012 and 2015. 

In any case. Dr. Taylor believes a second methadone clinic will actually result in further reductions in downtown crime.

"Having another location is probably a benefit," he tells SooToday.

He cites a program used in Massachusetts and eight other states, where reductions in crime are attributed to diverting drug addicts into treatment instead of jail.  

"I am of the opinion and the studies show in the states, that it will reduce your crime," Taylor says.

"The issue is the drugs and you've got to get that person under control. Methadone's going to help. Suboxone's going to help."

"You've got to help the people that have the issues. And that will help with crime in general."

No police incidents, no white coats

Taylor says he's had no police incidents inside any of his clinics.

His Sault Ste. Marie Road to Recovery clinic will dispense methadone and suboxone to patients dependent on morphine, heroin, oxycodone and other opioid drugs.

"We're following the model that we have in the other locations, because they work."

His approach is harm-reduction pharmacotherapy, using methadone and suboxone as substitutes for more dangerous drugs.

Taylor eschews the traditional physician's white coat, preferring more casual attire.

He figures white coats belong in hospitals.

And, he takes time to explore emotional and psychological aspects in each patient.

"I get involved in that too. I do MITI (motivational interviewing treatment integrity) motivational treatment. I use a stages-of-change model — especially at the beginning."

"If they're here already, they've already made that decision that they need to change. So now what we want to do is make sure that they stay there."

Taking the time

Nurses play a critical role at Taylor's clinics.

"They have to make sure that their medications are correct, but they're also there to talk to the patients, to see how they're doing, to see how things are going on in their life, socially, with the children, their work — whatever it is. That helps a lot."

"The very first time that a patient comes in, we take a pretty detailed history as to what is happening in their life. Not just the drugs that they're on. That's important, but also, do they have a family doctor? We don't take anybody and treat them as a family patient. That's left for the family doctor. But we'll take aspects of it."

"The biggest part, obviously, is the drug abuse. And we'll also deal with some psychiatric parts of it. So if they're depressed, if I think that I can handle it, I'll give them a medication for depression or anxiety. And then, if it's not working, I'll refer to a psychiatrist."

If I'm treated for drug dependency, will my family doctor know?

Does the family doctor find out when a patient is seen at Road to Recovery?

"That's a good question. If they're referred, the answer is yes," Taylor says.

"But if they're not and they're coming off the street, the only way that they really know is if they're on a benzodiazepine. Then we ask for consent from the patient to talk to their family doctor because we don't prescribe  benzodiazepines like Valium or Ativan to patients that are on methadone, because it's too dangerous. You can die from the combination."

Working in other clinics prior to starting Road to Recovery, Taylor wasn't always impressed by what he saw.

"I could just see the way that they are treated. Sometimes, they are not treated very well."

Success isn't automatic

"Our goal is also... to try and identify reasons that they may be failing. It's not just automatic that you come in and you're going to do well on methadone. It doesn't work that way. There are other reasons. Why are you still failing? Is it because you have triggers? Is there someone else that's giving you other drugs? The nurse plays a very important role in asking these questions, too."

Taylor is bringing his head nurse and a secretary from Toronto to train his Sault staff in Road to Recovery methods and electronic medical records. 

Initially, he'll be seeing Sault patients himself, on Mondays, Fridays and Saturdays, either directly, or, when College of Physicians and Surgeons criteria permit, using Ontario Telemedicine Network videoconferencing technology.

"We treat people with respect. We expect that in return," Taylor says.

"We have a sign out front that you have to be respectful to the staff, my nurses, myself. And we'll treat you the same. We're trying to help you. We're trying to help you reintegrate back into society."