Pubdate: Thu, 05 Nov 2015
Source: Vancouver Sun (CN BC)
Copyright: 2015 Postmedia Network Inc.
Contact:  http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Author: Ian Mulgrew
Page: A4

METHADONE PATIENTS SUE B.C. GOVERNMENT

Clinic fees: Lawsuit draws attention to province's opioid addiction
problem

Methadone patients on welfare have launched a class-action lawsuit
against the B.C. government for charging them fees for their medicine
which nobody else pays.

Although the litigation has several legal steps to clear before
proceeding in B.C. Supreme Court, it draws attention to the province's
burgeoning opioid addiction problem.

The suit involves a deduction of only $18.34 from social assistance
cheques, but like an iceberg, that small charge is the tip of a
sizable problem.

"The most vulnerable and neediest are being forced to choose between
food and necessary medical treatment," Vancouver lawyer Jason Gratl
said.

"It reduces what's already below subsistence to an even more desperate
level. Everybody else is making money."

There are about 15,000 opioid addicts in the province - that's up from
only 9,500 seven years ago - almost all of whom are on methadone, at
least three-quarters on assistance.

That's roughly a 60 per cent increase from 2007-08 - the greatest
rise, 80 per cent, seen in the Fraser Valley.

This group consumes medical services at a phenomenal rate and cost us
more than $15.2 million in hospital services alone in 2013, the most
recent numbers show. The number of pharmacies catering to them has
increased nearly 50 per cent to close to 2,900 in 2013, up from about
1,900 in 2007. Total pharmacy costs were some $51 million in 2013 -
$44 million paid by Pharmacare.

Medical Services Plan payments to physicians have doubled to more than
$12 million from about $6 million in 2007.

About 300 doctors have authorization to prescribe methadone and they
must take a certification course supplemented by addiction training on
an ongoing basis.

Like physicians, pharmacists must meet specific certification
requirements to dispense the methadone in liquid form (for witnessed
oral ingestion on site) or in carry-out packaging.

Pharmacare reimburses substitution ingredient costs and dispensing
fees as well as interaction fees for pharmacists who witness ingestion.

Those on welfare are eligible for full reimbursement of costs for
prescribing and dispensing, but clinics (run by doctors, pharmacists
or both) are adding fees for patient services not billable to MSP.

The representative plaintiff is Laura Shaver, a heroin addict
prescribed methadone who is also on social assistance.

Welfare for a single person is $610 a month, which hasn't risen in
eight years.

Although Shaver requires methadone because of her affliction, under a
provincial fee agreement, the clinic she visits receives $60 a month
from the government.

In addition to her general assistance cheque, Shaver receives a
medical supplement of $500 a year ($41.66 a month) toward the cost of
substance-use counselling or related services. This goes directly to
the clinic, but it doesn't cover its full fee.

The additional funds are drawn from her allowance, so $18.24 is
deducted from her monthly assistance to cover the remainder.

Basically, the government has created a "supplement" it channels
directly to methadone clinics and tops up by clawing back welfare payments.

In reality, the tariff is a euphemistic way for covering the nuisance
cost of the cohort: these patients are notorious for missing
appointments, being difficult to manage and considered far more
trouble than others.

"The province uses the fee agreement only in respect of methadone
prescriptions (i.e. heroin addictions), or, in the alternative, only
in respect of alcohol and drug addiction," the statement of claim says.

"The province does not use the fee agreement, or have any other
program or practice requiring persons on social assistance to make
co-payments for clinic fees, for any other medical services."

The total annual expenditure by the Ministry of Social Development and
Social Innovation for the addiction-counselling supplement in 2012-13
was $2.48 million, a majority of which went to clients engaged in
opioid treatment.

Gratl, who filed the suit Wednesday, said the annual per patient cost
averages $4,200, whereas untreated dependence is estimated to cost
between $40,000 and $45,000, taking into account health care, law
enforcement and other social costs.

"Ms. Shaver's treatment by the province discriminates against her on
the basis of her disability, opiate addiction, contrary to Section 15
of the Charter of Rights and Freedoms," he added.
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MAP posted-by: Matt