VANCOUVER - Doctors who participate in a proposed project aimed at fighting drug addiction among cocaine and crystal meth users may not be equipped to help the vulnerable population, says a spokesman for the B.C. College of Physicians and Surgeons.
Dr. Morris Van Andel, registrar of the college, said Vancouver Mayor Sam Sullivan's recent announcement about a research trial to substitute prescription drugs for illegal street drugs is more hype than reality.
"Currently, we're talking ideal, we're not talking real,'' Van Andel said of the Chronic Addiction Substitution Treatment research project, or CAST.
Sullivan has said the project could be launched in the fall. It's already being lauded by former drug addicts, and Sullivan has said it would reduce crime by those looking for money to score drugs.
Van Andel said that while he hopes the project will benefit addicts, the college has concerns.
"We have raised some questions and we continue to have questions, which may have suitable answers but which so far have not been answered.
"The suggestion is that the college would say, `this is wonderful, go for it,' and we are not prepared to say that,'' Van Andel said.
"From our point of view, the physicians who are involved in that should be knowledgeable. The assumption that every physician can prescribe a substitution drug to someone who is significantly addicted to crystal meth is a farce.''
Unlike Vancouver's safe injection site, the research trial won't need an exemption from Health Canada to proceed because legal prescription drugs will be used.
But the federal government will still need to approve the clinical trial itself.
Dr. Peter Selby, clinical director of the addictions program at the Centre for Addiction and Mental Health, said Canada has a shortage of doctors who are trained to deal with addiction.
"It's not that physicians are falling over themselves to come and get trained in this area,'' Selby said.
The Toronto-based facility is the only place in the country where physicians can learn to deal with the issue through a one- to two-year program, he said.
He added that doctors who become certified through the centre generally work in formal addiction programs and wouldn't be suited to help people in the Vancouver project.
"They never, ever see people, or very rarely see people, who are from the Downtown Eastside,'' Selby said, referring to the seedy part of Vancouver where addicts openly buy, sell and use drugs.
"Just getting certified is not adequate or sufficient for this. This is new, this is cutting edge, this is something that they will have to define,'' Selby said.
"The idea for the new kind of project in Canada will be to choose the right kind of physicians and train them based on literature or whatever method is determined,'' he said.
"If no one else has done this before, how would you do it? For physicians in general, even if you have certification courses, it's generally learning as you go.''
Even doctors who prescribe methadone for people hooked on heroin have only a few days' training and don't become experts on every aspect of that particular addiction, Selby said.
Family doctors committed to understanding addiction behaviour would be the best ones to participate in Vancouver's research trial because they would be suited to establishing a relationship with those who generally face numerous social disadvantages, he said.
Through an ethics review, the drug substitution trial will need checks and balances in regard to doctors' education and patient safety, Selby said.
