Methadone not good enough?

One of two Calgary methadone treatment centres that services about 500 patients is scheduled to close at the end of this month. The reasons include not meeting city standards for zoning and not adequately consulting with community associations before it opened in late 2008. 

How it managed to open despite these claims is anyone's guess, but is it justifiable that the community associations are legitimately worried? On one hand, they can be blamed for adopting a "not in my backyard" policy and fueling the stigma of those living with substance addictions. But if you put yourself in the shoes of a community resident, having addicts freely and frequently roam your streets may be a good enough reason to complain. 

Let's take a step back and look at the big picture for a second. Closing the treatment centre will leave a few hundred of people without the appropriate care and support needed to wean off their drug addictions. This will be particularly devastating to those who are already committed to their regimens, but that need convenience and habituation to carry themselves through. The risk of relapse will be high, potentially undoing years of hard work on the part of both patients and health care workers. 

Although immediate closure seems like a worst-case scenario, relocation is not that much better. As mentioned, treatment for substance abuse can be long and arduous. If people with addictions rely on routines to maintain compliance, any disruption in this pattern can be detrimental. How big of an impact will moving a clinic cause? I guess it depends on how far away it will be from the greatest locus of clients, how many health care personnel will continue to work in it, and if the services will be delivered at the same level of efficiency. It doesn't help that a 3-month wait time exists at the other methadone clinic, which cannot realistically take on more patients. 

What bothers me is this. Even though science (and perhaps some heart-warming testimonies) can show compelling evidence of the effectiveness of methadone treatment, the needs of substance abusers often come second to none. Are they less deserving of treatment because of who they are or what they do? You would be surprised if I told you that those with drug addictions come from all walks of life. 

Even then, a doctor would say no to this question because dealing with health and health care issues is what unifies all human beings. As Perri Klass puts it nicely, "doctors are engaged with individual humans at the level that makes everyone human." 

On the other hand, a policy-maker (as this is a career path I'm still considering) has to weigh several other opinions, ranging from those of city counsellors to community members to anyone else with a public interest on this matter. Policy-makers sorting through this dilemma would be hard-pressed to take sides between those that are healthy versus those that are unhealthy. Doctors, as advocates for their patients, have a clear position. 

How can someone reconcile being both a doctor and a policy-maker?

WC