Doctor Mary Hanne has a dream.
In it, patients no longer come to her walk-in clinic for “all this bad stuff.”
The “bad stuff” is addictive prescription meds, like Tylenol 3, Valium and Ativan.
“I never give any of this to patients under 20,” said Hanne, on duty at Kirillos walk-in clinic Tuesday afternoon.
“I don’t want to destroy their health too early.”
To everyone else, Hanne issues refills.
But they come with a warning.
“I tell my patients they are both addictive and form a dependency,” she said.
Hanne has been practising in Whitehorse for one year.
Every day her clinic sees 30 to 40 people — at least a third are there for T3s and Valium.
“Most of the patients had a problem or accident before and their doctor began them on these drugs,” said Hanne.
“And I find I have to refill.”
To cut patients off the drugs cold turkey would send them into serious withdrawal, she added.
The misuse and abuse of prescription meds is rampant in Whitehorse.
“We have people come tell us, all you have to do is walk in and you don’t even get two minutes,” said Kwanlin Dun nurse Maureen Crill.
“They don’t even ask what’s wrong with you; they just say what do you want and how many?”
It’s a crisis, said Yukon Medical Association president Rao Tadepalli.
Valium, T3s and Ativan fetch at least $20 on the street, or can be traded for tobacco or crack cocaine.
A few weeks ago, a 26-year-old girl with FASD walked into a downtown clinic.
She wanted T3s and Valium.
Five minutes later, she was out of the clinic, prescription in hand.
At a nearby clinic, a 30-year-old man with FASD was on the same mission.
All he did was ask for a refill.
The prescription was issued.
He’s been getting refills for six years, ever since he broke his finger.
The meds are free for First Nations, paid for federally through Non-Insured Health Benefits.
It’s the largest federal drug program in the country, and sees over 11 million claims a year, said Health Canada spokesman Scott Doidge.
The program, which has no legislative backing, services 780,000 people.
It also acts as a database, tracking who is taking what, and how often.
If you look at this database, it’s all red flags, said NIHB’s utilization evaluation advisory committee chair Richard MacLachlan.
“From (the NIHB database) we know, for the aboriginal population, that we are prescribing large numbers of benzodiazepines.”
This family of drugs includes minor tranquilizers, like Valium.
But minor is not an accurate description of the tranquilizers, said MacLachlan, also a practicing family doctor and professor at Dalhousie University’s faculty of medicine.
Valium is addictive and should not be used for more than a few weeks.
But MacLachlan sees it prescribed for years at a time.
And it’s the same with opioids, like T3s.
Doctors shouldn’t be prescribing Valium and T3s together, said MacLachlan.
And if they do, doctors should be monitoring those patients very closely.
The two drugs interact and also react with alcohol.
“So if you’re taking alcohol, T3s and Valium, they are all depressants fighting for the same place in your brain and they all can stop your breathing, particularly in higher doses” he said.
A man from Indian Brook First Nation in Nova Scotia just died this way, said MacLachlan.
The man’s drugs were paid for by Ottawa and prescribed by his doctor.
“I think the medical profession has used prescription medications, in particular the benzodiazepines and the opioids, to deal with the pains of life,” said MacLachlan.
Currently on a year’s sabbatical, the Halifax doctor is studying First Nations’ health.
“There’s no question when you talk to aboriginal communities that prescription-drug use and misuse is one of their biggest health concerns,” he said.
Most aboriginal communities are already dealing with poverty, unemployment and family violence. Throw aboriginal health concerns and quick-fix prescriptions in the mix, and it’s a mess.
During his studies, MacLachlan had one senior treatment counsellor tell him, “You’re using drugs, doctor, to treat the pains of our life.”
It’s true, said MacLachlan.
“These are populations with great health concerns, and I’m not wanting to disadvantage them in any way, but I think our quick-fix, rapid, fee-for-service, give-a-drug-and-send-them-out-the-door approach is not helping them in the long run.”
Prescription-drug abuse is a serious concern for First Nations leaders in the territory, said Council of Yukon First Nation health and social director Lori Duncan.
“It’s a huge issue and it’s getting worse because of access to walk-in clinics.”
Doctors operate on a fee-for-service basis, so it’s all about volume — how many people they can see in a day, she said.
“Physicians are bound by ethics and are professional, so they’re not supposed to do that, but I’m sure that’s what’s happening.
“They get more money each time they see somebody, so they’re not spending as long as they should to find out if there actually is a problem.”
Fee-for-service medicine is a profound problem, said MacLachlan.
In Nova Scotia where he practises, fee-for-service docs get $26 for every patient who walks through the door.
The fee is similar across the country.
So a doctor at one of the Whitehorse walk-in clinics, who sees 35 patients in a shift at $26 a pop, will make $910 a day.
And 30 to 40 patients is the norm, said Hanne.
If a doctor does a full exam, they charge even more.
“So I can see you, as a patient, for three minutes and you tell me you need something to calm you down, and I can deal with that in three minutes and give you a prescription,” said MacLachlan.
“Or I can take a half-hour or an hour, or rebook you to talk about all the problems of your life.”
For the last 20 years, MacLachlan has been working under contract.
It’s an option available to all doctors, but few choose it.
MacLachlan gets the same amount of money per day regardless of the number of patients he sees.
As a result, he makes substantially less than his fee-for-service associates.
“But I think that’s the way primary care should be done,” he said.
Solving the Yukon’s prescription-drug problem is the doctors’ responsibility, said Duncan.
“They are ultimately the ones prescribing the medicine,” she said.
“If they’re not doing their homework and examining the client, and they’re giving them drugs and keep on giving them drugs without having an adequate record of it, then ultimately it’s them.”
Trouble is, when a patient is already addicted to drugs, it’s hard to cut them off, said Hanne.
“What we’ve got are a significant number of individuals who have been prescribed these medications for months, if not years, if not decades on end,” he said.
And to wean someone off drugs, like Valium, it takes 12 to 18 months.
“So you need other health supports, and you need to know what’s going on in your life,” he said.
“It’s a whole complex mixing of supports that you need to get off that drug.”
It’s easier to just keep prescribing the drug, said MacLachlan.
“But it’s not right.”