Friday, February 25, 2011

Transfering Methadone Doctors

In British Columbia doctors who prescribed Methadone are licensed individually. Also the clinics where methadone patients can get their methadone are licensed as well.  Therefore if a patient's methadone doctor isn't available at the clinic at the time the person comes another methadone doctor can serve as the 'locum' prescriber for that person on that day.

However if a person wishes to change doctors or clinics then a formal transfer has to be made.  To do this the College of Physcians and Surgeons of BC requires that one doctor communicate first with another doctor and then forward notification to the College of the transfer of methadone prescribing.  If both doctors are in the same clinic it's really just a matter of the two doctors having a hallway chat to ensure that there is no untoward concerns that might influence ongoing care. If the doctor is at a different clinic then the doctors must contact each other by phone.

What arises sometimes is that the patient's methadone prescription has run out and the patient sees the new doctor.  For the new doctor to prescribe the old doctor must be notified.  The patient naturally needs medication and the new prescribing doctor can feel pressured to prescribe especially if they are unable to reach the old doctor by phoning their pagers and the clinics where they attend. Naturally this is worst at the end of a day or on Fridays.

The College regulations are very clear though and they say that because of the licensing of doctors and sites the patient can get their methadone at the old site from a 'locum' doctor because the records regarding the patient are at the site. Any concerns can be reviewed in the new chart, especially if there are any health concerns or concerns about diversion of methadone as an example.  The College's principal concern about methadone is that it doesn't get diverted as there have been case where the young have taken diverted  methadone and died.  While methadone is an extremely safe medication and extraordinarily helpful in the treatment of opiate and heroin addiction it's window of safety is individualized and defined.  It is therefore highly risky for another person to take a methadone dose tailored to any particular individual.

In the event that the original doctor can not be contacted despite various documented tries over a couple of days, review of the pharmanet record by the new clinician and testing of the patient's urine to confirm the presence of methadone, then the College can be contacted and a higher level solution arrived at.

The College of Physicians of BC methadone program exists for the benefit of all including the former addicts and community at large.  Though individually a person may feel very stressed by their inability to get their methadone immediately the rules are in place for the benefit of that individual as well as the program as a whole.  A solution is always forthcoming but of course it requires a little patience which is usually sadly in short supply when these unfortunate transfer complications can arise.  Not unusually the original doctor has given the patient a prescription for anywhere from 1 to 4 weeks, more than adequate time to find a new doctor and clinic.

The problem arises mostly because being human the methadone patient leaves the transfer to the day their prescription expires.  It would be best to change doctors and clinics early rather than late but fortunately thanks to the forethought of the College guidelines there are contingencies in place that provide a solution without compromising safety.


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