Addictions doctor says biggest challenge isn't her patients, it's the bureaucracy

A longtime addictions doctor says treating the growing number of people in New Brunswick who are hooked on crystal meth is proving to be a bigger challenge than anyone could have imagined.

Dr. Heather Logan, who has worked in addictions and mental health for 13 years, has seen a huge spike in the number of patients using crystal meth.

"You don't miss them," she said of meth users, who often have severe psychosis that remains even after they have stopped using.

"When people are using it they can become so violent and so disruptive that it affects other people."

They have a resilience and when you hear some of the stories of what they've been through, I am always left with a lot of admiration at how tough they are.- Heather Logan, Fredericton doctor

"Up until three or four years ago, it would be unusual to hear of anyone using crystal meth," Logan said.

"We've been hearing more about crystal meth and seeing more problems related to crystal meth over the past three to four years."

Of the nearly 400 patients she sees at the Victoria Health Centre in Fredericton, Logan estimates about 50 use the stimulant. Even though that is just 12.5 per cent, she said meth is causing users, and the communities where they live, a disproportionate number of problems.

"The psychosis and the aggression really does affect people around them to a significant degree."

Better outreach desperately needed

Logan, who treats patients every day in her outpatient clinic, believes she is only seeing the tip of the iceberg when it comes to people who are struggling with an addiction to methamphetamine.

"The way the system is set up … it really excludes the most unwell people that aren't able to make it to appointments because they're so erratic and disorganized," she said.

"They may not know what day it is, let alone what time of the day it is, so they may not be able to get to appointments for things like counselling … they're really struggling, they're really unwell. They require a lot of resources and time."

Logan is calling for more government resources to provide outreach and ongoing case management for people in the province who are addicted.

"You have to go to them, and I think sometimes the not-for-profit organizations do a better job of that."

Many have raised the issue of a lack of long-term, residential rehabilitation programs in New Brunswick, and Logan agreed more beds are needed.

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There are 12 beds at Campbellton Addictions Services and another 12 beds in Saint John at Ridgewood Addiction Services. The waits to get into one of those programs range from two months to more than six months.

"There's not a lot of the longer-term rehab beds, so we're sometimes a little bit stuck with what we have to offer," Logan said.

Options to treat addiction to crystal meth are even more limited, because there is no proven replacement therapy, as there is for those addicted to opioids.

Many of Logan's patients have found methadone and Suboxone helpful as they recover from an opioid addiction, but there is nothing similar for those hooked on meth.

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That, she said, makes it critical that people addicted to crystal meth have access to help immediately through outpatient services and long-term rehabilitation.

"The longer you use drugs the less likely that your brain is going to fully recover," Logan said. "It really illustrates the importance of trying to treat people as quickly as we can and having that treatment available."

Bureaucracy is biggest challenge

While she would like to see more outreach, more case management and more long-term residential programs, Logan said the lack of responsiveness within government departments is what bothers her most.

"Addiction services programs and treatments don't exist in a bubble," Logan said. "When people don't have those basic needs like safe housing and food met, then it's very difficult to treat them."

She said co-ordinating addictions and mental health treatment, affordable housing, prescription drugs and food means government departments, in particular the Department of Health and the Department of Social Development, have to work closely together.

"The most difficult part of my job is the bureaucracy within which we work."

"It's almost impossible," Logan said of navigating the system.

When you add in the "profound fatigue and depression" people experience when they stop using crystal meth, Logan said, it's a wonder anyone manages to stay clean.

"It's really difficult for them to just do basic things. Their thought processes are kind of mushed up … their memory isn't so good. It's why people relapse. If they don't have supports in place it is a challenge for them to stay away from it."

Prescription drugs must be available

One of the most frustrating situations Logan has seen again and again, is patients who are released from detox or a rehabilitation program without the ability to pay for prescription medication that is helping them.

"We struggle … to provide consistent medication coverage for people through their provincial drug program and other programs. And it makes it difficult."

They're either going to cost you less and you can treat them, or they're going to cost more. And people are less stable and communities are less safe.- Heather Logan, Fredericton doctor

Most of the patients she treats have "underlying, significant mental health issues," and without medication they will not be successful.

"There are easy ways that we could be addressing these things, but there's not the will to do it."

"If they go back to no housing, they're likely going to find it difficult to stay away from whatever drug of abuse they're using."

Ministers won't talk

CBC News requested an interview with Health Minister Ted Flemming and Social Development Minister Dorothy Shephard but was told both were unavailable.

Shephard was asked in an email how services might be streamlined for people who are trying to recover from addiction, and whether her department is considering an increase in the number of case workers or outreach workers.

Flemming was asked whether his department was considering adding more long-term rehabilitation beds.

Neither responded.

'They're going to cost you either way'

Logan loves working with her patients and said she has seen many people recover.

"We do see people that we treat get better, move on, get jobs, pay taxes and be successful. So make it easier. Make it easier."

She is calling on the government to think "outside of the box" and add outreach and case management for those who are struggling.

"They have a resilience and when you hear some of the stories of what they've been through, I am always left with a lot of admiration at how tough they are," said Logan.

"They're going to cost you either way. They're either going to cost you less and you can treat them, or they're going to cost more. And people are less stable and communities are less safe."