It is an hour or so before midnight when Dr. Todd Young’s truck peels onto the unlit strip of asphalt paved into a remote section of woods.
His pilot and plane are already waiting. This night’s flight was planned for tomorrow, but warnings of early morning fog have set off an urgent race to get Dr. Young up into the sky – and back down more than 500 kilometres south in Marystown – to ensure he can see the dozens of addictions patients registered to see him.
Prescription pads, specimen containers and patient files are hurriedly loaded into the Piper’s snug fuselage by the scant light of a half moon. Seatbelts click. Laughter over the mention of checking the dark airstrip for moose (although it is not actually a joke) ends when the 50-year-old plane’s twin-engines roar to life. The Piper picks up speed as it scuttles down the runway and pushes skyward, advancing one of the most ambitious rural medical efforts underway to provide opioid replacement therapy along the country’s easterly margin.
Dr. Young, a physician based in Springdale, the rural town of 3,000 where he was born and where his father is still the local barber, flies his own plane into eight-and-counting small Newfoundland and Labrador towns each month to provide treatment for opioid addiction. In most of those places, he is the only doctor willing to prescribe opioid-replacement medication – methadone or Suboxone – and he often has to convince pharmacists to dispense the medication.
In all but one of the towns he flies to, he is the only doctor who offers rapid access to treatment, meaning a patient asking for help is usually seen within five days (elsewhere in the province, patients wait an average of one month, although in rural areas, if there is a doctor who offers opioid addiction treatment, waits are often much longer).
Newfoundland has struggled in recent years to counter a growing opioid epidemic that, as in other provinces, has ensnared people from all walks of life. Even Liberal Premier Dwight Ball has spoken publicly about his own daughter’s struggle with addiction. The province was recently slammed for having the country’s highest opioid prescription rate per capita – and the country’s only increasing rate of opioid prescriptions – in a report published last year by the Canadian Institute for Health Information.
Apparent opioid-related deaths in the province have decreased, from 33 in 2017 to just 10 in 2018, according to provincial statistics. But addiction treatment advocates fear those low numbers belie the full extent of the local opioid problem. Approximately 2,700 Newfoundlanders were prescribed methadone or Suboxone in 2018, according to provincial statistics. The number of doctors willing to prescribe the medication nearly doubled between 2017, when there were just 54 prescribers, and 2018, which had 98.
Still, accessing that treatment remains a challenge. That is particularly acute outside the three urban centres – St. John’s, Cornerbrook and Gander – that have what the province calls “Opioid Dependence Treatment hubs.”
“This is not a popular form of medicine in Newfoundland,” said Dr. Young, who said many physicians “look at addictions patients as problem patients.” Thus, it is not uncommon for him to show up to work to find a patient who has hitchhiked hundreds of kilometers to beg for treatment, or another waiting in her truck before office hours begin, trembling with the onset of withdrawal and the determination to get help.
“Every nook and cranny is affected by addiction,” Dr. Young said. “People are suffering in the smallest of towns.”
Marystown is one of them. A Burin Peninsula hub with a population of 5,300, the town’s shipbuilding heyday is long over; hard times have befallen many and the spread of opioid addiction has deepened the desperation. Until Dr. Young set up his monthly clinic there last year, the closest opioid addiction treatment option was in St. John’s, a six hour journey with the return.
Getting there and back while trying to battle addiction, maintain a job, care for a family and pay the cost of travel was, for many, nonsensical.
On the early June day that Dr. Young is in town, close to 50 patients file in to see him. The earliest are Kim Boland and Steven Stacey, a young couple whose five-year-old son, Steven Jr., tags along.
"If it weren’t for methadone, I don’t know where I would be to,” said Mr. Stacey, an autobody mechanic with a thick Bayman accent. “We were the worst of the worst. We was bad drug addicts for five solid years,” he said, glancing at Ms. Boland, who nodded.
Steven Jr. was removed from his parents’ custody when he was eight months old, an act that Ms. Boland painfully recalls being grateful for. In the throes of her addiction, she could only concentrate on how to get her daily fix. “I wished somebody would come and take him – we never thought we’d get clean. We were going to put the kid in foster care,” she said, adding: “We weren’t there for his first birthday.”
The pair served jail terms for stealing and petty theft. Dr. Young, though, has helped them turn their lives around. He has Ms. Boland and Mr. Stacey on methadone. They have their son back and are planning for a summer full of family activities.
Next, Emma Foote talks in her appointment about weaning off methadone. She started on the treatment five years after moving to Ontario to get treatment. Then, she was told she would have to wait nine months for methadone in Newfoundland. “I was like, ‘I’ll probably be dead in mine months’,” she recalled. “I was so desperate. I felt near dead.”
Ms. Foote recently moved home to Marystown, but only because she could continue treatment with Dr. Young.
He currently manages about 600 patients that range in age from 15 to 94. That list grows daily because of a never-say-no policy Dr. Young adopted at the insistence of his best friend, Craig Wiseman. A former intensive care nurse, Mr. Wiseman works with Dr. Young as a “recovery coach.” That job involves sharing with patients his own struggle with opioid addiction, which began more than two decades ago.
Bored in a St. John’s hotel room after a patient transfer, Mr. Wiseman injected morphine. The addiction was instant.
“I was a nurse on top of my game, two little babies at home, everything to live for. I didn’t really fit what most people would consider the stereotype,” he recalled ruefully. “But there’s no set mold or pattern of people. What I did was I experimented and I got caught.”
Mr. Wiseman got help after abandoning plans to commit suicide while hunting in the woods; he reached out for support from Dr. Young, who he met in nursing school (Dr. Young was a nurse before he became a doctor).
Years later, it was Dr. Young’s turn to ask his friend for help. In 2015, in a deep depression, the doctor was battling alcoholism, a broken marriage and a licence suspension from the provincial College of Physicians and Surgeons for having inappropriate relationships with two patients.
“Things just spiralled down,” Dr. Young said. “What happened to me can happen to anybody given the right set of circumstances.”
Out of that dark period, in which Dr. Young himself struggled to get doctors to agree to treat him, came a new commitment to helping vulnerable patients who have few options – and few willing doctors – to turn to. He and Mr. Wiseman agreed to team up to treat opioid addictions, a problem Mr. Wiseman fears is far greater than government statistics reflect.
“The optics are not accurate. We only hear tell of the diagnosed overdoses, but no one would have thought of me, if they had come into to the woods and found my body, as an opioid addict,” Mr. Wiseman said. “But it would have been related to opioid use. The sickness is even bigger than it looks.”
Dr. Young hopes that his willingness to treat it will eventually entice other physicians.
“My goal with all these clinics everywhere … is for people to have their own physicians take care of them,” he said. “I’m not special in my knowledge base. Every family doctor is quite capable of managing addiction,” he said.
What sets him apart, perhaps, is his social conscience and his approach to addiction (“It is just another chronic disease,” he said).
“For me, the most socially responsible thing I could do is focus on mental health and addictions," he said, adding: “The easy thing would have been to stay in my office in Springdale and work nine-to-five.”
Tackling the rural opioid epidemic doesn’t strictly require a personal plane, although having the Piper has cut down on long highway commutes.
“It makes it a bit of an adventure,” Dr. Young said, grinning.