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Some B.C. doctors are saying that methadone-dispensing fees, which are the focus of legal action in the province, must be charged to secure support services for recovering addicts, like those who are addicted to heroin.

John Lehmann/The Globe and Mail

Methadone-dispensing fees that are the focus of legal action in British Columbia must be charged to secure crucial support services for recovering addicts, a doctor from Vancouver Island says.

Dr. Jane Clelland said while the province pays for physicians and drugs, public money doesn't cover counselling, which she called necessary.

Counselling is also a service supported by the B.C. College of Physicians and Surgeons.

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"They don't expect you just to see the patient, they expect you to provide a program," Dr. Clelland said in an interview about the medical-licensing and regulatory body.

"The clinic is supposed to help rehabilitate the person and get them a normal life and you're not going to do that only with methadone."

The treatment program has come under scrutiny after a proposed class-action lawsuit was launched against the province over the $18.34 additional fee automatically taken from the cheques of addicts on income assistance.

The fee agreement referenced in court documents is $60, which is reduced by $41.66 through a government-provided Alcohol and Drug Supplement. The remaining money is drawn from a client's monthly support allowance, according to documents filed this month in B.C. Supreme Court.

"I can see why this Pivot Legal Society thinks it's wrong to take money from these patients, and I agree," Dr. Clelland said. "But unless the whole system changes, if they just take away that money, then there's basically no way to run these programs."

Pivot is a legal advocacy group that works on behalf of marginalized groups. The legal action was launched by representative plaintiff Laura Shaver, who is addicted to heroin. She said she signed a government-drafted agreement "unwillingly and under duress" to authorize the deduction of money from her welfare cheques.

"In my view it's the wrong way to do it," said Dr. Clelland, describing addiction care in B.C. as "disjointed" and "a bit of a mess."

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"If they're going to fund this I don't understand why that money has to come from the patient. I don't understand why [the government] doesn't pay the $60."

Health Minister Terry Lake said the government is reviewing the way it delivers opioid-dependence services with an eye to modernizing and improving the program. He said the added fee was also under review but wouldn't say if it would be scrapped.

"Halfway through 2016 I think you will see significant changes in the way methadone and opioid addiction is treated in the province of British Columbia," Mr. Lake said.

There are 16,457 people in B.C. enrolled in the methadone-maintenance treatment program, and about two-thirds of them receive income assistance. PharmaCare pays more than $44-million annually for the program, a government statement said.

The college authorizes 528 doctors to prescribe methadone for opioid-dependence treatment, though the Ministry of Health revealed only 363 actively prescribe the drug.

Deputy registrar Ailve McNestry said the college's expectation that doctors offer clients additional services not publicly covered is based on solid research and best practices.

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"A very important component of the treatment of any substance-abuse disorder is counselling," said Dr. McNestry. "I think most addictions physicians would say it wouldn't be an appropriate program if the patient didn't have access to counselling."

While no legal requirement exists, she said there is a "fairly clear expectation" on doctors that counselling services are provided.

Dr. McNestry also raised the issue of access to addictions treatment, highlighting the concentration of methadone-licensed physicians in the Lower Mainland and on southern Vancouver Island and their dearth in rural and northern regions.

"They're not properly distributed," she said, adding that it mirrors the situation in other medical fields. "It's the same reason why you don't actually have a neurosurgeon north of Kamloops."

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