Pilot program expedites care for addicts

Dr. Mike Franklyn, program director, Sudbury Rapid Action Addiction Medical Clinic.

Dr. Mike Franklyn, program director, Sudbury Rapid Action Addiction Medical Clinic.

Rapid Action Addiction Medical clinic sees patients within 48 hours

People with substance abuse disorders who repeatedly show up in Emerg or walk-in clinics in Sudbury can now be referred to a Rapid Action Medical (RAAM) Clinic and see a doctor specializing in addiction medicine on an expedited basis.

“People with substance abuse disorders, whether it’s alcohol, benzodiazepines or opiates, are almost universally turned away or told ‘there’s nothing we can do for you,’ so this is a clinic where people can be seen within 48 hours,” said program director Dr. Mike Franklyn.

The Sudbury clinic, which is co-located with the Health Sciences North Withdrawal Management Unit downtown and open for two hours every Monday, Wednesday and Friday, is one of six pilots that are part of an implementation study being carried out by Women’s College Hospital and Health Quality Ontario.

Clients can be referred to the clinic by ER or a family doc, but can also book an appointment and walk in off the street, said Franklyn.

“One of our first clients was a young man who was referred to us by ER. He had come in by ambulance with his 10th overdose of Fentanyl in 90 days. Initially, he wasn’t interested in seeing me, but he showed up at the clinic and started on Suboxone. He has done spectacularly since then.”

The clinic offers both drug and talk therapy.

“We ask patients what it is they’re hoping to do because I don’t want to dictate,” said Franklyn. “It’s arrogant to think we know best for people. If they want to reduce their drinking, we’ll try to work towards that goal. If they want to stop completely, we’ll do that. These people have never had this conversation with a doctor.

“What’s missing is hope because things are so hopeless when you’re broke and homeless, have HIV and Hep C. You don’t see a way out. You know other people who are just like you, and they’ve died. You don’t see or hear about people who have turned their lives around and are living happy, chemical-free lives. When we tell people there are actually things we can do to help them, you see a spark go off.”

Franklyn’s patients run the whole gamut from down-on-their-luck alcoholics consuming 250 drinks per week to white collar professionals. The principal opiates being consumed since the delisting of Oxycontin are now Fentanyl and Hydromorph-contin.

The stigma of addiction is something addicts regularly encounter, whether on the street or in health-care settings, said Franklyn.

“It’s very easy to look down your nose and say, ‘they’re losers, they made a choice’ until you meet them or it affects one of your relatives. I gave a talk at Toastmasters and in a crowd of 20 people, six people (knew) a family member or co-worker suffering from addiction. We don’t often realize how rampant it is and how indiscriminate it is in terms of who it targets, but the public doesn’t have this perception. They just see a bunch of junkies and ne’er do wells hanging around on the street.”

According to Franklyn, addiction kills more people than motor vehicle accidents. “It’s the number one killer of young people. In the Sudbury area alone, just from Fentanyl we had 124 deaths from 2007 to 2014.”

Addicts are “super utilizers” of the health-care system, especially ER, which is fine if we were helping them, said Franklyn, “but we’re doing absolutely nothing for them.” The RAAM clinics in Sudbury, Ottawa, St. Catharines, Sarnia, London and York Region are one possible solution.

It’s also important to educate physicians because we’re extremely liberal in our prescribing habits,” said Franklyn. “All of these (opioid) prescriptions left a doctor’s pad and were either diverted, sold or stolen, so we need to work on the supply side of the equation… and we need to educate the public and tell people they don’t need an opiate for whatever ails them.”

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