source: The Ottawa Citizen
Date: October 20, 2003

Chronic-pain sufferers lose doctor
Pain specialist gives up his right to prescribe controlled substances

Jennifer Morrison

The pain just keeps getting worse and worse for hundreds of chronic-pain sufferers, who for the second time in a little over a year have lost their doctor, one of the few remaining specialists willing to treat their pain and prescribe narcotics.

Ottawa pain specialist Dr. Marcel Guilmet has given up his right to prescribe controlled drugs and substances, including methadone and opioids, a class of narcotics or morphine-like drugs used to treat patients with severe and chronic pain.

"He has voluntarily relinquished his prescribing privileges in respect to all controlled drugs and substances so he will no longer be permitted to prescribe these kinds of drugs," confirmed Kathryn Clarke, senior communications spokes-man at the College of Physicians and Surgeons of Ontario.

Ms. Clarke would not elaborate on why Dr. Guilmet volunteered his privileges, only saying "there were concerns about his ability to prescribe these certain specific medications."

Dr. Guilmet would not comment.

The decision means that as many as 1,000 of his patients, many of whom suffer from severe chronic pain -- a pain that persists for at least three months -- will have to look elsewhere for their treatment and medications.

The problem is there's nowhere for them to turn.

Dr. Guilmet is at least the sixth doctor in the region since 2001 to stop treating patients with chronic pain.

"There are a lot of us suffering here," said Shawn McLaurin, one of Dr. Guilmet's patients. "We have no doctors. Nobody wants to touch us and we're just left hanging."

The 29-year-old Manotick man said he's been turned away from countless family physicians and clinics, where doctors aren't willing to prescribe him his medication, which includes methadone and OxyContin, a narcotic approved for the treatment of pain. He said he's also contacted the college on several occasions, asking for their assistance in finding a doctor.

"I've tried it all and it's gotten me nowhere. It took me two years just to see one pain doctor and he's gone. I went through absolute hell for two years trying to get medication," he said. "It's looking bleak. The college doesn't even care. They won't even refer me to a doctor outside of Manotick."

Once his current prescriptions run out, he says he'll be left with no one to turn to -- except for the emergency room at the hospital. He's already running low and has only two weeks of methadone refills to pick up before there's none left.

It's the same for Etienne Hilzinger, a retired artist, whose pain is so great that even on a good day, he has a hard time getting around his Nepean home.

"The pain is all over my body now," he said.

"If I don't have my appointment and I don't have anyone who will take me on, it means I'm going to go into withdrawal," he said. "I'm not sure if my heart will be able to take it."

Even before Dr. Guilmet relinquished his prescribing privileges on Oct. 8, Ottawa had a shrinking pool of pain specialists. For the most part, they're swamped with more patients then they can handle, in addition to other responsibilities.

At best there's a "small dozen" of doctors who are willing to prescribe narcotics for treatment of pain patients -- three at the Ottawa Hospital's Civic campus, three at the General campus, two at the Montfort Hospital and a couple of family physicians.

"It's extremely unfortunate that Ottawa is the only large urban centre in Canada that I know of where we have had so little to offer people with chronic pain for so long," said Dr. Ellen Thompson, an anaesthesiologist who also sees some pain patients.

"It is quite bizarre that if you get heart disease and maybe you smoked and didn't exercise, we can offer you the world's best treatment and great facilities. However, if you develop chronic pain, which is mostly due to genetic predisposition, there is nothing really for you."

In January, Dr. Thompson closed the doors to her pain clinic, unable to take the pressure and stress anymore.

She still sees some pain patients, but not on a full-time basis.

"I don't know if it was the stress of the work that caused it, but I will tell you first hand that it's an awful task to try to meet the need and realize that even if one worked seven days a week, 24 hours a day, there is still no hope that an individual can meet the need," she said. "To have to say to all these desperate people that you can't help them is awful."

Dr. Guilmet, who himself suffers from fibromyalgia, a pain and fatigue disorder, just started seeing patients with chronic pain at his Innes Road office in August 2002.

It was at this time he took over the practice of Dr. Martin Gillen, a pain specialist who surrendered his licence to practise after he was caught on video stroking himself behind a heavily sedated patient.

In a short time, Dr. Guilmet developed solid relationships with his patients, who can't say enough positive things about him and the way he related to them.

"I thought he was the most wonderful man because he believed me," said Mireille Boisvert, who had been suffering from unmanageable chronic pain until Dr. Guilmet put her on opioids.

"This was the first time that someone heard what I said and understood how I felt. ... I started on the pain medication and it changed my life."

Before Dr. Guilmet, she said her quality of life was "horrible" and hardly worth living. She'd even considered suicide, but said she didn't have the energy to follow through with it.

With Dr. Guilmet out of the picture, she's not sure what she's going to do when it comes time to renew her prescriptions.

Ms. Boisvert's story is shockingly similar to others, all searching for a way to put and end to their pain or at least make it a little easier.

"I live in fear every day. My pain is in control today, but I don't have a pain doctor. If my pain is out of control tomorrow, what am I going to do?" said Ricki Samuels, a patient of Dr. Gillen and Dr. Guilmet whose chronic pain started in 1999 after a visit to the dentist to repair a chipped tooth.

Other patients, like Wendy Miller, have already started weaning themselves off some of their medications out of a fear they might not find a new doctor.

"We have a crisis which is severe and needs addressing," said Dr. Thompson.

"People with the decision-making power have to prioritize pain and accept that pain is a real major problem in our society and do something about it."

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