It’s the changes that can happen in people’s lives that excites Dr.David Marsh, Clinical Director of Addiction Medicine at the Centre for Addiction and Mental Health, (CAMH), about working with people who have addiction problems.
And it’s the dedication to his work with this often very stigmatized group of clients that is one of the factors that led him to being the recipient of the College of Physicians and Surgeons of Ontario’s Council Award this past May. The award is bestowed annually on four of Ontario’s 17,000 eligible physicians who, in the eyes of the selection committee, come closest to meeting society’s view of the ideal physician. The Council Award pays tribute to exceptional physicians whose dedication and personal effort result in important and often creative, health care and education initiatives within the practice of medicine.
Dr. David Goldbloom, former Physician-in-Chief at CAMH, who nominated Marshfor the award said, “I was proud to nominate David Marsh for this award. He embodies dedication, commitment, compassion and humility in all aspects of his conduct as a physician. If someone in my family were struggling with a severe addiction, I would want him to be his or her physician.” Goldbloom was also a recipient of the Council award in 2001.
Marsh came to his area of specialty by happenstance. He was working as a general practitioner psychotherapist in a community practice, when a position became available at the former Addiction Research Foundation, now part of CAMH.
Marsh’s philosophy of working with patients who have addiction problems was the same with his family practice. “Take everybody where they are,” said Marsh. At the time, methadone was relatively unavailable with 350 people on a waiting list for 100 slots at CAMH. The federal guidelines were very rigid regarding doses, take homes and frequency of appointments. Some practitioners felt if clients couldn’t follow these rigid rules, they should be excluded from the program. But Marsh and his colleagues took what was then an unusual, harm reduction approach, negotiating treatment in a client centred way so that even if the clients couldn’t follow the rules exactly, they could still derive some benefit from the treatment.
Since then Marsh has become one of the foremost experts regarding methadone and other alternative treatments for opoid addiction. He contributed significantly to the expansion of methadone as a treatment option in Ontario. Marsh worked closely with the staff from CAMH’s Communications, Education and Community Health department. He travelled around the province speaking to physicians, pharmacists, other key stakeholders and the public about opening methadone clinics in their communities.
Despite some opposition expressed, including among some physicians, that methadone was just one drug replacing another, Marsh was able to help people see the benefits of methadone treatment. According to Marsh, these include a decrease in drug use, both opiates and other drugs, a decrease in crime, the prevention of the spread of HIV, improved outcomes for pregnancy, increased social functioning and self-reported quality of life and decreased deaths from overdose. When Marsh started in 1995, there were 700 people on methadone in Ontario and today there are approximately 8,000.
An Assistant Professor in the Departments of Psychiatry and Family and Community Medicine at the U of T, Marsh is the President Elect of the Canadian Society of Addiction Medicine. While at CAMH, he has been involved intensively with various policy related issues including CAMH’s position on harm reduction and the decriminalization of cannabis and the organization’s opposition to proposed mandatory drug testing of social assistance recipients. He has similarly been able to help change policies so that methadone recipients are now eligible to receive organ transplantation, when they were formerly excluded from the waiting lists.
Marsh and his colleague, Bruna Brands, have contributed to a Best Practices Guide and Literature Review of Methadone Maintenance put out by Health Canada. His current research interests include exploring other alternatives to methadone. Marsh acknowledges that the treatment, while effective, does not work for everyone.
Marsh will be leaving CAMH in the new year to become the Physician Leader for Addiction Medicine for the Vancouver Community and Providence Health Centre, which includes St. Paul’s the area’s largest teaching hospital, encompassing the downtown east side of Vancouver, an area well known for its drug problems.
While Marsh is sad to leave many of his colleagues and friends at CAMH, he is looking forward to the challenges of his new position. And, as an avid golfer he is looking forward to the opportunity to play year round.
Teresa Marsh, CAMH’s former Manager of the Substance Abuse Program for African Canadian and Caribbean Youth (SAAPACY) is also looking forward to new opportunities as she joins her husband out west. We wish them well.