Vancouver resident Lee Wiebe knows what it’s like to endure perpetual agony. Wiebe, who is on the board of the Vancouver Area Network of Drug Users, suffers from chronic pain caused by an inflammatory arthritis known as ankylosing spondylitis. Despite being prescribed 100 milligrams of morphine daily for pain management, he says he is constantly struggling with physicians to have his much-needed prescription filled.

“I have troubles with the doctors at the clinic,” Wiebe told the Georgia Straight at the VANDU office on Hastings Street. “One of them said to me that he didn’t feel comfortable prescribing me morphine.”

Why would a doctor deny a patient the medication he requires in order to function? “It’s because I’m a drug addict who lives on the Downtown Eastside,” Wiebe said.

As a member of the VANDU injection-support team, Wiebe spends most of his time aiding and educating other drug users in the community. He said he often walks for hours picking up needles and talking to people on the streets despite suffering constant pain—sometimes so debilitating he’s confined to his bed for days. However, on other occasions, he can’t even travel to other areas of the city because doctors won’t fill his morphine prescription. Instead, he must go to the same Downtown Eastside clinic and be watched by a pharmacist as he takes his morphine each day. Wiebe claimed that this is discriminatory.

“It pisses me off,” he said. “I’m made to feel like a criminal, and it’s not going to change the way I would do drugs. It’s just a ball and chains since I can’t leave the city.”

This type of discrimination against drug users seeking pain medication is nothing new to Amy Salmon, a researcher at the Women’s Health Research Institute and the UBC School of Population and Public Health. Salmon conducted a study of drug users from the Downtown Eastside who tried to get medication for their chronic pain. It found that physicians were “overwhelmingly” turning away known drug users and not treating their chronic-pain conditions.

“The training that physicians are provided when navigating and negotiating with drug-seeking patients is often set up to systematically filter out people who use street drugs, people with addiction, or people with suspected addictions from being seen as anything other than drugs-seeking,” Salmon told the Straight in a phone interview.

This type of disconnect between patient and doctor is what health researcher Melanie Spence and lawyer Katrina Pacey from Pivot Legal Society would like to see corrected. Spence and Pacey, who spoke with the Straight at the Pivot law offices, explained that more communication is the key to establishing trust between drug addicts and their doctors.

“Everyone here has a pain story,” Spence said, referring to those living in the Downtown Eastside. “We’re trying to design a workshop with an eye to try and build better relationships between physicians and the people at VANDU who use those services.”

They hope that this awareness-raising initiative will help mend the “broken relationship” between doctors and their drug-addicted patients. They would also like physicians to understand that these addicts have legitimate health issues that can result in their demise if left untreated.

Dr. Gabor Maté, author of In the Realm of Hungry Ghosts: Close Encounters With Addiction, told the Straight in a phone interview that, addicted or not, if people have pain it needs to be taken care of. He went one step further and suggested the legal system with regard to drugs is "irrational" and needs an overhaul.

“Part of the problem is the system itself; the whole problem is that drugs are illegal,” he said. “Therefore, people who are addicted have to resort to sometimes illicit measures to get them, which sets up the whole problem with pain relief because the doctors don’t know what to do very often.”

Maté added that most people have trouble getting narcotics prescribed by their doctors, but he emphasized the rigorous scrutiny and suspicion that addicts go through when they require pain medication. “There is less trust and communication,” he said. “They [drug addicts] are more easily dismissed because of their low socioeconomic status—they become marginalized.”

“Addicts tend to get the short end of the stick because they are often accused of manipulation and diversion when it comes to legitimate pain needs,” he said. “That’s how the system works.”

Both Pacey and Spence acknowledge the complexity of the issue and understand that doctors don’t want to exacerbate a person’s addiction or contribute to the potential diversion of prescription drugs into the street market.

Pacey said that these are “legitimate concerns”, but she added that she and Spence worry that Downtown Eastside doctors act as if they are just treating a community of drug users without thinking on a patient-by-patient basis. “Physicians take an oath that says they’ll provide the best care that they can to the person that is presenting before them,” Pacey said. “We’re concerned that operating on assumptions of who addicts are and what they’ll do with a certain prescription may be influencing doctors’ decision-making as opposed to what is the best possible care they could give to this person and what will make them as healthy and safe as possible.”