PAG Interviews: Dr. Nathan Frank

PAG Interviews: Dr. Nathan Frank

Physician Advisory Group interview with Dr. Nathan Frank

“I am proud to treat all addiction patients with respect and compassion and I believe that I speak to patients no differently from how I speak to my friends and family, with empathy and without judgment.”

Dr. Nathan Frank was recently appointed to our Physician Advisory Group. Comprised of seven leading specialists in addictions medicine, these passionate doctors help guide our outpatient clinical practice, ensuring we stay on the leading edge of rapid access, evidence-based treatment for substance use disorder.

1. What drove you to specialize in addiction medicine? How did you get started in the field?

I became interested in addiction medicine while looking to expand the scope of my family practice in the late 1990’s. A few of my physician colleagues had addiction practices and explained to me how rewarding the work could be. I “sat in” on some patient interviews and group counselling sessions back then and the insight gained from this made me want to learn more. I enrolled in addiction-focussed, continuing medical education seminars to get a better sense as to what physicians needed to know about the field of addiction medicine, and I completed what was then a mandatory course in Methadone Maintenance Treatment Programs. 

With these new insights gained, I began by working a half day per week in the OATC clinic in Kitchener in 1999, quickly discovering that I had an aptitude for this branch of medicine and had an opportunity to contribute to an underserved patient population. My half-day became a full day, then 2 days per week, and eventually I resigned my family practice to devote my efforts full-time to the practice of addiction medicine.

I continued to subscribe to continuing medical education programs and in 2004 I qualified for certification in addiction medicine through the American Board of Addiction Medicine, a certification that I maintain to this date.

2. What are you most proud of in your career?

I truly believe our team is helping a community of patients who have limited access to doctors and allied health professionals. In sum, I know that we do good work. Without hyperbole, our treatments have to be viewed as potentially life saving, and this is truer now more than ever in the age of illicit fentanyl having taken over as the “street” opioid of choice. 

I am proud to treat all addiction patients with respect and compassion and I believe that I speak to patients no differently from how I speak to my friends and family, with empathy and without judgment.

3. What does being on CATC’s Physician Advisory Group mean to you?

I am honoured to have been chosen to sit on CATC’s Physician Advisory Group. I applied for inclusion largely as I wanted to have more of a voice into decisions that affect all aspects of how our clinics operate. Having practiced in multiple of our clinics for more than 20 years, and having seen an incredible evolution of addiction medicine in those 20-plus years, I believe I have insights and experience that I can share to assist in our constantly evolving care model.

4. What advice would you give to someone who is looking to start treatment, or who is worried about a loved one who might be struggling with substance use?

I believe that fear and stigma are significant roadblocks to patients entering into addiction treatment. Patients and loved ones all share these fears and taking that first step, which is recognition of the problem (sorry to sound cliché). It can be exceedingly difficult. We need to educate the general population that addiction is a disease, not a moral failing, and admitting to suffering from that disease should not be viewed as shameful. None of our patients wanted to be burdened with a substance use disorder, and to feel that this diagnosis is “the patient’s own fault” is harmful and ignorant. 

I would tell any prospective patient that programs such as ours have been around for more than half a century, and any patient in our care will benefit from what we have learned over these decades. Additionally, patients need to be advised of our commitment to confidentiality so that they can feel free to discuss all aspects of their drug use history and the damages it may have caused.

5. What makes CATC different, in terms of approach to care and patient outcomes?

CATC comprises a large group of clinics, with the largest collection of allied health professionals of any addiction program in the country (to my knowledge). There definitely is strength in numbers and our members together have a wealth of knowledge and experience that benefits us all, whether this is in educating one another, covering for others’ practices to allow for time off, or simply moral support when dealing with difficult situations.

Additionally, being part of a large group with substantial resources provides us, and by extension, our patients, with support that would not be possible in an independent practice setting, and recent events provide us with an excellent example of this. In March 2023, our Guelph clinic was gutted by a fire that started in the basement of the building in which the clinic is housed. We couldn’t access that clinic so, within hours, members of our  team had made alternative arrangements that ensured all our patients received their required medications that same day, with no interruption. When the local fire marshall made it clear that the Guelph clinic was beyond salvage, our management had confirmed acquisition of a new clinic within just a few days. There is no way that a small clinic group or a solo practitioner could have arranged any of this.

6. What is your philosophy and approach in helping people recover from substance use disorder and addiction? 

I believe that most people suffering from the disease of addiction are decent people who know that they have to devote themselves to their recovery. A large number of our patients have faced bias and have been discriminated against by members of society at large, but also by the medical establishment and often, by their own families. For these reasons, I always strive to make patients feel respected and work toward enhancing their sense of self-worth. Patients must not be shamed for having developed a substance use disorder, and it must be kept in mind that periods of abstinence and relapse can be normal features on the road to recovery, not evidence of failing to work toward one’s recovery.

7. What do you think is the biggest misconception about addiction?

The single most common misperception about addiction is that the addiction developed as some sort of moral failing, or even, by choice. This has led to the notion that “Just Say No” is a viable addiction treatment strategy. In truth, addiction should be treated as a chronic disease– one with genetic inheritance patterns.

8. In your view, what is the future of addiction medicine in Canada? How is CATC helping shape that future?

I fear for the future of addiction treatment options in Canada. Regrettably, healthcare is becoming increasingly expensive, and as our population grows and becomes older, it will become prohibitively expensive to the point where many services may be cut. It is a sad truism in our current medical system that when funding cuts need to be made, addiction and mental health services are amongst the first to have their funding slashed. We need a strong and unified voice to pre-emptively reach out to government bodies to combat these changes, and I believe a group such as CATC is best equipped to negotiate for addiction services benefits on behalf of our patients.

About the Physician Advisory Group

The Physician Advisory Group is an engaged group of highly-specialized physicians with deep expertise in addiction medicine and healthcare policy. Under the leadership of CATC’s Chief Medical Director, they oversee and guide our clinical practice related to Opioid Agonist Treatment across Canada, ensuring we remain on the leading edge of evidence-based substance use disorder treatment and intervention. This is one of the ways we uphold our commitment to our patients to provide best-in-class comprehensive care that meets their needs in response to the continuously evolving landscape of addiction in our communities.