Methadone Maintenance Treatment

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March 8, 2007
8th Annual Alberta Harm Reduction Conference
Richard Phillips and Corinne Sawarin AADAC ODP
Program
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Methadone Maintenance Treatment
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Myths Misperceptions Truths
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Agenda

• Dispelling myths associated with methadone
  maintenance treatment (MMT)
• Overview of AADACs Opioid Dependency Program
  (ODP)
• Recent developments and future trends in MMT

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Methadone only works for heroin addiction
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• Deaths from pharmaceutical opioid analgesics have
  overtaken those attributed to heroin and cocaine
  in the United States
• Between 1999 and 2002, there was an increase of
  over 91 in the number of opioid analgesic
  poisonings cited on death certificates.

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Substance Use Now Compared to Before Methadone
Treatment
No use or less use than before treatment Same
use or more use than before treatment
100
90
80
70
60
50
40
30
20
10
0
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Methadone is an effective treatment for cocaine
addiction
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Being on methadone is just replacing one
addiction for another
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What is Addiction?

• The 4 Cs of Addiction
• Loss of CONTROL
• Use despite CONSEQUENCES
• Increased COMPULSION to use
• CRAVING

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Replacing one addiction for another?

• CONTROL
• MMT gives back control to the patient.
• CONSEQUENCES
• Patient able to start rebuilding their lives.
• COMPULSION
• Patient no longer compulsively using opioids.
• CRAVING
• Patients cravings are controlled.

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Methadone is more addictive and harder to come
off of than other opioids
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People on methadone are zombie like, and
unmotivated
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Percent Better in Major Life Areas
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People on methadone dont do well in residential
treatment or day programs
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Why Accept People on Methadone?

• People on methadone have the same range of
  treatment needs as other people with alcohol/drug
  dependencies
• ODP clients have been working closely with their
  counsellor, nurse and clinic physician
• A thorough assessment is done to ensure the right
  clients are being referred to the right places
• There is increasing pressure from the community
  to provide services for those on methadone

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People on methadone might need and can take
other opioid painkillers
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Methadone leeches calcium causing your bones to
decay, and your teeth to rot
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Methadone is a long-term treatment
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Being on methadone will fix all of your problems
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AADAC ODP

• Clinics in Edmonton and Calgary provide
• Stabilization of methadone dose
• Ongoing support and monitoring (e.g. prescription
  management, medicals, urine testing, counselling)
• Links to community pharmacists/dosing
• Links to other addictions treatment services
• Links to other social and health support systems

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Stages of Program

• Admission 1st appointment
• Client history, medical, treatment agreement,
  urine test, first dose
• Stabilization Phase
• Daily dosing at clinic, gradual increase of dose
  until stabilized
• Community Phase
• Community pharmacy for dosing, random urine
  testing, carry-home doses when eligible

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• Clients choose if and when they want to
  voluntarily withdraw from methadone
• Mandatory withdrawal will only be used in cases
• of violent or abusive behaviour
• trafficking in drugs
• misusing methadone
• where  a client has not stabilized after a long
  period of time (over a year) and is not getting a
  benefit from the program       
• where a clients continued drugs use places him
  or her at an unacceptable risk for overdose

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THE WAY FORWARD

• Expansion of MMT Programs
• Framework for the Delivery of ODT
• CPSA Standards and Guidelines
• Improved Collaboration with Community Partners

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EXPANSION OF MMT PROGRAMS

• 1971 AADAC ODP - Edmonton
• 2002 CAMP Clinic - Red Deer
• 2003 AADAC ODP - Calgary
• First Street Medical Clinic - Calgary
• 2006 Chinook Alberta Clinic- Medicine Hat
• Panorama Medical Clinic- Edmonton

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CPSA STANDARDS GUIDELINES FOR MMT IN ALBERTA

• Drafted by panel of expert physicians
• Extensive consultation program
• Goals
• Raise awareness of opioid dependence
• Encourage physicians to address issue in general
  practice
• Improve patient care by increased consistency
  access to safe clinical MMT
• Lay groundwork for staged care model

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STAGED CARE MODEL