Preface

Methadone Maintenance Treatment: A Community Planning Guide

The purpose of this guide is to increase the capacity of the methadone maintenance treatment system in the province of Ontario. The decision to increase the availability of this substance abuse treatment option is based upon not only the success of the model both within this and other jurisdictions, but most importantly, client demand for the service. The development and expansion of methadone maintenance treatment (MMT) services in the province of Ontario is an initiative being supported by a number of partners including the Centre for Addiction and Mental Health (CAMH), Ministry of Health and Long-Term Care - Ontario Substance Abuse Bureau (OSAB), College of Physicians and Surgeons of Ontario (CPSO) and Ontario College of Pharmacists (OCP).

In 1995, the Bureau of Drug Surveillance (BDS), the federal authority responsible for the administration of federal regulations concerning methadone treatment and the exemption of physicians to prescribe methadone for this purpose, down loaded to the province of Ontario responsibility for the administration of these regulations. The Ministry of Health asked the College of Physicians and Surgeons of Ontario (CPSO) to take on these responsibilities.

The CPSO, in collaboration with the Addiction Research Foundation (ARF) and the Ontario College of Pharmacists (OCP), instituted new procedures for the exemption of physicians to prescribe methadone and developed new guidelines for methadone treatment (Methadone Maintenance Guidelines, August, 1996) which replaced the 1992 federal document titled "The use of opioids in the management of opioid dependence" (Bureau of Dangerous Drugs, Health and Welfare Canada). The new standards provide more detailed guidance for clinical decision-making than the previous ones and reflect a shift in emphasis from an abstinence-based model to treatment based upon harm reduction principles.

As a result of the changes to the guidelines, the number of patients involved in methadone treatment has increased dramatically in the province of Ontario. For example, in January 1996 there were approximately 770 patients while in January 2000 there were just over 5,000. In a four year period this represents an increase of almost 700%. Despite the increase, there are a number of communities in the province which have no, or inadequate amounts of methadone treatment services.

This guide is meant to complement several other resource materials that have been developed by the Centre for Addiction and Mental Health. It is highly recommended that planning groups utilize these materials since they provide more detailed information regarding such aspects as to the roles and responsibilities of physicians, pharmacists, counsellors and clients.

• Methadone Maintenance Treatment: A Physician's Guide to Treatment is used by physicians and pharmacists and provides valuable information in areas such as prescribing, dispensing, tapering, drug interactions, pain management and special populations (i.e. pregnant women).
• Methadone Maintenance: A Pharmacist's Guide to Treatment is a comprehensive manual which provides in-depth information to pharmacists who dispense methadone on aspects such as clinical issues of opioid dependence, toxicity, special circumstances (e.g. dispensing to pregnant or institutionalized patients) and contraindicated medications.
• Methadone Maintenance Therapy: Information for Clients is a pamphlet designed to give clients general pharmacological facts about methadone.

In addition, there are several works in progress including a counsellor's manual and a client handbook. As well, the Methadone Maintenance Guidelines, as described above, provides information on the new standards of practice for methadone maintenance treatment in the province of Ontario and it can be obtained through the College of Physicians and Surgeons of Ontario or the Centre for Addiction and Mental Health.

All of these materials are listed in the Recommended Resources section.

Next>> Introduction - How to Use the Guide

Methadone Maintenance Treatment: A Community Planning Guide

1. Preface
2. Introduction - How to Use the Guide
3. Methadone Maintenance Treatment - Rationale and Benefits
4. Methadone Maintenance Treatment - Service Components and Delivery Models
5. Critical Stages in the Development of Methadone Maintenance Treatment Services
   1. Identification and Verification of Need
   2. Establishment of a Community Working Group
   3. Methadone Maintenance Treatment Model Development
   4. Implementation
   5. Evaluation
6. Continuity of Care for Methadone Patients
7. Special Treatment Issues
8. Community Development Troubleshooting Guide
9. Appendix - Methadone Fact Sheet
10. References
11. Recommended Resources

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