Methadone ?Methadone and Treatment

By: Eleu Pontes CSW

Methadone is the most highly regulated and controlled area in addiction treatment, and also one of the most highly regulated in all medicine. In the eyes of the public, policy makers, as well as health and social service providers, there is an unfortunate stigma associated with methadone and people who receive Methadone Maintenance Treatment (MMT).

Brief History of Methadone

World War II and Va10820

1947 Eli Lilly Pharmaceutical patient Va10820 under the name Dolorphine in the US

Dolorphine

The Dolor is the Latin word for Pain

The word Finis or Phine is the Latin word for End

Dolor/ Phine or Pain/ End

Or End of Pain

Dr. Robert. HallidayIn 1959 to early 1960’s

Opened the first ever MMTP in the world in downtown East-side of Vancouver.

Dr.Halliday once say Methadone is to the Addict as Insulin to the Diabetic.

Dr Vincent.P.Dole,MD.

Canadian History of MMT

Narcotic Control Act 1972 assigned Narcotic prescribing (specifically methadone) to the Federal Government

1972 Approx. 24 MMT clients in Canada

1975 due to NCA there was a 33% in clients in treatment

1985 further reductions in treatment (only 1/3rd of the 1972 numbers were still in treatment)

• 1995 BC is granted Provincial control over methadone prescribing & dispensing

Ontario followed closely behind.

• 1996 Ontario– 700 clients

2000 Ontario --5,961 clients

2007 Ontario-16,406

Estimated 1,000 new clients enter treatment each year in Ontario.

The College of Physicians and Surgeons of Ontario

Who’s doing what for MMT ?

The number of Physicians holding exemption in Ontario to prescribe Methadone is 258 as of 2007

228 hold 3 year exemptions

30 hold 1 year exemptions

Ontario has about 10,000 Pharmacies.

3,059 are dispensing Methadone as of 2007.

358 are presenting accepting new clients as of 2007.

The Opium Poppy Plant

Opium

Historical records show the use of Opium as far back as

the 3rd Century BC.

The word “Opium” comes from the ancient Greek word

“JUICE”

The invention and availability of the Hypodermic Needle.

What is an Opiate ?

A term refers to drugs deriving from the Opium Poppy Plant.

Drugs like: Opium, Morphine, Codeine and others.

.

What are Opioids ?

It’s a family name.

These are synthetic drugs.

Drugs like Demerol, Dilaudid, Oxycodone, Methadone, and many more.

It has been estimated 80,000 regular illegal opioid users in Canada Centre of Addiction and Mental Health 2003.

What is Methadone ? It is a synthetic opioid.

It is a slow releasing synthetic opioid.

It is taken orally.

It is mix with an orange tang mix.

It begins to take affect within 30mins.

Peak level within 4hrs.

It effect can last for 24 to 36 hrs.

Tolerance.

A 40 t0 60 mgs of Methadone can be lethal to non-tolerant adult.

How MMT Program works ?

In the beginning your first visit (3 day waiting period).

Urine samples and/or Lab tests.

Number of weekly visits.

Visit to Pharmacy and Carries.

How to achieve carries.

Lock box.

Urine Samples (drug testing)

The benefits of MMT.An effective treatment for opioids dependence.

Helps prevent the transmission of HIV/AIDS and Hepatitis C Viruses.

Helps reduce Criminal Activities.

It has reduced the number of Deaths due to Overdosing.

Improves Economic Productivity.

It improves Physical and the Mental Health of the individuals.

Improves both the quality of life and outcome of pregnancies.

MMT is Cost effectiveEvery $1 spend on Methadone

Maintenance

Offers a cost belief of $4 to $13

Stoller & Bigelow, 1990 (USA) CALDATA study

MMT is cost effectiveOntario Stats

Estimate of total annual costs related to opioid addiction in Ontario = $660 million.

Estimate of total annual cost to supply MMT all of the above = $9 million

Based on very conservative estimate of 15,000 individuals.

TaperingThe one person to offer support is their

Physician.

The lack of Counseling, Therapist, and/or Social Worker.

Cases of positive tapering are few.

Clients feel they need to rush throw doctor appointments.

Methadone Maintenance treatment.

MMT does not cure opioid dependence: rather, it is a medical treatment that can help people manage their opiate addiction and stabilize their lives. It is not appropriate for everyone who is opioid dependent, and is only one of a number of treatment option that should be considered. When MMT is used appropriately however, it can be live-saving treatment.

Methadone Maintenance Treatment Practices Task Force. W.Anton Hart.