Methadone Maintenance Treatment New Resources and Treatment in Ontario June 3, 2008

1. Methadone Maintenance Treatment New Resources and Treatment in OntarioJune 3, 2008 OpiATE Project Opiate Awareness, Treatment and Education Janine Luce & Betty Dondertman Methadone maintenance treatment should now be called opioid maintenance treatmentMethadone maintenance treatment should now be called opioid maintenance treatment

2. Agenda Today MMT and stigma Prescription for Addiction The OpiATE project and resources Treatment approaches Discussion/Questions

3. Opioids are Opioids are a family of chemicals including some prescription pain medications, such as oxycodone, codeine and dilaudid Morphine and heroin

4. MMT Initiative �Our government is committed to providing better treatment for people who are addicted to heroin and other opioids. This new funding will allow for continuous improvement of professional services and increase awareness in communities about the value of methadone maintenance treatment.� George Smitherman - Minister of Health and Long-Term Care July 26, 2007

5. MMT Initiative MMT is one treatment for opioid dependence; others include case management/support, abstinence, and the other pharmacological treatments, such as buprenorphine. In Ontario, thousands of people are dependent on opioids. They deserve our support to find the right treatment. MMT works. It saves lives, and is a cost-effective way of addressing opioid dependence.

6. Facts and figures There are 17,000 people receiving methadone in Ontario There are 30,000 people who need it

7. Facts and figures DATIS 12.8 % of clients used prescription opioids in 2003/04; and 17.1 % used prescription opioids in 2006/07

8. Facts and figures OSDHUS 21% of Ontario students in grades 7 to 12 report using prescription opioid pain relievers for non-medical purposes. Almost 72% report obtaining the drugs from home

9. MMT Growth Substantial increase in use of MMT over the last 10 years The Task Force noted challenges: Access to services in a timely and equitable manner Ensuring MMT services are safe and effective Responding to concerns of local communities where MMT is provided

10. Partners College of Physicians & Surgeons of Ontario (CPSO) Ontario Pharmacists Association (OPA) Registered Nurses Association of Ontario, (RNAO) Centre for Addiction and Mental Health (CAMH) Ontario Federation of Community Mental Health and Addiction programs (OFCMHAP)

11. 3 OpiATE Strategies Raising Awareness Community Engagement Training and Professional Supports

12. Raising Awareness: Objectives Increase awareness of the benefits of MMT and other treatments Improve understanding of MMT and other treatment options with certain key audiences Initiate greater awareness of the issue of dependency on pharmaceutical opioids

13. Resources Education sessions for those working in addictions sector Reprinting/updating client guide to MMT in English and French Website providing accessible information Prescription for Addiction Media stories about opioid dependence

14. Community Engagement Objectives Reduce stigma and marginalization of addiction clients Promote collaborative , coordinated models of care Improve community and clinician acceptance of various treatment options in local communities

15. Community Engagement Resources Establish Community Coalitions/Identify Local Champions in 4 target communities: Ottawa, Thunder Bay, Chatham-Kent, Halton Revise CAMH MMT Community Planning Guide (2000)

16. Training and Professional Supports Objectives Broaden the scope � enhance training and professional supports for providers delivering treatments for opioid dependence (MMT and other treatments). Disseminate best practices / better practice recommendations about models of care for MMT. Best practices � lit review, Health Canada BPG, Task Force recommendations, other jurisdictionsBest practices � lit review, Health Canada BPG, Task Force recommendations, other jurisdictions

17. Best practices for MMT Case management along with comprehensive care. Facilitate physicians in group practice, FHTs, CHCs, hospitals, CCACs and mental health and addiction agencies to work together to provide services. Recognize clients as partners in their care.

18. Treatment Approaches Abstinence Case management Psychological and social supports Pharmacological treatments ��

19. Treatment Approaches Pharmacological Approaches (opioid agonist/partial agonists treatment) Methadone Buprenorphine (Suboxone) Suboxone is taken once a day, as a tablet placed under the tongue to dissolve. It combines Buprenorphine to manage physical symptoms of withdrawal cravings, with Naloxone, which deters abuse by causing unpleasant symptoms if the product is misused As with any medication, Suboxone will not be appropriate for every individual. It is, for example, not intended for use by patients under 18 or over 65 years of age, women who are pregnant or breast-feeding, those with breathing problems or liver disease; other risk factors may apply. Suboxone should not be taken with alcohol, and may interact with other medications. It is recommended that only appropriately accredited doctors, who have completed specific education requirements, may prescribe it . � Suboxone is taken once a day, as a tablet placed under the tongue to dissolve. It combines Buprenorphine to manage physical symptoms of withdrawal cravings, with Naloxone, which deters abuse by causing unpleasant symptoms if the product is misused As with any medication, Suboxone will not be appropriate for every individual. It is, for example, not intended for use by patients under 18 or over 65 years of age, women who are pregnant or breast-feeding, those with breathing problems or liver disease; other risk factors may apply. Suboxone should not be taken with alcohol, and may interact with other medications. It is recommended that only appropriately accredited doctors, who have completed specific education requirements, may prescribe it . �

20. Training and Professional Supports: Resources Clinic Toolkit � July 2008 Telephone support line � July 2008 Comprehensive, inter-professional curriculum � pilot Fall 2008 Best practice guide: pharmacists � March 2009 Best practice guide: case managers and counselors � March 2009

21. Education Program Pilot Plan Nine modules Webinars, online modules, and one face2face session A cohort of 40, from mid-Sept to mid November 2008 Even mix of physicians, nurses, pharmacists, counsellors and case managers Ten participants from each of the four target communities (Thunder Bay, Ottawa, Chatham, Halton)

22. Discussion Questions ?

23. Thank you!