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8 th Annual Alberta Harm Reduction Conference

March 8, 2007. 8 th Annual Alberta Harm Reduction Conference. Richard Phillips and Corinne Sawarin AADAC ODP Program. M ethadone M aintenance T reatment. M yths M isperceptions & T ruths. Agenda. Dispelling myths associated with methadone maintenance treatment (MMT)

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8 th Annual Alberta Harm Reduction Conference

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  1. March 8, 2007 8th Annual Alberta Harm Reduction Conference Richard Phillips and Corinne Sawarin AADAC ODP Program

  2. MethadoneMaintenanceTreatment

  3. MythsMisperceptions &Truths

  4. Agenda Dispelling myths associated with methadone maintenance treatment (MMT) Overview of AADAC’s Opioid Dependency Program (ODP) Recent developments and future trends in MMT

  5. Methadone only works for heroin addiction

  6. 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.

  7. 95.9% 86.9% 84.3% 15.7% 13.1% 4.1% Opioids Alcohol Other 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

  8. Methadone is an effective treatment for cocaine addiction

  9. Being on methadone is just replacing one addiction for another

  10. What is Addiction? • The 4 Cs of Addiction • Loss of CONTROL • Use despite CONSEQUENCES • Increased COMPULSION to use • CRAVING

  11. 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 • Patient’s cravings are controlled.

  12. Methadone is more addictive and harder to come off of than other opioids

  13. People on methadone are “zombie like”, and unmotivated

  14. 73.8% 73.4% 71.4% 64.3% How Feel About Self 64.2% Physical Health Use of Free Time Financial situation 51.6% Family relationships 47.9% Friend relationships Employmentor school Percent Better in Major Life Areas

  15. People on methadone don’t do well in residential treatment or day programs

  16. 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

  17. People on methadone might need and can take other opioid painkillers

  18. Methadone leeches calcium causing your bones to decay, and your teeth to rot

  19. Methadone is a long-term treatment

  20. Being on methadone will “fix” all of your problems

  21. 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

  22. 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

  23. 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 client’s continued drugs use places him or her at an unacceptable risk for overdose

  24. THE WAY FORWARD • Expansion of MMT Programs • Framework for the Delivery of ODT • CPSA Standards and Guidelines • Improved Collaboration with Community Partners

  25. 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

  26. 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

  27. STAGED CARE MODEL

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