Doing No Harm ....

"I honestly don't think it's a way of treating themselves [through legalized drug intervention with methadone treatment]. It's seen as a cheap, or free, high."
"What blows my mind is that I live in a fairly small community, and it seems so pervasive here."
Sandra Thorkelson, Corbeil, North Bay, Ontario

"It's kind of absurd to put a 21-year-old who has maybe played with OxyContin and hydromorphone for a year or two ... on lifelong methadone maintenance."
"All of a sudden the biggest opioid problem may actually be the maintenance treatment."
Benedikt Fischer, scientist, Ontario's Centre for Addiction and Mental Health

"Many, many of the individuals aren't getting the additional support they need or getting plugged into community health programs."
"We have an opportunity to really be bold here, and look at reforming in a substantive way our entire approach."
Dr. Eric Hoskins, Ontario minister of health

"The number of over-dose deaths [from opioid painkillers] are (sic) close to or higher than deaths from motor vehicle accidents."
"It seems an odd time to say there's too much treatment available ... We need as many effective treatments as possible."
Dr. David Marsh, medical director, Ontario Addiction Treatment Centres

In the past several years patients being treated with methadone to help wean them off addictive pain killers loved on the street for their opioid properties in withdrawing from reality and indulging in a chemical-high fantasy world, has risen astronomically. Those seeking out the legitimacy of a drug habit through methadone treatment, however they are motivated -- as a by-product of a doctor's prescription for pain management or associated with surgeries, or simply a habitual user -- the once-rare treatment has become stupefyingly commonplace.

In fact, an entire 'health-care' industry has grown around its now-pedestrian convenience in the fiction that moving drug addicts from conventional hard drug addiction to the use of methadone is useful. In one province, Ontario alone, patients on methadone clambered up a dizzying ladder from 3,000 in 1996 to over 50,000 at the present time. This represents just about four times the per-capita rate seen in the United States on similar drug management. And in the U.S. the drug of choice is not methadone, but a less hazardous drug called suboxone, safer and more easily administered.

In British Columbia the soaring population of methadone-treated patients has also doubled to 18,000 opioid-maintenance patients, a situation reflected throughout Canada. And with it has arisen an industry. One company alone has 57 methadone-maintenance clinics able to service over ten thousand patients on a daily basis. Not surprising that Dr. Marsh of the Ontario Addiction Treatment Centres insists that more such services are needed since the company he represents has 56 clinics in Ontario and one for starters in Manitoba.

Dr. Fischer and his colleagues published a substance-abuse commentary suggesting that before methadone treatment is automatically prescribed, other methods should first be explored for their potential benefits, such as detox and behavioural therapy. The drub suboxone as an opioid-maintenance drug as well is thought to be far less likely to be the cause of overdoses whereas methadone factored into an average 108 deaths annually in Ontario alone in a three-year period.

Vancouver Coastal Health alone has decided a change was required and they are shifting to suboxone, setting it at the forefront in Canada of opting for a more trustworthy alternative to methadone. There are some experts whose opinion is that caution is required before setting aside methadone treatment, however. Methadone, like heroin or oxycodone is an opioid; its use meant to aid injection-drug users avoid the hypodermic needles known for spreading disease.

A University of Montreal addictions expert, Julie Bruneau, speaks of long wait lists for treatment in Quebec, although she has reservations with methadone as the first choice in much of Canada for treatment as opposed to the safer suboxone which can be administered by family physicians. The Canadian Institutes of Health Research has funded a new trial to compare the benefits and risks of methadone and suboxone, and Drs. Bruneau and Fischer will be involved in that trial.

And in North Bay, Sandra Thorkelson speaks of her conversations with some patients known to her in her community who have informed her that all people have to do is show up at a clinic, test positive for a prescription opioid, claim to be addicted, and they're assured of a place set aside for them for time-indefinite methadone treatment.

Methadone maintenance treatment is a key component of a comprehensive treatment and prevention strategy to address opioid dependence and its consequences. A review of the literature (Health Canada, 2002) indicates that methadone maintenance treatment is considered an effective means of reducing the use of other opioids, the use of other substances, criminal activity, and the rate of mortality. Methadone maintenance treatment has also been found to reduce injection-related risk behaviours, other risk behaviours for transmission of human immunodeficiency virus (HIV) and sexually transmitted diseases, and the transmission of HIV (and potentially the transmission of hepatitis C virus (HCV) and other blood-borne pathogens). Methadone maintenance treatment improves physical and mental health, social functioning, quality of life, and pregnancy outcomes. Methadone maintenance treatment has also been found to increase retention in treatment. Health Canada, in collaboration with the provinces and territories, is involved in efforts to increase access to effective methadone maintenance programs.