College of Physicians and Surgeons of Ontario weighs in

To the Expositor:

Some from the M’Chigeeng community are questioning the effectiveness of methadone for the treatment of drug dependence, and are calling on a ban on take-home doses following the death of 35-year-old Daniel Anwhatin, whose cause of death you report is currently undetermined. It’s understandable that questions are raised when a family and community experiences the loss of a young man and, on behalf of the College of Physicians and Surgeons of Ontario, I would like to express condolences at this time.

I also want to provide some information to the community about the College’s methadone program, and the precautions that must be followed to ensure methadone is used safely and effectively.

Simply put, methadone saves lives. Studies have shown that patients are more likely to die if not receiving methadone treatment. In addition to decreasing death rates, it has many other benefits, including:

• Reduced illicit drug use and decreased illegal activity;

• Improved health status as a result of access to treatment;

• Decreased transmission of HIV, Hepatitis C and B.

However, for a person unaccustomed to taking opioids who may have purchased methadone on the street, even one small dose can be fatal.

That’s why there are many regulatory safeguards in place including that physicians must undergo training and ongoing assessments by the College in order to prescribe methadone. Because patients are at risk of overdosing if they are not accustomed to methadone, patients must be closely monitored in the initial stages of treatment when the correct dose is being determined that will give the desired effect of blocking drug cravings without causing an overdose. Most deaths caused by methadone overdose occur in the first week to 10 days of treatment. And a diverted dose to someone unaccustomed to methadone can be fatal.

Physicians are expected to adhere to the College’s standards and guidelines, which include rules about when it’s safe to give patients take-home doses. Take-home doses can only be prescribed when the patient is considered stable in treatment. The physician must ensure that patients understand how to store their methadone securely in a locked box, that they understand the risks of giving methadone to another person, and that they agree never to give or sell even part of their dose to others.

While methadone alone is an effective treatment for drug dependency, addiction is an illness and long-term success depends on a number of components, including an appropriate methadone dose; routine medical care, treatment for other substance dependence, stable housing, counselling, and psychosocial support.

With proper attention to the correct dose and monitoring of the effects of the drug, methadone can be administered safely to patients who need it. For some, the use of methadone may be a bridge to drug-free living, while for others treatment can be for a life time.

Regards,

Bob Byrick, MD

President, College of Physicians and Surgeons of Ontario