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Introduction to Methadone Maintenance Therapy

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  1. Introduction to Methadone Maintenance Therapy

  2. Presentation Outline • Introduction to Methadone Maintenance Therapy (MMT) • Introduction to Harm Reduction • Benefits of MMT • One Patient’s Perspective • Misconceptions about MMT • A Pharmacist’s Role • How to get started

  3. Warm-Up Exercise! Have you done a placement at a pharmacy that offered MMT? Have you considered implementing MMT in your community pharmacy? Do you feel like you need to learn more about MMT before making that decision?

  4. Introduction to MMT • Opioid dependence and addiction are an increasing problem. • MMT helps individuals who have become dependent on opioids by providing daily administration of methadone. • Methadone provides: • A similar pharmacologic effect • A better safety profile • A longer duration of action • Less euphoria Isaac P, Sproule B. Methadone Maintenance Treatment: Recommendations for Enhancing Pharmacy Service.Center for Addiction and Mental Health; 2009 The College of Physicians and Surgeons of Ontario.MMT Program Standards and Clinical Guidelines [Internet].2011; cited 2013 Feb 14]. Available from:http://www.cpso.on.ca/policies/guidelines/default.aspx?id=1984

  5. Introduction to MMT • MMT is most effective when used in combination with: • Addiction counseling • Case Management • Mental health services • Health Promotion • Outreach and advocacy • Disease Prevention and Education Isaac P, Sproule B. Methadone Maintenance Treatment: Recommendations for Enhancing Pharmacy Service.Center for Addiction and Mental Health; 2009 The College of Physicians and Surgeons of Ontario.MMT Program Standards and Clinical Guidelines [Internet].2011; cited 2013 Feb 14]. Available from:http://www.cpso.on.ca/policies/guidelines/default.aspx?id=1984

  6. Goals of Therapy • To reduce harm associated with drug use • To treat co-morbidity • To achieve a higher level of function within society The College of Physicians and Surgeons of Ontario.MMT Program Standards and Clinical Guidelines [Internet].2011; cited 2013 Feb 14]. Available from:http://www.cpso.on.ca/policies/guidelines/default.aspx?id=1984

  7. Harm Reduction "Harm reduction is any program or policy designed to reduce drug-related harm without requiring the cessation of drug use. Interventions may be targeted at the individual, the family, community or society." Individual Outcomes Community Outcomes Centre for Addiction and Mental Health.CAMH and Harm Reduction: A Background Paper on its Meaning and Application for Substance Use Issues [Internet].2012; cited 2013 Feb 14 2012. Available from: http://www.camh.ca/en/hospital/about_camh/influencing_public_policy/public_policy_submissions/harm_reduction/Pages/harmreductionbackground.aspx Young L. Essentials of Harm Reduction. Proceedings of the 2005 ACSW Conference [Presentation from the Internet]. 2005; Alberta. Available from:  http://www.acsw.ab.ca /pdfs/essentials_of_harm_reduction_for_acsw.pdf

  8. Benefits of MMT • Reduces crime • Improves health • Improves social functioning • Promotes a healthier community Erdelyan M, Young C. Methadone Maintenance Treatment: A Community Planning Guide.Center for Addiction and Mental Health; 2009 MarschLA.The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behavior and criminality: a meta-analysis.Addiction.1998 Apr;93(4):515-32.

  9. One Patient’s Experience Meet Ashley: http://www.youtube.com/watch?v=lX1u2g2G8bE

  10. Misconceptions about MMT Methadone will give the patient a high.

  11. Misconceptions about MMT People on methadone are still addicts even if they are not using other drugs.

  12. Misconceptions about MMT Only street drug users take methadone.

  13. Misconceptions about MMT Methadone maintenance therapy costs the system too much money.

  14. Your role as a pharmacist… • Treat patients receiving MMT with RESPECT • Optimize patients’ drug therapy • Develop relationships with: • Each patient • Exempted physicians • Other supportive healthcare professionals • Educate patients about MMT and other harm reduction programs • Provide patients with resources for: • Assault • Shelters • Mental Health • Financial Aid The Ontario College of Pharmacists. Methadone Maintenance Treatment and Dispensing Policy [Internet].2010; cited 2013 Feb 16. Available from: http://www.ocpinfo.com/client/ocp/OCPHome.nsf/d12550e436a1716585256ac90065aa1c/721a475f62e5768d852577f40071f438?OpenDocument&Highlight=2,methadone

  15. How To Get Started • Get the proper training • CAMH’s Opioid Dependence Treatment (ODT) Program • OPA’s Methadone Education Program • Notify OCP that the pharmacy is dispensing methadone • Follow OCP‘s Methadone Treatment and Dispensing Policy • Verify with Health Canada, that a prescribing physician holds a current/valid exemption for MMT. • Please visit my website for more specific details about requirements. The Ontario College of Pharmacists. Key Requirements for Methadone Dispensing [Internet]. 2012; cited 2013 Feb 16. Available from: http://www.ocpinfo.com/client/ocp/OCPHome.nsf/web/Key+Requirements+for+Methadone+Dispensing?OpenDocument

  16. Potential Revenue • ODB Reimbursement: • Rough Estimate of Gross Profit - $11.00/dose • $4015 / patient / year • Many third-party payers provide reimbursement but payment will vary depending on individual plan design • Many patients are MedsCheck Eligible - $60/ annually • Pharmaceutical Opinion Revenue - $15/intervention • MedsCheck Follow-Up (PDD) upon dose changes - $25 • Pharmaceutical Opinion Revenue - $15/intervention • Pharmacy Smoking Cessation Program • Funded by the Ontario Government Health Canada. Best Practices - Methadone Maintenance Treatment [Internet].2008; cited 2013 Feb 16. Available from: http://www.hc-sc.gc.ca/hc-ps/pubs/adp-apd/methadone-bp-mp/background-contexte-eng.php MOHLTC – MedsCheck Program and Pharmaceutical Opinion Program

  17. Based on what you have just learned… Would you considered implementing MMT community pharmacy?

  18. References • Isaac P, Sproule B. Methadone Maintenance Treatment: Recommendations for Enhancing Pharmacy Service.Center for Addiction and Mental Health; 2009 • The College of Physicians and Surgeons of Ontario.MMT Program Standards and Clinical Guidelines [Internet].2011; cited 2013 Feb 14]. Available from:http://www.cpso.on.ca/policies/guidelines/default.aspx?id=1984 • Centre for Addiction and Mental Health.CAMH and Harm Reduction: A Background Paper on its Meaning and Application for Substance Use Issues [Internet].2012; cited 2013 Feb 14 2012. Available from: http://www.camh.ca/en/hospital/about_camh/influencing_public_policy/public_policy_submissions/harm_reduction/Pages/harmreductionbackground.aspx • Young L. Essentials of Harm Reduction. Proceedings of the 2005 ACSW Conference [Presentation from the Internet]. 2005; Alberta. Available from:  http://www.acsw.ab.ca /pdfs/essentials_of_harm_reduction_for_acsw.pdf • Erdelyan M, Young C. Methadone Maintenance Treatment: A Community Planning Guide.Center for Addiction and Mental Health; 2009 • MarschLA.The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behavior and criminality: a meta-analysis.Addiction.1998 Apr;93(4):515-32 • The Ontario College of Pharmacists. Methadone Maintenance Treatment and Dispensing Policy [Internet].2010; cited 2013 Feb 16. Available from: http://www.ocpinfo.com/client/ocp/OCPHome.nsf/d12550e436a1716585256ac90065aa1c/721a475f62e5768d852577f40071f438?OpenDocument&Highlight=2,methadone • Health Canada. Best Practices - Methadone Maintenance Treatment [Internet].2008; cited 2013 Feb 16. Available from: http://www.hc-sc.gc.ca/hc-ps/pubs/adp-apd/methadone-bp-mp/background-contexte-eng.php

  19. THANK YOU! Questions? My website: http://methadonemaintenancetherapy.weebly.com