Methadone Treatment of Opiate Dependence in Canada

Abstract

Although methadone has been used in Canada for the treatment of opiate-dependent persons since 1959, information concerning its use in Canada is limited. Methadone treatment in Canada is discussed with respect to national and provincial drug laws, public and professional support for the treatment, patient characteristics, and me sources and types of illicit and licit opiates abused. The paper also reports on the results of a survey of the physicians in Canada who were authorized during 1981-82 to prescribe methadone to opiate-dependent persons. These physicians were asked to provide information on the number of patients they treated zvith methadone during the previous 12 months, their indication(s) for the use of methadone, the dosages used and duration of treatment, and the auxiliary treatments provided. Information concerning specific provincial methadone treatment programmes is also presented.

Defining "addiction."

“…Another strong indication that withdrawal symptoms and addiction are not always linked is that profound addictions often occur without withdrawal symptoms. For example, many researchers have found that a significant proportion of people who live the devastating lives of street junkies do not have withdrawal symptoms when heroin supplies are interrupted or when they are pharmacologically deprived by a "naloxone challenge" (e.g., Glasser, 1974; O'Brien, 1976; Peachy & Franklin, 1985).…”

The Case for a Heroin Substitution Treatment Trial in Canada

“…2 However, federal health authorities claimed "major problems of [methadone] abuse and misuse" in the same year, and the implementation of a federal committee report imposed rigorous restrictions and regulations for methadone treatment on physicians, clients and treatment procedures, including a general requirement for physicians to acquire a methadone prescription licence. 28,29 The numbers of opiate addicts in methadone substitution treatment and methadoneprescribing physicians subsequently dropped substantially, and until the late 1980s, Canada rarely had more than 1,000 opiate addicts in methadone treatment. Only the administrative shift of regulatory methadone treatment and licensing powers to two provinces, Ontario and British Columbia in the early 1990s, in combination with slightly altered treatment procedures and philosophies, triggered a tentative increase in numbers.…”

“…As of mid-1996, there were some 3,250 opiate addicts in methadone treatment in Canada. 19,29,30 However, when looking at national rates of methadone treatment spots per million capita, Canada (111) finds itself at the bottom end in comparison with public-healthoriented jurisdictions like Australia (1,020), Switzerland (2,000), Belgium (1,000), or countries such as Germany (247) which just started to use methadone treatment a few years ago, or even the U.S. (442). 25,[31][32][33] Although there are some efforts ongoing in Canada to expand the number of methadone spots available to opiate addicts and also to lower the 'thresholds' of such treatment, it would be a mistake to ignore the overall limitations and shortcomings of methadone maintenance treatment, even under optimal conditions of nationwide supply.…”

Compulsory Drug Treatment in Canada: Historical Origins and Recent Developments

“…Drug enforcement against drug users expanded substantially between 1960 and 1975, with numbers of arrests rising from a few hundred into the thousands [7,9]. On the treatment side, the establishment of methadone maintenance in the early 1960s made the idea of medical narcotics prescription a reality and expanded substantially in use and popularity through to the early 1970s [8,10].…”