Patient perspectives of methadone formulation change in British Columbia, Canada: outcomes of a provincial survey

Abstract

BackgroundIn British Columbia, Canada, methadone maintenance treatment formulation transitioned from the oral liquid compound Tang™-flavoured methadone to the ten-times more concentrated cherry-flavoured Methadose™ in February 2014. We quantitatively describe perceptions and reported consequences among a sample of patients on methadone maintenance treatment following this transition.MethodsA province-wide survey was used. Bivariable analyses utilized independent samples t-tests, Phi associations, and Chi-square tests. Multivariable logistic regression analyses evaluated factors related to dependent variables – namely, increases in dose, pain, dope sickness, and the need to supplement with additional opioids.ResultsFour hundred five methadone maintenance treatment patients from fifty harm reduction sites across British Columbia reported transitioning to Methadose™ in February 2014. The majority (n = 258; 73.1 %) heard about the formulation change from their methadone provider or pharmacist. Adjusted models show worse taste was positively associated with reporting an increasing dose (OR = 2.46; CI:1.31–4.61), feeling more dope sick (OR = 3.39; CI:1.88–6.12), and worsening pain (OR = 4.65; CI:2.45–8.80). Feeling more dope sick was positively associated with dose increase (OR = 2.24; CI:1.37–3.66), and supplementing with opioids (OR = 8.81; CI:5.16–15.05).ConclusionsMethadone maintenance treatment policy changes in British Columbia affect a structurally vulnerable population who may be less able to cope with transitions and loss of autonomy. There may be a psychosocial component contributing to the perception of Methadose™ tasting worse, and increased dope sickness, pain, and dose. Our study shows the pronounced negative impacts medication changes can have on patients without informed, coordinated efforts. We stress the need to engage all stakeholders allowing for communication about the reasons, risks and consequences of medication policy changes and provision of additional psychosocial support.

Unintended impacts of regulatory changes to British Columbia Methadone Maintenance Program on addiction and HIV-related outcomes: An interrupted time series analysis

“…Regardless, its adverse social and health effects cannot be overlooked. Indeed, in other settings, change intolerance has been associated with treatment disruptions, decreased social stability, relapse to illicit drug use, and involvement in illegal income-generation activities (Greer, et al, 2016; McNeil, et al, 2015; Silver & Shaffer, 1996; Steels, et al, 1992). …”

“…Persons on methadone’s input on key aspects of implementation strategies and their capacity to provide insights into potential unexpected outcomes (positive and negative) is of paramount importance. Other important considerations include the potential benefits of longer transition periods where both formulations would be available, closer clinical monitoring and dose modifications in response to withdrawal and overdose symptoms, as well as psychological support, particularly for more vulnerable individuals (Greer, et al, 2016; McNeil, et al, 2015; Silver & Shaffer, 1996). …”

“…As documented by qualitative studies and quantitative surveys, subsequent to the regulatory changes, concerns were voiced among persons on methadone that the new methadone formulation did not adequately control withdrawal symptoms, and that discontinuation of home delivery services resulted in interruptions in MMT and co-dispensed medications (e.g., antiretroviral therapy, psychiatric medications) (Greer, et al, 2016; McNeil, et al, 2015). However, to our knowledge, the broader effects of the new MMT policies, including on HIV prevention and treatment outcomes, have not been characterized.…”

Prevalence of Heavy Alcohol Use Among People Receiving Methadone Following Change to Methadose

“…A province-wide survey of 405 patients receiving Methadose reported statistically-significant negative impacts of this change on substance-related outcomes of people receiving Methadose, which included “feeling more dope sick and worsening pain,” “topping up” with other drugs following the switch to Methadose (Greer et al, 2016). Reporting more intense feelings of dope sickness was associated with increases in Methadose dose increases in use of other opioids.…”

“…Cumulatively, these previous research findings called for further investigation of the fluctuation of substance use during transitions to new methadone formulations, especially whether patients top up or substitute with alcohol or with illicit drugs. However, the impact of methadone formulation changes on the use of alcohol by MAT patients has been understudied (Greer et al, 2016; McNeil et al, 2015). Therefore, we examined whether a switch from methadone to Methadose was associated with increased heavy alcohol use among MAT patients.…”