MMT Program Standards and Clinical Guidelines

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(143 pages)

Approved February 2011, 4th Edition

Introduction and Table of Contents

In 1996, the College of Physicians and Surgeons of Ontario began to administer a methadone program on behalf of the Ministry of Health and Long-Term Care. The program goal is to improve the quality and accessibility of methadone maintenance treatment (MMT) in Ontario. This goal is achieved in cooperation with the Centre for Addiction and Mental Health (CAMH), and the Ontario College of Pharmacists (OCP). The profile of MMT in Ontario has been enhanced through outreach activities and the recruitment of physicians to prescribe methadone in the treatment of opioid dependence.

The College’s Methadone Committee was established in June 1999 by the CPSO Council. One important responsibility of the committee is to govern the establishment and maintenance of guidelines or standards applicable generally to the use of opioid agonists in the management of opioid dependence.

This document replaces the CPSO 2005, 2001, and 1996 MMT Guidelines, and Health Canada’s “The Use of Opioids in the Treatment of Opioid Dependence,” published in 1992.

It is acknowledged that other health-care professionals are involved in the care of opioid dependent patients. However, the intended audience for this document is MMT physicians. It is not intended as a comprehensive manual or to replace sound clinical judgment.

Standards are regarded as generally accepted principles of patient management. Standards are based on a synthesis of current literature and a high level of consensus among the Guideline Advisory Committee. Standards are differentiated from Guidelines in that they refer to clinical practices that potentially relate to patient morbidity and mortality and to community safety. Standards may be modified only under exceptional circumstances and where the reasons for departure from the standards are clearly documented.

Guidelines are systematically developed recommendations and educational references that assist the MMT physician in making clinical decisions about patient care. Clinical guidelines are recommendations that are supported by a synthesis of current literature and clinical consensus. Guidelines may be adopted, modified, or rejected according to clinical needs, individual patient considerations, local resources, and physician discretion. Guidelines do not establish inflexible protocols for patient care nor are they meant to replace the professional judgment of physicians.

 


Table of Contents

ACRONYMS

1. Preface

2. Introduction

3. MMT Physicians and Practice Settings

4. Pharmacotherapy Options other than MMT for Opioid Dependence

5. Initial Patient Assessment

6. Dosing During Initiation, Stabilization and Maintenance

7.0 Urine Drug Screening (UDS)

8.0 Take-Home Doses

9.0 Voluntary and Involuntary Withdrawal from MMT

10.0 Counselling and Case Management

11.0 MMT with Concurrent Mental and Physical Disorders

12.0 Methadone Toxicity

13.0 MMT Considerations during Pregnancy

14.0 MMT in Federal/Provincial Correctional Facilities

15. Hospital-Based MMT..

16. Telemedicine in the Delivery of MMT

APPENDICES.

Glossary

Bibliography

Tables

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