Methadone treatment in Ontario after the 1996 regulation reforms. Results of a physician survey

Abstract

Over two decades of rather restrictive regulations have kept the availability of methadone treatment (MT) at low levels in the province of Ontario, Canada. Regulatory changes in the Province of Ontario in the mid-1990s relaxed relevant authorization and treatment practice guidelines. Subsequently, the number of physicians authorized for methadone treatment and treatment spots increased substantially. A large number of the newly authorized physicians are general/local medical practitioners. This study reports on the results of a survey conducted with the majority of MT prescribing physicians in Ontario authorized at the time of study. Physicians were surveyed on their attitudes and practices with regards to the MT authorization system, treatment approaches, requirements and workload, patient 'stability', additional opiate substitution treatment needs, and with regards to general issues and concerns about the new MT governance system. The article also discusses patterns and differences that were found between physicians when comparing their geographic location, whether they see themselves practicing under a 'harm reduction' or an 'abstinence' approach, and whether they received MT authorization under the old or the new guidelines. It is concluded that the liberalized regulations and the increased incorporation of local physicians seems to provide for an overall more desirable system of governance of MT. However, some relevant concerns about the current system exist and are discussed.