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 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

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?

 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: o A similar pharmacologic effect o A better safety profile o A longer duration of action o 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:

 MMT is most effective when used in combination with: o Addiction counseling o Case Management o Mental health services o Health Promotion o Outreach and advocacy o 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:

1. To reduce harm associated with drug use 2. To treat co-morbidity 3. 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:

"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." 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 Available from: Young L. Essentials of Harm Reduction. Proceedings of the 2005 ACSW Conference [Presentation from the Internet]. 2005; Alberta. Available from: /pdfs/essentials_of_harm_reduction_for_acsw.pdf Individual OutcomesCommunity Outcomes

 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 Marsch LA.The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behavior and criminality: a meta-analysis.Addiction.1998 Apr;93(4):

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Methadone will give the patient a high.

People on methadone are still addicts even if they are not using other drugs.

Only street drug users take methadone.

Methadone maintenance therapy costs the system too much money.

 Treat patients receiving MMT with RESPECT  Optimize patients’ drug therapy  Develop relationships with: o Each patient o Exempted physicians o Other supportive healthcare professionals  Educate patients about MMT and other harm reduction programs  Provide patients with resources for: o Assault o Shelters o Mental Health o Financial Aid The Ontario College of Pharmacists. Methadone Maintenance Treatment and Dispensing Policy [Internet].2010; cited 2013 Feb 16. Available from:

 Get the proper training o CAMH’s Opioid Dependence Treatment (ODT) Program o 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:

 ODB Reimbursement: o Rough Estimate of Gross Profit - $11.00/dose o $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 o Pharmaceutical Opinion Revenue - $15/intervention  MedsCheck Follow-Up (PDD) upon dose changes - $25 o Pharmaceutical Opinion Revenue - $15/intervention  Pharmacy Smoking Cessation Program o Funded by the Ontario Government Health Canada. Best Practices - Methadone Maintenance Treatment [Internet].2008; cited 2013 Feb 16. Available from: MOHLTC – MedsCheck Program and Pharmaceutical Opinion Program

Would you considered implementing MMT community pharmacy?

1. Isaac P, Sproule B. Methadone Maintenance Treatment: Recommendations for Enhancing Pharmacy Service.Center for Addiction and Mental Health; The College of Physicians and Surgeons of Ontario.MMT Program Standards and Clinical Guidelines [Internet].2011; cited 2013 Feb 14]. Available from: 3. 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 Available from: n/Pages/harmreductionbackground.aspx 4. Young L. Essentials of Harm Reduction. Proceedings of the 2005 ACSW Conference [Presentation from the Internet]. 2005; Alberta. Available from: /pdfs/essentials_of_harm_reduction_for_acsw.pdf 5. Erdelyan M, Young C. Methadone Maintenance Treatment: A Community Planning Guide.Center for Addiction and Mental Health; Marsch LA.The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behavior and criminality: a meta-analysis.Addiction.1998 Apr;93(4): The Ontario College of Pharmacists. Methadone Maintenance Treatment and Dispensing Policy [Internet].2010; cited 2013 Feb 16. Available from: f40071f438?OpenDocument&Highlight=2,methadone 8. Health Canada. Best Practices - Methadone Maintenance Treatment [Internet].2008; cited 2013 Feb 16. Available from:

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