Physicians’ Attitudes to Methadone Maintenance Treatment in Nova Scotia Jessica Dooley*, M.Sc. Candidate Dr. Susan Kirkland*, Ph. D. Dr. Mark Asbridge*, Ph. D. Dr. John Fraser †, M.D. *Department of Community Health and Epidemiology, Dalhousie University † Direction 180, North End Community Health Centre

Introduction 60,000-90,000 Canadians misuse opioids Methadone Maintenance Treatment (MMT) is an effective treatment  Daily dosing with methadone (a long-acting opioid agonist) to prevent withdrawal symptoms, cravings and euphoric effects of opioids Extent to which policies and programs are developed and accessible varies between geographical/professional settings and facilities Office-based delivery suggested as a way of improving access and capacity Success of such a model depends on willingness of physicians to deliver it

Public health implications of opioid misuse Associated conditions include:  HIV, hepatitis C, overdose, suicide, endocarditis, abscesses, infection, poor nutrition, adverse drug interactions (Fisher et al., 2004, Hser et al., 2001, Health Canada, 2007) Associated co-morbidities include:  Poly-drug dependence, hypertension, diabetes, asthma, chronic liver disease, cirrhosis (Gossop et al., 1997; Haydon, et al., 2003, Brooner et al., 1997; Darke and Ross, 1997) Premature mortality is characteristic (Hser et al., 2001, Millson et al., 2004) Effects extend to families and communities  Blood borne diseases, criminality, economic implications ( Fisher et al., 2004; Hser et al., 2001; Wall et al., 2001 )

Efficacy and effectiveness of methadone Randomized controlled trials have shown methadone to be pharmacologically efficacious and safe (Novich et al., 1993; Kreek, 1973, Donny et al., 2005) Reduces opioid use, use of other illicit drugs, frequency of drug injection, high risk drug use behaviours, criminal activity, morbidity, mortality (Strain et al., 1993; Thiede et al., 2000; Johansson et al.; 2007, Fairbank et al., 1993, Dolan et al., 2003; Gossop et al., 2003, Willner-Reid et al., 2007; Millson et al., 2007; Fabris et al., 2006; Bell et al., 1997, Langendam et al., 2001; Brugal et al., 2005; Caplehorn and Drummer, 1999) Office-based MMT shown to be effective in numerous RCTs (Fiellin et al., 2001, Gossop et al., 1999, 2003) High patient and provider satisfaction (Fiellin et al., 2001) Advantages may include reduced stigma, more attention to medical and mental health concerns, easy geographical access, improved treatment retention (Fiellin et al., 2001; Salsitz et al., 2000).

Current Canadian context (Popova et al., 2006)

Overall objectives Assess acceptability of office-based MMT among non-specialist physicians in Nova Scotia Determine extent to which office-based MMT has the potential to enhance accessibility and capacity Establish the context in which office-based MMT could be integrated in Nova Scotia

Methods survey of population of all non-specialist physicians in Nova Scotia (1170) using OPINIO software  Administered twice, 10 days apart  Clarify attitudes about: Illicit drug use and maintenance-oriented treatment Treatment of opioid-dependent individuals in their practices Barriers and facilitators to MMT delivery in private office- based practice

Acceptability of office-based MMT Key Measures:  Willingness to participate in office-based MMT  Perceived barriers and facilitators to office-based MMT  Attitudes towards drug use Disapproval of drug use scale (DDU)  Attitudes towards principles of harm reduction Abstinence orientation scale (AOS)  Knowledge of the risks and benefits of MMT Test of knowledge of MMT (KNOW) (Caplehorn, 1996)

Preliminary Results (n=124) AgeSexCommunity Size Medical School Training in Addiction Medicine License to prescribe methadone for opioid dependence

Scale Scores ScaleGroupMeanSD KNOWAll (n=123) Licensed (n=11) Unlicensed (n=112) DDUAll (n= 124) Licensed (n=11) Unlicensed (n=113) AOSAll (n=122) Licensed (n=11) Unlicensed (n=111)

Barriers influencing decision to be involved in MMT delivery

Willingness to provide office-based MMT

Potential limitations Response rate Survey error Researcher bias Response selection bias Item bias Social desirability bias Generalizeability

Preliminary Conclusions Considerable acceptance of MMT in the province Potential for improved access to MMT in the province Areas for improvement for integration of MMT clearly highlighted  Education  Interaction with other providers  Support Services

Support In association with: The Atlantic Interdisciplinary Research Network for Social and Behavioural Issues in HIV/AIDS and Hepatitis C (AIRN) The College of Physicians and Surgeons of Nova Scotia Funded by: Canadian Institutes of Health Research Master’s Award Dalhousie University Faculty of Medicine Marvin Burke Award