Methadone Maintenance Treatment

How is methadone maintenance treatment delivered in Canada?

In Canada, as in many other countries, there is a national level regulatory framework for methadone prescription. The Office of Controlled Substances, Health Canada, works with provincial/ territorial governments and medical licensing bodies, among others, to facilitate increased access to methadone maintenance treatment. To date in addition to the Health Canada guidelines¹⁰,¹¹ on the use of opioids in the management of opioid dependence, several provinces have developed--or are in the process of developing-- guidelines and training for practitioners interested in providing methadone maintenance treatment.

Although provinces have become increasingly involved in delineating the conditions under which they recommend to Health Canada physicians who should be allowed to prescribe methadone, only physicians who have received an exemption under Section 56 of the Controlled Drugs and Substances Act are allowed to prescribe methadone.

Methadone maintenance treatment may be delivered in a variety of different settings including:

• substance use treatment services/clinics (outpatient/inpatient);
• community-based health centres/clinics;
• private medical clinics;
• individual physicians' offices & community pharmacies;
• hospital-based health clinics;
• HIV/AIDS services/clinics;
• mental health agencies/clinics; and
• correctional facilities.

Practitioners from many different disciplines and backgrounds--including medicine, substance use treatment, social work and mental health, among others--are involved in delivering methadone maintenance treatment programs. Their roles vary, depending on factors such as qualifications, program setting, available resources and geographic location. There are also differences--across jurisdictions and among programs--in terms of program philosophy, range of services provided, client groups served, level of client involvement, program policies, and program settings.