Methadone Maintenence Treatment (MMT)
Across Nova Scotia demand is growing for access to methadone maintenance treatment (MMT) for the management of opioid dependence. In response, more physicians are now providing this therapy, either through specialized clinics or integrated with the practice of family medicine.
Prescribing Methadone – Removal of Health Canada Exemption
Currently, physicians who wish to prescribe methadone for the treatment of pain or for use in opioid replacement therapy, must apply for an exemption from the CDSA. For an application to be approved, Health Canada requires a letter of support from the College. The proposed amendments, anticipated to be in place in May, will lift the need for such exemptions.
As with all questions on expanding scope of practice, the College expects physicians intending to prescribe methadone to be well trained. Although exemptions will no longer be required, MMT prescribers are expected to adhere to the standards and guidelines set out in the College’s Methadone Maintenance Treatment Handbook. In addition, the College would expect physicians to have taken the relevant courses offered by Centre for Addiction and Mental Health (CAMH).
Methadone is an important tool in the treatment of both pain and opioid use disorder. It is, however, not without risk. It is hoped that the announcement by the Health Minister will encourage physicians to enter this field. The expectation of the College is that those choosing to enter this important field will do so only with the appropriate knowledge and training.
In 2013 the College, with funding from the provincial government and in consultation with local experts, developed the Methadone Maintenance Support Program (MMSP). Through the MMSP, prescriber practices were assessed every three years against the standards and guidelines contained in the College’s Methadone Maintenance Treatment Handbook. Practice assessments provided feedback and support to MMT prescribers, thereby promoting high practice standards and patient safety.
From the program’s inception in 2013, the number of provincial MMT prescribers has grown from approximately fifty to more than eighty.
Funding responsibility for the MMSP has recently been transferred from the Department of Health and Wellness (DHW) to the Nova Scotia Health Authority (NSHA). The NSHA has indicated to the College that it does not intend to fund the MMSP and will instead direct their resources toward other initiatives. Lacking the necessary funds, the MMSP will close effective immediately.
The College wishes to thank partners and participants of the program for their contributions to the MMSP. Moving forward, the College is considering how elements of the MMSP may be incorporated into its new Physician Peer Review program.