Treatment of Prescription Opioid Disorders in Canada: Looking at the "Other Epidemic"?

Question 1

What does PO, OMT, and MMT all stand for?

Answer 1

Prescription Opioid
Opioid Maintenance Treatment
Methadone Maintenance Treatment

Question 2

Explain a pivotal difference between an MMT patient less than 30 years old, compared to an MMT patient who entered OMT pre-2000.

Answer 2

MMT patients less than 30 years old likely had relatively short or only tangential involvement with PO misuse prior to treatment. In addition, younger PO disorder patients are commonly more socio-economically integrated, and therefore feature less clinical risk profiles such as less severe addiction severity, less injecting and/or comorbidities, than the profiles of those patients who entered OMT pre-2000.

Question 3

What may be a reason for further increase in the number of people initiated on OMT?

Answer 3

Application of the new DSM-V criteria for PO disorders.

Question 4

Other than MMT and some suboxone-based therapy being the “de facto” first-line treatment for PO related disorders in Ontario, name another less intrusive treatment option Ontario may want to consider.

Answer 4

Buprenorphine-naloxone or Naltrex-one. Also, behavioural treatments have shown some effectiveness in combination with medical supplemental detoxification.

Question 5

What is the main goal for a “stepped-care model”?

Answer 5

Align treatment from different options, and treatment intensity, based on key characteristics that predict patient need. The overall goal is implementing least intensive but more promising treatment on a case-to-case basis. (work from least invasive treatment and build up if required).