title: Treatment of prescription opioid disorders in Canada: looking at the 'other epidemic'?
abstract: The magnitude and consequences of prescription opioid (PO) misuse and harms (including rising demand for PO disorder treatment) in Canada have been well-documented. Despite a limited evidence-base for PO dependence treatment, opioid maintenance therapy (OMT) - mostly by means of methadone maintenance treatment (MMT) - has become the de facto first-line treatment for PO-disorders. For example in the most populous province of Ontario, some 50,000 patients - large proportions of them young adults - are enrolled in MMT, resulting in a MMT-rate that is 3-4 times higher than that of the United States. MMT in Ontario has widely proliferated towards a quasi-treatment industry within a system context of the public fee-payer offering generous incentives for community-based MMT providers. Contrary to the proliferation of MMT, there has been no commensurate increase in availability of alternative (e.g., detox, tapering, behavioral), and less intrusive and/or costly, treatments which may provide therapeutic benefits at least for sub-sets of PO-dependent patients. Given the extensive PO-dependence burden combined with its distinct socio-demographic and clinical profile (e.g., involving many young people, less intensive or risky opioid use), an evidence-based 'stepped-care' model for PO dependence treatment ought to be developed in Canada where MMT constitutes one, but likely a last resort or option, for treatment. Other, less intrusive treatment options as well as the best mix of treatment options should be systematically investigated and implemented. This case study has relevance and implications for evidence-based treatment also for the increasing number of other jurisdictions where PO misuse and disorders have been rising.
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction & Mental Health (CAMH), Toronto, ON, M5S 2S1, Canada. bfischer@sfu.ca.|Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada. bfischer@sfu.ca.|Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, M5T 1R8, Canada. bfischer@sfu.ca.|Centre for Applied Research in Mental Health & Addiction (CARMHA), Simon Fraser University, Vancouver, V6B 5K3, Canada. bfischer@sfu.ca.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Fischer
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction & Mental Health (CAMH), Toronto, ON, M5S 2S1, Canada. paul.kurdyak@camh.ca.|Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada. paul.kurdyak@camh.ca.|Mental Health and Addictions Program, Institute for Clinical Evaluative Science (ICES), Toronto, ON, M4N 3M5, Canada. paul.kurdyak@camh.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Kurdyak
authors.affiliation: Centre for Applied Research in Mental Health & Addiction (CARMHA), Simon Fraser University, Vancouver, V6B 5K3, Canada. egoldner@sfu.ca.
authors.forename: Elliot
authors.initials: E
authors.lastname: Goldner
authors.affiliation: B.C. Centre for Disease Control (BCCDC), Vancouver, BC, V5Z 4R4, Canada. mtyndall@bccdc.ca.|Department of Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada. mtyndall@bccdc.ca.
authors.forename: Mark
authors.initials: M
authors.lastname: Tyndall
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction & Mental Health (CAMH), Toronto, ON, M5S 2S1, Canada. jtrehm@gmail.com.|Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada. jtrehm@gmail.com.|Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, M5T 1R8, Canada. jtrehm@gmail.com.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada. jtrehm@gmail.com.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D019468:Disease Management; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009864:Ontario; D058850:Opiate Substitution Treatment / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data*; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone