Opioid Replacement Therapy

The goal of treatment for opioid dependence is targeted at three main objectives: 


  1. Reducing or ceasing opioid use. 
  2. Preventing further harms related to the use of opioids. 
  3. Improving the quality of life and well being of the opioid dependent patient. 


For most patients just as with other chronic medical conditions, treatment will likely be long-term and require ongoing pharmacological and psychosocial supports to prevent relapse. The most effective treatment of opioid dependence is the use of an opioid agonist (i.e. methadone) or partial opioid agonist (buprenorphine). When administered daily at an appropriate dose for the individual patient, a stable level of opioid effect is produced that neither creates a "high" or results in withdrawl symptoms. This allows the patient to function normally, just as any other individual. 


Due to the nature of addiction, the prescription of methadone (and to a lesser extent buprenorphine) requires close monitoring to ensure the safety of the patient but also of others who may be at risk if the methadone is diverted (i.e. sold to others or consumed by someone other than the patient to whom it was prescribed). Patients are initially dispensed their methadone on a daily basis through directly observed dosing at the pharmacy or clinic. As the patient stabilizes both from an addiction and a social perspective, they may gradually be granted "carries" or "take home doses" so that they only have to come to pick up their medication once a week. For the majority of methadone patients, witnessed urine drug screens are performed on a regular basis (usually every 2 weeks) to ensure they remain free from other illicit drugs of concern. 


At RECAP, patients who are on methadone maintenance therapy are managed in line with the College of Physicians and Surgeons of Nova Scotia: Methadone Maintenance Treatment Handbooklast updated in 2012.