Camh - Making the Choice, Making It Work: Treatment for Opioid Addiction

Contents

Acknowledgments

The Centre for Addiction and Mental Health (CAMH) wishes to acknowledge the enthusiastic and valuable participation of the many clients, family members and health and social service professionals who contributed to the redevelopment of this handbook. Our gratitude also extends to all who contributed to the conception and development of the Methadone Maintenance Treatment Client Handbook , first published by CAMH in 2001, which provided a foundation for this new edition.

Creating this handbook has been a collaborative effort with professionals, clients and family members reviewing drafts and providing feedback, which was then carefully overlaid and woven into drafts based on the original handbook. The aim of this process was to create a book that carried forward the success of the original handbook, but that reflects the current realities of opioid addiction and treatment. We hope that this new edition will interest and inform people with addiction to opioids, and empower them to direct their own treatment and recovery. We hope that it will also help families, friends and others with an interest in opioid addiction and treatment to better understand the issue, and the people who struggle with it.

A special heartfelt thanks goes out to the people with experience of opioid agonist therapy (OAT) who provided us with the thoughtful quotations that illustrate the book. Your voices tell us that there is no one kind of person who becomes addicted to opioids, or no one kind of experience with the struggle to live with it. We also deeply appreciate the clients and family members who carefully reviewed a draft of the handbook, and provided their feedback.

Client quotes were provided by Andy, Angie, Ann, Ben, Brett, Chantale, Courtney, Dan, David, Eric, Gemma, Glen, J, Jessica, Jim, Jon, Jose, Joyce, Paul, Randall, Ruth, Sean, Shaun and Zar.

Clients and family members who reviewed the draft are Gemma Bennett, Malcolm Birbeck, Dante T. Colaianni Jr., Tammy Hyde, Jon, Betty-Lou Kristy, Sean LeBlanc, Patrick Loewen, Randy Post, Bill and Sheila Robinson, Charlene Winger, Sean Winger and others who chose to withhold their names.

This project would not have been possible without the contribution of the nurses, doctors, pharmacists, counsellors and other professionals whose work supports people with opioid addiction. These reviewers volunteered their time, thoughts and expertise from CAMH, across Ontario and across Canada.

Professionals from organizations outside CAMH also reviewed the draft: Kim Hennessy, Uptown Methadone Clinic, Saint John; Joni Ingram, Western Health, Cornerbrook; David Marsh, Northern Ontario School of Medicine and Canadian Addiction Treatment Centres; Tim Ominika, Nadmadwin Mental Health Clinic, Wikwemikong; Kendrah Rose, Sunshine Coast Mental Health & Addiction Services, Vancouver Coastal Health; Rhonda Thompson, Positive Living, Niagara; Andrew Tolmie, School of Pharmacy, University of Waterloo.

And the professionals who work at CAMH who gave their comments were Roshina Babaei-Rad, Carol Batstone, Alison Benedict, Jonathan Bertram, Narges Beyraghi, Susan Eckerle Curwood, Stephanie Gloyn, Katia Gouveia, Ahmed Hassan, Galit Kadan, Lisa Lefebvre, Heather Lillico, Tamar Meyer, Niall Tamayo, Kari Van Camp and Maria Zhang.

Thank you to CAMHs Provincial System Support Program (PSSP) central and regional team members for their support in organizing and conducting the client interviews, and in reviewing and commenting on the drafts. PSSP would especially like to acknowledge those who helped to organize and facilitate the focus groups of people with lived experience of opioid addiction. Thanks to Sean LeBlanc for facilitating the group in Ottawa and to Rob Boyd and Hana Dykstra of the Sandy Hill Community Health Centre for supporting the group; thanks also to Betty-Lou Kristy for facilitating the group in Oakville and Katie Kidd of the Opioid Outreach & Treatment Services of Missisauga/Halton for supporting the group. The feedback collected through these groups helped to shape the final draft, and to ensure that the guide is helpful to the people who can benefit from the information it provides.

Client interviews were conducted by Lia De Pauw, Erika Espinoza, Alexandra Lamoureux, Heather Lillico, Janet McAllister, Barb Steep and Cheryl Vrkljan; thanks also to The Hamilton Clinic; Ontario Addiction Treatment Centres; Street Health Centre, part of Kingston Community Health Centre; and Shannon Greene and the CAMH Addiction Medicine Service.

Other professionals who helped to answer questions and to provide accurate content are Ken English and Fiona Sillars, Ontario Ministry of Health and Long-Term Care; Steve Grootenboer, Ontario Ministry of Transportation; Tracey Marshall, College of Physicians and Surgeons of Ontario; Linda Ogilvie, Ontario Ministry of Community Safety and Correctional Services; and James L. Sorensen, University of California, San Francisco (for permission to adapt and reprint the Tapering Readiness Inventory).

The CAMH Education team for this project was Michelle Maynes, writing and development; Mara Korkola, design; and Jacquelyn Waller-Vintar, editorial.

How to use this book

This book should answer many of the questions you may have about opioid agonist therapy (OAT) with methadone or buprenorphine (Suboxone). The book can also help you to know what questions to ask your doctor, pharmacist, counsellor and others. Its put together so that you can either dip into it, or read it all at once, as you wish. Theres information here for those who are thinking about OAT, for the new client and the client who is already taking OAT, and for family and friends. You can use this information to help you to understand and make decisions about your treatment. You can use it to educate others. You can use it to help yourself.

A note to family and friends

If youve been struggling to understand what your friend or family member is experiencing because of opioid addiction, and why that person is considering or taking OAT, this book can answer some of your questions, and help you to support the person you care about. Some client and family reviewers have pointed out that chapter 2, , provides information that can help family and friends to start making sense of what is happening.

A note on the client quotes

The quotes included throughout this book are from people with personal experience with OAT. These are their words and opinions. The quotes are included to help those who are thinking about or starting OAT get a better idea of what to consider and what to expect, and to offer some encouragement.

Opioid agonist therapy FAQs

Q: What is an opioid agonist?

A: Methadone and buprenorphine (Suboxone) are opioid agonists. Opioid agonist therapy (OAT) replaces the opioids youve been using, and prevents you from getting sick with opioid withdrawal.

Q: Will methadone or buprenorphine get me high?

A: When you start treatment, you may feel lightheaded or sleepy. Once you develop a tolerance to these effects, you can expect to feel normal.

Q: Can I take opioid agonist therapy for a few weeks, and then stop?

A: Stopping OAT before you are ready carries a high risk of relapse, and of overdose. Continuing OAT over a longer term helps to keep you safe. People who start OAT usually continue with the treatment for at least a year or two. Some continue for many years. How long you stay in treatment depends on what is right for you.

Q: Are people on opioid agonist therapy still addicted to opioids?

A: The answer to this question is a bit complicated. Its true that people on OAT are still physically dependent on opioids, and that physical dependence on a drug is one of the signs of addiction; however, physical dependence on its own does not mean that a person is addicted.