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. 2018 Feb;64(2):e95-e103.

Patterns of methadone maintenance treatment provision in Ontario: Policy success or pendulum excess?

Paul Kurdyak  1 , Binu Jacob  2 , Juveria Zaheer  3 , Benedikt Fischer  4
Affiliations

Patterns of methadone maintenance treatment provision in Ontario: Policy success or pendulum excess?

Paul Kurdyak et al. Can Fam Physician. 2018 Feb.

Abstract
in English, French

Objective: To describe recent trends and patterns in methadone maintenance treatment (MMT) practice regionally and over time in the province of Ontario.

Design: Population-based descriptive study using health administrative data between September 1, 2011, and December 31, 2014.

Setting: Ontario.

Participants: All active MMT-prescribing physicians and patients receiving MMT in the study period.

Main outcome measures: Characteristics of MMT-prescribing physicians, including age, sex, specialty type, practice region, and practice volume; characteristics of patients receiving MMT, including age, sex, neighbourhood income, and region of residence.

Results: Between September 1, 2011, and December 31, 2014, the number of MMT-prescribing physicians and patients who received MMT increased by 26% and 42%, respectively. In 2014, there was a total of 312 MMT-prescribing physicians and 49 703 patients receiving MMT. In 2014 and on a per capita basis, patients receiving MMT were more prevalent in rural regions; and within rural regions, there were disproportionately large numbers of young female MMT patients residing in low-income neighbourhoods.

Conclusion: The number of physicians prescribing MMT and patients receiving MMT has increased substantially between 2011 and 2014, with the largest per capita distribution occurring in rural regions and involving young adults. While availability of and access to MMT has improved considerably from before 2000 to levels of high use, these developments are likely influenced by recent trends in the proliferation of prescription opioid misuse across general populations.

Objectif: Décrire les tendances et les modèles récents dans l’utilisation du TMM en Ontario, selon les régions et les périodes.

Type d’étude: Étude descriptive démographique à l’aide de données administratives sanitaires portant sur la période allant du 1er septembre 2011 au 31 décembre 2014.

Contexte: L’Ontario.

Participants: Tous les médecins actifs ayant prescrit des TMM et les patients auxquels ils l’ont prescrit au cours de la période à l’étude.

Principaux paramètres à l’étude: Les caractéristiques des médecins prescrivant les TMM, y compris l’âge, le sexe, la spécialité, la région de pratique et le volume de la clientèle; les caractéristiques des patients recevant le TMM, y compris l’âge, le sexe, le revenu des familles du voisinage et la région habitée.

Résultats: Entre le 1er septembre 2011 et le 31 décembre 2014, le nombre des médecins qui prescrivaient le TMM et celui des patients qui recevaient ce traitement ont augmenté respectivement de 26 % et 42 %. En 2014, un total de 312 médecins prescrivaient le TMM, et 49 703 patients recevaient ce traitement. En 2014, au prorata de la population locale, les patients ainsi traités étaient plus nombreux dans les régions rurales, et dans ces régions, il y avait un nombre disproportionné de jeunes femmes traitées qui habitaient des quartiers à faible revenu.

Conclusion: Le nombre de médecins prescrivant le TMM et de patients recevant ce traitement a augmenté de façon importante, la plus forte distribution per capita étant observée dans les régions rurales, particulièrement chez les jeunes adultes. Bien que la disponibilité et l’accès au TMM se soient améliorés considérablement depuis 2000, pour atteindre un taux d’utilisation élevé, ces changements sont probablement influencés par les récentes tendances dans la prolifération d’un mauvais usage des opioïdes d’ordonnance au sein de la population générale.

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Figures

Figure 1.
Figure 1.
Annual number of MMT-prescribing physicians and MMT-receiving patients in Ontario between 2011 and 2014 MMT—methadone maintenance treatment.
Figure 2.
Figure 2.
Distribution of MMT-prescribing physicians and MMT-receiving patients (per capita) in Ontario in 2014 LHIN—Local Health Integration Network, MD—medical doctor, MMT—methadone maintenance treatment. *The lowest rates of MMT-receiving patients were in urban and suburban areas (eg, Toronto and surrounding areas [Central, Central West, Central East, and Mississauga Halton LHINs] and Ottawa [Champlain LHIN]), whereas the highest per capita rates were in rural areas. The regional per capita distribution of MMT-prescribing physicians did not follow a similar pattern.
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