OPIOID DEPENDENCE TREATMENT PROGRAM

SUPPORTING EVIDENCE-BASED PRESCRIBING

The CPSA supports Alberta physicians in providing safe, accessible, effective and consistent clinical care to patients who may benefit from treatment with methadone or buprenorphine/naloxone(Suboxone®).

This includes patients who are diagnosed with an addiction disorder, have chronic pain, are in a palliative care setting or have been admitted to hospital when already on an opioid dependence therapy.

Physicians who wish to prescribe methadone must have a Methadone Exemption.


OPIOID DEPENDENCE CLINICS IN ALBERTA

Methadone Prescribing

To prescribe methadone for the treatment of opioid dependence or for analgesia in Alberta, physicians must apply to the CPSA for a methadone exemption under section 56 of the Controlled Drugs and Substances Act and meet specific requirements for initiating or maintaining methadone treatment.

Methadone Exemptions are issued directly to physicians by Health Canada. A letter of support from the College is required for a Methadone Exemption. (See FAQ section below for details).

To INITIATE methadone treatment you must have appropriate education and experience in a multi-disciplinary setting or postgraduate training.

To MAINTAIN methadone treatment for a patient stabilized by a specialist you must submit with your application a letter of support from the pain, addiction or palliative physician who initiated the methadone treatment for the patient.

Buprenorphine/Naloxone (Suboxone®) Prescribing

Buprenorphine/Naloxone (Suboxone®) is as effective as methadone for treatment of opioid dependence but with an improved safety profile. The agonist/antagonist action of Suboxone® creates a “ceiling effect” which makes it less likely to result in overdose and less attractive to abuse.

Although buprenorphine/naloxone has an improved safety profile compared to methadone, opioid dependent patients are high risk. It is strongly recommended to have a treatment agreement in place and to set appropriate boundaries with patients. Compliance monitoring by accessing PIN, or prescribing databases, and through urine drug screening is also important.

Physicians who wish to prescribe buprenorphine/naloxone for opioid dependent patients in Alberta must be registered to prescribe Triplicate Prescription Program drugs.

Completion of an online buprenorphine/naloxone prescribing course is strongly encouraged.

We recommend the following courses:

Other equivalent course (Contact us at methadone.info@cpsa.ab.ca to discuss options.)

FAQ

  1. Complete the Health Canada application form.
    Note: Please provide your CPSA registration number in the Licence(s)/ License(s) field.
  2. Mail or fax a copy of signed Health Canada application form* to:
    Methadone Program
    College of Physicians & Surgeons of Alberta
    Suite 2700 – 10020 100 Street
    Edmonton AB T5J 0N3
    Fax (780) 420-0651
    *Include a letter outlining your practice requirements, evidence of your education and training with methadone, if applicable.
    Attach a letter of referral from the specialist or program who initiated and stabilized the patient(s) on methadone.
  3. The College will review your application and file and prepare a letter of support to Health Canada which the College will send to Health Canada on your behalf – the College will notify you when this occurs.
  4. You may begin prescribing methadone only upon receipt of formal approval from Health Canada.

Yes – You may modify an existing Patient-specific Exemption by providing the name of the patient to add or delete in a written letter to the program. If adding a patient, attach a copy of a letter from the physician supporting your methadone prescribing for that patient.

Mail the letter to:
Methadone Program
College of Physicians & Surgeons of Alberta
Suite 2700 – 10020 100 Street
Edmonton AB T5J 0N3
Fax (780) 420-0651

We can connect you. Please contact the Methadone Program at methadone.info@cpsa.ab.ca or by calling 1-800-561-3899 for assistance with securing a post-training preceptorship.

Yes, if continuing treatment for a stabilized patient who started on a methadone program with a specialist (chronic pain, addiction or palliative care) and you are able to consult with the specialist if problems arise.

Note: Physicians must have considerable experience with the use of methadone if they wish to initiate a patient on methadone.

No. Exemptions from Health Canada are specific to dependence, pain associated with malignancy or chronic non-malignant pain.

Once you have received a methadone exemption, you may determine the number of patient caseloads you wish to handle. The College must be notified of all patients you wish to prescribe for and which clinic stabilized the patient initially on methadone.

Call RAAPID – Consult with an opioid dependency physician specialist over your patient’s care. Expert phone consultations available Monday to Friday: 8 AM – 10 PM & weekends and stat holidays: 8 AM – 6 PM.

Red Deer & North: 1-800-282-9911
Red Deer & South: 1-800-661-1700

This telephone consult service is for primary care physicians seeking timely advice regarding prescribing drugs like buprenorphine/naloxone (Suboxone®) or methadone, as well as treating patients with existing opioid dependency.

Service starts August 8, 2017. For more information, visit www.ahs.ca/opioidadvice

CPSA recognizes the  BC Opioid Use Disorder guideline recommendations relating to the use of Kadian® in opioid dependence treatment.  Additional to these guidelines, the Slow-release oral morphine (Kadian®) for opioid-dependence treatment in Alberta document provides some Alberta-specific information.

The College recommends that physicians wishing to prescribe  Kadian®  for ODT also hold a valid Methadone exemption under CDSA Section 56. Methadone Exemptions are issued directly to physicians by Health Canada. A letter of support from the College is required for a Methadone exemption.


WE CAN HELP

Methadone Program

1-800-561-3899 (in Canada)

methadone.info@cpsa.ab.ca