Availability of MMT
From: Chapter 3: The Fundamentals of Methadone Maintenance Treatment, in Methadone Maintenance: A Counsellor's Guide to Treatment (© 2003).
In the years leading up to 1996, heroin in Ontario became less costly, more pure and more available, and more people were using heroin and becoming dependent on it.
Although MMT had been employed as an effective and inexpensive treatment for opioid dependence for more than 30 years, its availability increased only minimally during this period. MMT treatment programs had more people on waiting lists than they had in treatment.
In 1995, user advocates successfully argued that MMT needed to be expanded across Ontario, particularly in light of the potential for an AIDS epidemic among people who inject opioids. Other jurisdictions had already experienced such epidemics. In the summer of 1996, the Ontario Ministry of Health, the College of Physicians and Surgeons of Ontario, the Addiction Research Foundation (ARF, now part of the Centre for Addiction and Mental Health) and the Ontario College of Pharmacists launched a joint effort to expand MMT while maintaining a high quality of care. New guidelines were developed for providing MMT, and the number of physicians prescribing methadone, pharmacies dispensing methadone and clients receiving methadone treatment in Ontario increased dramatically, particularly in the Greater Toronto Area (Brands et al., 2000).
Despite the dramatic increase in the number of clients in MMT across Ontario, it has been suggested that the demand for MMT in Ontario is still far in excess of the supply. A conservative estimate is that 10,000 people in Ontario would be eligible for MMT, well in excess of the number currently in treatment.
It should be noted that the expansion of MMT outside the Greater Toronto Area has been much less dramatic; there are still many medium-sized Ontario municipalities where MMT is not available, let alone small communities.
Furthermore, the increase in the number of physicians providing MMT has not kept up with the increase in the number of clients in treatment. Consequently, many community physicians are carrying relatively high MMT client caseloads that include significant numbers of very challenging clients.
Finally, although methadone prescribing has increased dramatically overall, the availability of drug counselling, mental health care and other psychosocial services to clients in MMT has not kept up, so the full potential of MMT remains to be realized.