Opioid use disorders

No. The psychosocial worker in the health care team is there to offer support if you want it to help you cope both with psychological difficulties and in dealing with housing assistance, food banks, social assistance, tax returns as well as with the Court, the Régie de l’assurance maladie du Québec [Quebec health insurance board], etc.

You will be expected to see your psychosocial worker from time to time to maintain contact, without it being psychotherapy.

You can, but people who live in Montreal will be given priority. It’s advisable to apply to the Hôpital Saint-Luc (Université de Montréal Hospital Centre), the Herzl Clinic at the Jewish General Hospital or the addiction rehabilitation centre (centre de réadaptation en dépendance – CRD) in your region at the same time.

In general, a detoxification centre is recommended if

• you have only been using opioids for a short while (less than a year);
• you find the opioid addiction treatment program too restrictive because it requires a high level of commitment: daily visit to the pharmacy to get the medication and weekly appointments at CRAN at the start of treatment;
• you would like to commit to short-term treatment rather than a medium- or long-term program, i.e., that spans several years, as is often the case with methadone or buprenorphine treatment.
   

The sooner you register, the sooner your name will be put on the waiting list. You can expect a wait time of around four to six weeks. To increase your chances of getting treatment quickly, we recommend that you apply at other places too: at the Hôpital Saint-Luc (Université de Montréal Hospital Centre), the Herzl Clinic at the Jewish General Hospital or the addiction rehabilitation centre (centre de réadaptation en dépendance – CRD) in your region.

Yes, for acute pain, for example, postoperative pain, a fracture or tooth extraction. A user who is receiving methadone treatment often needs a higher-than-usual dose of opioid pain medication because of his higher tolerance and because the pain may not be relieved by the usual dose. The dose of the opioid will then have to be tapered to prevent withdrawal. In this type of situation, the patient may relapse and abuse the tablets prescribed for him.

If the dose of buprenorphine is less than 8 mg, pain can be effectively relieved with opioid medications.

At a higher dose, buprenorphine’s properties effectively reduce the efficacy of other opioids in relieving pain. In this case, buprenorphine will be discontinued temporarily. It is recommended to plan to have a short-acting medication that will make up for the buprenorphine, while relieving the pain.

It’s important to clearly understand that opioid addiction treatment has a number of restrictions, including medication management. The Collège des médecins du Québec’s guidelines do not authorize more than one month of take-home doses for stable patients. You can change pharmacy provided the new pharmacy dispenses the medication and accepts prescriptions written in Quebec. As a last resort, you can be weaned off the medication. However, it would be an enormous challenge to apply this solution in such a short period of time.

Yes. A pharmacist should not provide buprenorphine after three missed doses even if the patient says he took his own medication. The same applies to methadone. It’s important to refer the patient to his health care team, which will have to reassess the patient before restarting the prescription. The dose will be lower, to be safe. The team will also look into the matter of the hoarded doses doses.

Some users have difficulty stopping using despite the prescribed methadone treatment. When this happens, it’s important to work in collaboration with other professionals to optimize the addiction treatment. This user would benefit from psychosocial support and acupuncture to learn how to manage his anxiety. To obtain these services, he can contact CRAN, his local community services centre (centre local de services communautaires – CLSC) for psychological support or a private acupuncture clinic.

Check what time he took the medication at and determine whether it is one of the following situations: