Opioid agonist therapy (OAT) with methadone or buprenorphine/naloxone is used to treat individuals with opioid use disorder. Pharmacists providing OAT are expected to have the necessary knowledge and training prior to dispensing and to practice in accordance with all applicable Standards of Practice, legislations, policies and guidelines. For more information, please consult the Ontario College of Pharmacists’ (OCP) Opioid Policy and fact sheet on Key Requirements for Methadone Maintenance Treatment (MMT). Below are additional resources to support pharmacy professionals who provide OAT.
Methadone
On May 1, 2020, the Methadone Maintenance Treatment Reimbursement Policy, 2020 came into effect and replaced the 2014 policy for the reimbursement of methadone for all pharmacy operators in Ontario that supply methadone to Ontario Drug Benefit (ODB) eligible persons requiring MMT for opioid use disorder. This new policy reflects the additional methadone 10 mg/mL oral liquid product options that are available and listed on the ODB Formulary. For more information about ODB’s reimbursement policy and claims submissions, please refer to the following:
In addition, pharmacy professionals are reminded that as of May 19, 2018, practitioners are no longer required to obtain a subsection 56(1) exemption under the Controlled Drugs and Substances Act (CDSA) to prescribe, administer, sell or provide methadone to their patients. Therefore, pharmacists will no longer need to contact Health Canada to verify if a prescriber holds a valid exemption. Please consult Health Canada’s webpage on the Methadone Program for more information.
Buprenorphine/Naloxone
Although both buprenorphine/naloxone and methadone can be used to treat opioid use disorder, the reimbursement policy for buprenorphine/naloxone is not the same as for MMT under the ODB Program. For example, separate claims for each take-home dose of buprenorphine/naloxone cannot be submitted for reimbursement to the ODB program as is the practice for MMT claims. Pharmacy professionals should refer to the Notice from the Executive Officer: Buprenorphine/Naloxone (Suboxone® and generics) Reimbursement Reminder under the Ontario Drug Benefit Program for more information about reimbursement and claims submissions.
COVID-19-Related Resources
OPA’s A Pharmacist’s Role in Managing Opioid Use Disorder During COVID-19 highlights potential adjustments to practice that may be required when providing OAT treatment during the pandemic. Topics covered include observed dosing, carries, delivery or pick-up by an authorized agent, and communication tips. Links to additional resources are also provided to support pharmacists managing OAT.
General Resources
OPA, supported by a grant from the Ontario Ministry of Health, offers a variety of tools and resources to support healthcare professionals who prescribe, administer, sell or provide methadone and or buprenorphine/naloxone for the treatment of opioid use disorder.
Methadone and Buprenorphine/Naloxone Toolkit
OPA’s Methadone and Buprenorphine/Naloxone Toolkit is designed for pharmacists who provide methadone and/or buprenorphine/naloxone programs in their pharmacies. These complimentary tools are provided to help pharmacists support patients on opioid substitution therapies, and include a general overview on addictions management principles, how to initiate OAT programs in your pharmacy, dispensing procedures, drug information about methadone and buprenorphine/naloxone, and answers to frequently asked questions.
Opioid Substitution Therapies Discussion Forum
This online discussion forum is designed to give healthcare providers who prescribe or dispense methadone and/or buprenorphine/naloxone a place where they can share best practices, discuss tough practice questions, and interact with other professionals who prescribe or dispense OAT for the treatment of opioid addiction. Log on to the forum to interact with subject matter experts in areas including (but not limited to) the administration of methadone maintenance therapy in pregnancy and lactation, managing concurrent psychiatric illnesses, and handling difficult situations.
Registration is free and the forum is open to all OAT dispensers and prescribers – click here to register.
Opioid Substitution Therapies Support for Professionals
If you have any questions related to Opioid Substitution Therapy, please send an email to [email protected] with your name, phone number, and your question. This mailbox is monitored by trained pharmacists Monday to Friday from 10 am to 3 pm.
Professional Development
OPA provides complimentary continuing education programs to help educate healthcare professionals about opioid addictions and substitution therapy. Programs are offered in both live and online formats. Please note that these programs qualify as approved training updates for pharmacists who dispense methadone, which are required at a minimum every 5 years as per OCP’s Opioid Policy as a requirement for dispensing MMT.
Live programs
These sessions offer healthcare professionals information about opioid agonist therapy, related special topics, policies guiding methadone dispensing in Ontario, operationalizing methadone dispensing policies in Ontario, and destigmatizing opioid use disorder.
Online modules
A collection of online education modules are available on topics such as the policies guiding methadone dispensing in Ontario, frequently asked questions about OAT, providing inclusive care for LGBTQ+ patients, and identifying the pharmacist’s role in harm reduction.