Barriers to methadone maintenance therapy access in British Columbia

Methadone maintenance therapy (MMT) is the most widely used and well-researched treatment for opioid dependency in Canada. MMT is regarded as an essential means to overcoming the health, social, and economic harms associated with opiate addiction, including preventing new HIV infections, reducing mortality, criminal activity, syringe sharing and unprotected sex. British Columbia was the first worldwide to launch a methadone program, and has long represented a model of excellence in MMT provision. However, barriers to MMT access continue to occur, particularly among Aboriginal people and the most marginalized members of society. The number of patients receiving MMT has declined since 2002, in spite of a reported unmet need for MMT provision. Canadian health care providers and the patients they serve continue to regard MMT as a controversial treatment. At the root of the concern may be feelings by patients that their needs are not being met, barriers with patients' ability to carry on with their lives and access other treatments, and differences in treatment goals between patients and health care providers. Azar Mehrabadi is investigating policies, attitudes and access related to MMT provision in BC. She is conducting interviews with family physicians and the patients they care for from private and public clinics across BC, drug user advocacy groups, decision-makers, and MMT regulatory body representatives, and gauging their attitudes and beliefs around optimal MMT outcomes. Mehrabadi’s work has important implications for health policy related to addiction, infectious disease prevention, and primary health care provision for marginalized populations in Canada. In particular, best practices for MMT delivery in BC have an important influence on addictions health policies in the rest of Canada and the United States.