Beyond the scope of this document, there are other topics related to methadone and the treatment of opioid dependence that are important and require future consideration. In particular, pharmacists providing methadone services for patients with pain outside an addiction context still require knowledge of methadone’s unique pharmacology, to protect against the risk of overdose, and knowledge of its potential for abuse, to protect against the risk of diversion. Also, buprenorphine is emerging in Ontario as an alternative medication for the treatment of opioid dependence. Buprenorphine has some unique pharmacological properties that positively impact clinical care (e.g., improved safety profile, potential for less than daily dosing). However, pharmacists must also understand its pharmacology to appropriately start a client on buprenorphine (i.e., induction strategies). This drug also has a risk for diversion. Clinical practice guidelines for buprenorphine are not yet available in Ontario. Future best practice documents for the treatment of opioid dependence should include both methadone and buprenorphine.
The purpose of this guide is to provide recommendations for enhancing pharmacy services in methadone maintenance treatment in Ontario at the pharmacy and system level. It addresses issues beyond the individual pharmacist, making recommendations related to the pharmacy environment, pharmacist education programs, accessibility of pharmacy services and research needs. Consideration and adoption of these recommendations by pharmacy managers, corporate executives, the Ontario College of Pharmacists, pharmacy educational institutions, research scientists, professional pharmacy organizations and the government would provide significant support to pharmacists to provide best practice methadone services, with the goal of enhancing safety and improving therapeutic outcomes for clients in MMT. The results of needed pharmacy practice–based research would help inform future best practice guides for pharmacists providing service for opioid-dependent clients.