Segue Clinic

Opioids are a family of drugs used therapeutically to treat pain that also produce a sensation of euphoria (a “high”). They are naturally derived from the opium poppy plant (e.g. opiates such as morphine, opium) or produced synthetically or semi synthetically in the lab to act like an opiate (e.g. fentanyl, oxycodone). Chronic repeated use of opioids can lead to tolerance, physical dependence and addiction.

Natural opioids (Morphine, Codeine, Opium, etc.) are substances that are derived from the opium poppy while semi-synthetic opioids (OxyContin, Hydromorph Contin, Dilaudid, Percocet, Heroin, Fentanyl, etc.) are produced in a laboratory from natural opioids. Synthetic opioids (Fentanyl, Methadone, Demerol, etc.) are manufactured in a laboratory. The following are some of the opioids being used now:

• OxyContin: OxyContin is a time-released, 12 hour pain medication for people who need around-the-clock pain relief.
• OxyNeo: OxyNeo is the new form of OxyContin that was brought in to curb abuse of the original drug. It can still be broken down and used to get high fairly easily.
• Percocet: Percocet is similar to OxyContin, but only lasts about five hours. It contains Oxycodone and Acetaminophen (the drug in Tylenol), which makes people sick if they take too much.
• Fentanyl: Fentanyl is most commonly available as a skin patch, but can appear in the form of lozenges, pills, shots and even a film that dissolves in your mouth. Used to treat extreme pain, and often for cancer, Fentanyl patches are often chopped up and put inside the mouth, or smoked and injected.
• Morphine: Morphine is a common medium to strong painkiller, often used after surgery.
• Hydromorphone: Hydromorphone or Hydromorphs are more often abused because Oxycodone is harder to obtain.
• Carfentanyl:  Carfentanyl is an analog of Fentanyl.  It is 10,000 times more potent than Morphine, making it one of the most potent and dangerous opioids.

Addiction is a neurobiologic disease with genetic, psychologic, social and environmental factors influencing its development and manifestation. It is characterized by behaviours that include:

• Impaired control over drug use.
• Compulsive use.
• Continued use despite harm.
• Cravings.

When an opioid addiction develops, that person has an opioid use disorder. It can range from mild to severe.  

Research has shown that with or without psychosocial support, Methadone and Suboxone are effective treatments for opioid use disorder. 

Methadone is a synthetic opioid medication used to reduce withdrawal and is used to help stabilize and facilitate recovery among those suffering from opioid use disorders.

Suboxone is also used to treat opioid use disorder. The active ingredients of Suboxone are buprenorphine (a semi-synthetic opioid) and naloxone. This mixture is intended to reduce cravings while preventing misuse of the medication.

• An initial interview to decide if this approach is the best treatment.
• A medical examination and laboratory test.
• Urine drug testing to monitor your progress.
• Addiction counselling and ongoing medical assessments.
• Connection to appropriate recovery oriented community resources.

Research demonstrates that the best recovery outcomes occur when medical management is combined with addiction behavioural counseling, housing help and psychosocial supports.

Recovery is the process of improved physical, psychological, and social well-being and health after having suffered from a substance use disorder. Depending on the individual, we connect the person to a variety of resources to facilitate change.

Some people may choose to resume limited drug use or experience a recurrence while on methadone or suboxone. If so, medication adjustments are possible and additional access to recovery oriented resources are encouraged.

Methadone and Suboxone are the mainstay of our medication treatment. Rather than introduce other opioids, we focus on rapid access, accessibility and connection to quickly stabilize each person.

Many people have complex pain problems. Unfortunately some of them also develop an opioid use disorder as a result of treatment. We use Methadone and Suboxone to help manage both conditions. Connections can also be made to other community resources to facilitate an integrated pain management plan.

We offer access to care from 7am to 7pm on weekdays as well as a Saturday morning clinic. A weekend on-call physician service is also provided.

All physician services and urine tests are covered by the Ontario Health Insurance Program (OHIP). Out-of-province patients are covered by their individual provincial health plans (excluding Quebec).

The cost of methadone is covered by the Ontario Drug Benefit Program for those patients who are covered by that plan. Otherwise, there may be costs for the medication and/or dispensing at your pharmacy.

Suboxone is usually covered by private drug plans and special coverage may be available through the Ministry of Health’s special consideration department.