What are Opioids?

Opioids are a family of drugs used therapeutically to treat pain that also produce a sensation of euphoria if used in higher doses. They are derived from the poppy plant (opium) or produced in the lab (for example morphine, oxycodone, hydromorphone and fentanyl). Chronic repeated use of opioids can lead to tolerance, physical dependence and addiction. When these medications are abused, they are commonly snorted, smoked or injected for an immediate euphoria [high].

The following are some of the opioids being used now:

Morphine is a common medium to strong strength analgesic, depending on the dose. It is often used intravenously after surgery. It is also available orally as short acting [morphine sulphate] and long-acting extended release formulations (Kadian) to manage chronic pain.

Oxycodone is a strong analgesic with a higher risk for abuse. It comes in short acting tablets [such as Percocet] as well as long-acting formulations [OxyContin and Oxyneo].

Hydromorphone is a strong analgesic that can come in short acting tablets [like Dilaudid] and long-acting formulations. Hydromorphone has an analgesic potency up to 8 times greater than morphine.

Fentanyl is a synthetic opioid typically used to treat severe pain. It is 100 times more potent than morphine. Illicit fentanyl is manufactured abroad and smuggled into Canada. It is typically mixed with other illicit drugs to increase its potency (such as benzodiazepines, xylazine). It is the primary driver of the overdose deaths in Canada.

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.

What is Methadone?
Methadone is an oral medication used to treat opioid use disorder.  It is a long acting opioid powder that is dissolved in an orange drink and dispensed by the pharmacist. The medication will last 24 hours when a stable dose has been identified. The dosage for each patient is carefully customized, typically during the first 1 or 2 months of treatment. By taking the place of illicit opioids, methadone prevents craving and withdrawal symptoms. People report feeling normal, functional and having a clear mind all day long. This can allow those in treatment to focus on therapy and establish a strong basis for recovery.
Methadone appears to be the most effective option for patients with a severe opioid use disorder and IV users.
What is opioid use disorder?

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.

What is medication assisted treatment?

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.

What services are provided in our program?
  • 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.
Why does Segue Clinic encourage counselling?

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

What is recovery?

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.

What happens if I use other opioids while on Methadone or Suboxone?

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.

Do we prescribe other opioid medications?

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.

What about my chronic pain problem?

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.

What are your hours of availability?

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.

Is there a cost for the program?

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.

Can I take suboxone and methadone safely in pregnancy?

The correct answer is: Yes.  In fact, stopping any opioid including methadone or suboxone suddenly enough to induce a withdrawal syndrome is to be avoided for the safety of the baby.

Suboxone versus methadone - how do they compare?

Suboxone and methadone have similar rates of success. People taking these medications are twice as likely to stay in treatment compared to those without medication.
Suboxone is also preferred in mild to moderate opioid use disorder because it has a lower risk profile. However methadone appears to be more effective with severe opioid  use disorder and keeping people in treatment (75% vs 50% retention).

What is precipitated withdrawal?

Precipitated withdrawal is when sudden withdrawal symptoms are caused by a medication, rather than the avoidance  of opioid drug use. Examples of medication that can cause precipitated withdrawal include:

Suboxone. When starting Suboxone for the first time, an abstinence period is required (typically 12–24 hours). If it is taken before moderate withdrawal symptoms develop during this interval,  it can precipitate withdrawal.
If this is a concern, your physician will recommend suboxone microdosing to prevent this problem.

Naloxone (Narcan) which is typically used to reverse an opioid drug overdose.

How long will I be in treatment?

You and your physician will collaborate to design a program for you that achieves the best possible outcome given your particular goals and circumstances. The more time you are willing to invest in your recovery, the less likely relapse will be when you complete the program.
Will I become addicted to Methadone or Suboxone?

The DSM-5 has eleven criteria, or symptoms, for substance use disorders based on decades of research. The DSM-5 has helped change how we think about addictions by not overly focusing on withdrawal.

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