Patient perspectives of methadone formulation change in British Columbia, Canada: outcomes of a provincial survey
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RESEARCH
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Patient perspectives of methadone formulation change in British Columbia, Canada: outcomes of a provincial survey Alissa M. Greer1*, Sherry Hu1, Ashraf Amlani2, Sarah Moreheart3, Olivia Sampson1 and Jane A. Buxton2
Abstract Background: In British Columbia, Canada, methadone maintenance treatment formulation transitioned from the oral liquid compound Tang™-flavoured methadone to the ten-times more concentrated cherry-flavoured Methadose™ in February 2014. We quantitatively describe perceptions and reported consequences among a sample of patients on methadone maintenance treatment following this transition. Methods: A province-wide survey was used. Bivariable analyses utilized independent samples t-tests, Phi associations, and Chi-square tests. Multivariable logistic regression analyses evaluated factors related to dependent variables – namely, increases in dose, pain, dope sickness, and the need to supplement with additional opioids. Results: Four hundred five methadone maintenance treatment patients from fifty harm reduction sites across British Columbia reported transitioning to Methadose™ in February 2014. The majority (n = 258; 73.1 %) heard about the formulation change from their methadone provider or pharmacist. Adjusted models show worse taste was positively associated with reporting an increasing dose (OR = 2.46; CI:1.31–4.61), feeling more dope sick (OR = 3.39; CI:1.88–6.12), and worsening pain (OR = 4.65; CI:2.45–8.80). Feeling more dope sick was positively associated with dose increase (OR = 2.24; CI:1.37–3.66), and supplementing with opioids (OR = 8.81; CI:5.16–15.05). Conclusions: Methadone maintenance treatment policy changes in British Columbia affect a structurally vulnerable population who may be less able to cope with transitions and loss of autonomy. There may be a psychosocial component contributing to the perception of Methadose™ tasting worse, and increased dope sickness, pain, and dose. Our study shows the pronounced negative impacts medication changes can have on patients without informed, coordinated efforts. We stress the need to engage all stakeholders allowing for communication about the reasons, risks and consequences of medication policy changes and provision of additional psychosocial support. Keywords: Methadone, Methadose, Opioid substitution therapy, Medication formulation change, People who use drugs, Change intolerance, Policy change
Background Methadone is a long-acting synthetic mu-opioid agonist with unique dual opioid receptor agonist and nonselective N-methyl-D-aspartate (NMDA) receptor antagonist abilities [1]. Methadone has been available for more than 50 years and is viewed as an efficacious and safe agent for the treatment of chronic pain and opioid * Correspondence: [email protected] 1 University of British Columbia, School of Population and Public Health, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada Full list of author information is available at the end of the article
addiction [1–3]. Taken orally once daily, methadone is used to initiate a
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