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There has been dramatic recent expansion of methadone prescribing in the Province of Ontario, Canada (Brands J, Brands N and Marsh D. Addiction Research, 2000, Vol. 8, Number 5, pp 485-496). This expansion was achieved through major reliance on generalist, office-based physicians who are trained and supported by the College of Physicians and Surgeons of Ontario (CPSO); it was made possible by removal of some key regulatory constraints (e.g., a maximum number of patients that a physician could treat), abandonment of abstinence as the goal of methadone treatment and its replacement with a harm reduction orientation, delegation by the Federal government to provincial authorities responsibility for monitoring, regulation and policy development in this field of medicine and shortening of the training period for physicians from 15 days to 2. Since January, 1997, training has been provided jointly to physicians and community pharmacists.
The results: In the beginning of 1996 770 patients receive methadone for addiction in Ontario; by the end of 1998, the number exceeded 4,000. In mid-1996 41 physicians were prescribing methadone; at the end of 1998 there were 110, and the average number of patients in each practice had risen from 24 to 37. It is postulated that willingness of physicians to participate was enhanced significantly by the more reasonable training requirements and by establishment of a central referral system whereby those seeking treatment could be referred to a local general practitioner without that doctor's name being publicized.
In addition to the major expansion of treatment capacity and the impact on the previous waiting lists (a year or more was "not uncommon"), the authors note the marked enhancement of convenience for patients, who previously often had to travel long distances for their case. Finally, the system of reliance on community-based physicians has "resulted in previously 'captive' patients being able to shop around ... after what had been a treatment provider monopoly.