Evaluation of a Low-Threshold/High-Tolerance Methadone Maintenance Treatment Clinic in Saint John, New Brunswick, Canada: One Year Retention Rate and Illicit Drug Use

Objective. To report the one-year retention rate and the prevalence of illicit opioid use and cocaine use in the Low-Threshold/High-Tolerance (LTHT) methadone maintenance treatment (MMT) clinic located in Saint John, New Brunswick, Canada. Methods. A description of the LTHT MMT clinic is provided. The one-year retention rate was determined by collecting data on patients who enrolled in the LTHT MMT clinic between August 04, 2009 and August 04, 2010. The prevalence of illicit drug use was determined using a randomly selected retrospective cohort of 84 participants. For each participant the results of six consecutive urine tests for the most recent three months were compared to the results of the first six consecutive urine tests after program entry. Results. The one-year retention rate was 95%, 67% of the cohort achieved abstinence from illicit opioids and an additional 13% abstained from cocaine use. Conclusion. The novel feature of the LTHT MMT clinic is that patients are not denied methadone because of lack of ancillary services. Traditional comprehensive MMT programs invest the majority of financial resources in ancillary services that support the biopsychosocial model, whereas the LTHT approach utilizes a medical model and directs resources at medical management. 1. Introduction Most Canadian methadone maintenance treatment (MMT) programs have limited treatment capacity, hundreds of people on wait-lists and wait-times that exceed 6–12 months [1]. The result is that many people, who are motivated to seek treatment for their addiction, remain untreated. In Canada, the provision of MMT is regulated by Health Canada’s guidelines, with each province and/or territory having the option of developing their own [2]. A review of the Federal Guidelines and those of seven provinces demonstrate that each adheres to the biopsychosocial model of MMT and require, among other things, the provision of psychosocial counseling, random urine testing, and mechanisms for the involuntary discharge of patients [3–9]. This paper will report the evaluation results of the low-threshold/high-tolerance (LTHT) MMT clinic in Saint John, New Brunswick, Canada. The LTHT approach is novel because it utilizes a medical model rather than the traditional biopsychosocial model that predominates in Canada. This model incorporates recommendations of the Government of Canada “best practices” document with the foundational premise that the provision of MMT should not be contingent on the availability of resources for psychosocial treatment [10, 11]. The “low-threshold” aspect refers to the