Providers Ignoring the Evidence - Difficult to Comprehend!

An article just published in J subst Ab Treatm (2010, vol. 39, pp22-31) discusses "trends in methadone maintenance treatment ... in British Columbia, Canada. It was found that compliance with "minimally effective dose guidelines" dropped from 2001 to 2006, and that this decline was mirrored in the decline of 12-month retention data. Another "... troubling finding was the low rate of compliance to guidelines on starting doses and dose titration" despite the fact that the risk of fatal methadone overdose during the first two weeks of treatment is estimated to be 6.7 times higher than that of heroin-dependent patients not in treatment and 98 times higher than that of patients on maintenance doses of methadone". Specifically, 47% of patients were started on a daily dose greater than 40 mg.

What could the clinicians possibly be thinking, and how many lives have been lost as a result of their refusal to comply with guidelines? When patients are non-compliant they generally are threatened with a host of sanctions, including termination of care. Providers of treatment seem to be immune to sanctions of any kind. Tough to figure!