Can I get carries if I take long-term dilaudid or fentanyl prescribed by my other doctor? It would be hard or impossible for us to monitor if the fentnayl, dilaudid, oxycontin, or other opioid is being taken according to its prescription or if it's being diverted, abused, and/or supplemented from an illicit source.  So the answer is that carries could not be issued if you are getting opioids from another doctor on a long-term basis (more than 2-3 weeks).

The very rare exceptions are if the patient has been very stable in the past with methadone without problematic drug use, and if more than one doctor including a specialist have documented the exact pain diagnosis and the long term need for the other opioid, and this after other treatments have failed. Even in such cases, the other opioid would have to be prescribed in stable, low to moderate doses, and dispensed in a controlled way which would include take home doses in sequence with methadone carries and observed dosing of the other opioid for the days methadone is taken observed.  

I am currently on methadone maintenance at another clinic. Can I switch to your clinic? Yes.  You can an appointment by contacting one of our locations near you.  However remember that you can be registered in only one methadone clinic at a time. We can help you with the paperwork associated with this process.

How long should I stay on methadone? This is a very common question. The methadone maintenance program is a voluntary program and a patient can choose to stop the program at any time. This should be done gradually in a process called "taper", the rate of which can be determined between the patient and the doctor.

If the patient's goal is not just to get off methadone but also not to relapse to opioid abuse after methadone, then there is no quick answer to how long. The best possible answer is that most people who are successful coming off methadone with long-term abstitence from drug use, show three important characteristics:

1- Their lives have been stabilized after they've been on methadone maintenance treatment and have shown abstinence from drug use for more than a year.

2- The decision to stop taking methadone is made with their doctor, who gradually decreases the dose while providing support. The rate of decrease may be different depending on each patient's needs and preferance, but is generally no faster than 5-10% once a week.

3-They've made changes in their lives that show they're stable. For example, they may have a stable family life, support from the non-drug-using community, steady satisfying employment and fewer financial or legal difficulties.

It is important to understand that methadone, when taken as prescribed, is a safe and effective medication that individuals can take for years. Sometimes people stay on methadone as long as they need to and some patients have chosen to stay on methadone for life. Whether short-term or long-term, research has shown that methadone maintenance is the most effective treatment for opioid dependence.

I used to be a patient on methadone maintenance and then left the program. Can I come go back on methadone treatment? The answer is generally yes. However a doctor's consultation would be necessary to determine this for certain. Please make an appointment at one of our locations.

I am currently on suboxone maintenance at another clinic. Can I switch to this one? Yes.   You can make an appointment to be seen by a physician at one of our clinics to determine this.

I am currently on methadone and have carries. If I switch to your clinic, will I be able to keep my carry level? The answer is generally yes or maybe. It would depend upon a full evaluation by our physician including a review of the previous clinic's documents and pharmacy records.  Our doctor may also need to speak to your previous doctor.

Furthermore, if there has been an interruption of more than 3 days of dosing, and/or if there has been relapse to drug abuse, no carries are issued upon transfer.

How can I pay for your program or methadone? If you are covered by OHIP, then your clinic visits with the physician will be fully paid for.  

The methadone itself which is dispensed at a pharmacy like other medications, will be paid for if you are covered by a private plan, ODSP, Ontario Works, or another form of coverage (a co-pay may apply).  If you don't have any coverage and you don't qualify for any government plan, then your pharmacy can explain to you the costs.

How can I pay for your program or Suboxone? If you are covered by OHIP, then your clinic visits with the physician will be fully paid for.  

The Suboxone itself which is dispensed at a pharmacy like other medications, is usually covered by most private medication plans.  You should consult with your pharmacist about your particular private plan. 

Subxone may be covered by government plans such as Ontario Drug Benefits (ODB) if certain medical criteria are met.  Your physician would be able to explain these.

Do you give carries? Take-home doses of methadone or "carries" are an essential part of an MMT.  The criteria for getting carries are standardized across the province and stipulate that, barring very exceptional circumstances, a patient has to be in the program at least 8 weeks before obtaining a carry for one day per week. Additional requirements for carries are demonstrated lack of problematic drug use, medical and social stability, and secure housing.  The Standards also stipulate that  patients, when meeting these requirements, can achieve an additional carry every 4 weeks, for up to 6 carries per week.

Do you prescribe medications besides methadone and suboxone? Yes, if related to addiction and mental health, such as anti-depressants, sleeping aides, and mood stabilizers.  Also if related to the side effects of treatment, such as laxatives, stool softeners or medications that can help excessive sweating.

Can I get carries if I don't use opioids but use cocaine or crystal meth? The answer is no. We do check for these drugs in urine samples.

Can I get carries if I take valium or clonazepam prescribed by my family doctor? Benzodiazepines such as valium, clonazepam, lorazepam, etc have a dangerous interaction with methadone in causing overdose and death.  This makes carries more dangerous.  For this reason, strict criteria have to be met before carries are issued even if the benzodiazepines are prescribed.  Some of these criteria are that the dose of the benzodiapeine be low to moderate, and that they be dispensed in limited supplies.  The full extent of these criteria can be discussed with your doctor.

It is very important to discuss with your methadone doctor before your family doctor or other doctor starts you on benzodiazepines or any medications that relax you or help sleep.   It is also important that you disclose with all your physicians and pharmacists that you are on methadone so as not to take any other medications that may interact with methadone.

Which is better? methadone or suboxone? There is no right answer.  Each medication may be more suited for certain group of patients. There are many medical and social factors that may suggest one of these medication may be more appropriate for a particular patient. In addition, there is the issue of patient preference which would play an important role in the decision over which medication to use. 

A full medical evaluation and consultation with a physician would be needed to decide upon whether any or either of these medications should be used for the problem of opioid abuse or addiction.  You can make an appointment here.


What happens if I miss a dose? Methadone and suboxone are long-acting medications.  This means that it takes 3-4 days for a new dose to reach a stable level in one's blood.  If one skips a dose, this level can be disturbed for the next 2-3 days.  An unstable dosing schedule and the resulting unstable blood level of medication can cause the patient to feel anxious, agitated, and to have cravings for other opioids.

If you miss more than one dose, this could affect the program itself.  By regulation, if you miss 2 days in a row in the first 2 weeks of the program, the entire prescription will be canceled by your pharmacist and you will need to restart the program by seeing your physician again.  After the first 2 weeks of the program, it will be 3 missed days in a row that will cause your prescription to be canceled, thus necessitating an assessment by your physician to restart the program.

Does Tyloneol show up on urine tests? Isn't "Tyleonol 1" just over the counter? Sometimes patients take acetominephen-codeine combination tablets, thus causing their urine to show "opiates" on testing.  When asked, some patients answer that they ingested just "Tylenol" and thus tend to dispute the results of the office urine test.

It is improtant to note that acetominophen-codeine combination tablets are NOT Tyelnol and are very different than plain Tylenol that contains only acetaminophen and no codeine.  Likewise "Tylenol 1", "Tylenol 2", "Tyleonol 3" are not Tylenol.  They are codeine-containing combination tablets that are controlled substances and not sold on the shelf in the pharmacy.  Tylenol 2 and 3 are never sold without a prescription in Canada.  "Tylenol 1", which is almost never sold under this brand name anymore, is sold as "acetaminophen 325mg/codeine 8mg" tablets without a prescription, but not over the counter.  It is kept behind the counter, and sold by a pharmacist in limited quanities, only aftr questioning and showing proper ID. 

If your urine shows opiates because you took a codeine-containing tablet without proper authorization from your physician, your carry status will likely be affected as codeine is an opioid, which is converted by the liver into morphine.