Recruit service providers

Recruiting health care providers and partnering with community support services are challenging tasks of the development stage. Involve service providers as early on in the program development process as possible. While the model of care should focus on the needs of the clients, you must also consider the needs and resources of the service providers to have an effective, collaborative program.

QUICK FACT

Too many people (service providers included) see opioid addiction as a self-inflicted disease of the will. They believe that a drug-free state is the only acceptable goal and that any attempt at treatment will inevitably fail. However, opioid drug addictions can indeed be effectively treated with significant benefits to the individual and to society (NIH Consensus Conference, 1998).

Recruitment of service providers will involve breaking down biases and stereotypes and correcting misconceptions. You should educate potential service providers by engaging them in awareness outreach activities.

To raise awareness and gain acceptance of MMT, you can:

hold information sessions, including arranging in-service presentations
prepare service provider-specific handouts (See http://methadonesaveslives.ca.)
enlist the support of guest speakers (e.g., peers, clients or subject-matter experts)

“…addiction is a very marginalized illness. Society doesn’t understand it very well. Doctors don’t understand it very well. To bring it out into the open as an illness that is [treatable] …would be wonderful.” — family physician and MMT prescriber

Revise the presentation you made to the working group to suit the specific service-provider audience. (See The first meeting.) Information sessions may be given to groups or in a one-on-one setting. The education portion of the meeting could be presented by a physician or other health care professional experienced in methadone treatment. You may also wish to partner with related organizations and associations to educate and recruit service providers, for example:

CAMH
CPSO
local medical school
local medical society
community health centres
emergency department
local pharmacy association
local network of addiction agencies
LHIN.

TIP

Doctors who already provide MMT in your area or in another community can help raise awareness and acceptance among potential service providers. A physician supporter, or champion of the cause, can help educate and recruit.

These organizations and associations can help your education and recruitment efforts. They may be able to:

hold methadone information sessions in conjunction with their regularly scheduled association meetings
endorse information sessions or meetings that you host
send out invitations to the meeting to their members, using their letterhead or e-mail
send out follow-up information
give you a list of their members
provide guest speaker(s) for information sessions
provide honorariums for client and family speakers.

Recruitment of service providers, especially physician and pharmacists, is often an ongoing effort. Having them help shape your program model is ideal. However, you may need to continue recruiting after you have decided on a program model. You may find that some physicians and other service providers may be willing to join the program only once you have community acceptance of the project plan.

Similarly, some (especially physicians) may join the team after program elements have been established, for example a program site, access to case management and counselling services, administrative support, links to health and social support services. Service providers joining the program later in the development process may offer additional infrastructure or service delivery components that will modify the program model.

MMT Policy Changes in Canada

Given the proven benefits of MMT, the following policy changes were made in 1996 in Canada to improve access to this effective treatment option for opioid dependency and to ease the shortage of physicians and other health care providers who can deliver MMT (Fischer et al., 2002, Strike et al., 2005).

Regulatory oversight was transferred from the federal government to the provinces.

Administration became the responsibility of the Colleges of Physicians and Surgeons.

Treatment guidelines were revised.

Caseload limits were rescinded.

Training requirements were shortened.

Physicians

Physicians are an imperative component to any MMT service delivery model. Without them, a program cannot be established. They are responsible for the prescription of methadone treatment and all attending liabilities. Physicians must be approved by Health Canada, on the recommendation of their provincial regulatory body, and receive an exemption to be able to prescribe methadone for opioid addiction. In Ontario, this requires the completion of approved training offered by CAMH. (See Training for service providers.)

CAMH’s Opioid Dependence Treatment Certificate Program

The interprofessional Opioid Dependence Treatment Certificate Program prepares physicians, pharmacists, nurses and counsellors to assess and treat people with opioid dependence. The core course meets the CPSO and OCP regulatory requirements for prescribing and dispensing methadone and buprenorphine for treatment of opioid dependence. Participants receive relevant continuing education credits upon completion of the course.

The program uses a blended-learning approach that includes online and classroom components. Participants are required to complete:

core course: five self-directed online modules followed by a one-day workshop

elective courses: three or four elective courses.

Contact CAMH for more details and upcoming course dates. See Resources for more information.

To recruit physicians, you can:

get a list of local doctors from your local medical societies, LHIN or a physician contact
contact the CPSO for guidance and support on physician recruitment
invite physicians to an information session
seek endorsements from the LHIN and the local medical society
enlist a subject-matter expert to facilitate the meeting
invite other appropriate supporters to make presentations at the meeting, such as practising MMT peers, clients, members of the working group, CPSO representatives
set up one-on-one meetings with individual physicians or physician cooperatives
show the documentary Prescription for Addiction (DVD)
present clinical research and support materials about MMT, its benefits, your project and the physician exemption and training requirements
supply attendees with contact information for the working group, CPSO and CAMH where they can get more information
arrange to have an MMT physician speak during grand rounds at the local hospital.

Doctors who already provide MMT in your area or in another community can help raise awareness and acceptance among local doctors about the program model and its related benefits. A physician supporter can also help educate and recruit other service providers, such as pharmacists, nurses, nurse practitioners, related health care providers and counsellors.

“Be patient but persistent. You only have to engage one or two physicians in order to get the clinic started. All of our physicians were recruited by a physician already prescribing methadone.” — MMT program director

Ideally, your community should have more than one MMT doctor so that they can support one another and provide consistent care in the case of illness, vacations and out-of-town commitments. If you cannot successfully recruit a physician, you may invite an MMT physician from another community to assist temporarily until a physician from within the community can be recruited.

“The mandate of CPSO’s program to improve the quality and accessibility of MMT in Ontario is achieved in cooperation with CAMH and OCP. The profile of methadone treatment in Ontario has been enhanced through outreach activities and the recruitment of physicians to prescribe methadone in the treatment of opioid dependence.” — CPSO website

Pharmacists

Community pharmacists are also essential service providers for an MMT model. Any pharmacy can dispense methadone provided that the methadone policy outlined by OCP is followed. Methadone training through CAMH’s Opioid Dependence Treatment Certificate Program or approved course is highly recommended for all pharmacists and is required for the pharmacy manager and at least one staff pharmacist.

The decision whether or not to dispense methadone is entirely the choice of the pharmacist or pharmacy owner. Your recruitment goals will include increasing awareness and acceptance of your program among your community’s pharmacists and owners or designated managers of the local pharmacies.

To recruit pharmacists, you can:

get a list of local pharmacists from the local pharmacist association or pharmacist contact
invite pharmacists to an information session
ask for support from pharmacist associations, such as the OCP and the Ontario Pharmacists’ Association (OPA)
enlist a subject-matter expert to facilitate the meeting
invite other appropriate supporters to make presentations at the meeting, such as other pharmacists who dispense methadone, an MMT physician, and clients and members of the working group
show the documentary Prescription for Addiction (DVD)
present clinical research and support materials about MMT, its benefits, your project and training opportunities
supply attendees with contact information for the working group, OCP, OPA and CAMH where they can get more information
ask physicians involved in the program to help recruit pharmacists with whom they work closely
set up one-on-one meetings with individual pharmacists or staff of pharmacies.

QUICK FACT

The Ontario College of Pharmacists published their updated Policy for Dispensing Methadone in 2006. All Ontario pharmacists dispensing methadone are required to follow the policy. See www.ocpinfo.com for more information.

Laboratory Services

Laboratory services are also an important component of the model, primarily providing collection and analysis of urine samples. Your recruitment should start with the laboratories that your physicians work with. Invite laboratory owners to information sessions to dispel any stigma and raise awareness and acceptance of the MMT program.

Case Managers and Counsellors

Case managers and counsellors are an integral part of an MMT program. They provide support and ongoing assessment and adjustment of a client’s treatment program. They also link clients to the health and social support services they may need. CAMH’s interprofessional Opioid Dependence Treatment Certificate Program is also recommended for counsellors.

To recruit case managers and counsellors, you can:

partner with addiction treatment agencies or other community support services to share case management and counselling loads
seek funding to hire case managers and counsellors for the program. (See Secure resources and funding.)

“Addiction counselling is really important.” — family physician and MMT prescriber

Nurses and nurse practitioners

Nurses and nurse practitioners are sometimes included in MMT care team. Depending on the service delivery model their responsibilities can include the administration of methadone, counselling and health education, and client care coordination with other agencies on behalf of the client. CAMH’s interprofessional Opioid Dependence Treatment Certificate Program is also recommended for nurses.

To recruit nurses, you can:

get a list of local nurses from a nursing association or nurse contact
invite nurses to an information session
enlist a subject-matter expert to facilitate the meeting
invite other appropriate supporters to make presentations at the meeting, such as other nurses or doctors who work with methadone clients, clients and members of the working group
show the documentary Prescription for Addiction (DVD)
present clinical research and support materials about MMT, its benefits, your project plan and training opportunities
supply attendees with contact information for the working group and CAMH where they can get more information
ask physicians involved in the program to help recruit nurses.

Health and Social Support Services

You should strive to include health and social support services in your program and establish partnerships with them. Which services you are able to include will depend on the services available in your community and your resources to engage additional services. Services you may wish to consider for your program include:

general counselling
primary health care
mental health care
social assistance
financial assistance
child care assistance
supportive housing
employment assistance.

Reconnect with the people you met during the earlier planning stages from local addiction treatment and mental agencies, public health units, social service departments and other related agencies. Members of the working group may be representatives from these agencies or have close ties to them. These working group members can create links and help establish successful partnerships to ensure that support services are included in the program.

“Partnerships are key. They spread the load and lend credibility to your project.” — MMT case manager

While many of these potential partners may be interested in participating in the program, they may not have the staff or funding available to provide the necessary counselling and case management services. (See Secure resources and funding.)