The Scope of Methadone Maintenance Treatment in London, Ontario

CURA2 Conference, 2015Lamplighter Inn, London, ON

Team

• Dr. Abe Oudshoorn, Western University• Ken Kirkwood, Western University• John Fleming, City of London• Gregg Barrett, City of London• Jacquie Carr, Addiction Services Thames Valley• Donna Baxter, City of London• Jan Richardson, City of London

Purpose

• The purpose of this quantitative descriptive study was to better understand the geographic spread of those currently accessing MMT within a medium sized urban area

• Hypothesis: Individuals accessing MMT reside in all residential neighbourhoods of London

Background

• Opioid addiction and morbidity– HCV and HIV

• Opioid addiction and mortality

• Community costs– $243,000,000 law enforcement costs in Canada– Social and family costs

Methadone Maintenance Treatment (MMT)

• What it is• How it works• Short term goals• Long term goals

Demographics of Opioid Addiction

• Link to:– Poverty– Low education– Poly-substance use– Mental health challenges

• But…– A more diverse group addicted to prescription opioids

Result?

• Proliferation of MMT clinics• Clashes with neighbourhoods• Questions regarding municipal policy

Literature Review

• Stigmas:– Disorder– Contagion– Crime– Harm to children– Not needed in our neighbourhood

Literature Review

• Reality– Many treatment centres go unnoticed– Treatment centres are low on the list of causes for a person to spend

significant time in a particular area– Treatment centres reflect those seeking treatment– Presence of treatment centres reduces community-wide crime– Variety stores much more related to geographic crime than treatment

centres– Low rate of critical incidents around treatment centres

Gap in the Literature

• ?? Persons seeking treatment geographically dispersed ??• We do know that lack of rural clinics brings people to urban

clinics

Local Policy Context

• Interim control by-law• Zoning by-law– On transit– Separation between clinics and from schools– Adequate parking

• Licensing by-law ($700)

Methodology

• 5 clinics and 1 pharmacy approached• 796 unique individuals representing 581 data points from 1

clinic and 1 pharmacy• Mapped over 26 residential neighbourhoods in London

Findings

Hypothesis Supported

• Individuals accessing MMT reside in all residential neighbourhoods of London

Discussion

• Confronting NIMBYism with evidence• It’s not that clinics attract people with addictions, it’s that

people with addictions already live in all neighbourhoods

• Zoning implications– Beware overly restrictive zoning– Respect public opinion, but not where it stands counter to best

evidence

Questions