Harm Reduction and the chronic disease opioid use disorder (OUD)

Most opioid replacement clinics in Ontario work within a harm reduction philosophy. In simplified form this means that we believe decreasing use of a substance has value – complete abstinence is a goal but even decreasing use leads to better outcomes for the patient, their family and society as a whole. There is plenty of scientific data that support this approach.

Some agencies consider opioid maintenance inherently harm reduction because patients are still taking a “drug”. At BMC we disagree. We see methadone and buprenorphine as medications, prescribed by a physician for a chronic disease. The disease is opiate dependency. There is an accepted clinical description of the disease, the resulting changes to the brain can be seen on functional brain scans (PET and fMRI) and the medical therapy is very effective. A disease, no question.

We do have harm reduction patients – those that choose to continue using opiates or other drugs. They continue on methadone and buprenorphine because the program does improve their lives. We hope that in the future they will stop this residual use but it is their choice. They are still welcome at BMC.

However we feel that the majority of patients – those that become drug free and work towards recovery, getting their lives back, supporting their families and contributing to society are no longer addicts. They no longer manifest the maladaptive behaviors that define OUD. Note that mal means bad and adaptive means they were not the persons behaviors before they started using substances. Of course they are always at risk of falling back into addiction similar to a person who has been “cured” of cancer – there is a risk that the cancer will return.

Contingency Management

Most opioid replacement clinics in Ontario also follow this principle of treatment. With contingency management, rewards are provided to patients contingent (depends on or conditional) on staying substance free and maintaining a stable lifestyle. These rewards are carries or take home doses. Carries make life much easier for our patients in recovery and we encourage them to work towards these rewards which not only recognize their effort and progress but facilitate transitioning back into society. In fact if patients do not earn carries many eventually get tired of methadone or buprenorphine maintenance. The treatment that at first made life so much easier eventually becomes tiresome for many Рof course if they leave the program abruptly they usually relapse. We think for most people considering methadone or buprenorphine maintenance their goal entering the program should be to become substance free.

Clinic Policy

Besides Harm Reduction and Contingency Management there are specific BMC Policies for Patients. These are contained in a document you will be given and asked to read, understand and sign before starting the program. Most importantly the polices define the behavior that is not accepted at BMC Рwe do not allow threatening or disrespectful behavior to patients or staff nor illegal activity including dealing drugs on BMC property. Breaking these two simple rules will lead either to immediate discharge or a final warning.

At BMC we strive to provide a safe, respectful, tolerant and caring environment. We believe this helps our patients in their journey through recovery. We will also protect your privacy – treatment is confidential.