Impact of a methadone maintenance program on an Aboriginal community: a qualitative study.

© 2016 Joule Inc. or its licensors CMAJ OPEN, 4(3) E431 Illicit drug use and dependence continue to plague populations worldwide and contribute to the global burden of disease.1 Further contributing to the world’s drug problem is the ever-growing epidemic of nonmedical usage of prescription drugs.2 Among illicit and prescription drugs, opioids are responsible for the highest rates of morbidity and mortality related to problematic drug use.3 In Canada, the prevalence of illicit opioid (heroin) use is estimated at 0.9%,4 and the misuse of prescription opioids was reported in 5.2% of the general population.5 Patients with opioid dependence are at an increased risk of infectious diseases, including viral hepatitis6 and HIV.7 Premature death in these patients is multifactorial, but HIV/AIDS-related complications and drug overdose represent the major causes of death in people who inject drugs.8,9 Illicit opioid use also has societal consequences, with individuals who are engaged in risky use of opioids being affected by poverty, homelessness and criminality more frequently than the general population.10 Opioid addiction has been recognized as a chronic relapsing condition that can be controlled through pharmacotherapy maintenance programs. The most predominant form of opioid pharmacotherapy is the administration of oral methadone through methadone maintenance treatment programs.11 These programs have proven benefits at both the individual and societal levels, including reductions in use of injection drugs, acquisition and transmission of viral hepatitis and HIV, death, crime rates, and improvements in participants’ overall quality of life.11,12 In Canada,13 the United States14 and Australia,15 rates of opioid dependence tend to be higher in Aboriginal than in non-Aboriginal communities, as are the rates of associated harms and death.16 However, the beneficial effects of methadone programs are similar among both Aboriginal and Impact of a methadone maintenance program on an Aboriginal community: a qualitative study