A Primary Care/Multidisciplinary Harm Reduction Clinic Including Opiate Bridging

Abstract

Wait times for methadone maintenance programs are associated with significant dropout rates. This puts the substance user at risk of continued illegal and high-risk behavior. We describe a unique model of daily dispensing opiates other than methadone to “bridge” clients awaiting methadone management. The Health and Harm Reduction Clinic is a community-based, primary care health clinic in Edmonton, Alberta, Canada, an urban city of 1 million. The team is comprised of a family physician, nurse practitioner, social/mental health worker and addictions counsellor. Descriptive data utilizing chart reviews from 2001 to 2005 are presented: one hundred four noninjection drug users and 86 injection drug users, with 43 of the latter being “bridged.” This team model, which includes opiate bridging to a methadone program, appears to provide a reasonable approach for community-based practices to offer quality care for substance-abusing patients. Further clarification of the impact on health outcomes and health service utilization is suggested.

Keywords:

• bridging
• harm reduction
• methadone
• primary care
• multidisciplinary
• dropout

Notes

¹ Addiction treatment is a misnomer. Treatment can be briefly and usefully defined as a planned, goal directed change process, which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users-of whatever types-which aren't also used with non-substance users. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) treatment-driven model, there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Editor's note