Survey of Physician Willingness to Provide Methadone Maintenance Therapy Among Primary Care Physicians in Alberta

Methadone has been proven to be a cost-effective treatment for opioid dependence, but availability of treatment is often inconsistent. Currently in Calgary, Alberta, there is a wait-time in excess of three months to access Methadone Maintenance Therapy (MMT) in dedicated Opioid Dependency Programs operated by Alberta Heath Services for the treatment of Opioid Dependence. There are also relatively few primary care physicians in possession of a Methadone exemption. The aim of this study was to identify the reasons for which primary care physicians in Alberta are reluctant to obtain a methadone exemption. We disseminated a survey to family physicians in Alberta in an attempt to identify barriers to obtaining an exemption to provide MMT. Logistic regression analysis was performed to determine how perceived barriers were related to physician willingness to provide MMT. We found that physicians who perceived their practice as requiring modification or a shift were more willing to obtain an exemption (p < 0.05). Willingness was also greater in those less comfortable working with patients with addiction and those with less sense of obligation to provide MMT. The MMT exemption procedure was also identified as a barrier. Among non-exempted physicians barriers included the patient population being difficult (55%) and a lack of experience, training or education in MMT (63%). Among primary care physicians in Alberta, issues of practice modification, the exemption procedure, a perceived difficult patient population and lack of training stand out as barriers to obtaining an MMT exemption.