Methadone Substitute 'Methadose' Arrives In Ontario

methadose ontario

September 1 has finally come and gone, and here in Ontario it marked the arrival of a new formulation of Methadone by Mallinckrodt Pharmaceuticals know as "Methadose." There has been plenty of discussion regarding the switch and it's negative impacts in British Columbia; some vehemently opposed to the change, others standing firmly behind the position that there is absolutely no difference between the two formulations. However, I no longer have to go by second hand accounts, as I have now officially made the Methadone to Methadose switch myself. 

Changes Are Afoot

When I began hearing about the changes to the Methadone formulation in B.C. as well as the problems being raised by patients, my reaction was mixed. My first thoughts were those of empathy, discontent and relief. I truly felt for those patients in B.C. who were not adjusting well to the switch, and experiencing painful withdrawals. I was very unimpressed with the Province for making changes that are putting peoples hard earned recovery and sobriety at risk. However, if I'm being honest, I was also completely and utterly relieved that there was no mention of Ontario in this switcharoo.

This article was first published on Studio L Online. Read the original here.

Just a few short months later while at the pharmacy for our daily dose of Methadone, Mr. L mentions he overheard discussion about something called "Methadose" and changes to Methadone, and asked me if I had heard anything of it. As soon as the word "Metha-DOSE" left his lips, my heart sunk. Fuck. I shook it off, and hoped to hell what he had just overheard did not pertain to us. I was just itching to hop on my bike and get myself home so I could dig into the treasure trove of information that is Google -- searching for anything and everything remotely related to Ontario and Methadose.

The search results revealed exactly what I didn't want to see. The Ontario Ministry of Health and Long-Term Care had indeed made the decision to change from the current formulation of Methadone to Mallinckrodt Pharmaceuticals "Methadose" as of September 1, 2014.

Journey to Recovery

I have been on Methadone for three years now. It has allowed me to reclaim my life and my freedom from the hell that is addiction. I lost everything I had to my addiction, exhausted all options and help from friends and family, and had ended up on the streets. was a total wreck; a homeless IV drug addict at age 24. Not where I had planned on being, ever. The only thing I had left was Mr. L. But then I found Methadone Maintenance Treatment (MMT), and made the decision to give it a go. I had absolutely nothing left to lose. I had attempted and failed every time I tried weaning myself off, going cold turkey, or going to rehab. It never worked. My addiction had become far too powerful. I could no longer function like a normal human being.

Opiates had become as vital to my being as the air I breathe, and it completely consumed me.

Only a week or two into my Methadone treatment, I began to notice changes in myself. For the first time in years the fogginess had lifted, and I felt clearheaded and aware. It wasn't only mental improvements I noticed. Physically, I was slowly able to shoot up less and less, and the powerful withdrawals I felt were beginning to fade and decrease as well. It was overwhelming in such a wonderful way. I could feel my once "all-powerful" addiction loosening its grip on me. With each passing week, things only improved further. With time, effort and commitment, I was able to completely turn life around. I had finally reached my optimal dose, and for the first time in years I was stable, sober and had a place to call home. I was myself again.

The thought of my hard earned recovery and sobriety being put at risk is not something I take lightly. With approximately one in four patients experiencing problems with the transition in B.C., it's not at all comforting to know that there could be as much as a 25 percent chance that all of my hard work and efforts could go right out the window based on complaints and reports of once-stable patients in B.C. (although no official studies or investigation has been completed as of yet). Of course, I know that those odds aren't set in stone, and I know that there is a very good chance that I will experience absolutely zero issues during my transition. However, the simple fact that there is a risk here at all is what irks me. The whole point of this treatment is to keep me stable and sober.

So why would the Ministry of Health and Long-Term Care (MOHLTC) switch things up in a treatment program that depends so much on patient stability? Money.

The Ministry of Health and Long-Term Care doesn't see the stability issue, as the deep discount in price seems to be blinding them -- even with the glaring issues occurring in B.C. Yet the MOHLTC touts that this whole switch is for an oddly similar reason; consistency. In order to provide consistency, individual pharmacies will no longer be compounding the Methadone; it now comes premixed. However, every pharmacy staff member I have spoken to has rebutted this, saying that the regulations on the compounding of Methadone were so strict, that inconsistencies in mixtures were a non issue. Changing Methadone formulations is messing with the very fragile stability that patients work so hard to achieve and maintain.

Regardless of the reasons or opposition, the change has now officially taken place, with September 1 being the first day my pharmacy dispensed the new formulation.

Downing The First Dose

For those unfamiliar with how Methadone is dispensed, below is a diagram of a typical Methadone or Methadose electronic bottle top dispenser commonly used by pharmacies to accurately measure liquid doses of medication.

Taste and consistency are two immediately noticeable differences. The new Methadose is cloudy in color and has the consistency of a loose syrup. It does not pour as easily out of the cylinders, as the thickness of the solution seems to work against it, causing residue of the patients dose to be left behind in the graduated cylinder. In my opinion, this could be problematic, as at the higher concentration of 10mg/ml, missing out on even a small amount of syrup could have an impact on the dosage consumed by the patient. When 10mg are packed into a single milliliter, getting the full amount of that liquid counts -- especially when on a low dose. When mixed in with Tang, the solution is considerably thinner than I was expecting. I imagined some flavorless version of children's Cough syrup, however, in reality the Methadose is not near as thick.

As for the taste ... Well, compared to the Methadone, there isn't much in the taste department. My pharmacy is dispensing the sugar-free flavorless version of Methadose, rather than the Cherry flavor (Thank GOD). Methadone had an extremely potent taste; even when mixed with Tang, it was the type of thing you want to ingest in the style of a shot, as its taste is fairly overwhelming. Hell, it could be quite entertaining at times in the morning watching patients faces pucker up after downing their dose. So I was fairly surprised when I took my first mouthful, only to be met with very little in the taste department. It has only a very mildly bitter taste. You can certainly tell something is mixed in with the Tang, but the potency of taste is significantly less than that of the Methadone.

To the eye it also appears to be a considerably smaller dose due to the higher level of concentration. Previously, a dose of 125mg of Methadone would be presented to the patient in a graduated cylinder, with the liquid hitting the top measurement line at 25ml. Now, when the Methadose is presented to the patient in a graduated cylinder, the liquid only hits the 12.5ml measurement line on the cylinder; visually 50% less. In only two visits to the pharmacy totaling all of maybe 15 minutes, I have seen many different patients immediately notice this difference in volume and cry foul; rightfully concerned that they were not being presented with their usual full dose. The basic explanation given by pharmacy staff is generally less than satisfying, leaving some patients fairly confused.

I have to criticize the Province on their complete lack of patient education throughout this transition. Unless you figure it out for yourself through Google, the only information given to us was a red piece of paper taped to the wall of the pharmacy which contained all of two sentences stating that they were switching to Methadone on September 1, but that we would still be receiving the same strength of medication. That's about it. Even when inquiring to pharmacy staff, the answers given were basic at best. Many patients are not fully informed about the changes to their treatment, and get quite confused and hesitant when they are presented with a smaller volume of a very different looking liquid.

I can't speak for any other patients, but I want to be fully informed about, and involved in my treatment at all times. My life and ability to function currently depends on this treatment. If any changes are being made to it, I want every last little detail -- and I mean every. I am stable. I have absolutely no desire to re-experience the hell that is withdrawal, or an intravenous drug addiction and homelessness -- because that's exactly where it will end up. I know that all too well. I consider myself extremely lucky to have survived it the first time around, and I have absolutely no desire to take my chances at a second turn. I'll pass. But, thanks to the MOHLTC, I really have no choice in the matter.

My criticisms and ranting about the process aside, I feel it is honestly too early for me to start making any big judgments or comments, as I have only had two doses, and technically the Methadone only just barely making its way out of my system by this point. However, as of the publishing of this post, I am feeling just fine. I have not experienced any symptoms of withdrawal as of yet, nor have I experienced any cravings to use.

I hesitated to include this last observation, as I feel like no matter what words I use, it will be twisted and interpreted as saying Methadone patients experience a "high." But I feel that in order to be as unbiased and honest as possible, it's only fair to include all of my observations. In the two days I have been taking it, I have noticed that the Methadose does seem to come on faster and stronger than Methadone. This is not to say I get high. That is not the case, and never has been. MMT does not get patients high when they are on the proper dose, as I am. I simply mean to say I feel "normal" and ready to start my day in a much smaller period of time than it seemed to take with Methadone.

Regardless of all the changes I'm staying positive. As of 12 hours into dose #2, so far so good ...

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Studio L is a freelance writer living in Southwestern Ontario. She is a recovering IV drug user, methadone patient, and harm reduction advocate, and covers these issues in her blog.