With another young Nova Scotian’s life cut short due to substance misuse — this time because of methadone — the topic of treating opiate dependence has been in the spotlight.

In recent days, many opinions have been shared about how to manage opiate dependence in our province. I would like to return the focus of the conversation to what the evidence tells us.

We actually know a great deal about the treatment of opiate dependence, what is effective and what is not.

We know that abstinence-based programs, though well-suited for problems such as alcohol dependence, do not work well for opiate dependence.

The most effective treatment for opiate dependence is substitution therapy — providing another opiate, such as methadone or buprenorphine, in a controlled manner.

Such programs have been shown to reduce crime, reduce death and chronic illness, and decrease the transmission of infectious diseases such as HIV and hepatitis.

People treated in such programs also experience higher rates of returning to work or school and increased quality of life.

However, simply handing out prescriptions is not enough. Ideally, an opiate treatment program should include a strong programming component involving education and therapy, helping people recover from addiction and rebuild their lives.

Best practice examples of therapies that have been shown to make a difference in supporting people’s recovery include cognitive behavioural therapy, contingency management, motivational enhancement therapy or structured relapse prevention.

When individuals die due to illicit methadone, many assume it became available as a result of a client diverting it from a treatment program.

This is not always the case. Organized crime is a major player in the illicit provision of methadone. At times, in some jurisdictions, physicians and pharmacists have been responsible for diverting narcotics.

Such physicians and pharmacists represent only a tiny minority among their profession.

Similarly, methadone patients who divert their medication represent only a small percentage of total clients served by opiate dependence treatment programs.

In fact, most clients spend years, sometimes decades, on methadone without incident.

For many of the clients in our treatment programs, methadone has been a life-saver, and often they require methadone maintenance therapy over the long term, occasionally lifelong, in order to stay well.

Having privileges to take home doses of methadone (“carry home privileges”) is part of the recovery process and represents an important step in rebuilding one’s life.

To suggest that all patients should be observed consuming their methadone every day for their entire treatment because a minority divert their methadone is an overreaction.

This would be a standard of care that does not exist anywhere else in North America.

This is not to say that we could not do a better job of monitoring and controlling opiate treatment.

I would advocate for stronger monitoring of programs and an accepted standard of care for methadone treatment, one mandated by the province.

Currently, each methadone program operates independently, with no overarching framework to ensure that, along with funding, there is accountability for the delivery of scientifically sound and medically safe programming.

The Nova Scotia College of Physicians and Surgeons recently released methadone guidelines, which were comprehensive and excellent. But what process is in place to ensure that these guidelines will be followed consistently?

For example, the guidelines recommend that any new patient be closely monitored daily for a minimum of three months before being granted “carry home” privileges, which is the standard that we will be adopting at Addiction Prevention and Treatment Services, Capital Health.

Nova Scotians deserve a provincial vision and strategic plan for how opiate treatment will be delivered safely, effectively and consistently across all health districts. Patients and their family members deserve the same level of care whether they are living in Yarmouth, Halifax or New Waterford.

Nova Scotia is at a crossroads in treating opiate dependence. We need to be proactive about this opportunity and insist that our opiate treatment programs across Nova Scotia be evidence-based, incorporate best practices and that there be accountability and oversight ensuring that individuals suffering from opiate dependence are receiving the safe, sound, optimal care that they deserve.

That is what will save lives.