Monthly Archives: February 2011

Methadone Treatment and Recovery Require Scheduling

methadonecalendarAdmission to a methadone clinic is initially prompted by an individual's daily struggle with opioid withdrawal symptoms and the desire to avoid being sick. To address this problem, new clients arrive each day to receive their medication. The first 1 – 3 months are referred to as the induction period, and center around increasing a client's methadone dosage until the client's opioid withdrawal is effectively eliminated. Regular daily visits to the clinic are critical to this process.

Being a client in a methadone program requires careful attention to program guidelines and expectations. Clients must dose within a specified time frame, keep appointments for counseling, and provide a urine specimen upon request for random drug testing. There are payments for treatment services, and other considerations like participating in pill counts with the nurse, occasional lab work, and "call backs" for take home accountability, etc. 

Some clients find it helpful to keep a personal calendar so as to schedule their activities in advance. Planning ahead & becoming better organized is a highly useful recovery tool. Get into the practice of writing things down. This will lead to more success in meeting daily responsibilities. Not to mention the positive effect of reducing one's stress level. 

The addictive lifestyle often breeds a number of "bad habits". A goal of treatment is to gradually replace bad habits with healthy practices! Time management & scheduling are indeed healthy practices that yield great benefits for recovering individuals. Getting by with minimal effort is a common bad habit that often becomes characteristic of an addictive lifestyle and an addictive mindset. This will need to change … sooner or later.

The old cliche suggests "we get out of it what we put into it." Think about this a bit. Maybe keeping a personal calendar is a good idea for you & a solid investment in managing your recovery. Operating with a schedule in mind doesn't have to be limiting, or a nuisance. It's about being conscious of what's important in your new drug-free life. And being sure you don't shortchange yourself by accidentally forgetting important things. Maybe scheduling would be a good topic for your next counseling session

Running a Quality Methadone Program

methadone76Not all methadone programs are the same. While regulations do exist that govern the operation of methadone clinics, the standard of quality & care will most definitely vary from one clinic to another. At the core of every reputable, high-level methadone clinic is genuine dedication to the consumer patient.

All clinics have a business component in which revenue is a major consideration. Sometimes clients will complain "Oh, it's all about the money with them." In reality, a clinic's revenue must be an important ongoing consideration. In fact, it's that way throughout all of health care in America. The true bottom line is being able to remain open & to offer a valuable service. Without revenue, this will not happen.

For-profit clinics, and non-profit clinics, both have an important task. And that is to provide a quality treatment service to their clients who have suffered with a debilitating opioid addiction. Good quality clinics will maintain an acceptable counselor to client ratio so that the counselor is available to meet with clients and to assist them with planning & the processing of important treatment issues pertaining to their recovery.

In North Carolina, the maximum client caseload ratio is 50 clients for every 1 counselor. This is often a very challenging ratio in that 50 active clients, each with his or her own unique needs, will keep a single counselor enormously busy. Add in heavy documentation requirements and the counselor will be in a near perpetual state of dancing & juggling in order to get things done by the end of the day. Many clinics are aware of this and will consequently set a more manageable counselor to client ratio like 35 clients for every counselor. This allows for better quality of care although it can negatively affect a clinic's revenue, and particularly so when clients do not make sessions that equate to billable revenue for the clinic.

Clinics invariably develop a reputation within the local community based on their internal policies and their treatment of clients over time. Important aspects of a quality methadone program include:

  • Caring staff who treat clients with respect
  • Qualified treatment staff who receive ongoing clinical supervision
  • Program staff who communicate clearly
  • Well-developed internal policies & procedures for running the program
  • Knowledgeable medical and clinical personnel who work together as a unit
  • A treatment & recovery focus that emphasizes skill-building and goal setting
  • Accountability measures are in place for both clients & staff
  • Clients have defined rights and a process for airing concerns/grievances
  • A clear safety orientation exists that underlies all key clinical decisions
  • Do not readily prescribe/allow benzodiazepines, and take active measures to ensure that clients are achieving progress in recovery

Running a quality methadone program is a complex, multi-faceted endeavor requiring the careful attention & effort of individual team members. Each person on the team contributes to, or detracts from, the overall quality of the clinic's operation (and reputation).

It goes without saying that most methadone clinics require organization and dedication in order to deliver good services to their consumers. Moving from average to good to great … is a process that evolves with practice & time. To be a great clinic should be the aspiration of every clinic. We owe this to our consumers.

New York Methadone Clinics

methadone5New York City has the highest concentration of methadone clinics and buprenorphine providers in the country. Not only is New York the most populated city in the United States, but it is also one of the most densely populated areas in the world with 8 million people living in an area just over 300 square miles.

With larger populations come larger numbers of people in addiction. Consequently, it stands to reason that New York City would be a leader in providing opioid addiction treatment. There are well over 100 New York methadone clinics and area physicians approved to write prescriptions for suboxone (containing buprenorphine).

At one time, methadone was a treatment of choice primarily used for heroin addiction. However, with the enormous increase in pain pill addiction (Oxycontin, Vicodin, Percocet, etc.), methadone clinics are now accessed by many clients who have never used heroin. Quite a number of individuals report beginning their use of oral opioids as a means of controlling pain. But tolerance & continued use over time developed into a long term opioid dependency.

The emergence of methadone clinics across America is a very positive development. Medication-assisted treatment prevents opioid related deaths, reduces crime, reduces risk of severe health problems, and allows individuals to restart their lives in an unprecedented manner. Not too many years ago, one had to live near a major metropolitan city in order to gain access to methadone treatment. This trend is changing rapidly as America comes to grips with the problem of addiction. Buprenorphine is also part of the answer, and has increased the number of viable options available to those seeking recovery.

Methadone Treatment Benefits Many

methadoneclientsThe amount of misinformation that is circulated in regard to methadone is pretty astounding. Methadone is truly one of the most well-researched addiction treatment medications in history, and is widely accepted as the most efficacious opioid addiction treatment ever.

Today, I reviewed a number of videos on YouTube based on the search word "methadone", and found a plethora of wild rants, exaggerations, and obvious paranoia … often expressed by local community citizens who seemed determined to prevent a methadone clinic from operating in their locale. I wonder how many of these people would feel that way if it were their daughter that needed the clinic, or their best friend.

As an addiction treatment professional who has witnessed firsthand methadone's dramatic life changing benefits, I can only shake my head at the irrational beliefs, and mean-spirited condemnation, held by everyday people. Many of these folks seem to have good intentions, but suffer from phenomenal ignorance on the topic of addiction & addiction treatment. Methadone stabilizes individuals physically, provides a means for dealing with one's addictive disease, and offers tremendous opportunity for moving forward in life and regaining one's sense of hope.

Many of our agency's clients hold professional positions, have become top moms & dads, and live peaceful, responsible lives. This is not hyperbole, it's reality. Receiving methadone for these individuals is no different than taking a daily pill for a health condition. And the majority are identical to anyone else that you might encounter on a daily basis.

Some methadone treatment clients are satisfied to simply tread water (which is far better than drowning in one's addiction). Perhaps their overriding goal was to just avoid withdrawal sickness, and they weren't aiming for much more than that. Fortunately, they are alive, are no longer committing crime, and they no longer feel driven to desperate measures to feed an opiate addiction. There is considerable value in this type of lifestyle change which reflects more a Harm Reduction level of benefit.

Harm reduction is an approach which allows an addicted person to reduce their exposure to risky addiction lifestyle practices. Effective harm reduction for an individual also yields harm reduction for the surrounding community as well. A no brainer.

So whether one's methadone treatment participation leads to dramatic improvements, or merely small life changes, the sum gain is nearly always positive. Methadone treatment benefits many. This is the reality. With society's judgment often being harsh, it's no wonder that methadone clients are reluctant to step forward publicly. If critics could see personal & up close the methadone client they fear, a wonderful positive shift could occur, and both methadone clients & methadone treatment more readily embraced. We are on our way to this new destination, one client at a time. (read more on community acceptance)

Methadone Maintenance Increases Functionality

methadone77Methadone maintenance offers stability. Clients who have moved to maintenance often report a return of mental clarity, an improved mood, and elimination of withdrawal symptoms. "I feel normal again" is an encouraging statement often heard by treatment staff and it represents the ability of an individual to become employed again, return to school, reconnect with family, and ascend to a higher plateau.

The average methadone dose is between 80 and 120 milligrams daily. However, the correct dose is whatever works for a particular client. There are clients who will need more than 120 mg/daily, and there are those who can maintain comfortably below 80 mg per day. Each person's metabolism and opioid tolerance are different. To become stable, and to then transition into a maintenance phase, will take some months for most methadone clients. It's an adjustment process.

However, once stable on a consistent dose, many clients begin to experience a notable refocusing on life & personal goals. When a client achieves successful methadone maintenance, it is a joy to behold in that people smile again and enjoy being in the position to live a more full and complete life. This journey from active addiction to a stable life free from illicit drugs is remarkable. To see clients, who have suffered, now experience relief from the torture of addiction is gratifying for friends, family, and treatment professionals.

Perhaps this is an overused metaphor, but the door to recovery opens, and individuals do learn to live again. Without methadone support, this would not happen for a large number of people. Thankfully, medication assistance is here to stay. It is a tried & true path to recovery. With over 2 million Americans currently facing an opioid problem, proven treatment interventions are essential to saving lives.