Category Archives: Drug Rehab Programs

Methadone Programs and Prohibited Medications

rx-medication-abuseMany clients in methadone programs have co-occurring disorders like depression, anxiety, or adult attention deficit disorder (ADD). Historically, clinics have attempted to treat psychiatric symptoms with established, FDA-approved psychotropic medications which have proven useful across many settings in managing symptoms.

In the past decade, it became very apparent that benzodiazepines (commonly prescribed to treat anxiety) had become a popular alternative drug of abuse for individuals with an opioid addiction. “Benzos” are a particularly dangerous medication when used in conjunction with methadone, and the combination of these two contributed to a number of overdose deaths in recent years.

For this reason, many safety-oriented, reputable methadone clinics (and independent physicians) either discontinued or noticeably restricted their use of benzodiazepine medications with patients on methadone. Common benzodiazepines include prescription meds like klonopin, valium, xanax, and ativan. As an alternative to these high risk medications, non-addictive options like Buspar are utilized to help clients better manage their anxiety symptoms as well as cognitive therapies for teaching stress reduction and anxiety management skills.

Stimulant therapy is the use of stimulant-based medications to aid adults struggling with attention deficit disorder. Popular medications in this class include adderall, ritalin, and concerta. Unfortunately, these medicines are also widely abused and often illegally sold by patients thus forcing treatment providers to reconsider the use of these medications in their programs.

Positively, there are several medications which can help ADD and which have a low abuse potential. Some psychotropic medications can also be used off label to help reduce attention deficit problems. Off label means the drug was not designed specifically to treat a symptom, but has been found to have a beneficial effect on reducing that symptom.

In the end, methadone programs must employ the safest protocols to insure that clients receive treatment that genuinely helps them and will not place them at risk. There are instances in which benzodiazepines and stimulant therapies are appropriate and in the best interest of the client. However, medical and clinical staff must utilize a careful sense of discretion and evaluate the merits of a particular high risk medication against its potential for harm.

Clients can help this process by being open, honest, and direct with their treatment staff. Clients should report to management any person who is known to sell prescription medications to other clients. While this type of behavior typically occurs among a minority, it can have an extremely negative impact on other clients and the clinic itself.

Choosing To Face Reality

woman-12To be curious is a basic part of human nature. We live each day naturally drawn to things which interest us, which feel good physically or emotionally, or which might incite some curious inclination down inside of us. It is literally wired into the human DNA to be inquisitive and to seek new experiences.

We live in an information age in which most anything one wants to know is available via the internet. We know that drugs are dangerous. Yet, we naturally assume substance problems are something that happens to someone else. We know that addiction is real and can wreck one’s life, but we look past the potential danger and conclude that these risks don’t really apply to us at this time, or in this particular situation.

There is an old saying in recovery circles that no addict started out with the intention to become addicted. This is, of course, true. No one starts out intending to become an addict. So what is it that we tell ourselves when we face the potential dangers of addiction? Do any of these sound familiar?

  • Well, just this one time. One time won’t hurt.
  • I’ll stop before things get out of control.
  • Well, she did it and she doesn’t have a problem.
  • I don’t have to have it. It’s just something I like doing from time to time.
  • I’ve had a terrible day. I deserve a break. It’s not like I’m addicted!

Addiction is a complex problem. Drug use alters brain chemistry. For some people, these neurological changes are rapid and dramatic leaving the individual with an addiction that builds quickly before they are even aware of it. And denial keeps people from facing the truth even longer.

The door to addiction is often wide open and one only needs to take a small step to pass through to that other side where addiction becomes a harsh reality. Facing the truth is always the first step. No one gets well until they admit they are sick. The journey of recovery does not begin until a first step is taken.

If you have an ongoing opioid addiction and have honestly tried to get well, then medication-assisted treatment may be the next step that you take. Addiction progresses. Inevitably, addiction will make your life worse if left untreated. This downhill slide only stops when you make the decision to get into treatment or obtain effective help through some other proven means.

The message is this: Choose to face your own reality! Whatever it is, it can likely be changed. It can likely be improved. But it can only happen with your cooperation and your good intentions. Move in the direction of a solution. Commit yourself to getting help.

Time Limits on Methadone Programs

methadone-servicesThere is growing interest from a number of entities in regard to America’s opioid addiction problem, methadone treatment, suboxone treatment, and the always important funding considerations that accompany these subjects.

This interest is coming from hospitals & the larger medical establishment across the country, your local community, the Federal government’s Medicaid services division, your State’s Division of Health and Human Services who allocate state dollars for opioid treatment, private insurance companies, employers, and the list goes on and on.

The nationwide costs and consequences of addiction are enormous. The cost of treating addiction is also very large. However, research has proven repeatedly that addiction treatment produces undeniable cost benefits. In other words, treating addiction saves money in the long run by helping addicted individuals arrest their disease and become functional again. For many of the entities listed above, it’s all about the dollars. And more specifically, saving dollars when it comes to treating addiction.

The U.S. economy has been hit hard and we have a growing number of people depending on entitlements and public assistance. This, of course, creates a scenario in which more and more people are relying on a “government pie” whose slices keep getting cut smaller and smaller. The recent reductions in funding for public addiction programs have caused some agencies to close their doors … while other agencies simply had to cut back on the services they are able to offer their addicted clients.

An important consideration, which may become a hot topic soon, is how much counseling a methadone or suboxone patient can receive. Or, how long he or she can remain on their opioid replacement medication before public assistance funding begins to stop. Medicaid and State dollars presently help to fund the treatment for many opioid addicted clients in programs. There are currently more people in need of opioid treatment than there are funds available to pay for that treatment. So inevitably, patients may find themselves needing to help pay for their treatment.

I would not like to see patients be pressured to taper off of methadone before they are ready. Experience has shown us that gradual tapering, initiated & paced by the client, is the most successful means of coming off of methadone or suboxone successfully. Government public assistance is becoming more like private “Managed Care Organizations” with every passing day. As this paradigm continues to evolve, we may possibly see time limits of some sort imposed on methadone & suboxone maintenance clients. Some may view this as reasonable and necessary since such limits and caps are already applied to recipients of other health care services.

If time limits are ever applied to one’s length of time on methadone or suboxone, we will likely see clients increasingly picking up the funding for their opioid treatment. This happens everyday around the country in private, self-pay methadone clinics. In the end, we know that opioid replacement therapy works. It’s been proven! The availability of Medicaid and State funding is a great benefit to many people across the country. How this might change in the years ahead will bear close observation.

Doctors and Methadone

factsHow doctors view methadone is becoming a hot topic. A friend recently informed me that the TV celebrity doctor, commonly known as Dr. Drew, was against methadone and had publicly made negative comments about the medication. I was disappointed to learn of this because Dr. Drew has a fairly large national audience who follow his opinion on medical matters. I then noticed that Dr. Jana Burson (a well-educated and experienced opioid addiction professional) had written on this topic, and herself questioned why Dr. Drew had made derogatory comments in regard to methadone. Dr. Burson knows firsthand how incredibly beneficial methadone is to those suffering with chronic opioid dependency. If a physician deserves a national audience & voice on this topic, it is Dr. Jana Burson, not Dr. Drew Pinsky.

Physicians typically seem to fall into one of two camps: either those who are educated on addiction and modern addiction treatment approaches, or those who are not. This may seem like a simplistic analysis, but is surprisingly accurate. Sadly, in my experience, physician critics of opioid replacement therapies often jump to conclusions that stem from personal bias or opinion based on very limited exposure to methadone and its benefit to the recovering community. Methadone is not “alternative medicine”, or some unproven sideline drug that one must obtain via the black market in a third world country.

Methadone is the leading medically-approved pharmaceutical treatment intervention for opioid addiction in the United States. There is no medical “speculation” on methadone’s success in the treatment of opioid addiction. It is a proven method of saving lives and restoring quality of life for a large subset of those who are addicted to opioids. These are not hyped opinions, but are medical facts that are beyond dispute. That any “physician” would reject methadone as a legitimate treatment for opioid addiction … is professionally irresponsible, and suggestive of medical incompetence in the area of treating drug addiction.

Methadone has been in widespread use in America for over 40 years. The number of addicted individuals whose lives have been saved and/or improved (through the medically supervised use of methadone) is well documented. SAMHSA (the United States Substance Abuse and Mental Health Services Administration) publish evidenced-based Treatment Intervention Protocols (known as TIPS manuals) that are available to treatment centers all across America. They have several such manuals, published and widely distributed, that are specifically dedicated to treating opioid addiction with methadone and buprenorphine (suboxone). SAMHSA also maintain a U.S. government website listing all of the methadone clinics in the USA and U.S. physicians approved to dispense buprenorphine for the treatment of opioid addiction. Why do they list these? So that suffering people can find help for their addictive disorder.

Perhaps Dr. Drew should interview actual patients in methadone treatment programs. Then interview the staff of professionals (including dedicated, knowledgeable physicians) that work in these facilities. Then interview the families of methadone patients that regained their sons, daughters, mothers, and fathers. Then read the evidenced-based literature & research available (through SAMHSA) on the beneficial use of methadone in treating opioid addiction.

That might require Dr. Drew to walk off of the TV production set, out of the celebrity limelight … and into the everyday real world. It’s a place where people like Dr. Jana Burson work for many years, with thousands of opioid addicted people, using medical interventions that are proven and effective. Dr. Drew would do well to have a sit down conversation with professionals like Dr. Jana Burson. This might allow him to replace negative personal bias … with medical fact. Only then, would he be equipped to speak to the public about methadone and opioid addiction. Until then, he is just part of the TV & celebrity noise … where drama, ratings and sensationalism … are cherished over the truth.

The Cost of Running a Methadone Program

studyThe results of a NIDA-funded study prepared by RTI International in Research Triangle Park, NC were just released. The study sought to determine the approximate annual cost, per client, of providing a quality methadone treatment program.

The study was completed in close association with Alcohol and Drug Services who operated three methadone clinics in Greensboro, High Point, and Burlington, North Carolina. Estimating the costs to operate an opioid treatment program is a difficult undertaking with many variables which must be accurately factored into a comprehensive analysis.

Some of the variables include: numerous monthly facility-related fees (lease, utilities, cleaning & maintenance), staff salaries, medication, medical equipment, urinalysis testing & lab fees, office equipment (phones, computers, copiers), educational materials and media devices, marketing & promotion, administrative & accounting costs, accreditation fees, medical records, and many other miscellaneous costs. The client census for any opioid treatment program also factors heavily into the clinic’s financial viability as well as does the clinic’s policy on charging for take home medication and other ancillary services.

The RTI study results were based on a clinic census of 170 clients. The largest single cost was labor since all methadone programs require a number of professionals working together as a team in order to deliver quality services. Labor constituted 86.5% of the costs to operate a methadone clinic.

Based on an average daily census of 170 clients, the study defined the annual per client cost to be $7,458. Divided by 365 days per year, this equates to $20.43 per day, per client, to run a quality methadone treatment program. “Quality” mean that clients are receiving regular individual and group counseling services in addition to case management and referral, and some supplemental medical monitoring, referral, and oversight.

Many methadone programs charge their clients far less than $20.43 per day thus promoting the question as to how a clinic can survive financially on an average $13.00 per day client fee. Delivering services at break even or for-a-profit will require that the clinic either cut costs by operating with minimal underpaid staff, offering minimal counseling services, receiving some supplemental State or Federal funding to offset their costs, collecting additional client fees from those whose treatment is partially funded through State/Federal monies, raising their client census to make up losses by serving a larger volume of methadone clients, or acquiring additional funding through grants, donations, or special community funding such as United Way contributions.

Some of these approaches are more problematic than others. “Quality treatment” is always a direct function of having knowledgeable, well-trained staff who are motivated to work with clients and to advocate for their needs and personal growth.

Ultimately, methadone clinics provide life saving treatment and a valuable opportunity for people to reclaim and restart their lives. However, establishing & running a quality methadone program is not cheap. For the addicted individual, opioid treatment is a much more affordable option than buying illicit drugs off the street and living an exhausting, high risk, unhappy existence.

Fortunately, many methadone programs are partially paid for through Medicaid, private insurance, or State dollars earmarked for substance abuse treatment. Even these publicly funded programs struggle … especially when Federal and State budgets are cut year over year.

Drug Rehab for Teens

rehab-for-teensTeen drug abuse is a persistent problem in America, and unfortunately, is on the rise again. With recent State and Federal budget cuts, funding across the country for adolescent drug treatment has dwindled. There are far fewer drug rehab facilities today than there were just 5 years ago. Locating inpatient and outpatient teen rehab programs has become a challenge for parents and adults seeking local teen drug treatment resources.

RehabForTeens.org is a new online information center which provides general information on teen substance abuse and contact information for a variety of teen drug rehab programs across the United States. The site was launched in January 2012 and will undergo periodic updates to keep people informed on the availability of teen rehab programs in each U.S. state.

RehabForTeens.org describes the different types of drug treatments available for teenagers and offers a blog from the unique perspective of parents as well as drug treatment professionals. Drug rehabilitation for teens has emerged as a very important social topic with so many young people facing tough choices on a daily basis.