Category Archives: Medication Assisted Treatment

Methadone Maintenance For Opioid Treatment

methadone-and-opioid-treatmentOpioid Treatment is a category that includes several different interventions or approaches relating to opioid use disorders. People sometimes mistake opioid treatment for “opioid detox” when they are technically two different processes.

Opioid detox refers to the process of helping an opioid addicted individual discontinue their use of opioids and be medically monitored as the body withdraws from them. In a supervised setting, a person is typically assisted through a short-term opioid detox (3-10 days) by the administration of various medications used to manage withdrawal symptoms like clonidine (to guard against high blood pressure), vistaril (to reduce nausea and anxiety), and even buprenorphine (to minimize the severity of the opioid withdrawal process).

There are also variations on an opioid detox referred to as a taper. A taper often occurs on an outpatient basis and involves a more gradual reduction in dosage of either methadone or buprenorphine (suboxone) over time. This taper may take as long as 90 days and allows the individual to adjust more comfortably due to the slower, milder reduction in dosage that occurs over a coarse of weeks or months.

Maintenance is the term which refers to maintaining an individual for a significant period of time on either methadone or buprenorphine (suboxone) to allow for stabilization on the opioid replacement medication. Since opioid addiction introduces dramatic brain chemistry changes in conjunction with strong physical dependency and cravings for opiates, many people find that they need a substantial period of stabilization on methadone in order to have a realistic chance at building a personal recovery. Numerous individuals have decided that they will utilize methadone for only a few weeks with the intention of tapering off of it very quickly. This strategy is prone to failure and tends to end in dramatic relapses back to heroin and other illicit opioids.

Methadone maintenance for most opioid-addicted persons involves receiving methadone for a year or more. This length of time dramatically raises the probability of successful physical stabilization and necessary thinking, behavior, and lifestyle changes which lead to long-term drug abstinence and sustained, productive living. Put very simply, when people attempt to rush through the process of stabilization & recovery, they sabotage their chance of experiencing real success. For that reason, maintenance is a therapeutic process which should be regarded as a one year commitment or longer, and tapering off of methadone or buprenorphine should not be rushed. Bear in mind that not all individual situations are exactly the same and there are unique exceptions.

There are many different factors that play into how long a person needs to remain on methadone or suboxone maintenance. This is highly individualized depending on the length and severity of one’s opioid abuse history, one’s present medical status and general state of health, the availability of social & emotional supports, and the presence of any co-occurring psychiatric disorders like depression.

There is considerable misinformation about methadone tapering and a bit of fear-mongering that often occurs around the topic. People that generally taper successfully off of methadone or suboxone are individuals that have invested time in counseling and personal recovery growth, and who have developed a good working relationship with their doctor or treatment staff. These individuals approach tapering as a gradual goal and are allowed to halt or slow down their taper as needed. This allows their body time to adapt to the somewhat lower dosage. It also allows them to proceed slowly and carefully such that any anxiety or fears can be successfully identified and managed.

Choosing The Right Direction: Detox – Methadone – Suboxone

CRC Health Group to Receive $495,000

feature4bAn article in Maine’s Bangor Daily News outlines a case recently decided in which the Town of Warren, Maine was found to have adopted an ordinance that was ruled discriminatory and in violation of the Americans With Disabilities Act.

CRC Health Group had been fighting to open a methadone clinic in Warren to provide treatment services to those struggling with the disease of opioid addiction. However, the town of Warren had opposed this initiative for several years. U.S. District Court Magistrate Judge John Nivison approved an agreement in which the town of Warren will pay $495,000 to CRC Health Group to drop its lawsuit.

CRC offers a variety of behavioral health treatment programs around the country and has a special focus in opioid addiction services utilizing medication-assisted treatment like methadone and buprenorphine.

Maine has a substantial opiate addiction problem and is in need of more resources for those individuals stuck in the vicious cycle of opiate addiction and withdrawal.

Historically, there have been other similar cases in which town planning boards attempted to oppose the construction of a local methadone clinic. This is commonly referred to as NIMBY (Not In My Back Yard). However, denying people ready access to a needed medical service appears to come with serious financial repercussions.

For More: A Message To The Community

Advocating For Addiction Treatment

recovery-journeyTreatment for addiction is one path which may be taken to help rebuild a person’s life when alcohol or drugs have become a problem. There is a compelling documentary recovery film recently out entitled The Anonymous People. The film is an interesting retrospective on the recovery movement in the United States and how it evolved, beginning with AA in the 1930′s, until present day.

A special focus in the film is highlighting the message that people do recover from addiction, that there is a solution to this disease – and that solution is the decision to choose recovery. Recovery is a process that changes lives and takes individuals to a new destination in their life. Recovery is the journey that saves & enhances lives. To that end, recovery from addiction is of incomparable value.

In life, bad choices are made every day. As human beings, we learn to make better choices – often through the mistakes we endure as we travel through life one day at a time.

In reviewing the variety of recovery “paths”, there exist several routes by which an addicted person can find hope and direction in learning to live a drug free life. Some find their answers in church-based recovery programs. Churches recognize the reality of substance addictions and many have developed their own spiritual programs for dealing with drug addiction and offering hope for a better future.

12 Step Programs have been in widespread use for a long time and many lost in addiction have found the support, fellowship, and help needed in the rooms of AA, NA and other 12 step based programs. Some people in recovery from opioid addiction may find that their decision to take methadone or buprenorphine (suboxone) is not well-received in 12 step programs. This can make it difficult to feel accepted or supported there. However, not all NA or AA meetings are the same. NA and AA have themselves evolved over time, and some NA and AA members welcome all people suffering from addiction regardless of their drug of choice.

Addiction treatment is yet another path that leads toward recovery and the possibility of positive change. Treatment, like 12 step meetings, can vary considerably from one program to the next. Opioid treatment in particular often uses medication assistance as an additional tool to help people in their recovery journey. While medication assistance is scientifically proven to be beneficial to opioid addicted persons, it has endured some controversy through the years as those on the outside looking in chose judgment & criticism over compassion and understanding. Methadone and suboxone are proven, effective tools for alleviating the suffering that comes from opioid withdrawal.

In The Anonymous People documentary, there is a strong message that addicted people deserve love & support. Addicted people are from all walks of life. If treatment works, then advocating and supporting treatment is just and worthwhile. The film makes a persuasive argument that better advocacy is needed for the funding of addiction treatment services across the country. Addiction treatment advocacy has not been as effective as advocacy for other critical health conditions like HIV/AIDS or cancer.

As more families struggle with addiction and more voices are ultimately heard in their plea for treatment funding & support, we will hopefully see a shift in society whereby recovery is embraced as the answer to addiction.

Medication-Assisted Treatment for Teens and Young Adults

opioid-addiction-childrenThere is increasing momentum building for opioid addiction treatment in response to the growing opioid addiction problem in the United States. Many teenagers and young adults who are being introduced to prescription opiates are at risk for developing a crippling drug dependency. The risk is increased as these youth discover that heroin is a relatively cheaper alternative than pain pills purchased on the street.

The Partnership at DrugFree.org has published a 36 page guide outlining opioid addiction and the therapeutic role that medication-assisted treatment can have even for teens and young adults. Methadone, suboxone, buprenorphine, and naltrexone are highlighted in the guide with an accompanying description of each medication and its use in opioid treatment.

Opioid replacement therapy has historically been used as a treatment of last resort in adult populations. The dilemma is that a high percentage of opioid addicted individuals are unable to remain drug free with traditional models of treatment that do not include medication assistance of some variety like naltrexone, buprenorphine, or methadone. Overcoming opioid withdrawal without effective symptom relief presents a serious obstacle in the recovery process.

The Partnership at DrugFree.org recognizes that the wave of opioid addiction in America is mounting. The news media have been covering this issue too with some regularity over the past year. Effective remedies need to be in place as all ages seek help for opiate addiction. If we are to save lives, the stigma of medication-assisted therapy and the misunderstanding around it must be finally removed.

Methadone Dosage Increases

methadone-increaseWhen a new client joins a methadone program, they go through a process called induction. Induction is the initial delivery of a methadone dose and the subsequent increases in dosage over the next 1 to 2 months as the medical team help get the client stabilized & comfortable on a dose of methadone that effectively eliminates their painful opioid withdrawal symptoms.

Induction is historically a high risk span of time since there is an increased risk of accidental overdose with methadone. It is extremely rare that overdose occurs during induction especially if clients are abstaining from other illicit substances during the induction process.

Therein lies the dilemma. Some clients become impatient with the process of methadone induction and will supplement their methadone dose with other unapproved opiates or benzodiazepines. This is dangerous and actually undermines the benefit of what methadone can achieve for the patient.

To help the treatment team determine the level of methadone increase to provide a patient, they use the Clinical Opiate Withdrawal Scale, or COW Scale. This is a withdrawal assessment tool that helps the clinical or medical team determine the prevalence and severity of opioid withdrawal symptoms. The scale produces a score based on the client’s reported symptoms and the team’s observation of withdrawal symptoms. The higher the COW scale score, the more severe the symptomology and thus a greater justification for allowing a higher dosage increase.

Some clinics are known to take clients up 10 mg at a time. Many physicians consider this high risk and too rapid of an increase. Note that methadone is a slow acting, long lasting opioid agonist with a much longer half life than heroin and most other prescription opioids. What this means is that methadone stays in the system much longer and builds cumulatively over time. So the actual effect of a dosage increase is not immediately felt and may take 1-3 days before the full effect of that dosage increase is realized.

With an impatient client, they may receive a dosage increase but not feel the immediate relief they were hoping for. Consequently, they may use additional unapproved opiates that then mix with the methadone increase that is still being absorbed into their system. This puts the client at risk of overdose.

Many clinics use 5 mg increases every few days while some clinics adjust each requested increase in accordance with the COW Scale score. For example, a client may receive several 5 mg increases because they have moderately severe withdrawal symptoms, but then receive a 3 mg increase days later and possibly a 2 mg increase days after that as the symptom severity begins to diminish. This more cautious approach reduces the risk of overdose while still addressing the client’s unresolved physical discomfort.

A well-managed methadone induction is tailored to the individual client’s needs, and the client’s safety is always the chief concern. Methadone dosage increases are provided only to alleviate measurable physical withdrawal symptoms or closely associated anxiety, restlessness, or psychological distress from withdrawal.

Drug Addiction, Methadone, and Suboxone

suboxone-articleAn article was brought to our attention by Dr. Dana Jane Saltzman, a New York City physician who specializes in the treatment of opioid addiction. Dr. Saltzman uses suboxone in her private practice to help those seeking recovery from a severe opioid habit.

The article was posted in The Village Voice and attempted to depict the duality of opioid replacement therapies. This duality stems from the highly therapeutic & legitimate uses of suboxone (buprenorphine) contrasted against the attempts of some addicts to create a black market cottage industry with the medication selling it illegally online via Craigslist, Facebook, and other social media.

In the world of medicine and addiction treatment, selling suboxone is certainly criminal, and also behavior characteristic of someone who is not grounded in recovery. Many medical & clinical treatment professionals across the country have endeavored for decades to provide safe, effective treatment to suffering addicts. When FDA-approved opioid treatment medications are misdirected and sold on the black market, all varieties of abuse and exploitation occur ending in overdoses and a deepening of damaging social stigma about medications such as suboxone and methadone.

The Village Voice article plays it straight up the middle with perhaps some emphasis on the growing underground market for suboxone targeted to those who want to bypass the cost or inconvenience of signing on with a suboxone-approved physician.

Individuals who attempt to treat their own addiction with opioid replacement therapy are going to fail a high percentage of times. First, most  have no medical basis for understanding the complex nature of opioid addiction in the brain, and they can even deepen their addiction through the inappropriate use of opioid replacements. Addicts often go with what feels right opting for their own intuition as opposed to following proven best practice protocols like those employed in structured treatment programs supervised by suboxone-approved doctors.

Addicts who treat themselves with street suboxone or methadone are also completely missing the counseling component of recovery which addresses the underlying psychological factors that drive addiction. Taking street suboxone without counseling is akin to taking diabetes medication while eating doughnuts. In other words, the individual makes their complicated dilemma even worse.

There are some generic equivalents of suboxone in development which may make opioid replacement therapy more accessible to the larger population. Suboxone and methadone have a definite place in addiction treatment. It is critical however that early recovering addicts receive quality counseling so that they can better understand how to cope with relapse patterns and develop the skills necessary to successfully manage the disease of addiction. Addicts treating themselves with medications acquired on the street will remain stuck in a vicious cycle of addiction.

True recovery requires humility and commitment to higher principles. Chasing shortcuts to recovery creates more pain and wastes valuable time that would be better invested in real solutions.