When 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.
A new methadone clinic in North Haven, Connecticut recently opened called APT. Lynn Madden, who is the acting CEO of APT Foundation, has made a concerted effort to connect with the local community in order to help citizens understand that methadone clinics can be operated safely and discreetly with no adverse effects to the surrounding neighborhood.
The clinic currently has about 800 patients. An article by the New Haven Register documents the comments of local residents and businesses who all report that the clinic has been good for local business and has resulted in no problems or increase in crime.
The article goes on to explain how the clinic is actually situated in close proximity to a large community development, but positioned such that neither is really aware of the other. This demonstrates how some clinics are expertly planned and managed.
At Methadone.US, we wrote two years ago about a New York City methadone clinic that is housed in a downtown church and serves many hundreds of clients per day. This clinic there is so private and quiet that local businesses did not even know it was in operation for years just across the street.
This type of well run facility and seamless community integration provides good evidence that the fears and criticisms of methadone naysayers are largely unfounded.
Lynn Madden of APT was quoted as saying that New England has a very high rate of addiction to opioids. We know that this phenomenon is increasing across the country, and consequently will demand more attention, and funding, in the years ahead if we are to adequately address the opioid addiction problem.
APT seem to have a good strategy for dealing with the unfortunate stigma that still exists around methadone. The key is education, outreach, and clinics staffed with professionals who are adept at explaining the benefit of drug treatment to the local community. Treatment solves problems. Treatment saves lives, reduces crime, and restores economic productivity on both a personal/familial level and a community level.
Recovery is for everyone and anyone with a genuine desire for change. Treatment in a methadone program offers the potential for change, and a new path which can lead to a much improved life.
In the field of addiction recovery, there are a multitude of methadone treatment programs all across the country. These programs vary considerably one to another, and this is a result of treatment philosophy, staff experience & qualifications, funding availability, and the underlying structure and operation of the methadone clinic itself.
Some methadone treatment programs are for profit and some are non-profit. Both can deliver high standards of client care and ethical treatment of their clients. "Good" treatment programs are generally identified as being so by their own clients. Conversely, if a particular methadone program is "not so good", their clients will recognize it immediately and the word will get out very quickly.
What makes a "good" methadone program? From most clients' perspectives, it is these things:
checking-in and receiving their medication in a timely fashion
being shown courtesy and respect by staff
feeling like the clinic is staffed by sincere, committed professionals
being treated as an individual instead of a number
paying reasonable fees for the service provided
rules, regulations, and expectations are clear and are enforced fairly
being heard & supported … when there is a problem
What is a "well run program" from a clinic perspective? These are important …
has clear policies and operating procedures
staff are professional, accountable, and self-motivated
there is a culture of respect & consideration shown for all staff and clients
costs & expenditures are carefully tracked and managed
the program of treatment is designed and delivered with integrity
documentation of services is consistently completed in accordance with standards
services are funded on a consistent basis (otherwise, the clinic will close)
Methadone treatment, and opioid addiction recovery, are not radically different from other substance abuse treatment programs or models of change. The underlying addictive disorder is fundamentally very similar. What separates opioid addiction from some other addictions is the overwhelming physical dependency that can develop with opioids and the associated withdrawal syndrome.
The cognitive-behavioral changes, and eventual psychological growth, that occur in opioid addiction recovery are exactly the same as in any other addiction recovery path. The essential difference is the utilization of opioid replacement medication to thwart the terrible physical withdrawal symptoms that derail recovery year after year. Methadone and suboxone, when used properly, are highly effective in helping addicted persons move forward with their personal recovery. Methadone treatment … and recovery! They go hand-in-hand, and are not mutually exclusive.
Posted in Addiction Recovery, Drug Treatment, Medication Assisted Treatment, Methadone, Methadone Benefits, Methadone Clinics, Methadone Programs, Methadone Success, Methadone Treatment, Opiate Treatment, Recovery, Suboxone, Suboxone Clinics
In browsing articles on current methadone treatment, I came across a brief one in the United Kingdom’s Daily Record specifically from the Scottish news section. The article contained a number of derogatory quotes (in regard to methadone) from Scotland’s Maxie Richards. Ms. Richards runs a foundation for addicted people in recovery.
One quote from Ms. Richards pertaining to methadone included: “To me it represents a hopeless road, a road to nowhere.” Another comment was “I think it is such a waste to let young people spend years on methadone because we don’t think there’s any hope for them.” Ms. Richards is openly critical of the government’s support of methadone treatment programs.
Her words “a hopeless road” are not a fitting description of the life enhancing benefits of methadone in treating addiction. To the contrary, methadone is often the single most beneficial intervention for someone struggling with opioid addiction. In my experience, any addiction professional who is categorically against methadone is revealing a lack of education on evidence-based treatments, and is merely expressing an unsubstantiated personal bias that is easily refuted.
Today, a former client made a surprise visit to our clinic. She had been in methadone treatment with our agency for a little over 4 years and had come off of methadone one year ago. Today, standing in our lobby, she was full of life, smiling, and enthusiastically talking about how well things were going in her life. She said that methadone had been instrumental in saving her life. Since leaving treatment, she had remained completely drug free, was full-time employed, enjoying positive relationships with her family. And she looked wonderful, very healthy, and had a beautiful complexion.
Was her methadone treatment a “hopeless road’? Absolutely not! She, and we, knew that it was a bridge to a better life. She had originally arrived at our clinic beat down, lost in addiction, hopeless, and desperate for an answer after having tried everything she knew of to get clean and sober. Choosing methadone and counseling worked for her. I wonder what Ms. Richards might think if she had the chance to see and to speak with our former client today? Results speak for themselves. Methadone programs save lives and provide a deeply desired new opportunity. True, not all methadone programs are the same. Some are better than others.
Hope … is what many addicted people find when they begin dosing with methadone. Relief … from painful opioid withdrawal symptoms is what they feel. Gratitude … is what they express for a new start in life. And eventually happiness. Which is what our former client had come to share with us on this day.
Posted in Addiction Recovery, Medication Assisted Treatment, Methadone, Methadone Benefits, Methadone Clinics, Methadone Maintenance, Methadone Safety, Methadone Success, Methadone Treatment, NIMBY, Opiate Treatment, Recovery
How 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.
Posted in Addiction Counseling, Addiction Recovery, Drug Rehab Programs, Drug Treatment, Medication Assisted Treatment, Methadone, Methadone Benefits, Methadone Programs, Methadone Success, Methadone Treatment, Opiate Addiction, Opiate Treatment, Recovery, Suboxone
A majority of clients who enter methadone programs do so without immediate family involvement in the admissions process. Often, a significant other knows of their loved one’s decision to enter treatment, but chooses to remain “on the outside”. There are several reasons for this including: apprehension about methadone clinics, feelings of embarrassment that their loved one has an opioid addiction, not wanting to invest time in the recovery process, or simply being too busy to spare the time.
Consequently, clients enrolling in methadone treatment programs typically go it alone early on. It is of course highly beneficial for each client to have some outside support, encouragement, and to be able to share their recovery journey with someone who cares about their struggles and progress.
I have found that many family just do not understand opioid addiction or the enormous benefit that medication-assisted treatment provides to those who are embarking on the journey of early recovery. There exist a notable social bias too against methadone which is born almost exclusively out of a lack of education on methadone’s efficacy as a medically-approved form of treatment for opioid addiction.
As has been stated on this website, the media have done an extremely poor job of reporting the widespread benefits of methadone as a useful opioid replacement medication. These factors sometimes steer families in the direction of harboring critical views & fears about methadone (or buprenorphine) as a legitimate addiction intervention. Where there is fear of something (whether justified or not), there usually exists detachment from, and a negative view of, that which is feared.
I have had the fortunate experience of meeting families, educating them on methadone as a recovery tool, and being able to answer questions about our methadone program. This face to face contact almost always builds a bridge by demystifying methadone and what it represents in the addiction recovery process. Education, knowledge, and trust consistently replace ignorance, fear, and negative social stigmas. When a family member comes to understand how methadone works and how it is part of a larger recovery effort, that person then becomes part of the recovery solution. Recovering individuals need this acceptance and family support. It is so very valuable.
Educating the family on methadone treatment can be accomplished in a variety of ways. A pamphlet, a phone call, inviting them to a family counseling session, or referring them to a fact-based website on methadone’s purpose. Helping families understand addiction and addiction solutions is always a worthwhile effort.