Category Archives: Methadone Benefits

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.

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.

Methadone Clinics Have Good Intentions

legaldomains_1A 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.

Methadone Treatment and Recovery

methadone-recovery-2Recovery 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.

Anti-Methadone Sentiment Not Rooted in Reality

methadone52In 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.