Category Archives: Methadone Maintenance

Couples in Opioid Treatment Together

womens-recoveryIt is good news when an addicted couple find their way into treatment. Opioid addiction is a very lonely journey, and alienating friends and family comes with the territory when one is deep into a drug addiction.

With severe addiction, it is not uncommon for both members of a couple to be struggling with an opiate dependency. While this bond is certainly not a healthy one, it is one that makes sense for the couple, who often find themselves feeling like it’s “us against the world”. As they plow through addiction, sometimes one hour at a time for years, a bond is formed … like two friends going through a war together each watching the other’s back in a never ending fight to stay alive.

At some point, one member of the couple will have the good thought about entering treatment and may push their partner to seek treatment together. Sometimes this works out and sometimes not. When it does work, the couple will begin dosing with methadone or suboxone and hopefully attempt to re-orient themselves to a sober way of living. This is a beautiful experience to behold when two people are ready, and they encourage each other to make better choices.

In 12 Step recovery circles, recovering couples are strongly encouraged to seek their own individual recovery apart from their partner. Couples often resist this suggestion, but it is a very wise approach. It is so easy to relapse when one’s partner goes back to using. So, having one’s own circle of support outside of this relationship can be critical in helping a person to remain drug free when their partner has relapsed. It actually helps the relapsed partner too when he or she sees their spouse not compromising on recovery principles and continuing to make appropriate choices.

With stable couples who have methadone take homes or who receive the same psychotropic medication, there can be the occasional temptation to swap each other’s medications. When they were actively using, they shared works, pills, anything and everything. Now that they’re stable, it may not seem like a big deal to to take a partner’s medication if one has run out or misplaced their own. However, it is a big deal and should be always avoided. Successful recovery is not easy. It requires personal discipline and a strong commitment to do what is right, even when doing the right thing is challenging and difficult.

While couples in treatment can be a complicated affair, it can work and does work everyday around the country. It is important to note that a couple may not progress at the same rate. While one partner stabilizes quickly on methadone and discovers their cravings & withdrawal disappear, the other partner may have uncomfortable withdrawal symptoms and struggle with urges to use illicit drugs for a period of time.

Good methadone programs will strive to support the couple’s mutual effort to be drug free together, but they will also work with each patient separately. This will include being in separate treatment groups and having separate individual counseling sessions.

With private self-pay programs, there are instances in which a couple may not have enough money for each person to dose on a particular day. This can pose a stressful dilemma for the couple and there is often no easy answer. One member of the couple may just go without. While there is typically an apprehension that missing a day of dosing will bring about immediate withdrawal sickness, this is often not the case. Since methadone has a long half life and is designed for extended duration, some people discover that they are comfortably maintained even through a missed day of dosing. This is not a recommended practice since missing doses is often correlated with illicit drug use, but it is an interesting and useful piece of information.

In the final analysis, a “couple” can suffer for years with simultaneous opioid addictions and a severely compromised quality of life. Choosing to enter drug treatment, either as a couple or as separate individuals, is a positive decision that should be supported wholeheartedly by family, friends, employers, recovery self-help programs, and the treatment community.

Safety and Security With Methadone

methadone-safetyIf you are currently a client in a methadone clinic, then you have most likely heard treatment staff emphasize the importance of safety with methadone and the necessity of carefully securing take home methadone doses. Methadone is a powerful medication that is tremendously helpful to recovering individuals. It is also potentially lethal in the wrong hands and consequently must be deliberately safeguarded.

There is a recently published article on Bloomberg regarding methadone being diverted and then taken by someone who later died from an overdose. This turn of events has led to newly proposed legislation in five states (Maine, Indiana, Minnesota, West Virginia, and Pennsylvania) that would further tighten regulations regarding the operation of methadone clinics and their award of methadone take home medication to their clients.

The reported misuse of methadone, and associated deaths, was allegedly tied to several private, for-profit clinics that operate in these states. One of the criticisms of the private, for-profit clinics was that they are not providing "enough services". This is intended to mean that the clinics in question were not providing sufficient education & counseling support or adequate monitoring of those who receive take home methadone.

It is critically important that all methadone clinics (both private and publicly supported) implement thorough measures to educate clients on methadone safety concerns as well as institute monitoring protocols like 24 hour callbacks and random drug testing. 24 hour callbacks require take home recipients to return to their home clinic within 24 hours and to produce their methadone take home doses for count and inspection by the clinic's medical staff.

It is also important that methadone clinics only award take home medication privileges to those clients who have achieved certain progress milestones such as successive months of clean urinalysis, attendance to required counseling sessions, the absence of criminal charges, and demonstrated appropriate behaviors & attitude toward staff and peers at the clinic.

When individuals intentionally divert methadone doses or mishandle methadone through lax practices (such as leaving it sitting out in plain view), they put others at risk and ultimately undermine the delivery of methadone services in the community. In other words, the mistakes of a few can negatively affect everyone. This also erodes the community's confidence in methadone as a life-saving medical treatment.

In the end, it is the shared responsibility of all methadone clinics and their clients to insure that methadone is taken as prescribed, and safeguarded from diversion. When proper precautions are not honored, tragedies will occur. This will lead to state legislators taking matters into their own hands with additional laws & regulations that may keep worthy individuals from receiving a valuable privilege. Take home medication is so very beneficial to honest, hard-working individuals in recovery. It frees them to seek employment, hold a job, care for family, and to more easily meet many other important responsibilities in their lives.

When Methadone Clients Get Stuck

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Clients across the country in methadone clinics and suboxone treatment programs are required to receive counseling while taking methadone or suboxone medication. Opioid replacement therapy specifically treats the painful opiate withdrawal, but counseling addresses the thinking, behaviors, and lifestyle that fed the addiction or that made individuals more vulnerable to developing addiction-related problems.

While in early recovery from opioid addiction, individuals begin to look at themselves and their lives through the process of counseling. It is during this time that clients face the truth about themselves and the effects that their addiction may have had on family and friends, finances, personal reputation, employment, and a host of other real world considerations.

It is easy to understand how some people can feel overwhelmed as they take their first sober look at the consequences of their recent addiction-based lives. However, change does occur … and change is a choice. A very personal and deliberate choice.

Many addicted individuals come to understand that one must face recovery one step at a time. No matter how much one wants to erase or repair past damage, there is only so much that he or she can do on any given day to start anew. What is required in this early phase of recovery is the simple desire to stay drug free and to try and make better decisions one-by-one with each new day. This sounds simplistic, but is a profound & powerful personal philosophy that leads the recovering person down a road to success. ACTION is a must. Action … is not optional.

Many suffering addicts are tired from fighting their addiction, but they also have an innate desire to move forward and to address their addiction problem. So many people become stuck in an active opioid addiction, spinning round and round, sometimes for years. They wonder if things will ever change. As the addiction becomes a familiar foe, addicts grow weary of the fight and settle for feeding the monster just to get through the day.

If you are opioid addicted, you do not have to be "stuck" in this addiction. You do not have to settle for a life of perpetual worry. It is important that you take action. You must take action. You must not wait for someone to come along and drop a miracle at your doorstep. Get into treatment immediately. Connect yourself with an addiction counseling center or detox or inpatient rehab. There is hope there. There are answers. There is support. There is real recovery going on everyday all over this country, and it is happening to people just like you. Believe that … because it is true! There are recovering people who have made the journey. There are treatment professionals with decades of experience. They have a clear road map and can offer you a new direction.

You can become unstuck! Methadone or suboxone treatment may be a part of the new solution for you. Or perhaps a medically supervised detox where they ease your withdrawal symptoms using safe medications. And you then follow that up with admission to an intensive outpatient counseling program (IOP) to learn the new coping tools you'll need in order to avoid relapse.

Maybe your first step is to go to a 12 Step meeting and ask for help, or a friend, or a pastor, or walk into the local mental health clinic and ask for a referral. Being "stuck" is a result of inaction, or taking the wrong action over and over. If you're serious about a new life and finally facing this opioid addiction, take the right action for yourself. So much is possible. You can do this. It can be done.

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.

Balancing Methadone Client Rights With Accountability

methadone-clinic-13Methadone “take home” medication (also referred to as “take outs”) is a true convenience for those enrolled in a methadone clinic. Typically, clients who demonstrate that they are drug free and progressing in their substance abuse treatment can earn the privilege to receive take home medication.

Receiving take home methadone requires that the prescribing physician (and clinic) have safety and accountability measures in place to help reduce the chance of methadone or suboxone getting into the wrong hands. When clients take medication home, it is critical that the opioid replacement medication be kept secure and out of the reach of children. Overdoses can occur with individuals that have no developed tolerance to opioid replacement medication.

Receiving take home methadone is a privilege, not a “right”. This decision to award take home medication is usually a collective decision made among the clinical and medical staff in a treatment program. They base a client’s readiness to receive take home medication on that person’s level of recovery stability, absence of active psychiatric symptoms, and the safety & security of their immediate home environment.

Methadone and suboxone have considerable “street value” and can be resold or misdirected. Therefore, clinic staff want to be as assured as possible that any particular client receiving methadone is sincere, stable, and appropriately focused on his or her own recovery.

Methadone and suboxone patient rights are of course always very important. Clinics and physicians sometimes walk a fine line between accommodating the patient and requiring accountability measures that are perceived by the patient as a hassle. For example, methadone clinics are required to perform random “call backs” in which a client is contacted and required to bring their methadone medication back to the clinic within 24 hours for a recount. This helps the clinic insure that the patient is not over-taking their medication or misdirecting (selling) their medication. While not a guarantee of good behavior, it does encourage patients to treat their take home medication responsibly and with substantial care.

Another safety measure is random urinalysis. It is not safe for patients to receive take home medication if they are using other unapproved drugs. If a random drug test shows the recent use of illicit substances, then this requires the clinic to suspend take home privileges for some period of time, at least until it can be established that the patient is back on track and testing drug free again.

If a patient feels that their rights have been unfairly compromised, then they have access to the clinic’s internal review process and/or the state’s methadone board who hear and investigate client grievances. In the end, the patient and the methadone clinic should be in a cooperative partnership. This is the working ideal in any health care relationship one has with their treating physician. Clinics exist to treat and serve patients, and opioid addicted patients need the services of opioid treatment providers. This relationship is extremely valuable and should be nurtured by both parties both at initial intake and ongoing for the duration of the treatment process.

Methadone Clinic Transportation

bridgeOne of the chief hurdles clients face in considering methadone treatment is how convenient it will be to get to the methadone clinic for daily dosing. Metropolitan areas traditionally have a timely bus system and access to taxis, but those in rural areas can often find themselves stuck in the country with no way to get to the clinic.

Family members and close friends often become part of the equation providing a daily ride until a client can earn methadone take home privileges. Some clients have their own car, but the cost of gas can be a detrimental factor. Clients with children and limited income, or with a verifiable disability, may be eligible for Medicaid transportation. Any person can apply for Medicaid benefits through their county Department of Social Services.

Attending a clinic session to dose with methadone is a “medical appointment” and generally covered under approved Medicaid services. At our clinic in North Carolina, a number of clients are brought each day to the clinic by Medicaid transportation in order to participate in their treatment.

Another factor to consider in utilizing a methadone clinic is the clinic’s designated dosing time. Some clinics provide a wide window of time in which you can arrive to be dosed. Other smaller clinics may have more restricted hours of operation. Consequently, a person may have to observe time carefully to make sure they arrive before closing time in order to dose. Many clinics will accommodate a late client if that client has a legitimate reason for arriving late and calls ahead before closing time to inform the clinic nurse of their dilemma. However, it is always best to consult first with clinic staff to learn of their policy on arriving late and late dosing.

Interested in more information on methadone? Try our Q & A methadone information page!