Category Archives: Methadone Maintenance

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

Pregnancy and Opioid Treatment

pregnancyWhen a woman is pregnant and addicted to opioids, she faces extraordinary stress and very often a wave of judgment from those around her that is emotionally painful and difficult to deal with. The criticism of others is understandable since no one wants to see an unborn baby placed at risk through the mother’s drug use. But this cauldron of angry emotion and public condemnation often overwhelms a pregnant mother, who may already feel guilty, and it pushes her further into isolation and inaction. This isolation only places the mother and unborn baby at greater risk of overdose and possible miscarriage.

Fact: It has been thoroughly researched and the findings conclusive that pregnant opioid-addicted women have a much better chance of carrying their baby to term and having a healthy baby when the mother is receiving medication-assisted treatment. Every day, addicted mothers receiving methadone or buprenorphine give birth to healthy babies that thrive and develop normally.

Methadone and buprenorphine (Subutex) are very different medications compared to heroin and painkillers like oxycodone. Heroin and painkillers manufactured for break-through pain act quickly, but also dissipate quickly. For those with an opioid addiction, this momentary relief from opioid withdrawal does not last long and they are back out there again desperately trying to find more heroin to avoid becoming sick.

With methadone or buprenorphine, mothers are medically stable and able to avoid debilitating cycles of withdrawal as well as the dangerous drug-seeking behaviors and lifestyle that put them and the baby at risk. A woman is already in a state of increased vulnerability when pregnant. If lonely, isolated and forced to go to the street to find dope or pills, she will find herself in dangerous situations and exposed to a drug culture that values money over human life.

This harsh reality is what some women face as they struggle to survive while carrying an unborn child. If in treatment at a methadone clinic or under the supervision of a caring physician who utilizes buprenorphine, the pregnant woman can start the process of personal recovery. She can avoid becoming sick from opioid withdrawal and avoid taking grave risks just to avoid that withdrawal. She can receive emotional support and medical assistance to maximize her health and that of the unborn baby. She can better prepare herself to be a good mom once the baby is born.

There are those who may indignantly exclaim “But the baby will be born addicted”. The reality is that it is much safer for a baby to be born to a mother receiving methadone or buprenorphine than for the baby to be repeatedly exposed to adulterated street heroin and combinations of drugs riddled with unknown contaminants. Think about that. Technically, the baby may be born with some physical dependency, but this is successfully managed all the time by medical professionals across the country. Buprenorphine has been found to have a milder withdrawal syndrome and is utilized successfully in helping infants comfortably detox. Methadone is successfully used for this purpose as well.

It is important to also make a distinction between “addiction” and “dependency”. They are not the same. “Addiction” encompasses the persistent craving for opiates, the mental preoccupation with securing them, and the inappropriate behaviors and lifestyle aberration that develop as people lose control over their ability to choose. “Dependency” can occur with anyone who has been using an opioid for a sustained period of time. Someone who has become “dependent” can readily taper off of the medication and will not be necessarily driven to obsess over drugs or desperately seek them. A baby who is born temporarily dependent on methadone or buprenorphine can be successfully tapered off of the medication. Obviously, a baby does not meet the definition of “addicted” so to use that term is technically inaccurate and misleads the public.

Finally, methadone and buprenorphine are safer for the baby. It’s ultimately about helping that unborn baby to develop normally in the womb and to be born alive, healthy, and with maximum opportunity for a good life. Chances are that the mother will indeed be that baby’s primary caretaker for a long time. It is much better that she be introduced to recovery and various avenues of support through methadone or buprenorphine treatment than to be left on her own with no support, little guidance, and struggling to find dope on a daily basis.

 

Methadone and Other Medications

doc66Methadone is FDA-approved for pain management and the treatment of opioid addiction. Methadone is a relatively safe and highly effective medication when used exactly as prescribed. It is currently in use in the United States and around the world following years of conclusive research on methadone’s efficacy and safety.

It is important for patients receiving methadone to know that it can interact with other central nervous system depressants like alcohol and benzodiazepines such as xanax, klonopin, valium, and librium as well as similarly acting non-benzodiazepine agents like ambien (a popular sleep aid). When methadone is mixed with these other medications, there is an increased risk of sedation and loss of consciousness. In extreme cases, individuals mixing methadone and other CNS depressants have gone into respiratory failure.

For those who have chosen to receive methadone in an opioid treatment program, they will discover that a proper dose of methadone not only eliminates opiate withdrawal & cravings, but will also block the euphoric effects of any other opiates. This is typically a positive side effect in that it discourages illicit opiate use or supplementing with street drugs like heroin. Since methadone binds so well to the brain’s opiate receptor sites, any other opiates that are ingested have no means of creating a euphoria or a high since the body’s opiate receptors are occupied by methadone. This removes the incentive to misuse other opiates and can facilitate the process of recovery.

There are instances in which a patient’s physician has prescribed a benzodiazepine for anxiety management while also prescribing methadone. Such decisions should always be accompanied by a thorough discussion with one’s doctor of the potential risks & complications. There are other, safer alternatives for treating anxiety such as Buspar and cognitive therapy. These other options should be considered when a patient is already receiving methadone. In addiction treatment, the use of benzodiazepines for anxiety is typically monitored carefully through increased random urinalysis testing and medication counts.

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

methadone-clinic-3

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.