Category Archives: Methadone Taper

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.

The Cost of Running a Methadone Program

studyThe results of a NIDA-funded study prepared by RTI International in Research Triangle Park, NC were just released. The study sought to determine the approximate annual cost, per client, of providing a quality methadone treatment program.

The study was completed in close association with Alcohol and Drug Services who operated three methadone clinics in Greensboro, High Point, and Burlington, North Carolina. Estimating the costs to operate an opioid treatment program is a difficult undertaking with many variables which must be accurately factored into a comprehensive analysis.

Some of the variables include: numerous monthly facility-related fees (lease, utilities, cleaning & maintenance), staff salaries, medication, medical equipment, urinalysis testing & lab fees, office equipment (phones, computers, copiers), educational materials and media devices, marketing & promotion, administrative & accounting costs, accreditation fees, medical records, and many other miscellaneous costs. The client census for any opioid treatment program also factors heavily into the clinic’s financial viability as well as does the clinic’s policy on charging for take home medication and other ancillary services.

The RTI study results were based on a clinic census of 170 clients. The largest single cost was labor since all methadone programs require a number of professionals working together as a team in order to deliver quality services. Labor constituted 86.5% of the costs to operate a methadone clinic.

Based on an average daily census of 170 clients, the study defined the annual per client cost to be $7,458. Divided by 365 days per year, this equates to $20.43 per day, per client, to run a quality methadone treatment program. “Quality” mean that clients are receiving regular individual and group counseling services in addition to case management and referral, and some supplemental medical monitoring, referral, and oversight.

Many methadone programs charge their clients far less than $20.43 per day thus promoting the question as to how a clinic can survive financially on an average $13.00 per day client fee. Delivering services at break even or for-a-profit will require that the clinic either cut costs by operating with minimal underpaid staff, offering minimal counseling services, receiving some supplemental State or Federal funding to offset their costs, collecting additional client fees from those whose treatment is partially funded through State/Federal monies, raising their client census to make up losses by serving a larger volume of methadone clients, or acquiring additional funding through grants, donations, or special community funding such as United Way contributions.

Some of these approaches are more problematic than others. “Quality treatment” is always a direct function of having knowledgeable, well-trained staff who are motivated to work with clients and to advocate for their needs and personal growth.

Ultimately, methadone clinics provide life saving treatment and a valuable opportunity for people to reclaim and restart their lives. However, establishing & running a quality methadone program is not cheap. For the addicted individual, opioid treatment is a much more affordable option than buying illicit drugs off the street and living an exhausting, high risk, unhappy existence.

Fortunately, many methadone programs are partially paid for through Medicaid, private insurance, or State dollars earmarked for substance abuse treatment. Even these publicly funded programs struggle … especially when Federal and State budgets are cut year over year.

Methadone Tapering Can Be An Achievable Goal

methadone-taperMost clients choosing opioid replacement therapy have it in mind that they will one day taper off of methadone once they are feeling better and have restarted their lives. Interestingly, there is considerable confusion around tapering, and this seems to be the result of opioid addicted people having tried unsuccessfully to “detox” themselves at home, or possibly having come off of methadone cold turkey.

For some, the vivid memory of abrupt withdrawal tends to exaggerate one’s fears & apprehensions. And of course, there is always someone around who seems to enjoy telling horror stories of “how bad it was” when they came off of methadone. The reality is that nearly always this person did not follow the appropriate taper process, and came off of their medication far too quickly.

So what is the reality of methadone tapering? First, a recovering individual needs to avoid being in a hurry to taper. Methadone (and suboxone) must be given the proper chance, and proper time span, to allow for establishing stability in one’s life and the building of a solid recovery. A person should pursue tapering as a goal only after they have invested time in the recovery process. Without some degree of positive change & personal inner growth, tapering off of methadone too early leaves a person with nothing to fall back on … except the same old thinking and lifestyle choices that led to addiction.

Once an individual has their life in better order, and with some new skills & supports in place, then considering a taper becomes a reasonable goal. Sadly, some methadone clinics (and private physicians too!) do a poor job of preparing their clients for successfully tapering off of opioid replacement medication. Good clinics will always be open to tapering … as a valued client alternative, and right.

Successful tapering begins with the belief that tapering is a possibility. This requires that a client be educated on the merits of gradual dosage reduction, and reassured that their clinic will walk with them every step of the way. Gradual dose reduction might be just 1-2 mg per week, and with occasional pauses or breaks in between dosage reductions. This eases one into tapering … like sticking one toe at a time into a bath to see how hot or cold the water is. This is much preferable to just diving in head first!

The gradual approach allows clients to test the waters with very small decreases, thereby giving their bodies (and minds) time to adjust to slightly less medication. Many clients find that this strategy works very well for them. After slowly reducing one’s dosage in this fashion, a client can begin to build confidence that tapering is a do-able process, as opposed to some insurmountable wall that they will never scale.

Aiding this process is the support & guidance of one’s counselors & medical staff, as well as one’s family or friends. These individuals can either help or hurt the process depending on their level of knowledge about tapering and their attitude toward the client during this process. Sometimes, family and others in the recovering person’s life will apply pressure to hurry the taper process.

Even members of the 12 Step recovering community can sometimes exhibit judgmental attitudes toward methadone treatment clients as they move through their recovery journey. Positively, some AA/NA members are becoming more educated on opioid replacement therapy, and are adjusting their views to support people in methadone treatment instead of ostracizing them. This rejection phenomenon also occurred some years ago in regard to psychotropic medications prescribed for people with co-occurring disorders like depression. Thankfully, the larger 12 Step-based recovering community became educated on medication therapy, and eventually supported people on medication for depression and other mental health conditions.

In closing, I want to encourage methadone clients to invest in their addiction treatment and the recovery process. Developing support & coping skills enables one to face and overcome challenges which used to seem overwhelming. Our clinic recently had two clients successfully taper down to 0 mg of methadone (that’s completely off!) over a course of 12-24 months. There are indeed some people who may need to remain on opioid replacement for the duration of their lives, which is a topic for another day. But do not automatically assume this is true for you.

Yes, each client in methadone treatment should view their life & circumstances from a realistic perspective. But each client should also be encouraged to consider all of their options, including the possibility of a successful medication taper. Successful tapering happens everyday. It is a reality. Science is advancing. Addiction treatment is advancing. New medications and new approaches are being implemented most all the time.

Do not rush to taper off of methadone or suboxone if they are working for you. But, do not be afraid to consider this option either. Tapering is a distinct possibility, and a worthy goal. Approach it with patience, cultivate a positive attitude in regard to tapering, and discuss it periodically with your counselor or physician. Do not underestimate yourself or your ability to accomplish things which are important to you.