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What is Methadone
Methadone is a synthetic opioid medication that is used in chronic pain management and in the treatment of opiate addiction. As a treatment for addiction, methadone is taken orally on a daily basis in either a liquid or tablet form.
There’s a new spin being proposed on the dispensing of methadone to Opioid Use Disorder (OUD) patients. A federally-funded project is underway between Scene Health and The University of Washington in which patients video themselves taking their daily methadone dose, and then submit that video to the treatment provider.
The project is evaluating this new modified approach that falls somewhere between in-person daily dosing and unsupervised take home dosing.
This new approach is currently being referred to as Video DOT (video direct observation therapy) and has been successfully implemented with other health issues including hepatitis C, asthma, and diabetes.
While this experiment seems appealing at first glance, it does raise legitimate questions about the ability to insure proper safety protocols with the provision of methadone medication to new patients. The project may possibly demonstrate the usefulness of Video DOT methadone dosing. But assuming this new approach one day becomes common practice, it will be important that physicians or clinics have in place a procedure for quickly reclaiming methadone doses that are not ingested on schedule.
Imagine a new patient receives 7 take home doses of methadone, but then only sends in the required video of their medication use on day one. At what point does the prescribing clinic intervene, and how will the unaccounted for doses be retrieved?
Approved Opioid Treatment Programs currently have “callback” procedures in which stable patients are randomly selected to return to their home clinic with their unused take home doses. This allows the clinic medical staff to perform a medication count, and it acts as a safeguard to insure patients are taking their medication as prescribed.
Patients who have earned take home privileges through months of treatment progress are less inclined to divert or misuse methadone than someone who just started treatment. New patients must be inducted gradually on a stabilizing dose of methadone. And time is typically needed to help these patients adjust to methadone while eliminating use of all other illicit substances. This is where the benefit of a structured treatment program is most relevant. OTP’s provide extremely valuable life management skills training in conjunction with medication therapy.
It remains to be seen if “easy access” to methadone is truly an advancement in care, or a step backwards in accountability & safety for patients and the public.
Historically, access to methadone for the treatment of opioid addiction has been through enrollment in a local clinic licensed to dispense methadone. As a result of Covid restrictions, some of these clinic regulations were relaxed. For example, many patients across the U.S. were allowed to begin receiving take home doses of methadone as a result of Covid lockdowns and decreased clinic access.
Critics have begun to express the belief that clinic restrictions are cumbersome and that methadone should be made available for pick-up at local pharmacies. On the other hand, the concern remains that methadone can be misdirected or mishandled thus reinforcing the need for close supervision, particularly in the early phases of opioid treatment. Decades of research has shown that taken under proper supervision, methadone’s safety profile is excellent.
In this recent era of contaminated street opiates and overdose concerns, it is clear that methadone is a phenomenally effective medication for promoting health, well-being, and physical safety.
Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, recently shared that deregulation of methadone would likely increase the diversion of methadone and methadone-related overdose deaths.
Following a period of stability, most U.S. clinics do allow patients to begin dosing at home with methadone. This system of care is working well throughout the country where methadone is readily available. However, many U.S. citizens are still lengthy distances from methadone-approved clinics. So, the challenge continues to link those with opioid addiction to effective resources in their local community. Legislators are presently examining a range of options as the opioid epidemic marches on.
Counseling and support services are an integral part of the treatment process. Recovery from opioid addiction involves education on the addictive process and the development of skills that support lifestyle change.
Medication assistance is key in managing opioid withdrawal sickness, but counseling offers the opportunity to learn valuable skills like identifying common high risk triggers for relapse and methods for reducing that risk.
Addiction is a complex illness. Many patients who achieve early stability with methadone or suboxone will relax their commitment to treatment. They let their guard down and begin to take shortcuts. This is a frequent issue in treatment clinics that often leads to relapse.
Sustained recovery from addiction requires a full commitment to change. Individual counseling and group counseling provide the necessary roadmap for staying on the recovery path. Counseling allows patients to achieve a deeper understanding of the challenges they will face as they learn to live drug free.
Opioid addiction can seriously impact a person’s life in many areas, and climbing out of that hole is not easy. Making the correct recovery-based decisions can at times be confusing, and even feel overwhelming. This is where the value of support & input from a counselor, stable friends, and concerned others can make a real difference.
Most MAT clinics and physician practices across the U.S. provide counseling as a component of their opioid treatment program. Participate in these services. These sessions with a therapist or in a counseling group can greatly enhance your ability to stay on course, and ride out the difficult days that you will certainly encounter. There is no replacement for commitment and positive action. These are the foundation of success when true recovery is the goal.
Several articles recently addressed a study which found that providing buprenorphine after an overdose significantly increased the likelihood of individuals accessing opioid use disorder (OUD) treatment.
The current protocol for paramedics and emergency departments in treating opioid overdose is to administer naloxone in order to reverse the effects of overdose. A recently published study showed that also providing buprenorphine immediately afterward reduced withdrawal discomfort and increased outpatient addiction follow-up care.
A separate article referenced data showing a nearly six-fold increase in patients accessing outpatient addiction treatment within 30 days of the overdose event.
These are highly encouraging finds which demonstrate the far-reaching effectiveness of medication-assistance in the treatment of opioid addiction. Saving a life through overdose reversal is obviously a critical benefit, but increasing motivation for follow-up treatment is a huge step in helping addicted individuals plug into a long-term solution.
Structured treatment which utilizes medication-assistance provides so much to those aspiring to face their addiction challenges. Naloxone, buprenorphine, and methadone have saved countless lives, and these medications have provided an unrivaled opportunity for those in opioid addiction to plot a new path in life.
Minnesota officers recently seized a large quantity of fentanyl in the Midwest based on extensive investigation and “very, very good police work”.
The drug bust removed enough fentanyl pills to kill over 1 million people, and the suspected dealer now faces federal charges for possessing a large quantity of synthetic opioids.
Of particular concern was that the fentanyl doses had been pressed into a familiar pill that was indistinguishable from that provided in a typical oxycodone prescription. So oxycodone obtained on the street now presents with a much higher risk of fatal overdose than was previously thought.
The article reported that large quantities of fentanyl continue to come across the U.S. southern border. The U.S. Senate is currently examining how this influx of fentanyl is impacting American communities as drug seizures hit historic levels.
Those currently struggling in active opioid addiction should explore getting professional help as soon as possible. Fentanyl “in disguise” is making its way across the country.
The Counseling Component
Methadone alone can eliminate opiate withdrawal. But without counseling support and behavioral therapy, many addicted individuals will relapse. Coping skills development and lifestyle change are important to the recovery process.
Counseling teaches skills for understanding the addictive process, avoiding relapse, and successfully managing one's recovery during and after treatment.
Many opiate dependent individuals may have a co-occurring disorder, like depression or anxiety, that require special interventions. Comprehensive treatment will address these areas of need too so that a patient’s stabilization and recovery are successful long term. (read more about counseling)
Dependency on opiates can become an uphill battle for someone caught in the chronic cycle of opiate use and opiate withdrawal. Methadone treatment is a solution for many individuals struggling with this type of addiction.
Read Dr. Burson's Blog on Opioid Addiction & Medication Assisted Treatment.
Inspiring, Thoughtful, and Informative!
Methadone Clinic Operation