Methadone programs across the country differ in their quality of service. Some are simply better than others. Why is this?
Each program is shaped by the experience, professionalism, and treatment approach of the staff who are employed there. Quality programs emphasize comprehensive recovery and client skill-building in addition to medication assistance (like methadone or suboxone dosing). Importantly, each client should be provided regular counseling & active support that is characterized by consistent respect shown for clients at all times.
Opioid addiction recovery involves more than just receiving methadone. It requires lifestyle change, improvements in thinking and behavior, and a willingness to learn and adapt to the challenges of life. Opioid replacement medication, by itself, cannot provide all of this. Consequently, quality methadone clinics will encourage their clients to use treatment as a means of enriching their lives and moving to higher plateaus. Methadone programs that do not provide this opportunity are called “dosing mills”.
Dosing mills usually exist to dispense methadone and collect a fee. Treatment services and attention to client growth are not a priority. There is definite value in helping an addicted person to stop using illicit drugs and in stabilizing them on a safer opioid substitute, like methadone or suboxone. But this “medication only” approach is not recovery, and does not address the root problem of addiction or its underlying causes. The goal of quality methadone treatment programs is to empower their clients to live the fullest lives possible.
While the list below does not cover every possible area, here are some characteristics of higher quality methadone programs that one should expect:
- Every staff member in the clinic understands & endorses the value of opioid replacement therapy.
- Staff demonstrate care for clients and treat them with respect. Clients are welcomed, and their decision to enter opioid treatment is viewed as a commitment to a better life.
- There are counseling groups and/or the availability of individual counseling sessions, and clients are required to attend these.
- The clinic starts new clients on modest doses of methadone, increases their dosage gradually, and monitors the client closely as he/she acclimates to methadone. This is an important safety protocol that no decent clinic should sidestep. Rapidly hiking clients up to high levels of methadone is medically irresponsible and poses an unnecessary safety risk.
- Clients have access to an appeals process.
- The clinic strives to be organized and efficient for the convenience of its clients. This is often a challenge, but a clear effort is made to minimize a client’s wait time before dosing.
- Clients are subject to random urinalysis and other accountability measures. This promotes client responsibility, raises program integrity, increases client safety, and shows the community that the methadone program is all about quality and ensuring that the program is conscious of the community’s needs and concerns.
- Illicit drug use (relapse) is not overlooked, but is addressed promptly with each client in a constructive manner. Various treatment alternatives & interventions are offered to help relapsing clients get back on track.
- The program engages in comprehensive assessment, and either provides in-house services for co-occurring disorders (ex. depression), or coordinates a referral for help in this area.
- The program practices diversion control in order to minimize the risk of methadone being misdirected. Additionally, take home medication awards are made based on client progress with treatment and demonstrated stability, not just the passage of time.
As a client, it is important to remember that you have rights. Your clinic staff should review these with you and should provide you a manual or handbook which outlines the program’s guidelines, dosing hours, fees, and other expectations. If you do not have this handbook, then please request it.
In closing, various methadone programs do differ in their approaches, policies, and procedures … just like any other medical service provider. There are many high-quality programs around the country staffed by capable & dedicated professionals. As is the case with most any industry, some companies/organizations rise to the top and are better than others. The “bad” ones should not reflect negatively on the good ones. Both will likely always exist to a degree.
As a treatment provider, hopefully you will continually strive to be the best that you can be. As a client, it’s important to be an informed consumer of services. Sometimes, talking with a number of other existing clients can give you a heads up on whether a particular clinic you are considering has earned a good or bad reputation. Stick with the better clinics if at all possible. You’ll be glad you did.
Methadone take homes (or carry outs) are awarded to clients that have demonstrated treatment progress, stability, and personal responsibility. A take home dose of methadone may be earned once a client has met a number of criteria set by each methadone clinic. Each state has its own methadone authority that provides additional guidelines regulating take home award. Consequently, take home medication awards may differ from one clinic to the next, and from one state to the next.
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It has been said in the treatment and recovery community that addiction is a disease of feelings. What is specifically meant by this is that addicted individuals typically have difficulty coping with emotions and are often triggered by them to use drugs in the traditional chemical coping paradigm.
