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.
The U.S. Dept. of Health and Human Services has awarded $1.5 billion in an effort to support States in their fight against opioid addiction.
The grant programs will provide funding to increase access to “24/7 Opioid Treatment Programs”. $104 million will be specifically allocated to bring treatment services to rural areas of the country that have been historically underserved.
While stabilizing and rebuilding lives through medication-assisted treatment is a priority, the prevention of overdose deaths is a distinct goal of the new funding initiative. Major confiscation of fentanyl continues month to month as law enforcement authorities intercept huge quantities of the drug pouring across the southern border.
Another $20.5 million is being earmarked for the development of programs that help connect individuals with addiction issues to local community resources that can enhance their overall recovery effort.
Additional focus will be placed on increasing the availability of naloxone which is the emergency medication that can quickly reverse the effects of opioid overdose. Thousands of lives have been saved in the last 10 years through the timely administration of naloxone to those who have overdosed.
The White House report outlines further efforts to disrupt global drug trafficking through the addition of more law enforcement officers.
Providence, Rhode Island is the first location in the United States to offer a mobile methadone service. This article profiles CODAC Behavioral Health who operate a 27 foot RV that has been modified to function as a mobile methadone unit.
The concept behind this innovative approach is to bring essential medication-assisted treatment services to the rural areas of Rhode Island where many prospective patients are underserved.
Access to methadone and buprenorphine-based treatments remains an ongoing challenge as nearly 83% of those with opioid use disorder (OUD) are not yet utilizing medication to help with their opioid withdrawal symptoms. Opioid withdrawal sickness is the primary driver of illicit opioid use, opioid overdose, and lifestyle disruption.
CODAC received their FDA approval in July 2022 to begin dispensing methadone from their mobile unit.
Methadone clinics are a lifesaver for many thousands of recovering individuals across the country. There are a number of new clinics opening each week, but the provision of a methadone mobile service offers an interesting alternative that will be closely watched and evaluated in the years ahead.
BrightView provides high quality addiction treatment with a specialty in opioid addiction recovery. Currently, the organization operates in six states: Ohio, Kentucky, Virginia, Delaware, North Carolina, and Massachusetts.
BrightView was originally founded by a doctor, a lawyer, and a businessman with the intent of transforming addiction medicine. In Cincinnati, opioid addiction had severely impacted the local community as it had done in so many other areas of the country.
Consequently, BrightView founders wanted to design a system of service delivery that would make it easy for people affected by opioid addiction to get the help they needed with minimal obstacles and delays.
While most BrightView clinics specialize in the use of buprenorphine, suboxone, and vivitrol, several clinics also offer methadone. Their recovery model is built upon a combination of top tier medication-assisted treatment in conjunction with counseling and behavioral therapies.
In addition to opioid-specific treatment services, BrightView also offers specialized treatment for alcohol, methamphetamine, and other substance use disorders. Being patient-centered is a hallmark of the company’s approach to helping.
Most BrightView facilities can see a patient within 24 hours of calling for an appointment. If interested in contacting BrightView, you can reach them at 866-928-5995.
A new study by the School of Medicine and Public Health at the University of Wisconsin found that a patient’s length of treatment is directly tied to lower risk of overdose.
In particular, treating opioid addiction with medication for at least 60 days generated a 61% reduction in the incidence of overdose.
Numerous other studies over the last two decades have shown that positive outcomes are tied to longer duration in outpatient addiction treatment. Not only does greater length of time in treatment allow for physical stabilization with methadone or buprenorphine, but it provides each patient with time to develop improved coping skills and relapse prevention capability.
Higher levels of functioning are able to be achieved, such as gainful employment and improved parenting, when a patient is able to remain in addiction treatment for longer periods of time.
Marguerite Burns, who led the Wisconsin study, found that recovery success and overdose prevention are enhanced the longer that patients take medication over a 12 month period. Medication-assistance plays a key role in helping opioid addicted patients find long lasting recovery.
Impressively, the study was based on treatment outcomes recorded for 293,160 Medicaid patients diagnosed with opioid use disorder.