Category Archives: Methadone Diversion Control

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.

Methadone Take Home Medication

methadone78Methadone 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.

Some clinics provide an automatic take home for Sunday (often because the clinic is closed on Sunday), although a number of treatment programs have discontinued the “automatic” Sunday take home and are now open every day of the week for medication dispensing . This change resulted from a move to increase patient safety and to help ensure that take home medication was provided only to those with a good track record of program success & compliance.

It should be noted that pain management clinics and addiction treatment clinics, both of which provide their patients with methadone, are very different programs and operate with significantly different standards and oversight. Opioid addiction treatment programs are subject to much tighter regulation and require that new participants be seen face-to face everyday in order to be evaluated before they receive their methadone dose.

This is not required of pain management clinics who are able to dispense opioid pain medication (including methadone) without the same level of oversight. Consequently, much of the methadone diversion concerns making the news (including related overdoses) are the result of diversion of methadone provided by the less regulated pain management clinics.

Unfortunately, the general public have often wrongly assumed that addiction treatment clinics were at fault. While diversion of methadone does occur on occasion in both settings, methadone treatment clinics offer much more comprehensive accountability & monitoring measures than do most pain management clinics.

A majority of methadone take home recipients are very responsible with their medication. They take it exactly as prescribed, and store it safely & securely. Many patients have properly utilized their take home medication for years without incident or problems of any kind.

A number of clinics allow their patients to receive up to 13 take home doses requiring an in-person visit to the clinic on the 14th day. Some clinics provide up to a month of take home medication for patients showing long-term stability and responsible handling of their take home medication. Take homes are earned one-at-a-time at specific time intervals as clients move through phases (or levels) in the opioid treatment program.

It is important to note that take home medication is a privilege, and not a right. The award of take home medication is usually a team consensus decision based on a patient’s excellent urinalysis results, consistent attendance to & participation in treatment sessions, and evidence of psychiatric stability and good decision-making ability. If a client relapses or is having a particular problem coping, then take home medication is suspended for the client’s safety, and until the treatment team determines that the client is doing well enough to resume take homes.

Methadone Diversion Control and Safety

lockboxMethadone clinics all have a medication diversion control policy. Methadone is a strong medication, and must be maintained in a secure location at all times. This becomes particularly important when a client earns methadone take home privileges.

With take home medication comes the responsibility of insuring that no one else has access to a client's methadone take home dose(s). This requires that each client provide a locked container of some type in which he or she will store their take home medication.

Each day's methadone dose is packaged & labeled separately. Upon receipt of take home doses from the clinic nurse, a client will collect & place all doses in their respective lock box container. Losing or misplacing take home doses is usually a violation of a clinic's take home agreement and can result in suspension of take home privileges.

While this may seem like a stiff penalty, it is good practice and helps to insure that all parties involved are taking necessary precautions. Methadone is safe when used properly, but can lead to serious medical emergencies if ingested by a child or non-tolerant user. Ultimately, each client must be responsible. And each clinic must take all available safeguards. The public depends on it, and regulatory authorities demand it.