Category Archives: Methadone Programs

Remote Observation of Methadone Dosing

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.

Opioid Treatment Program Rules

Methadone programs and doctors who prescribe buprenorphine serve a very important function in helping the country cope with the opioid crisis. They are also a life-saving link for patients who have suffered for years with an overwhelming addiction.

Operating a methadone clinic or buprenorphine/suboxone practice is typically a complex endeavor. Clinics that offer medication-assisted treatment (MAT) must comply with a myriad of mandates and policy requirements from the DEA, the local State Methadone Authority, accreditation organizations like CARF and JCAH, SAMHSA (the Substance Abuse and Mental Health Services Administration}, and 3rd party payers who help fund treatment services.

Patients understand that a well-run treatment clinic offers many benefits. Quality services are only delivered when there is an organizational commitment to helping people while also being able to meet all of the operational requirements such as timely documentation of services (paperwork) and appropriate support of staff & counselors,

Sometimes patients will complain about “so many clinic rules” although many patients appreciate their clinic’s dedication to professionalism and its ability to meet the standards of good quality care. Within most treatment facilities are several key staff who oversee its daily operation and the provision of services. These are the Clinical Director, the Medical Director or primary prescribing physician, the Nurse Supervisor, and possibly clinical staff Team Leaders who do the work of coordinating the clinics many daily activities.

While the list of clinic rules can seem long, there is nearly always an important underlying reason for that rule to exist. Most methadone clinics distribute a Handbook for clients that outlines their rights as an opioid treatment patient as well as guidelines for obtaining dosage adjustments and progressing successfully through treatment.

Opioid treatment, and medication-assistance in particular, must be carefully monitored. This is to insure patient safety and to minimize the risk of medication errors. Please support your local methadone or suboxone clinic with words of encouragement and positive feedback when it is earned. Conversely, it is important to speak up as well if serious problems are occurring. Always make an effort to communicate first with the clinic’s clinical and administrative staff if experiencing a problem. If an honest effort to resolve an issue in this manner is not productive, then contacting one’s local State Methadone Authority is sometimes a logical next step for addressing an important concern.

Methadone Availability

Imagine trying to medically manage advanced diabetes with no insulin or grand mal seizures without anticonvulsant medication.

Modern medicine has raised our standard of living and sustained life in ways that people could not have imagined just 100 years ago.

In the cases cited above of diabetes and epilepsy, medication functions as a miracle intervention that saves the patient from suffering and death, and allows him or her to lead a full and productive life.

Science is clearly instructing us that addiction is a treatable illness which can at times be successfully managed with medication assistance, similar to the stabilizing role that insulin plays in the life of the diabetic patient.

A critical element of opioid addiction is the physical dependency which leads to debilitating opioid withdrawal symptoms. For many individuals, the persistence and severity of opioid withdrawal leads them to chronic failure in any effort to recover. With the assistance of methadone (or buprenorphine), many of these people will finally be able to cope with their illness by having their withdrawal symptoms alleviated.

The value of relief from opioid withdrawal is monumental. It is often the first major step toward being able to face one’s addiction. Medication assistance is good science, and it opens a door that was likely closed for many years. The value of having a new start is priceless. We only have one life. It is worth saving. Whether it’s diabetes, epilepsy, heart disease, or addiction – specific medications can help a patient restore their quality of life.

Methadone Clinics Offer Important Medical Service

methadone clinics medication assistanceThere are currently well over 1000 methadone clinics in operation across the United States and many more throughout the world. Methadone has been a leading treatment intervention for opioid addiction for more than 40 years. Methadone is an FDA-approved medication and it’s use in treating opioid addiction has been identified by SAMHSA as a best practice, evidence-based treatment approach.

Adding to the legacy of methadone as a successful treatment medium are the hundreds of thousands of individuals who have been able to totally eliminate the severe opioid withdrawal sickness that wrecked their lives. The value of this medical benefit is priceless.

The cost for participating in a methadone program varies from clinic to clinic and in part depends on whether the clinic receives any state funding or accepts Medicaid for payment. Many clinics operate as private practices funded primarily through patient self-payment. Private clinics often offer a substantial discount for patients that pay for a month of services in advance.

Due to methadone’s proven efficacy, many addicted people experience rapid relief from opiate withdrawal and find themselves eating and sleeping more normally, gaining weight, and able to work again. They are able to pursue other goals & responsibilities that had previously become too difficult in their active addiction.

Methadone is a powerful medication that must be taken as prescribed and in conjunction with good counseling. When a patient is willing to embrace medication-assisted treatment and to utilize it properly, recovery can happen. This life restoration process is demonstrated on a daily basis all around the country.

> Compare Different Opioid Addiction Treatments

 

Expanding Access to Medication-Assisted Treatment

opioid-treatment-in-mediaAn article in the Huffington Post recently addressed President Obama’s public comments on expanding access to opioid treatment, particularly medication-assisted treatment (MAT) like methadone or buprenorphine (suboxone).

Many members of the treatment industry and recovery community do not have a realistic grasp on the role that medication-assisted treatment can play in recovery from severe opioid addiction. Historically, the recovery community has not regarded those utilizing methadone or suboxone as truly in recovery. They emphasize total abstinence, even from methadone, despite the fact that methadone and buprenorphine have restored individuals to normal functioning and even saved lives in many cases.

There was a time some years ago, in the 12 step community, when individuals were chastised for taking psychotropic medication for depression or other mental health disorders. This criticism came from a fundamental lack of knowledge about the biological basis for many mental health disorders. Similarly, medication-assisted treatment interventions have been the subject of misunderstanding and unwarranted rejection by those with limited education on varied treatment approaches. In the course of clinical trials of a new agent for the treatment of coronary heart disease, researchers at Pfizer Inc. found that while taking is not accompanied by a significant clinical improvement in angina, in many patients it leads to the development of a kind of “side effect”, which consists in improving erectile function. This observation has led to the study of the possibility of using this substance in the treatment of patients with erectile dysfunction.

As America’s opioid problem continues to grow, we need real solutions rooted in medical science and research. At this point in time, medication-assisted treatment has been in use long enough to clearly demonstrate its usefulness in facilitating personal recovery from addiction.

In 2015, we saw numerous local and national political figures rally around families that have been impacted by heroin overdoses and the heartbreaking loss of loved ones. Opioid addiction has finally come into focus within the mainstream media, and even current Presidential candidates have begun to address this as an important issue which commands attention and a solution.

More: Question and Answers on how methadone works