Category Archives: Methadone Programs

Time Limits on Methadone Programs

methadone-servicesThere is growing interest from a number of entities in regard to America’s opioid addiction problem, methadone treatment, suboxone treatment, and the always important funding considerations that accompany these subjects.

This interest is coming from hospitals & the larger medical establishment across the country, your local community, the Federal government’s Medicaid services division, your State’s Division of Health and Human Services who allocate state dollars for opioid treatment, private insurance companies, employers, and the list goes on and on.

The nationwide costs and consequences of addiction are enormous. The cost of treating addiction is also very large. However, research has proven repeatedly that addiction treatment produces undeniable cost benefits. In other words, treating addiction saves money in the long run by helping addicted individuals arrest their disease and become functional again. For many of the entities listed above, it’s all about the dollars. And more specifically, saving dollars when it comes to treating addiction.

The U.S. economy has been hit hard and we have a growing number of people depending on entitlements and public assistance. This, of course, creates a scenario in which more and more people are relying on a “government pie” whose slices keep getting cut smaller and smaller. The recent reductions in funding for public addiction programs have caused some agencies to close their doors … while other agencies simply had to cut back on the services they are able to offer their addicted clients.

An important consideration, which may become a hot topic soon, is how much counseling a methadone or suboxone patient can receive. Or, how long he or she can remain on their opioid replacement medication before public assistance funding begins to stop. Medicaid and State dollars presently help to fund the treatment for many opioid addicted clients in programs. There are currently more people in need of opioid treatment than there are funds available to pay for that treatment. So inevitably, patients may find themselves needing to help pay for their treatment.

I would not like to see patients be pressured to taper off of methadone before they are ready. Experience has shown us that gradual tapering, initiated & paced by the client, is the most successful means of coming off of methadone or suboxone successfully. Government public assistance is becoming more like private “Managed Care Organizations” with every passing day. As this paradigm continues to evolve, we may possibly see time limits of some sort imposed on methadone & suboxone maintenance clients. Some may view this as reasonable and necessary since such limits and caps are already applied to recipients of other health care services.

If time limits are ever applied to one’s length of time on methadone or suboxone, we will likely see clients increasingly picking up the funding for their opioid treatment. This happens everyday around the country in private, self-pay methadone clinics. In the end, we know that opioid replacement therapy works. It’s been proven! The availability of Medicaid and State funding is a great benefit to many people across the country. How this might change in the years ahead will bear close observation.

Opioid Craving Similar to Food Hunger

Clients tell me that their loved one does not understand why stopping opiate use is so hard. Most non-users think that it is simply a matter of "willpower". While determination is very important in overcoming active addiction, "willpower" alone is usually not enough to overcome one's physical opioid dependence once it has taken hold.

There is a page here on Methadone.US that is dedicated to explaining opioid addiction and the overwhelming compulsion that addicted people feel to keep using these drugs. If you are suffering with an opioid addiction, I recommend that you have your family or friends read this page. It helps to explain (using easily relatable examples) how and why addicted people have such a hard time avoiding opioid use when their withdrawal symptoms and cravings begin to build.

Opioid addicted people are no more able to "just not use" than most people are able to "just not eat". The need to satisfy hunger and the need to avoid opioid withdrawal are similar physiological drives. Both are powerful needs that a person cannot ignore.

Opioid addiction causes profound biochemical changes in the brain. The potential for becoming addicted is always present. Thus, this risk of addiction is something that all physicians should discuss with their patients when they prescribe them opiates for whatever reason.

Prescriptions for Opiates

opiatesThere are many legitimate and appropriate uses for opioid medications. Opioids are excellent at managing acute or chronic pain for back injuries, post-surgical recovery, dental work, and other medical conditions that generate unbearable pain.

For those who may become physically dependent upon opioids, their difficult journey often does not begin with a chase for euphoria or a “drug high”, but with a short-term prescription from their physician for a pain killer … in order to minimize the pain and discomfort from a recent surgery or injury.

How the brain & body respond to opiates varies from one person to the next. Some individuals have a very high tolerance for pain and may need relatively less pain relief medication than someone who possesses a high sensitivity to pain.

If an individual takes pain medication for a long enough period of time, they may run the risk of developing a tolerance to the medication such that only higher doses of it are effective at reducing pain. As the person begins to increase their use of the pain medication, a physical dependency begins to set in resulting in withdrawal symptoms when the opioid relief wears off. The only thing that will eliminate the uncomfortable withdrawal symptoms is taking more of the pain medication. And thus, a vicious cycle sets in.

It is important to consider than no one starts out intending to become addicted. Unfortunately, many prescribing physicians do not explain to their patient the potential for developing an addiction to opioids. In fact, there is general consensus emerging that pain prescriptions are too readily given out. Many admissions to methadone clinics include individuals whose opioid dependency began with a legitimate prescription for pain medication. It is important that both doctors and patients share responsibility in addressing the potential for addiction with opioid medications. We do not want to discourage the appropriate use of pain medications. They are extremely effective at helping people manage their pain and be able to function. But education is critical if we are to help individuals adopt the proper caution & awareness in regard to potential opioid dependency.

Doctors and Methadone

factsHow doctors view methadone is becoming a hot topic. A friend recently informed me that the TV celebrity doctor, commonly known as Dr. Drew, was against methadone and had publicly made negative comments about the medication. I was disappointed to learn of this because Dr. Drew has a fairly large national audience who follow his opinion on medical matters. I then noticed that Dr. Jana Burson (a well-educated and experienced opioid addiction professional) had written on this topic, and herself questioned why Dr. Drew had made derogatory comments in regard to methadone. Dr. Burson knows firsthand how incredibly beneficial methadone is to those suffering with chronic opioid dependency. If a physician deserves a national audience & voice on this topic, it is Dr. Jana Burson, not Dr. Drew Pinsky.

Physicians typically seem to fall into one of two camps: either those who are educated on addiction and modern addiction treatment approaches, or those who are not. This may seem like a simplistic analysis, but is surprisingly accurate. Sadly, in my experience, physician critics of opioid replacement therapies often jump to conclusions that stem from personal bias or opinion based on very limited exposure to methadone and its benefit to the recovering community. Methadone is not “alternative medicine”, or some unproven sideline drug that one must obtain via the black market in a third world country.

Methadone is the leading medically-approved pharmaceutical treatment intervention for opioid addiction in the United States. There is no medical “speculation” on methadone’s success in the treatment of opioid addiction. It is a proven method of saving lives and restoring quality of life for a large subset of those who are addicted to opioids. These are not hyped opinions, but are medical facts that are beyond dispute. That any “physician” would reject methadone as a legitimate treatment for opioid addiction … is professionally irresponsible, and suggestive of medical incompetence in the area of treating drug addiction.

Methadone has been in widespread use in America for over 40 years. The number of addicted individuals whose lives have been saved and/or improved (through the medically supervised use of methadone) is well documented. SAMHSA (the United States Substance Abuse and Mental Health Services Administration) publish evidenced-based Treatment Intervention Protocols (known as TIPS manuals) that are available to treatment centers all across America. They have several such manuals, published and widely distributed, that are specifically dedicated to treating opioid addiction with methadone and buprenorphine (suboxone). SAMHSA also maintain a U.S. government website listing all of the methadone clinics in the USA and U.S. physicians approved to dispense buprenorphine for the treatment of opioid addiction. Why do they list these? So that suffering people can find help for their addictive disorder.

Perhaps Dr. Drew should interview actual patients in methadone treatment programs. Then interview the staff of professionals (including dedicated, knowledgeable physicians) that work in these facilities. Then interview the families of methadone patients that regained their sons, daughters, mothers, and fathers. Then read the evidenced-based literature & research available (through SAMHSA) on the beneficial use of methadone in treating opioid addiction.

That might require Dr. Drew to walk off of the TV production set, out of the celebrity limelight … and into the everyday real world. It’s a place where people like Dr. Jana Burson work for many years, with thousands of opioid addicted people, using medical interventions that are proven and effective. Dr. Drew would do well to have a sit down conversation with professionals like Dr. Jana Burson. This might allow him to replace negative personal bias … with medical fact. Only then, would he be equipped to speak to the public about methadone and opioid addiction. Until then, he is just part of the TV & celebrity noise … where drama, ratings and sensationalism … are cherished over the truth.

Educating the Family on Methadone

methadone_family2A majority of clients who enter methadone programs do so without immediate family involvement in the admissions process. Often, a significant other knows of their loved one’s decision to enter treatment, but chooses to remain “on the outside”. There are several reasons for this including: apprehension about methadone clinics, feelings of embarrassment that their loved one has an opioid addiction, not wanting to invest time in the recovery process, or simply being too busy to spare the time.

Consequently, clients enrolling in methadone treatment programs typically go it alone early on. It is of course highly beneficial for each client to have some outside support, encouragement, and to be able to share their recovery journey with someone who cares about their struggles and progress.

I have found that many family just do not understand opioid addiction or the enormous benefit that medication-assisted treatment provides to those who are embarking on the journey of early recovery. There exist a notable social bias too against methadone which is born almost exclusively out of a lack of education on methadone’s efficacy as a medically-approved form of treatment for opioid addiction.

As has been stated on this website, the media have done an extremely poor job of reporting the widespread benefits of methadone as a useful opioid replacement medication. These factors sometimes steer families in the direction of harboring critical views & fears about methadone (or buprenorphine) as a legitimate addiction intervention. Where there is fear of something (whether justified or not), there usually exists detachment from, and a negative view of, that which is feared.

I have had the fortunate experience of meeting families, educating them on methadone as a recovery tool, and being able to answer questions about our methadone program. This face to face contact almost always builds a bridge by demystifying methadone and what it represents in the addiction recovery process. Education, knowledge, and trust consistently replace ignorance, fear, and negative social stigmas. When a family member comes to understand how methadone works and how it is part of a larger recovery effort, that person then becomes part of the recovery solution. Recovering individuals need this acceptance and family support. It is so very valuable.

Educating the family on methadone treatment can be accomplished in a variety of ways. A pamphlet, a phone call, inviting them to a family counseling session, or referring them to a fact-based website on methadone’s purpose. Helping families understand addiction and addiction solutions is always a worthwhile effort.