Category Archives: Methadone Programs

When Methadone Alone is Not Enough

methadone-clinicA methadone clinic where I work has received a surge in calls from prospective clients who are interested in methadone to deal with their opioid addiction. We typically perform a telephone triage when someone calls, which is a sort of mini assessment to determine what services a client may be eligible for. After completing this brief telephone interview, we then offer recommendations which may include potential admission to our clinic for methadone treatment.

Some of these callers are currently in methadone treatment at a competing agency, but are interested in transferring to our clinic. The reasons for requesting a transfer are numerous. Sometimes it is because the client can save money, or they are simply closer to our particular location (less driving time).

I have had some clients report that they receive practically no counseling. In other words, they are basically paying to dose each day with methadone (which obviously eliminates their withdrawal symptoms), but they are receiving very little psychological counseling to help them understand their addiction, or to aid them in developing sound relapse prevention practices. While it is true that some clients desire only dosing, many clients are interested in participating in counseling sessions to help them achieve improved coping skills and a better quality of life. Clients who aim for this type of comprehensive growth stand the best chance of having a real and complete lasting recovery.

This, of course, raises the inevitable question as to whether methadone alone is ever enough. There is a school of thought that methadone alone is much preferable to illicit drug use. I happen to agree that methadone is a much better substitute for illicit opiates, and there is a significant “harm reduction” benefit that is gained when an addicted individual utilizes methadone under the supervision of a reputable clinic.

Another view on this subject is that methadone, in conjunction with counseling, is the superior treatment approach. I fully endorse this viewpoint and know firsthand how recovery is accelerated and enhanced when an addicted individual wants to learn, grow and change through the process of counseling & education.

Perhaps there is value in both approaches. Some individuals who are stabilizing on methadone, but who are not yet invested in counseling, can still be moving in the direction of recovery. Perhaps they are now refraining from injection drug use and illegal behaviors. Perhaps they are feeling better physically and are able to work, or now care for their family with daily withdrawal symptoms being eliminated. If this is the case, who among us can deny that these improvements have value?

Recovery is a process that involves forward steps. Sometimes, the addicted person has only enough energy to take one forward step. That first step may be the decision to receive methadone instead of injecting heroin or snorting Oxycontin. With time, the addicted person may become ready for more. When they become ready for counseling, we as treatment providers want to be ready to give them what they need. Recovery occurs in stages and plateaus. The recovering individual can achieve as much positive change as their heart desires. Counseling is a powerful medium for this positive change. Methadone plays a very important role as well.

The Cost of Running a Methadone Program

studyThe results of a NIDA-funded study prepared by RTI International in Research Triangle Park, NC were just released. The study sought to determine the approximate annual cost, per client, of providing a quality methadone treatment program.

The study was completed in close association with Alcohol and Drug Services who operated three methadone clinics in Greensboro, High Point, and Burlington, North Carolina. Estimating the costs to operate an opioid treatment program is a difficult undertaking with many variables which must be accurately factored into a comprehensive analysis.

Some of the variables include: numerous monthly facility-related fees (lease, utilities, cleaning & maintenance), staff salaries, medication, medical equipment, urinalysis testing & lab fees, office equipment (phones, computers, copiers), educational materials and media devices, marketing & promotion, administrative & accounting costs, accreditation fees, medical records, and many other miscellaneous costs. The client census for any opioid treatment program also factors heavily into the clinic’s financial viability as well as does the clinic’s policy on charging for take home medication and other ancillary services.

The RTI study results were based on a clinic census of 170 clients. The largest single cost was labor since all methadone programs require a number of professionals working together as a team in order to deliver quality services. Labor constituted 86.5% of the costs to operate a methadone clinic.

Based on an average daily census of 170 clients, the study defined the annual per client cost to be $7,458. Divided by 365 days per year, this equates to $20.43 per day, per client, to run a quality methadone treatment program. “Quality” mean that clients are receiving regular individual and group counseling services in addition to case management and referral, and some supplemental medical monitoring, referral, and oversight.

Many methadone programs charge their clients far less than $20.43 per day thus promoting the question as to how a clinic can survive financially on an average $13.00 per day client fee. Delivering services at break even or for-a-profit will require that the clinic either cut costs by operating with minimal underpaid staff, offering minimal counseling services, receiving some supplemental State or Federal funding to offset their costs, collecting additional client fees from those whose treatment is partially funded through State/Federal monies, raising their client census to make up losses by serving a larger volume of methadone clients, or acquiring additional funding through grants, donations, or special community funding such as United Way contributions.

Some of these approaches are more problematic than others. “Quality treatment” is always a direct function of having knowledgeable, well-trained staff who are motivated to work with clients and to advocate for their needs and personal growth.

Ultimately, methadone clinics provide life saving treatment and a valuable opportunity for people to reclaim and restart their lives. However, establishing & running a quality methadone program is not cheap. For the addicted individual, opioid treatment is a much more affordable option than buying illicit drugs off the street and living an exhausting, high risk, unhappy existence.

Fortunately, many methadone programs are partially paid for through Medicaid, private insurance, or State dollars earmarked for substance abuse treatment. Even these publicly funded programs struggle … especially when Federal and State budgets are cut year over year.

What Opioid Addicted Persons Want To Know About Methadone Treatment

methadone89Since launching Methadone.US earlier in the year, I have received daily questions & requests from site visitors in regard to methadone services and methadone treatment referrals. Some inquiries pertain to the benefits of Suboxone (buprenorphine) although the majority pertain to methadone medication specifically.

Listed below are some of the most popular and frequently asked questions by those suffering with an opioid dependency. The answer to each of these questions is already provided here on the site, but I will post the short answer again.

Q1. I live in ‘Anytown USA’ and would like to find a methadone clinic near me. Can you help?

A1. Each city page on Methadone.US lists both methadone clinics & suboxone (buprenorphine) approved physicians for most populated U.S. locations. Just scroll toward the bottom of your city page to view contact information for clinics in your vicinity. If your city is not listed, write me (admin) and I will perform an individualized search for you.

Q2. How much does methadone treatment cost?

A2. Methadone clinics operate independently of one another and each one sets their own fees for services. Some clinics are private (accepting only client self pay), while others receive government or public funding. The best way to learn of a clinic’s fees is to contact that clinic directly and ask them to explain/list their treatment pricing for you over the phone.

Q3. I want to guest dose in (Anytown USA). How do I go about setting that up?

A3. Guest dosing must be coordinated by the staff of your methadone treatment “home clinic”. Contact your primary counselor (or the dispensing nurse) to request assistance with guest dosing arrangements. Many clinics require 72 hours advance notice to set-up guest dosing. The guest clinic will charge a daily fee for guest dosing with them. You cannot guest dose unless you are an active client in a methadone clinic.

Q4. My son, daughter, family member has tried to detox several times, but never been successful. Will methadone really take away the withdrawal symptoms? Can they function if they take methadone?

A4. Yes, methadone is highly effective in eliminating opioid withdrawal. And yes, he or she can live an entirely normal life and be fully functional.

Many other additional questions have been emailed to Methadone.US, but these are the ones that are most often repeated. Also, the Methadone Assessment has been popular with a substantial percentage of assessment takers indicating that they have been dealing with a moderately problematic opioid addiction.

Thanks for visiting Methadone.US. And best of luck with your recovery efforts!

Methadone Treatment Takes Work, Don’t Become Complacent

Often times, new methadone treatment clients experience a renewed sense of hope and vigor. The prospect of no longer feeling sick, or having to spend hours looking for opiates, brings incredible relief. Most clients familiarize themselves with the requirements of treatment and then follow the program as is prescribed. And particularly so if their home clinic is professional, organized, and takes an active role in interacting with their clients on a regular basis.

However, human nature tends to look for the path of least resistance, “the easy way”. This sometimes results in a client beginning to skip individual or group counseling sessions. Or in other cases, procrastinating on completion of their Medicaid renewal forms which results in the sudden termination of Medicaid payments for their methadone treatment. For some clients, old bad habits are hard to break, and they can ease back into complacency & put off important things once the crisis which brought them into treatment has been alleviated.

It is important that treatment clients identify daily priorities, live in accordance with a schedule, and develop the necessary discipline to follow through on important matters. Addiction is a cunning and baffling disease that undermines progress in both subtle and mysterious ways. Every client in recovery (and in methadone treatment) must make a firm personal commitment to put their recovery needs first. This mindset (and the accompanying healthy choices which are made on a daily basis) are essential to long term success.

Admission to an opioid treatment program is an excellent first step, a life saving decision for so many. When clients pursue real growth and try to re-engage with life, then real living can begin. Not being “dope sick” is valuable in itself, but investing in the recovery process and accepting the challenge to change leads to great discoveries, and a much better quality of life. Don’t just stand idle on the sideline. Step onto the field. Life is waiting!

Methadone Tapering Can Be An Achievable Goal

methadone-taperMost clients choosing opioid replacement therapy have it in mind that they will one day taper off of methadone once they are feeling better and have restarted their lives. Interestingly, there is considerable confusion around tapering, and this seems to be the result of opioid addicted people having tried unsuccessfully to “detox” themselves at home, or possibly having come off of methadone cold turkey.

For some, the vivid memory of abrupt withdrawal tends to exaggerate one’s fears & apprehensions. And of course, there is always someone around who seems to enjoy telling horror stories of “how bad it was” when they came off of methadone. The reality is that nearly always this person did not follow the appropriate taper process, and came off of their medication far too quickly.

So what is the reality of methadone tapering? First, a recovering individual needs to avoid being in a hurry to taper. Methadone (and suboxone) must be given the proper chance, and proper time span, to allow for establishing stability in one’s life and the building of a solid recovery. A person should pursue tapering as a goal only after they have invested time in the recovery process. Without some degree of positive change & personal inner growth, tapering off of methadone too early leaves a person with nothing to fall back on … except the same old thinking and lifestyle choices that led to addiction.

Once an individual has their life in better order, and with some new skills & supports in place, then considering a taper becomes a reasonable goal. Sadly, some methadone clinics (and private physicians too!) do a poor job of preparing their clients for successfully tapering off of opioid replacement medication. Good clinics will always be open to tapering … as a valued client alternative, and right.

Successful tapering begins with the belief that tapering is a possibility. This requires that a client be educated on the merits of gradual dosage reduction, and reassured that their clinic will walk with them every step of the way. Gradual dose reduction might be just 1-2 mg per week, and with occasional pauses or breaks in between dosage reductions. This eases one into tapering … like sticking one toe at a time into a bath to see how hot or cold the water is. This is much preferable to just diving in head first!

The gradual approach allows clients to test the waters with very small decreases, thereby giving their bodies (and minds) time to adjust to slightly less medication. Many clients find that this strategy works very well for them. After slowly reducing one’s dosage in this fashion, a client can begin to build confidence that tapering is a do-able process, as opposed to some insurmountable wall that they will never scale.

Aiding this process is the support & guidance of one’s counselors & medical staff, as well as one’s family or friends. These individuals can either help or hurt the process depending on their level of knowledge about tapering and their attitude toward the client during this process. Sometimes, family and others in the recovering person’s life will apply pressure to hurry the taper process.

Even members of the 12 Step recovering community can sometimes exhibit judgmental attitudes toward methadone treatment clients as they move through their recovery journey. Positively, some AA/NA members are becoming more educated on opioid replacement therapy, and are adjusting their views to support people in methadone treatment instead of ostracizing them. This rejection phenomenon also occurred some years ago in regard to psychotropic medications prescribed for people with co-occurring disorders like depression. Thankfully, the larger 12 Step-based recovering community became educated on medication therapy, and eventually supported people on medication for depression and other mental health conditions.

In closing, I want to encourage methadone clients to invest in their addiction treatment and the recovery process. Developing support & coping skills enables one to face and overcome challenges which used to seem overwhelming. Our clinic recently had two clients successfully taper down to 0 mg of methadone (that’s completely off!) over a course of 12-24 months. There are indeed some people who may need to remain on opioid replacement for the duration of their lives, which is a topic for another day. But do not automatically assume this is true for you.

Yes, each client in methadone treatment should view their life & circumstances from a realistic perspective. But each client should also be encouraged to consider all of their options, including the possibility of a successful medication taper. Successful tapering happens everyday. It is a reality. Science is advancing. Addiction treatment is advancing. New medications and new approaches are being implemented most all the time.

Do not rush to taper off of methadone or suboxone if they are working for you. But, do not be afraid to consider this option either. Tapering is a distinct possibility, and a worthy goal. Approach it with patience, cultivate a positive attitude in regard to tapering, and discuss it periodically with your counselor or physician. Do not underestimate yourself or your ability to accomplish things which are important to you.