Category Archives: Methadone Safety

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.

Balancing Methadone Client Rights With Accountability

methadone-clinic-13Methadone “take home” medication (also referred to as “take outs”) is a true convenience for those enrolled in a methadone clinic. Typically, clients who demonstrate that they are drug free and progressing in their substance abuse treatment can earn the privilege to receive take home medication.

Receiving take home methadone requires that the prescribing physician (and clinic) have safety and accountability measures in place to help reduce the chance of methadone or suboxone getting into the wrong hands. When clients take medication home, it is critical that the opioid replacement medication be kept secure and out of the reach of children. Overdoses can occur with individuals that have no developed tolerance to opioid replacement medication.

Receiving take home methadone is a privilege, not a “right”. This decision to award take home medication is usually a collective decision made among the clinical and medical staff in a treatment program. They base a client’s readiness to receive take home medication on that person’s level of recovery stability, absence of active psychiatric symptoms, and the safety & security of their immediate home environment.

Methadone and suboxone have considerable “street value” and can be resold or misdirected. Therefore, clinic staff want to be as assured as possible that any particular client receiving methadone is sincere, stable, and appropriately focused on his or her own recovery.

Methadone and suboxone patient rights are of course always very important. Clinics and physicians sometimes walk a fine line between accommodating the patient and requiring accountability measures that are perceived by the patient as a hassle. For example, methadone clinics are required to perform random “call backs” in which a client is contacted and required to bring their methadone medication back to the clinic within 24 hours for a recount. This helps the clinic insure that the patient is not over-taking their medication or misdirecting (selling) their medication. While not a guarantee of good behavior, it does encourage patients to treat their take home medication responsibly and with substantial care.

Another safety measure is random urinalysis. It is not safe for patients to receive take home medication if they are using other unapproved drugs. If a random drug test shows the recent use of illicit substances, then this requires the clinic to suspend take home privileges for some period of time, at least until it can be established that the patient is back on track and testing drug free again.

If a patient feels that their rights have been unfairly compromised, then they have access to the clinic’s internal review process and/or the state’s methadone board who hear and investigate client grievances. In the end, the patient and the methadone clinic should be in a cooperative partnership. This is the working ideal in any health care relationship one has with their treating physician. Clinics exist to treat and serve patients, and opioid addicted patients need the services of opioid treatment providers. This relationship is extremely valuable and should be nurtured by both parties both at initial intake and ongoing for the duration of the treatment process.

Anti-Methadone Sentiment Not Rooted in Reality

methadone52In browsing articles on current methadone treatment, I came across a brief one in the United Kingdom’s Daily Record specifically from the Scottish news section. The article contained a number of derogatory quotes (in regard to methadone) from Scotland’s Maxie Richards. Ms. Richards runs a foundation for addicted people in recovery.

One quote from Ms. Richards pertaining to methadone included: “To me it represents a hopeless road, a road to nowhere.” Another comment was “I think it is such a waste to let young people spend years on methadone because we don’t think there’s any hope for them.” Ms. Richards is openly critical of the government’s support of methadone treatment programs.

Her words “a hopeless road” are not a fitting description of the life enhancing benefits of methadone in treating addiction. To the contrary, methadone is often the single most beneficial intervention for someone struggling with opioid addiction. In my experience, any addiction professional who is categorically against methadone is revealing a lack of education on evidence-based treatments, and is merely expressing an unsubstantiated personal bias that is easily refuted.

Today, a former client made a surprise visit to our clinic. She had been in methadone treatment with our agency for a little over 4 years and had come off of methadone one year ago. Today, standing in our lobby, she was full of life, smiling, and enthusiastically talking about how well things were going in her life. She said that methadone had been instrumental in saving her life. Since leaving treatment, she had remained completely drug free, was full-time employed, enjoying positive relationships with her family. And she looked wonderful, very healthy, and had a beautiful complexion.

Was her methadone treatment a “hopeless road’? Absolutely not! She, and we, knew that it was a bridge to a better life. She had originally arrived at our clinic beat down, lost in addiction, hopeless, and desperate for an answer after having tried everything she knew of to get clean and sober. Choosing methadone and counseling worked for her. I wonder what Ms. Richards might think if she had the chance to see and to speak with our former client today? Results speak for themselves. Methadone programs save lives and provide a deeply desired new opportunity. True, not all methadone programs are the same. Some are better than others.

Hope … is what many addicted people find when they begin dosing with methadone. Relief … from painful opioid withdrawal symptoms is what they feel. Gratitude … is what they express for a new start in life. And eventually happiness. Which is what our former client had come to share with us on this day.

Methadone and the Importance of Safety

safety1Methadone is so very beneficial when used properly and judiciously (as prescribed). However, in the wrong hands, methadone can lead to tragic consequences. Here is a cautionary tale.

Making the news in Gaston County, North Carolina was the recent death of a young man who was a member of his school’s football team. His name was Harry Cohen, and he was 17 years old.

Harry had played in an extraordinary football game on August 26, just days before his death. He is reported to have rushed for 241 yards and passed for 107 yards. A very impressive performance. He is also reported to have taken some hard hits in the game. His family indicated that he was sore from the highly physical contact.

While visiting with his grandmother later (who had a legitimate methadone prescription for pain management), Harry decided to take some of the medication to ease his physical pain. His mother found him the next morning in bed. He had died from a methadone overdose as a result of not having developed a tolerance to the medication.

This story reinforces how important it is that methadone (and all potentially high risk medications) be carefully safeguarded. The Gaston County article had a number of comments and opinions posted by local community members expressing their sorrow over Harry’s death. Fortunately, no one blamed “methadone”.  Most commenters emphasized the importance of treating prescription meds with caution. This is exactly the right sentiment, and a message that bears repeating over and over.

Often, children & teens assume that a medication must be “safe” if it is prescribed by a doctor and sitting out in plain view. Of course, this is not the case in many instances. It is imperative that adults think twice about securing medications, and also educate themselves on the associated safety concerns that come with various medications.

It saddens all people when something tragic like this hits a family and a community. Hopefully, we can draw from this loss an important lesson … that will help to prevent future losses.

Characteristics of a Quality Methadone Program

methadone-programsMethadone programs across the country differ in their quality of service. Some are simply better than others. Why is this?

Each program is shaped by the experience, professionalism, and treatment approach of the staff who are employed there. Quality programs emphasize comprehensive recovery and client skill-building in addition to medication assistance (like methadone or suboxone dosing). Importantly, each client should be provided regular counseling & active support that is characterized by consistent respect shown for clients at all times.

Opioid addiction recovery involves more than just receiving methadone. It requires lifestyle change, improvements in thinking and behavior, and a willingness to learn and adapt to the challenges of life. Opioid replacement medication, by itself, cannot provide all of this. Consequently, quality methadone clinics will encourage their clients to use treatment as a means of enriching their lives and moving to higher plateaus. Methadone programs that do not provide this opportunity are called “dosing mills”.

Dosing mills usually exist to dispense methadone and collect a fee. Treatment services and attention to client growth are not a priority. There is definite value in helping an addicted person to stop using illicit drugs and in stabilizing them on a safer opioid substitute, like methadone or suboxone. But this “medication only” approach is not recovery, and does not address the root problem of addiction or its underlying causes. The goal of quality methadone treatment programs is to empower their clients to live the fullest lives possible.

While the list below does not cover every possible area, here are some characteristics of higher quality methadone programs that one should expect:

  • Every staff member in the clinic understands & endorses the value of opioid replacement therapy.
  • Staff demonstrate care for clients and treat them with respect. Clients are welcomed, and their decision to enter opioid treatment is viewed as a commitment to a better life.
  • There are counseling groups and/or the availability of individual counseling sessions, and clients are required to attend these.
  • The clinic starts new clients on modest doses of methadone, increases their dosage gradually, and monitors the client closely as he/she acclimates to methadone. This is an important safety protocol that no decent clinic should sidestep. Rapidly hiking clients up to high levels of methadone is medically irresponsible and poses an unnecessary safety risk.
  • Clients have access to an appeals process.
  • The clinic strives to be organized and efficient for the convenience of its clients. This is often a challenge, but a clear effort is made to minimize a client’s wait time before dosing.
  • Clients are subject to random urinalysis and other accountability measures. This promotes client responsibility, raises program integrity, increases client safety, and shows the community that the methadone program is all about quality and ensuring that the program is conscious of the community’s needs and concerns.
  • Illicit drug use (relapse) is not overlooked, but is addressed promptly with each client in a constructive manner. Various treatment alternatives & interventions are offered to help relapsing clients get back on track.
  • The program engages in comprehensive assessment, and either provides in-house services for co-occurring disorders (ex. depression), or coordinates a referral for help in this area.
  • The program practices diversion control in order to minimize the risk of methadone being misdirected. Additionally, take home medication awards are made based on client progress with treatment and demonstrated stability, not just the passage of time.

As a client, it is important to remember that you have rights. Your clinic staff should review these with you and should provide you a manual or handbook which outlines the program’s guidelines, dosing hours, fees, and other expectations. If you do not have this handbook, then please request it.

In closing, various methadone programs do differ in their approaches, policies, and procedures … just like any other medical service provider. There are many high-quality programs around the country staffed by capable & dedicated professionals. As is the case with most any industry, some companies/organizations rise to the top and are better than others. The “bad” ones should not reflect negatively on the good ones. Both will likely always exist to a degree.

As a treatment provider, hopefully you will continually strive to be the best that you can be. As a client, it’s important to be an informed consumer of services. Sometimes, talking with a number of other existing clients can give you a heads up on whether a particular clinic you are considering has earned a good or bad reputation. Stick with the better clinics if at all possible. You’ll be glad you did.