Category Archives: Methadone Safety

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 Used With Newborn Babies

methadone-babyThere is a fascinating article in The New York Times which explores the use of methadone and buprenorphine in treating babies born addicted to opioids. While this is often an emotionally-charged subject, it is a very important topic and points to the benefit of methadone in relieving suffering and in stabilizing one’s health through the elimination of painful opioid withdrawal.

The article explains the dilemma that hospitals face when an opioid addicted woman is pregnant. Depending on the type and length of her opioid use, her baby may be born with an opioid dependence. And the newborn could begin experiencing painful withdrawal symptoms within 1 to 5 days.

The Times article addresses the use of methadone (or buprenorphine) in alleviating a baby’s suffering. Prior to birth, methadone has also been used to reduce the chance of miscarriage and the probability of in utero seizures. Many doctors have little to no experience with this type of treatment, and are consequently apprehensive about taking on the risk of treating an opioid addicted mother-to-be.

As of yet, there is no single universal protocol which has been established for treating newborns with methadone. However, several medical centers have been working in this area using a combination of medications such as methadone, phenobarbital, clonidine, and buprenorphine.

Early indications suggest that it is hard to predict which infants will need opioid replacement medication. To determine which babies may be experiencing withdrawal, nurses use a checklist of symptoms and assess each baby every few hours … if the baby has been identified as “at risk” due to the mother’s opioid addiction.

The Times article goes on to speak about the growing opioid addiction in America and the need for medical professionals to further educate themselves on available treatment options. We all need to remain solution-oriented, and to address this problem straight on in a constructive fashion. Thankfully, opioid addiction is a treatable illness, and opioid replacement therapy is a viable option for coping with this growing epidemic.

Methadone and buprenorphine are the best interventions we have at present for treating opioid addiction. Without them, many addicted persons would remain lost in their addiction for years on end. And babies born to addicted mothers would needlessly suffer. With time and good public education on opioid replacement, more people will find their way into a life of recovery.

Methadone is Not Meth or Methamphetamine

methadone-medicationI was speaking with someone the other day about methadone and they asked me if methadone was the same thing as “meth”. They had heard about “meth labs” on the news and people being arrested for manufacturing “meth” in their homes to sell illegally on the street. This individual was wondering if “meth” and methadone were the same thing. They are not!

“Meth” is a slang term often used in print and TV media to refer to the illegal drug crystal methamphetamine. Crystal meth is a highly addictive stimulant drug that can lead to devastating effects for its users (paranoia, hallucinations, heart attack, stroke, and death). Addiction often develops rapidly, and users are left with severe depression and fatigue as they crash following use of the drug. Crystal methamphetamine wreaks havoc on the brain’s neurotransmitters, and it is estimated that around 20% of those who abuse it develop psychotic symptoms similar in appearance to schizophrenia.

Unfortunately, crystal methamphetamine can be manufactured relatively easily. Consequently, it has sprung up around the country as small home operations began to make and sell the drug for easy profit.

It is easy to see how the general public could confuse methadone and “meth”, not realizing they are completely different substances. It is important that people understand the two have no connection, and that “meth labs” are referring specifically to the illegal production of crystal methamphetamine, not methadone.

Methadone is a leading medication-of-choice in the treatment of opioid addiction. As stated on this site numerous times, methadone is one of the most well-researched medications in history with a proven track record of efficacy in helping opioid dependent individuals avoid illicit opiate use and live productive lives.

Prescription Monitoring Helps Suboxone and Methadone Treatment

methadone40Dr. Jana Burson, in her opioid treatment blog, has written two important and interesting entries on the value of prescription monitoring programs (entry 1, entry 2). Prescription monitoring allows approved physicians to review a database listing controlled substances a patient receives (like opioids or benzodiazepines), the prescribing physician, and the pharmacy that filled the prescription.

This information is extremely useful for monitoring patient behavior in opioid treatment and helping to provide a measure of patient accountability. Some patients have a pattern of doctor shopping and abusing prescription medications even after entering opioid treatment. This monitoring program allows doctors to identify doctor shopping activities and to intervene with their patients who may be abusing prescription meds or selling them.

Dr. Burson writes that 42 states have approved a prescription monitoring program, and a majority of them already have the program up and running in their state. One notable exception is the state of Florida. Dr. Burson writes that Florida’s Governor Scott has blocked the implementation of the prescription monitoring program. This is detrimental to identifying & managing prescription abuses across the state. It is reported that Governor Scott has been contacted by other State Governors urging him to reconsider.

Methadone and suboxone treatment programs aim to help their clients change their lifestyle & behavior, and to make choices rooted in healthy recovery. Prescription monitoring enables treatment professionals to assist their clients in examining negative behaviors and correcting them.

Some individuals who doctor shop find themselves in legal trouble and facing possible incarceration. This can derail a client’s opioid treatment, as well as compromise the integrity and reputation of the methadone treatment program trying to serve addicted people. It is much better to identify prescription abuses early on and to intervene quickly.

Prescription monitoring programs are ideal for the safety and security of clients and the welfare of communities. The over-prescribing of opioids and benzodiazepines has become a major problem in the United States, and prescription monitoring is a huge forward step in rectifying this troubling issue.

Benzodiazepine and Methadone Considerations

safetyAnxiolytics are a frequently prescribed classification of drugs that are utilized to reduce anxiety and which may provide some anticonvulsant benefits for those at risk of seizure. The most common of this class are benzodiazepines such as Xanax, Ativan, Valium, Klonopin, or Librium. These medications have helped many people who suffer with generalized anxiety or panic disorder.

However, there is some consensus that benzodiazepines are over-prescribed. They are typically provided on a short-term basis only since tolerance & dependency can develop with prolonged use. Of particular concern to opioid treatment providers is the potential for fatal overdose when "benz" medications are taken in conjunction with methadone.

This is a delicate issue in that many methadone clinics have adopted a policy that disallows any use of benzodiazepines while a client is receiving methadone. This decision came about several years ago, as a safety measure, when a number of client deaths occurred tied specifically to benzodiazepine and methadone use combined.

It must be said that there are methadone patients who have received & taken benzodiazepine medication responsibly and experienced no problem. But the medical and addiction treatment community have recognized a significant risk associated with the mixture of these two potent medications. Ultimately, a program's physician is the one who bears responsibility for which medications can be safely administered. When benzodiazepines are determined to be "too risky", this can leave a methadone patient feeling defenseless & concerned about their ability to manage their chronic anxiety. No doubt, unmanaged co-occurring disorders (and uncomfortable associated symptoms) can put clients at increased risk of drug relapse.

It is very important that treatment providers (opioid programs) give their clients ample support & alternative options for coping with their anxiety. There are non-addictive medications-of-choice for treating anxiety such as Buspar, and also a variety of cognitive-behavioral approaches that help clients learn to moderate their anxiety symptoms using newly developed skills.

In the end, opioid program clients put their trust in the expertise of the clinic physicians & staff who aim to help them. Sometimes, there is no perfect answer. And clinic staff must base a treatment decision on maximum client safety as well as factoring in liability concerns that could even jeopardize the clinic's existence. Benzodiazepines will remain a high priority topic for some time to come. They too, like methadone, are helpful medications. They too, like methadone, must be closely monitored and used appropriately.