Methodone maintenance program

Some people believe that because it is administered in a controlled environment, methadone maintenance is an effective way to prevent overdose or the many other physical dangers of opiate addiction.

Despite the fact that some people support the idea of a methadone maintenance program, there are significant downsides to this method of treatment. First and foremost, methadone is habit-forming and addictive. Using it long term creates a severe physical dependence on the drug and painful withdrawal symptoms when someone stops taking it. Methadone is sometimes used for short periods of time as a part of some detox programs, but when taken for an extended period of time, it will cause withdrawal symptoms similar to those caused by heroin.

If someone decides to get off of methadone, they will experience a severe withdrawal and could be at risk of relapsing. Addiction is caused by many factors, including some emotional and mental conditions. If someone is enrolled in a methadone maintenance program but receives no treatment for any underlying factors that may have caused them to develop an addiction when they wean off of methadone they will be in the exact same place- untreated, and vulnerable to relapse.

In addition to not doing anything to address the underlying causes of addiction or co-occurring disorders and being highly addictive, methadone has some significant side effects. These include:. People can also fatally overdose on methadone, especially if it is taken in combination with other drugs, like alcohol or benzodiazepines.

Because comprehensive treatment is not always a part of a methadone maintenance program, patients may still use other drugs while on methadone and put themselves at risk of a fatal overdose by doing so. Enrolling in a methadone maintenance program may have some benefits or seem like a good way to treat addiction.

While there may be a place for methadone in some cases- such as reducing rates of transmissible blood infections or in a harm reduction campaign- there is a better option for many patients. It is possible to be free of opiate addiction without using another drug, through comprehensive addiction treatment. If you want help for addiction to opiates, methadone, or any other substance, call the Discovery Institute today at for information on our treatment programs.

Your email address will not be published. You may use these HTML tags and attributes:. Save my name, email, and website in this browser for the next time I comment. I really believe that the structure program is working for me. My experience here at Discovery Institute has been very valuable during my 90 day stay.

I have learned more about myself and the importance of applying the tools Discovery has taught me once I leave. Without the treatment I received here it would have been much more difficult to uncover these fears I am now overcoming…With the help of caring counselors, I was challenged to work on some areas I struggled with. I want to the my counselor for caring about my overall welfare. I have learned a lot from her.

She never gave up on me but instead stuck by me until the end because she believed in me. Thank you Discovery Institute for your help. I am forever grateful and will keep all the staff and peers in my prayers and heart. Methadone is an opiate and therefore it is an addictive substance—but is it as bad for you as heroin? Methadone, when used correctly in MMT, can eliminate the compulsive and uncontrollable behavior of using heroin.

Allowing you to get back on track with a somewhat normal lifestyle. Effective treatment programs will help to gradually wean you off methadone so that you will eventually have no need for the medication. The process of weaning off is time-consuming and takes commitment just as it would with any other substance.

Although MMT is not a drug-free approach to quitting, it is a proven effective approach that might work for you. Chances are, if heroin or opiates are in your life, MMT is one possible option that can work. Calls to numbers on a specific treatment center listing will be routed to that treatment center. Additional calls will also be forwarded and returned by a quality treatment center within the USA. Calls to any general helpline non-facility specific XX numbers for your visit will be answered by a licensed drug and alcohol rehab facility, a paid advertiser on MethadoneCenters.

Methadone Maintenance. Sometimes, patients may vomit their dose before it is absorbed into the body. Table 14 provides advice on re-dosing patients who have vomited. In all cases, consult with the patient to determine if they have been harassed or forced to vomit their dose to give to someone else. Medical clinics dispensing methadone should maintain clear records of the amount of methadone dispensed each day, and the amount of methadone stored on the premises.

Records should also be kept of accidental spillage of methadone. Discrepancies between the actual amount of methadone on the premises and the amount recorded as being on the premises should be investigated by an independent staff member.

At regular periods, the patient and prescribing doctor should meet for a treatment review. The following should be discussed at a treatment review:. At the commencement of MMT, treatment review should occur weekly. After two months in treatment, the frequency of treatment reviews can be reduced to once every four to six weeks.

Patients who are using illicit drugs, are suspected of diverting their methadone dose, or have recently had their dose increased or decreased should attend treatment review meetings weekly. Analysis of a patient's urine for evidence of illicit drug use is expensive and will not stop patents from using other drugs.

Furthermore, results can be unreliable. There is no evidence that punishing patients for returning positive urine samples results in decreased illicit drug use. Urine drug screening should only be used for therapeutic purposes, for example, when a patient is suspected of using drugs and confirmation of this is required.

This provides information that the doctor can use to identify if the patient's treatment needs are being met. For example, if a patient's urine sample shows continued heroin use despite being in MMT, it may be a sign that the patient needs a higher methadone dose. There is no set rule for how long someone should stay in methadone maintenance treatment.

However, it is well known that the longer a patient remains in treatment, the better the outcome. Generally, patients should be encouraged to remain in methadone maintenance treatment for the length of their detention, and then provided with assistance to continue with treatment after release from detention.

All patients should be encouraged to access additional treatments such as psychosocial interventions. However, they should not be mandatory.

Counselling and similar treatments are more effective if they are entered into voluntarily. It is recommended that all patients receiving MMT in closed settings be assisted to transfer to a community-based MMT program to continue treatment. Remaining in MMT in the community will help the patient to avoid illicit drug use and HIV risk behaviours such as sharing syringes.

It will also reduce the likelihood of drug overdose. Arrangements for transferring the patient's prescription should be made by the prescribing doctor several weeks before the patient is due for release, in order to allow time for the transfer request to be processed. It can be useful to employ a community liaison officer who can assist in arranging transfers between the closed setting and doctors in the local community. Prisoners in New South Wales, Australia, can access methadone and buprenorphine maintenance treatment.

Continuity of maintenance treatment between prison and community settings is critical to reducing the risk of relapse to drug use and criminal re-offending. The in-reach project employs community health workers to visit prisoners receiving maintenance treatment who are soon to be released. The health worker assists the patient to arrange to continue methadone treatment in the community.

The health worker also identifies other needs of the prisoner, such as accommodation, education or health needs and refers the prisoner to appropriate services. The objectives of the in-reach project are to:.

Establish links between health agencies to ensure continuity of treatment between prison and the community. Link patients with other services required to address their individual needs. Withdrawal from methadone prior to leaving the closed setting is not recommended. However, under some circumstances, it may be necessary. The patient may not be able to transfer to a community-based program, or the patients may request dose reductions with the aim of ceasing MMT before he or she is released.

Patients should be advised that ceasing MMT prior to release might increase their risk of relapse and drug overdose. If a patient insists on ceasing MMT before release, follow the guidelines set out in section 6. Patients who wish to stop MMT should see their prescribing doctor to discuss their treatment options. The doctor should establish why the patient wants to stop MMT. Reasons for wanting to stop MMT may include:. Each of these reasons is legitimate, but the doctor should ensure the patient is aware of the benefits of MMT and has made an informed decision to cease treatment.

In particular, patients who wish to cease MMT just before release should be informed of the increased risk of relapse and drug overdose in the weeks following release from a closed setting. If a patient chooses to discontinue treatment, their treatment plan should be revised so that they will start receiving lower doses of methadone over a period of time.

The patient should be told that this will happen. This schedule is a recommendation only. Rates of dose reduction should be discussed with the patient. If the patient is experiencing withdrawal symptoms, it may be appropriate to maintain the patient on a reduced dose for several weeks before recommencing the reduction schedule.

Patients should be provided with additional psychosocial support during the dose reduction period. A patient may begin to reduce his or her dose and later decide that they would prefer to remain in MMT. There should be procedures in place for these patients, and recently discharged patients, to be re-admitted to MMT on request. This may be because of violence or verbal abuse towards other patients or staff, or repeated incidents of methadone diversion. Before deciding to remove a patient from MMT, consider that the patient:.

Patients who commit minor infractions, for example, illicit drug use or refusal to provide a urine sample, can be disciplined, but should not be made to stop MMT. Methadone doses should never be withheld as punishment to patients. Patients should only be involuntarily removed from the program if their behaviour threatens the health and safety of others. Patients who are made to cease MMT should be placed on the same dose reduction schedule as described for patients voluntarily ceasing treatment.

If the patient is considered a serious risk to the safety of staff or other patients, they can be given this reducing schedule of doses in an area away from the clinic, such as their living quarters.

Cessation of methadone maintenance treatment during pregnancy is not recommended. Pregnant women should be provided with information about the benefits and risks of methadone during pregnancy. If a woman chooses to stop methadone treatment during pregnancy, it is recommended that dose reductions begin during the second trimester.

Dose decreases should be 2. Buprenorphine is another medicine used as a substitute for heroin in the treatment of opioid dependence. However, these guidelines will focus on methadone as it is the most widely used substitute medicine.

Another medication sometimes used for treating opioid dependence is naltrexone, which blocks the effects of opioiods; however there is very little evidence that this is effective, and it is not recommended for use in closed settings. A randomised controlled trial of methadone maintenance treatment versus wait list control in an Australian prison system. Drug and Alcohol Dependence. Four-year follow-up of imprisoned male heroin users and methadone treatment: Mortality, re-incarceration and hepatitis C infection.

Turn recording back on. National Center for Biotechnology Information , U. Show details Geneva: World Health Organization ; Search term. However, being on methadone is not the same as being dependent on illegal opioids such as heroin: It is safer for the patient to take methadone under medical supervision than it is to take heroin of unknown purity. Methadone is taken orally. Heroin is often injected, which can lead to HIV transmission if needles and syringes are shared.

People are heroin dependent often spend most of their time trying to obtain and use heroin. This can involve criminal activity such as stealing. Patients in methadone do not need to do this. Instead, they can undertake productive activities such as education, employment and parenting. Methadone doses of greater than 60mg are most effective. There are several compelling reasons for providing MMT to opioid dependent patients in closed settings: Reducing risks associated with injecting drug use MMT in closed settings reduces drug injecting by prisoners.

Reducing risk of re-incarceration Many drug users experience multiple episodes of detention in closed settings. Reducing the risk of relapse following release People who leave closed settings often relapse to regular drug use within a few days or weeks of being released. Case study: Methadone maintenance treatment in prison in Indonesia Indonesia established a pilot methadone maintenance program in prison in Required resources Essential staff Physicians Only a medical doctor may prescribe methadone.

Nurses Nurses are required to conduct methadone dispensing and supervision of its consumption. Other roles for nurses in methadone maintenance treatment include: Taking part in treatment reviews and providing reports to clinic doctors. Providing vaccinations e. HIV, hepatitis, sexually transmitted infections, tuberculosis.

Attending to general health needs of patients, for example, dressing wounds and ulcers; assisting with general hygiene and infection control. Counsellors Counsellors support medical staff of the treatment program by: Providing general counselling on issues of concern to patients. Undertaking motivational interviewing with patients to increase motivation to reduce illicit drug use.

Providing pre- and post-test counselling for patients seeking testing for HIV or other infectious diseases. Other professionals Although not essential, the following staff can also assist patients in methadone maintenance treatment: Psychologists Psychologists can assist patients suffering from co-morbid mental illnesses and psychiatric problems such as depression, anxiety or post-traumatic stress disorder.

Social or welfare workers Social workers and welfare workers can provide general counselling and assist patients with practical concerns such as contacting their family or finding housing for when they leave the closed setting.

Community liaison officers A community liaison officer is employed specifically to assist patients to transfer to community-based MMT programs on their release from the closed setting. Facilities Medical clinic Methadone should be dispensed via a medical clinic within the closed setting. Secure storage area Methadone must be stored in a secure area within the medical clinic, for example, locked in a room or safe.

Post-dosing supervision room Following dosing, patients must move into a supervision room located next to or close to the medical clinic. Effects of methadone Methadone is a synthetic opioid agonist. However, there are some side effects of methadone, including: Disturbed sleep. Interactions between methadone and other medications Interactions between methadone and other drugs can lead to overdose or death.

In particular it is important to note interactions between methadone and medications used to treatment HIV and tuberculosis: Table 12 Methadone-medication interactions. The HIV medications nevirapine and efavirenz increase metabolism of methadone, causing opioid withdrawal.

Some protease inhibitors PIs may have the same effect, especially when associated to a small boosting dose of ritonavir. The tuberculosis medication rifampicin increases metabolism of methadone and reduces the half-life of methadone. Patients must also be able to give informed consent for methadone maintenance treatment. Contraindications Patients with severe liver disease should not be prescribed methadone maintenance treatment as methadone may precipitate hepatic encephalopathy.

Patients who have been on community methadone maintenance treatment programs. In these cases, the patient should continue MMT in the closed setting at the dose that they were receiving in the community.

It is very important that the patient's treatment is not interrupted unnecessarily; hence, the closed setting should have a procedure in place for people who are detained while on methadone.