Methadone Maintenance - Page 2

I use to work at a methadone clinice many many years ago. When we checked urines they were usually positive for heroin. The doctor in charge didn't care about dirty urines and didn't kick anyone out. He just wanted his money and that was it. I remember a nurse telling me about a urine specimen she received. She said she couldn't barely even pick it up because it was so hot. She said the guy had brought in a urine that was recently microwaved. She said she went over and put her hand on his forehead and said "Wow, you must really have a high temperature!!!! He knew he was busted when she said his forehead didn't even feel warm. When I worked at that place, I went to an open meeting of narcotics anonymous at a local church. I was curious of what they thought of methadone. I talked to 4 different members and they all agreed that methadone is not good and that it is not recommended for addicts trying to get clean.

These kind of problems are why there is so much controversy about methadone maintenance programs. But lots of people are making a lot of money of operating the clinics, courtesy of the federal government ...

I have heard some nurses and physicians who work in addictions say that they "love addicts". Can anyone explain this to me? I have worked in a number of specialities but would never say I love people because of their particular disease - as in I love cardiac patients or people with an ingrown toenail.

Ditto that ...

(I wonder if the people saying that mean it sardonically, in that they are a reliable source of income???)

I am still in nursing school and have lots to learn, but I am having a hard time understanding how doctors can justify giving methadone (and morphine combos) to patients for "pain control." I'm not talking about end-stage patients, I am talking about chronic pain patients. There were quite a few people in long term care and on the transitional care unit we were at who were prescribed both of these drugs together for pain management. It seems that the methadone creates a very strong addiction....risk vs. benefit seems off here.

This is a topic that really hits home for me. My daughter is in methadone maintenance treatment for opiate addiction. I am not thrilled about it at all. However, it was legal methadone or buying illegal Oxycontin off the street. Buying the illegal pills, she would steal money from me or others. Her drug seeking for the day was similar to the hours working at a job. She spent all day on the phone, ignoring her child, looking for her fix. I have had my savings account drained. She had stolen my bank card.

For now, the MMT is the lesser of the two evils.(better than seeking illegal drugs) She does function. She goes to work everyday. She is attentive to her child.

Does all of this mean that I am pro-MMT? Absolutely not. I feel that methadone is putting a band-aid on the problem. Most addicts have a dual diagnosis, and the primary diagnosis is a mental illness. The mental illness needs treated prior to the substance abuse. Or, both at the same time. But, treating the drug addiction without addressing the mental issues will only lead to relapse.

There are some clinics that absolutely do not care about the clients. My DD was going to one of those clinics years ago. Then she became addicted to benzos and needed a rehab for that addiction. No rehab would take her until her methadone dose was down to 35 mg. Then they would wean her over to suboxone. After being on suboxone for a few days, she was weaned off. She was in treatment for three weeks. She relapsed shortly after being discharged from rehab. (three weeks) Then, she went back on suboxone. She did good for 1 month on that, but then starting selling her suboxone and returned to her oxys. Eventually, she was caught in having a dirty urine. The dr. discharged her. She tried to find another suboxone dr., however, there were none in our locality. I refused to allow her to drive a distance to get on suboxone for her to only sell them for her drug of choice. But, she still got her oxys off the streets. Then she begged me to support her into going to methadone clinic. And, this meant using my car and babysitting while she went to the clinic.

There was another clinic in our area that was more reputable. Their guidelines were much stricter. Also, the director is trying to get it where clients are not allowed to dose on methadone if they are taking benzos.

Shortly, after my DD was going to the methadone clinic, I learned that she was using benzos, as well. I contacted her probation officer and asked they force her into long-term rehab. He did trick her and pulled a surprise drug test on her. (we learned that she was using others' urine and informed the PO of this) She turned up dirty for benzos and the probation officer wanted her to to long-term treatment. But, the judge was happy that she was working. He said to give her one chance and to test her weekly. However, she was scared by having to spend the night in jail and not having any idea what her fate was. She learned the next morning, that she was given a second chance. And, she did a 180 with her drug use. Dropped all active using friends. The probation officer was uncertain as to his feelings about methadone, but thought that maybe it may work for her. So, I agreed to let her continue.

I am very on the fence about methadone. I know that my DD had a horrible time withdrawing from it and swore she would never go on it again. But, she then believed that was the only thing that worked for her. Now, I am seeing her getting sick for no reason. She has the sweats,nauseous and sleeps when she is not working. She probably needs an increase in her dose. Now, she is fearful of increasing her dose, as she knows how rough it is wean. I know that she hates that she has to go to the clinic. I know that she hates that she will get sick if she misses the clinic.

Pros -I believe that methadone is good in that people can function and lead productive lives. I believe that it is good because people are not stealing, or other illegal activities. When taking the methadone as prescribed with no other drugs, I do not believe that it impairs patients. Combined with groups and counseling and a plan to taper off, it can be helpful. But, aftercare must be carefully planned.

Cons - It is only a short-term fix. Ones with take home doses may trade or sell their methadone. It has a very long half-life and the withdrawal is horrendous. This is not accepted by most of society, and you are looked down upon when people learn that you are taking methadone. NO LFTs are performed while being on this drug.

I think that I am more con-methadone than I am pro-methadone. Mainly because I don't feel that it is safe to take this for a lifetime. It has to be taxing the liver. I think that suboxone is safer and easier to wean from. But, the core issues of drug addiction need to be addressed. Why are they self medicating?

I insist that my DD is compliant with her mental health treatment. There will be a plan to wean her from methadone to suboxone to ease the withdrawal, then drug free treatment. Her brain needs retrained.

I am seeing many, many misconceptions about methadone treatment here! I feel I can answer from an EXPERT point of view, as I have experienced this issue from both sides: I am a nurse, AND an addict being treated with methadone maintenance therapy.

I have been a nurse in the areas of critical care, emergency, flight, labor and delivery, and pediatrics for 20 years. I have been monitored by the board of nursing's diversion program. I have been in intensive outpatient drug treatment, and NA/AA for 10 years! Now I am participating in methadone treatment. NONE of the other treatments worked, at all. I vigilantly tried, over and over, to comply with everything that was recommended by all the professionals, yet I kept relapsing. I knew in my heart that I have an organic disease, one that could be treated. Yet, even though I was a nurse, I did not know that methadone was that treatment! In desperation I sought treatment at the local methadone clinic, and my life has been changed.

People with opiate addiction have a genetic, physiologic disease. Whenever I took opiates, I did not feel "high," I felt normal! Instead of feeling depressed, numb to the world, isolated and dysfunctional, I suddenly felt organized, calm, and wanted to be part of the world around me. And not in a way that caused me to be high, or unable to perform my functions as a professional nurse, mother, and friend. Opiates, for me, acted just as an anti-depressant works for people that are depressed. Just as insulin works for people with diabetes. Just as blood pressure pills work for people with hypertension. You get the idea.

When I began methadone treatment, I got my life back. Today, nearly a year later, I have used NO drugs or alcohol in any form, and don't miss it. I DO NOT feel high from my methadone, EVER. I am not addicted to methadone. My BODY is dependent upon the medication, but that is NOT addiction! I do not seek, abuse, misuse or otherwise use methadone inappropriately. That is the definition of addiction: use of any substance in a compulsive, damaging way. Methadone, used properly, is just another medication. The misconceptions that everyone who has posted thus far are DAMAGING to people that could really benefit from methadone treatment. Most of the people in my clinic are like me: a history of abusing mostly pharmaceutical opiates. We do not sell drugs out back, we do not use our medicine to get high, and we are not low-life scum seeking free drugs. We are normal people, going to a medical clinic, to receive the medicine that allows us to function as normal, responsible citizens. There are certainly people that do use the system in a dysfunctional or illegal way, but those are the minority. The majority of us are benefiting immensely, and thus, society is as well. Methadone has allowed us to return to a productive life where we can serve others (I can go back to saving lives, bringing new babies into the world, helping people in pain and sickness get better. I am VERY good at my job!). Please to not allow the stigma and misinformation about methadone delay or prevent people that would really benefit from getting into treatment.

Methadone is just one part of my recovery. At the clinic, we are seen by therapists, psychologists, nurses and physicians on a regular basis. We go to classes and group therapy. We are given UAs regularly to ensure we are following the treatment recommended for us. There are other ways to recover from addiction, and this is just one way. This is the way that works for me. It might not work for you, but then again, it might save your life just as it saved mine. We are getting better. Don't perpetuate ignorance.

It is true that you have much to learn.

Please consider that the long term care patient who is experiencing pain is unlikely to become "addicted" to this medication. They will develop "tolerance" but that is expected and manageable. Their pain management needs are most likely chronic and not likely to go away over time...these folks need pain meds chronically, just like the diabetic needs his insulin or the epileptic the depakote...

Morphine and methadone are not unusual combinations in "aggressive" pain management protocols. Often those plans of care will include other adjuvant medications such as Elavil or similar. When you see people with medication plans like that you should assess them for "mixed" pain...your nursing assessment should reflect that. What is the difference between visceral, somatic, and neuropathic pain? This a distinction that is important in a nursing pain assessment.

I have visited elderly women in their homes who cried in pain...who couldn't get out of bed some days because of the pain. They actually had morphine and fentanyl, but the MD refused to consider that the doses had not been adjusted in MONTHS and were currently inadequate AND the patients were experiencing mixed pain...somatic AND neuropathic pain. This is so common in elderly diabetics. No increased doses, no adjuvant therapy, and no pain relief...so sad. The docs were afraid that the patients would become addicted...that they would get in trouble for writing the Rxs...that they would overdose, etc, etc. I used the plural descriptors because this was pathetically common in the Detroit area...it was mostly women but also men. Sometimes they were caring for their elderly spouse while suffering themselves.

This was my breaking point in Home Care and I had to transition to Hospice where the philosophy is ALL about comfort.

Please advocate for the pain control that your patients desire and deserve.