Methadone

sonoma_gal · Feb 3, 2004

I have dispensed Methadone in two different settings. How are

you currently handling your situation. Does the local Methadone Clinic bring a supply?

Crawsu · Feb 5, 2004

Yes, the local clinic brings the supply. It is brought out in a locked box and we have the key in our safe. It all has to be cosigned by 2 nurses, then the orders have to be taken off, and med sheets made for each individual. The methadone clinic verifies that a person is actually in a methadone program before it will be dispensed to them. It has really been a headache for us as we have only 4 nurses on staff to do sick call and one of has to stop seeing pts. in the middle of sick call to dispense and/or check in methadone. Plus, almost all the junkies want to claim they are in the program when they book in, which requires us to call the clinic, fax over the claim for verification, etc... I also found an interesting case on the internet about an inmate that overdosed on methadone. 2 people on the program got their dose, went back to their dorm and induced vomitting and then gave the vomit to another person not on methadone. The person (it's gross, aak) drank the vomit, and died of overdose!! GAG!!!

sonoma_gal · Feb 6, 2004

In our county it is up to the Methadone Clinic to decide whether or not to detox. the person off Methadone (using Methadone) or

continue them on a Maintenance dose.

They deliver the Methadone to us usually in the afternoon and

usually at least one of us is in the nurse's station to accept the

supply (usually a one week supply). If the Methadone arrives

too late for day shift to dispense then the evening shift will

dispense that dose.

We have other narcotics too. If someone is withdrawing from

Heroin we use Valium and Bentyl per protocol. We also have

narcs like Norco and Vicodin but use them very sparingly.

Too bad you have to deal with this without adequate preparation.

Seems like whoever is in charge needs to work out a better

system for you. Maybe have a consistent time of day when the

Methadone is delivered so you don't have to interrupt your routine.

I wouldn't worry too much about the overdose problem. If you are concerned make sure the patient opens their mouth after

taking the dose or have them drink additional water. Overdoses

are much more of a problem with people out and about and still

using Heroin on top of Methadone.

Crawsu · Feb 6, 2004

In the case I read about, the patient had swallowed the methadone, then regurgitated it for another inmate to take. I just feel that the methadone clinic is getting the gov't money to distribute this stuff, so they should take care of dispensing it as well. It takes our nurses away from taking care of of sick people, not addicts. Sorry, but I'm not on the methadone bandwagon. This was pushed on us by our psych dept. who now say they don't have enough nurses to deal with it. We end up dealing with everything that nobody else will deal with. Psych is only there 8 hr 5 days a week, we are there 24/7, so have to deal with all. It is just a nuisance to us and takes away from pt. care that is really needed. Most of the methdone clients are shooting heroin as well, so what dos that tell us about the effectivness of methadone tx? My main c/o with this is that the dept, getting the grant money should take care of the program. Not take nurses away from their main job of treating sick inmates.

DOCS RN · May 18, 2004

In NY the State Prisons take care of these kinds of things. Counties use the clinics.

jailDON · May 19, 2004

Don't you have to have a special DEA license to handle Methadone?

At our jail, we detox only unless it's a pregnant woman. It would threaten the pregnancy to detox.

fiestynurse · May 21, 2004

Unless a particular state has legislation requiring jail and/or prisons to dose inmates on methadone or even setting standards for detoxing inmates on methadone, jails and prisons with a few exceptions have a great deal of leeway in detoxing/dosing inmates on methadone. The U.S. Supreme Court has refused to accept any Methadone cases.

Interestingly, the NCCHC has just developed standards for Accreditation as a Methadone Treatment Program in Corrections.

Most jails that I am familar with only keep pregnant inmates on Methadone because of the risks to the baby. (Detoxing a pregnant woman can cause premature labor and other problems for the developing fetus.) Everyone else gets detoxed.

As far as the DEA license goes - Methadone Treament requires special licensing in most states, unless it's used for pain control. Then, you can obtain it under the doctor's DEA license to have it in stock. (the doctor obtains a second DEA license with the facility's address on it)

cindyrn1 · May 22, 2004

I am new to Correctional Nursing but I found your thread to be very interesting and somewhat scarey. Is this a new thing to dispense Methadone to IM's? Is this something that all States are trying to get in their correctional settings? I have worked with a Methadone clinic in my years in nursing and let me tell you, it's a great drug for detox, but dangerous as well. And you have to be so detailed in the dispensing of it etc. In my State of Missouri a physician can only have 30 patients who are taking methadone to detox or to stay off drugs. So how does one physician handle the hundreds of IM's that might be on methadone? I would like to know more information from those of you that are using Methadone in your setting and how you do what you do and if there is a chance that other States are looking at starting methadone on the IM's. Thanks.

Guppy · May 23, 2004

I work in a jail in Toronto, Canada. We the RN's give out the methadone ...our pharmacist usually prepares the individual obttles but if it is on the weekend we have a stock supply that we "pour" from. The inmates are brought to health care and the have to give their name and dose which we verify from our records and the inmate card. We show them the sealed bottle and then we pour juice into the bottle then the I/M drinks it then we refil the bottle with juice after the I/M drinks that he has to eat a slice of bread and wait 20 minutes before he goes back to his unit. these measures were put in place as we have had inmates vomit the meth and sell it on the unit or kiss each other to transfer the meth..we have had I/M tie condoms to their back teeth so the meth goes in their...I won't relay any more incidents to you...if they are new I/M's we never give Meth the first night and we ask for a urine sample and a signed consent form and we almost always do a dip for other drugs as well. Good Luck

cindyrn1 · May 24, 2004

An excellent way to ensure the IM is taking his meth. Of course, I do not understand how anyone who is coming off drugs would WANT to give their methadone away! And to drink someone else's vomit to get it??????? Sick! I just hope our facility doesn't start this methadone programming. It's an excellent idea and I am a methadone advocate for treatment of drug dependency but with 1600 women, I think they would all take it if we offered it to them.

Crawsu · May 28, 2004

We only dispense methadone to pts that are current in their program on the outside. Currently we have only 14 people on it. The clinic brings out the doses and the Dr.'s orders with it. It has to be locked in a safe, seperate from everything else. The clinic has to verify all the particulars, we just dispense it. Of course, almost every junkie that comes in tries to tell you they are on it, some have been in the past, but not currently.

One guy came in and told me he'd been in the methadone program, but it was too expensive, so he went back to heroin. When I asked him what it cost for both, it worked out that the methadone was cheaper. However, he said he was a musician and that the methadone stifled his creative energy. Go figure... :chuckle