Methadone

I have dispensed Methadone in two different settings. How are
you currently handling your situation. Does the local Methadone Clinic bring a supply?

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.

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

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.

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)

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.

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