[Crawsu]

I work in a county jail setting and they have recently started giving methadone to inmates that are incarcerated. Has anyone else had to deal with this situation in a correctional setting, and if so, do the methadone clinics handle it, or is your staff expected to take care of it.
We have more or less had it dumped on us. It actually came about due to the psych dept. and they were handling it but unfortunately, both our psych nurses have left( wonder why ) and it has now become medical's responsibility.
Any input would be appreciated.
The real kicker here is that we do not give narcotics in this facility, and if an inmate comes in on methadone for pain control they are put on withdrawl protocol. Only pts. from the methadone program are cotinued on this. Does that make any sense?
Think this has something to do with grant money, not pt care, But that's an opinion on my part.
Any thoughts on this?

[sonoma_gal]

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

[Crawsu]

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]

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]

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]

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

[jailDON]

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]

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]

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]

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