Methadone Clinic Employment

steven007, BSN, MSN · Jul 17, 2019

When I was a high school student, I worked at a pharmacy that did the methadone program.

As a nurse manager, I managed unit that had a methadone treatment program built-in.

I would research methadone treatment, in terms of the pharmacology and use. But from a practical standpoint, how a methadone treatment program works is:

1. You prepare the methadone per order. You don't let the patient see the dose, they aren't generally privy to the dose they are getting. It is mixed with a high concentration/strong tasting base such as orange juice to mask the taste. It is supposed to remain confidential and unknown to the patient what dose they are getting (at least in Canada).

2. You administer the medication in full view. You ensure that they are swallowing it and not diverting it. You do a mouth check and generally make them wait 15 to 20 minutes before leaving, giving the meidcation enough time to be absorbed. Expert diverters will puke this stuff up afterwards to sell (and people buy it! Its disgusting!!!)

3. Liaise with the pharmacist and physician/nurse practitioner about how the patient is doing and any side effects. Monitor for withdrawl and you can use a validated withdrawl scale on the patient. Generally at your first point of contact with the patient at each treatment session you will be evaluating for signs and symptoms of withdrawl.

4. Health teach and assess to see if there is a change in their condition. This may signal a change in their response to the meidcation, a general change in their health or that they are still abusing other illict drugs. You need to be vigilant in ensuring that they are following the treatment regimen and not diverting or abusing other drugs on the side.

That's all I can think of right now. Best of luck!

ana9 · Jul 17, 2019

steven007.....

I am new here and dont know where to acknowledge your response. Thank you so much - it is perfect. I really appreaciate it!

steven007, BSN, MSN · Jul 17, 2019

Just now, ana9 said:
steven007.....
I am new here and dont know where to acknowledge your response. Thank you so much - it is perfect. I really appreaciate it!

No problem! Just wanted to provide any info I can.

Best of luck! It is a really interesting job!

Davey Do · Jul 18, 2019

My experience with supervising a methadone clinic, along with the medical services at a community mental health clinic in the early aughts, was a little different than what steven007 submitted, ana9.

Firstly, the client was made aware of the dose as prescribed by the MD and was titrated to their response. As the the program is designed with the goal of the client avoiding using illicit street drugs and eventual drug abstinence in mind, everything was on the up and up.

Our treatment team consisting of the medical director MD, supervising RN, and the LPN, who did most of the actual client-contact. We would meet with the client, discuss their status and/or history, and the MD would prescribe the dose. These meetings took place on a weekly basis.

New admissions would need to come into the clinic as much as twice a day to be dosed, whereas older trusted clients would come in maybe once a week to be dosed and take their daily doses home with them.

If the client had any other areas of medical concern, the MD, who was an internist, would prescribe treatment in conjunction with their methadone treatment. It was the nurses' responsibility to monitor and report the outcome or any follow up areas of concern to the MD.

Clients would submit specimens for a UDS on a regular basis or randomly. Random urine drops included those who were suspected of using other non-prescribed controlled substances.

In a case in point, when one client was found to have had a dirty drop, the MD put him on a fast comedown, lowering the dose in increments, then discontinuing the methadone entirely, evicting him from the program ."If you're going to be using street drugs, the doctor said, "you don't need us!"

Another client was pregnant and experienced n/v due to morning sickness. She would wait, as steven007 pointed out, 20 minutes before leaving to be sure the methadone was absorbed.

I happened to have some shredded cabbage one day from my bring-from-home lunch supply. Knowing cabbage helps to soothe GI distress, I offered the shredded cabbage to the client. She said eating the cabbage helped and began eating it regularly on her own accord!

I have more information you can ask for PRN, ana9, and many more stories, but let's let this be it for now.

The best of luck to you!

ana9 · Jul 18, 2019

oh Davey Do,

thank you so much! interesting - gonna go eat some cabbage ?