Methadone Maintenance

CASTLEGATES · Feb 8, 2010

My opinion doesn't matter since it's a federal program (too big for me to change so acceptance is easier for me).

It's a harm-reduction treatment for chronic relapsers. 1. it wakes up the "monster" and may promote drug seeking

2. on the other hand it may prevent drug seeking.

individual experiences very so much that all opinions are spot on )

Meriwhen, ASN, BSN, MSN, RN · Feb 11, 2010

We have a patient who was referred to a methodone clinic...and who developed a monster methadone addiction that we are now attempting to detox them from. They tried to detox themselves and in doing so, developed a benzo addiction as well.

This patient has to be going through the worst detox I've ever seen...and IMO, a few days in our facility isn't going to cut it--this patient's daily methodone usage was so high, I think they need long-term detox. So right now I can't say I'm on the "For" side as far as methadone goes.

elkpark · Feb 11, 2010

Methadone maintenance tx does nothing to help the "fight against addictions"; as CASTLEGATES notes, it is a harm reduction strategy rather than addiction treatment -- it maintains the person's addiction but simply substitutes a legal, longer-acting opiate ... (I am aware that methadone can be used to taper people down in real "treatment" -- I'm speaking specifically of methadone maintenance tx, which is what the OP asked about).

Thanks to the development of methadone programs all over the US, methadone abuse/dependence is now a big problem, and there are often problems with the methadone maintenence clinics. I worked a number of years ago in a medium-sized Midwestern city (which shall remain nameless :)) and part of my job was doing the ED substance abuse evals and either admitting people for acute medical detox or referring them to outpatient tx. I spoke to lots of people who, when we were discussing a referral to methadone treatment, would ask me to refer them to the methadone clinic in a city 1-1/2 hours' drive away from where we were. There was a clinic right in our city, but these people would tell me that the local clinic was completely sleazy and corrupt -- you could regularly see clinic staff selling methadone (illegally) out back in the parking lot, and everyone in the addict community in our city knew this was going on. The people who were serious about getting off opiates would rather drive >1-1/2 hours each way every day to attend the other clinic than risk the temptations/corruption of the local clinic. However, that's just one example -- obviously, there are good clinics, also (like the one in the other city people wanted to go to). And many clinics offer both maintenance tx and tapering-off-opiates-for-good tx.

As Meriwhen notes, because methadone is so much longer-acting, detoxing from it (acutely, as opposed to a slow taper over time) is a long, difficult, painful process.

KADRN · Feb 11, 2010

Thanks for the responses. I am new to the addiction field and this is something I am curious about. It is my understanding that methadone clinics are used in an attempt to cut down on diseases such as HIV and hepatitis that come with IV drug abuse and also overdoses. The patient remains addicted, but just in a more controlled way. Is this a correct synopses of the program?

elkpark · Feb 11, 2010

Thanks for the responses. I am new to the addiction field and this is something I am curious about. It is my understanding that methadone clinics are used in an attempt to cut down on diseases such as HIV and hepatitis that come with IV drug abuse and also overdoses. The patient remains addicted, but just in a more controlled way. Is this a correct synopses of the program?

Yes -- that's the meaning of the public health term "harm reduction"; you're not fixing (or even attempting to fix) the underlying problem, but you're reducing the damage the underlying problem causes ...

However, it is important to distinguish between methadone maintenance programs and programs that use methadone to taper people slowly off opiates entirely (which is treating the addiction directly). Some clinics do only methadone maintenance, and some offer both programs.

caroladybelle, BSN, RN · Feb 11, 2010

While I have pts on it more for pain control rather than maintenance, some of those pts had previous addiction issues.

One of the big issues that I have seen, is that methadone is a tricky and dangerous drug to titrate. It has a disproportionate lag time in the system than can last several days after initial effects have resolved. If most MDs titrate every few days, you may end up "stacking" the drug in the pts system, or if the pain control pt decides it is not adequate and takes an extra dose, you can end with serious respiratory depression.

There have been a large number of deathes due to this issue.

CrazierThanYou · Feb 13, 2010

Harms. I think its nothing more than legalized drug sales. In this area anyway.

CASTLEGATES · Feb 21, 2010

There's also the phenomenon where the same consistent dose begins to illicit withdrawals unless the dose is increased. My brain is lacking the term at the moment but it's seen with many opiates. Here's an article on dispositional tolerance-maybe that's it.

One does not take into effect the liver exercising and metabolizing it more rapidly as it gets used to being hit with opiates over time (which is why some can pop 20 percocets and not die while a non chronic user, the acetaminophen would kill them-their liver gets accustomed to breaking down acetaminophen).

http://www.toxicologyassociates.com/UNDERSTANDING%20OPIATE%20TOLERANCE.htm

terri925 · Mar 31, 2010

I have worked at a methadone maintenance treatment program for over 4 years now and it is a BUSINESS. The majority of the patients have been in this program for years. We have over 600 patients at the clinic I work in, they get a transportation check monthly which is free money for many of them since they are within walking distance to the clinic. And to top it off they still use heroin on top of the methadone they receive everyday. :rolleyes:

Blackcat99 · Mar 31, 2010

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.

elkpark · Mar 31, 2010

I have worked at a methadone maintenance treatment program for over 4 years now and it is a BUSINESS. The majority of the patients have been in this program for years. We have over 600 patients at the clinic I work in, they get a transportation check monthly which is free money for many of them since they are within walking distance to the clinic. And to top it off they still use heroin on top of the methadone they receive everyday.

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 ... :mad: