Methadone Maintenance

explorer13 · Apr 5, 2010

I have heard some nurses and physicians who work in addictions say that they "love addicts". Can anyone explain this to me? I have worked in a number of specialities but would never say I love people because of their particular disease - as in I love cardiac patients or people with an ingrown toenail.

KADRN · Apr 5, 2010

I have heard some nurses and physicians who work in addictions say that they "love addicts". Can anyone explain this to me? I have worked in a number of specialities but would never say I love people because of their particular disease - as in I love cardiac patients or people with an ingrown toenail.

I work in addictions and I have never heard this said and I have never said this, I suppose I am just not one of those people you are speaking of. As a patient population addicts (most, not all) tend to be very difficult and demanding.

elkpark · Apr 6, 2010

I work in addictions and I have never heard this said and I have never said this, I suppose I am just not one of those people you are speaking of. As a patient population addicts (most, not all) tend to be very difficult and demanding.

Ditto that ...

(I wonder if the people saying that mean it sardonically, in that they are a reliable source of income???)

wahwahgerman · Apr 11, 2010

I am still in nursing school and have lots to learn, but I am having a hard time understanding how doctors can justify giving methadone (and morphine combos) to patients for "pain control." I'm not talking about end-stage patients, I am talking about chronic pain patients. There were quite a few people in long term care and on the transitional care unit we were at who were prescribed both of these drugs together for pain management. It seems that the methadone creates a very strong addiction....risk vs. benefit seems off here.

iwanna · Apr 28, 2010

This is a topic that really hits home for me. My daughter is in methadone maintenance treatment for opiate addiction. I am not thrilled about it at all. However, it was legal methadone or buying illegal Oxycontin off the street. Buying the illegal pills, she would steal money from me or others. Her drug seeking for the day was similar to the hours working at a job. She spent all day on the phone, ignoring her child, looking for her fix. I have had my savings account drained. She had stolen my bank card.

For now, the MMT is the lesser of the two evils.(better than seeking illegal drugs) She does function. She goes to work everyday. She is attentive to her child.

Does all of this mean that I am pro-MMT? Absolutely not. I feel that methadone is putting a band-aid on the problem. Most addicts have a dual diagnosis, and the primary diagnosis is a mental illness. The mental illness needs treated prior to the substance abuse. Or, both at the same time. But, treating the drug addiction without addressing the mental issues will only lead to relapse.

There are some clinics that absolutely do not care about the clients. My DD was going to one of those clinics years ago. Then she became addicted to benzos and needed a rehab for that addiction. No rehab would take her until her methadone dose was down to 35 mg. Then they would wean her over to suboxone. After being on suboxone for a few days, she was weaned off. She was in treatment for three weeks. She relapsed shortly after being discharged from rehab. (three weeks) Then, she went back on suboxone. She did good for 1 month on that, but then starting selling her suboxone and returned to her oxys. Eventually, she was caught in having a dirty urine. The dr. discharged her. She tried to find another suboxone dr., however, there were none in our locality. I refused to allow her to drive a distance to get on suboxone for her to only sell them for her drug of choice. But, she still got her oxys off the streets. Then she begged me to support her into going to methadone clinic. And, this meant using my car and babysitting while she went to the clinic.

There was another clinic in our area that was more reputable. Their guidelines were much stricter. Also, the director is trying to get it where clients are not allowed to dose on methadone if they are taking benzos.

Shortly, after my DD was going to the methadone clinic, I learned that she was using benzos, as well. I contacted her probation officer and asked they force her into long-term rehab. He did trick her and pulled a surprise drug test on her. (we learned that she was using others' urine and informed the PO of this) She turned up dirty for benzos and the probation officer wanted her to to long-term treatment. But, the judge was happy that she was working. He said to give her one chance and to test her weekly. However, she was scared by having to spend the night in jail and not having any idea what her fate was. She learned the next morning, that she was given a second chance. And, she did a 180 with her drug use. Dropped all active using friends. The probation officer was uncertain as to his feelings about methadone, but thought that maybe it may work for her. So, I agreed to let her continue.

I am very on the fence about methadone. I know that my DD had a horrible time withdrawing from it and swore she would never go on it again. But, she then believed that was the only thing that worked for her. Now, I am seeing her getting sick for no reason. She has the sweats,nauseous and sleeps when she is not working. She probably needs an increase in her dose. Now, she is fearful of increasing her dose, as she knows how rough it is wean. I know that she hates that she has to go to the clinic. I know that she hates that she will get sick if she misses the clinic.

Pros -I believe that methadone is good in that people can function and lead productive lives. I believe that it is good because people are not stealing, or other illegal activities. When taking the methadone as prescribed with no other drugs, I do not believe that it impairs patients. Combined with groups and counseling and a plan to taper off, it can be helpful. But, aftercare must be carefully planned.

Cons - It is only a short-term fix. Ones with take home doses may trade or sell their methadone. It has a very long half-life and the withdrawal is horrendous. This is not accepted by most of society, and you are looked down upon when people learn that you are taking methadone. NO LFTs are performed while being on this drug.

I think that I am more con-methadone than I am pro-methadone. Mainly because I don't feel that it is safe to take this for a lifetime. It has to be taxing the liver. I think that suboxone is safer and easier to wean from. But, the core issues of drug addiction need to be addressed. Why are they self medicating?

I insist that my DD is compliant with her mental health treatment. There will be a plan to wean her from methadone to suboxone to ease the withdrawal, then drug free treatment. Her brain needs retrained.

KADRN · Apr 28, 2010

I feel for you in your current situation. I also have battled with family memebers who became addicts. Good luck to you and your family. Stay strong.

Logosha1876 · Dec 5, 2010

I am seeing many, many misconceptions about methadone treatment here! I feel I can answer from an EXPERT point of view, as I have experienced this issue from both sides: I am a nurse, AND an addict being treated with methadone maintenance therapy.

I have been a nurse in the areas of critical care, emergency, flight, labor and delivery, and pediatrics for 20 years. I have been monitored by the board of nursing's diversion program. I have been in intensive outpatient drug treatment, and NA/AA for 10 years! Now I am participating in methadone treatment. NONE of the other treatments worked, at all. I vigilantly tried, over and over, to comply with everything that was recommended by all the professionals, yet I kept relapsing. I knew in my heart that I have an organic disease, one that could be treated. Yet, even though I was a nurse, I did not know that methadone was that treatment! In desperation I sought treatment at the local methadone clinic, and my life has been changed.

People with opiate addiction have a genetic, physiologic disease. Whenever I took opiates, I did not feel "high," I felt normal! Instead of feeling depressed, numb to the world, isolated and dysfunctional, I suddenly felt organized, calm, and wanted to be part of the world around me. And not in a way that caused me to be high, or unable to perform my functions as a professional nurse, mother, and friend. Opiates, for me, acted just as an anti-depressant works for people that are depressed. Just as insulin works for people with diabetes. Just as blood pressure pills work for people with hypertension. You get the idea.

When I began methadone treatment, I got my life back. Today, nearly a year later, I have used NO drugs or alcohol in any form, and don't miss it. I DO NOT feel high from my methadone, EVER. I am not addicted to methadone. My BODY is dependent upon the medication, but that is NOT addiction! I do not seek, abuse, misuse or otherwise use methadone inappropriately. That is the definition of addiction: use of any substance in a compulsive, damaging way. Methadone, used properly, is just another medication. The misconceptions that everyone who has posted thus far are DAMAGING to people that could really benefit from methadone treatment. Most of the people in my clinic are like me: a history of abusing mostly pharmaceutical opiates. We do not sell drugs out back, we do not use our medicine to get high, and we are not low-life scum seeking free drugs. We are normal people, going to a medical clinic, to receive the medicine that allows us to function as normal, responsible citizens. There are certainly people that do use the system in a dysfunctional or illegal way, but those are the minority. The majority of us are benefiting immensely, and thus, society is as well. Methadone has allowed us to return to a productive life where we can serve others (I can go back to saving lives, bringing new babies into the world, helping people in pain and sickness get better. I am VERY good at my job!). Please to not allow the stigma and misinformation about methadone delay or prevent people that would really benefit from getting into treatment.

Methadone is just one part of my recovery. At the clinic, we are seen by therapists, psychologists, nurses and physicians on a regular basis. We go to classes and group therapy. We are given UAs regularly to ensure we are following the treatment recommended for us. There are other ways to recover from addiction, and this is just one way. This is the way that works for me. It might not work for you, but then again, it might save your life just as it saved mine. We are getting better. Don't perpetuate ignorance.

tewdles, RN · Dec 9, 2010

I am still in nursing school and have lots to learn, but I am having a hard time understanding how doctors can justify giving methadone (and morphine combos) to patients for "pain control." I'm not talking about end-stage patients, I am talking about chronic pain patients. There were quite a few people in long term care and on the transitional care unit we were at who were prescribed both of these drugs together for pain management. It seems that the methadone creates a very strong addiction....risk vs. benefit seems off here.

It is true that you have much to learn.

Please consider that the long term care patient who is experiencing pain is unlikely to become "addicted" to this medication. They will develop "tolerance" but that is expected and manageable. Their pain management needs are most likely chronic and not likely to go away over time...these folks need pain meds chronically, just like the diabetic needs his insulin or the epileptic the depakote...

Morphine and methadone are not unusual combinations in "aggressive" pain management protocols. Often those plans of care will include other adjuvant medications such as Elavil or similar. When you see people with medication plans like that you should assess them for "mixed" pain...your nursing assessment should reflect that. What is the difference between visceral, somatic, and neuropathic pain? This a distinction that is important in a nursing pain assessment.

I have visited elderly women in their homes who cried in pain...who couldn't get out of bed some days because of the pain. They actually had morphine and fentanyl, but the MD refused to consider that the doses had not been adjusted in MONTHS and were currently inadequate AND the patients were experiencing mixed pain...somatic AND neuropathic pain. This is so common in elderly diabetics. No increased doses, no adjuvant therapy, and no pain relief...so sad. The docs were afraid that the patients would become addicted...that they would get in trouble for writing the Rxs...that they would overdose, etc, etc. I used the plural descriptors because this was pathetically common in the Detroit area...it was mostly women but also men. Sometimes they were caring for their elderly spouse while suffering themselves.

This was my breaking point in Home Care and I had to transition to Hospice where the philosophy is ALL about comfort.

Please advocate for the pain control that your patients desire and deserve.

crzychick · Dec 12, 2010

I work in an MMP, have for almost 5 years now, and I enjoy it. Harm reduction is a tricky job. We support our clients in their choice to remain or detox. By two years out, 90% relapse, which is a big number, but then again, so is 10 out of a hundred. We do get paid for VA patients, but other than that, don't accept any other funding.

The basic misconception with methadone maintenance is that one is not addicted when taking methadone for opiate dependence, they are dependent.

Addiction is a neurobiological disease that has genetic, psychosocial, and environmental factors. It is characterized by one or more of the following behaviors:

Poor control over drug use
Compulsive drug use
Continued use of a drug despite physical, mental and/or social harm
A craving for the drug

Physical dependence is the body's adaptation to a particular drug. In other words, the individual's body gets used to receiving regular doses of a certain medication. When the medication is abruptly stopped or the dosage is reduced too quickly, the person will experience withdrawal symptoms. Although we tend to think of opioids when we talk about physical dependence and withdrawal, a number of other drugs not associated with addiction can also result in physical dependence (i.e., antidepressants, beta blockers, corticosteroids, etc.) and can trigger unpleasant withdrawal symptoms if stopped abruptly.

(My apologies for the lazy cut and paste, I'm just that tonight, lazy :))

Our state requires a percentage of negative clients. 90% for opiates (after one year) and 70% for other drugs (after 3 months). Failing to maintain those, will end up with a probation of the program with possible closure. We do have risk diversion policies and we follow those.

Have touched some hot pee in my day, I am always amazed, I guess is the word, by the creativity and skill of addicts with manipulation. I have been accused many times of altering their urine, enough that I've lost count.

Benzos suck, doctors overprescribe them and are too soon bullied into prescribing them.

Suboxone is not the wonder drug it was thought to be (in my experience anyway). And then you have the doctors who don't know what they're doing prescribing it. But that's a different rant. :)

I heard a quote several months ago, and I believe it to be more and more true every day. (Apologies for the misquote, but this is the gist) It is the human condition not to understand or empathize with which one does not experience themselves.

sadd · Jun 30, 2011

I have worked at a methadone clinic for 5 years as a medical secretary i went on for my LPN as i was so impressed with the nurses and the wonderful jod they do!! Substance Abuse on a hold is a very difficult and time consuming field. I do believe that methadone helps tremendously if managed correctly I have seen it changed peoples' lives significantly but I dnt believe it works without counseling though people on methadone for herion addiction should also be in counseling as MM is not a quick fix and addiction is a mental illness. there is also the downside where as a opioid methadone can be deadly if not taken with precations as it interacts with other meds & illegal drugs this is where Physician & Nurses plays a very vital role in teaching and assessing patient to see if they are in withdrawals or sedated.. This is a very interesting field & a nurse can learn give so much working in this are..

xtxrn, ASN, RN · Jul 13, 2011

When I worked in chem dep rehab nursing, the people trying to get off of methadone had THE worst detox of any substance. I personally believe that treatment for the original opiate addiction is much kinder. It's still hard, but methadone detox was horrendous, no matter how long they'd been on or how much they took.