What to Know about Methadone Clinics

A methadone clinic is a place where a person who is addicted to opioid-based drugs, such as heroin or prescription painkillers, can receive medication-based therapy. Patients receive methadone, or the brand name version known as Dolophine, which is an opioid analgesic. This treatment is often referred to as replacement therapy.

According to the Substance Abuse and Mental Health Services Administration, methadone can be administered as a pill or in liquid and wafer forms. It is used to block the effects of opiate pain medications, including morphine, codeine, oxycodone, and other semi-synthetic opioids. Although the treatment must be prescribed by a doctor, it is not a cure for addiction issues. It is nonetheless considered effective during the treatment and rehabilitation process as part of a comprehensive treatment program.

The two main types of clinics are public and private. All methadone clinics in the US are strictly regulated by state and federal laws. The treatment provided at a clinic has several effects. People who have visited one may see the following benefits.

  • A reduction or avoidance of opioid withdrawal symptoms
  • A decrease in opioid cravings
  • Blocking of the effects of illicit opioids
  • Ceasing of a physical need for opioid substances, so a person can function normally

Who Is Most Likely to Visit a Methadone Clinic?

There are many methadone clinics throughout the United States. SAMHSA’s 2011 OTP Survey found nearly 245,000 people were admitted into opiate treatment programs in 2010. More than half of those admitted required maintenance and detoxification services. About 22 percent were individuals seeking only maintenance treatment.

Methadone was the primary medication given to those in treatment; the survey reported nearly 270,000 people receiving methadone in March 2011.

Anyone who is addicted to opiates may visit a methadone clinic under a doctor’s supervision. More than half who do are male, although a significant percentage of visits are by female clients as well. Nearly a third of all people treated were in the same program for two or more years. The SAMHSA survey also noted many veterans were in treatment programs, often at facilities managed by the Department of Veterans Affairs.

SAMHSA’s 2014 National Survey on Drug Use and Health estimated that 435,000 people used heroin, accounting for those aged 12 and up. People in the 18-25 age range were most likely to abuse heroin, although the study reflected an increase in use by adults 26 and older.

About 2.9 million adults 26 years and older were using pain relief drugs for nonmedical use, according to the study. In the 2011 edition of the study, just over 11 percent of people overall who abused drugs or alcohol received the medical treatment they needed.

According to US law, methadone can only be given via a SAMHSA-certified opioid treatment program. These facilities provide a range of services. Clients can receive help with reducing or eliminating drug use or preventing it in the first place. An OTP facility can also address the spread of infectious disease and take preventive measures against criminal activity in order to improve the wellbeing and quality of life of people in treatment.


Most Likely Reasons to Visit a Methadone Clinic

Methadone has been legal in the country since 1947. It is known to suppress drug withdrawal symptoms for a day. Sometimes, it works for up to 36 hours after administration, according to the National Drug Intelligence Center’s Methadone Fast Facts.

There are actually a variety of circumstances in which a person might visit the clinic. The most obvious is to seek relief from daily struggles with opiate abuse. People can go to their appointment to fulfill the requirements of an ongoing drug treatment program. It’s also possible for someone who falls back on a habit to seek methadone to manage cravings or withdrawal symptoms.

The first time people visit a methadone clinic, they usually don’t receive medication. They generally go through a screening in which they talk about the nature of their problem to a counselor or nurse.

Patients are asked about their history, potentially given blood and/or urinalysis tests, and informed about the treatment program, its goals, and its guidelines. Drug use history, co-occurring disorders, and the impact of substance abuse on life are assessed via a clinical evaluation, while a medical evaluation reviews health history, current health, present medication requirements, and overall condition in regard to being given methadone.

In addition, people might also visit a clinic to attend counseling sessions. Counseling can focus on relapse prevention, how to repair and rebuilt personal or professional relationships, or deal with stress. Group, family, and one-on-one sessions may be offered. The format can vary according to each client because some people attain stability more quickly while others take more time.

Patients are also required to visit a methadone clinic to satisfy guidelines for receiving doses. Local regulations may dictate whether participants have to be present on a daily basis. Depending on the individual and the circumstances, one might be permitted to manage doses offsite and visit the clinic less frequently.

Family members, partners, and friends have the option of accompanying a program participant to an appointment at any time. Professionals, such as physicians, nurses, and counselors, may regularly or periodically be present at a methadone clinic. Receptionists, treatment advisors, and others involved in the individual’s case may be there as well.

How Treatment Is Administered

Male doctor at the hospital with his teamMethadone must be administered by a team of trained medical professionals. Treatment is provided based on the principal addiction. Since each person reacts to the specific type of drug and treatment differently, each individual’s care is tailored to their unique problems. This is not limited to drug use. The program must also focus on the appropriate treatment setting, family and work life, how the person functions in society, and what is needed to be functional and productive.

Other aspects of the treatment protocol include its length of time and other needs. Methadone clinic treatment does not only focus on drug abuse. There can be social, medical, job-related, and legal matters that need to be addressed. People with co-occurring disorders, such as psychological issues, need to have their addiction and co-occurring disorders controlled so they can have a healthier, more productive future.

Following a complete evaluation of the person’s history and health, treatment can begin. The National Institute on Drug Abuse (NIDA) outlines the Principles of Drug Addiction Treatment, which provides a basic idea of how addiction is treated in general. Methadone is the preferred course of treatment at a clinic, and often part of other protocols. Recommended basic treatment options include:

  • Medication-assisted treatment: Prescription medications can block how opioids affect the brain and even manage aspects of brain chemistry that control drug cravings and dependencies. In addition to methadone, used since the 1960s, other more recently introduced medications include buprenorphine, which is used to relieve drug cravings with fewer side effects; naltrexone, a nonaddictive substance, that blocks the effects of opioids and does not cause physical dependence; and an injectable form of naltrexone, known as Vivitrol, that is administered monthly rather than daily like most other opioid treatment drugs.
  • Cognitive Behavioral Therapy (CBT): Drug abuse often comes with a set of behaviors and expectations on the part of the user. Counselors can work with clients to change these in the hopes of getting people on a healthier track. Clients can also work on developing various coping skills. CBT is common for those with heroin addiction and in methadone treatment, as the therapy focuses on dealing with substance cravings and general stress factors that lead to drug abuse as a coping mechanism.
  • Medical detox: Withdrawal is associated with many acute physical reactions. Some can be severe but treated with medications to prepare the individual for long-term recovery. With medical detox, clients are monitored until withdrawal is over, so their safety and comfort can be prioritized. Opiate withdrawal symptoms generally abate in a week, but may last up to a month. Emotional symptoms, such anxiety, insomnia, and low energy can last for a few months, especially for those used to high opiate doses.
  • Common physical symptoms include runny nose, teary eyes, and hot and cold sweats. A person withdrawing from opiates may yawn a lot. Other symptoms include muscle aches and pains, nausea, vomiting, diarrhea, and abdominal cramps.

    Risks of Treatment

    Methadone treatment has its risks. While the medication is used to treat addiction, it can be addictive if not administered properly. Doses must be adapted for each individual, and periodic adjustments are typically required. This process is known as induction and must be closely managed by medical staff. Healthcare providers must always have a complete health history on hand to ensure the client’s safety.

    Common side effects of taking methadone include:


    • Feeling lightheaded
    • Labored or shallow breathing
    • Chest pain
    • Rapid heartbeat
    • Confusion
    • Hallucinations
    • Muscle tremors
    • Nausea/vomiting
    • Diarrhea
    • Abdominal cramps

    When taking methadone, there can be potential interactions with other medications. In some cases, these can affect the heart, while the active ingredients in other medications can remain in the body for longer than usual, triggering an overdose. Methadone should always be taken in the prescribed dose, at the right time. People should never stop taking it, double up after a missed dose, or change their dosing schedule without a doctor’s permission.

    When on methadone, it’s also important to:


  • Avoid alcohol consumption.
  • Be careful when driving or operating machinery.
  • Store the medication at room temperature.
  • Keep methadone away from light sources.
  • Contact emergency services in case of an overdose.
  • Methadone overdoses are becoming more commonplace because it is more widely available than it used to be. Since it does not yield the same euphoric effects as other drugs, individuals who become addicted may consume lethal doses to compensate. Signs of an overdose, per the U.S. National Library of Medicine’s MedLine Plus, include constipation, nausea, vomiting, and stomach/intestinal spasms. Low blood pressure, weak pulse, breathing disturbances, dizziness, fatigue, disorientation, weakness, blue fingernails and lips, cold and clammy skin, and coma may result as well. The consequences are potentially fatal.

    According to a CDC report, methadone overdose deaths increased by 5.5 times between 1999 and 2009. In 2014 alone, 14,000 people died from prescription opioid overdoses from medications such as methadone.

    Pros of methadone treatment, according to the National Alliance of Advocates for Buprenorphine Treatment, include decades of experience using it to treat opioid addictions and a cost that is typically less than other treatments. Pricing may be calculated based on the patient’s income. If a person gains tolerance to the medication, dosages can be increased under medical supervision to relieve withdrawal symptoms. Methadone clinics are not legally restricted in terms of patient volume, so they generally don’t turn people away if they are in need of help.

    There are also cons to methadone treatment, which tends to be administered based on strict protocols. This can make those being treated feel like they have no control. A person who abuses opioids can still possibly use these drugs, despite being in a treatment program. Other cons include having to travel far, sometimes a requirement for daily visits, and dealing with self-esteem and other emotional and psychological issues associated with visiting a clinic. Also, if an employer were to do urine testing, methadone can show up in the results.

    Despite the positives and negatives, methadone remains a common form of treatment for opioid addiction and withdrawal.

    When Avoiding Methadone Is a Better Idea

    People should avoid methadone if they have been addicted to the drug before. Methadone should also be avoided if alcohol or other opioid-based substances have been consumed.

    The combination of these substances can depress the central nervous system even further, while the interaction between methadone and alcohol or Valium can be deadly, says the Centre for Addiction and Mental Health.

    If someone has a similar drug addiction or symptoms and is given methadone, it does not mean the same medication or dosage is right for someone else, regardless of how similar the two people seem. Methadone should be avoided unless taken under the supervision of a medical professional familiar with the individual’s case. Taking it otherwise can have unintended consequences.

    Methadone should also be avoided by those who:


    • Take pain, antidepressant, anti-anxiety medications, sleeping pills, tranquilizers, or antihistamines
    • Take medications for heart arrhythmias
    • Plan to become or are pregnant
    • Have a seizure disorder, such as epilepsy
    • Have low blood pressure
    • Have asthma, sleep apnea, chronic obstructive pulmonary, disease, or other breathing disorders
    • Have a history of head injuries
    • Have liver, kidney, thyroid, gallbladder, prostate, or adrenal gland problems


     

    Controversy

    The American Journal of Psychology says the DSM-5 manual, which doctors use to diagnose mental health disorders, describes methadone as a safe substance for treating substance use disorders, but years of experience have proven people need to be careful with it. Various myths have plagued public perception as well. The drug being a substitute for heroin, for one, is incorrect, as it is a much longer-acting formulation intended to treat opioid addiction. The risk potential is therefore lower since there is less reward. Also, people taking methadone as part of a medical protocol are physically dependent, rather than addicted, but this can be managed by reducing or maintaining doses under medical supervision.

    Controversies between methadone clinics and law enforcement have arisen as well. The Beyond Methadone study in New York City monitored 29 locations where patients had been stopped by police, all near treatment clinics. For a period in 2010, 40 percent of people surveyed had reported being checked by law enforcement while 70 percent of others said they witnessed such activity.

    In 2014, the Institute for Research, Education, & Training in Addictions conducted a study and found that there was no increase in crime due to the presence of methadone clinics in Baltimore. The report highlights the benefits of methadone maintenance therapy stated by the CDC. It also assessed the frequency of crimes within certain distances of clinics, which did not yield evidence of increased crime reports.

    How to Find the Right Methadone Clinic

    There are a number of online resources for finding local methadone clinics. One can search by state or city, read customer reviews, or get referrals. Some sites provide resources based on specific treatment services or even insurance companies. In 2011, methadone contributed to 26 percent of opioid-analgesic overdose deaths, the National Center for Health Statistics reported, so it is important to find an experienced and reputable medical facility.

    Many state and federal guidelines cover methadone clinic safety. One must feel comfortable in the facility and amongst its staff members. Those that don’t adhere to local and national regulations are best avoided, and a clean, supportive environment should always be present. Next, people should look for a clinic they can afford. While free methadone clinics do exist, many also offer payment plans and other payment options.

    Some clinics are crowded, and that can invoke fear and anxiety. Others may cater to specific demographics; certain clinics cater to a specific gender or religion, for example, to maximize the comfort of their clients.

    Lastly, it’s essential to find a clinic that can handle one’s specific issues. Medical detox, withdrawal, counseling, and treatment for co-occurring disorders are considerations many drug treatment clinics can handle. In many instances, a comprehensive, private addiction treatment program may be preferable to a methadone clinic. The services, staff, and reputation of the facility need to be taken into account before enrolling in care.

    In Summary

    Proper use of methadone is sometimes appropriate for certain individuals in recovery. SAMHSA’s guidelines, Follow Directions: How to Use Methadone Safely, outlines the risks, considerations, and precautions of taking the medication. Methadone clinics are functional medical facilities where staff members work to assist patients with rehabilitation and first steps on the road to recovery. In some cases, these clinics may be the appropriate choice for those in early recovery. In other instances, different types of addiction recovery programs may better serve the individual. Regardless of the type of treatment chosen, comprehensive care is always needed.

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