OPIATE TREATMENT PROGRAMS
Objective: The student will acquire an understanding of opiate treatment programs and be able to describe the various accepted
types of treatment programs and the advantages and disadvantages of each treatment program including, Methadone, Buprenorphine,
Buprenorphine- Naloxone, Clonodine, and Lofexidine. The student will be able to list the negative side effects and dangers
apparent in each program.
Note: This training is a supplement to the training for chemical dependency counselors
and it is understood that administration of medication is within the scope and approval of the medical supervisor of programs.
Chemical dependency counselors must understand the various pharmacology treatment programs, but do not administer medication.
This information is for educational purposes only.
METHADONE TREATMENTMethadone is
a synthetic narcotic analgesic, patented in 1941 by a German company. The drug was originally used as an analgesic and for
withdrawal from heroin. It is still use for these purposes. As a maintenance program, methadone has several advantages; when
administered in a single dose, it lasts between 24-26 hours without creating euphoria, sedation, or analgesia. This allows
the patient to perform mental and physical tasks without impairment. The methadone reduces the consistent “hunger”
for the drug which is a possible contributor to relapse. The medicine also creates cross- tolerance, and in this way blocks
the effects of normal street doses of opioids such as heroin. Research studies have revealed that patients with doses of 60
mg per day or more resulted in better treatment outcomes than with lower doses. The dosage levels must be determined individually
with consideration of the patient’s metabolism, body weight, duration of heroin use, and most importantly, maintenance
of appropriate methadone blood levels over a 24 hour period.
The side effects reported with methadone include; tolerance
within 4-6 weeks, but some symptoms can persist longer, such as constipation, sexual energy (libido), and sweating. Therefore
it is essential for the counselor to monitor and report to the physician side effects so the physician can monitor the patient’s
problems with compliance. Methadone prescribed in higher doses (up to 150 mg per day) on a long term basis has not proved
to be toxic or to increase side effects. Patient’s may also experience periodic skin rash, weight gain, and water retention.
Problems with irregular menses or amenorrhea are reported.
In the United States, methadone maintenance programs
are strictly regulated by the federal and sate governments, the Food and Drug Administration (FDA) and the Drug Enforcement
Agency (DEA).
Admission into a methadone maintenance program by federal standards requires the following:
1. A
minimum of 1 year of addiction to opiates as well as current evidence of addiction (but there are allowances for pregnancy
and recent discharge from a chronic care facility or prison).
2. The minimum age for entry is 18 years, or younger with
parental or legal guardian consent. Applicants younger than 18 years, must have at least two prior documented treatment episodes,
either short term detoxification or drug-free treatment, before they can be enrolled.
In the United States, most
methadone programs have three stages:
1. Stage 1: Stabilization stage- This stage lasts approximately 3 months during
which the patient adjusts to the medication. This stage is characterized by a thorough psychosocial history and assessment,
and physical examination. The patient is oriented into the program and provided with all related issues of program compliance,
rules, and how to deal with crisis situations. New patients must report to the program daily (6 or 7 days per week) during
this stage.
2. Stage 2: Review stage- During this stage, the patient is subjected to a review and modifications of the
treatment plan, Take home medication may be issued depending on compliance issues. Counseling issues, vocational and educational
goals are provided and reviewed.
3. Stage 3: Continued maintenance stage- The patient is monitored for compliance and
there may be a reduction of adjunctive services. Continued submission of urine specimens is required fro drug screening and
to ingest a dose of methadone under observation, and continued consultation as desired, with program staff.
Other
Issues for Medical and Counseling Staff:
1. Studies have revealed a reduction of HIV acquisition when on continuous methadone
treatment programs. Issues of tuberculosis, and especially treatment resistant tuberculosis and an increase in hepatitis C
has been occurring, and hepatitis C is expected to supersede the death rates of HIV in the future.
2. Alcohol and cocaine
(crack and cocaine hydrochloride) have been reported as major substance abuse alternatives among patients on methadone maintenance.
3. Reductions in criminal activity have been reported among methadone maintenance patients.
4. The majority of
reported deaths among methadone patients is due to poly-drug abuse involving other psychoactive substances.
