- Addiction & recovery
August 20, 2021
Opioid misuse and dependence remain a major public health crisis in the United States. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), around 9.7 million Americans aged 12 and older misused prescription opioids in 2019. The opioid crisis in the United States has been long-standing, but the emergence of COVID-19 has further compounded this situation.
There are currently three medications approved by the U.S. Food and Drug Administration (FDA) to treat opioid use disorders (OUD), including methadone, buprenorphine, and naltrexone. While all these medications are available through an opioid treatment program (OTP), popularly known as methadone clinics, the Drug Addiction Treatment Act of 2000 allowed licensed practitioners in (non-OTP) medical clinics to prescribe and administer buprenorphine and naltrexone. However, methadone, on the other hand, can only be exclusively dispensed through SAMHSA-certified methadone clinics.
The epidemic’s mounting health concerns have highlighted various questions concerning the access to medications for opioid use disorder (MOUD), among other treatments. To help increase access to methadone maintenance treatment during such difficult times, the federal government published proposals allowing for the extension of take-home methadone dosages, among other regulatory changes.
But before we delve into these changes, let’s get a better understanding of what a methadone clinic is and how it functions.
What Is a Methadone Clinic?
A methadone clinic is a medical facility that provides MOUD treatments. Because they also provide other medications like Suboxone and naltrexone, they are more appropriately referred to as substance use disorder services (SUDS). However, since methadone is the most frequently prescribed medication in such facilities, this term is more associated with such clinics.
To dispense OUD medications such as methadone, OTP clinics must be approved by the Substance Abuse and Mental Health Services Administration (SAMHSA) and registered with the Drug Enforcement Agency (DEA).
Methadone clinics provide medications for a specific period to help people in recovery overcome withdrawal symptoms and cravings and, in turn, help them enhance focus on other elements of their recovery. To ensure that each individual receives comprehensive care, they also offer family, group, and one-on-one counseling and other evidence-based therapies.
Services Provided by Methadone Clinics
Clinics must meet specific government regulations to receive OTP certification. In addition, all clinics must provide a minimal set of services, which includes:
- Every individual is provided with a comprehensive physical examination by a physician or a health care practitioner under the supervision of a program physician. Clinics are also required to provide complete documentation of the evaluation.
- Policies and procedures must be in place at clinics to handle the special needs of pregnant women. For example, the clinic must provide prenatal care or refer the individual to a facility that can.
- Individuals accepted into an OTP must be provided with a treatment plan and regular evaluations throughout treatment to enhance efficacy.
- Individuals must be provided with appropriate therapy and counseling services by an addiction specialist qualified to assess social and psychological backgrounds, contribute to the treatment plan, and track progress.
- Clinics are required to conduct at least eight random drug tests per person each year. An initial drug test is required if the individual is in a short-term detox program. An initial drug test, as well as randomized monthly testing, are required during long-term treatment.
A methadone clinic must provide these services as a bare minimum. However, other clinics may go above and beyond these standards by providing a wide range of counseling and holistic therapies.
Treatments Offered at Methadone Clinics
Everyone’s addiction recovery is unique, and people require various treatment alternatives to obtain the best treatment possible. Most methadone clinics provide a variety of treatment options. And medication for opioid use disorder is, of course, at the heart of OTP treatment. However, methadone clinics also place a strong emphasis on counseling and behavioral therapy to provide a whole-person approach to OUD treatment.
The following are the most common treatments offered at methadone clinics:
- MOUD: When taken as directed by a licensed healthcare professional physician, MOUD blocks the effects of illicit opioids on the brain, resulting in reduced cravings and dependence. Methadone is the most commonly prescribed treatment medication in MOUD due to its effectiveness and low cost.
- Medical detox: Methadone clinics offer medically supervised detox programs that allow people to go through the withdrawal process while being monitored by physicians.
- Cognitive-behavioral therapy (CBT): Individuals who participate in CBT learn to recognize and rectify harmful behaviors by applying healthy coping skills to prevent substance misuse and address various other issues that often co-occur with it.
- Recovery support services (RSS): RSS encourages a healthy lifestyle that reduces the risk of relapse. Individuals who receive opioid use disorder treatment alongside RSS have a higher long-term recovery rate than those who don’t.
What Happens at a Methadone Clinic?
Individuals who are addicted to opioids can walk into a methadone clinic and ask to be treated. However, treatment is only provided once an individual is deemed eligible through various initial screening processes and interviews.
Most OTP has similar features, and the process can be divided into three stages.
Assessment and Induction – On the first day, individuals discuss their overall health and substance use history with a healthcare provider at the clinic. Individuals will go through a screening test to confirm that they are in an appropriate withdrawal stage before beginning treatment. An intake counselor will review the individual’s medical history and current condition to tailor a personalized treatment plan.
The physician will decide whether or not you can start taking MOUD the same day based on the findings of your assessments. Before being given the first dose, individuals will be required to review the treatment policies and procedures and sign a consent form stating that they voluntarily agree to treatment and are willing to comply with the rules.
Stabilization – Individuals will start with a low dose of medication. They will receive the same dose for three days to allow the medication to build up in the system. After three days, it’s time to evaluate how well the medication is working. If they are still experiencing withdrawal symptoms, the dose will be increased once every three days until they reach maintenance level.
Maintenance – For the first 90 days, all individuals must visit their methadone clinic daily for treatment. Individuals who meet their treatment goals and show adequate commitment for the first six months may be allowed to take home medications for a few days or weeks.
Eligibility for Treatment at Methadone Clinics
MOUD treatment is only available to those who meet certain requirements. For example, an individual must be physically dependent on opioids during OTP treatment to meet state and federal standards for this form of treatment. Additionally, they also had to have struggled with their addiction for at least a year before seeking treatment.
Individuals can use a doctor’s letter or records of any previous treatment to prove that their opioid use disorder has lasted at least a year. Suppose a person cannot obtain this documentation; they can have a family member complete a notarized certification of their opioid use. A history of being arrested for opioid use or possession, as well as confirmation from a probation officer, may also qualify a person for treatment.
However, there are exceptions to the one-year rule, such as:
- If the candidate is pregnant.
- Has been released from prison within the last six months.
- Has participated in a methadone treatment program in the past.
MOUD treatment is often reserved for individuals with severe or long-term addiction and has not responded to other forms of therapy. But individuals under the age of 18 are usually not treated at methadone clinics.
Finding the Right Methadone Clinic
Finding the right methadone clinic is the first step toward recovery from opioid use disorder. It’s important to choose a reliable and experienced medical treatment facility that’s accredited, licensed, and follows federal, state, and local methadone clinic procedures. Candidates can start this process by looking up a methadone clinic’s online reputation.
Here are some important factors to consider when choosing a methadone clinic:
- Individuals should feel at ease with the staff members and treatment program upon visiting the facility. In addition, the clinic should have a clean and welcoming atmosphere.
- The facility should offer support services like counseling and community connection resources. These are important components to facilitate successful treatment and help individuals stay on the path to recovery.
- The facility should offer an individualized treatment plan that is assessed regularly and modified when necessary.
- Every individual must receive a comprehensive physical examination by a health care professional under the supervision of a program physician.
- Individuals will initially spend every day in the clinic; therefore, the clinic must be accommodating and flexible.
- All clinics must employ strict protocols to ensure the safety of individuals within the facility, under the social distancing and infection prevention procedures provided by the Centers for Disease Control and Prevention (CDC).
Taking Precautions During Covid-19
Due to the age of social distancing, the Substance Abuse and Mental Health Services Administration (SAMHSA) has made regulation changes as of March 2020 to help ease and improve the accessibility of MOUD treatments. This regulatory modification included the expansion of take-home methadone doses and access to consume their medication in an unsupervised setting, which appears to be an effective way to ensure that those in treatment have easier access to MOUD treatment during the pandemic.
It’s important to note that state regulations control how medications are dispensed in each opioid treatment program; thus, methods and guidelines may vary from provider to provider depending on the state in which they are located.
The following are SAMHSA guidelines for OTPs during the pandemic:
- States may request that OTPs provide 28 days of take-home doses for all stable individuals in recovery.
- For individuals who are not as stable but are deemed to manage their medications safely, the state may request up to 14 days of prescriptions.
- Individuals who are unable to handle their meds will be allowed to visit the OTP each day.
- OTP may provide drop-off services for individuals under quarantine.
Furthermore, the DEA has relaxed regulations requiring health care practitioners in OTP to provide one-on-one consultations. OTP is now allowed to provide virtual consultations during an initial evaluation.
Since behavioral health services will most likely be limited, individuals in recovery are encouraged to join online support groups such as “In the Rooms” or “SMART Recovery.” These virtual support groups can help you cope with the stressors of COVID while also providing a sense of community with others in similar situations.
If you are seeking help with your loved one’s addiction, contact us today or complete our quick contact form below, to speak with an addiction treatment specialist.
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