High risk poly drug use: all opioid substitution treatments should be approached with caution in individuals using other drugs, particularly those likely to cause sedation such as alcohol, as well as benzodiazepines and antidepressants in doses outside the normal therapeutic range.
Particular attention should be given to assessing the level of physical dependence on opioids, co-dependence on other drugs and overdose risk. Co-occurring alcohol dependence : due to the significant management problems presented by this group, consideration should be given to concurrent disulfiram or acamprosate therapy.
If disulfiram or acamprosate are used, a methadone liquid formulation that does not contain alcohol should be considered to reduce the risk of reactions.
Recent history of reduced opioid tolerance: after a period of treatment with naltrexone, or having recently completed a period in prison or an opioid withdrawal program, the patient can be expected to have reduced tolerance to opioids and is at significant risk of overdose if they use opioids see Section 3. Psychiatric illness also see Section 4. Note: at entry to methadone most patients exhibit some degree of depression which usually resolves quickly with MMT.
Most of these patients do not require antidepressant treatment before commencement of methadone. High risk of self-harm : Individuals at moderate or high risk of suicide should not be commenced on methadone in an unsupervised environment and specialist consultation should be sought. Chronic pain — refer for specialist assessment first Concomitant medical problems: A significant proportion of methadone related deaths involve individuals who were in poor health and had other diseases particularly hepatitis, HIV and other infections which may have contributed to their death.
This emphasises the importance of giving consideration to concomitant medical problems. Head injury and increased intracranial pressure : This is generally seen only in the hospital emergency setting. Phaeochromocytoma : aggravated hypertension has been reported in association with heroin use. Asthma and other respiratory conditions : In such patients even usual therapeutic doses of opioids may decrease the respiratory drive associated with increased airways resistance.
Both of these situations warrant further assessment to establish whether current opioid dependence exists. Warning signs of possible drug seeking include a pattern of behavior in which a patient finishes narcotic prescriptions early, insists on replacement prescriptions and concurrently solicits prescriptions from multiple physicians.
Evidence of a short-term relapse is perhaps best characterized by opioid intoxication e. Traditionally, methadone maintenance is managed through dedicated clinics, which provide dosing and a broad array of counseling and rehabilitative services. Methadone maintenance programs currently exist in 42 states, the District of Columbia, Puerto Rico and the U. Virgin Islands. These treatment programs are listed in the Narcotic Treatment Program Directory.
Addiction Treatment Forum www. Methadone Awareness newsletter, published by Philadelphia chapter of National. Methadone Information Exchange www. Narcotic Treatment Programs Directory www. Another treatment option is dispensing methadone through a general medical practice. In this circumstance, a physician provides methadone pharmacotherapy contingent on registration with the Drug Enforcement Administration, the U.
Food and Drug Administration and the state methadone authority. Physicians and patients must comply with methadone maintenance program requirements. This is a useful treatment option for patients who have limited access to specialized clinics, especially those who live in rural areas. Nevertheless, the burden of the federal and state requirements make this option unpopular with physicians. Moreover, this form of treatment is as restrictive to patients as traditional methadone clinic care.
Recent changes in the Federal regulations advocate less restrictive alternatives, highlighting an increasing interest in providing care outside of traditional methadone clinics as a means of extending access to narcotic addiction treatment.
Federal regulations established in endorse office-based opioid therapy OBOT , in which primary care physicians provide methadone pharmacotherapy within comprehensive medical care for a segment of the methadone-maintained population.
To practice OBOT, physicians must have training in addiction medicine, be affiliated with a methadone clinic or be monitored by the medical director of a methadone clinic. Physicians may incorporate up to 30 methadone-maintained patients into their practice. Eligible patients are referred exclusively from methadone clinics and must be stabilized and have achieved three years of successful methadone maintenance.
The advantage of OBOT to patients is the fact that primary care physicians can dispense up to a day supply of methadone, thus easing the scheduling demands characteristic of traditional methadone clinics.
Some research suggests that methadone treatment from a general medical practice is as effective as that provided in specialty clinics. The goals of the early induction dosages of methadone are to attenuate withdrawal symptoms, diminish opioid craving and arrive at a tolerance threshold, while preventing euphoria and sedation from overmedication.
Subsequent induction dosages are adjusted on the basis of dose response, particularly an evaluation of abstinence symptoms. The maintenance phase of dosing is attained when the patient's dosage is satisfactory and effective for at least 24 hours. The length of the maintenance phase lasts as long as treatment benefits the patient. Periodic dosage increases are warranted in cases of patients who relapse or abuse other drugs. For example, because alcohol, barbiturates and sedative-hypnotics accelerate methadone metabolism, they foster withdrawal symptoms.
In addition, patients sometimes need a dosage increase when taking prescribed medicines e. Detoxification is indicated when a patient demonstrates consistent, long-term abstinence and possesses adequate supportive resources e. Patient receptiveness to community resources for opiate addicts, such as NA, is a good sign.
NA is a useful tool in relapse prevention. Local chapters of NA are listed in the telephone book. Further resources are provided in Table 3. Methadone detoxification involves the induction of opioid withdrawal symptoms and typically refers to either a short-or a longterm process. Short-term detoxification does not exceed 30 days. Gradual detoxification tends to be more successful than a sudden dose discontinuation.
The physician runs the risk of either overestimating or underestimating the intensity of withdrawal. For these reasons, detoxification must be undertaken on a case-by-case basis. Generally, it is a good idea to taper the methadone level to a low dose e. Pain and discomfort are best managed with nonnarcotic agents. If diarrhea develops, it is helpful to recommend loperamide Immodium in a dosage of 2 mg following each loose stool over a few days until stools are formed.
For insomnia, a short course of hypnotics may be appropriate. Opioid-dependent patients undergoing methadone treatment are susceptible to a number of medical problems. They may also experience unusual manifestations or require specific modifications to therapy for a wide range of health problems. Because some of these conditions or diseases are communicable e. Moreover, it is helpful for the physician to act in an instructive capacity and educate family members, especially partners, about the chronic, often relapsing, course of opioid dependence.
Physicians should urge family members to make use of the support services, resources and information listed in Table 3 , particularly Nar-Anon, a self-help support group for family members of addicts.
The prevalence of HIV infection is as high as 60 percent in opioid-dependent persons. Retesting is warranted six months after any possible HIV exposure. HIV-seropositive status requires a medical evaluation, including a physical examination, a baseline CD4 T-lymphocyte count, viral load and tuberculin skin tests, and an update of the patient's immunizations.
Additionally, women who are pregnant or individuals who have recently gotten out of prison are eligible for methadone treatment without meeting the one-year requirement. People who have received treatment a methadone clinic previously may also be able to bypass the one-year requirement of opioid addiction. Many methadone programs operate in a similar manner but may vary slightly in the treatment methods offered.
However, patients must earn this privilege over several months. If you or a loved one is struggling with opioid addiction, a treatment program at a methadone clinic may be an option to consider.
There are several methadone clinics throughout the nation that can help you overcome an opioid use disorder and reclaim your life in sobriety. If you would like to learn more about what to expect at a methadone clinic or to discuss your treatment options, contact an Vertava Health treatment specialist today. Call us at This page does not provide medical advice.
Don't Wait. Learn about other MAT medications. SAMHSA offers tools, training, and technical assistance to practitioners in the fields of mental health and substance use disorders. To sign up for updates or to access your subscriber preferences, please enter your contact information.
Skip to main content. Mono Bar U. Main menu. Territories for mental and substance use disorders. Ellos escuchan. They Hear You. Solr Mobile Search. Share Buttons. Page title Methadone. What Is Methadone? How Does Methadone Work?
0コメント