Opiate addiction is a chronic disease that affects millions of people in the Unites States. This deadly epidemic is one that in most cases requires some form of medical treatment. There are many treatment options available to those struggling with addiction.
The three most well-known options are rapid detect, jukeboxes, and methadone maintenance (Medication-Assisted Treatment for Podia Addiction Facts for Families and Friends).
Though each form of treatment has its own advantages and disadvantages, they all have one common goal; drug freedom. Research has shown that those receiving treatment are nearly twice as likely to achieve their goal of drug freedom (Mayo Clinic). Opiates are highly addictive powerful drugs that are derived from the poppy plant and are generally used to relieve pain (mayo clinic). There are two types of opiates, natural and man-made. Though both are prescribed by physicians with the exception of heroin, often times when dealing with someone that has become addicted they are obtained illegally.
Because of the potential for prescribed opiates to end up being sold or traded on the streets, stricter regulations have been put in lace for physicians to prescribe them (samara). Where they were once a little quicker to write a prescription for a schedule II narcotic, they are now telling patients to “take a Ethylene or Motoring” (Levied). These regulations have become a necessity in the war against opiate addiction. Deciding to enter into treatment for opiate addiction is one that requires much thought. Generally when one decides that it is time for them to enter treatment, they have hit rock bottom (Levied).
However, rock bottom is different for every person. For some, treatment may be court ordered and they are in a situation where their form of retirement is being chosen for them. For some, they are on the verge of losing everything that is important to them, or they may have already lost it. Whatever the reason may be, getting the treatment needed is a life changing decision. The best form of treatment varies from person to person. For some, the idea of a rapid detect would be the best. It is a quick process that only requires a short stay of usually 2-4 days in a detect facility or a hospital (mayo clinic).
In most cases, the person will be given medication to assist them in dealing with the side effects of withdrawing from opiates. During a rapid detect, patients are monitored around the clock for a period of time for signs life-threatening withdrawal symptoms such as cardiac distress and seizures (ASSAM). Those that choose a rapid detect can expect to be sedated to keep them as comfortable as possible during this time period. Prior to sedation, they are generally given Maltreatment, to block the effects of opiates. Other medications may also be given during this time as withdrawal symptoms increase.
In many cases medication to help control blood pressure and seizures become necessary. Jukeboxes has become popular because it does not require one to report to a clinic lily, but rather are given a prescription to be filled at a pharmacy. Jukeboxes comes in two forms, a tablet and a film, both are administered subliminally (jukeboxes). Though there are regulations governing the prescribing of jukeboxes, they are not nearly as strict as those in place for methadone (FDA). In order for a physician to begin prescribing jukeboxes, they are required to complete online training that is very limited (Manson).
For many, that is the only training they have in addiction. Methadone is a synthetic drug that acts in a similar way to narcotics. Methadone moms in the form off tablet, powder, or liquid. The tablet and powder form are dissolved prior to administering the medication. When methadone is taken on a regular schedule, it will build up in the tissues making the effects last longer (samara). Methadone will not provide the same effects of opiates such as sedation or euphoria; it will instead block these effects if other opiates are used (Catatonia 8). A stable dose will vary from person to person.
Generally once someone achieves a stable dose of methadone it will hold them for 24-48 hours without them feeling dope sick (Levied)” Medication-assisted treatment has proven to be the most successful form of treatment for someone wishing to become drug free. However, these forms of treatment face tough criticism. It has been said that treating opiate addiction with medication is simply trading one addiction with another. However for those dealing with the daily struggle of addiction, they depend on these forms of treatment to gain control of their lives.
For those people, the daily routines, the counseling, the referrals, the support of others and the consequences is what gives them hope; the pop that they will beat this disease that plagues them (in my own words). Methadone Maintenance treatment is the one form of treatment available that offers all of those things and more. When properly used, I feel that methadone maintenance treatment is the safest and most effective way to treat opiate addiction. There are many reasons that I feel methadone maintenance is the safest form of treatment available to someone battling opiate addiction.
Contrary to what some may think, or some of what has been reported, these facilities can have a life changing effect on those who are committed to the program (Methadone Maintenance Treatment Facts). These programs are not only a place for someone to come in, pick up a prescription and leave. Instead these programs require patients to report daily for their medication, at least until they are able to meet all requirements for take home privileges. While there, patients interact with office staff, nursing staff, and clinical staff on a daily basis.
Patients are monitored for any changes in their appearance, attitude, alertness, and overall demeanor (Levied). This helps to ensure that if someone is having an issue that staff is there to offer assistance right away. For many that battle addiction, Just knowing someone is there to listen and offer as much assistance as possible is enough to get them headed on the right path (In My Own Words). The guidelines set by the federal and state governments are much stricter for methadone maintenance that those set for jukeboxes (samara).
For instance, in jukeboxes clients walk into a clinic to sign up and within a matter of a couple of hours they are able to walk out with at the very least medication that should last them a week. When people struggling with addiction first make the choice to enter into a retirement program, they are scared, sick, and in many cases about to lose everything important to them (In My Own Words). These patients are still using illicit drugs daily, and are at this point willing to do whatever it takes to avoid being “dope sick. Jukeboxes often ends up being sold illegally on the streets because people that have been lying, cheating, and stealing for a long period of time are now given a large amount of medication to take home with them (Levied). Methadone maintenance has a lengthy set of requirements before one is able to obtain the privilege of taking home medication (Blanchard and Crappy). One must be in treatment for 90 days, and produce at least 3 illicit free urine drug screenings before earning the privilege of one dose of medication to take home.
In order for someone to have a full week worth of medication to take home with them at one time as they do in jukeboxes treatment after one day, they must be enrolled in the program for a minimum of three years and produce at least 12 illicit free urine drug screenings (SMASH). That is Just one of many requirements for one to earn the privilege of taking home their medication. They also have to participate in regular counseling sessions. The amount of time required for each session varies from patient to patient depending on the amount of time they have been enrolled in the program as well as their use of illicit substances.
Patients are required to sign releases for every physician that they see so that care can be coordinated properly. It is very important that medication that physicians prescribing other medications are aware of the patient being on methadone. By the time patients in methadone maintenance are able to start taking home doses of their medication, they have started on the right path (Levied). They are on a stable dose that effectively holds hem without the use of opiates, and they like the freedom of not having to report to the clinic to be dosed for the day.
These take home bottles that are so hard to obtain, are so easy to have revoked as well. If someone produces an illicit urine drug screening, or does not get their required amount of counseling time in for the month among other things, they will have to start earning their take home privileges all over again. Those that receive take home bottles are also subjected to “call backs (Medication-Assisted Treatment for Podia Addiction. )” This is when the client is allied and given a short notice of when they will have to report to the clinic with all of their used and unused take home bottles.
At this time, the bottles are thoroughly inspected to be sure that their medication is in fact being administered the correct way (SAMARA). Because of these guidelines being as strict as they are, less methadone is sold illegally in the streets making it a safer choice. Methadone is also the safest form of treatment for pregnant women who happen to be struggling with opiate addiction (Practical Approach). In fact, it is currently the only FDA approved medication for treating opiate addiction during pregnancy Methadone Maintenance Treatment (MET): A review of Historical and Clinical Issues. When properly prescribed, methadone has proven to provide an environment that is less stressful on a developing fetus (Catatonia, 19). While a proper dose of methadone will help to prevent miscarriage and pre-mature labor, other forms of treatment seem to cause these issues. The use of maltreatment has been proven to cause spontaneous abortion, fetal distress, premature labor, and stillbirth Issues. ) Because methadone is a long acting medication, it is able to provide the fetus with an environment that promotes development.
Though methadone during pregnancy is considered to be the safest of the options available, it comes with side effects (About Methadone). Babies born to mothers prescribed methadone are at risk for low birth weight. This is a very small risk to take when compared to risks faced with other forms of treatment such as jukeboxes or rapid detect. Some of those risks include fetal distress and miscarriage. During pregnancy, women are monitored very closely by the physician at the clinic and are also required to provide proof of prenatal care from an BOGGY (Levied).
Studies have shown no long term effects on babies that are born to mothers prescribed methadone during their pregnancy. At birth, these babies will test positive for methadone in their systems, however are able to be weaned in a timely manner (Catatonia, 20). When compared to a rapid detoxification and jukeboxes, methadone maintenance is the safest choice. When a rapid detect lasting 2-4 days in most cases is completed, the patient is left without any aftercare other than what they obtain on their own. They are given a stack of paperwork that in most cases will contain a few referrals for mental health providers and a list of AN meetings.
At this time, the patient may be wrought the worst part of the withdrawal process, but they are still unstable (ASSAM). These patients still need the support of clinical and medical personnel, but sadly many will not get that support. Those that do not will most likely find themselves in the same situation they were in previous to the rapid detect. Though patients in jukeboxes treatment have more of a clinical and medical support than those choosing rapid detect, they still do not have the same support as those in methadone maintenance.
Those Just starting out in treatment, whatever option they may choose, are at the lowest points in their lives. It is because of that I feel that they are in need of the most support that is available to them. To me, that support comes from a friendly smile when they walk into the clinic every day that reminds them that they are Just another Junkie, they are a person. They are a person that deserves to be monitored daily, given referrals for housing, food, clothing, medical care, and anything else that they could possibly need. For many addicts, the clinic is the safest place that they are in all day (In My Own Words).
The goal of any form of treatment is to improve the patient’s health as well as their laity of life (Marion). For many struggling with addiction, their health has come last while obtaining opiates in order to avoid feeling “dope sick” has come first. For many, this low point in their lives will lead them to participate in high risk behaviors. Those that find themselves addicted to opiates will often turn to theft or prostitution in order to fund their habit, while others will share needles used to administer drug such as heroin.
These high risk behaviors not only put them at risk for many other infectious diseases such as Hepatitis and HIVE, but for legal troubles as well (Marion). Though the long term results of any treatment lays largely on the person in treatment, studies show methadone maintenance to be the most effective form available at this time (Medication-Assisted Treatment for Opiate Addiction). Drug freedom is a long term commitment that has to first be taken seriously by the person in treatment. If the dedication on their part is not there, the efforts of clinic staff will not be enough to help them (Pogo).
Research has shown that that rapid detect treatment has a high rate of relapse (Medication- Assisted Treatment for Podia Addiction). Those that choose a rapid text as a form of treatment often have difficulty transitioning into a lifestyle of recovery. Often times, they are still living in the same places, with the same phone numbers, and associating with the same people making abstinence from opiates even harder to maintain (Mayo Clinic). For most choosing this form of treatment, it only takes one poor decision to be back in the same situation they were before.
These poor decisions have devastating effects on their sobriety making this form of treatment the least effective of the three most well-known forms of medication assisted treatment. Psychosocial counseling has proven to be very beneficial to those dealing with addiction. Those enrolled in both Jukeboxes and Methadone Maintenance is required to participate in counseling. However for those that has chosen a rapid detect, this counseling is not a requirement. . Referrals are given to the patients upon discharge from the facility, but not everyone follows through with it .
For some it is simply because they feel they do not need it, for some it is because they are unable to afford it (Mayo Clinic). Jukeboxes treatment does require some counseling though the guidelines for this is not nearly as strict as those set for ethanol maintenance. For those enrolled in a methadone maintenance treatment program, there are strict rules for clients to obtain this counseling (Pogo). Clients enrolled in a methadone maintenance program are required by state and federal regulation to have a minimum of 2. 5 hours of counseling time per month (ASSAM).
Clients will usually meet with their counselors once or twice each week to discuss progress in treatment as well as the goings on in their lives. By discussing issues that the client is dealing with, the counselors are able to teach them skills that will be useful to the client as they continue on the path to drug freedom. During this counseling, clients are taught many ways to recognize triggers that were once their excuse to use illicit substances so that they are able to refrain from using (Pogo). Counselors discuss in depth the things that seem to be holding the clients back from achieving their goal of drug freedom.
By doing this, they are able to form treatment plans for the client. These treatment plans list goals as well as steps needed in order to achieve the goals. If needed, clients are given referrals during this time. When referrals are given to a client, the counselor will check in with the client to see if they ere able to get the assistance they were in need of (Pogo). The fact that the counselors take the time to follow-up on things discussed during these sessions hold the client accountable for their treatment. Because they are held accountable, I feel that it helps to make methadone maintenance a more effective form of treatment.
The goal of methadone maintenance treatment is to stabilize the patient. A stable dose of methadone with effectively block the craving for one to use illicitly while avoiding withdrawal symptoms which in turn permits one to function “normally. ” When taken properly, methadone will not create sedation or euphoria. It should have no adverse effects on mental capacity, motor skills, or the ability for one to maintain employment. A stable dose of methadone will hold a person for 24-48 hours which will allow them the time and energy to devote to making improvements in their lives.
However, methadone maintenance treatment is a long term commitment. It can take up to a month to achieve a stable dose in order for a patient to get the most benefits out of treatment. A stable dose of methadone varies from person to person (Levied). There are many factors that will affect the dose that one would require to become stable. For many, the tolerance that they have built up over years of illicit use will require them to have a much higher dose of methadone in order to remain stable.
For others, health factors and other medications will affect the way their body is able to metabolize the methadone requiring them to have a higher or lower dose. Once a stable dose is achieved, one is usually able to begin the process of getting their lives back on track by dealing legal obligations, following up on medical care that has been pushed to the side, and mending broken relationships with family members (Pogo). The longer one remains committed to treatment; they will have a greater success rate for maintaining their goal of drug freedom.
It is recommended that one remain in a methadone maintenance program for a minimum of one year. For many, once they achieve a stable dose and they are able to provide illicit free urine drug screenings, they feel that they will be able to effectively remain drug free on their own. In these cases, the rate of relapse is much higher than those who remain committed to the program for a year or in many cases longer (Methadone Is an Effective Treatment for Heroin Addiction). Those who remain in treatment for at least year are nearly three times as likely to remain drug free than those who are only in treatment for a short period of time.
In a methadone maintenance program, the patient along with the influence of clinical and medical staff decide when they have reached a point in their treatment that they are ready to begin decreasing their dose in order to discharge from the treatment program. There is no set time frame to this process. When one decides they are ready to begin decreasing, they have generally been on a stable dose for an extended period of time and have shown that they are able to effectively manage heir new abstinent lifestyle.
Patients that decrease their doses slowly have proven to have the most success in remaining drug free. The slow taper allows their bodies time to adjust to the change in medication so that they are able to refrain from having withdrawal symptoms. These withdrawal symptoms are what will push a person into illicit opiate use again. Once a decrease in a person’s methadone dose is taken, they are encouraged to remain at that lower dose for a period of at least 2-4 weeks.
During this time, the clinical and medical staff is able to monitor the patient o ensure that they are handling the decrease in medication with no adverse effects. This process for tapering will continue until the patient has reached a dose of OMG when they will be able to “walk off’ from the treatment. After the patient has been able to discontinue the use of methadone, they will still receive after care. Clinical staff will make phone calls to check in on the patient and offer them resources that will assist them in remaining drug free.
Methadone and Jukeboxes clinics face tough criticism from many. People living in communities where these clinics are located are often unpleased with having a clinic n their neighborhood. Many feel that it will bring drug addicts and crime into their otherwise peaceful neighborhoods (Swisher). What they fail to realize is that these addicts are a part of their communities regardless of if they are enrolled in a treatment facility or not (In My Own Words). It is a common misconception that it is very easy to “pick out” an addict (Mayo Clinic).
However, that could not be more untrue. There are people everywhere that struggle daily with addiction. Some of these are doctors, lawyers, teachers, actors and actresses, and professional sports figures to name a few (Mayo Clinic). These are people that are clean, well dressed, well groomed and well spoken. Not every addict lacks personal hygiene and an education. There are certain risk factors that may be a factor in opiate addiction. For many who suffer from addiction, the environment that they are in plays a large role in them remaining dependent on illicit substances.
There are also inherited traits that will influence one’s addiction. Those that have immediate family that suffers with addiction are at a higher risk of also having addiction issues themselves. Research has also shown that males are nearly twice as likely to have addiction problems as males (Mayo Clinic). Methadone was approved by the FDA in 1972 for the treatment of opiate addiction. Methadone is considered to be the most effective treatment available to those addicted to opiates (Methadone Maintenance Treatment (MET): A Review of Historical and Clinical Issues).
It is estimated that upwards of 170,000 individuals in the United States currently are enrolled in a methadone maintenance program. It has been proven that illicit drug use has decline by over 60% for those that have been enrolled in a methadone maintenance program for a year. For those that main committed to the program for at least two years, the use of illicit opiates declines by nearly 85% (Accreditation Of Methadone Maintenance Treatment: Assuring Quality of Care. ) Furthermore, crimes committed by these individuals are also significantly reduced.
After lengthy research, I am confident is saying that methadone maintenance treatment is not only the safest method of medication assisted treatment available to those battling opiate addiction, but it is also the most effective Accreditation of Methadone Maintenance Treatment: Assuring Quality of Care). The regulations overriding methadone maintenance are much stricter than those for other forms of treatment. Methadone maintenance is the only form of medication assisted treatment that is approved by the FDA for pregnant women.
It also remains the form of treatment that has the most thorough requirements for admission, and for supplemental and after care. As with any form of treatment, there are pros and cons, however it has been proven that for someone struggling with this disease that the pros far outweigh the cons. This form of medication has assisted thousands of people in getting their lives back. It has made it possible for patients to function successfully in society. These people will be able to maintain employment and be productive. The counseling that they receive will help them to recognize triggers and effectively avoid them.