Methadone clinic

A methadone clinic is a clinic which has been established for the dispensing of methadone (Dolophine), a schedule II opioid analgesic, to those who abuse heroin and other opioids. The focus of these clinics is the elimination or reduction of opioid usage by putting the patient on methadone. Some clinics also offer short- or long-term detoxification services to their patients using methadone. A common term for the type of treatment at a methadone clinic is "replacement therapy". While generally considered successful as a treatment method, the use of this maintenance treatment is often viewed as controversial.

Regulation and policy

In the United States, there are generally two types of methadone clinics, public and private. The public clinics are generally cheaper to attend. However, there is usually a waiting list due to limited funding. The private clinics are more expensive to attend but usually have either a short or no waiting list. In many parts of the United States, methadone clinics are few and far between, which presents problems for addicts seeking methadone treatment who live far from a clinic. The greatest concentrations of clinics are in California, Maryland, New York, and New Jersey.

Methadone clinics in the United States operate under close federal observation and regulation. The medication is monitored by nursing staff and is prescribed by a physician. Regulations require that to enter this form of treatment, the person must show current addiction to an opioid. This is generally established by a simple urine sample. A medical examination is given prior to administration of the methadone, and new patients are often tested for certain conditions which are known to be prevalent in addict populations, such as HIV, hepatitis, and tuberculosis.

Use of methadone clinics

Although not required by regulation at this time in the United States, people are usually encouraged to attempt other types of treatment methods prior to entering methadone treatment programs. While not restricted to adults, this treatment method is generally not considered for people under the age of 18. As of 2013 due to the strict changes in receiving prescription pain medication as well as decreases in prescription abuse the requirements to be accepted into methadone clinics have changed in areas such as New York State. Requirements for individuals to be accepted into a methadone clinic include abusing opiates for a minimum of one year and using 135 mg of Oxycodone, 90 mg of oxymorphone, 6 bags of 25% pure heroin and 200 mg of hydrocodone.

An important part of treatment for addiction is counseling. Methadone clinics are only for recovering addicts from opioids. Clinics require attendance at counseling groups as well as individual counseling contacts. It is generally accepted that the more intensive the counseling contacts the individual is willing to submit to, the higher the success rate of the program.

Methadone clinics operate as any other addiction medical facility. The staff usually consist of a physician to monitor the medications and treatments and nurses to administer the medication and ensure effective delivery (i.e. the person will actually consume the product). Additionally, drug counselors will be available for individual and group counseling, and there will be administrative staff to run the administrative functions. The clinical operations of the clinic are often housed in a hospital setting, although this is not required by U.S. law.

Effectiveness

While methadone clinics are generally considered to be effective treatment options for patients addicted to opioids, especially when other interventions have failed, there is controversy surrounding the placement of methadone clinics. There is a perception that the presence of the clinics attracts crime to surrounding areas.^[1] However, one study by the University of Maryland School of Medicine found that is not the case, crime rates do not increase when a methadone clinic is opened.^[1] This finding is contradicted by several studies, including a 2004 GAO study that found "“Although these clinics are intended to help those in need of rehabilitation, patients who seek treatment must navigate their way to and from the clinics in an environment in which illegal sales of narcotics are daily occurrences. The efforts of patients who are seeking rehabilitation, and clinic professionals who serve them, are significantly undermined by this criminal activity that surrounds them." ^[2]

Relapse rates are high in patients who discontinue methadone maintenance, between 70-90%^[3] The high relapse rate may be partially due to the severity of cases seen at methadone clinics, as well as the long-term effects of opioid use. Some patients will be on methadone for the rest of their lives, which generates criticism regarding the effectiveness of the clinics. Supporters argue that the clinics aim not just to eliminate narcotic addictions, but also to help people function in their lives.^[3]

Methadone clinics may decrease the use of emergency rooms by patients addicted to opioids^[4] According to a 2009 Cochrane review, methadone maintenance treatments decreased the likelihood that heroin dependent patients would use heroin, but did not change crime or mortality rates.^[5]

References