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What to expect when starting Methadone Maintenance Treatment (MMT)

Discussion in 'Opiate addiction' started by Electrolingus, Jun 2, 2009.

  1. Electrolingus

    Electrolingus Platinum Member & Advisor

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    Starting Methadone Maintenance Treatment
    --- This information deals with U.S. MMT. ---

    Depending on where you live, you may have a choice of methadone providers, or you may live in an area where methadone treatment is not available. If you have not already made contact with a doctor or clinic that treats opioid addiction, find out whether treatment is available nearby.
    • Talk with your family doctor. Generally, your doctor is not authorized to prescribe methadone for addiction treatment or withdrawal management purposes. Ask to be referred to an authorized doctor or a methadone clinic, or ask whether other treatment options such as buprenorphine are available.
    • Contact a referral service. To find the treatment provider closest to you, search online for a treatment facility or contact your local hospitals social work department.
    • Or visit the Drugs Forum Rehab Index. http://www.drugs-forum.com/forum/forumdisplay.php?f=196
    Assessment

    Assessment includes determining your history with drug use as well as a physical examination by a doctor. You should be asked about medical problems that are commonly associated with opioid addictions, and you may be asked to consent to a blood test to check for HIV, Hepatitis, and other infectious or sexually transmitted diseases.

    Expect questions. You may be asked about your drug use, your physical and mental health, your home and family, and your employment.​

    Ask questions. What are you being tested for? What other services are available? Remember, knowledge is power.

    You may be assessed again during treatment to review your progress.​

    Dosing

    For safety, your first dose of methadone will be low or moderate. New patients usually start at a dose not to exceed 30 to 40 mgs. A larger dose of 60 to 120 mgs a day may be required for long-term maintenance. You and your physician should determine what dose works best for you.

    Your dose is right when withdrawal symptoms, drug cravings, and side effects fade. With a correct dose, you should feel more energetic, clearheaded, and able to do the things that matter in your life. Until you have adjusted, make sure not to drive a car or operate heavy machinery.

    You should discuss a dose adjustment with your doctor if you still are experiencing drug cravings. The majority of properly dosed patients have no physical desire to use other opioids.

    Drug Testing

    Routine tests of urine or oral fluids will show whether you have been using other illicit or inappropriate drugs and whether you have been taking your methadone. You may have to give supervised samples to ensure they are yours. With continual negative results, you’ll be asked to take drug tests less often.

    If you test positive for other drugs, it may hold up your schedule for taking home doses, and your provider may ask that you take drug tests more often.

    Some providers expect zero drug use while others are more tolerant. If you test positive for a drug when you know you haven’t used, you can request to be retested.

    Confidentiality

    Drug treatment patients are protected by special Federal confidentiality regulations. No one will be told you are in treatment or what you talk about in treatment, except for certain situations:
    • Information about a client often is shared within a treatment team in the clinic.
    • You may consent in writing that your information be shared under certain specified conditions—for example, to forward your records to another doctor or clinic.
    • If your doctor or counselor has reason to think you might hurt yourself or others, he or she must inform others.
    • If you are facing trial, the court may subpoena your treatment records.
    • If you test positive for HIV and other communicable diseases, these facts will be shared with public health officials. In certain States, your intimate partners at risk for these diseases may be told that they have been exposed.
    Take Home Doses

    At the start of treatment, you will have to go to the clinic daily to take your dose under observation. This daily contact confirms to the staff that you are taking the dose ordered by the physician. It also helps the staff to see if your dose is enough or too much and whether you are experiencing side effects, in which case an adjustment may be necessary. After a few months, your provider may allow you 'take home' doses for unsupervised use. Ask to find out when and under what conditions you will be given take home doses.

    It is likely that you will be asked to sign an agreement claiming responsibility for using and storing the doses safely. Your provider may take away your take-home privileges if you do not comply with the agreement or if your drug tests are positive for drug use.

    Safety and Storage

    Your maintenance dose of methadone could seriously harm or kill someone who has no tolerance for the drug. Take precautions:
    • Never transfer your medication to a container that might make it easier to mistake what’s inside.
    • Keep your doses in a locked box, such as one sold for fishing tackle or cash. (many times this is required by ones program)
    Hospital Stays

    If you are admitted to the hospital, let the staff there know that you are a methadone patient. This is vital so that you can receive your dose and because other drugs can be dangerous if combined with methadone. Urge the hospital staff to talk with your MMT doctor about your medication and care. If you are scheduled for surgery, make sure you inform the anesthesiologist of your current methadone dose and dosing history.

    Dealing With Side Effects

    Methadone maintenance carries some side effects:
    • Constipation. Eat foods that are high in fiber and drink plenty of water. You also should avoid foods that are high in fat; they are harder to digest and tend to make your system sluggish.
    • Excessive sweating. Adjusting the dose may stop the sweating, and there are other medications available to help control this.
    • Changes in sex drive. Some people on methadone have little sex drive and/or are unable to have an orgasm. Talk with your doctor about possible treatments that will improve this side effect.
    Methadone and Employment

    Once you’re on a stable dose of methadone, it shouldn't affect the work you do or how well you do your job. For most jobs, there’s no need to mention that you take methadone. Your employer has no right to know.

    HIV, Hepatitis, and Methadone

    Methadone can be a great benefit if you are HIV/AIDS or Hepatitis B (HBV) or C (HCV) positive. However, prescription drugs for your HIV/AIDS or HBV/HCV may interfere with methadone, and your dose may need to be adjusted. Talk with the program doctor about other drugs you have been prescribed. (see Combinations With Methadone That Can Result in Withdrawal Syndrome.)

    Patient Rights and Responsibilities

    If you are unhappy with your treatment; for example, you feel your dose has not been adjusted correctly, talk it over with your doctor or counselor. If a treatment problem hasn’t been fixed to your satisfaction by talking with your doctor or counselor, you may consider changing your provider.

    You also can anonymously report problems with your treatment provider to his/her accrediting agency.

    As a patient in treatment, you are protected by a set of Medication-Assisted Treatment Patient Rights and Responsibilities.

    Methadone and Pain Relief

    Methadone can provide effective pain relief. Yet, once you are on a stable dose of methadone, you may be tolerant to its pain-relieving effects and may require additional pain medication. Some MMT patients need more pain medication than patients who are not a part of MMT.

    Mixing Methadone With Other Drugs Can Be Dangerous

    Methadone interacts with many medications. This can change the safety of the methadone you are taking and can potentially cause withdrawal or possible overdose. It is important to tell your doctor about all of the drugs you take. Combining methadone with benzodiazepines should never be done unless under the care of a physician who knows that you are taking methadone.

    Combinations With Methadone That Can Result in Withdrawal Syndrome:

    Opiate antagonists such as:
    • Naloxone
    • Naltrexone
    Partial agonists such as:
    • Buprenorphine (Subutex, Suboxone)
    • Butorphanol (Stadol)
    • Nalbuphine (Nubain)
    • Pentazocine (Talwin)
    Anti-Retroviral Agents that may decrease plasma levels of Methadone:
    • Abacavir
    • Amprenavir
    • Efavirenz
    • Nelfinavir
    • Nevirapine
    • Ritonavir
    • Lopinavir + Ritonavir combination
    How Long Will I Be on Methadone?

    The longer you’ve been dependent on opioids, the more likely it is that you may benefit from being on methadone. Those who withdraw from methadone after short-term treatment may be more likely to return to drug use than those who stay in treatment until they have obtained the optimal benefits.

    Recovery to a normal life is possible. You should stay in treatment as long as you are benefiting from it. The length of time you stay in MMT is an issue that should be decided solely by you and your physician. Some people are in MMT only for a few weeks, while others choose to stay in MMT indefinitely.

    Ending Treatment

    If you are thinking about ending MMT, talk with the doctor at the program. It can be a slow process to taper off of methadone. Though doses are tapered slowly to reduce withdrawal symptoms, you may experience some aching, insomnia, and lack of appetite for a few weeks. You also may feel a sense of loss, sadness, and sleeplessness for months. However, over time this should dissipate.

    Long-term withdrawal can take from 6 months up to a year before you can completely taper off of methadone treatment. You should never set time limitations on yourself—taper off at your own pace in cooperation with your treatment provider.

    Throughout treatment and after treatment ends, be sure to maintain and extend your support network. You can request to come back to the program every few weeks for the first year and expect to have the same privileges that you did before tapering off. Should you feel that you may relapse, return to your program immediately for re-dosing. You always can return to treatment. Returning to treatment is not a failure—it’s a choice about what is best for you.
     
    Last edited: Oct 6, 2009
  2. Dickon

    Dickon

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    Re: What to expect when starting Methadone MT

    Thank you Electro for this detailed and well-presented information. If getting onto a methadone programme is significantly different in the country you live is different from this, I would be grateful if you could provide details. It would add to this valuable resource.

    Many thanks

    Dickon
     
  3. dyingtomorrow

    dyingtomorrow R.I.P.

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    Re: What to expect when starting Methadone MT

    Thanks electrolingus for the information.

    SWIM will add his own personal experience which will hopefully be helpful to some people considering methadone. SWIM was 25 years old at the time (need to be at least 18 to get on it), living in the U.S. in Chicago, and addicted to heroin for about a year:

    He walked into the methadone clinic in moderate withdrawals and told them he wished to get on Methadone Maintenance Treatment (MMT). He had to sit there for about 5-10 minutes before they were ready to start the process.

    The first thing they did was have him fill out some standard paperwork with his info, and concerning his rights and the like. After that they had him urinate in a cup, which they tested to make sure he was actually on heroin (or some kind of opiate). They brought him to the nurse from there, who took some of his vitals, and gave him a couple quick tests for common IV heroin diseases. After that he had to wait again to see the resident doctor.

    The doctor asked him how much he was using, and informed him that they could only start him on 30mg max by law, and that they could go up 5mgs daily. He then went to the payment center, and paid the $55 cash that the clinic cost per week. From there he went to the dosing station with his paperwork, and was given the 30mgs of methadone. They had him wait there for about 20 minutes to make sure he wasn't going to overdose. After that they signed him up for a meeting later in the week with the (beautiful :) ) woman assigned to be his counselor. All and all it was about 30 - 40 minutes between when he first walked in there and when the gave him the dose of methadone, so if you have a bit of cash (but not enough to last you a week of heroin), and are really sick with no hope, it is something to consider.

    After that, each day he went up 5mgs and saw the doctor daily until he was comfortable. Also, the way the clinic worked was that you had to come there every day between 5am and 1pm, or between 4pm and 7pm, Monday through Saturday; although this differs by clinic. On Saturday you received a takehome bottle for Sunday, because the clinic was closed then. When he signed up they also gave him a lock box for his takehome bottles. Another important point was that the takehome bottles all had a sticker on them, which allowed you to carry the methadone by law. Without the sticker you could get arrested for it on the spot, although I believe once they verified that you were signed up at the clinic they would release you.

    As far as tapering, they didn't even want to consider it until you had been there at least 6 months. Then they would start taking you down 1mg a week. You could only get 2 medical overrides to force them to take you down, so you could not force the process to go the way you wanted. At least that is what they told SWIM was the rules. This may not legally be the case, but be aware that methadone is typically considered, in methadone clinics, to be a long term type of thing. You aren't going to be getting off of it in a month or two.

    Finally, concerning the take homes, after about a month of being there, provided you did not fail the monthly drug test and came every day (or had a valid excuse for days you missed), you could apply to start recieving more takehomes, meaning you would only have to come in 4 days a week instead. As time passed and you consistently followed the rules, you could eventually work yourself up to recieving a takehome of all your methadone once a month, although this took at least a year to acheive I believe.

    One other thing: at one point SWIM needed to take a week long trip to Las Vegas. The methadone clinic was able to arrange for him to go to a clinic out there. SWIM believes this is something all clinics can do (he's not sure though), which is of course very convienent.

    That was SWIM's experience at the methadone clinic and all the information he knows concerning its operation. SWIM is sure they differ slightly in some aspects, but it should be a good outline for people new to the process. SWIM has also been on bupe/suboxone, and notices there is a kind of "war" between the two about which is better. Just like most things, everyone is different, and what works for one person might not work for another, so don't soak up the prejudices you may hear about one or the other prior to trying them.


    Hope it helps and take care everyone!


    P.S. SWIM went to a needle exchange program (check the recent thread), and they offered to get him on MMT for FREE. This might not be the case at all needle exchange programs but it's definitely worth checking out!

    Edit: SWIM forgot to add - some methadone clinics charge a sign up fee. SWIM's little bro tried to go to one in the suburbs, and they wanted like $125 to "join."
     
    Last edited: Jun 2, 2009
  4. Benniboi

    Benniboi

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    Re: What to expect when starting Methadone MT

    Generally, within the UK, methadone MT is done through drug agencies like BAIS who monitor your progress with the help of a keyworker who is assigned to you, and you are required to see in fortnightly periods.
    Generally this aspect of the treatment is non-negotiable. You will not be able to get a dose the day you go in to register for treatment, because unfortunately due to shitty government constraints on buget, there is usually a waiting list of anywhere from 2 weeks to 6 months to begin.

    When they eventually call you in to see the doctor for a consultation you will have to go through the same rigorole as described above with the urine testing, dosing, waiting to make sure an overdose is not going to happen and sending you on your merry way.

    Like SWIDyingtomorrow says, the standard starting dose is between 30 and 40ml and will usually go up between 5 and 10 ml every 3 days at the beginning of treatment until a suitable dosage is achieved, then dose titaration can be done with the keyworker bi-monthly depending on subjective factors i.e using on top etc.

    Again similar to above, with methadone they do not see it as a short taper and for the most part you generally may be in treatment for a minium of 6 months before dosage is reduced, I think you need to be 100% sure that you want this treatment before you go ahead with it because this can be with you for a while and methadone is not an easy monkey to get off your back by any stretch of the imagination!

    Obviously consider the benefits of alternate treatment and discuss with the keyworker: subutex/suboxone replacement treatments/detoxes and even just a clonidine or lofexadine detox if your a brave muvafucka' (and can handle feeling like shit for a week at least) before you make your final decision.

    I know that some private doctors can prescribe physeptone tabs to morphine sulphate extended release preperations for opiate dependence but I believe these are a rare commodity in the good ol' UK, so you will probably have to go with a drugs service as stipulated above, but by all means go to your doctor and give it a whirl, you don't really have anything to lose!

    One last thing; if you're not working the treatment is free, otherwise you will have to pay a prescription charge- like £6 whenever you renew your script.

    If you live anywhere in south London here is a link to the service that you will need to contact if you wish to get into treatment, the sooner you call them the better as like SWI said above, there is usually a waiting list.

    http://www.slam.nhs.uk/services/servicedetail.aspx?dir=1&id=755

    The best of luck for anyone wishing to make this tenuous transition, but if you are serious about recovery it is worth getting help to deal with the problem.

    B.Boi
     
    Last edited: Jun 3, 2009
  5. Spucky

    Spucky Palladium Member

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    AW: What to expect when starting Methadone MT

    Swim add here one more Time the File in English about the German Methadone History, about the Treatment and how it look alike!

    Imo. the Therapy is a little bit different from the US. or GB.?
    a. That Addicted People can get a Substitut inside of a Prison helps a lot.
    b. We can get our Methadone 1. via the Home-Doctor for a 30 Day`s Holiday in 158 States of the World
    or 2. via a local MMT-Center with a Prescription (eg. USA.)
    c. Take Home we will get "normally" not anymore, because the Doc can earn Money only via the allocation of the Substitute!
    Only if the Patient have a Full Time Job there will be a exception!

    The File is a very good one because everybody can get a Insideview how Things works in Germany!
     

    Attached Files:

    Last edited: Jun 13, 2009
  6. missparkles

    missparkles Platinum Member & Advisor

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    Re: What to expect when starting Methadone MT

    When swim eventually realised she had a "problem" swim went to her GP and "fessed" up.
    Surprisingly swims GP was very understanding.
    He asked swim how much she was using, took a urine sample and started swim on 25mls straight away. The chemist that swim went to monitered swim every morning giving the GP written feedback on the back of the script that swim had.
    If swim seemed too high the pharmacist could get in touch with swims GP and swim would have had to go back and explain why swim was using and taking Methadone. Swim didn't use while she was taking Methadone but it did take a long time to find the right dose for swim.
    Again swims doctor would increase swims dose every three day if the pharmacist contacted swims doctor to tell him swim was rattling.
    Swim was fortunate that where she lives the doctor and pharmacist work together to keep swim comfortable.

    Swims doctor(whilst not a pushover by any means) did realise that if swim was getting the correct dose swim was less likely to use on top of it. Swim could also see a drug councellor who would direct swim to other services swim needed, such as specific therapy for swims specific issues. Swim would also be called into the GPs to give a urine sample every so often just to make sure swim wasn't using on the side. If swim had been swim knows her GP would have wanted an explanantion, and swims script could have been stopped.

    The more swims GP trusted swim the less strict he became with swim concerning random urine testing and swim was eventually allowed to pick up her meds every 2-3 days.
    If swim felt vulnerable and told her GP he would then put her back on a daily pick up, which swim was grateful for, as swim couldn't trust herself at times.
    Swim has found that it does vary from town to town, according to the to the services available.

    Swim has realised, in the last few years, that honesty is always the best policy with swims GP, if swim is deceptive or untruthful swim will be found out.
    Even if swim has done something swims GP will not be happy about, by owning up swim still retains the trustful relationship with her GP. If swim doesn't tell her GP when she's having problems swims GP cannot help her, he's not psychic.

    Swim has heard some horror stories concerning other Methadone users and their experiences with the health service provided to users. Swim is pleased her GP listens to swim.
    Don't get the wrong impression, it took swim years of pain and drug use to come to these personal conclusions, swim didn't gain awareness overnight. Swim used to be a very devious, manipulative person, the fear of running out and going into W/D meant swim has lied in the past to anyone who would give her a script for the substances swim needed.
    Just got older and wiser I guess.;)
    Take care all.
    :vibes:
     
    Last edited: Jul 5, 2009
  7. just some chick

    just some chick

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    Re: What to expect when starting Methadone MT

    Swim was very niave when starting MMT. Swim got her dose up to 132 mg because she liked the nod she got from it. She had started at the meth program because she was tired of getting sick but didn't really care much about getting clean, in addition it was somewhat forced on her so she didn't think about the long term effects. At first swim had to go six days a week with random drug tests, but after some time was able to start getting carries (take home bottles) until swim was given enough meth to last for two weeks.

    Swim first got on the clinic over six years ago and found out it wasn't easy to get off of. Swim is now down to 36mg but has had a real rough time getting any lower than that. She has a state funded slot at the clinic so she only pays $10 per week but without health insurance, she doesn't have a GP to help her with the meds needed for detoxing, colonipin patch, sleeping pills, etc. so alas swim has reached a stand still.

    Definite advice for a new comer to the MMT program, don't jack your dose in order to get high, you'll pay for it later on when you try to get off. Swim will admit, however, that now, while on a lower dose, the cravings have been much worse and swim has relapsed so there is a definite fear of getting off the clinic entirely. The one swim goes to is outside of chicago and due to budget cut backs, the staff is minimal so the counseling aspect of treatment has become quite lax.

    Though it is a definite step up from using everyday and going to the spot, the long term withdrawl from methadone were not made very clear to swim so be aware of this. Where heroin withdrawls last only three days or so, the effects of methadone are much longer which makes that transition off much harder.
     
  8. missparkles

    missparkles Platinum Member & Advisor

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    Re: What to expect when starting Methadone MT


    That's an extremely good point.
    Swim wasn't made aware of just how long methadone can hang around in her system either. If she'd have known she would have still gone with the programme but she might have kept to a lower dose than 150mls.
    Swim had only quit from "H" in the past. That's a ferocious detox, but clean and quick.
    But the benefits of methadone outweigh the drawbacks. Being able to get a clean regular supply of opiate, being able to deal with issues as one reduces their dose, made it worth it.
    Hang in there JSC, relapse is part of recovery. Swiy will get there. Sometimes it just takes a few attempts.
    :thumbsup:
     
  9. east_of_eden

    east_of_eden Titanium Member

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    Re: What to expect when starting Methadone MT

    just to point out a difference, when swim first got on methadone maintenance about 7 years ago, they started her on 60mg and she thinks she could have gone higher if she wanted.

    the process swidying tomorrow talked about is exactly how it was for swim.

    getting off of methadone after such a long time is sooo difficult. swim really believes that should be gone over much more thoroughly with the prospective patient before they sign up.

    swim is trying to wean herself off methadone now by taking as little as possible (about 20mg daily) and more heroin until she can get off of the methadone entirely.

    like what was said above, it's a much shorter withdrawal from heroin than it is for methadone.
     
  10. missparkles

    missparkles Platinum Member & Advisor

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    Re: What to expect when starting Methadone MT

    Swim sympathises with swiy east of eden. But going from 20mls of Methadone back to "h" again is just prolonging the agony for swiy.
    Swim knows that fear of stopping, the sheer terror that thought can evoke. Being totally clean for swim was an unfamiliar place to be. It meant dealing with life...on life's terms, not swims. But once she had actually made that decision to quit it was easier. Swim can't explain why, it just was. Swim could have stayed on Methadone for the rest of her life, but she got fed up of giving control of her life to an opiate.
    Swim also knows that is she had substituted "h" for a low dose of Methadone her using would have increased. That's why she went on methadone in the first place.
    But each person finds their own road to recovery, what worked for swim won't necessarily work for swiy. But thanks for telling swim how it is for swiy. If swiy doesn't share swim can't learn.
    Thanks.:thumbsup:
     
  11. Stevepmd

    Stevepmd Newbie

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    Re: What to expect when starting Methadone MT

    SWIM said...

    Hello,
    I was addicted to Oxycontin taking about 2 or 3 a day. I stoped taking them and I got so sick and out of money to buy more so a friend took me to a methadone doctor.

    He started me at 20mg for my first dose and I would have to see him every Tuesday and increased it by 10mg a week. You might feel light headed and a really good feeling and might find your self falling asleep but this will go away with in a few days.

    The best tip I can give you is start off with 20ml a week and see how you feel methadone will make you feel normal but if you can stay at say 30mg and under it will be easier to get off with a slow taper. I'm on 6mg of methadone down from 85mg a week. If you have any other question just send me a PM. Oh one last thing once you are on methadone for a few month you will have no sex drive at all.

    Hope this helps
     
    Last edited by a moderator: Oct 22, 2009
  12. Spucky

    Spucky Palladium Member

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    AW: What to expect when starting Methadone MT

    Methadone is known for a prolonging effect of the qt-interval:

    [FONT=Arial, Helvetica, sans-serif]Methadone linked to prolongation of QT interval[/FONT]
    [FONT=Arial, Helvetica, sans-serif]Research published in the journal ‘Heart’ suggests that heroin-dependent patients on methadone maintenance therapy have a high incidence of QT prolongation, which may explain the increased risk of syncope associated with methadone use.

    A total of 450 patients in the Drug Addiction Service of Copenhagen who were taking methadone or buprenorphine for the management of heroin addiction were included in the study. Each participant was interviewed regarding any experience of syncope, and each had blood samples taken. In addition, a 12-lead ECG was performed to allow estimation of the QT interval.

    The researchers found that methadone was associated with a longer QT interval of 0.140 ms/mg (p = 0.002). A total of 28% of men and 32% of women treated with methadone had prolonged QTc interval; there was however no association of this adverse effect with buprenorphine. The ECG and patient history findings suggested that every 50mg increment in methadone dose was associated with a 1.2 (95% CI 1.1 to 1.4) times higher risk for syncope. Eight participants had a QTc of >0.500 s, and all of these were taking >100 mg methadone per day; the team suggests that ECG recording is done when the methadone dose is above this limit. They also advise that methadone patients be switched to buprenorphine if QT or QTc >0.500 s.

    [Editor’s note: the CHM advises that patients with certain risk factors for QT interval prolongation are monitored carefully whilst taking methadone (see BNF); patients requiring methadone doses of >100mg daily should also be monitored – this is therefore in agreement with these study results].

    source:
    [/FONT]http://www.ukmicentral.nhs.uk/headline/database/printstory.asp?NewsID=6432

    Before swiny start`s a MMT. a EKG (Electro-Kardio-gram) is recommended!
    Bupre. is a alternative!

    Writing because of swinys Heart-problem!
     
  13. kailey_elise

    kailey_elise Gold Member

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    Re: What to expect when starting Methadone MT

    I don't know if a methadone clinic would even take someone if they're only addicted to DXM. Hmm.

    Anyway, I do want to mention that all 4 of the methadone clinics I have encountered while helping various people over the years NEVER dose people the day they go in for the first time. So, if one were to try to take dyingtomorrow's advice, I'd be sure to call first to be certain they will dose you same day! The experiences of my friends has been to be dosed about a week after your intake appointment...and I've seen clinics so busy that the intake appt is 4 months away!

    Some clinics will up your dose 5 - 10mg a day to an arbitrary max (about 120mg) during your induction phase (usually 10-14 days), while some will only increase you 5mg every 3 -5 days (& those policies were in 2 clinics 1 city apart). Most clinics in my area apparently start between 30 - 40mg on day 1, going up from there; I've only heard of one person starting lower than that (20mg), but he had a long history of coming in and out of his particular clinic & a large benzo 'script/habit, so it's assumed that had something to do with it.

    Most methadone clinics are very concerned with concurrent benzodiazipine usage, even if it's a legit prescription, and will monitor that client more closely.

    ~Kailey
     
  14. jloops

    jloops Silver Member

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    Re: What to expect when starting Methadone MT

    More about the US & methadone:

    Knew a cat who was on methadone in the US.

    Had 2 weeks of take-homes within 1.5 years.

    Can get 1 month of take-homes upon request -- with no clearance, no reason, etc. -- at any time.

    Can get 1 month of take-homes everytime if a reason can be given that attending twice monthly is difficult.

    Get diskettes, don't have to deal with a million bottles of liquid.

    Don't test for pot, and don't reduce your take-homes unless you test positive 2 months in a row (for something other than pot). Test 1 time per month.

    Nice people who don't do any of the insane garbage cat hears happens at other clinics work there. (E.g., they don't try to stop you from reducing your dose, or force you to increase it, and whatever fee-tox they do is something like 10 mg. per week or thereabouts, maybe even 5 mg., and no more than 5 mg. per week at the tail end, so it's not completely heartless, and they do not take away your take-homes during that period.)

    In general, they do it as well as they possibly can given the federal rules. (Any better, and it would be as if methadone was legal! Only thing they could do is give you a few months of take-homes after the first few weeks, but the federal rules don't allow it)

    Oh yeah, and they don't force you to do counseling whatsoever, although you can meet with your counselor as often as you like, and you can continue to see your counselor for an indefinite period after ceasing methadone.

    I cannot fathom how people stick with the nasty clinics for so long, and I (and my cat) feel very bad for them. (Then again, they do struggle against those reins and taper down much earlier than people at a nice clinic, I'm sure...)
     
    Last edited by a moderator: Nov 17, 2009
  15. paisleypomegranates

    paisleypomegranates

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    Re: What to expect when starting Methadone MT

    anyone who i considering methadone, jade, from experience, found that it would have been much easier to just kick the habit you already have and get support/counseling rather than substituting for a more gnarly addiction. they usually provide counseling at clinics, but you cant really work through things if you're still getting loaded. they will up your dose if ou ask, & the reality is this, if you don't get on methadone & get right back off, say within a week or 2, you will be ball and chain with it for a lot longer...
     
  16. Spucky

    Spucky Palladium Member

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    AW: What to expect when starting Methadone MT

    The always noisy, busy and hungry multicolored Cat found a good information
    about:
    "How to transfer Take-Home Privileges"!

    This Info. is for the US. but the Cat is sure it will work everywhere else too!

    Question: I live in Nevada, and I've earned methadone take-home privileges at my opioid treatment program.
    I'm thinking about moving to another state. Will I be able to keep my take-home privileges when I transfer to another clinic?
    Also, I'd like to consider office-based methadone medical maintenance as a treatment option.
    Where is it available? - the noisy Cat, Las Vegas, NV.

    Answer: Current federal regulations on methadone take-home doses allow a one-month supply for patients
    who meet the eight criteria for eligibility!


    Edit by the Cat:
    States and individual clinics can choose to implement policies that are stricter than the federal regulations.
    What really matters is the individual program's policy on take-homes, because any program can be stricter about eligibility and take-homes than the state requires.
    "When patients are moving, they usually call programs and discuss financing, policy, procedures, and philosophy,"
    Nicholas Reuter, MPH, senior public health advisor with the Division of Pharmacologic Therapies at the Center for Substance Abuse Treatment (CSAT), told ....
    "Then they make the decision of which program to go to."
    To transfer your take-home privileges, your current program needs to contact the opioid treatment program (OTP) you want to transfer to.
    Your current program should ask about any state or program policies on transferring take-home privileges.
    You will need to sign a confidentiality waiver allowing both programs to discuss your treatment history.

    CSAT recommends sending one years' worth of treatment records to the new program. Mark Parrino,
    president of the American Association for the Treatment of Opioid Dependence (AATOD) agreed,
    suggesting that the current program prepare a one-page overview documenting the patient's stability,
    such as negative toxicology results, lack of arrests, and employment information.

    It's important to minimize the burden on the patient, but at the same time the new OTP is responsible for the patient, Mark Parrino said.
    It's unlikely that you will get your full take-home privileges right away, but also unlikely that you will be denied them.
    You may be asked to visit twice a week during the first month, for example.

    CSAT would be concerned if stable patients were unfairly being denied take-home privileges.
    "I'm pro-patient," CSAT director H. Westley Clark, MD told ....
    "I want to know if there are any complaints about people being kept from having take-homes,
    not because of state law, but because of draconian rigidity in the receiving programs."

    CSAT's Reuter noted that office-based methadone medical maintenance (MMM) exists in only a handful of programs in New York and Baltimore,
    and one in Seattle. "We changed our rules in 2001 to permit patients who are stable in treatment to receive a one-month supply of methadone,"
    he said. "That pretty much meets their needs. That is what has come to be known as medical maintenance, in our view."

    Resource:
    The information source for each state's take-home regulations in the State Opioid Treatment Authority.
    A direct link (listed under the previous name, State Methadone Authority) is available [edited out gov link - Dickon]

    Kindly Regards :thumbsup:
     
    Last edited by a moderator: Mar 8, 2010
  17. just some chick

    just some chick

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    Re: What to expect when starting Methadone MT

    Swim wanted to post on here because she wasn't really given a heads up on the methadone withdrawls when she started. There are pro's and con's to starting MMT. With the right counselor and treatment, it can be beneficial. It does give one the chance to get their life back together but on the flip side swim jacked her dose because no one told her not to, the dangers of withdrawls, the longterm commitment, the trouble getting off the program etc. Swim definitely suggests looking into this before getting on a program. For swim she just didn't want to go through withdrawls but when she started she had no idea it would be almost seven years before she got off the program, by accident none the less, and that she'd end up using just to get through the worst of the methadone withdrawls.

    A good clinic will explain the risks, teach swiy coping skills and really work through the issues that lead to use in the first place. Unfortunately swim did not find such a clinic and instead ended up in a pretty bad place, addicted to methadone with a counselor who wouldn't help her detox and no practical coping skills once she finally got off the program. Although not every clinic is like the one swim went to, there are plenty that are, so be aware of the dangers as well as the benefits.

    Sorry if swim reiiterated anything previously stated, she just wanted to get her two cents in after finally getting off MMT.
     
  18. grassrox

    grassrox Silver Member

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    Re: What to expect when starting Methadone MT

    A pink flamingo dreamed ....

    First I would like to state that I am a methadone addict.

    Now, with that said, I would STRONGLY discourage anyone from beginning MMT (unless you are a IV user who shares needles). If you don't know this already, methadone is the hardest drug to dt from, I know. I've dt'd from heroin, oc's, morphine & xanax. Methadone is by far the hardest dt to endure...it goes on FOREVER. Methadone dt is the only sub. I've never made it through.

    Eventually, you will want to stop. Suboxone isn't much different. Trading one addiction for a stronger one is the stupidest thing anyone can do unless, again, you can't come up w/sterile points.

    All the medical jargon above is a way of justification, sort of. The simple truth is MMT is the worse thing a person can do. If you want to go legal, DT. Don't try to convince yourself that MMT is anything other than trading your addiction up for a more powerful one.

    Tapering your dose doesn't work. DT's still last 45 days or so (I tapered from 120mg to 2.5mg before stopping, gave up on day 20...heroin, morphine, oc's, you're home-free at 20 days!).

    I'm not slamming addicts, I'm one too. But if I had it to do over, methadone would have NEVER entered the equation. I am a fool, if you're not on methadone, don't start.
     
    Last edited by a moderator: Feb 9, 2010
  19. ditto

    ditto Silver Member

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    Re: What to expect when starting Methadone MT

    Just wanted to say, this is not always the case. There are certain methadone dispensing clinics where, even if you are working full time, the treatment, including the prescription to methadone, is free. e.g. Kaliedoscope in Kingston Upon Thames.

    Regards, ditto
     
  20. VANMan

    VANMan Newbie

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    Re: What to expect when starting Methadone MT

    First of all thanks for sharing your knowledege and first hand expereinces all :) SWIM started Methadone 6 months ago. I have to say it has changed SWIM s life in a ve ry psitive way . SWIM was not never IV user , only smoked opiates . But SWIM is h appy now that he is on methadone. If you look at addiction as a desease, then we addicts need medication to cope with our deases, the same as a person with diabetes ta ke asoline , we need to take methadone daily. But the advantages of Methadone for SWIMfirst hand expereinces have been : 1- you get a consistent quality , unlike the heroin or oipuim on the streets that change in quality all the time . 2- you are doing nothing illegal ,so no fear or guilt . 3- Saving money , it is much cheaper
    SWIM has some questions though that will ask later in here from the more expereinced methadone users . GOD Bless