Buprenorphine-naloxone is a highly effective outpatient treatment for opioid addiction, yet few physicians offer it. Researchers in Washington State examine barriers to prescribing buprenorphine among physicians who have been trained in its use, and they find that a lack of mental health and psychosocial support, time constraints, and a lack of specialty, institutional and partner support were commonly cited barriers. Of the 78 physicians interviewed, only 22 (28 percent) reported prescribing buprenorphine, though almost all reported positive attitudes toward the treatment. (Source: Health News from Medical News Today)
Barriers to primary care physicians prescribing of buprenorphine for opioid addiction
Buprenorphine-naloxone is a highly effective outpatient treatment for opioid addiction, yet few physicians offer it. Researchers in Washington State examine barriers to prescribing buprenorphine among physicians who have been trained in its use, and they find that a lack of mental health and psychosocial support, time constraints, and a lack of specialty, institutional and partner support were commonly cited barriers. Of the 78 physicians interviewed, only 22 (28 percent) reported prescribing buprenorphine, though almost all reported positive attitudes toward the treatment. (Source: Health News from Medical News Today)
Abuse and diversion of buprenorphine sublingual tablets and film
Abstract: Buprenorphine abuse is common worldwide. Rates of abuse and diversion of three sublingual buprenorphine formulations (single ingredient tablets; naloxone combination tablets and film) were compared. Data were obtained from the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS®) System Poison Center, Drug Diversion, Opioid Treatment (OTP), Survey of Key Informants’ Patients (SKIP), and College Survey Programs through December 2012. To control for drug availability, event ratios (rates) were calculated quarterly, based on the number of patients filling prescriptions for each formulation (“unique recipients of a dispensed drug,” URDD) and averaged and compared using negative binomial regression. Abuse rates in the OTP, SKIP, and College Survey Programs wer…
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Letter to the Editor
I was very encouraged by the stark reality so clearly delineated by Ms. Coggins (Letter to the Editor, January 2014) concerning the inability of nurse practitioners (NPs) to prescribe the drugs (Suboxone and Zubsolv) now available for opioid dependence. There is an epidemic of opioid deaths, particularly within the New York City area. My particular county of Richmond has the highest rate of opioid deaths. Different legislative laws now require checking a Web site to determine which patient may be seeking additional narcotic medication or doctor shopping. New York has taken firm steps to deal with the high death and addiction rate. (Source: The Journal for Nurse Practitioners)
Barriers to primary care physicians prescribing buprenorphine.
CONCLUSION Interventions before and after training are needed to increase the number of physicians who offer buprenorphine for treatment of addiction. Targeting physicians in clinics that agree in advance to institute services, coupled with technical assistance after they have completed their training, their clinical teams, and their administrations is likely to help more physicians become active providers of this highly effective outpatient treatment.
PMID: 24615308 [PubMed – in process] (Source: Annals of Family Medicine)
Barriers to primary care physicians prescribing buprenorphine.
CONCLUSION Interventions before and after training are needed to increase the number of physicians who offer buprenorphine for treatment of addiction. Targeting physicians in clinics that agree in advance to institute services, coupled with technical assistance after they have completed their training, their clinical teams, and their administrations is likely to help more physicians become active providers of this highly effective outpatient treatment.
PMID: 24615308 [PubMed – in process] (Source: Annals of Family Medicine)
Letter to the Editor
I was very encouraged by the stark reality so clearly delineated by Ms. Coggins (Letter to the Editor, January 2014) concerning the inability of nurse practitioners (NPs) to prescribe the drugs (Suboxone and Zubsolv) now available for opioid dependence. There is an epidemic of opioid deaths, particularly within the New York City area. My particular county of Richmond has the highest rate of opioid deaths. Different legislative laws now require checking a Web site to determine which patient may be seeking additional narcotic medication or doctor shopping. New York has taken firm steps to deal with the high death and addiction rate. (Source: The Journal for Nurse Practitioners)
Methadone Clinic Locator
There are many licensed methadone clinics throughout the US that provide methadone treatment for opiate addiction.
Data gathered by the National Institute of Drug Abuse show as many as 105 people die every day from drug overdoses. With the widespread abuse of heroin and prescription medications, more than a few of these deaths result from opiate overdose.
Making the decision to get help for an opiate addiction represents a new beginning in a person’s life. Methadone, a well-proven treatment for opiate addictions, has helped many recovering addicts maintain drug-free lifestyles for the long-term.
As methadone treatment for opiate addiction falls under heavy federal regulations, this drug can only be accessed through authorized methadone clinics. Locating a methadone clinic is fairly easy online, however it’s important to know what to look for in a methadone clinic program.
As with any search engine, methadone clinic locators allow you to narrow down a search to meet certain criteria. Since addiction affects different people in different ways, identifying a person’s treatment needs and understanding how methadone is used can go a long way towards selecting the right methadone clinic.
Regulation Requirements for Methadone Clinics
The Substance Abuse & Mental Health Services Administration or SAMHSA oversees all methadone programs throughout the United States. The regulation requirements put in place by SAMHSA work to ensure authorized methadone clinics provide a safe treatment environment. This safety requirement also dictates how any one clinic approaches addiction treatment.
SAMHSA defines addiction as a medical condition or disease that affects different people in different ways. From this standpoint, methadone clinics are expected to employ an individualized treatment approach that considers each person’s condition and circumstances when developing his or her treatment plan. These provisions help ensure recovering addicts receive the type of care that will best meet their individual treatment needs.
Medication-Assisted Treatment Approach
According to the Substance Abuse & Mental Health Services Administration, methadone is a synthetic opiate drug designed to duplicate the effects of addictive opiate drugs without producing the characteristic “high” that drives addictive behaviors. As one of a few medication-assisted treatment approaches, methadone works as a type of medication therapy that helps recovering addicts gain control over ongoing drug cravings and withdrawal effects.
Though synthetic, methadone stills falls within the narcotics class of drugs and so requires strict monitoring and regulation through government agencies. Consequently, methadone clinics must meet certain federal requirements in order to dispense the drug. In turn, any clinics listed in a methadone clinic locator search must have the necessary certifications to treat opiate addictions.
Based on the protocols and guidelines put in place by regulatory agencies, methadone clinics combine medication-assisted treatment with behavioral therapies in order to provide a whole-patient drug treatment approach.
Methadone Maintenance Therapy Process
Methadone clinics employ a specialized type of opiate addiction treatment known as methadone maintenance therapy. Methadone’s therapeutic effects work in much the same way as insulin treatments do for diabetic conditions. It does this by supporting brain and body chemical processes so a person can function normally in everyday life.
When first starting methadone treatment, doctors must determine what dosage amount will best reduce withdrawal effects and drug cravings without producing overly sedating effects. Once a stable dosage level is reached, patients check in on a regularly scheduled basis to ensure they’re not experiencing overwhelming withdrawal effects or drug cravings. Dosage amounts can be adjusted accordingly.
Once a person reaches the point where methadone treatment is no longer needed, dosage amounts are gradually tapered off. Since methadone functions in the same way as other opiate drugs, tapering schedules should run for a minimum of 12 months to ensure a person doesn’t run the risk of relapse once treatment ends.
Methadone Treatment Benefits
While methadone clinics do follow certain procedural guidelines, clinics may also offer additional services as part of an overall treatment approach. Methadone’s ability to reduce withdrawal and cravings enable recovering addicts to take steps towards re-building normal lives while in treatment, according to the Centers for Disease Control & Prevention.
Someone looking for vocational training and development may want to look for clinics that offer vocational assistance as part of the methadone treatment program. Recovering addicts with family obligations may have some work to do in terms of repairing family ties and restoring normal family function. Some methadone clinics offer a range of family services designed to help addicts regain connection within their family units.
As many people in treatment have come out of the criminal justice system, their rehabilitation needs can be quite different from someone who doesn’t have a criminal history. Some methadone clinics offer specialized services to help ex-cons regain their footing in everyday society. Whatever a person’s circumstances, the more specific your search for methadone clinics the more closely aligned the listings will be to your particular treatment needs.
Co-Occurring Disorders
Opiate’s damaging effects on normal brain functions gradually deteriorates normal brain functions over time. Co-occurring psychological disorders, such as depression, anxiety and bipolar conditions can develop as a result of long-term opiate abuse. These conditions can also trigger drug use behaviors as some people turn to drugs as a way to relieve feelings of anxiety and depressions.
For people who battle a psychological disorder on top of an opiate addiction, it’s essential that both conditions be treated at the same time in order for any one treatment to do any good. Even in cases where a person only suspects another condition may be at work, finding methadone clinics that offer treatment for co-occurring disorders is essential to ensuring a person reaps the full benefits of methadone treatment.
Affordability
While the strict government regulations surrounding methadone clinic programs can make methadone treatment less accessible than other forms of treatment, government involvement does help keep program costs down. Most methadone clinics receive some form of federal and/or state funding, which enables programs to offer treatment services at affordable rates.
According to the National Survey of Substance Abuse Treatment Services, at least half of the people admitted to methadone programs paid out-of-pocket costs of $13 to $25 a day. With most forms of health insurance offering benefits for substance abuse services, this can further help defray program costs. For people who must pay out-of-pocket, many methadone clinic programs offer a sliding fee payment scale based on a person’s earnings level.
Knowing how you’re going to pay for treatment costs provides yet another way of narrowing down your search when using a methadone clinic locator.
Methadone Maintenance Treatment
Methadone is an opiate addiction treatment that helps individuals avoid relapse by reducing drug cravings.
First administered in the early 19070s, methadone maintenance treatment has a solid track record as an effective treatment for opiate addiction. According to the National Library of Medicine, methadone maintenance treatment – a nationwide, publicly funded addiction treatment program – was the very first opiate addiction treatment approach ever developed.
Opiate effects in the brain and body warrant unique medication-based approaches for managing withdrawal symptoms. Methadone maintenance treatment works as a medication replacement therapy designed to help recovering opiate addicts manage the persistent withdrawal effects and drug cravings that occur when a person stops using. Since the 1970s, other medication treatment approaches do exist, though methadone remains the standard against which most all new treatments are measured.
Methadone, as a medication therapy, can be used as both a detox treatment and long-term maintenance solution. As a maintenance treatment approach, methadone enables recovering addicts to resume normal everyday life while engaged in the drug treatment process.
As methadone maintenance treatment only address the physical aspects of opiate addiction, ongoing psychosocial treatment combined with methadone is necessary to ensure long-term abstinence and a successful recovery.
Medication Replacement Therapy
Medication replacement therapies in addiction treatment attempt to replace the effects of an addictive drug with those of a therapeutic agent. According to the National Institute of Justice, methadone – a long-acting synthetic opiate – works as a replacement therapy for the addictive effects of opiates.
As a synthetic opiate, methadone can mimic the effects of addictive opiates without posing a high risk for addiction. Since methadone occupies the same cell receptors as an opiate drug, it can greatly reduce the severity of withdrawal effects while at the same time curbing any existing drug cravings a person may have.
Administered under strict federal regulations, methadone maintenance treatment programs must be registered with the U.S. Drug Enforcement Agency and certified by the Substance Abuse & Mental Health Services Administration. Methadone’s status as a synthetic opiate places it in the Schedule II narcotic drug category, which accounts for why these programs are so heavily monitored.
Opiate Effects in the Brain
Opiates, such as heroin, Demerol and Oxycontin, all have the same slowing effects on the body’s central nervous system. These effects originate at specific brain cell receptor sites. When activated, these sites secrete dopamine, a vital neurotransmitter chemical responsible for regulating pain and pleasure sensations throughout the body.
Opiates not only activate these receptor sites, but cause massive amounts of dopamine to be secreted. Over time, the brain stops secreting dopamine on its own as opiate effects gradually take over the job of regulating central nervous system functions. At this point, the brain and body require opiate effects in order to carry out normal bodily functions.
When a person starts taking methadone, the drug’s opiate-like effects pick up where addictive opiate drugs leave off. In this way, central nervous system functions can operate normally as the body adjusts to the absence of addictive opiates in the system.
Drug Cravings & Withdrawal Effects
For people with a long history of opiate abuse, drug cravings and withdrawal effects are the two biggest barriers that prevent a person from stopping drug use. These barriers also continue to be a problem for people who’ve been in recovery for years, oftentimes driving recovering addicts to relapse.
Methadone’s ability to address these problems accounts for why methadone maintenance treatment is an effective opiate addiction solution, according to the Centers for Disease Control & Prevention. Without some form of medication replacement therapy, the brain continues to crave opiate effects. At the same time, the lack of opiates sets off a range of withdrawal symptoms that can make life unbearable without some form of necessary treatment.
Ultimately, methadone maintenance treatment makes recovery possible for many addicts who otherwise wouldn’t be able to stop using.
Dosing Procedures
Methadone comes in disk-shaped tablets that dissolve in liquid. Unlike the multiple “hits” an addict has to take throughout the day to function, methadone’s long-acting effects only require a single daily dosage amount. The therapeutic effects from one dose can last anywhere from 24 to 36 hours.
For detox purpose, initial doses of 20 to 30 milligrams work to keep uncomfortable withdrawal symptoms, such as chills, nausea and irritability at bay. Methadone maintenance treatment doses work to prevent withdrawal effects and reduce drug cravings. These doses run anywhere from 80 to 120 milligrams.
Dosage amounts are based on the severity of a person’s addiction, medical status and his or her age. Since methadone occupies the same cell receptor sites as opiates, it can also block the effects of other opiates in the event a person tries to get “high” on other drugs.
Taper Period
Some people may only need to be on methadone maintenance treatment for a short period while other may require treatment for several years. Since the overall purpose for treatment is to enable recovering addicts to live drug-free lives, at some point a person will want to stop taking methadone.
As methadone produces opiate-like effects, a person cannot just stop taking the medication without experiencing intense withdrawal effects. Doing so places him or her at dangerous risk of relapsing back into old drug-using behaviors. For this reason, methadone maintenance treatment includes a tapering period where dosage amounts are gradually decreased over a period of time.
According to Canada’s Center for Addiction & Mental Health, tapering periods run a minimum of 12 months in length, however some people may require several years of tapering to avoid experiencing distressing withdrawal effects.
Considerations
Methadone maintenance treatment meets a vital need in terms of treating the body’s physical dependency on opiates. While breaking the physical dependency is a mandatory first step, treating a person’s psychological dependency on opiates enables him or her to remain drug-free on a long-term basis.
An effective methadone maintenance treatment program will also provide psychosocial treatment services that help recovering addicts work through the psychological aspects of addiction. Psychosocial treatments include psychotherapy, group therapy, 12-Step support groups and drug education courses.
For people dealing with chronic opiate addictions, the need for psychosocial treatment may very well last considerably longer than the need for methadone maintenance treatment. Otherwise, overlooking a person’s psychosocial treatment needs places him or her at dangerous risk of relapse, overdose and an ever-worsening state of addiction.
Methadone Side Effects
Methadone is a medication maintenance therapy that is used to treat opiate addiction.
Methadone, a well-known treatment for heroin and prescription pain pill addictions, offers a wide range benefits to people who need help overcoming opiate addiction. While research within the addiction field has come a long way towards developing effective drug treatment approaches, methadone side effects still make it difficult for some people to remain in treatment.
As a medication therapy, the effects of methadone target certain chemical processes brain, much like addictive opiate drugs do. This similarity with other opiate drugs gives rise to many of the same problems that cause addiction. Methadone also has long-acting effects that further increase the risk of experiencing methadone side effects.
People with long histories of opiate addiction, more oftentimes than not, develop other medical and psychological conditions that may alter the effects of methadone. When this happens, methadone side effects can actually increase in intensity.
Ultimately, keeping people engaged in the treatment process becomes all the more imperative considering the risks they face when quitting or leaving methadone treatment. As the overall effects of methadone can both help and hinder a person’s recovery process, each person must decide whether the good outweighs the bad or vice versa.
Methadone Treatment
Opiate drugs as a whole carry strong analgesic properties that easily slow the body’s central nervous system processes. According to the National Highway Safety Administration, methadone is also an opiate drug, though synthetically made. In effect, methadone produces many of the same effects as other opiate drugs, though its addiction potential remains considerably lower than other opiates.
Methadone’s ability to mimic the effects of other opiates without being addictive makes for a highly effective opiate addiction treatment approach. The effects of methadone combined with ongoing behavioral therapy treatments provide recovering addicts with the tools they need to live a drug-free life.
Compared to other addictive opiate drugs, methadone produces a slow-acting effect that only requires a daily dose as opposed to the multiple “fixes” addicts typically ingest throughout the day. This slow-acting mechanism can produce methadone side effects for some people. Side effects may take the form of –
- Lightheadedness
- Drowsiness
- Dizziness
- Stupor-state
- Slow reflexes
These types of methadone side effects may develop when dosage levels are set too high. Daily dosage level amounts ultimately determine how effective methadone treatment will be for any one person. Too high a dosage will produce unwanted sedating effects that can potentially impair a person’s ability to carry out daily living activities. Too low a dosage leaves a person at risk of experiencing drug cravings and withdrawal effects.
Tolerance, Dependence and Withdrawal Effects
As any opiate addict well knows, the body tends to crave larger “fixes” the longer a person continues to use. Even though it’s synthetically made, methadone still retains many of the same properties of opiate drugs. This means, people who remain in treatment for long periods of time will likely develop a tolerance to the effects of methadone. This process runs counter to the drug’s intended therapeutic effects, making increasing tolerance levels another methadone side effect.
As tolerance levels increase, the body, in turn, becomes more and more dependent on methadone’s effects. For this reason, dosage level amounts may require adjustment from time to time for the duration of the methadone treatment process. This methadone side effect, in particular can create additional problems, especially in cases where a person has a long history of opiate abuse.
Unless the necessary dosage adjustments are made, a person will likely experience the withdrawal effects of methadone. Methadone withdrawal effects may include –
- Nausea
- Diarrhea
- Muscle aches
- Irritability
- Chills
With withdrawal effects and drug cravings being the two main challenges recovering addicts face, this methadone side effect can quickly place a person at high risk of relapse.
Drug Interactions
The therapeutic effects of methadone rely on the rate at which the body metabolizes the drug. Anything capable of altering a person’s metabolism rates can potentially offset the intended effects of methadone. People who take medications for medical conditions or psychological disorders may experience methadone drug interactions.
Methadone side effects, such as slowed reflexes, dizziness and lightheadedness can develop in cases where a person is taking another type of central nervous system depressant. Likewise, methadone side effects can take the form of withdrawal symptoms in cases where a person takes medications that stimulate the body’s central nervous system.
Drugs likely to induce methadone side effects include –
CNS Depressants
- Tranquilizers
- Tricylic antidepressants
- Alcohol
- Hypnotics
CNS Stimulants
- Pentazocine
- Buprenorphine
- Butorphanol
- Nalbuphine
Toxicity
Compared to other opiate drugs, methadone has a longer half-life in terms of how long the drug stays in the body. According to the National Library of Medicine, methadone’s half-life duration contributes to its slow acting therapeutic effects.
Unfortunately, methadone’s half-life of eight to 59 hours runs considerably longer than its therapeutic effects, which only run from four to eight hours. This imbalance in the drug’s effects can cause considerable problems for someone just starting out on methadone treatments. In this case, toxic levels of methadone can build up in a person’s system before he or she experiences the drug’s therapeutic benefits.
As a methadone side effect, the risk of toxicity is especially high at the start of methadone treatment and in many cases can lead to death. For this reason, prescribing physicians must keep a close watch on the effects of methadone to prevent toxic levels from developing.
Overdose Risks
The risk of overdosing while receiving methadone treatment is no doubt the worst of all methadone side effects. During the treatment process, the long acting effects of methadone place patients at risk of overdose each time a dosage adjustment is made. In general, a change in dosage amounts can take anywhere from three to five days before any therapeutic effects become apparent. Dosage increases made before the three-day mark can potentially place patients at risk of overdose.
As with other opiate drugs, the risk of overdose increases when combining methadone with other central nervous system depressant drugs. Consequently, people who attempt to use other opiates while taking methadone place themselves at considerable risk of overdose.
Methadone side effects, in general, can create real problems for people in treatment and eventually cause a person to discontinue treatment altogether. Likewise, the effects of methadone can be deadly in cases where a person attempts to abuse the drug or unknowingly takes medications that alter methadone’s intended effects.