In the Clinic today…(2)

A series presenting real encounters in a Methadone Maintenance Treatment (MMT) program. Hopefully revealing how this common medication-assisted approach to opioid addiction treatment might work for you:

The scenario:

An established client comes in for his annual medical review (each program has a physician medical director who assesses each client on entry to the program, annually and as needed). He’s doing well and is on a stable dose of 140 mg/day of Methadone with take-home privileges (that means that this client doesn’t have to come to clinic daily for methadone dosing. He has earned the privilege of receiving several individually packaged “take home” daily doses, which he self-administers). This client feels well and has no complaints. He has a chronic pain issue and wants to remain on methadone indefinitely or at least for the foreseeable future. He is overweight and smokes tobacco products.

The Issues:

For him, there are no major issues and that is good. He feels satisfied with his progress so far in treatment and his recovery using Methadone. We discussed several considerations for further enhancing his recovery from opioid use disorder (OUD)/addiction, while in medication-assisted therapy (MAT) with methadone (MMT). Some of these issues were:

• Smoking Cessation: Many clients in substance use disorder recovery smoke and traditionally this has been overlooked, as the lesser of two evils. More recently however more emphasis is being put on smoking cessation, even while in therapy for illicit drug use/addiction because of the devastating long term health consequences of tobacco/nicotine addiction.

• Weight management/Diet & Nutrition: Many clients gain weight in therapy as their lifestyles become less disordered. At this time it becomes essential to focus on diet and nutritional issues. This is a frequent complaint and occurrence in MMT and often methadone is blamed. Regardless of the cause, I encourage clients to become more mindful of the issue and to institute a personal plan to address it.

• Community level Recovery support: I recommend to all clients to become engaged in a local, community-level, support group, for people living with/managing chronic illnesses. A good, peer-led, example of this are 12-step programs of recovery, which are based on the AA (Alcoholics Anonymous) model. NA (Narcotics Anonymous), would be the most widely known one specifically focused on opioid use disorder (OUD)/addiction or opioid-dependence. Such programs are usually free and provide opportunites for learning, fellowship, improvements in personal recovery and mentorship, as mentor or mentee.

• Medically supervised withdrawal/detox from Methadone: This is a jargoned way of saying, “getting off the drug”, or “detoxing”; in this case, the treatment drug is methadone. For methadone, as with/when “detoxing” from any opiate, the process should be slow and gradual, in order not to trigger relapses. This is the final stage in/of any medication-assisted opioid addiction treatment-the reversal of the medically maintained opioid-dependence and the return to total abstinence from all opioids. This is a critical process that should not be rushed and should probably not be attempted solo, unaided/unsupervised.

Summary:

By and large, I’m of the opinion that methadone works well for medication-assistance therapy (MAT) of OUD. There are other MAT medications available, such as Buprenorphine, Naltrexone, and several symptom-targeting medications for relieving short term detox/withdrawal symptoms. Any one of these medication-assistance approaches may work well for individuals but it is virtually impossible to determine, with certainty, which medication choice or technique will work best for any individual. A thorough discussion with an experienced and knowledgeable health/medical provider could go a long way towards revealing biological, psychological, social and historical factors which may point to which treatment option might be more favorable. A fact-finding call or visit to a local Opioid Treatment Program is an easy and cost-free way to accomplish. The cost of treatment is reasonable, especially compared to ongoing active illicit drug use and considering that you’ll be receiving treatment medication and professional counseling at the same location.

Bye for now,

(Dr.) Stu