Please, I ask that you take the time each month
to cast your vote to the question we are asking.
It takes very little time to ask of you but your
answers help us in providing better quality of
service to you. - - - If we are aware of the area
problems are developing in,then we can provide
the data to those in authority to look at and see
if they can provide a solution. Please, Vote!!!
1. What is the cost of treatment (both intake and weekly fees)? Is there a sliding fee scale? What forms of payment do you accept? - - - - What would happen if I couldn’t make a payment at some point during treatment?
2. What are the dosing hours?
3. What are the intake requirements ($, identification, lockbox, etc) ? - - - - I’m transferring from a clinic in Illinois; will transfer records excuse me from any of these requirements (ie: physical, labwork, tb test, etc.)? If so, how would you like the transfer records (ie: fax, mail, hand-carry) ? - - - - May I schedule an intake appointment ahead of time or do I have to guest dose first or come in - person to schedule?
4. Are there any dose restrictions? My dose is 136mg, will I be maintained on this dose? If I choose to increase or decrease my dose, how does that work (ie: am I required to see a physician or may I request increases/decreases from the nurse)? If I change my dose, will this affect my take-home status?
5. What form(s) of methadone do you offer? I’m on liquid methadone; is that available? Am I able to watch the nurse prepare my doses (or do you blind dose)? If lockboxes are required, do I need to bring it for each clinic visit or just show that I have one at intake?
6. Are there any state restrictions/limitations on take home status? - I currently attend my clinic every other week; - - will I be able to maintain that status when I transfer? What documentation would I need to provide to maintain this take-home status? Does my dose level influence my take homes at all? Do you have a call-back policy? If so, how does it work? - - - If I go on an extended vacation, can I request extra carry doses?
7. What are the treatment requirements, such as urine specimens (what drugs are tested for and how often are specimens collected), counselor contact (credentials of counselors, how often is it required and for how long), groups (are they offered, are they required)?
8. I have chronic pain and sometimes receive prescriptions for short-acting opiates for pain relief. Will this cause any problems with my treatment/take-home status? What would I have to do to document this (ie: would a prescription suffice or would I have to sign a release of information for the doctor)?
9. Do you have a psychiatrist on staff to treat co-occurring conditions? If not, do you refer to any local psychiatrists or mental health centers? - - - - - Are there psychotropic drugs that may be prescribed that would interfere with my treatment/ take-home status (ie: I’m prescribed benzodiazepines for anxiety; would this be a problem)?
Reference: Peter Monichen @Cap Quality Care 8 December 2005
| A Message From The Director :|
Deborah Shrira, RPH,CMA
I started the website to help all of you with addiction problems, the ones who had never heard of methadone, or of the new medication, buprenorphine, but truly for the "Active Methadone Patients." I thought maybe I could make it easier for them, than it was for me. I truly desired to help each and everyone of you with all my heart and every fiber of my being. I knew what it was like!!! I had grown up with an alcoholic and drug-addicted Father, but then I was just a child and knew noth-ing about Addiction.
I just know everyone in our small town knew He drank. Our friends were unable to spend the night with my sister or I and most of them never invited us to their spend a night parties. We ended up paying the price for his alcoholism. I could never quite understand why we had to pay for our Father's activities. We didn't drink, nor use any form of drugs, nor even slip around and smoke cigarettes.
Parents, I can tell you, children don't understand. I am sure, if you as parents, are using, drinking or smoking pot - - it is hurting your children. It may not be quite as it is in a city, like Atlanta, - where some people have no idea of even who their neighbors are, compared to a small town but I promise you, children learn what they live. It is more widely accepted today, for in a city like Atlanta, I am sure you can find a clique of friends whose parents are alcoholics, addicts and many smoke pot. Some of them shoot up right in front of their children, smoke a joint or come home drunk as a skunk never once giving a thought of what they are doing to their off-spring.
They may follow in their parent's footsteps at an early age. They grow up learning to hate all of it . - - They hated it as a child, and were neglected, and we can not imagine how they must have suffered at the hands of their peers. -They never were allowed to participate in any of the school activities. - If they had smaller siblings, they usually had to take care of them. They never knew from one day to the next what to expect!!! - - Would they come back one day and find one of their parents dead from an overdose, maybe both? Then what would they do? Who would take care of them? -Soon, it becomes too much and even they turn to medications to help them cope.
They become emotionally crippled. - - - I think they feel more shame than guilt. - -They continue to self-medicate as they grow older and usually end up marrying an alcoholic and the cycle starts all over again. -They never learned how to cope with life because they never were taught. Children learn what they live, and I want you to remember what I am saying. - - - It hurts me to set here and type but if I can help just one of you to see the light then it will all be worth it. We do exactly what we were taught from our role models (parents). Did they teach us the correct way to cope? -They taught us when the going got rough to self-medicate as they did.
Yet, - - we get totally blamed when we use medications to cope when it is how we were programmed - - and the only way we possibly can react to circumstances we can't handle, - - yet if we get caught using then we end up spending time in prison for doing all we knew to do. - - -Something is just not right about the scenario.
Children learn what they live. I'm sure a lot of children grew up thinking their life was normal because they looked up to their parents. I am sure most thought every one lived as they did until later when they discovered it wasn't true. --- -Then they grew up envying how others lived and some blamed their parents because of their
childhood. I guess, I can say I blamed mine, but then you really can't because they learned from their parents, and it goes on. You can start where you are now and we are here to help you. I hate injustice! - - I don't believe we have been treated
fairly, some of us have more horrid stories than others but we can get help for ourselves and try and make life better for our children by fighting against what is not right. We are children of alcoholics and drug addicts. - - -Some of us never experienced a childhood. Most of us were neglected and never felt approval. We all share a bond in common. - -We need to bond and form a chain that won't be broken by standing up for each other and fighting for our God-Given rights.
We are unable to accept any long-distance calls collect because we stay busy - you may call when the phone is being used to speak with another patient. We want to give each of you the same quality of time by not interrupting your phone - call. I think it is very rude. We want to give you our undivided attention when we speak with you. - - - This is why we ask you, to send us a message, leaving your name, number and the best time to call, and if there is anyway possible, we will call you at the time you asked, at our expense. I think we manage to make most of them but when we do call - we won't interrupt your call to take another, unless it is an absolute emergency.
We are here to answer your questions about methadone if it is your first time seek-ing "Methadone Maintenance Treatment." - - We will even call at our expense to follow up after you have started. If you need help in locating a Facility - we give Personalized V.I.P. Treatment to everyone. Why? You are each a unique person
deserving the very best life has to offer. - - You have been hurt and some of you wounded badly and we want to make it right for you. We will give you the truth
and we will walk the extra mile with you, because we believe in you.
- - - -We try and provide as much information on our website about "Medication Assisted Treatment." - - We want you to know what to expect when you enter the Facility the very first day, instead of wondering. You can read over the information other patients have left about their methadone facilities. We encourage all patients to report on their facilities. It provides us with information concerning which ones are abiding by the regulations set forth by 2001 Federal Revision. There should be no cap dosing on methadone. You can risk losing your accreditation. - - They are some facilities in most every state not abiding by the regulations set forth. - - -We may not could do anything yet, but continue to report them but we broadcast any regulation they break on our website and encourage our patients to seek other facilities. We can shut down some of their business by reporting all of it to our members on our website. - - We need all of your help to do this but we know
there are some very valuable methadone facilities and employees working in them and we want to hear about those too. Please take your time and write them up for soon we are going to start acknowledging them in a special way.
|Administering Appropriate Dose Levels|
- - - - - The consensus panel believes that programs should monitor and adjust patients' dose levels of methadone and other opioid treatment medications to ensure that they receive therapeutic dosages with-out regard to arbitrary dose - level ceilings that are unsupported by research evidence. - - - - - - Dosage decisions should be appropriate and tailored to each patient.
We receive a lot of questions and complaints. Most patients complain about their dose. ---- They are unable to get their dose increases. Even though the law was
revised in 2001 leaving the decision basically up to the Doctor, whom is enlisted by the Methadone Maintenance Treatment Program. It really didn't change for a lot of people. I think leaving the decision totally up to a physician who only sees the patient once a year for a physical --- unless the patient asks for an increase, and then the patient does not always see the Doctor. ---- How can they possibly make a fair decision ? ---- They should never have total control over a patient's dose.
No one person should have control over whether a person receives an increase. If you have to ask why, then you know nothing about human nature and should not even be working with patients where decisions affecting their life and well-being should be made.
Progress has been made to ensure that patients receive the therapeutic dosage levels they need to remain stabilized; - - however, the panel finds it troubling that some Opiate Treatment Programs still fail to prescribe medication in adequate doses ( D'Aunno and Pollack 2002).
Patterns of opioid abuse have changed in the past decade. or example, in some areas of the country, patients are presenting with addiction to pain management medications as a primary admission indication (CSAT 2001; Office of National Drug Control Policy 2002). -- -OTPs report that patients addicted to pain management medications require higher therapeutic methadone levels than other patients. - - - Since the mid-1990s, the prevalence of lifetime heroin use has increased for both youth and young adults. From 1995 to 2002, the rate among youth ages 12 to 17 increased from 0.1 to 0.4 percent; among young adults ages 18 to 25, the rate rose from 0.8 to 1.6 percent (Substance Abuse and Mental Health Services Administration 2003
INVOLUNTARY DISCHARGE FROM MEDICATION ASSISTED TREATMENT
Unfortunately, involuntary discharge from Medication Assisted Treatment, some-times called administrative discharge, occurs frequently. - - the consensus panel believes that these discharges are, - - in many cases, evidence of program short-shortcomings . - - - A number of recent changes, including the Substance Abuse and Mental Health Services Administration (SAMHSA)-administered Opiate Treat-ment Program accreditation system with its emphasis on patient care and rights and requirements for consistent policies and procedures (CSAT 1999, amended 2001 [Federal Register 66:4076]), - - require OTPs to consider and document the reasons and methods for administrative discharges far more carefully than in the past. Other specific details vary from State to State.
In their review of numerous studies, Magura and Rosenblum (2001) concluded that patients who were discharged from medical maintenance or long-term detoxification treatment had consistently worse outcomes than patients who remained in treatment. Zanis and Woody (1998) found substantial increases in death rates among those involuntarily discharged for continued drug use. - -The consensus panel strongly recommends that involuntary discharge be avoided if possible, especially when patients would like to remain in - - - and might benefit from Medication Assisted Treatment. - - - - - When discharge is unavoidable, it should be handled fairly and humanely, following procedural safeguards that comply with Federal regulations and accreditation guidelines.
REASONS FOR ADMINISTRATIVE DISCHARGE
SAMHSA accreditation guidelines mention "violence or threat of violence, dealing drugs, repeated loitering, [and] flagrant noncompliance resulting in an observable, negative impact on the program, staff, and other patients" as well as "nonpayment of fees" and "incarceration or other confinement" - - - - - - - as possible causes for administrative discharge (CSAT 1999b. 17-18).
PATIENT AND EMPLOYEE SAFETY
OTPs are responsible for the safety and security of both patients and employees and for maintaining order in the facilities. Threats of violence should be taken seriously, and interventions should be rapid. Staff should document problem behavior. (For discussion about the ethics of discharging patients, see Appendix D.)
Reference: Medication Assisted Treatment --- Chapter 8 --- TIP 43
Written and compiled by: Deborah Shrira - Updated: 27 March 2007 -