For decades, methadone treatment programs for opiate addictions were segregated from the mainstream medical society and available only through established methadone clinics that were strictly regulated be the federal government. Methadone doctor roles were limited in their abilities to make informed clinical decisions and to be able to treat their opioid-addicted patients with the compassion and respect they deserved.
Throughout the years these programs lacked funding, upgraded technologies, and current medical practice skills, and were located in geographical areas where heroin addictions were most prominent. There where long waiting lists to get enrolled, long lines to wait in for dosing, and an overall stigma of negativity attached to the programs and those who use them, leaving a gaping hole in access and desire for the effective methadone therapies.
The use of methadone has been proven to successfully reduce the use of illicit opioids and the associated behaviors and consequences of their use. In 2001, oversight of methadone treatments for methadone detox therapies and methadone maintenance were transferred to the Substance Abuse and Mental Health Services Administration (SAMHSA) to improve treatment methods and certify methadone providers for the effective treatments of opiate addictions.
The improvement measures conclude that opiate addiction is a chronic brain-related medical disorder requiring effective treatment in line with mainstream medical practices. While methadone doctors are less limited in abilities to provide methadone for the treatment of pain, they are required to have specialized training in providing methadone for the diagnoses and treatment of opiate addictions.
With reductions in the unnecessary regulations of methadone treatment programs, more doctors are being certified to service the overwhelming need and with increased recognition of the benefits to society overshadowing the negative images of methadone therapies, public and private insurance programs have become involved in offsetting the costs.
Who Are the Methadone Doctors?
Methadone can only be dispensed for the treatment of opiate addictions through a registered Opioid Treatment Program (OTP) provider. Methadone doctors play a critical role in assessing the patient’s physical and psychological needs for methadone, and appropriately prescribing safe doses to:
- Suppress signs and symptoms of withdrawals
- Control the cravings and intrusive thoughts or compulsive urges to use illicit opioids
- Block the effects of other opioids to deter their abuse
- Restore or normalize physiological functions, to the most extent possible, that have been disrupted by chronic opioid abuse
Methadone doctors may be directly involved with the OTP and operate through methadone clinics or registered OTPs in centers, independent agencies, and private facilities. They may also operate from a physician’s office or an affiliated program sponsor hub with intentions to provide greater access to the much needed opioid addiction treatments.
Methadone doctors will use information gathered in their assessments regarding health from physical and psychological exams, types, patterns, methods, and duration of opioids and other substance abuse, prior detox histories, and other consideration factors to determine the levels of dependency and appropriate methadone treatment planning. This may include assessing risks for infectious or communicable diseases along with education and referrals regarding specialized treatments.
Methadone is a long acting opioid medication that can be used to help patient’s detox from short acting opioids with a gradual tapering off of the medication at a desired termination point which is usually determined by the patient’s ability to abstain from illicit opioids and progress toward an independent and healthy lifestyle without medication assistance. In detox programs, this can occur over a period of a week or more and up to 6months at which time, the person may choose to participate in a methadone maintenance therapy for ongoing treatment needs. According to the World Health Organization, “Studies comparing short-term opioid agonist treatment (i.e. weeks to months) to longer term treatment (6–12 months) find better results for longer term treatment.”
Educating patients about the side effects and risks of methadone use is essential. The methadone doctor should emphasize:
- The risks of using other drugs, prescribed or illicit, that are also central nervous system depressants such as alcohol, benzodiazepines, and other opioids which may lead to fatal respiratory failure.
- Potential cardiovascular risk factors which may be aggravated by methadone and symptom awareness of arrhythmia including palpitations, lightheadedness, dizziness, syncope, and seizures that require immediate medical attention.
- Maintaining dosage schedules, amounts, and other medication regimens to avoid adverse side effects and interactions.
Initial dosing of methadone must be at a level that keeps the patient comfortably free from cravings and withdrawals with the highest degree of safety. Methadone doctors should emphasize safety precautions prescribing the least dosage possible and frequently monitoring the patient, especially during the first few days, to determine patient responses.
A steady state of dosing is usually reached within about 5 days where the amount of methadone eliminated in the urine is equal to the amount in the blood plasma levels. By this time, patients generally develop a cross tolerance to other opioids and a decreased desire to use them along with a reduction in sedative and euphoric effects.
Metabolism rates vary by individual and it is up to the methadone doctor to determine the appropriate dosage levels based on opioid treatment guidelines and tests. Maintaining the individual on methadone requires assessment follow-ups based on the patient’s recovery progress, goals, and needs.