Jane's Story of Methadone Treatment
by Marvin PIRILA
This is Jane's (fictional name) account of how the methadone treatment program works.
Methadone is used to treat prescription pain pill [usually for pain] and heroin addiction (opiates). Delivered generally in liquid form it effectively blocks receptors that cause withdrawal symptoms.
Methadone clinics are limited in the number of daily doses they may administer. After this quantity is provided, those failing to get theirs must travel to another methadone clinic in the state. In the case of local patients, this usually means a trip to Brainerd that costs up to $500.
Patients covered by Medica have their transportation paid for and often rely on taxis for transportation. They may be covered by medical assistance but must first be paid out of pocket. Medica covers both privately covered clients as well as the publicly subsidized.
Individuals are usually on their last straw when they finally call, only to find that they are put on a waiting list for up to six to eight months. During that time, they continue to use and some die in the process. If the patient is pregnant, they are provided treatment right away. During treatment, doctors may or may not also dose the unborn baby.
Treatment starts with patients seeing a counselor, watching a video, (on STD's, needles, AIDS, etc.) and meeting with the doctor. After that, they see the counselor weekly. The clients get homework assignments to complete and return the following week. When the homework assignments aren't completed, most still receive their daily dosage.
Jane said that counselors are constantly coming and going, posing an issue with drug addicts that have a problem with trust.
The program requires clients to go to the clinic every day, except days they are closed. Take-homes are given for closed days. Clients must dose during official hours (between 5 a.m. and noon) at the Lake Superior Clinic. The dosage starts at 30 milligrams and increases 10 mg after each three months, after evaluation and approval of nurses. Clients see a doctor once a year for a physical that will determine their dosage. Regardless of a patient struggles or need, there are no inpatient services.
Patients max out at 150 mg [some experts say up to 300 mg], but most receive a dosage that keeps them comfortable during treatment. Some will exceed the dosage they intend to use so they can sell it for up to $1 per milligram. Others will sell all of theirs.
Patients that faithfully pick up their doses, pass random drug tests, and keep their appointments are allowed to take their dose home. The take-home plan allows more dosages to be brought home as you gain more time and keep to the requirements. The rest must take their liquid dose in front of the nurses who dispense them in plastic cups. Take home doses are given in locked boxes. The next day the boxes are returned, inspected, and refilled.
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[“Any patient in an opioid treatment program may receive a single take-home dose for a day that the clinic is closed for business, including Sundays and state and federal holidays.” Minnesota Statute 245A.192 , Subd. 5 (1) – this opens the door for any patient to resell their methadone.]
[Minnesota Statute 245A.192, Subd. 6: “(b) During the first 90 days of treatment, the take-home supply must be limited to a maximum of a single dose each week and the client shall ingest all other doses under direct supervision. (c) In the second 90 days of treatment, the take-home supply must be limited to two doses per week. (d) In the third 90 days of treatment, the take-home supply must not exceed three doses per week. (e) In the remaining months of the first year, a client may be given a maximum six-day supply of take-home medication. (f) After one year of continuous treatment, a client may be given a maximum two-week supply of take-home medication. (g) After two years of continuous treatment, a client may be given a maximum one-month supply of take-home medication, but must make monthly visits.”]
The failure to pass a random drug test results in the loss of take home privileges, nothing more. You may also lose take home privileges for missing an appointment. [According to Minnesota Statute 245A.192, Subd. 4, “Each client enrolled in the program must receive a minimum of eight random drug abuse tests per 12 months of treatment. These tests must be reasonably disbursed over the 12-month period…”]
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After all the costs and time spent in treatment, only about 5% of client's complete treatment. Coping skills are taught only near the end of the program. After treatment, she says there is no counseling.
Jane says it costs about $500 a month ($17/day) for treatment. This money must be paid up front and may be reimbursed by insurance. If you can't pay you don't get your dose.
There are lines of people, some with their children, each day to get their daily dose. Clients often argue and fight in the lines, requiring either security guards or calls to the police. As most of the users do not work, there are often arguments between those that are trying to make it to work and those that have no where to be. When the clinic has implemented hours for those that work and have to be in and out quicker, the non-working people have shown up anyway to receive treatment.
Despite the problems with the program, Jane feels that Methadone is the only true drug there is that works with opiate addictions.
Update: Jane has fallen back into opiate addiction and hitting her regular suppliers. What will become of her two young children that lie in the fallout of her and her boyfriends endless addiction cycle?