Medication-assisted treatment (MAT) with methadone is a time-tested, evidence-based treatment that occurs in specialized treatment centers originally known as methadone clinics. These methadone clinics are now officially called opioid treatment programs (OTPs) and operate under the guidance of the Food and Drug Administration (FDA) and the Drug Enforcement Agency (DEA). Rules around access to methadone changed during the COVID-19 pandemic, which increased access to methadone clinics for many patients with opioid use disorder (OUD).
The Opioid Crisis in the United States
The opioid crisis in the U.S. continues to claim lives at an alarming rate.
In 2022, a total of 109,680 people died of drug overdose, with 74 percent – or 81,045 – of those death attributed to opioids. That’s 300 drug overdose deaths overall per day, and 222 opioid overdose deaths per day.
Each of those deaths – whether from opioids or another drug – leaves friends, families, and loved ones behind, in mourning, wondering they could’ve done to help. In many cases, loved ones did everything they could, but it wasn’t enough. They had to face the fact that only one person can create real change in the life of a person with a substance use disorder: the person with the disorder themselves.
The National Institute on Drug Abuse (NIDA) reports the following data about prescription opioids:
- 21% to 29% of people prescribed opioids misuse them
- 8% to 12% will develop an opioid use disorder (OUD)
- 4% to 6% will initiate illicit heroin use
These percentages translate into millions of people with a life-threatening medical condition, which we call opioid use disorder (OUD).
- Opioid misuse in the past year:
- Total: 9.2 million
- Opioid prescription misuse:
- Total: 8.7 million
- Opioid use disorder: 5.6 million
- Heroin use: 1.1 million
- Heroin use disorder: 1.0 million
That’s the data: millions of people need help, because the disordered use of opioids and/or heroin leads to severe, and sometimes life-threatening problems, such as overdose.
The Consequences of Opioid Addiction/Opioid Use Disorder (OUD)
For many people who experience chronic drug use and develop a substance use disorder, the future can feel bleak and even hopeless. In most cases, people with opioid or heroin use disorder spend their days preoccupied with seeking, finding, and using opioids or heroin. This can disrupt relationships, impair academic achievement, and degrade work performance. In extreme cases, opioid and heroin use can lead to unemployment and homelessness. But let’s be clear. Doctors, CEOs, and lawyers experience opioid and heroin use disorder as well. However, they may not end up unemployed or on the street, because they have a more substantial financial safety net than others.
In any case, people engaging in active, chronic opioid use often feel that their happiness, joy, and ability to participate in the healthy parts of life are all but gone.
Many people give up hope completely. And every single person with opioid use disorder faces the risk of fatal overdose, which has increased in recent years due the influx of dangerous additives in the illicit drug supply in the U.S., such as fentanyl and xylazine.
If you or someone you love is living with the disordered use of any substance, whether opioids, alcohol, or something else, there is hope – and it’s just a call away.
Treatment for Opioid Use Disorder: The Role of Methadone Clinics
There are millions of people who need help and support for opioid use disorder/opioid addiction. Thousands of those people seek that treatment and support every day – and among those, there are millions around the world in recovery. They’ve made a proactive decision to choose health and wellness and give themselves the opportunity to celebrate the joy of life every day.
At Pinnacle Treatment Center, we understand how difficult the recovery journey can be. Our knowledgeable, experienced, compassionate staff help people across the nation 24/7/365. Medical conditions like opioid use disorder don’t take days off – and neither do we.
As we mention in the introduction of this article, evidence shows the best available treatment for opioid use disorder is medication-assisted treatment (MAT) with one of the three medications for opioid use disorder (MOUD). In fact, experts call MAT the gold standard treatment for opioid use disorder (OUD). There are three medications approved by the FDA for OUD treatment: methadone, buprenorphine, and naltrexone.
Here’s the latest data on MAT treatment, published in the 2021 National Survey on Drug Use and Health (2021 NSDUH):
Medication-Assisted Treatment for OUD
Among the 5.6 million people diagnoses with OUD in 2021:
- 2 million people received treatment for OUD
- 533,000 people received MAT for OUD
- 1 million people received MAT for opioid use, with or without OUD diagnosis
- 887,000 who misused opioids, without OUD diagnosis, received MAT for OUD
This article will discuss the oldest of the MOUDs approved for MAT: methadone.
Methadone is considered a full opioid agonist. That means it completely occupies the same receptors in the brain as both prescription and illicit opioids. However, due to its slightly different chemical structure, methadone does not include the same euphoria associated with other opioids – but it’s similar enough that it can significantly reduce withdrawal symptoms associated with stopping opioids, and also significantly reduce cravings for opioids. These aspects of methadone have been studied extensively since the 1950s, when methadone was first used to treat heroin use, and since the 1970s, when the first methadone clinic in New York City.
Treatment professionals also use methadone for the misuse/disordered use of other opioids, including prescription opioids like oxycodone and illicit opioids like fentanyl.
Methadone is a medication that can only be prescribed by a licensed medical provider in an Opioid Treatment Program (OTP) that’s certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and registered with the Drug Enforcement Agency (DEA). Patients receive methadone in either a tablet or liquid form.
Many OTPS, such as those at Pinnacle Treatment Centers, administer an initial medical assessment, create an individualized treatment program, dispense the first dose, and provide daily dosing according to the treatment plan and federal guidelines. That’s a very basic idea of how methadone clinics – i.e. OTPSs – work for most patients.
Let’s take a closer look at treatment at a federally licensed Opioid Treatment Program (OTP) at Pinnacle Treatment Centers.
Understanding How Methadone Clinics Work
Methadone clinics exist for the purpose of dispensing medications used in medically assisted drug therapy treatments. In many cases, treatment locations called methadone clinics provide other medications for opioid use disorder (MOUDs) such as Suboxone and naltrexone.
As we mention above, the first step in engaging in MAT with methadone is a comprehensive assessment – called a biopsychosocial assessment – administered by a licensed and qualified healthcare professional. Once the assessment is complete, patient and provider collaborate on a treatment plan. This is when most patients learn something critical about MAT:
The medication is only part of the treatment.
Federal guidelines require methadone clinics to offer the following services:
- Rules require methadone clinics to offer addiction counseling provided by an experienced addiction treatment provider.
Rules require methadone clinics OTPs to provide education about addiction, relapse prevention, and other topics that promote long-term recovery.
Community Support/Peer Self-Help Meetings:
Rules require methadone clinics to offer the support required to connect MAT patients to community resources, vocational assistance, and other social services that support and promote health, wellness, and recovery.
Rules require clinicians at methadone clinics to create a treatment plan that includes:
- Relapse prevention
- Stress management
- Lifestyle changes, such as healthy eating, exercise, and recovery-friendly activities
Before the COVID-19 pandemic, rules required close monitoring for the first week to ten days of treatment, and required patients to visit the methadone clinic every day to receive their medication. Most patients were required to receive their medication in person on a daily basis for at least six months. Then, after the first six months – if a patient complied with the rules, regulations, and expectations of the clinic and their individual treatment plan – they were allowed to take home a limited supply of medication.
However, during the COVID-19 pandemic, the federal government allowed states to ease these rules around take-home doses of methadone. These new rules were in effect until May 2023. Clinics were allowed to continue to operate under these new rules if they applied for exceptions by May 10th, 2023:
- For stable patients in treatment for less than two weeks, new rules permitted providers to dispense up to 7 take-home doses
- For stable patients in treatment for 15-30 days, new rules permitted providers to dispense up to 14 take-home doses
- Finally, for patient in treatment for 31 or more , new rules permitted providers to dispense up to 28 take-home doses
Note: Patients should contact their potential provider/methadone clinic to learn whether they’ve applied for continued exceptions to take-home dose rules established during the COVID-19 public health crisis. If they haven’t, some version of the original guidelines apply. If they have, the new rules may apply. In any case, patients should contact their methadone clinic directly to find out about their current take-home dosage policies.
The Benefits of Treatment at Methadone Clinics
Here’s what we want anyone reading this article to take away: MAT with methadone can be lifesaving and lifesaving.
However, it’s not as simple as taking medication and calling oneself cured. As we mention above, the only person that can create real change in the life of a person with opioid use disorder is that person themselves.
They have to show up and do the hard work of recovery – otherwise they have very little chance of creating real change.
We’ll say it this way:
The medication is not magic.
Patients have to commit to recovery and follow their treatment plan closely.
It’s essential for patients engaging in MAT with methadone to stay on the prescribed amount of methadone consistently and adhere to all the protocols established by their methadone clinic. This is how methadone clinics work, and their successful track record reinforces the importance of the protocols. This is also how a patient can meet the criteria for stability that allows them to request take-home doses.
In the context of MAT treatment at a methadone clinic, a.k.a. a federally licensed OTP, a patient must meet the following criteria to be considered stable:
- No additional active substance use disorders
- No physical or behavioral health conditions that increase the risk of harm
- Regular attendance for medication distribution
- No serious behavioral problems that increase risk of harm to themselves or others
- No diversion of methadone for illicit purposes
- Ability to safely store and transport medication
In addition, patients must meet any further criteria their supervising physicians, clinicians, or providers deem essential for the safety of the patient and the safety of the patient’s family and community.
Research has shown that when a person adheres to a methadone treatment program, their lives can change for the better. Positive outcomes include:
- Decreased opioid-related mortality (death)
- Increased time-in-treatment, which increases likelihood of long-term recovery
- Decreased opioid use
- Decreased criminal behavior related to opioid use
- Reduced transmission of infectious disease
- Increased ability to seek and maintain employment
- Improved outcomes for pregnant women with OUD, for both mother and child
That’s why it’s important to follow the protocols in a treatment plan. When a patient adheres to a treatment plan with methadone, they can experience all those lifechanging, and in some cases, lifesaving benefits.
Treatment and Support is Available Now
If you or someone you love needs professional support for opioid use disorder (OUD), we want you to know help is available. There are kind, caring, compassionate providers who understand addiction: some of our providers are in recovery, themselves, and bring their wealth of experiential knowledge to the Pinnacle Treatment Centers experience. We understand that taking the first step – making that first phone call – can often be the hardest step in the entire treatment journey.
At Pinnacle, we promise to be there for you every step of the way – not just during your official treatment program, but for your entire recovery journey.
Methadone Treatment at Pinnacle Treatment Centers
In our medication-assisted treatment programs, we use every tool available to help as many people as possible achieve sustainable recovery. MAT helps patients build a full, vibrant, purpose-driven life, free from opioids and opioid use disorder.