Relevant Questions Regarding Methadone Treatment

A colleague recently posed several relevant questions that many in the addiction treatment field face. I would be interested in hearing other opinions on these questions as well.

Q: We have had a few requests from clients to stop methadone therapy. What can we do in this case - how will we decrease the dosage?

A: Patients will almost always express the desire at some point to leave treatment - it is a major burden the frequency of visits, inteference with life and travels, constant reminder that one has a problem that requires meds, pressure from family and/or friends/employers, etc. The most one can do - and the least one must do - is to ensure that patients know there's a very high likelihood of relapse to illicit opiates when methadone is discontinued. Sure- a few make it and achieve and maintain abstinence, but they are the small exception. So . . . they should be well informed. If they insist, I'd encourage them to proceed as slowly as possible - maybe 5 mg each week - and tell them that any time they say the word you're prepared to discontinue further decrease in doses and to go back up. No shame - no problem. And finally, I'd make sure they know that if they do relapse at any time you will welcome them back with open arms.

Q: We also have a few clients that started the MMT, but after two-three days they leave, and after one week they come back for methadone. Should we admit them again?

A: Patients who "drop out" for longer or shorter periods, after just a few days or after many months - they're a problem. Ordinarily I'd say of course, take them back. They obviously need the help you provide. But you also have an obligation to thousands of other local residents who need help and are on the waiting list. I would probably suggest a four-week wait before permitting return to treatment - but it's no easy answer (if that person dies during the 4 weeks: horrible; if a patient dies on the waiting list who was denied admission because the former patient came first - also horrible. Tough business.