Most people know what a methadone clinic is, thanks to widespread representation in movies and TV. However, if you ask the average person how one of these clinics actually operates or what it’s meant to do, you’re likely to get a blank stare. Methadone clinics are a bit of a mystery for people who haven’t been to one, and that can be nerve-wracking when you or someone you care about is considering this form of addiction treatment.
You’ve got a lot of important questions about methadone treatment, and this guide will give you the understanding you need to choose the right program with confidence.
What Is Methadone?
Methadone is a long-acting analgesic in the opioid family. It is chemically related to opium but is completely synthetic. A group of German scientists first made methadone in the 1930s. Initially, they were searching for a painkiller that did not have the extremely addictive properties of morphine. The two scientists, Max Bockmhl and Gustav Ehrhart, synthesized a substance they called polamidon. During World War II, a shortage of painkillers pressed a different team of scientists to start synthesizing the substance, and they changed the name to methadone.
Methadone came to the United States in 1947, as a pain reliever useful in treating multiple conditions. Over time, it became clear that methadone was useful in treating addictions to narcotics. With a surge in heroin addiction in the 1960s, researchers were scrambling to find a substance that would get rid of or at least reduce cravings for drugs as well as symptoms of withdrawal. Methadone was the ideal candidate.
Methadone reduces the painful symptoms of withdrawal and helps suppress cravings for drugs for 24 to 36 hours, all without providing any feelings of euphoria. This medication makes recovery more achievable and is generally taken for at least a year. This type of treatment is called methadone maintenance.
In 1971, the federal government formalized the recognition of methadone as an effective recovery assistant by developing regulations governing its use in treating addiction to heroin. Those regulations stayed essentially the same until 2001, when they were modified so doctors and certain other health care professionals could provide methadone to patients more consistently. Today, methadone maintenance treatment is considered the gold standard for opioid addiction treatment.
What Is a Methadone Clinic Used For?
A methadone clinic is a facility where people seeking opioid addiction treatment can go to receive medication that will help them begin their journey to addiction recovery. Methadone clinics are more accurately called substance use disorder services clinics (SUDS) since they are also equipped to dispense naltrexone and Suboxone. However, since methadone is the primary medication dispensed, the two terms have become synonymous to most people.
All methadone clinic programs must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and registered with the Drug Enforcement Agency (DEA). As of 2018, there were about 1,500 methadone clinics in the U.S., most of which were concentrated in New York, New Jersey, Maryland and California.
There are two types of methadone clinic — public and private. Public clinics are less expensive, but limited government funding means people usually end up on a waiting list. With an issue as serious as addiction, having to wait days or weeks to begin treatment greatly lessens the chances of a person actually returning, and increases the likelihood that they won’t get the help they need.
Private clinics are undoubtedly more expensive, but the benefits are also clear. There is often no waiting list at a private clinic, and if there is one, it will be short. The care provided at private clinics is also markedly better since staff and medical professionals are far less likely to be overworked.
What Are the Requirements for a Methadone Clinic?
To gain the certification necessary to dispense methadone and other treatments, clinics must meet specific federal requirements. All clinics have to offer a minimum range of services, including:
- Initial examination: Every patient must receive a complete physical by a physician or a health care professional under a program physician’s supervision. Clinics must provide full documentation.
- Services for pregnancy: Clinics must have policies and procedures in place to address the unique needs of pregnant patients. The clinic must be able to provide prenatal care or be able to refer the patient to an appropriate service.
- Assessments: Patients accepted for a treatment program must receive an initial assessment including a treatment plan, as well as subsequent periodic assessments throughout treatment.
- Counseling: Patients must receive adequate substance abuse counseling from a professional qualified to assess social and psychological backgrounds, contribute to the treatment plan and monitor the progress of patients.
- Drug testing: Clinics must conduct at least eight random drug tests per year, per patient. If the patient is in a short-term detox treatment, they must receive an initial drug test. Long-term detoxification requires an initial drug test as well as randomized monthly tests.
These are the bare minimum of services a methadone clinic must provide. The best clinics go above and beyond these requirements by offering multiple types of counseling and holistic services.
How Do Methadone Clinics Work?
Individuals struggling with an opioid addiction can walk into a methadone clinic and request to be treated. Once the clinic has established the individual’s eligibility through various initial screening exams and interviews, patients can receive methadone on-site. Some programs allow patients to take home doses for self-administration once they have earned the privilege.
The medication is dispensed by an appropriate practitioner who is licensed by the state or federal government to give out opioids. Pharmacists, nurse practitioners and registered nurses can also dispense methadone and other opioid treatment medications if a licensed practitioner supervises them.
When someone enters a methadone treatment program, they receive a daily dose of methadone and must participate in counseling of some kind. Methadone treatment at a clinic is often a long-term commitment.
Who Is Eligible for Methadone Treatment?
Methadone maintenance treatment is only an option for people who meet specific requirements. To meet state and federal requirements for this form of treatment, a person must be physically addicted to opioids at the time treatment is requested. They must also have struggled with the addiction for at least a year before requesting the treatment.
You can prove your opiate addiction has lasted at least a year with a doctor’s letter or records of any past treatment you have received. If you cannot get that, you can have a family member draw up a notarized certification of your opioid use. A history of being arrested for opioid use or possession can also qualify you, as can a confirmation from a parole or probation officer. You can even ask a member of the clergy to give you a notarized letter if you’re out of other options or that’s easier than asking a family member.
There are exceptions to the one-year rule. If you are pregnant, have been released from prison within the last six months, or have participated in a methadone treatment program in the past, you don’t need to prove one year of addiction.
For the most part, methadone clinics don’t serve individuals under the age of 18. Because methadone is an opioid, its effects may be more significant on brains that haven’t matured yet, and other treatments are preferred when possible. However, minors can become eligible for methadone if they can provide two things:
- Documentation of two detoxification or treatment attempts within the past 12 months
- Written consent of a parent or guardian
Methadone maintenance treatment is generally reserved for people with a severe or long-term addiction, for whom other types of treatment have not been completely effective.
Common Reasons Why People Use Methadone Clinics
Methadone clinics are becoming available to more and more people across the country due to the opioid crisis. From 2014 to 2018, 254 new clinics were established. The people attending these programs are struggling with addictions to the following common opioids.
Many people are surprised to find that codeine, the active ingredient in some cough syrups, can be dangerous. When ingested, codeine is broken down in the liver, where it reverts to morphine. There’s a good reason why cough medicine is locked up behind the counter — the sleepy feelings of pleasure it provides in excessive doses can lead to unexpected addiction.
The most common form of codeine abuse is mixing cough syrup with Sprite to make what’s known as “lean.” This concoction, which can also contain alcohol, is a staple of rap culture. Artist Mac Miller, who died of a drug overdose in 2018, was open about his struggle with codeine.
Oxymorphone is a schedule II opioid analgesic. The original drug was approved for medical use in 1959 but only came in injectable and suppository forms. In 2006, the Food and Drug Administration (FDA) approved immediate-release and extended-release tablets to be taken orally. The trade name for these tablets is Opana, and the release of the tablet format coincided with a jump in addiction rates. From 2010 to 2011, the number of emergency department visits triggered by oxymorphone use skyrocketed from 4,599 to 12,122.
3. Hydrocodone and Oxycodone
These closely-related medications have been in the top 10 drugs involved in overdose deaths from 2011 to 2016, and continue to be some of the most common sources of addiction. Because physicians prescribe these drugs, many people don’t fully understand their addictive potential.
Morphine addiction is not terribly common because it’s not readily available in pill format, and is heavily safeguarded in medical settings. For the most part, morphine is delivered via an intravenous drip. Because it is easier for medical professionals to obtain, doctors and nurses are the most likely to develop a morphine addiction. Like other opioids, misuse of morphine can rapidly spiral out of control.
Heroin is one of the most potent and deadly opioid drugs in the world, as well as one of the most addictive. Notably, 86% of heroin users in urban areas report that they first used prescription opioids before moving on to heroin. Abusing it leads to physical deterioration and serious health problems in a matter of weeks. Withdrawals from heroin are extremely severe, making it even more challenging to quit successfully.
Benefits of Methadone Clinics
What does a methadone clinic do for recovery? No matter the specific drug, methadone maintenance treatment is highly effective in combating addiction. One of the main reasons people choose methadone is its cost-effectiveness and convenience as compared to residential treatment. With methadone maintenance, you just pay for the medication and services, not for accommodations.
Perhaps the biggest benefit of methadone clinics is the time efficiency. Rather than putting life on pause for weeks or months to receive treatment at a residential center, patients receiving methadone can continue to live their lives with minimal interruption. As long as you can schedule time for counseling and go once a day, every day, to receive your medication, you can successfully participate in a methadone maintenance program.
Being able to take what you’re learning in therapy and apply it to life as you go helps you learn more effectively. It also gives you and your counselor the chance to work out problems as they arise, rather than suddenly facing a slew of unexpected issues at once upon leaving residential treatment. Overall, methadone clinics provide a way to begin and sustain recovery while remaining independent.
Signs That Your Addiction Needs Help
Addiction doesn’t usually develop overnight, and it can be difficult to spot whether your use of a medication or drug has evolved into dependence. There are several signs to watch out for if you suspect you may be struggling with addiction, and not all of them are obvious. Here’s a list of the most common signs you need to seek treatment:
- Inability to stop using: By the time most people seek treatment, they have tried and failed to stop using a substance on their own at least once. You don’t need to make a big proclamation that you are quitting for this to apply to you. If you find yourself internally saying “not today” and then using the substance anyway, you may be addicted.
- Use despite health issues: Most people can feel it when their drug or alcohol abuse has become a problem because the continued use gives rise to health issues. If someone keeps drinking alcohol despite feeling tired and sick every day, or keeps taking too many painkillers despite problematic constipation, addiction is a likely explanation.
- Problem use: Many addictions begin with using the drug to avoid dealing with problems in life. If instead of processing your emotions and taking steps to improve a situation, you turn to drugs, your risk of addiction skyrockets.
- Obsession: People with an addiction spend inordinate amounts of time thinking about their drug of abuse. This tendency is at its worst when someone is nearing the end of their supply and becomes frantic about where and how to get more.
- Risk-taking: If you have ever considered entering a risky or illegal situation to obtain your drug of abuse, you’re a good candidate for treatment. With illicit drugs like heroin, risk-taking behavior is already there at the outset. But thinking about getting opioids on the street when you previously had a prescription is exactly the type of risk-taking addiction encourages.
- Increased dosages: All drugs of abuse carry the issue of tolerance. When you find yourself needing one more drink, smoke or pill to achieve the same high, it’s because your body is developing a dependence.
All these signs are accompanied by things like loss of interest in social activities and hobbies, reduced performance at work or school and a general feeling like you’re not yourself anymore. By its nature, addiction tells you it’s not a problem, that this is just a phase and you’ll get over it eventually. But if you see any of these signs in your life, it’s time to give serious consideration to addiction treatment.
What Happens at a Methadone Clinic?
If you’re not sure how to get into a methadone clinic or how a methadone clinic maintenance program works, you’re not alone. The process can be difficult to get information on, but it’s straightforward once you have chosen a program. Most programs operate on similar parameters, and you can break the process down into three phases.
1. Assessment and Induction
When you select a methadone clinic for treatment, the first stage involves a significant amount of paperwork and discussions with medical professionals. On your first visit, you will receive a complete physical assessment to gauge your general health and the effects your addiction has had on your body. The drug screen will help confirm that you are in an appropriate state of withdrawal to begin methadone treatment and that you have not left any other drugs out of your history. Basic medical factors like height and weight also play into the initial dosage your physician prescribes.
You will also receive a consultation with an intake counselor to establish your history of addiction to opioids. This process can be a bit uncomfortable if you’re not used to speaking openly about your addiction, but it’s important to be straightforward and truthful with your counselor. If you are abusing multiple drugs or have mental disorders along with your addiction, the intake counselor needs to know so they can help tailor the program and counseling services to your individual needs.
Depending on the results of your assessments, your physician will decide whether or not to allow you to begin taking methadone the same day. Before being given your first dose, you will review the program policies and procedures. You’ll need to sign a consent form stating that you voluntarily agree to treatment and are willing to comply with conduct requirements.
The first few days of switching over from opioids to methadone are called stabilization. You will start off with a low dose of methadone, between 10 and 30 milligrams. The medication comes in the form of a pill, dissolvable tablet or oral solution.
For three days, you’ll receive the same dose to allow the medication to build up in your system. After three days, it’s time for you and your doctor to evaluate how well the methadone is working. If you’re still experiencing withdrawal symptoms, your doctor will increase the dose once every three days until you reach the maintenance level that works best for you.
Once you and your doctor have found your ideal maintenance dose, you continue to take it daily until you can safely stop opioids completely. Clinics offer take-home privileges to patients who demonstrate adequate commitment and progress during treatment. For the first 90 days, you will have to visit the clinic daily to receive your methadone, except for one take-home dose per week to cover days when the clinic is closed. As you progress in treatment and meet certain criteria, you will become eligible for larger take-home supplies.
The maximum supply of take-home medication outlined by federal law is one month, but many states implement more stringent restrictions. The maximum supply can only be obtained after two years of continuous, successful treatment.
Frequently Asked Questions About Methadone Clinics
It’s perfectly normal to be a little nervous about starting a methadone program, and you probably have several more questions about the process. Here are five of the most common questions related to starting and continuing methadone maintenance treatment:
1. What Should I Bring to My First Appointment?
You’ll need to bring valid photo identification, any prescriptions you are currently taking, an insurance card if you plan on using it to pay for treatment and payment for the first day’s medication fee. Pregnant patients should bring proof of pregnancy, and in some cases, written permission from their OB/GYN is required.
2. What If Methadone Doesn’t Work for Me?
Unlike other types of treatment, methadone works the same way for everyone. As long as you aren’t taking any medications or drugs that have negative reactions with methadone, you can rest assured that you will feel relief from withdrawal symptoms once your maintenance dose is established.
3. How Long Do I Have to Take Methadone?
Methadone maintenance is different for everyone, but the minimum recommended length of treatment is 12 months. Many individuals continue to benefit from methadone for years. It is possible to safely withdraw from methadone, as long as you work with your physician to taper off slowly.
4. Is It Safe to Take Methadone While Pregnant or Breastfeeding?
Yes. Opting for methadone treatment is much safer for your baby than continuing opioid abuse or going through withdrawals. Minimal amounts of methadone may make it through into breast milk, but the benefits of the medication outweigh the very minimal risks.
5. Will Methadone Show up on a Drug Screen?
Unless your employer specifically tests for methadone, it will not show up on a drug test for opioids like heroin or morphine. Methadone is a legal medication, and as long as you are following the guidelines of your program, you won’t have any trouble with drug screens.
Forms of Treatment at a Methadone Clinic
Addiction recovery is a little bit different for everyone, and people need options to receive the best individual treatment. Most methadone clinics offer a few forms of treatment that can benefit patients. The core of methadone clinic care is, of course, medication-assisted treatment (MAT).
1. Medication-Assisted Treatment
When a person uses opioids, the drugs cross the blood-brain barrier and attach to receptors in the brain. This triggers a sudden release of neurotransmitters that produce the euphoria associated with an opioid high. The high interacts with the brain’s reward system and reinforces the behavior that produced the initial flood of feel-good chemicals. Every time someone uses opioids, the brain gets a little slower and less efficient at producing its own reward chemicals.
Over time, the brain stops making these chemicals altogether, because it gets them from the opioids. However, this means when opioids are removed, the brain can’t function properly and throws a person’s system into withdrawal.
Medication-assisted treatment for opioid addiction uses methadone or buprenorphine to stop withdrawals before symptoms become bad enough to make a person give in and start using opioids again. These two medications are partial opioid agonists, which means they bind to the same receptors as drugs like heroin and prescription painkillers. But instead of making someone feel high, they simply help people feel normal enough to live their lives without extreme withdrawal symptoms.
Methadone clinic MAT also focuses heavily on counseling and behavioral therapy to take a whole-patient approach.
2. Other Treatments Offered at Methadone Clinics
The types of other treatment offered by methadone clinics can vary. These three are the most common to encounter as part of an MAT program:
- Cognitive behavioral therapy (CBT): Drug abuse and addiction are associated with specific behaviors and thought processes that drive a person to use drugs to cope. CBT helps people change ingrained behaviors and learn healthy coping skills.
- Medical detox: Some people’s addictions are so severe that withdrawal causes intense, dangerous physical reactions. With medical detoxification, the patient remains under the close supervision of medical professionals until withdrawal is over.
- Group therapy: In addition to individual counseling, the social aspect of group therapy can benefit people in recovery. Being able to talk about issues with other people who understand your situation can be immensely freeing.
Common Side Effects of Taking Methadone
Although methadone is a less potent drug than heroin or prescription painkillers, it is still an opioid agonist. There may be side effects to MAT with methadone, including:
- Dry mouth
- Retention of urine
- Gastrointestinal distress
In some patients, methadone can cause psychological side effects like anxiety, delusions and paranoia. Insomnia is a fairly common symptom as well, though it tends to get better over time. In general, these side effects are significantly less unpleasant than going through opioid withdrawals. However, some people can have more severe side effects that interfere with the efficacy of the medication, such as:
- Heavy sweating
- Nausea or vomiting
- Slowed breathing
- Depressed respiratory function
- Irregular heartbeat
If you experience any of these rarer symptoms while taking methadone, tell your doctor right away. It may be a sign that your dose is too high or that another course of treatment may be better for you.
To minimize the side effects of methadone, you must be open about any other medications you are taking and to avoid alcohol. Mixing methadone with other substances can be dangerous, and rob the medication of its ability to help you.
Avoiding Relapse During and After Treatment
The temptation of relapse is something everyone struggles with during recovery. Even when treatment is going well and methadone is minimizing withdrawal symptoms, you may have a hard time with cravings. Keep the following tips in mind:
- Practice mindfulness and be aware of your emotional state
- Minimize free time
- Invest in building healthy relationships
- Identify your triggers
- Build a support network
- Keep an emergency contact list
Preventing relapse is easier when you know its mental and emotional signs. If you’re feeling moody, wanting to isolate yourself or struggling with anger, you are at higher risk of turning back to opioids. Mental signs include glamorizing your past drug use or fantasizing about using drugs again.
One of the critical elements of relapse prevention is to keep physically healthy. Addiction takes a toll on the body, which can, in turn, affect your mind and emotions. Focusing on the three most significant elements of health can strengthen your body and resolve for recovery:
- Nutrition: People struggling with addiction don’t usually pay much attention to nutrition, which can make recovery harder. Good nutrition is linked to better mental health, which can strengthen your resistance to relapse.
- Exercise: Studies have suggested that exercise combined with other treatments can have a significant positive impact on relapse rates. In addition to keeping you physically healthy, exercise helps keep you occupied and distracted from cravings.
- Sleep: American adults have a hard time getting enough sleep altogether, and addiction makes it even more challenging to get a good night’s sleep. However, doing what you can to improve your sleep quality and duration will make it easier to stay emotionally healthy throughout recovery.
During treatment, you and your counselor will work together to create a relapse prevention plan. The strategies you learn to cope with cravings are lifelong tools you can use throughout your new, sober life.
Have Methadone Clinics Gotten a Bad Reputation?
Absolutely. Many people believe methadone clinics increase crime and are there to get you hooked on drugs. The most pervasive misconception people have is that methadone treatment simply means swapping out one addiction for another. This incredibly harmful perception is rooted in the fact that methadone is an opioid, but does not take into account the stark differences in potency. People don’t usually understand what a methadone clinic is for. Methadone does not get anyone high when it is used as directed by a doctor, and it greatly increases the chances of sustaining addiction recovery.
Throughout methadone clinic history, there has been one constant — they are there to help people overcome their addictions. The stigma around methadone clinics is part of a greater issue. People tend to view addiction as a personal or moral failure, and believe methadone maintenance treatment is a scam in some way. This attitude is harmful to people in recovery, and it affects a huge portion of people seeking treatment. One study estimates that 78% of people undergoing methadone maintenance treatment have experienced stigma.
The bottom line is MAT with methadone works. That’s why it has been in use for decades, and why more and more people are flocking to methadone clinics as a response to America’s opioid crisis.
Finding and Choosing the Right Methadone Clinic
Starting the journey to methadone clinic recovery starts with finding the right program. There are many factors to consider, but these three can help you narrow down your options quickly and with confidence:
- Proximity: Once you enter a treatment program, you’ll be attending the clinic every day. Starting off with a query like “where is the nearest methadone clinic” will show you the locations most convenient to you.
- Experience: Your recovery journey should be guided by professionals you trust. Choosing an established clinic increases your chances of getting the best care possible.
- Individualization: Some methadone clinics offer better flexibility in treatment plans than others. If a clinic doesn’t have options to fit the different needs of individuals, you likely won’t receive the most effective care from that provider.
Another consideration in choosing a methadone clinic is how you’ll pay. Many clinics accept Medicaid, and some commercial insurance plans will cover methadone maintenance treatment. Be sure to contact your prospective treatment facility to find out more about their payment and insurance policies.
Make Recovery a Reality With MedMark
If you’re ready to find out more about starting your recovery from opioid addiction, MedMark is here to help. We have clinics located in five states, all staffed with compassionate staff and licensed medical professionals. Our addiction treatment services are designed to provide all the support and education you need to build healthy coping skills and get your life back.
Contact us today to get more information about the MedMark clinic closest to you, and find out more about the next steps on your new path to recovery from opioid addiction.