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zenith

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Posts: 1,662 Member Since: 02/21/10

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Feb 21 10 4:03 PM

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Many folks new to MMT (Methadone Maintenance Treatment) want to know what to expect their first few days in treatment. Though all clinics are different, and each state has different regulations that they must follow, we can give you a general idea of what to expect your first few days in treatment. 

Usually you must call the clinic first and set up an intake appointment. Expect this to be quite early in the morning.  Some clinics will do all the admission requirements the first day and dose you then and there--others will require several appointments for intake before you get dosed, and still others have a waiting list for new patients, so call first so you are prepared. 

In the USA, you must be able to show that you have been addicted to opiates for at least one year. If you are an IV addict you can show them your track marks--if an oral addict, you may be asked to bring in your prescription records/bottles, etc. You may or may not be asked to provide "letters of addiction" from doctors or family'friends saying you have been an addict for at least one year. 

When you go to the clinic you will be asked to provide a urine specimen. This specimen MUST be positive for opiates in order for you to be admitted for treatment. Methadone clinics do not treat PAIN so if pain is your primary complaint (as opposed to addiction) you will be sent elsewhere.  

The clinic will have you fill out paperwork outlining your medical history and your addiction history--what drugs you used, how much and for how long. They will ask about any prior attempts at treatment. They may ask if you are under legal supervision. This is all confidential. They cannot provide this information to anyone else without your consent unless they have a court order. They cannot even tell anyone you are a patient there. 

They will then have their doctor do a brief medical examination. You may be offered the opportunity to be checked for HIV or Hepatitis C if you want to. They may draw blood to check your general health. They will want to know what other Rx drugs you are taking.  SOme meds interact badly with methadone so it is important to be honest. If you are taking prescription benzodiazepines (Xanax, Klonopin, Ativan, Valium, etc) you can expect there to be some concerns. Some clinics will not admit patients on these drugs, even if legally prescribed. Others require them to be prescribed by a psychiatrist ONLY, or they may not allow you to have take home doses until you are off benzos, etc etc. Rules vary. This is due to the extreme danger of combining these meds--they can lead to a fatal overdose by shutting down your breathing reflex. SO be prepared for some conflicts if you take these medications. 

If this is a private pay clinic they will ask for you to pay the first week's fee and the induction fee, which vary greatly--weekly fees are usually anywhere from $60 to $100 or more. Clinics usually require payment of the week's fees by monday and if you are late they may start reducing your dose until you pay up (administrative detox). 

At this point, once you are admitted, you will be dosed--usually the starting dose is 30mgs--sometimes less if you had a light habit. The Federal Regs allow the clinic to give you another 10mgs after a couple of hours if you appear to still be in withdrawals, but many clinics do not do this, and often it is too late in the day by the time you get dosed to wait around another 2 hours anyhow. 

The clinic will then send you home with instructions to return the next morning. Hours vary but usually they open quite early--around 5:30-6 am--to accommodate early workers. Some clinics require you to show proof of employment to dose this early.  Lines may be long so expect a wait. 

The nurse will ask you how you are feeling, when withdrawal symptoms began after your last dose, etc. They will titrate your dose upwards within their own parameters (varies from clinic to clinic). Some increase you as quickly as 10mgs per day, others as slowly as 5mgs every few days. It can take a few weeks to get to the correct dose for you, so you can expect to feel less than fabulous during this time period, but it is important to increase slowly as methadone has a long half life and remains active for 72 hours in the body, so each dose builds on the previous day's dose, and what seems like not enough on day one may be enough by the third day, etc. The goal is for you to feel comfortable for a full 24 hours. You should not wake up in withdrawals feeling like if you are not the first patient through the door you will die. The average dose is 80-120 mgs, but some need less and some need more. There really is no low dose or high dose--just the right dose for YOU--but some clinics are unethical or just ignorant and try to keep the patient at a low dose for no good reason. 

The clinic will usually require you to meet with a counselor weekly at first, and then every month. You will be asked to provide a minimum of 8 UA's per year (usually more). You may or may not be required to attend groups at the clinic. 

Take home doses are given out slowly. If the clinic is closed on sundays, you will receive a takehome dose for that day right away. You will be asked to bring a locking box to put it in. Other than that, the first takehome is given usually at 90 days if you have been complaint, clean, etc--this would be for saturday if closed on sunday, and for sunday otherwise.  The next takehome would be given at 6 months. At 9 months you may just be going in 2-3 times a week, and at one year it may be just weekly, if you remain clean. After that it depends on the state laws--some go up to monthly takehomes, others give two week takehomes as a max, others just one week.  If you have an emergency or need to travel you can ask for a special exception. 
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rkey2000

Posts: 10 Member Since:02/24/10

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Feb 24 10 8:24 AM

One thing I would like to ad is try to get a counselor that you feel comfortable with. It can make the world of difference having someone that can explain the program and answer your questions so you can understand them. Most clinics will let you switch counselors at least once if you ask.

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gcrosswhite1960

Posts: 9 Member Since:05/06/10

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May 7 10 7:58 AM

 Zen you have done a great job at explaining the first few days/weeks as usual.I have only one thing to add and that is it has been proven to me that the area,(ie the city etc) will often times effect the rate at which your dose is raised,not always but I have found that clinics in larger cities such as Houston usually treat you a little more expediantly and will usually have counselors with more understanding.Please dont take this as written in stone but it has been what I have experienced.
Some states also will require several written statements as to your degree of addiction,I discovered this to my horror in Oklahoma,where it could take as long as a week or longer to be admitted.But as Zen stated it is usually being required by a clinic not following the federal standards.
 Most clinics I have been to simply asked for a UA to determine if you were in fact positive for opiates and once you filled out the book of documents would dose you and have you return the next day and so on and so forth.
 Most clinic I have found have been extremely helpful and compassionate towards you and will do everything possible to help you.I have even seen a clinic administrator make the police sign for a dose for a guy they arrested in the parking lot of the clinic which if I an correct is not really legal.I have always been advised we have the right to have a save place(without police harrassment) to dose.
 But of course there are ways around everything.Non the less most clinics will do the best they can to help you.
gene

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HenryHenry

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Posts: 34 Member Since:11/13/14

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Jan 21 15 7:54 PM

Months have passed, I've never expected that I would be needing these info on this thread. I thought I could do it by myself and wouldn't need any treatment, but I was wrong, I think I would be needing it.
I've tried to be sober but it doesn't work well for me, I keep saying that I would do it but it's just hard to get through with this addiction. And hopefully rehab center would work well for me, I've not yet been there and I don't know what to do, but thanks to this thread I've got some ideas what to expect when I enter. But I haven't yet sure where to go, I've searched on some sites and I stumbled upon on this Drug Detoxification Daly City CA, not yet sure if this will work for me. Anything more that I should know? You could tell me some advice/suggestions, I would really appreciate it. Thanks in advance.

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