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{{Short description|Substance use disorder services clinic}}
Methadone Clinics have been established for the distribution of Methadone to heroin abusers. The focus of these clinics is the elimination of heroin use by the replacement of heroin addiction with Methadone. A common term for the type of treatment at a Methadone Clinic is "Replacement Therapy". While generally considered successful as a treatment method, the use of this replacement treatment is considered controversial.
{{Globalize|date=June 2023}}
A '''methadone clinic''' is a medical facility where medications for [[opioid use disorder]] (MOUD) are dispensed-—historically and most commonly [[methadone]], although [[buprenorphine]] is also increasingly prescribed. Medically assisted drug therapy treatment is indicated in patients who are opioid-dependent or have a history of opioid dependence.<ref name="Clinical Guidelines" /> Methadone is a [[Controlled Substances Act#Schedule II controlled substances|schedule II]] (USA) [[opioid]] analgesic, that is also prescribed for pain management. It is a long-acting opioid that can delay the [[opioid withdrawal]] symptoms that patients experience from taking short-acting opioids, like [[heroin]], and allow time for withdrawal management.<ref>Ilene Anderson, Thomas E Kearney (January 200) “Use of Methadone.” Medicine Cabinet. Retrieved November 11, 2018.</ref> In the United States, by law, patients must receive methadone under the supervision of a physician, and dispensed through the Opioid Treatment Program (OTP) certified by the [[Substance Abuse and Mental Health Services Administration]] and registered with the [[Drug Enforcement Administration]].<ref>Substance Abuse and Mental Health Services Administration (09/28/2015) “Methadone”. Retrieved November 11, 2018</ref>


==Regulation and policy==
Methadone Clinics in the United States operate under close federal observation and regulation. The medication is monitored by nursing staff and is prescribed by a physician. Regulations require that to enter this form of treatment, the person must show current addiction to an opium substance. This is generally established by a simple urine sample. Frequently, other tests are performed... other blood work is drawn and a physical is given prior to administration of the Methadone.
In the United States, there are approximately 1,500 methadone clinics that are federally certified opioid treatment programs.<ref name=":0">{{Cite journal|date=February 2018|title=Medications for Opioid Use Disorder – Pharmacotherapy for Opioid Use Disorder (Part 3 of 5)|url=https://store.samhsa.gov/product/tip-63-medications-opioid-use-disorder-%E2%80%93-pharmacotherapy-opioid-use-disorder-part-3-5/sma18|journal=Treatment Improvement Protocol|volume=63|via=Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (SAMHSA)}}</ref> There are generally two types of methadone clinics, public and private. The public clinics are generally cheaper to attend. However, there is usually a waiting list due to limited funding. The private clinics are more expensive to attend but usually have either a short or no waiting list. In many parts of the United States, methadone clinics are few and far between, which presents problems for addicts seeking methadone treatment who live far from a clinic. All methadone clinics must register as an accredited opioid treatment program with the Substance Abuse and Mental Health Service Administration and renew yearly or every three years based on the accreditation time frame awarded. Additionally, methadone clinics must register with the Drug Enforcement Administration before methadone can be dispensed.<ref name=":0" /> While not restricted to adults, this treatment method is generally not considered for people under the age of 18.


Methadone clinics in the [[United States]] operate under strict regulations by state and federal laws. Before entering treatment, a patient must be given adequate information to provide [[informed consent]] about starting treatment. This information includes reasons for treatment and recommendations, the side effects and risks of treatment, and rules that must be followed to receive methadone treatment.<ref name="Clinical Guidelines">{{cite web |last1=Information |first1=National Center for Biotechnology |last2=Pike |first2=U. S. National Library of Medicine 8600 Rockville |last3=MD |first3=Bethesda |last4=Usa |first4=Bethesda |title=Methadone maintenance treatment |url=https://www.ncbi.nlm.nih.gov/books/NBK310658/ |publisher=World Health Organization |access-date=3 November 2018 |language=en |date=2009}}</ref> After a physician ensures that the patient voluntarily chooses to receive treatment through a consent form, treatment planning can begin. The patient must show current addiction to an opioid, using accepted medical criteria such as those listed in the [[DSM-5]] and have evidence that he or she became addicted at least 1 year before admission for treatment.<ref name="ReferenceA">“42 CFR 8.12 - Federal Opioid Treatment Standards.” Legal Information Institute, Legal Information Institute, Retrieved November 1, 2018</ref> Before administration of treatment, a clinical evaluation is required asking about drug use history, co-occurring disorders, and impact of substance use on life, along with providing information about the treatment goals and guidelines. A medical evaluation is also given in the form of a [[Clinical urine tests|urinalysis test]], a review of past and current health history, and a test for certain conditions which are known to be prevalent in addict populations, such as HIV, hepatitis, and tuberculosis. The medication is monitored by nursing staff and is prescribed by a [[physician]]. As of 2013, due to the strict changes in receiving prescription pain medication as well as decreases in non-medical prescription use, the requirements to be accepted into methadone clinics have changed in areas such as New York State.
In the United States, there are generally two types of Methadone Clinics, public and private. The public clinics generally are cheaper to attend however, there is usually a waiting list due to limited funding. The private clinics are more expensive to attend but usually have either a short or no waiting list.


==Use of methadone clinics internationally==
⚫
An important part of treatment for addiction is counseling. All Methadone Clinics will offer counseling by regulation. However, the emphasis of counseling will vary widely. At some clinics, counseling is considered complete after 10 minutes with a counselor. Other clinics require attendance at counseling groups as well as individual counseling contacts. It is generally accepted that the more intensive the counseling contacts the individual is willing to submit to, the higher the success rate of the program.
Methadone clinics can provide methadone for on-site administration.<ref>{{cite journal|last1=Lagisetty|first1=Pooja|last2=Klasa|first2=Katarzyna|last3=Bush|first3=Christopher|last4=Heisler|first4=Michele|last5=Chopra|first5=Vineet|last6=Bohnert|first6=Amy|date=2017-10-17|title=Primary care models for treating opioid use disorders: What actually works? A systematic review|journal=PLOS ONE|volume=12|issue=10|pages=e0186315|doi=10.1371/journal.pone.0186315|issn=1932-6203|pmc=5645096|pmid=29040331|bibcode=2017PLoSO..1286315L|doi-access=free}}</ref> Additionally, some methadone clinics provide the following: oversight of treatment, observed dosing, consultation services, urine drug test, [[naloxone]] distribution, mental health services, primary care services, and [[HIV]] and [[Hepatitis C|HCV]] services.<ref name=":0" />


=== United States ===
Although not required by regulation at this time in the United States, people are usually encouraged to attempt other types of treatment methods prior to entering Methadone treatment programs. Most treatment programs will only accept someone to treatment after failure at less intense treatment methods. While not restricted to adults, this treatment method is generally not considered for people under the age of 18.
Before the 1960s, abstinence-based detox was the only option for opioid addicts in the United States and produced high relapse rates. However, in 1965 clinicians at Rockefeller University published a report in the Journal of the American Medical Association of the successful treatment of 22 men addicted to heroin with the use of orally administered methadone. In September 1969 the first methadone maintenance treatment program was created in Washington, D.C by Robert DuPont, M.D, that oversaw 25 parolees.<ref>{{Cite web |title=How treatment for addiction came out of the Dark Ages |url=https://medicine.yale.edu/news/yale-medicine-magazine/article/how-treatment-for-addiction-came-out-of-the/ |access-date=2023-08-14 |website=medicine.yale.edu |language=en}}</ref> Currently methadone must be provided through opioid treatment programs (OTP) in the United States and can not be prescribed in office settings.


Although not required by regulation at this time in the United States, people are usually encouraged to attempt other types of treatment methods before entering methadone treatment programs. Since its use began in the 1960s, methadone is still the preferred choice of treatment at the clinics, and is often part of other protocols. The [[National Institute on Drug Abuse]] (NIDA) provides the protocol of how to treat addiction with recommended options including medication assisted treatment, [[cognitive behavioral therapy]] (CBT), and medical withdrawal management. Other than methadone, newer medications with fewer side effects including [[buprenorphine]] and [[naltrexone]] have been introduced, relieve drug cravings, block opioid effects, and avoid physical dependence. CBT is an individualized treatment plan that allow therapists to explore patterns of maladaptive substance use to help generate alternative behavior skills. Medical withdrawal management ensures safety and comfort by providing long-term monitoring until the symptoms of withdrawals are over.<ref>"What to Know About Methadone Clinics." American Addiction Centers, Retrieved November 1, 2018</ref>
Clinics operate as any other addiction medical facility. The staff usually consist of a physician to monitor the medications and treatments. There will be nurses to administer the medication and ensure effective delivery (i.e.. the person will actually consume the product). Drug counselors will be available for individual and group counseling, and there will be administrative staff to run the administrative functions. Frequently, the clinical operations of the clinic will be housed in a hospital setting although this is not required by US law.

⚫
An important part of treatment for addiction is [[Psychotherapy|counseling]]. Methadone clinics are only for recovering addicts from opioids. Clinics require attendance at counseling groups as well as individual counseling contacts. It is generally accepted that the more intensive the counseling contacts the individual is willing to submit to, the higher the success rate of the program.
Also, an integral part of counseling is on preventing the exposure and transmission of HIV. Clinics should be able to provide or refer patients to various services: community resources, [[vocational rehabilitation]], education, employment, and prenatal-care.<ref name="ReferenceA" /> There is no set guideline for duration of methadone treatment, however, longer treatments are associated with better outcomes. Patients receiving methadone treatment in a closed setting should be assisted when transferring to a community-based setting. Patients who voluntarily decide to stop methadone treatment should speak to their provider to discuss why they want to stop and other treatment options.<ref name="Clinical Guidelines" />

=== Canada ===
In Canada, methadone can be prescribed in office settings and then picked up by patients at their local pharmacies. Regulations for methadone are made at the provincial level in Canada in comparison to the United States where much of the regulations comes from a federal level. While these offices offer counseling services, they are not required in order to receive methadone treatment. This practice coupled with methadone being accessible at community pharmacies makes the treatment more accessible to communities. In 1972, Canada's Narcotics Control Act prohibited the prescription of methadone to patients which stood in effect until 1996 when regulation of methadone became decentralized. Prescribers were still required to receive a federal exemption to prescribe methadone until 2018, during a spike in opioid overdose deaths, when the federal government removed this previously needed authorization. Nurse practitioners are also allowed to prescribe methadone in Canada. There is encouraged communication between the prescriber and pharmacist overseeing the treatment. Methadone will be denied to patients that show up to pharmacies visibly intoxicated or sedated state. In addition to pharmacies, methadone can be dispensed in assisted living facilities, long-term care facilities, and jails/prisons.<ref>{{Cite journal |last1=Kleinman |first1=Robert A. |last2=Brothers |first2=Thomas D. |last3=Danilewitz |first3=Marlon |last4=Bahji |first4=Anees |date=September–October 2022 |title=Office-based Methadone Prescribing for Opioid Use Disorder: The Canadian Model |journal=Journal of Addiction Medicine |volume=16 |issue=5 |pages=499–504 |doi=10.1097/ADM.0000000000000950 |issn=1935-3227 |pmc=9271524 |pmid=35020695}}</ref>

=== Ukraine ===
The epidemic of [[HIV/AIDS in Ukraine]] is quickly growing and was the reason for research into opioid agonist therapies (OAT) in the country as a means to curb the spread of HIV. Ukraine has the highest rate of HIV in Europe at 1.2% and most of the spread of HIV in Ukraine is primarily through people who inject drugs and secondarily through these drug users sexual partners. In 2016, opioid agonist therapies were only being given to 2.7% of the 346,000 people who inject drugs in Ukraine. OAT utilized Buprenorphine starting in 2004 and Methadone in 2008. However, due to the cost of OAT, government regulation prohibits the number of patients that can receive such therapies at a time, meaning a new patient can enter only after another has left. From 2010 to 2013 this number patients remained at a ceiling of roughly 9,000 patients throughout the country. As of 2016 OAT for these 9,000 patients is being administered only by narcologists at 174 licensed treatment centers.<ref>{{Cite journal |last1=Farnum |first1=Scott O. |last2=Makarenko |first2=Iuliia |last3=Madden |first3=Lynn |last4=Mazhnaya |first4=Alyona |last5=Marcus |first5=Ruthanne |last6=Prokhorova |first6=Tanya |last7=Bojko |first7=Martha J. |last8=Rozanova |first8=Julia |last9=Dvoriak |first9=Sergii |last10=Islam |first10=Zahedsul |last11=Altice |first11=Frederick L. |date=January 2021 |title=The real-world impact of dosing of methadone and buprenorphine in retention on opioid agonist therapies in Ukraine |journal=Addiction |volume=116 |issue=1 |pages=83–93 |doi=10.1111/add.15115 |issn=1360-0443 |pmc=7674222 |pmid=32428276}}</ref>

=== Kyrgyzstan ===
Kyrgyzstan has a similar HIV/AIDS problem as Ukraine and to try and combat this, started a trial methadone program within prisons. The first program started in a solo prison is 2002 and expanded to multiple in 2008. It is estimated that half of incarcerated individuals in Kyrgyzstan inject drugs and the use of unsterilized needles and transfer of HIV is higher in the prison setting. While the offering of methadone in prisons would help curb the spread of HIV/AIDS, the internal prison governance of inmates and their reliance on the drug trade is a hard barrier. Heroin being used as currency as well as methadone users being assigned to separate living quarters than non-users creates a social separation between users and non-users. These outcasting factors can make methadone treatment not worth it for some inmates. The number of eligible prisoners using methadone through a methadone program is estimated at only 7%.<ref>{{Cite journal |last1=Liberman |first1=Amanda R. |last2=Bromberg |first2=Daniel J. |last3=Azbel |first3=Lyuba |last4=Rozanova |first4=Julia |last5=Madden |first5=Lynn |last6=Meyer |first6=Jaimie P. |last7=Altice |first7=Frederick L. |date=August 2021 |title=Decisional considerations for methadone uptake in Kyrgyz prisons: The importance of understanding context and providing accurate information |journal=The International Journal on Drug Policy |volume=94 |pages=103209 |doi=10.1016/j.drugpo.2021.103209 |issn=1873-4758 |pmc=8373625 |pmid=33838398}}</ref>

==Effectiveness==
While methadone clinics are generally considered to be effective treatment options for patients addicted to opioids, especially when other interventions have failed, there is controversy surrounding the placement of methadone clinics. There is a perception that the presence of the clinics attracts crime to surrounding areas.<ref name=CrimeStudy /> However, one study by the [[University of Maryland School of Medicine]] found that is not the case, crime rates do not increase when a methadone clinic is opened.<ref name=CrimeStudy>{{cite news |title=Methadone clinics don't attract crime, study finds |author=Andrea K Walker |url=https://www.baltimoresun.com/2012/04/30/methadone-clinics-dont-attract-crime-study-finds/ |newspaper=The Baltimore Sun |date=April 30, 2012 |access-date=May 27, 2012}}</ref> Another study by University of Pennsylvania found within a 200 m radius, the presence of a methadone clinic causes a significant decrease in property and total crime but a significant increase in drug and violent crime.<ref>{{Cite journal |last1=Moyer |first1=Ruth A. |last2=Ridgeway |first2=Greg |date=2020-06-01 |title=The effect of outpatient methadone maintenance treatment facilities on place-based crime |url=https://doi.org/10.1007/s11292-018-9347-1 |journal=Journal of Experimental Criminology |language=en |volume=16 |issue=2 |pages=227–245 |doi=10.1007/s11292-018-9347-1 |s2cid=255131833 |issn=1572-8315}}</ref> A 2004 GAO study notes that placement of clinics can impede recovery and exacerbate relapse:

“Although these clinics are intended to help those in need of rehabilitation, patients who seek treatment must navigate their way to and from the clinics in an environment in which illegal sales of narcotics are daily occurrences. The efforts of patients who are seeking rehabilitation, and clinic professionals who serve them, are significantly undermined by this criminal activity that surrounds them."<ref>See U.S. Gov’t Accountability Office, GAO-04-946T, Drug Rehabilitation Clinics: Illegal Drug Activities Near Some District of Columbia Clinics Undermine Clinic Services and Patient Rehabilitation 4 (2004)</ref>

Between 70 and 90% of patients who discontinue methadone maintenance will relapse.<ref name=Maine>{{cite news |title=Clinicians say giving addicts maintenance methadone serves them and society best |author=Christopher Williams |url=http://www.sunjournal.com/news/maine/2012/05/27/clinicians-say-giving-addicts-maintenance-methadon/1199164 |newspaper=Maine Sun Journal |date=May 27, 2012 |access-date=May 27, 2012}}</ref> The high relapse rate may be partially due to the severity of cases seen at methadone clinics, as well as the long-term effects of opioid use. Some patients stay on methadone for the rest of their lives, which generates criticism regarding the effectiveness of the clinics. Supporters argue that the clinics aim not just to eliminate narcotic addictions, but also to help people function in their lives.<ref name=Maine />

Methadone clinics may decrease the use of emergency rooms by patients addicted to opioids<ref>{{cite journal |last1=Schwarz |first1=Ryan |last2=Zelenev |first2=Alexei |last3=Bruce |first3=Douglas |year=2012 |title=Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence |journal=Journal of Substance Abuse Treatment |volume= 43|issue= 4|pages= 451–7|doi= 10.1016/j.jsat.2012.03.008|pmid=22534003 |pmc=3419304}}</ref>
According to a 2009 Cochrane review, methadone maintenance treatments decreased the likelihood that heroin dependent patients would use heroin, but did not change crime or mortality rates.<ref>{{cite journal |last1=Mattick |first1=Courtney |last2=Breen |first2=Jo |last3=Davoli |first3=Marina |year=2009 |title=Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence |journal=The Cochrane Database of Systematic Reviews |volume=2009 |issue=3 |page= CD002209| doi = 10.1002/14651858.CD002209.pub2 | pmid = 19588333|url=http://researchonline.lshtm.ac.uk/11159/1/Methadone%20maintenance%20therapy%20versus%20no%20opioid%20replacement%20therapy%20for%20opioid%20dependence_GREEN%20VoR.pdf |pmc=7097731 }}</ref>
However, the bulk of the current research supports the hypothesis that methadone clinics do in fact reduce overdose and substance-related crime.<ref>{{cite web|url=https://addiction.surgeongeneral.gov/sites/default/files/Spotlight-on-Opioids_09192018.pdf|title=Facing addiction in America
|website=surgeongeneral.gov|date=29 March 2019
|access-date=26 July 2023}}</ref>

== References==
{{Reflist}}

{{Opioidergics}}

{{DEFAULTSORT:Methadone Clinic}}
[[Category:Substance dependence]]
[[Category:Drug rehabilitation]]
[[Category:Clinics]]
[[Category:Opioids]]

Latest revision as of 11:34, 12 October 2024

A methadone clinic is a medical facility where medications for opioid use disorder (MOUD) are dispensed-—historically and most commonly methadone, although buprenorphine is also increasingly prescribed. Medically assisted drug therapy treatment is indicated in patients who are opioid-dependent or have a history of opioid dependence.[1] Methadone is a schedule II (USA) opioid analgesic, that is also prescribed for pain management. It is a long-acting opioid that can delay the opioid withdrawal symptoms that patients experience from taking short-acting opioids, like heroin, and allow time for withdrawal management.[2] In the United States, by law, patients must receive methadone under the supervision of a physician, and dispensed through the Opioid Treatment Program (OTP) certified by the Substance Abuse and Mental Health Services Administration and registered with the Drug Enforcement Administration.[3]

Regulation and policy

[edit]

In the United States, there are approximately 1,500 methadone clinics that are federally certified opioid treatment programs.[4] There are generally two types of methadone clinics, public and private. The public clinics are generally cheaper to attend. However, there is usually a waiting list due to limited funding. The private clinics are more expensive to attend but usually have either a short or no waiting list. In many parts of the United States, methadone clinics are few and far between, which presents problems for addicts seeking methadone treatment who live far from a clinic. All methadone clinics must register as an accredited opioid treatment program with the Substance Abuse and Mental Health Service Administration and renew yearly or every three years based on the accreditation time frame awarded. Additionally, methadone clinics must register with the Drug Enforcement Administration before methadone can be dispensed.[4] While not restricted to adults, this treatment method is generally not considered for people under the age of 18.

Methadone clinics in the United States operate under strict regulations by state and federal laws. Before entering treatment, a patient must be given adequate information to provide informed consent about starting treatment. This information includes reasons for treatment and recommendations, the side effects and risks of treatment, and rules that must be followed to receive methadone treatment.[1] After a physician ensures that the patient voluntarily chooses to receive treatment through a consent form, treatment planning can begin. The patient must show current addiction to an opioid, using accepted medical criteria such as those listed in the DSM-5 and have evidence that he or she became addicted at least 1 year before admission for treatment.[5] Before administration of treatment, a clinical evaluation is required asking about drug use history, co-occurring disorders, and impact of substance use on life, along with providing information about the treatment goals and guidelines. A medical evaluation is also given in the form of a urinalysis test, a review of past and current health history, and a test for certain conditions which are known to be prevalent in addict populations, such as HIV, hepatitis, and tuberculosis. The medication is monitored by nursing staff and is prescribed by a physician. As of 2013, due to the strict changes in receiving prescription pain medication as well as decreases in non-medical prescription use, the requirements to be accepted into methadone clinics have changed in areas such as New York State.

Use of methadone clinics internationally

[edit]

Methadone clinics can provide methadone for on-site administration.[6] Additionally, some methadone clinics provide the following: oversight of treatment, observed dosing, consultation services, urine drug test, naloxone distribution, mental health services, primary care services, and HIV and HCV services.[4]

United States

[edit]

Before the 1960s, abstinence-based detox was the only option for opioid addicts in the United States and produced high relapse rates. However, in 1965 clinicians at Rockefeller University published a report in the Journal of the American Medical Association of the successful treatment of 22 men addicted to heroin with the use of orally administered methadone. In September 1969 the first methadone maintenance treatment program was created in Washington, D.C by Robert DuPont, M.D, that oversaw 25 parolees.[7] Currently methadone must be provided through opioid treatment programs (OTP) in the United States and can not be prescribed in office settings.

Although not required by regulation at this time in the United States, people are usually encouraged to attempt other types of treatment methods before entering methadone treatment programs. Since its use began in the 1960s, methadone is still the preferred choice of treatment at the clinics, and is often part of other protocols. The National Institute on Drug Abuse (NIDA) provides the protocol of how to treat addiction with recommended options including medication assisted treatment, cognitive behavioral therapy (CBT), and medical withdrawal management. Other than methadone, newer medications with fewer side effects including buprenorphine and naltrexone have been introduced, relieve drug cravings, block opioid effects, and avoid physical dependence. CBT is an individualized treatment plan that allow therapists to explore patterns of maladaptive substance use to help generate alternative behavior skills. Medical withdrawal management ensures safety and comfort by providing long-term monitoring until the symptoms of withdrawals are over.[8]

An important part of treatment for addiction is counseling. Methadone clinics are only for recovering addicts from opioids. Clinics require attendance at counseling groups as well as individual counseling contacts. It is generally accepted that the more intensive the counseling contacts the individual is willing to submit to, the higher the success rate of the program. Also, an integral part of counseling is on preventing the exposure and transmission of HIV. Clinics should be able to provide or refer patients to various services: community resources, vocational rehabilitation, education, employment, and prenatal-care.[5] There is no set guideline for duration of methadone treatment, however, longer treatments are associated with better outcomes. Patients receiving methadone treatment in a closed setting should be assisted when transferring to a community-based setting. Patients who voluntarily decide to stop methadone treatment should speak to their provider to discuss why they want to stop and other treatment options.[1]

Canada

[edit]

In Canada, methadone can be prescribed in office settings and then picked up by patients at their local pharmacies. Regulations for methadone are made at the provincial level in Canada in comparison to the United States where much of the regulations comes from a federal level. While these offices offer counseling services, they are not required in order to receive methadone treatment. This practice coupled with methadone being accessible at community pharmacies makes the treatment more accessible to communities. In 1972, Canada's Narcotics Control Act prohibited the prescription of methadone to patients which stood in effect until 1996 when regulation of methadone became decentralized. Prescribers were still required to receive a federal exemption to prescribe methadone until 2018, during a spike in opioid overdose deaths, when the federal government removed this previously needed authorization. Nurse practitioners are also allowed to prescribe methadone in Canada. There is encouraged communication between the prescriber and pharmacist overseeing the treatment. Methadone will be denied to patients that show up to pharmacies visibly intoxicated or sedated state. In addition to pharmacies, methadone can be dispensed in assisted living facilities, long-term care facilities, and jails/prisons.[9]

Ukraine

[edit]

The epidemic of HIV/AIDS in Ukraine is quickly growing and was the reason for research into opioid agonist therapies (OAT) in the country as a means to curb the spread of HIV. Ukraine has the highest rate of HIV in Europe at 1.2% and most of the spread of HIV in Ukraine is primarily through people who inject drugs and secondarily through these drug users sexual partners. In 2016, opioid agonist therapies were only being given to 2.7% of the 346,000 people who inject drugs in Ukraine. OAT utilized Buprenorphine starting in 2004 and Methadone in 2008. However, due to the cost of OAT, government regulation prohibits the number of patients that can receive such therapies at a time, meaning a new patient can enter only after another has left. From 2010 to 2013 this number patients remained at a ceiling of roughly 9,000 patients throughout the country. As of 2016 OAT for these 9,000 patients is being administered only by narcologists at 174 licensed treatment centers.[10]

Kyrgyzstan

[edit]

Kyrgyzstan has a similar HIV/AIDS problem as Ukraine and to try and combat this, started a trial methadone program within prisons. The first program started in a solo prison is 2002 and expanded to multiple in 2008. It is estimated that half of incarcerated individuals in Kyrgyzstan inject drugs and the use of unsterilized needles and transfer of HIV is higher in the prison setting. While the offering of methadone in prisons would help curb the spread of HIV/AIDS, the internal prison governance of inmates and their reliance on the drug trade is a hard barrier. Heroin being used as currency as well as methadone users being assigned to separate living quarters than non-users creates a social separation between users and non-users. These outcasting factors can make methadone treatment not worth it for some inmates. The number of eligible prisoners using methadone through a methadone program is estimated at only 7%.[11]

Effectiveness

[edit]

While methadone clinics are generally considered to be effective treatment options for patients addicted to opioids, especially when other interventions have failed, there is controversy surrounding the placement of methadone clinics. There is a perception that the presence of the clinics attracts crime to surrounding areas.[12] However, one study by the University of Maryland School of Medicine found that is not the case, crime rates do not increase when a methadone clinic is opened.[12] Another study by University of Pennsylvania found within a 200 m radius, the presence of a methadone clinic causes a significant decrease in property and total crime but a significant increase in drug and violent crime.[13] A 2004 GAO study notes that placement of clinics can impede recovery and exacerbate relapse:

“Although these clinics are intended to help those in need of rehabilitation, patients who seek treatment must navigate their way to and from the clinics in an environment in which illegal sales of narcotics are daily occurrences. The efforts of patients who are seeking rehabilitation, and clinic professionals who serve them, are significantly undermined by this criminal activity that surrounds them."[14]

Between 70 and 90% of patients who discontinue methadone maintenance will relapse.[15] The high relapse rate may be partially due to the severity of cases seen at methadone clinics, as well as the long-term effects of opioid use. Some patients stay on methadone for the rest of their lives, which generates criticism regarding the effectiveness of the clinics. Supporters argue that the clinics aim not just to eliminate narcotic addictions, but also to help people function in their lives.[15]

Methadone clinics may decrease the use of emergency rooms by patients addicted to opioids[16] According to a 2009 Cochrane review, methadone maintenance treatments decreased the likelihood that heroin dependent patients would use heroin, but did not change crime or mortality rates.[17] However, the bulk of the current research supports the hypothesis that methadone clinics do in fact reduce overdose and substance-related crime.[18]

References

[edit]
  1. ^ a b c Information, National Center for Biotechnology; Pike, U. S. National Library of Medicine 8600 Rockville; MD, Bethesda; Usa, Bethesda (2009). "Methadone maintenance treatment". World Health Organization. Retrieved 3 November 2018.{{cite web}}: CS1 maint: numeric names: authors list (link)
  2. ^ Ilene Anderson, Thomas E Kearney (January 200) “Use of Methadone.” Medicine Cabinet. Retrieved November 11, 2018.
  3. ^ Substance Abuse and Mental Health Services Administration (09/28/2015) “Methadone”. Retrieved November 11, 2018
  4. ^ a b c "Medications for Opioid Use Disorder – Pharmacotherapy for Opioid Use Disorder (Part 3 of 5)". Treatment Improvement Protocol. 63. February 2018 – via Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (SAMHSA).
  5. ^ a b “42 CFR 8.12 - Federal Opioid Treatment Standards.” Legal Information Institute, Legal Information Institute, Retrieved November 1, 2018
  6. ^ Lagisetty, Pooja; Klasa, Katarzyna; Bush, Christopher; Heisler, Michele; Chopra, Vineet; Bohnert, Amy (2017-10-17). "Primary care models for treating opioid use disorders: What actually works? A systematic review". PLOS ONE. 12 (10): e0186315. Bibcode:2017PLoSO..1286315L. doi:10.1371/journal.pone.0186315. ISSN 1932-6203. PMC 5645096. PMID 29040331.
  7. ^ "How treatment for addiction came out of the Dark Ages". medicine.yale.edu. Retrieved 2023-08-14.
  8. ^ "What to Know About Methadone Clinics." American Addiction Centers, Retrieved November 1, 2018
  9. ^ Kleinman, Robert A.; Brothers, Thomas D.; Danilewitz, Marlon; Bahji, Anees (September–October 2022). "Office-based Methadone Prescribing for Opioid Use Disorder: The Canadian Model". Journal of Addiction Medicine. 16 (5): 499–504. doi:10.1097/ADM.0000000000000950. ISSN 1935-3227. PMC 9271524. PMID 35020695.
  10. ^ Farnum, Scott O.; Makarenko, Iuliia; Madden, Lynn; Mazhnaya, Alyona; Marcus, Ruthanne; Prokhorova, Tanya; Bojko, Martha J.; Rozanova, Julia; Dvoriak, Sergii; Islam, Zahedsul; Altice, Frederick L. (January 2021). "The real-world impact of dosing of methadone and buprenorphine in retention on opioid agonist therapies in Ukraine". Addiction. 116 (1): 83–93. doi:10.1111/add.15115. ISSN 1360-0443. PMC 7674222. PMID 32428276.
  11. ^ Liberman, Amanda R.; Bromberg, Daniel J.; Azbel, Lyuba; Rozanova, Julia; Madden, Lynn; Meyer, Jaimie P.; Altice, Frederick L. (August 2021). "Decisional considerations for methadone uptake in Kyrgyz prisons: The importance of understanding context and providing accurate information". The International Journal on Drug Policy. 94: 103209. doi:10.1016/j.drugpo.2021.103209. ISSN 1873-4758. PMC 8373625. PMID 33838398.
  12. ^ a b Andrea K Walker (April 30, 2012). "Methadone clinics don't attract crime, study finds". The Baltimore Sun. Retrieved May 27, 2012.
  13. ^ Moyer, Ruth A.; Ridgeway, Greg (2020-06-01). "The effect of outpatient methadone maintenance treatment facilities on place-based crime". Journal of Experimental Criminology. 16 (2): 227–245. doi:10.1007/s11292-018-9347-1. ISSN 1572-8315. S2CID 255131833.
  14. ^ See U.S. Gov’t Accountability Office, GAO-04-946T, Drug Rehabilitation Clinics: Illegal Drug Activities Near Some District of Columbia Clinics Undermine Clinic Services and Patient Rehabilitation 4 (2004)
  15. ^ a b Christopher Williams (May 27, 2012). "Clinicians say giving addicts maintenance methadone serves them and society best". Maine Sun Journal. Retrieved May 27, 2012.
  16. ^ Schwarz, Ryan; Zelenev, Alexei; Bruce, Douglas (2012). "Retention on buprenorphine treatment reduces emergency department utilization, but not hospitalization, among treatment-seeking patients with opioid dependence". Journal of Substance Abuse Treatment. 43 (4): 451–7. doi:10.1016/j.jsat.2012.03.008. PMC 3419304. PMID 22534003.
  17. ^ Mattick, Courtney; Breen, Jo; Davoli, Marina (2009). "Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence" (PDF). The Cochrane Database of Systematic Reviews. 2009 (3): CD002209. doi:10.1002/14651858.CD002209.pub2. PMC 7097731. PMID 19588333.
  18. ^ "Facing addiction in America" (PDF). surgeongeneral.gov. 29 March 2019. Retrieved 26 July 2023.
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