Methadone maintenance treatment in the U.S. : a practical question and answer guide / Wendee M. Wechsberg & Jennifer J. Kasten ; with contributions from Nancy D. Berkman & Amy E. Roussel.

Format:

Book

Author/Creator:

Wechsberg, Wendee M.

Contributor:

Kasten, Jennifer J.

Language:

English

Subjects (All):

Methadone maintenance--United States--Miscellanea.

Methadone maintenance.

Methadone--therapeutic use.

United States.

Opioid-Related Disorders--rehabilitation.

Substance Abuse Treatment Centers--organization & administration.

Medical Subjects:

Methadone--therapeutic use.

United States.

Opioid-Related Disorders--rehabilitation.

Substance Abuse Treatment Centers--organization & administration.

Genre:

Trivia and miscellanea.

Physical Description:

xviii, 198 pages : illustrations ; 23 cm

Place of Publication:

New York : Springer, [2007]

Summary:

Methadone maintenance treatment (MMT) has been the primary form of treatment for opiate dependence in the U.S. for over 40 years. In the United States alone, there are more than 1,200 MMT programs, with an estimated staff of 20,000, serving more than 200,000 patients annually. Yet, to date, there has been no comprehensive, user-friendly professional reference book on these programs.

This book fills that gap with information garnered from over 100 MMT programs nationwide and is written for a diverse audience-including clinicians, program administrators, policymakers, substance abuse treatment researchers, and other health service professionals. This professional guide will help those who want to learn about all aspects of MMT, especially those interested in establishing new programs, by offering: Insights into the effectiveness of methadone, Characteristics of successful methadone treatment programs (budgets, services, staff, etc.), Core treatment services that an MMT program must provide, Dosing practices, Funding, regulation, and accreditation issues.

Contents:

Why do we need a user-friendly book on methadone treatment? 1

What is methadone maintenance treatment? 2

What are some pharmacologic alternatives to methadone treatment? 3

What is the history of opiate addiction and treatment in the United States? 5

What is the scope of opiate abuse in the United States today? 6

How is injecting drug use associated with hepatitis and HIV? 9

Do communities support MMT? 13

How does MMT act as a harm-reduction strategy? 14

Chapter 2 The Effectiveness of Methadone and the History of Regulation 17

Is MMT effective? 17

What is the history of MMT regulation in the United States? 19

What is the quality of MMT services? 22

How has MMT regulation changed in the United States? 24

What impact does the new regulatory system have on how MMT is provided? 27

Why was an evaluation of accreditation needed? 29

Chapter 3 The Accreditation Evaluation Study 31

What is the Accreditation Evaluation Study? 31

What was the Evaluation Study's design? 31

Who participated in the Evaluation Study? 32

What data were collected? 35

How were the data analyzed? 36

How did the Evaluation Study change from its inception? 37

Chapter 4 Methadone Maintenance Treatment Program Characteristics 39

How many patients do MMT programs serve? 39

Who owns MMT programs? 40

Where are MMT programs located? 40

How long have MMT programs been operating? 41

How stable are MMT programs? 41

How do MMT programs assess and evaluate patient needs? 42

What quality assurance activities are used to assess performance? 46

Do MMT programs differ in their treatment orientation? 47

How do MMT programs provide services during an emergency or disaster? 51

Do MMT programs seek input from their communities? 52

Chapter 5 Core and Ancillary Methadone Maintenance Treatment Services 53

What services do MMT programs provide? 53

What services do MMT patients report receiving? 55

How do MMT programs provide core and ancillary services? 56

How does service delivery differ by organizational ownership and size? 60

What specialized services do MMT programs provide to vulnerable populations? 61

Chapter 6 Dosing Practices in Methadone Maintenance Treatment Programs 64

What are the principal approaches to methadone dosing? 64

How is methadone administered? 65

What dosing levels are used in MMT? 65

What restrictions are placed on initial methadone dosing? 66

What is the average MMT dosage? 67

What approaches do physicians use to establish dosages? 70

What are take-home privileges? 71

Who makes the decision for a patient to receive take-home privileges? 73

How many patients receive take-home privileges? 74

What is diversion? 75

How do MMT direct care staff prevent methadone diversion? 78

What is methadone-associated mortality? 80

Chapter 7 The Costs and Funding of Methadone Maintenance Treatment 83

How much does MMT cost? 84

What are the costs of specific MMT services? 86

How is MMT funded? 95

Chapter 8 Direct Care Staff and Their Activities 98

Who provides MMT services? 98

Who are the direct care staff? 99

Are there staff differences by race in MMT? 101

Are there staff differences by age? 101

Are there staff differences by educational level? 102

How many direct care staff report being in recovery? 103

What certifications have direct care staff completed? 103

Who are the physicians providing MMT services? 104

How long have direct care staff and physicians worked in substance abuse treatment in general and MMT in particular? 106

How do MMT program staff spend their time? 107

Are MMT program staff encouraged to attend ongoing training? 110

What is the retention rate among MMT direct care staff? 111

What are the perceptions of direct care staff about treatment services and working environments? 111

Chapter 9 Methadone Maintenance Treatment Patients 115

Who are the patients receiving MMT services? 115

How do MMT patients today compare with patients from previous national studies on substance abuse treatment? 115

How do the general characteristics of MMT patients differ by gender and race? 117

How have MMT patient gender and racial characteristics changed over the past decade? 118

How many MMT patients are involved with the criminal justice system? 120

How long do MMT patients stay in treatment? 121

What is the physical health status of patients in MMT? 122

What is the physical health status of patients in MMT, by gender and race? 122

What is the psychological health status of patients in MMT? 123

What is the psychological health status of patients in MMT, by gender and race? 125

What substances do patients report using before and during MMT? 126

How does substance use by MMT patients differ by gender and race? 128

What treatment services do MMT patients report receiving? 130

How do treatment services received differ by gender and race? 131

Do patients report being satisfied with MMT services? 134

Chapter 10 Accreditation Outcomes 136

Why was accreditation recommended for MMT? 136

What does accreditation assess? 138

What are the possible accreditation outcomes? 139

Were MMT programs accredited before being required to seek accreditation under the new regulations? 141

In what areas are MMT programs performing well or needing improvement? 142

What is the cost to MMT programs of pursuing accreditation? 147

How many staff hours are needed to prepare for accreditation? 150

Chapter 11 Regulation of Methadone Maintenance Treatment 153

How does the federal government regulate MMT? 153

How do states regulate MMT? 153

What do states regulate? 154

How do states vary in their regulation of MMT? 154

How does state funding work with state regulation? 157

What do states think about regulatory change? 157

How do local jurisdictions regulate MMT? 159

Chapter 12 Summary and Future Challenges 160

What is the current state of MMT? 160

Is MMT becoming a streamlined service? 161

How will FDA approval of buprenorphine change the landscape of opiate dependence treatment? 162

How can MMT continue to play a role in reducing the spread of HIV and HCV? 164

How will the characteristics of the MMT patient population change? 165

What does the future hold for MMT professionals? 165

Will the quality of care change? 166

What impact does stigmatization have on the future of MMT? 167

How can lessons from opiate dependence treatment be shared internationally? 168

What does the future hold for MMT? 168

Appendix A Opiates and Opioids 175.

Notes:

Includes bibliographical references (pages 185-195) and index.

ISBN:

0826101305

9780826101303

OCLC:

84900352