Making Residential Treatment Available to Methadone Clients Oakland, California

Zweben, Joan E.; Aly, Tanya; Martin, Judith; Wengrofsky, Susan; Bacci, Joanne; Meddaugh, Robert

doi:10.1016/s0740-5472(98)00073-7

Cited by 10 publications

(18 citation statements)

References 5 publications

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“…However, Zweben and colleagues (1999) also describe some practical operational concerns that may serve to prevent equal access to care. As they describe, “residential programs vary widely in their sophistication, and some have little or no experience in dealing with medication and related matters” (Zweben, 1999, pp.250). Consequently, these programs may feel unable to adequately address issues such as safe storage, monitoring patient dosage, and collaborating with physicians and methadone programs.…”

Section: Contributing Factorsmentioning

confidence: 99%

“…Greenberg, Hall, & Sorensen (2007) point out that there was similar ideological contention years ago, when psychiatric medications were first being utilized in addiction treatment centers, but now psychiatric medications are seen as the standard of care for patients with co-occurring disorders. In addition, at least two published articles have demonstrated that the potential barriers to integration of MMT and residential treatment can be successfully overcome with appropriate staff training and collaboration between sites (Zweben et al, 1999, Sorensen et al, 2009). …”

Section: Arguments In Support Of Increasing Access To Carementioning

confidence: 99%

“…In fact, many substance abuse treatment providers assert that MMT is incompatible with recovery and the abstinence-based treatment models of most residential treatment programs. Methadone maintenance program staff have reported years of frustration in trying to obtain residential treatment services for their MMT patients, as many state-licensed and publicly funded residential treatment programs have policies in place that explicitly deny access to care for MMT patients (Zweben et al, 1999). This paper is not intended to an exhaustive critique of access to care issues for MMT patients, but proposes to focus on several key factors that may contribute to access to care problems in the United States, offer several arguments in favor of increasing access to care, and provide some practical recommendations for increasing access to care for this population.…”

Section: Introductionmentioning

confidence: 99%

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Access to Care for Methadone Maintenance Patients in the United States

Hettema

Sorensen

2009

Int J Ment Health Addiction

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This policy commentary addresses a significant access to care issue that faces methadone maintenance patients seeking residential treatment in the United States. Methadone maintenance therapy (MMT) has demonstrated strong efficacy in the outpatient treatment of opiate dependence. However, many opiate dependent patients are also in need of more intensive interventions, such as residential care. Many publically-funded residential treatment programs explicitly decline to admit MMT patients, contending that methadone raises both clinical and administrative problems in treatment. Although advocates within the field believe that this issue is a violation of the American's with Disabilities Act (ADA) in the United States, no lawsuits have been brought forth, and there is no legal precedent or public policy to inform the debate. The present paper provides an overview of this problem and discusses factors that may contribute to the problem, including an abstinence-oriented philosophy and treatment program operational concerns. The paper also draws parallels between methadone and other medical conditions and analyzes the problem in the context of disabilities encompassed in the ADA. Finally, recommendations on strategies for increasing access to residential care for MMT patients are provided.

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Section: Contributing Factorsmentioning

confidence: 99%

Section: Arguments In Support Of Increasing Access To Carementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Access to Care for Methadone Maintenance Patients in the United States

Hettema

Sorensen

2009

Int J Ment Health Addiction

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“…Indeed, in a review of opioid detoxification methods, including newer approaches such as anesthesia-assisted detoxification and the use of naltrexone, O'Connor (2005: 962) stated " ... for a significant proportion of opioid-dependent patients, especially those with a high level of dependency and long-term drug use, al l detoxifica tion-based approaches, regardless of the specific method used, are likely to be ineffective." Despite this compelling evidence, MMT is not a popular treatment for residential programs (Zweben et al 1999). Considering the common practice of tapering patients in residential treatment, one would expect to find evidence that tapering was safer, yet the literature does not indicate this is a safe decision.…”

Section: Maintenance Ve Rsus Tapermentioning

confidence: 99%

Methadone Maintenance Therapy in Residential Therapeutic Conmmunity Settings: Challenges and Promise

Greenberg¹,

Hall

Sorensen

2007

Journal of Psychoactive Drugs

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The therapeutic community (TC) and methadone maintenance treatment (MMT) have individually demonstrated consistent positive outcomes yet rarely have been combined. This article describes how a well-established residential therapeutic community integrated methadone maintenance treatment into its activities. Practical recommendations regarding how to incorporate MMT in a residential program are provided including topics for staff (training, coordination with the methadone service provider agency), patients (education, confronting stigma about methadone maintenance), and potential therapeutic activities (methadone group therapy). The implementation of these staff, patient, and therapeutic adaptations can assist residential substance abuse treatment programs in integrating these two addiction treatment modalities.

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“…Relapse to illicit opioid use during or after discontinuation would indicate strongly that abstinence is not an appropriate treatment goal for the particular patient and MMT should be resumed. Zweben et al (1999) describe a need for more programs that integrate clients on MMT into eventual abstinence-based treatment.…”

Section: Users Of Oral Prescription Opioidsmentioning

confidence: 99%

Management of Opioid Dependence in Pregnancy: A Review of the Evidence

Young

2007

Int J Ment Health Addiction

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Conventional wisdom regarding management of opioid dependence in pregnancy calls for methadone maintenance in nearly all cases. The scientific literature and historical background upon which this recommendation is based, newer evidence indicating the safety of methadone discontinuation during pregnancy and recent studies raising concerns about the effects of methadone on the fetus and neonate are reviewed. More flexibility in the management of opioid dependence during pregnancy is recommended.

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Making Residential Treatment Available to Methadone Clients Oakland, California

Cited by 10 publications

References 5 publications

Access to Care for Methadone Maintenance Patients in the United States

Access to Care for Methadone Maintenance Patients in the United States

Methadone Maintenance Therapy in Residential Therapeutic Conmmunity Settings: Challenges and Promise

Management of Opioid Dependence in Pregnancy: A Review of the Evidence

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