Special Treatment Issues

Methadone Maintenance Treatment: A Community Planning Guide

On this page:

• Concurrent Psychiatric Disorders
• Polysubstance Use
• Hepatitis C
• HIV/AIDS
• Pregnancy
• Criminal Justice Issues

As most professionals in the social service field are aware, working with substance abusers can be difficult and present a number of different challenges. The complexity of each case can increase depending upon the types, intensity and number of issues that the individual is experiencing. Methadone patients may present professionals with problems in areas such as psychiatric disorders, polysubstance use, hepatitis C, HIV/AIDS, pregnancy and criminal justice. During the development of methadone treatment services, the working group and providers need to be prepared to address and take into account these special needs. Listed below are issues along with some of the special considerations that should be reviewed as services are developed.

Concurrent Psychiatric Disorders

According to the research, a substantial number of individuals who have opioid dependence problems have co-existing mental health problems. A study by Strain, Bronner and Bigelow (1991) showed that almost 50% of clients in methadone maintenance treatment had a history of non-substance use psychiatric diagnoses with the most common ones being Antisocial Personality Disorder and Major Depression (12).

The implication for the community is that methadone patients need to be screened for mental health problems. It is recommended that screenings be completed at three month intervals. Treatment planning for this group should be based upon individual need. If the client is to be seen by both providers in the addiction and mental health systems, the treatment must be coordinated. Historically, these two systems have not worked closely together considering they may be working with the same clients. As discussed earlier, communication, case conferences and joint training workshops may assist in bringing these two systems together.

Polysubstance Use

A barrier to the effectiveness of methadone maintenance treatment is polysubstance use. Substances which are commonly abused by methadone patients include heroin, cocaine, alcohol and benzodiazepines. Some of the negative effects of polysubstance use include: higher incidence of HIV through shared needles and unprotected sex, increased criminality, increased diversion of methadone and poor treatment retention . Counselling interventions in the area of mental health, employment and case management assist in decreasing relapse rates. Ball and Ross (1991) concluded that programs with counselling options had lower rates of polysubstance use as compared to those which did not have those options (11).

Hepatitis C

A significant number of methadone patients have hepatitis C with contaminated needles and syringes being the most probable causes of transmission. Some studies have shown that the rates of hepatitis C in injection drug users ranges from 65-80 per cent (13). All methadone patients should have a hepatitis serology ordered by their physician. Depending upon the results, some patients may require to be seen by a hepatologist.

Clients with hepatitis C should be educated about the risks of spreading the disease. It is recommended that "hepatitis C carriers avoid multiple sexual partners, practice safe sex to reduce contact with blood and body fluids, and inform prospective sexual partners of their hepatitis C status"(14). Hepatitis C patients should also avoid sharing items such as toothbrushes or razors because these items may contain contaminated blood.

HIV/AIDS

Opioid-dependent clients with HIV should be given priority access to methadone treatment. Some clinics, such as the CAMH Opiate Clinic in Toronto, allow this group to enter treatment immediately because of their health status. Part of the rationale is that the risk of the individual contracting other strains of the virus and also for transmitting the disease is lowered. In addition, these clients can experience positive health benefits from their involvement in methadone treatment.

Pregnancy

Compared to the risks associated with continued opioid use, the use of methadone during pregnancy is safe for both the mother and the fetus. Studies have shown there are no long-term negative effects on the fetus as a result of the mother's involvement in a supervised course of methadone maintenance treatment. As in the case of HIV/AIDS, expectant mothers should be accepted into treatment immediately. Some of the advantages of methadone treatment include: better prenatal care and nutrition, improved birth weight and decreased infant mortality (15).

Ancillary and support services in the areas of prenatal, child-care and parenting classes should be part of the treatment regimen for this group. Community agencies like the local public health unit should be utilized and consulted to assist in providing information to clients about these valuable programs. Information on accessing housing, food, financial assistance and specialized supplies for the baby such as furniture and clothing should be made available to the mother and family members.

Criminal Justice Issues

Some clients presenting for treatment may have a history of involvement with the criminal justice system. Due to their criminal background, they may have outstanding charges which need to be addressed. For those clients who may have to be incarcerated to deal with these convictions, considerations need to be taken into account as to the continuation of methadone treatment while in a provincial or federal institution. Each system currently has existing policies and protocols for methadone treatment. However, it may be beneficial for the case manager to review with the institution their ability to comply with these regulations. The implication being that if the facility is not able to meet the client's needs, arrangements may have to be made to transfer this individual to another institution. In some instances, these transfers may take several weeks to prepare which means that the counsellor/case manager may want to explore this issue as soon as possible.

For institutions which offer methadone maintenance treatment within the facility, communication protocols should be established with the clients's community physician to ensure that the person is receiving optimal care. Special arrangements may also need to be established with local pharmacies for the dispensing and delivery of methadone to the institution.

Next>> Community Development Troubleshooting Guide

Methadone Maintenance Treatment: A Community Planning Guide

1. Preface
2. Introduction - How to Use the Guide
3. Methadone Maintenance Treatment - Rationale and Benefits
4. Methadone Maintenance Treatment - Service Components and Delivery Models
5. Critical Stages in the Development of Methadone Maintenance Treatment Services
   1. Identification and Verification of Need
   2. Establishment of a Community Working Group
   3. Methadone Maintenance Treatment Model Development
   4. Implementation
   5. Evaluation
6. Continuity of Care for Methadone Patients
7. Special Treatment Issues
8. Community Development Troubleshooting Guide
9. Appendix - Methadone Fact Sheet
10. References
11. Recommended Resources

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