The Methadone Intake Process -- Your First Appointment



Those looking to methadone as a possible treatment option have questions about what happens at their first appointment.  Once you’ve chosen a clinic and verified that they have available slots, you’ll go through what is known as the intake process.  The intake process varies from clinic to clinic and state to state, but there are some basic procedures that are uniform throughout all clinics.  So what goes on at your intake appointment?

You will first meet with a nurse or a counselor.  Once they verify that you are at least eighteen years old, they will discuss methadone treatment with you.  They want to ensure that you understand what methadone treatment entails, and that you are making an informed decision to begin treatment.  Often payment is discussed at this stage in the intake.  Methadone clinics are generally broken in to two groups: public, non-profit clinics, and for-profit clinics.  The public clinics accept Medicaid and may also have paying clients.  The for-profit clinics sometimes accept insurance, but most often expect to be paid in cash, up front.  The clinician will discuss penalties for non-payment or late payment, including the notorious “feetox”.  In a nutshell, if you are in treatment but suddenly find yourself unable to pay for a certain period of time (usually a week, but sometimes more and sometimes less), the clinic will institute a “feetox”.  Once the clinic starts feetoxing you, they will rapidly bring your dose down a certain number of milligrams per day, for several days, until it is zero.  Then you will be kicked out of the program.  It’s brutal, but it’s legal.

You will next have the clinical evaluation.  You will be asked about your drug history.  You should be open and honest at every step of the intake process, but especially here.  You will discuss your history and the reasons you use drugs, including any mental health issues you may have.  Most state laws require that you be addicted to an opiate (not necessarily heroin, but also Oxycontin, etc.) for a period of at least one year before starting treatment.  During the clinical evaluation you will continue to discuss the program, and you will start signing many, many forms.  The issues the forms address include consent to treatment, emergency notification, hospital admissions history, release of personal information, and much more.

Once you fill out all the forms and discuss the methadone program, you will often meet with the clinic’s physician.  Before this, you will have to give a urine sample.  This is primarily to check for the presence of illegal drugs.  When you meet with the clinic’s doctor, you will undertake a medical evaluation.  The doctor will take an in-depth history of any past or current health problems you may have.    The doctor will ask you about any medications you take, and will conduct a physical exam to make sure that you are healthy enough to begin treatment.  Once the exam is completed and the doctor is satisfied that you are ready to begin treatment, you will receive your first dose of methadone.
The first dose of methadone you receive is known as the induction dose.  It is usually thirty milligrams.  It could be less depending on the severity of your habit, but it is never more.  You will be warned to watch carefully for signs of overdose, and then sent home.
In the days following your first dose, the dispensing nurse will monitor you and ask you how you are feeling.  They are primarily concerned with how the methadone dose is controlling your withdrawal symptoms.  If you are still having symptoms, your dose will be slowly adjusted until you receive the “right” dose. 


10 comments:

  • pete says:
    April 27, 2012 at 5:02 PM

    I believe the induction dose is 40 mgs and sometime given in 20 mg doses 30 minutes apart

  • Grey says:
    April 28, 2012 at 5:29 AM

    Hey Pete -- good catch. I believe the induction dose varies from clinic to clinic. Apparently the maximum initial dose allowed by federal law is 30 milligrams, but more may be given later if withdrawal symptoms persist. There is a maximum total allowable federal induction dose of 40 milligrams on the first day of induction.

    Thanks so much for reading and commenting!

    ...

    Initial Dosing
    Once again, TIP 43 provides the most comprehensive reference in providing guidance to OTPs during the induction phase.

    “For patients actively abusing opioids, a typical first dose of methadone is 20-30mg and it is limited by regulations to no more than 30mg. If withdrawal symptoms persist after 2-4 hours, the initial dose could be supplemented with another 5-10mg. The total first day dose of methadone allowed by federal regulations is 40mg unless a program physician documents in the patient record that 40mg is insufficient to suppress opioid withdrawal symptoms.”

  • wayovermyhead says:
    May 7, 2012 at 8:04 PM

    I received 30 milligrams and two hours later an additional 10 milligrams my first day

  • Grey says:
    May 8, 2012 at 5:06 AM

    way: that's interesting. I received 30, and that's it. Maybe I told them that my withdrawal was gone -- it was a long time ago, I don't remember.

  • Ray Ashton says:
    December 10, 2012 at 5:57 PM

    You could actually visit a 24 hour urgent care phoenix if you have any doubts or worries about the medicine you'll be taking, cause the staff there are all professionals and they could help you in any concern as long as it is health-related.

  • Jonathan Park says:
    January 7, 2013 at 9:09 PM

    Thanks a lot for the tips. I'm really anxious when I try something new like that meditation courses I took a couple of months ago. I'm so glad it worked out fine. I just hope my luck won't run out on this one.

  • Liberty Silvagni says:
    January 10, 2013 at 3:21 AM

    I seriously need to hire a virtual assistant. After being appointed as the vp for sales, I always forget to make it to my medical appointments. A little reminder from someone would do.

  • Christine stem says:
    January 20, 2013 at 12:25 PM

    My boyfriend was abusing heroin and just started on a methadone clinic its day 3 and he sleeps a lot and he has been irritable and mean I guess...I Dont understand all of this, I just want this nightmare over, he wants to take drugs at night, he's dosed in the morning and by early evening, about dinner time he becomes Mr Hyde..I Dont know how to interact with him..what should I be doing to support him?? And protect myself? I feel borderline crazy...

  • ivy valentine says:
    September 16, 2013 at 10:42 PM

    I'm going to method clinic for first time tomorrow.. all I have in my system is suboxone, I couldn't find any pain pills. And didn't want to withdraw.. will they accept me with suboxone n my system?

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