Opioid Treatment

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We are thinking about starting a methadone program in our jail, but we don’t know where to begin. What advice can you give us?

If you are considering an opioid treatment program using methadone, by federal law, OTPs based in correctional facilities must obtain certification from the Substance Abuse and Mental Health Services Administration. To become certified, the OTP first must be accredited by a federally approved body—which NCCHC is, and we offer OTP accreditation. The NCCHCStandards for Opioid Treatment Programs in Correctional Facilities are based on federal regulations but address the special nature of care provided in correctional facilities as well as the necessarily limited focus of such treatment in this setting. For more information, including how to obtain the Standardsclick here.
— From CorrectCare Volume 25, Issue 4, Fall 2011

 
 

Is there any resource about the use of methadone to treat drug addiction in jails? Whenever I raise the subject, our facility physician says it’s just substituting one drug for another. Our sheriff says such a program is more trouble than it is useful.

Addiction to heroin, morphine and some prescription opioids is a major problem in many communities. Our country has a long history with the use of opioids; they were even used during the Civil War to reduce pain. Perhaps because of this long-term experience with opioids, there are many misconceptions about the treatment of opioid addiction.

There are two schools of thought about treatment. The first is that this addiction originates because the person is weak-willed and lacks the individual strength to resist drugs. Other environmental or psychological factors may also contribute to addiction. In this model, abstinence is the only way to treat. The second approach is that opioid addiction is an incurable disease that requires long-term maintenance with medication—just as for hypertension or diabetes. Known as medication-assisted treatment (MAT), this approach is advocated by the American Society of Addiction Medicine, a supporting organization of NCCHC. Working with SAMHSA and CSAT, NCCHC has developed an educational CD-ROM on MAT and the use of methadone in correctional facilities and will send it to jails and prisons this summer. You may find it helpful in answering the objections that your medical director and sheriff have raised.
— From CorrectCare Volume 21, Issue 2, Spring 2007

 
 

This question concerns use of methadone in jails. From a session at the 2004 National Conference, I understood that methadone should not be used in jails except for pregnant inmates, for whom it is imperative that she not miss any doses. Now I read an article in CorrectCare (Vol. 19, Issue 1) that encourages continuation of methadone if the person is in a maintenance program. Which is it? Should we continue it or not? What if the person comes in on methadone prescribed by his primary care physician for chronic pain? I have an inmate now in that situation, with a medical history that precludes the use of NSAIDs or Tylenol, and we generally do not use narcotics for chronic pain. We want to be doing the correct thing.

Your questions are timely. The use of methadone to treat opioid dependence—not to mention its use in correctional settings—remains controversial, and experts sometimes differ in their recommendations.

Based on new research findings, however, the leading view in the field of addiction treatment now is that some opioid-dependent persons need methadone analogous to the need of some diabetics for insulin. Methadone has become part of the community standard of care as a method of detoxification, and methadone maintenance is one of several legitimate treatments for opioid addiction. As such, its use is to be expected in correctional settings, especially jails.

Naturally, use of this controlled substance is highly regulated by federal authorities. So if your jail (or any other correctional facility) decides to operate an on-site opioid treatment program that uses methadone, your OTP must obtain certification and accreditation as required by the federal Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment, which regulates OTPs.

Such requirements may not apply in some circumstances, such as the medical use of methadone solely for pain control and/or to protect the fetus in an opioid-dependent pregnant woman, or the use of buprenorphine by a trained physician. The only way to be sure you are operating within the law, though, is to contact SAMHSA/CSAT.

Required federal certification is contingent upon accreditation by a CSAT-approved accrediting body (AB). The only AB that focuses on corrections, NCCHC based its OTP accreditation standards on federal regulations but with attention to the special nature of correctional facilities. (See the 2004 Standards for Opioid Treatment Programs in Correctional Facilities.)

Federal grant money is available for technical assistance and, at least for the next two years, subsidies of OTP accreditation fees. Please contact NCCHC for assistance on these issues.
— From CorrectCare Volume 19, Issue 3, Summer 2005