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The Future of Narcotic Addiction
Published in Albert A. Kurland, S. Joseph Mulé, Psychiatric Aspects of Opiate Dependence, 2019
Albert A. Kurland, S. Joseph Mulé
A sensitive indicator and a case in point is the consequences that follow in the aftermath of an increasing number of substance abusers, especially polydrug users. This phenomenon usually foretells an increase in the number of those who eventually may be resorting to opiates. As the number of opiate addicts grows, more individuals will seek treatment, placing increased demands on treatment resources already suffering from many limitations, a consideration that has already found expression in the concern over the functioning of the methadone clinics. In a discussion of the current status of the methadone programs 10 years after the original optimistic report on their pioneering experiences, Dole and Nyswander4 complained bitterly of “politically inspired controls resulting in jammed clinics, with addicts processed on a take-it-or-leave-it basis with little or no effort made to provide the supporting counseling or job help that contributed towards making their original experiments so successful.” Consequently, there follows a corrosion of the morale of patients and staff, with the great majority of heroin addicts continuing to remain on the streets, thereby adding to the spread of the disorder as the programs lose their ability to attract attention.
The methadone game: control strategies and responses
Published in Jane Fountain, Dirk J Korf, Drugs in Society, 2019
During my study on the everyday life of methadone maintenance clients in Denmark, it became clear that in addition to the official and medical aims of stabilising and ‘normalising’ drug addicts, methadone and methadone maintenance treatment serve other important purposes. In this chapter, I will describe how methadone and methadone clinics can be seen as central means of controlling and disciplining drug addicts. I will illustrate how the clients respond to this surveillance and control, and finally I will demonstrate that, in the views and hands of the clients, methadone represents far more than a medical substitute for heroin.
Narcotic Addiction
Published in Mark S. Gold, R. Bruce Lydiard, John S. Carman, Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
Mark S. Gold, Charles A. Dackis, A. L. C. Pottash, R. Bruce Lydiard
The advent of methadone maintenance in the treatment of opiate addiction introduced the concept of eliminating dysfunctional drug use rather than drug use itself. Methadone clinics have provided the addict with a stable source of drug, eliminating the disruptive need to procure supplies. Substitution of heroin with methadone enables the avoidance of illegality, and the exposure to the criminal life style and multiple medical illnesses so often associated with drug-seeking behavior. The psychological craving is reduced and the individual can function more effectively as the cost and frequency of drug taking decreases. However, methadone maintenance is not in itself a treatment but rather a drug delivery system which is not acceptable to all individuals. Many individuals desire complete abstinence or prefer treatment in a private setting where they can reduce the risk of exposure to criminal elements. Others are abstinent but in danger of relapse.
Continuity of illicit drug use among Malay patients attending methadone clinics in Kelantan, Malaysia
Published in Journal of Ethnicity in Substance Abuse, 2023
Syazilawaty Ab Lloh, Noraini Mohamad, Salziyan Badrin, Ruzilawati Abu Bakar, Imran Ahmad
However, studies in Malaysia have shown the alarming prevalence of continuation of drug use among patients attending methadone clinics in the past 10 years. Even though continuation of drug use, either clinically proven by urine tests or by patients’ self-report, is not a criterion for patients to be terminated from the treatment program, the impact posed by this problem and its high-risk-related behaviors, such as needle sharing and involvement in drug-related criminal activities, should not be taken lightly or ignored (Salleh & Hatta, 2000). Previous studies suggested that continuity of illicit drug use among patients in a methadone program is associated with inadequate dosage, low motivation to change, and environmental factors such as family problems (Ali et al., 2018; Mamat et al., 2020).
Preparing for the future of medical education: A case series of traditional and virtual clinical rotations in addiction medicine spanning the COVID pandemic
Published in Substance Abuse, 2022
Curtis Bone, Nils Wendel, Shou Ling Leong, Bethany Snyder, Heather Costigan, Joy Bowen, Jarrett Sell, Sarah Kawasaki, David Giampetro, Don Dissinger, Bill Milchak, Alexis Reedy-Cooper, Heather Stuckey
The traditional addiction medicine elective, prior to the COVID pandemic, was a 4-week rotation that was structured around the competencies established by the state of Pennsylvania for medical education. Clinical time during this elective was evenly split between shadowing and patient care activities in four settings: a methadone clinic, an outpatient chronic pain clinic, an inpatient pain consult service, and an inpatient addiction consult service. Additionally, students attended an AA meeting while accompanied by the course director. Students were also tasked with development of a presentation on a topic of their choosing at the close of the elective. Finally, these students participated in a summative assessment involving a standardized patient case of chronic pain and opioid use disorder (Appendix).
Perceived impact of COVID-19 on prevention, treatment, harm reduction, and recovery services for opioid use disorder: National survey of local health departments
Published in Substance Abuse, 2022
William L. Swann, Terri L. Schreiber, Serena Y. Kim, Heidi McNeely, Jake H. Hong
Notably, 72.2% (95% CI = 62.7–80.0%) of LHDs reported continuing telehealth/telemedicine options for OUD at an increased level. Other services were increased at a lower frequency. Counselors (addiction counselors) to provide non-medication treatment for OUD (12.4%, 95% CI = 7.5–19.8%) and medications for opioid use disorder (MOUD) (10.0%, 95% CI = 5.7–16.7%), including methadone clinics or office-based buprenorphine or naltrexone, were reported as the next two highest in the treatment area. In harm reduction, 23.8% (95% CI = 17.8–31.1%) and 21.7% (95% CI = 13.1–34.0%) reported increasing naloxone distribution and SSPs, respectively. Proportions for children/family mental health education (e.g., adverse childhood experiences) (15.3%, 95% CI = 9.7–23.3%) and peer recovery coaching services for individuals with OUD (18.0%, 95% CI = 11.9–26.2%) were highest for such continuation in prevention and recovery, respectively.