Methadone Maintenance Treatment Program (MMTP) and Suboxone/Buprenorphine Treatment in conjunction with comprehensive outpatient treatment.
Opioid substitution therapy (OST) or opioid replacement therapy (ORT)
provides care to people struggling with addiction to opiate based substances. OST/ORT is a medical procedure of replacing an illicit or addicting opioid, with a longer acting but less euphoric opioid; Methadone or Buprenorphine are two commonly used drugs and are taken under medical supervision. The overall purpose behind using and opioid substitution drug is its capacity to assist the patient in gaining stability. It also provides the opportunity for the substance user to experience a reduced level of withdrawal symptoms and drug cravings while not producing the euphoric effects often experienced with illicit drug use.
OST/ORT is a proven effective treatment for improving the overall all health and wellbeing of people experiencing opiate use disorders and have lead to a reduction of opioid related deaths, and a decrease in financial expenditures related to drug-related crime and healthcare.
The primary target group for this program is the consumer who has a long-term pattern of opioid dependence. We understand that many of these individuals are also “addicted” to a variety of other substances. Our primary area of concern is to provide treatment to eligible individuals residing in the Eastern Region of North Carolina, particularly those who are being treated with Methadone. To this end, special policies are developed for coordination of care with substance abuse programs in the Eastern Region. The program adopts as its policy concerning eligibility, the recommendations in 21-CFR-291.505, and the “Guidance of the Use of Methadone In Maintenance and Detoxification Treatment of Narcotic Addicts” of March 1989. The program has available its eligibility requirements to interested clients, family, and other parties. The program eligibility requirements include those consumers who meet the accepted medical criteria of the DSM-IV diagnosis of Opioid dependence and the consumer became addicted at least 1 year before their treatment admission. This condition can be waived for the following consumers if clinically appropriate:
- 1. Pregnant women
- 2. Those released from incarceration in the last 6 months
- 3. If the consumer was previously treated for Opioid dependence.
Qualified personnel complete an initial screening on all referrals made to the MMTP. Screenings are conducted as a means for quickly determining a patients eligibility and appropriateness for the program. Not all patients will be screened and in lieu of a screening will have a Comprehensive Clinical Assessment completed. This is determined based on first available appointment. During the screening, if the patient requires immediate/intensive intervention, a referral may be made for detoxification services and/or inpatient treatment if deemed necessary. Additionally, a preliminary ‘needs assessment’ will be done, and the patient will continue to be offered counseling services until admission to treatment.
Each patient being considered for MMTP will have an evaluation conducted by a program counselor. This assessment will entail a psychosocial summary, including family/social history, chemical use history, presenting problem/precipitant to treatment, treatment history, medical history, mental status exam, formulation of current status/problem, and initial diagnosis and/or diagnostic impression consistent with DSM-V-criteria. It is essential that the patient voluntarily agrees to participate in the treatment process.
Counselor will present summary of assessment to the Case Staffing Team within five working days of the assessment. The multi-disciplinary team present at the Case Staffing Meeting will consist of a physician, supervisor, practitioners, registered nurse, case manager and representation by outreach staff. This team will formulate appropriate treatment recommendations from intake, including appropriateness of MMT versus other treatment options for client, and recommendations for addressing other pertinent holistic client needs. Diagnosis shall be made following DSM-V criteria.
When the case review team recommends Methadone Treatment for the evaluated client, s/he will then be admitted to the I.V. Drug Methadone Program. Priority will be given to clients who are Pregnant, HIV positive, and who have other serious medical/psychiatric condition(s). At the point of admission a History and Physical will be completed, blood work and urine drug screen will be ordered, and TB testing will be administered. Subsequent to aforementioned tasks, methadone induction will ensue. Further details regarding the admission process willed upon notification of admission to the program.
PORT Human Services policies require that a treatment plan be developed for every patient upon admission. This plan will address short and long-term goals, specific behavioral tasks, educational, vocational, and employment requirements, recommendations for medial, psychosocial, economic, legal, and other support services, level, duration, and frequency of services needed, and outcome indicators.. The patient will be involved in the development of his/her treatment plan. In some instances, the treatment team may deny admission to the MMT due to ineligibility. In such cases, the MMTP staff will help facilitate a referral to an alternative level of care.
Buprenorphine Program services are designed and implemented to:
• Support the recovery, health, and well-being of the persons or families served
• Enhance the quality of life of the persons served
• Reduce symptoms or needs and build resilience
• Restore and/or improve functioning
• Support the integration of the person served in the community
Services provided by PORT Health Services emphasize supports needed to increase independence and maximize integration into the community. Recovery focuses on the development of new meaning and purpose as individuals or families grow beyond the problems associated with the concerns that led them to seek services (i.e. mental illness, addiction, or family violence).
To be eligible a patient must be addicted to opioids and be a member of a priority group (see above). There are no geographic constraints but the patient must be able to travel and attend the required treatment schedule.
Cases referred to the program will be evaluated by the outpatient program counselors for eligibility. An admission assessment will be completed and the use of Buprenorphine and program policies explained. The patient will be requested to have initial lab tests completed. An initial treatment plan will be developed including arrangements for outpatient group counseling. All cases will be assigned to a program counselor at the Outpatient Program in the Adult Outpatient Clinic.
Eligible case will be scheduled for a 60 min. examination by the psychiatrist. After examining the patient, reviewing the lab results and explaining the use of the Buprenorphine, a prescription will be written and treatment will begin.
• Assessment to determine appropriateness and eligibility for admission or referral
• Once determined eligible and appropriate client will be scheduled for an individual appointment with Buprenorphine Program facilitator to screen for client’s appropriateness for the Buprenorphine Program
• Once client is seen by Buprenorphine Program facilitator and determined to be appropriate for induction into the Burprenorphine Program, patient will be assigned to the most appropriate level of substance abuse treatment; such as intensive outpatient or regular outpatient.
• Once client is seen by Buprenorphine Program facilitator and determined to be appropriate for induction into the Burprenorphine Program, client will also be scheduled an appointment with the Psychiatrist/Resident for psychiatric evaluation and dosing will begin immediately following evaluation
• Client will be seen by the psychiatrist and buprenorphine program facilitator for subsequent visits throughout treatment enrollment in the program.
PORT Health Services and the Buprenorphine Program require that a Person-Centered Plan (Individual Plan) be developed for every person served upon admission. It is a fluid document that is developed/revised throughout the treatment process, and changes as a result of on-going comprehensive and integrated team input that involves the active participation of the person served and other individuals and agencies of his/her choice (consumers are encouraged to involve their family members in the treatment process when applicable or permitted). The PCP is prepared from the information gathered during assessment and completion of interpretive summary. The plan is based on the needs, strengths, preferences, and desires of the person served with focus on his or her integration and inclusion into the local community, the family, when appropriate, natural support systems and other needed services. The PCP will identify any needs beyond the scope of the program and those that can and will be provided by the program. Any referrals or additional services will be detailed and all information will be communicated in a manner that is understandable to the person served. Once the PCP is completed a copy is offered and provided to the person served if desired
The PCP includes two main components; first it addresses the global needs of the person served which is demonstrated through the identification of goals and its knowledge and awareness of the critical global needs of the person served. The second component of the PCP provides the blueprint for individual service development that is consistent with the outcomes expected by the person served, the Buprenorphine Program, and the organization.
To help individuals and families navigate through life’s challenges by providing effective and efficient substance abuse, mental health and intellectual/developmentally disabled services and supports.
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