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Handbook Centre for Addiction
and Mental Health

Chapter 4 - Living with methadone

Methadone Maintenance Treatment: Client Handbook

In this chapter:

Carry doses

For the first two months of treatment, you will be expected to go to the clinic or pharmacy daily to drink your dose under observation. The daily contact during this initial period helps the staff to see how the treatment is working for you. They’ll be looking to see if your dose is enough or too much, if you are experiencing side-effects, and if you are using other drugs. After two months, you may be able to begin to take home, or “carry,” doses.

Carry doses are a privilege given to you when you have progressed well in treatment, and are prepared to take responsibility for using and storing the doses safely. Some providers grant carry privileges only to those who produce drug-free urines.

You will likely be asked to sign an agreement stating that you take responsibility for the safe and secure storage of carry doses, and that you understand that the doses are to be taken by you and only you. Your carry privileges may be taken away if you fail to meet the terms of agreement, or if your urine tests positive for drug use.

Before you begin to carry doses, you must agree to bring any empty or full dose bottles back to the clinic or pharmacy at any time, if requested. You must also agree to provide a urine sample upon request. Giving away or selling carry doses may result in criminal charges being laid against you, and in the suspension of your carry privileges.

You must come to the clinic or pharmacy to collect your carry doses. Home delivery is not available.

Some clinics or pharmacies require that you return all carry dose bottles once they are empty.

Safety and storage

Your maintenance dose of methadone could seriously harm or kill someone who has no tolerance for the drug. A small child might mistake your dose for ordinary juice, drink it, and die. Never transfer your dose to a container that might make it easier to mistake what’s inside. This has led to tragedy in the past. You are responsible for the safekeeping of your doses, and you will be held responsible if someone else drinks your dose.

Even though carry doses are generally stored in childproof bottles, you are strongly urged to keep your doses in a locked box, such as one sold for fishing tackle or cash.

It’s recommended that you keep your carries in the fridge, but some clients find that the juice mix used to dilute your dose keeps well at room temperature.

Schedule

The length of time it takes for you to begin to carry doses may vary depending on your provider. Also,the number of doses you are given at any time may vary depending on your provider. Whether or not you have been using illicit drugs will be considered, as will the safety and stability of your home. Ask to find out when and under what conditions you will be given carry doses.

Lost or stolen doses

Carry doses that are lost or stolen may not be replaced, and must be reported to police in order to alert the public and prevent harm. Loss or theft of carry doses may result in having your carry privileges suspended, meaning you will have to report to the clinic or pharmacy every day to collect your dose. It is your responsibility to store your carry doses safely.

When you can’t get to the clinic or pharmacy

It’s important that you don’t miss your dose even if you can’t make it to the clinic or pharmacy. Your treatment need not be interrupted even in the following situations:

  • You wish to travel away from home.
  • You are ill.
  • You are in an accident.
  • You are hospitalized.
  • You are arrested.

In general, follow these guidelines to help ensure you don’t miss your dose:

  • Some clinics will issue you a methadone client photo ID card. If you have one, carry it with you at all times to identify you as a client.
  • Keep the phone number of your clinic or pharmacy and doctor in your wallet. If you are hospitalized or arrested, contacting your pharmacy or doctor will ensure that you receive the correct dose.
  • Talk to your doctor about getting a Medic Alert bracelet stating that you are a methadone client, and wear the bracelet at all times. If you are in an accident, this will ensure you get the correct medication.

Going out of town / out of Canada

It takes a little organization and thinking ahead, but if you want to travel, you can go a long way, and still get your methadone. You may be able to “guest dose” at another pharmacy, in another town or city, in another province, or even in another country. When planning a trip, talk to your doctor well in advance for help in making the arrangements for guest dosing.

If you have earned carry privileges, and you wish to take a short trip outside Canada, you may want to carry your doses across the border. Many people do travel with carries, and have no problem with border guards. You should know, though, that carrying methadone across the border into some countries is, by the books, against the law, although the law is not enforced. If you’re travelling to the States, for example, and you want to take your carries with you, it can be done, it is done, and U.S. customs will even tell you that you can do it, but officially it’s not legal.

When crossing any border, it’s always wise to treat the guards with polite respect, and not draw attention to yourself. Don’t try to hide your methadone; if they find it hidden they’ll get upset. If they ask, show it to them. It’s a legally obtained prescription drug. It’s your medication.

Here are some guidelines from U.S. customs for taking methadone across the border:

  • Be sure the bottles containing your doses are marked by the pharmacy with your name and the prescription information.
  • Carry only the doses you will need for personal use while you are in the U.S.
  • Travel with a letter from your doctor or clinic that describes your treatment and your dose. Be sure the letter includes a telephone number to call to confirm the letter.

Methadone is available as a prescription drug in many countries around the world. The INDRO Web site (http://indro-online.de/travel.htm) has information on methadone travel regulations for over 150 countries. The site includes, for some countries, names of methadone providers, and customs contacts. Follow up to be sure the information is up to date. If you don’t have access to the Web, your pharmacist should be able to find out about the legal status and availability of methadone in the country that you wish to visit.

Illness

Methadone can only be administered by qualified medical personnel. Even if you qualify for carry doses, you cannot arrange to have them delivered to your home. If you are too ill to get to the pharmacy to collect your dose, contact your pharmacy to let them know. In extreme situations your pharmacist may be willing to deliver your dose and watch you take it.

Hospital

If you are admitted to hospital, either as a planned visit, or in an emergency situation, it’s extremely important that the staff there know that you are a methadone client. This is important not only so that you can receive your dose, but also because there are other drugs that can be dangerous if taken in combination with methadone. Encourage the hospital staff to speak with your doctor about your medication, and your care.

“I was taken in to emergency, and when I told them I was on methadone, I thought, oh my God, I’m going to have one hell of a time getting this, and it was so quickly set up, I had my dose exactly when I needed it. You need to contact your doctor, of course, and it might depend on what hospital you’re going to, but for me it was no problem.” — Jackie, 36, on methadone five years.

Arrest / jail

If you have to spend time in a provincial or federal jail in Ontario, you should be able to continue your treatment while in jail. Both the provincial and federal governments are striving to provide methadone treatment to anyone who was receiving treatment immediately or soon before arrest or the beginning of a sentence. If you have any problems with receiving treatment, be sure to contact your methadone doctor or clinic for help in advocating for you. Doctors serving jail populations in Ontario are either authorized to prescribe methadone, or are able to arrange that it be made available. At the present time, you may continue, but not begin, methadone treatment while in jail.

Dealing with side-effects

Constipation

Like other opioid drugs, methadone can cause constipation. The best way to treat this annoying complaint is with foods that are high in fibre. Stock up on bran cereal, whole-wheat bread, brown rice, fresh fruits and vegetables. Canned beans are loaded with fibre. Prunes and prune juice are a good old-fashioned tried-and-true remedy. Wash it all through with plenty of water.

Beware of foods that are high in fat like cheese and pastries. These are harder to digest and tend to make your system sluggish.

If you’re not used to a high-fibre diet, go easy at first. These foods can cause bloating and gas. Gradually your body will be able to process this diet, without too much embarrassment.

Avoid treating ongoing constipation with laxatives. These drugs interfere with the absorption of nutrients in your body. They are only meant for occasional use. If the high-fibre diet is not enough, or if you don’t think you can stand another bite of bran, fibre supplements are available at pharmacies. These contain psyllium, which are the seeds of a banana-like plant. These must be taken with a lot of water. They are perfectly safe, and should provide relief.

And finally, exercise can help. You might prefer something vigorous like running or dancing, but if you don’t, even a relaxed stroll after a meal or tossing the Frisbee in the park can keep things moving. The point is to keep active.

Excessive sweating

This persistent symptom can be difficult to control. Sometimes, if you are on a high dose, lowering the dose may stop the sweating, although some people continue to experience this side-effect even on a low dose. If a higher dose is what you need to stay comfortable in other ways, or if lowering your dose doesn’t help, you may need to learn to live with the sweating. Lighter, natural-fibre clothes, strong antiperspirant and baby powder helps some to feel less humid.

Changes in sex drive

Some people on methadone say they have little sex drive, and are unable to experience an orgasm. Others say that since they are off other opioids and feeling better, their sex life has improved. It’s an individual experience. In some cases, you may be taking another medication that’s affecting your sex drive. If you are having problems of a sexual nature, your doctor may be able to offer some good advice.

Methadone and employment

Once you’re on a stable dose, the fact that you take methadone shouldn’t affect your choice of work, or how well you do your job. For most jobs, there’s no reason to mention that you take methadone, and your employer has no right to know. If you wish to do a job that involves operating a vehicle, however, your doctor must be willing to “recommend” you for a license. Methadone clients applying for a commercial license are considered on a case-by-case basis, and must prove that they are stable, and show no other drug use on their urine test.

HIV, hepatitis C and methadone

Methadone can be a great benefit to opioid users who are HIV or hepatitis C (HCV) positive. Because methadone allows you to lead a “normal” life, it’s easier to take care of yourself, to eat better, and to take your medications at the right times. Methadone helps you to feel well, and to be able to do the things you want to do with your life.

Be sure to discuss any prescription drugs you are taking with your methadone doctor. Some of these drugs may interfere with methadone, and your dose may need to be adjusted.

Resolving treatment problems

If you are unhappy with your treatment, your first approach should be to talk it over. If, for example, you feel your dose has not been adjusted correctly, talk to your doctor, explain what you feel. That might be all it takes to fix the problem.

If you feel there’s a problem with your treatment that hasn’t been fixed by talking to your doctor or your counsellor, you may consider changing your provider. If you live in the Toronto area, there are a number of doctors and clinics to choose from. You should be able to find one whose approach to treatment meets your needs. If you live in a smaller community, you might have to work it out. There may only be one doctor who can prescribe methadone where you live.

As a last resort, and if you feel the problems with your treatment provider are severe and remain unresolved, you can complain to the College of Physicians and Surgeons of Ontario at 416-967-2600.

Most of the professionals you’ll meet through treatment will treat you with respect, and offer support and encouragement. Be good to them, and nine times out of ten, they’ll be good to you.

“Talk to your doctor, tell him or her everything that you’re feeling, be open and honest. It’s so important that you build a relationship based on trust.” — Beth, 39, on methadone four years.

“I object to being made to wait so long to see my doctor. I usually have to wait from 15 to 45 minutes to be seen. If this were an occasional thing, it wouldn’t be so bad, but I have to see my doctor very frequently. It makes me late for work. I think that if an addict like me can be on time, then surely a professional doctor can be on time.” — Chris, 49, on methadone 17 years.

“I love the staff here. It’s not easy to deal with angry and distrusting addicts. They fought for me when I didn’t think I was worth fighting for.” — Sharon, 46, on methadone four years.

“Always treat staff with respect, regardless of the circumstances or your mood. Be assertive, not aggressive. Don’t whine. Don’t complain to the staff about another staff member. If you don’t behave like a model client, all you get is medicated, nothing more, nothing less.” — Janet, 46, on methadone four years.

“I am constantly amazed that after I have a blow out, i.e., I freak out at clinic staff, they are always very nice to me like nothing ever happened. I really really appreciate that because I feel badly enough that I was rude to them in the first place.” — Bonnee, 43, on methadone two years.

“Clinics vary. I’ve been to a few different places. At one place, the doctors, pharmacist, etc. were all exploitive and clueless. At another everyone was very cold, there was no support. Where I am now is amazing, all the staff, including my counsellor, are superb.” — Spacey, 30, on methadone six years.

Changing methadone providers

If you move to a different neighbourhood or town, or if you do decide you want to try another doctor or clinic, you can change your methadone provider. All that it takes, once you identify where you want to go and they’ve agreed to take you, is for you to give permission to have your records transferred. There will be a form to sign. Ask how long the process will take.

Involuntary discharge

All methadone treatment providers have some rules, and some are stricter than others in how they deal with a client who breaks the rules. Understand that, depending on the rules of your treatment provider, you may be discharged from treatment if you do any of the following:

  • behave in a threatening, violent or disruptive manner toward staff, other clients or other people
  • sell or give away your methadone
  • don’t show up to pick up your dose more than three days in a row, or miss picking up your dose often (without good reason)
  • commit an illegal act on the premises, such as shoplifting or selling drugs
  • continue to use other drugs
  • fail to attend group therapy sessions.

Some providers may taper down your dose before you are cut off, and some may help you to organize a transfer to another program. Some may accept you back at a later date. Incidents of violent or other criminal behaviour can result in an abrupt end to treatment. How involuntary discharge is handled is entirely at the discretion of the clinic or pharmacy.

Methadone Maintenance Treatment: Client Handbook

Methadone myths and realities

  1. Methadone and other options
  2. Learning about methadone
  3. Going on methadone
  4. Living with methadone
  5. Methadone and other drugs
  6. Counselling and other services
  7. Women, family and methadone
  8. Looking ahead on methadone

Resources

CAMH Switchboard 416-535-8501
CAMH General Information Toronto: 416-595-6111 Toll Free: 1-800-463-6273
Connex Ontario Help Lines
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