I think for some it is Jerry Palmore. No two people are alike so I believe that there is no one right tx for everyone. Since its beginning, if patients use it according to procedure, it can be a great step in changing their lives. Unfortunately, some folks always have to find the tricks of the trade and therefore continue using. Suboxone works to a certain degree. Patients have to pay out of pocket for suboxone and therefore it may work a bit better but my experience is that if patients choose to use, they will no matter what.
From what I've witnessed,
I live in Bucks County PA, which has one of the highest overdose rates of young men in PA. More Young Men Overdose In Bucks County Than Anywhere Else In PA - LevittownNow.com
Many of my friends have fallen to addiction, I've witnessed that the ones who become and remain clean the longest are the ones who were forced through their withdrawal effects.
I have a friend who is so scared of the withdrawal effects that he has remained on methadone for 10 years....
However, everyone is different...
Better used for acute detox from opioids, but withdrawing from long-term methadone maintenance is brutal.
The physical effects of withdrawal from opiates is so strong partly because of the emotional pain. If the emotional pain can be treated with EMDR and EFT in CBT, then the physical withdrawal is more manageable. Having said that, a person who tries abstinence only for an opiate addiction will likely relapse within the first year--a 90% relapse rate is the statistic on that. If they go on medication assisted treatment such as methadone or suboxone and are on it for at least two years and do a good taper and have received mental health counseling for their emotional pain as well as drug counseling, both one-one and group A&D, their chance of remaining clean for five years is greater--60% will remain clean and sober for five years after such treatment. Some people do continue to use even though they are on methadone. Those folks don't earn take-outs. If they can produce negative UAs for two months and show good behavior in other ways, they can earn a take home day which means they don't have to go to the clinic that day. Two more months of negative UAs and they can earn another take-out and so on. This is very motivating to MAT patients. Some patients, however, won't be motivated to earn take-outs for a long time because they actually form an attachment to the clinic and using is their number one intention of the day rather than stability and improved relationships. Such patients would do well to get into legal trouble and thus be assigned a probation officer who mandates negative UAs.
I think that methadone treatment with individual counseling can be very effective.
We use it when a patient is not in good pain control. It has to be closely monitored, but from a hospice perspective, it has proven useful.
It can be effective if used correctly. We have a suboxone program. We do use methadone but not for addiction, only rarely for pain management. As we are on an island with limited resources for Intesnsive therapy, individual counseling is available, but expensive. We have had better luck getting people off opiates with suboxone, but methadone is a bugger to get them off. It always depends on the situation and patient.
It is "harm reduction". Unfortunately most clinics are a for profit and not concerned with ever getting them "drug Free". Most clinics are not even allowed to address other substance use so long as they are not using opiates, benzos are huge in the methadone circles. I don't feel it is effective. suboxone was supposed to be "short term detox drug", but now they have maintenance programs for that too. Money thing!
I am glad we are nonprofit and can't turn patients away. We actually lose money on our suboxone patients as most of them don't have insurance and we do the testing here in office free (we end up writing it off usually) vs sending it off to the lab for the much more expensive test. It also depends on the Medical Director of the time and who is running the program. We have a provider now that is working more closely with the Behavioral health providers and is discussing dose decreases with all patients. The provider before would never include bh and never discuss the end goal. It is certainly not a money thing with us. We write off what we can, sign them up for our extremely generous sliding scale, help with insurance, etc. It help[s if we CAN get paid but it is never the thought process.
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