Methadone:

Recovery-Oriented Methadone Maintenance

William L. White, Lisa Mojor-Torres (2010) Great Lakes Addiction Technology Transfer Center

What we did at Le Mont with regard to medication: As the provider of a recovery management/recovery residence, I did not feel it was our right to insinuate ourselves into a relationship between patient and doctor. If a resident was earnestly participating in the other recovery management elements required to live in our home, and if they had in good faith established a relationship with a local Addiction Medicine Specialist, and if out of that relationship emerged the shared decision to use a particular medication, even a controlled substance, as part of that resident’s overall recovery plan, then it was our job to facilitate that part of the resident’s plan, not to judge the clinical decision made.

Nevertheless, from a safety perspective, there is risk in bringing an addictive medication onto the premises. To offset that risk, we developed a “Controlled Substances Protocol.” The medication was stored in a secure manner (a safe in a locked staff-only office). Every dose of the medication taken by the resident was witnessed and recorded. Staff conducted pill/strip counts daily and recorded the result. As part of regular drug testing of the staff, the medication in question was added to the testing panel. It was essential for our staff to have a good relationship and open communication with the prescriber to report the resident’s Recovery Plan performance.

We found, with this level of structure, very few problems regarding medication occurred. We saw no diversion of the medication. There were no conflicts between staff and residents about the medication, nor were there conflicts between residents on medication and those not on medication. We found that good Recovery Management principles reduced, if not eliminated, the problems often purported to medication-assisted treatment.