How the Methadone Detox Protocol Works

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How the methadone detox protocol works depends on the protocol used. Although there are several different protocols of methadone detox or detoxification, the main steps to the protocol remain virtually the same.

According to the National Center for Biotechnology Information’s Publication, “Treatment and Improvement Protocols,” there are three main phases of treatment with methadone or one of its counterparts. These are induction or acute, stabilization or rehabilitative, and maintenance or supportive care phase.

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How the Induction or Acute Phase Works

treatment for opiate addiction

Methadone can be used for detox or maintenance during opiate addiction rehab.

The induction phase is the first phase of treatment. This involves replacing the opiate with a less dangerous, less addictive drug such as methadone. Doctors use methadone because it works similarly to addictive opiates. A doctor switches the desired opiate for methadone in a safe, controlled environment. The environment can be a clinic, inpatient rehab facility, or in some high-risk cases, a hospital intensive care unit. This is the only phase that is not typically considered outpatient although it is sometimes conducted on an outpatient basis.

Most often, the induction phase lasts two to ten days, but there are several factors are taken into consideration during treatment. These factors are:

  • type of opiate the patient is addicted to,
  • the length of the addiction,
  • other substances in use during the addiction,
  • the health of the patient, and
  • amount of drug ingested or injected at each incidence of drug use.

In the induction phase, the doctor identifies the patient’s history, medical needs, and drug use. Then the doctor administers the dosage of methadone according to the patients’ needs to prevent withdrawal symptoms. If the symptoms of withdrawal still present after the initial dose, more methadone or drugs that alleviate the withdrawal symptoms are given. This is one of the reasons why it is important to conduct the first portion of this phase in a clinic. If withdrawal symptoms continue, the doctor increases the dose gradually until the patient is functioning at a level normal to them.

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How the Stabilization or Rehabilitative Phase Works

The purpose of the stabilization phase is render the individual craving free. This phase usually lasts between two and six months but can last longer depending on the patient.

The doctor evaluates the patient at the start of the stabilization phase. He looks for:

  • illicit opiate use – doctors use drug tests and patient confessions to establish illicit use
  • withdrawal symptoms – sweating, vomiting, discomfort, confusion, etc.
  • other drug use – whether or not the patient is using other drugs in place of the illicit opiate
  • other disorders – according to the Aegis University other concurrent or previous disorders may reveal themselves after opiates are stopped.

The goal of the stabilization or rehabilitative phase is to stabilize the patient. This includes the patient’s drug use as well as the rest of the patient’s life circumstances. This is usually where behavior therapies, cognitive therapies, and drug counseling usually take place. Counseling occurs in a rehab clinic or as outpatient therapy. There are a variety of nonclinical programs that offer counseling that patients are encouraged to take advantage of.

During this phase, a steady dose of methadone completely replaces opiate use. The dosage is enough to remove withdrawal symptoms but not enough to cause intoxication. During stabilization the incidents of relapse are high due to the patients remaining desire to become intoxicated. It is important during this phase to make sure that the patient removes triggers and maintains abstinence from the opiate. A relapse to illicit opiates might cause overdose.

Employment or re-employment aide, life coaching, and other life skills training starts during this phase. Doctors are in frequent touch with the patient during stabilization since the dosage of methadone might need to be adjusted. At the end of this phase, the dosage of methadone is stable and the patient is becoming self-sufficient and self-supportive.

How Does the Maintenance or Supportive Care Phase Work?

This is by far the longest phase of the average methadone protocol. This phase involves:

  • treating the long term side effects of drug use,
  • making certain that the patient can function normally,
  • addressing any legal or judicial consequences of drug use and treatment, and
  • addressing other drug use.

This phase lasts until the patient decides to phase the methadone out completely. Long term management of methadone depends on what the patient’s overall goals are. Each patient is different and it is up to counselors and their patients to decide how and when the goals are accomplished. Long term goals should involve employment, stable housing, and the mending of relationships. As these goals are accomplished, the patient is still monitored for illicit opiate use.

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Common Methadone Treatment Protocol Issues

This is how the methadone protocol generally works. There are some considerations when trying this protocol. There are many other medications in use. The FDA approved methadone in 1947 so it is one of the longest studied treatments. It does have serious adverse short term and long term side effects. Whether to engage in a methadone treatment protocol is up to the treating physician and the patient. Because of its potential for abuse, methadone may not be the ideal treatment protocol for opiate addiction in some patients. It is possible for the patient to become addicted to the methadone just as they are addicted to opiates but with proper therapy and dose reduction, it works.

The three phases of methadone treatment is one of the most common treatment protocols for methadone addiction despite its side effects and issues. The combination of methadone and therapy in this sequence is proven to work for many patients suffering from opiate addiction.


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