Whether you’re someone who is interested in enrolling in one of our programs, a healthcare provider, a family member of someone suffering from substance use disorder, or even a community member, we know there are a lot of questions about what we do. Below are three sets of FAQs that we hope you find helpful.
You may also be interested in these pages: Our Services, Get Started, Current Patients, Recovery Stories
The difference between being dependent on opioids and an opioid use disorder is the problematic pattern of opioid use leading to clinically significant impairment or distress. Typically this means a harmful relationship to the drug that includes drug-seeking behavior, giving up important relationships and activities in favor of the drug, and generally focusing your life more and more on the drug at the expense of everything else. In 2010, 1.9 million people in the U.S. were addicted to prescription opioids and 359,000 were addicted to heroin. An opioid use disorder is considered to be a chronic, relapsing medical conditions, much like diabetes and hypertension, that can be very effectively manage with medication and supportive services.
It means that people with use disorders typically experience long-lasting physical and psychological symptoms of these condition, even with effective medical treatment. Like diabetes or hypertension, many people require ongoing or lifelong medical treatment to remain stable during their recovery.
Opioid use disorders alter a person’s brain chemistry. The brain is impacted by a disruption to the naturally occurring reward system and the way it experiences pleasure/pain. It also impacts the decision making processes. These impacts have been shown repeatedly in brain research. This explains why more and more of the drug is needed in order to produce the same effects, a condition known as tolerance, as well as the negative behaviors associated with substance use disorders like dishonesty, and continued use despite negative consequences.
Because this is a chronic, relapsing medical condition, the brain changes are often very long-lasting. Despite working very hard at recovery, many patients realize that staying on the medication is the best way to abstain from opioid abuse. The medications have very few side effects and are considered to be safe for long term use. At ETS, we work with patients to manage their condition so they can have safe and productive lives for as long as our patients benefit from working with us.
Medication assisted treatment (MAT) is an evidence-based approach that combines brain-stabilizing medication with comprehensive support services including counseling, drug screens, and medical monitoring.
These treatments work. They are the medical standard of care for opioid use disorders. Research has shown repeatedly that patients in medication assisted treatment have the greatest likelihood of living successfully in recovery. In addition, communities that offer MAT benefit: problems associated with property crime, homelessness, and expensive use of emergency services are all positively impacted when MAT is available to people in need. Cost-benefit analyses indicate that for every $1 spent for MAT, a $4- $5 return is realized.
The waiting period at ETS varies greatly from site to site. Please call a location near you for the current timeline.
The current cost of our opioid treatment program is approximately $18 per day. ETS accepts Medicaid and most types of insurance.
Medication assisted treatment for pregnant women with opioid use disorders is considered the standard of care for this condition. In contrast to the highs and lows associated with untreated opioid use disorders, babies of women on MAT throughout their pregnancy are healthy and develop normally. Please let our intake staff know if you are pregnant and your ETS medical provider will fully answer any and all questions you may have. We want to get you into treatment as soon as possible in order to protect your growing fetus.
You may also be interested in these pages: Who We Are, Our Work, Education, Recovery Stories, ETS Blog
Evergreen Treatment Services is a private, 501(c)(3) nonprofit organization which has been delivering evidence-informed substance use disorder treatment services in Western Washington since 1973. Since our founding, we have earned a national and regional reputation for excellence. Our interdisciplinary team includes clinicians with advanced degrees in medicine, psychiatry, nursing, psychology, social work, counseling and acupuncture.
ETS uses a comprehensive approach to treatment which combines medication assisted treatment with wraparound services such as medical monitoring, counseling, and case management services.
We are in the midst of a nationwide opioid epidemic. Partnership at Drug Free.org reports that “in 2012, nearly one million Americans, ages 12-25, were abusing or dependent on prescription pain relievers (primarily) or heroin.” Data from the Alcohol and Drug Abuse Institute (ADAI) at the University of Washington shows that, in the same year, heroin was the most common drug of abuse among 18-29 year olds admitted into substance abuse treatment in our state.
ETS has excellent relationships with the communities in which we work and we have open lines of communication with local governments, businesses, law enforcement and social service organizations. Most communities welcome the services provided by ETS as a way to address the pressing problem of opioid use disorders that drains local resources. In the immediate vicinity of our clinics, we work closely with our neighbors and work diligently to making sure that our patients are complying with agency rules.
The difference between being dependent on opioids and an opioid use disorder develops problematic pattern of opioid use leading to clinically significant impairment or distress. Typically this means a maladaptive psychological relationship to the drug that includes drug-seeking behavior, giving up important relationships and activities in favor of the drug, and generally focusing your life more and more on the drug at the expense of everything else. In 2010, 1.9 million people in the U.S. were addicted to prescription opioids and 359,000 were addicted to heroin. An opioid use disorder is considered to be a chronic, relapsing medical conditions, much like diabetes and hypertension, that can be very effectively manage with medication and supportive services.
It means that people with an opioid use disorders typically experience long-lasting physical and psychological symptoms of this condition, even with effective medical treatment. Like diabetes or hypertension, many people require ongoing or lifelong medical treatment to remain stable during their recovery.
Opioid use disorders alter a person’s brain chemistry. The brain is impacted by a disruption to the naturally occurring reward system and the way it experiences pleasure/pain. It also impacts the decision making processes. These impacts have been shown repeatedly in brain research. This explains why more and more of the drug is needed in order to produce the same effects, a condition known as tolerance, as well as the negative behaviors associated with substance use disorders like dishonesty, and continued use despite negative consequences.
Because this is a chronic, relapsing medical condition, the brain changes are often very long-lasting. Despite working very hard at recovery, many patients realize that staying on the medication is the best way to abstain from opioid abuse. The medications have very few side effects and are considered to be safe for long term use. At ETS, we work with patients to manage their condition so they can have safe and productive lives for as long as our patients benefit from working with us.
For people struggling with an opioid use disorder, the next fix becomes an all-consuming focus. Due to the physiological changes created by opioids, this focus is often pursued with little regard to a person’s own health or safety or that of their community. Some people lose their jobs and their stable living situations and turn to petty crime and other illegal activity for income. Family relationships and social networks break down. Health deteriorates; people lose weight and are at a high risk of contracting infectious diseases like Hepatitis C and HIV from unsafe needle use, developing abscesses, bacterial infection, and overdose.
Medication assisted treatment (MAT) is an evidence-based approach that combines brain-stabilizing medication with comprehensive support services including counseling, drug screens, and medical monitoring.
ETS uses the gold standard of medication assisted treatment to treat this condition. We combine medications that help patients to manage their opioid use disorder, such as methadone, buprenorphine/ naloxone (Suboxone), or buprenorphine (Subutex) with important rehabilitative services such as medical monitoring, counseling, case management, Hepatitis C and HIV testing, and education about overdose risk and infectious disease prevention. Our full range of services supports our patients and boosts their chances for full, long-term recovery. For a complete list of services, go to the medication assisted treatment page.
These treatments work. They are the medical standard of care for opioid use disorders. Research has shown repeatedly that patients in medication assisted treatment have the greatest likelihood of living successfully in recovery. In addition, communities that offer MAT benefit: problems associated with property crime, homelessness, and expensive use of emergency services are all positively impacted when MAT is available
to people in need. Cost-benefit analyses indicate that for every $1 spent for MAT, a $4- $5 return is realized.
No. This is a very common misunderstanding about medication assisted treatment. Similar to other chronic, relapsing medical conditions like diabetes or hypertension, ongoing stabilization of brain chemistry often requires medication. The medications used for treatment at ETS are long-acting and allow patients to stabilize their bodies through use of a long-acting medication prescribed at a dose that keeps withdrawal symptoms, including craving at bay but does not produce euphoria. Once a patient experiences physical stability, they can manage their condition and begin recovery.
Because of the extensive brain changes that occur with chronic use of opioids, it is not typically a condition that can be “cured” when patients simply decide they want to stop using their drug. The vast majority of patients in an absence-only approach will relapse — as many as 90% within 12 months. This is why medication assisted treatment and wraparound services are considered the medical standard of care – it works by stabilizing brain chemistry and helps keep people from relapsing. Willpower alone usually doesn’t work to change the biological and psychological reality underlying this medical condition.
If you know or suspect that someone you care about is suffering from an opioid use disorder, communicate your concern for them, for their safety, and for their health. This is the first step. Unfortunately, due to the altered physiological and mental state associated with opioid use disorders, your loved one may not be capable of recognizing his or her condition and may not be receptive to your concerns. Recognize that this is a medical condition, not a weakness or moral failure on the part of your loved one. Continue to offer support, know your limits, educate yourself about this condition, and seek available community resources. Check with health care resources to find federally certified opioid treatment programs like ETS or medical doctors in your area that are certified to prescribe Suboxone. Strongly consider purchasing an overdose prevention kit at your local pharmacy. Go to stopverdose.org for more information about this.
Most importantly, know that this is a difficult and challenging condition and that there are very effective treatments available.
Outreach Services
In 1996, ETS founded the REACH team which provides street-based outreach and case management services for adults in the greater Seattle are who are living outside, many of whom who have substance use disorders. The REACH team currently serves more than 1,000 clients with more than 50 staff. REACH also provides the case management services for the Law Enforcement Assisted Diversion (LEAD) program in collaboration with many city and county stakeholders including The Defender Association, Seattle Police Department, and the King County Prosecutor’s office.
Training
Helping to train future clinicians in empirically-grounded approaches to substance use disorder treatment is an important part of our work. We are a training site for social work, physician assistants, and addiction medicine fellows from Swedish Medical Center and medical residents from the University of Washington Medical Center. We also provide training in acupuncture with our patients to students from Bastyr University.
Integrity: We are ethical and professional.
You may also be interested in these pages: Our Services, Medical Records Request, Courtesy Dosing
Medication assisted treatment (MAT) is an evidence-based approach that combines brain-stabilizing medication with comprehensive support services including medical monitoring, counseling, and drug screens.
These treatments work. They are the medical standard of care for opioid use disorders. Research has shown repeatedly that patients in medication assisted treatment have the greatest likelihood of living successfully in recovery. In addition, communities that offer MAT benefit: problems associated with property crime, homelessness, and expensive use of emergency services are all positively impacted when MAT is available to people in need. Cost-benefit analyses indicate that for every $1 spent for MAT, a $4- $5 return is realized.
The waiting period at ETS varies greatly from site to site. Please call a location near you for the current timeline.
More information be found on our Flex Care Page.
Patients must leave randomly collected urine samples at least once per month. Our dispensary staff can also request a urine sample on a patient at any time.
When properly prescribed, patients on methadone or buprenorphine are not getting high. The proper medication dose relieves withdrawal symptoms (under medicating) but does not produce noticeable medication effects (over medicating). Because of this, our patients are able to function and report that they feel ‘normal’. Please see the pamphlet published by Drug Policy Alliance, About Methadone and Buprenorphine, “when used in proper doses in maintenance treatment, methadone does not create euphoria, sedation or an analgesic effect.”
Treatment of pregnant women with opioid use disorders should involve medication assisted treatment. Maintenance of opioid use disorders with methadone or buprenorphine is not harmful to the developing fetus – but detoxification can be. The effects of methadone and buprenorphine on pregnancy have been widely studied and when properly prescribed for pregnant women, methadone provides a non-stressful environment in which the fetus can develop.
Taking methadone or buprenorphine during pregnancy may help prevent miscarriage, fetal distress, and premature labor for mothers with an active opioid use disorder. During pregnancy, the patient’s dose should be sufficient to avoid cravings, avoid street drugs, and prevent withdrawal.
When an ETS patient enters the hospital, the hospital staff, medical provider, or social worker should contact his or her ETS dispensary to verify the patient’s current enrollment in medication assisted treatment and the current medication dose. Upon discharge, the patient should be provided with documentation showing:
By federal regulation, ETS is not permitted to communicate with a patient’s primary-care doctor or anyone else without the patient’s written permission to do so. In addition to the Health Insurance Portability and Accountability Act (HIPAA), ETS operates under Title 42 of the Code of Federal Regulations Part 2 (42CFR part 2) which provides very strict confidentiality protection of patient drug treatment records.
ETS enrolls adults who are willing and able to enter treatment. Referral information can be found here.
The timeline for admission can vary based on site staffing, the patient census level permitted by the local county, and individual patient circumstances. Intake information can be found on the intake page.
The current cost of our opioid treatment program is approximately $18 per day. ETS accepts Medicaid and most forms of insurance.
To remain in good standing with ETS, we expect compliance with the prescribed treatment protocol including:
Patients can be discharged for noncompliance to their treatment plan including ongoing drug or alcohol use, lack of attendance, and/ or behavioral concerns. To re-enter the program after being discharged for non-compliance, there is typically a waiting period of at least 30 days, after which patients will have to re-apply.
Have the patient sign two-way a release of information allowing exchange of information, fax it to ETS, and then call ETS to confirm receipt of the fax and begin coordinating care. Because a person’s alcohol and drug records are protected under the federal 42 CFR Part 2 confidentiality regulations, we cannot discuss any aspect of a patient’s care without proper authorization.
Take-home doses are medication doses that patients are allowed to take home with them for ingestion on the proper day at the proper time. Take-homes are given:
Patients can earn incentive take-home privileges if they are fully compliant with treatment and demonstrate stability as evidenced by their urine drug screens and attendance at all required appointments including dosing. These privileges are carefully granted only to those patients who are making observable and verifiable progress in treatment. Eligibility is determined by an interdisciplinary ETS team.
Patients can be granted medical take-homes if the patient submits documentation from their primary medical care provider that justifies the patient’s need for reduced clinic attendance due to an acute or chronic health condition. This documentation must detail:
The patient’s ETS medical provider will review the documentation and determine whether take-home privileges are warranted. If medically justified and approved by the ETS Medical Director, medical take-homes may be granted due to an acute or chronic medical condition. The patient will be required to submit subsequent documentation from their primary care provider at a frequency requested by the ETS Medical Director or medical provider to justify ongoing medical take-home status.
Patients on a stable dose of these medications for the treatment of an opioid use disorder have tolerance to the analgesic, sedative, and euphorigenic effects of the medication. Both methadone and buprenorphine are also very long lasting which, combined with tolerance, is what makes this treatment effective. However, if there is an acute pain problem, these medications may not be sufficient to appropriately address the patient’s pain condition. Our medical providers will coordinate any acute pain prescriptions with you so that we can ensure our mutual patient remains both safe and medically stable.
Open Letter to Medical & Dental Providers Treating Patients on Methadone Maintenance
Open Letter to Medical & Dental Providers Treating Patients on Buprenorphine
Many different pain medications are available for patients on methadone or buprenorphine maintenance for opioid use disorders. Non-narcotic pain analgesics can be prescribed when the pain is not severe. For severe pain, prescribing short acting opioids may be appropriate. Due to the patient’s tolerance level, the patient may need a higher and more frequent dose of a short-acting opioid medication than is usually prescribed to non-opioid dependent patients with similar medical disorders. Mixed opioid-agonist/ antagonist drugs such as Talwin, Nubain, Suboxone, and Stadol should never be used in a methadone-tolerant person as they may precipitate severe withdrawal. Our medical providers would like to coordinate any acute pain prescriptions with you so that we can ensure our mutual patient remains both safe and medically stable.
Open Letter to Medical & Dental Providers Treating Patients on Methadone Maintenance
Open Letter to Medical & Dental Providers Treating Patients on Buprenorphine
No. ETS is licensed for the treatment of opioid use disorders; we are not licensed to treat pain. Treatment of pain issues in ETS patients is best closely coordinated with ETS medical staff.
Disclaimer: This list is not intended to be comprehensive. Please exercise caution when prescribing medication to patients in opioid treatment programs. Consult with the ETS Medical Provider whenever possible so that we can coordinate care.
The following commonly prescribed medications cause the liver to metabolize methadone more quickly and may necessitate an increased methadone dose:
Some medications slow the metabolism of methadone. Some people will feel the effect of methadone more strongly when they take the following medications, and sometimes they experience withdrawal symptoms when they stop taking them:
Some medications are opioid blockers and may cause withdrawal. These block the effect of methadone and should not be taken if you are taking methadone:
Disclaimer: This list is not intended to be comprehensive. Please exercise caution when prescribing medication to patients in opioid treatment programs. Consult with the ETS Medical Provider whenever possible so that we can coordinate care.
Other substances with interactive effects: