Treatment questions

• What is medications for opioid use disorder (MOUD)?

  Medications for opioid use disorder (MOUD) is an evidence-based approach that combines brain-stabilizing medication with comprehensive support services including medical monitoring, counseling, and drug screens.

• Why does ETS use medications for opioid use disorder (MOUD)?

  These treatments work. They are the medical standard of care for opioid use disorders. Research has shown repeatedly that patients taking medications for opioid use disorder have the greatest likelihood of living successfully in recovery. In addition, communities that offer MOUD benefit: problems associated with property crime, homelessness, and expensive use of emergency services are all positively impacted when MOUD is available to people in need. Cost-benefit analyses indicate that for every $1 spent for MOUD, a $4- $5 return is realized.

• How long will I have to wait before I can start treatment?

  The waiting period at ETS varies greatly from site to site. Please call a location near you for the current timeline.

• What is Flex Care?

  More information  be found on our Flex Care Page.

• How often are patients drug tested?

  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.

• Are patients getting high on their medication?

  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.”

• Can a pregnant patient be on methadone or buprenorphine?

  Treatment of pregnant women with opioid use disorders should involve medications for opioid use disorder. 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.

• We have an ETS patient in our hospital. What information does ETS need from the hospital before he or she returns to treatment?

  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 medications for opioid use disorder and the current medication dose. Upon discharge, the patient should be provided with documentation showing:

  • Dates of hospitalization.
  • Diagnoses.
  • Methadone or buprenorphine dosing information while the patient was in treatment at the hospital including date and time of last dose. A copy of pharmacy or hospital ward medication logs may be used for this purpose.
  • All discharge medication, especially methadone and buprenorphine, including the dosage amount and the number of doses provided.
  • Name, title, and phone number of the person providing the information.
  • Inpatient Hospitalization and/or Outpatient Procedure Information form
• Why does ETS need a specific release of information to coordinate care for a shared patient?

  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.

  LINK TO FORM

Intake and patient expectations questions:

• How do I get someone enrolled in your treatment program?

  ETS enrolls adults who are willing and able to enter treatment. Referral information can be found here.

• How quickly can someone be admitted to ETS?

  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.

• How much does MOUD cost?

  The current cost of our opioid treatment program is approximately $18 per day.  ETS accepts Medicaid and most forms of insurance.

• What do you expect from patients?

  To remain in good standing with ETS, we expect compliance with the prescribed treatment protocol including:

  • Attend the clinic for every expected medication dispensing day. Patients typically start out at six days per week dosing with a Sunday take home. Patients must safely store any medication provided as take homes.
  • Attend the required orientation group within the first 4 weeks of treatment.
  • Attend the required group on blood borne pathogens, communicable diseases and family planning within the first 2 months of treatment.
  • Participate in weekly individual counseling for at least the first 90 days. The frequency of sessions may be reduced over time as you stabilize. The schedule for this will be determined by your counselor.
  • Work with your counselor on your individualized treatment plan.
  • Inform all outside medical providers or prescribers of your participation in medications for opioid use disorder. This helps you stay safe and receive high quality care.
  • Sign releases of information for coordination of care when requested.
  • Register all prescription medications within three days of having them filled at the pharmacy. Note, we do routinely check the Prescription Drug Monitoring Program for all patient medications.
  • Abstain from alcohol and non-prescribed drugs.
  • Participate in random urinalysis testing a minimum of once per month.
• Why do people get discharged from your program?

  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.

• What’s the best way to coordinate care with your team?

  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 dosing questions:

• What are take-home doses?

  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:

  • For days when ETS clinics are closed, such as on Sundays and holidays
  • As a result of the patient’s stable, observable and verifiable progress in treatment
  • For medical reasons
• What are incentive take-homes?

  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.

• What are medical take-homes?

  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 nature of the health condition
  • The reasons the patient is challenged to come to the agency on the regular schedule
  • The recommended dosing frequency
  • The length of time these special privileges will be needed

  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.

Medication interaction questions:

• Is it appropriate to provide pain medications to someone on methadone or buprenorphine? Aren’t they prescribed to treat pain?

  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

• What pain medication can I give ETS patients?

  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

• Can ETS give medications for pain?

  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.

• What medications may interact with 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.

  The following commonly prescribed medications cause the liver to metabolize methadone more quickly and may necessitate an increased methadone dose:

  • Carbamazepin (Tegretol)
  • Phenytoin (Dilantin)
  • Neverapine (Virammune)
  • Rifampin
  • Efavirenz (Sustiva)
  • Amprenavir (Agenerase) – methadone also significantly reduces the level of amprenavir.
  • Ritonavir (Norvir) – less of an effect

  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:

  • Amitriptyline (Elavil)
  • Cimetidine (Tagamet)
  • Fluvoxamine (Luvox)
  • Ketoconazole (Nizoral)

  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:

  • Pentazocine (Talwin)
  • Naltrexone (Revia)
  • Tramadol (Ultram), in most cases
  • Barbiturates initially interact with methadone to cause sedation, but then the opposite occurs, and they can cause withdrawal symptoms.

  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:

  • Cocaine can increase the dose of methadone required (NOTE: ETS closely monitors illicit drug use and indications of ongoing cocaine use may result in a discharge from the program, not an increased methadone dose).
  • CNS depressants, such as benzodiazepines (Xanax and Valium) or alcohol may cause overdose.