Return to Author Return to Main PageTo follow on from my last article Realigning Australian Community Expectations of Methadone Programs
I have decided to present a list of questions one should consider to assay if terminating the Methadone Maintenance Program (MMP) is premature.
It is important to note this article is not campaigning for or against Methadone, nor is it advocating to terminate or remain on Methadone, as these considerations are best discussed between the clients and there relevant health professionals. Instead, this article is intended to encourage the reader to openly explore the clients circumstances in relation to maintaining abstinence in an unbiased manner should the terminating methadone topic arise. Only by asking relevant experiential questions with regards to the clients addiction do we better comprehend and are better placed to estimate the likelihood of opioid relapse should a client terminate the MMP.
I want to get off Methadone
or I'm coming down off the Methadone
are common phrases addiction therapists are likely to hear from recovering opioid dependant clients during counselling sessions. Ceasing Methadone is not really the issue, however how one prepares to terminate the methadone and maintain the stability without jeopardising there health is the central issue. To give the client the best possible chance of maintaining abstinence, the client should at the very least have prepared themselves i.e relapse prevention strategies, stress mitigation techniques, relevant support in place I.e health professionals, counsellor, psychologist, family, friends etc. The client should also have been educated upon the risks of overdose should the event of a relapse arise2, in addition to the side effects of Methadone cessation i.e sleep disruption etc.
Further probing questions regarding the clients decision to terminate the MMP may identify the client decision is not well founded, instead spurred by emotion or being fed up such as plainly not wanting to participate on the Methadone. While other ideations may be due to external pressures, unrealistic self expectations or an urge to use Opioids under the fallacy of being able to control or limit the drug use so it does not escalate in an uncontrollable manner again. Impulsive superficial decisions refusing to maintain the MMP without planing and preparation laced with the ideology of remaining abstinent is somewhat a vastly different experience altogether to staying substance free and overcoming all the challenges to remaining abstinent.
The reasons cited by clients are varied, however typically the clients I have worked with reported reasons such as mobility restrictions Liquid Handcuffs
, discrimination, health complication concerns, being prescribed Methadone for too long and feel they are able to abstain or should not need Methadone
. While other reasons accounting for prematurely exiting a MMP may be due to disagreement over program rules, conflict with counsellor, feetox and scheduled conflicts
as noted by Reisinger et al 2009.1
The questions supplied below are the more typical questions I discuss with clients during there conceptual exploration regarding maintaining the MMP or terminating the MMP.
Should I stop taking my Methadone? 14 Questions for Consideration
No — OK
Yes — The client maybe responding to external pressures and the decision to terminate the MMP may not be the correct decision at the time, the client may not feel confident in resisting drug use, may not have prepared appropriately to maintain there abstinence.
No — OK
Yes — Drug use behaviour is still present and risk of relapse is likely
No — OK
Yes — Drug use behaviour is still present and risk of relapse is likely
No — OK
Yes — Drug use behaviour is still present and risk of relapse is likely
No — Ongoing or increased stressors may lead to early relapse in an attempt to alleviate stress, prolonged stress may lead to the emergence of past maladaptive coping behaviours.
Yes — OK
No — Ongoing or increased stressors may lead to early relapse in an attempt to alleviate stress, prolonged stress may lead to the emergence of past maladaptive coping behaviours.
Yes — OK
No — OK
Yes — Mental health which is not stabilised may trigger relapse, it is essential mental health is stabilised for a decent period prior to reduction or terminating the MMP
No — OK
Yes — Some physical aliments i.e pain may trigger relapse especially Opioid use
No — OK
Yes — Client should consider the likelihood of relapse if repeated relapse has occurred in the past. The risk of death in relation to opioid overdose in close proximity to terminating MMP have been documented.2
No — OK
Yes — Client must seriously reconsider the significant risk of relapse that may cause them to become incarcerated due to relapse.3,4
No — OK
Yes — The client should be made aware how drug use historically escalated and the risks involved with terminating the MMP. Rapid escalating drug use5 may see the client disengaging in contact, escalate unmanageable drug use leading to potential life dysfunction i.e worst case imprisonment or death.
No — The client should undertake relapse prevention counselling to identify and prepare relapse prevention strategies prior to ceasing MMP6
Yes — OK
No — Psycho-education regarding the risks of overdose is imperative prior to the client ceasing the MMP.2
Yes — OK
No — The client should be provided any necessary supporting contacts list prior to terminating the MMP
Yes — OK
The Author declares a previous professional affiliation with Dr. Stella Dalton, however during the construction of this article there have been no receipt of gifts, research grants, nor do I have any affiliation to any pharmaceutical company who produces Methadone. This article was purely constructed of freewill and without encouragement in order to create public awareness.
This page was last updated: 28/10/2019
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Copyright © 2019 Darren Hamburger. All rights reserved.