Substitut-Maintenance Program, how it look alike?

[Spucky]

My Cat do a lot of research but cant find explanation and difference
between the Country`s, States and Prefectures.
For a easy understand i write now how a German-Program looks

We have two different main Systems,
one is via a normal Doc with a qualification (normal Doc`s can have only 3 Patients until 6 month)
two is via Ambulances.

After 6 month People without Drug-Consume can get Take-Home for a Week,
but the majority have to pick it up every day!
After 6 month it is also possible to get a holiday-Ration up to 30 Day`s.
(Once in a Year)

In Germany every case get monitored by our Government,
every case get checked up in a two years interval.
This happend in a anonym randomized Mode!

Mainly People have to pay only the Money for the Prescription (10 Euro?),
but also Private is possible!
In fact many Doc need this extra Money,
so they prefer this Patients.

Subutex, Suboxone, Methadon, Polamidon are allowed,
DHC and other`s only in special cases!

Ach ja, People do not be nearly Dead to apply for Substitut`s anymore.

How it look alike in the Scandinavian, EU.,American Country`s and all the others?

Thanks for any Reply!

[electrolingus]

Due to the fact that SWIY mentioned a "take home", SWIM will assume that they are talking about methadone. Here is the run down on program protocol in the U.S.

State or non-private program.
For no insurance, one can get on an non-private program that works on a sliding fee scale. If you have no employment, the minimum payment is usually between $2.00 and $5.00 a week. The non-private programs are not as convenient as private programs for a few reasons. These are...

1) Program hours. Some programs split dosing times into two categories. Early hours for those with employment and late hours for non-employed clients.
2) Weekly therapy or recovery groups. Most non-private programs require a certain amount of weekly groups that must be attended to keep ones status active on that program. Private programs require little or no group activity.
3) Take homes. U.S. law requires a general protocol regarding the amount of take homes and the length of time it takes to get those take homes. A good number of non-private programs do not give the first take home till 30-90 days without a dirty urine. Private programs will usually give Sunday take homes from the first day.
4) Urinalysis. Private programs often require less urine's than non-private.

Take homes need to be progressively earned. The usual progression is; first take home, 0-90 days. Second 90-days to 6 months, then progressively continuing until the fifth take home. It gets a little harder to earn more then five take homes. Also, one gets a 'vacation' ration once a year depending on ones status.

Private programs can run anywhere from $70.00-$200.00 a week if one decides to pay cash. Many people choose to pay cash to keep from using ones employment insurance. We in America call these programs the "gas and go's" because little is required of the client except to just show up for dosing.

Methadone can be acquired by a medical doctor in the U.S. But it is very rare now days due to the introduction of suboxone. There was a time that methadone "pain management" through a physician could eliminate a lot of government hassle. However, these types of programs are now few and far between.

SWIM hopes that this is what SWIY was referring to in their post. The info that SWIM has given is not always the same for every methadone program. It is just an average.

Reputation Comments on this post:

lotta good info

[Spucky]

Arigato gozaimasu,
inside of the US all States (from Alaska to Texas) have the same regulation?
How People get kicked out if they not follow the Rules?

[electrolingus]

Accreditation for methadone programs in the U.S falls under the U.S. Department of Health and Human Services / Substance Abuse and Mental Health Services Administration (SAMHSA).

This is a link to those criteria.
http://www.dpt.samhsa.gov/pdf/OTPAcc...lines-2007.pdf

Originally Posted by Spucky

How People get kicked out if they not follow the Rules?

Quite easily actually. Here's how...

The main reason clients are eventually 'dismissed' from a U.S. methadone program is because they continue to abuse illegal drugs or they continue to use non-permitted prescription drugs.

Continued dirty urine's for opiates will not get one kicked off as fast as other drugs like cocaine or benzodiazepines. The repeated use of opiates like heroin while on a MMT program tells the clinician two things. The first being that ones methadone dose is not high enough to provide stability in eliminating cravings. Actually, if one is having a hard time convincing a program of a dose increase, a dirty for heroin will usually do the trick in reinforcing ones argument for the increase in the first place. (THIS IS NOT RECOMENDED). SWIM is just familiar with clinic "politics" and many seem to politic the same way. The second and only other accepted possibility for repeated opiate use is that the client is simply non-compliant to, or not ready for treatment.

The continued use of cocaine will get one let go from a program very quickly. Most programs follow a probation protocol for repeated cocaine use. This could include increased urinalysis and a mandatory weekly cocaine group attendance in addition to any other mandatory groups that are required.

The last of these drugs are benzo's. Benzo's will get one dismissed the quickest of any other drug. Quite simply, the clinic does not want to be responsible for a client's death. The usual protocol for repeated benzo abuse while on MMT is an immediate dose reduction or a dose split (half of ones dose in the morning, the other half in the evening). This usually continues until significant improvement is shown.

The next thing after continued drug use is non-payment of program fees. Many clinics will institute what is known as a fee detox regiment. This means that ones dose continues to go down (quickly, up to 10mg. per day) until full payment is received. The general rule of thumb is the "three strikes and you're out" rule. This simply means that your third fee detox is the final detox. See ya!

Finally, the last is failure to show up for daily dosing. Here we have another "three strikes rule" If one misses more than three consecutive days, one must wait and see the program doctor in order to be reinstated. The main reason for missing more than three consecutive days is incarceration.

Keep in mind that there are several other actions or behaviors that can get a client dismissed (violence towards staff or other members, drug dealing on the premises, sexual misconduct, etc...). Some private programs have a bit more tolerance for rule bending then state/non-private (inexpensive) programs. In fact, most if not all state programs will make a client participate in a "rules and conduct" class before one gets dosed on the very first day of MMT.

Reputation Comments on this post:

answer with source!

[nateup]

Swims is nowhere near that strict on any of that stuff. Except fees. At Swims, if you dont pay, you dont dose period.

You also get 7 consecutive days before you are dismissed from the program round here.

Just thought Id give the other end of the spectrum that we have here.

We have jail dosing here, which costs more

and guest dosing which aslo cost more

[Spucky]

Originally Posted by nateup

We have jail dosing here, which costs more

and guest dosing which aslo cost more

Please don`t use Slang-Words,
swims English is not soooooo good
What it mean?

Thanks for your Reply!

Whats happen with the real problematic People
with a lot of consume, Psychos and Homeless ones?
Do They have a possibility to get Substitut`s?
Do they have MMT. in the Prisons?

Maybe someone from Australia and Scandinavia can give Swim also enlightenment?

Edit: Here something about the German MMT. in English:
http://www.harmreductionjournal.com/content/4/1/5

[nateup]

Jail dosing is when someone recieves their methadone dose while incarcerated. This is only possible in towns where the local government is in cooperation with the local treatment facility.

Guest dosing is when a patient recieves their dose from a different clinic. The home clinic faxes the patients records to the clinic they are visiting, and the patient recieves their dose from that clinic. This is an option for those who need to go out of town but have not earned "take homes" yet.

[Mesaja]

Here in SWMs country,we only have one program for addiction,and thats MMT.
And to apply for it,you must be addicted to Heroin,and Heroin only.
Addictions from other opiates are not recogniced,its almost like they doesnt exist.
SWIM is hoping that the situation will get better some day,and maybe we`ll have other programs and cures for addiction,such as:Subutex,Ibogain,etc...

Ach ja, People do not be nearly Dead to apply for Substitut`s anymore.

You have to be like that here,since we only have 2-3 addiction centres,and they are already overcrowded,so if you go there and tell them ur addicted to something else exept Heroin,they`ll laught at you,and probably kick you out.

[Spucky]

@ Mesaja,

thanks for this Reply!
Do you know who is signing Responsible
and who pay this MMT.?
Do you have any links for further information?

Regards!

[Mesaja]

I think that the country pays for the treatment,but i`m not very certain about that.
Dont know if i understand SWIY correctly,but i think that doctors are responsible for the treatment.
Another thing is(to my knowledge atleast,i`ve never been there),that there is two separate programs for quiting Heroin addiction in Kisela Voda(thats the name of the center).
One of them is the above mentioned MMT,and the other is Cold Turkey threatment,in which the patients(if they choose to),are closed in a looked room until the w/d are over.
Hope this is enough info for SWIY.
Peace and love.

Reputation Comments on this post:

Named the Town-Name swim was looking a long time! Domo.

[Spucky]

@ swinMesaja, domo arigato,
swim found something and will add. here!