Though methadone clinics have been widely accepted as effective treatment options for opioid dependent patients, especially after other interventions fail, there has been controversy about the location of methadone facilities. There is a common perception that the clinics encourage crime in surrounding areas. According to a University of Maryland School of Medicine study, crime rates do NOT increase when a methadone facility is opened. GAO studies in 2004 have shown that clinics can be detrimental to recovery and worsen relapse.
Counseling is an important part in addiction treatment. Methadone clinics should only be opened to addicts suffering from an addiction to opioids. Individual counseling is required at clinics. It is generally agreed upon that the greater number of counseling contacts a person is willing or able to accept, the higher their success rate. A key part of counseling is to prevent the transmission and exposure of HIV. Clinics should be capable of referring patients to different services, such as education, prenatal-care, vocational rehabilitation, employment, and community resources. There is no established time limit for methadone treatments. However, patients who receive longer treatment are likely to have better outcomes. Patients receiving methadone treatment within a closed setting need to be assisted when they move into a community-based setting. Patients who have made a decision to stop taking methadone should speak with their provider.
Although it is not required for treatment in the United States right now, patients are often encouraged to try different methods of treating methadone addiction before starting treatment. Methadone has been used since the 1960s. The National Institute on Drug Abuse has a list of recommended treatment options for addiction, including medication assisted therapy, cognitive behavioral Therapy (CBT), medical detox and medical detox. Newer medications have been introduced that have fewer side-effects than methadone. They can be used to curb drug cravings, stop opioid effects, and prevent physical dependence. CBT allows therapists the opportunity to look at patterns of addiction and develop new skills. Medical detox assures safety and comfort with long-term monitoring, until withdrawal symptoms have passed.
Under the newly passed Opioid Crisis Response Act, Medicare coverage of methadone therapy for those 65 and older is scheduled to start in January 2020, considerably increasing the potential revenue for opioid treatment providers.
Alabama, Arkansas, Idaho, Illinois, Iowa, Kentucky, Louisiana, Nebraska, North Dakota, South Carolina, Tennessee, Texas, and Wyoming are the remaining states that do not permit Medicaid reimbursement for methadone treatment. Several of these states have some of the highest rates of opioid addiction and overdose deaths in the country.
The opioid treatment industry has the financial incentive it needs to invest in new facilities as reimbursement for methadone treatment started becoming available in the past four years in many of the 33 states and the District of Columbia where Medicaid has been expanded under the Affordable Care Act to cover low-income adults.