MMT Treatment
How Do I Start & What Should I Expect!
This Link Takes You To The SAMHSA Substance Abuse Treatment Facility Locator 
1. Find A Clinic Near You.
2. Make The Call.
You may be asked to do a phone interview to determine your eligibility for MMT. Just answer the questions honestly. Remember any information you give them is protected by the HIPAA laws so it is strictly confidential. During this interview they may ask you...Why you feel this program would work for you, How you found out about them( ie. Internet, friend, family referral, etc.), How long its been since you last used, What drug you last used and how much, What sort of withdrawal you are having (if any),What sort of withdrawal symptoms you usually have, How long you have been using drugs & alcohol, What sort of drugs you have tried, What type of detoxes you have tried, How many times you have been to rehab, What was the longest period of time you have been abstinent since becoming addicted and what was the circumstances behind that period of abstinence. Then you may be asked questions regarding your insurance or financial situation, job status, etc. This basically addresses your ability to pay. If you are not working it doesn't necessarily mean your inability to pay but they may want a co-signer (for me it was my Dad). He had to bring in financial statements from work, bank statements, etc. but this is unusually strict. They may also ask you questions about any pending legal matters. This is in case you start the program and have a charge against you that could result in jail time. They need to know because you may be detoxing cold turkey and this time won't be held against you whereas if you don't show up because your in jail over a previous charge they may think you quit and you have to start all over to get back in.Finally, if you are a good Candidate for MMT they will set you up with an appointment.
Who Is A Good Candidate For MMT?
Someone Who...
*Is Addicted Only to Opiates. You may have used other drugs on occasion but Heroin, Hydrocodone, Oxycodone, Morphine, Demerol, Dilaudid, etc. are your "Drugs of Choice" and without them you begin having withdrawal symptoms.
*Has been using opiates for at least one year or more unless pregnant in which case this may be waived.
*Exhibits signs of addiction (ie. withdrawal, unlawful behavior to obtain narcotics, preoccupation with obtaining the drug despite negative consequences).
*Has previous failed attempts to detox in other types of recovery treatment centers (ie. inpatient, cold turkey, abstinence based, 12 step NA, etc)
*Is Over 18 yrs. old.
*Is positive for opiates with a drug screen but negative for benzodiazepines (Xanax, Valium, Klonipin), and other forms of narcotics. While some centers are more lenient than others with this rule & will allow benzo's with a doctors prescription many will not allow entrance into the program until a urinalysis shows positive only for opiates. This can be confusing because another requirement by clinics is that you need to be in mild - moderate withdrawal but be positive for opiates. This is based on the fact that most addicts with tolerance high enough to safely take Methadone cannot go more than 24hrs.without medication AND it prevents people from coming in saying they are in withdrawal only to get Methadone which can lead to overdose in a non-tolerant person. Basically if you have taken pills or used Heroin 24 hours prior to the test you should be OK.
3. The First Day of the Rest of Your Life!This will be the longest day you will have at the clinic. First you will take a urine test. This may or may not be supervised depending on your State Regulations. While we are discussing the regs let me explain that also. There are federal regulations which is the minimum all states have to do to stay in business. They can be reviewed by using the link below...
The State Regulations are usually stricter than the state guidelines. Not every state has State guidelines. You can find out whether or not your state does and what the regs are by using the following link...
After the urine screen you will probably meet the doctor for your physical. They will be observing for signs of withdrawal by using something called the COWS (Clinical Opiate Withdrawal Scale) A copy of this scale can be viewed at the following link..
Clinical Opiate Withdrawal Scale (COWS) Take Home Doses Your eligibility for "take home doses" is based on fulfilling 8 separate criteria. These can be viewed by visiting the Federal Regulations Link above also. (i) Absence of recent abuse of drugs (opioid or nonnarcotic), including alcohol; (ii) Regularity of clinic attendance; (iii) Absence of serious behavioral problems at the clinic; (iv) Absence of known recent criminal activity, e.g., drug dealing; (v) Stability of the patient’s home environment and social relationships; (vi) Length of time in comprehensive maintenance treatment; (vii) Assurance that take-home medication can be safely stored within the patient’s home; and (viii) Whether the rehabilitative benefit the patient derived from decreasing the frequency of clinic attendance outweighs the potential risks of diversion If it is determined that a patient is responsible in handling opioid drugs, the following restrictions apply: (i) During the first 90 days of treatment, the take-home supply is limited to a single dose each week and the patient shall ingest all other doses under appropriate supervision. (ii) In the second 90 days of treatment, the take-home supply is two doses per week. *Remember these are only the Federal Guidelines, Some States have created their own guidelines which can be stricter than the federal guidelines but not less than them. What is A Stable Dose? A stable dose is considered a dose that.... There is no such thing as a standard dose. The correct dose is the dose that produces stability. This varies from person to person. However, there are a few things scientists have discovered with doses. Methadone doses of less than 80 mg.'s have been shown to result in higher incidents of relapse. Doses between 80-110 is the average dose most patients are on that produces stability and reduces relapse but remember this varies. Do not be afraid to ask for an increase or decrease. When you begin going to the clinic and are asking for an increase probably every other day it will be increased 5mg at a time. You should tell the nurse the symptoms you are having that make you think you need an increase. Be specific because she will need to document them. Simply say, "I am still experiencing diarrhea, nausea, sleeping problems, etc. so I believe I need an increase." I know when I started I felt like they thought I was just trying to get more medication when I was still requesting to go up every other day and two weeks had passed. LOL So, don't worry if you feel that way too. They take you up so slowly and spread out the time it just seems that way. Better to ask now than relapse later. Remember during the first few months your body is adjusting to a new way of life that it probably has not known in a very long time. So give it time. You didn't become an addict overnight & you won't recover overnight.You may have some symptoms related to the Methadone which are normal and should go away after about 1-3 months. These may include sweating (different from withdrawal sweats), cravings for sweets, weight gain (not a result of the Methadone but from eating normal for the first time in years), weight loss, loss of sexual desire, irregular menstruation. The good news is that within the first few days to weeks you will feel remarkably better. After my first week I felt normal. I still had sleeping irregularities, a few stomach queesies, some major sweating & sweet cravings after dosing. All which disappeared after the first month but overall I experienced a miracle! I was not high, not sick, I was Normal! There are some symptoms that are not normal and require immediate attention. These usually result from mixing your Methadone with other medications, especially Benzodiazepines (Xanax, Valium, Klonipin), alcohol, Heroin, other opiates. All of these can cause respiratory depression and death when mixed with Methadone. Pentazocine (Talwin), Naltrexone (Revia), Tramadol (Ultram),can lead to severe withdrawal. For a complete list of drugs that interfere with Methadone use the link below.. Dial 911 if you experience any of the following symptoms or your family notices any of the following... Difficulty / Shallow or Slow Breathing, Pinpoint Pupils, Vomiting / Nausea, Disorientation / Dizziness, Itching / Hives / Rash, Seizures,Difficulty In Swallowing as if The Throat Feels Like Its Swelling Shut, Inability To Arouse While Sleeping, Loud Snoring or Gurgling. Remember, Methadone doesn't work for everyone. If it turns out to not work for you don't get discouraged. There is something that will work. Some patients who couldn't take Methadone used Suboxone with great success, others have had success with treatments not available in the US yet like Ibogaine. The main thing is whether its 12 Step Abstinence or life long Methadone there is a treatment that will work for you as long as you are ready to devote your all to treatment. This does not mean "willpower". We all know if willpower was the problem most of us would have been clean long ago. It is more a matter of dedication to your treatment. So, hang in there. God Bless. CONGRATULATIONS
They will also observe your body for signs of track marks. The doctor will of course listen to your heart & lungs, as well as asking you questions regarding your drug use. You may have an EKG done to check for any irregular heart rhythms. In addition, the nurse will draw blood to test for any problems including HCV & HIV. You will also receive a TB Skin test. 
Next you will meet your counselor. He/she will go over the rules & regulations with you. Be prepared this takes some time. Many clinics will allow you to dose before this so you aren't dying in withdrawal during the interview. However, my clinic has a rule that once you dose you leave No Exceptions! 
The last step may or may not be receiving your first dose of Methadone. You will be observed for about 15minutes after taking the Methadone to ensure you are having no reactions. Federal regulations state you can receive no more than 30 mg for your first dose.Your clinic may even "blind dose" you for the first week or two meaning you won't be told how much you are receiving. This is hard to tell with the liquid but my clinic takes the pills and dissolves them in water so I was able to recognize the pills and add my dose. I received 20mg. the first day with a 5 mg. increase every other day till I become stable. You will return every day for the first 3 months to take your medication in front of a nurse. As long as you are increasing your dose to become "stabilized" the nurse will assess your vitals before you dose.
(iii) In the third 90 days of treatment, the take-home supply is three doses per week.
(iv) In the remaining months of the first year, a patient may be given a maximum 6-day supply of take-home medication.
(v) After 1 year of continuous treatment, a patient may be given a maximum 2-week supply of take-home medication.
