2. Entry into methadone treatment

A comprehensive assessment by a medical practitioner authorised to prescribe methadone is essential.

Indications
Contraindications
Precautions
Key features of assessment for treatment with methadone
Informed consent and patient information
Meeting legislative requirements
Coordinated care

Indications

• Opioid dependent.
• 18 years or older (check jurisdictional requirements regarding age limits for MMT).
• Able to provide proof of identity as is required for treatment with all S8 medications.
• Capable of giving informed consent.

Contraindications

• Severe hepatic impairment or respiratory insufficiency.
• Hypersensitivity to methadone or other ingredients in the formulation.

Precautions

Particular caution should be exercised by prescribers when assessing individuals with the following clinical conditions (seek specialist advice or assistance in such cases):

• High risk poly drug use.
• Co-occurring alcohol dependence.
• History of naltrexone use.
• Psychiatric illness.
• Chronic pain – refer to pain clinic for assessment first.
• Concomitant medical problems.

Top of page

Key features of assessment for treatment with methadone

Opioid use

• Opioids used, quantity, frequency, route of administration, duration of current opioid use, use over the last 3 days
• Severity of dependence
• Age of commencement, age of regular use, age of dependence, timing and duration of periods of abstinence
• Episodes of overdose

Other drug use

• Including alcohol, illegal and prescribed drugs, current medications.

Health status

• Diseases from drug use (blood borne viruses, other)
• Intercurrent health conditions (psychiatric, general)

Psychosocial status

• Legal
• Social - employment, educational/vocational skills, housing financial, family
• Psychological – mood, affect, cognition.

Past treatment

• Where
• When
• Periods of abstinence
• Degrees of success/acceptance of treatment

Patient views regarding treatment

• Motivation for treatment
• Trigger for seeking treatment
• Patient goals for treatment episode
• Stage of change

Physical examination

• Observation of clinical signs related to drug use (needle track marks, intoxication, withdrawal)
• Evidence of medical problems (eg liver disease – jaundice, ascites, encephalopathy).

Investigations

• Urine tests may be indicated if there are concerns about the accuracy of the drug history and diagnosis and may also be useful to confirm benzodiazepine and other drug use.
• Investigations for HIV and hepatitis B and C if indicated.

Top of page

Informed consent and patient information

Obtain informed consent to methadone treatment in writing from the patient before he/she enters treatment.

For patients to make a fully informed decision provide them with written information about:

• The nature of methadone treatment
• Other treatment options
• Program policies and expectations
• Recommended duration of treatment
• Side effects and risks associated with taking methadone
• Risks of other drug use
• The potential impact of methadone on their capacity to drive or operate machinery
• Availability of further information

Methadone may affect the capacity of patients to drive or operate machinery during the early stages of treatment, after an increase in dose, or when patients are also taking other drugs. Warn patients about this effect before entry into treatment, when the dose of methadone is increased, or when the use of other drugs is suspected.

Meeting legislative requirements

Methadone is a Schedule 8 medication.

• A medical practitioner must be authorised by the relevant jurisdictional body to prescribe methadone for addiction.
• Prescribers must obtain authority to prescribe methadone for each patient.

Check your jurisdictional policy for details of authorisation procedures.

Coordinated care

• Effective methadone treatment requires ongoing regular collaboration between the prescriber and dispenser.