I work at a busy assessment center in an area where most patients are homeless. It’s not uncommon for me to encounter a heroin addict who’s been through inpatient rehabs twenty or thirty times. I always suggest methadone maintenance, and am surprised at how many times the patient rejects it. Is it really so awful?”
I’ve never been on methadone, so I wouldn’t know from experience. I have worked in assessment centers with patients like yours, and there is a certain amount of resistance among many of the people you would otherwise think are the best candidates for Opioid Treatment Programs.
In some cases, it’s just that the patient is looking for a bed, and OTP doesn’t provide that. In others, the patient has heard horror stories from other addicts about different programs — criminal activity, abuse of power by the staff, drug use by clients, etc.
And of course, how difficult it is to withdraw from methadone once you’re ‘hooked’. This is one of the reasons buprenorphine is popular — it’s much easier to terminate treatment if you change your mind.
Some of what patients hear is gossip and folklore, something for which the addict community is famous. But there is a wide variation in quality among OTPs. We’ve all heard about the ‘gas and go’ programs where counseling and testing are minimal and other drug use common. OTP can be very lucrative and has a rep for attracting the unscrupulous operation.
Still, there are a lot of good programs out there, run by responsible clinicians in accordance with established best practices. Whether you agree with the idea of maintenance or not, these programs do deliver quality care to people who want it.
My suggestion, based on my own experience — visit some of the most prominent OTPs in your area. Ask the questions of them that your assessment clients will ask of you. You’ll quickly see which providers you feel comfortable referring a client.