What to Expect

Addiction treatment clients have the right to confidentiality, respect, accurate information, and the right to make decisions about their treatment.

Providers gather and review information from an assessment of your drug use and from your health checkup. They will talk with you about treatment options. Then, they will work with you to create a treatment plan to help you achieve your goals.

Your concerns and your questions need to be part of the discussion and the treatment planning.

You can use the tool, Talking to a Provider, to make sure you have the information you need and to help organize and remember your questions.

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Your appointment

When you go in for your appointment, it helps to be prepared. Here are some tips:

  • Have a list of all current prescribed medications.
  • Provide details of any substances you use or take so drug interactions can be avoided.
  • Arrange a ride home from your first few MAT appointments. You will not be able to drive until the side effects of methadone or buprenorphine are stable.
  • Have a long term-plan for reliable transportation if you have to get to a methadone clinic daily.
  • Expect daily appointments at the doctor’s office when you start buprenorphine. They gradually become less frequent.
  • Urine samples for drug screenings are taken frequently. Sometimes, an oral swab is used.

Research shows that when programs monitor clients with drug screenings, the clients do better. Records of negative drug screenings that prove a person has been clean can benefit anyone, but especially those under court supervision. Sometimes treatment programs or courts may relax some restrictions if drug screens verify a period of clean time.

Your rights

The federal government has recognized that stigma, discrimination, and fear of prosecution can keep people from entering drug treatment. There are special laws that protect people in addiction treatment.

The best way to protect your rights is to know what they are. Here are some of your rights in MAT:

  • You have the right to fair and respectful treatment.
  • Information about your treatment is confidential. You have a right to know about any exceptions.
  • Opioid treatment programs are required to help with medical, counseling, and vocational needs.
  • It is illegal to discriminate against people because they are receiving MAT.
  • Child welfare or probation/parole legally cannot require you to stop MAT.
  • Government services, student loans, and food stamps cannot be denied because of MAT.
  • Employers can drug test; they are allowed to ask for proof that you are in treatment, if you test positive for methadone or buprenorphine.
  • If you are truthful about your treatment, and provide proof, they legally cannot fire you for it.

You also have the right to be informed before you give your consent for treatment. Information should be understandable and in your best language. It should include:

  • A program’s rules and regulations;
  • Your rights and responsibilities;
  • Medication risks and possible drug interactions;
  • Cost and other financial aspects of treatment; and
  • Other treatment options.

If you feel that your rights are violated, you can file a complaint with government agencies that deal with discrimination. You do not need a lawyer, but you should do it as soon as you can. You can also complain to the head of the program or contact an advocacy group.

For more information:

Assessments

The assessment asks questions about your past and present drug use. There are also questions about your family background, living situation, work history, legal problems, and your needs and strengths.

The assessment is the starting place for finding the best treatment options for you. Providers are responsible for making sure you can use MAT safely. They need to know everything that could affect your health or put you at risk. This includes the amount and types of substances you use, and your ability to follow the instructions for taking the medications and storing them safely. They also need to know about your medical conditions, mental health conditions, prescribed medications, and any over-the-counter medications or supplements you are taking.

If you are seen at a clinic or treatment center, a licensed professional usually does the assessment before you meet with the doctor. If you are seen in a doctor’s office, you may be referred to an addiction counselor for assessment.

Most assessments have questions in several areas:

  • Use history
  • Sample question: How much money would you say you spent on drugs in the last 30 days?

  • Employment and means of support
  • Sample question: How many days were you paid for working in the last 30 days?

  • Legal status
  • Sample question: Are you on parole or probation?

  • Family and social relationships
  • Sample question: With whom do you spend most of your free time?

  • Mental status
  • Sample question: Have you ever been prescribed any medication for psychological or emotional problems?

Health checkup

The doctor will ask about your health history. You will also have a number of routine health screenings, including blood and urine tests and confidential, voluntary screening for HIV and hepatitis.

Sometimes people who use opioid drugs avoid regular health checkups and medical care. Some people are anxious about checkups. They may have health conditions that need attention or may be uneasy about various tests. Many health problems are treatable and may be easier to treat if diagnosed early.

Treatment plan

After the assessment, health checkup, and tests are completed, your doctor or counselor will talk with you about the results. You will find out if you can begin MAT safely. This is also the time to discuss your concerns and questions, talk about your preferences, and ask about the risks and precautions that go along with MAT.

The information from the assessment and checkup is used to help create a treatment plan. Your individual treatment plan is an agreement between you and your providers. It is a roadmap to help you get to where you want to go, tailored to your situation and your goals.

Getting started

There are four stages of MAT: induction, stabilization, maintenance, and tapering.

  • Induction is the starting phase. Your doctor should make sure you are adjusting to the medication safely by starting with a low dose and increasing slowly until you feel right.
  • Stabilization begins when you are on the right dose, and your body and brain have adjusted to the new medication.
  • Maintenance is the long-term phase of treatment with medication. It can free you from addictive use, craving, and anxiety for a sustained period, while you build a life in recovery.
  • Tapering is medically managed withdrawal from a medication through gradually reduced doses.

When you begin MAT, your body has to get used to the new medication. After the first dose of methadone or buprenorphine, you will usually stay at the clinic or doctor’s office for a few hours.

The doctor or nurse may want to check on you to see how you react. If withdrawal symptoms are a problem 2–4 hours after taking the first dose, you may be given another small dose. The goal is to find the dose that controls withdrawal symptoms with the fewest side effects by starting low and increasing slowly.

  • There is an increased risk of death during the first 2 weeks of taking methadone, especially in the first 4 days. The risk is higher if you have a low tolerance to opioids or if you also use alcohol or benzodiazepines. The same risks apply to buprenorphine, but they are lower.
  • Methadone may be started at any time.
  • Buprenorphine may be started 12–24 hours after the last opioid use. If you start it earlier, it may cause uncomfortable symptoms.
  • Naltrexone must be started at least 7–10 days after the last opioid use to avoid triggering withdrawal symptoms. With naltrexone you do not usually need to stay at a doctor’s office to be observed.

For more information about starting MAT:

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