Medical Information

MEDICAL INFORMATION

Methadone and buprenorphine are a man-made (synthetic) opiate, which are given by mouth in our program.  They produces physical dependence.  They are used in our program to block the effects of other opioid medications and prevents withdrawal symptoms from the discontinuation of other opioids. We do NOT treat pain with methadone or buprenorphine from our program.  A properly prescribed methadone or buprenorphine dose will decrease or stop the desire to use other opioids.  They will, at the proper dose, not cause sleepiness or intoxication (a “high”).  Various medical and environmental changes can change your dose requirements.  Your methadone or buprenorphine dose can be adjusted specifically to accomplish these goals, so your dose may increase, decrease or remain constant while you are in treatment.

 

For those abusing standard opiates, once your methadone dose is at 60 mg/day, you will be required to wait 14 days before requesting another medication dose increase.

 

For those abusing fentanyl, once your methadone dose has reached 70mg, you will be required to wait 7 days before requesting a medication increase. Once that dosage has reached 80mg, 14 day waiting periods will be required between medication increases.

 

 

BIRTH CONTROL/PREGNANCY

We encourage patients not to become pregnant during opioid replacement treatment.  All women who could become pregnant will have a urine pregnancy test conducted at intake.  However, a woman who becomes pregnant while on opioid replacement treatment should NOT discontinue opioid replacement treatment until after the baby is born.  Women who wish to prevent pregnancy should use an effective birth control method.  Our staff can meet with you to recommend places to receive birth control and family planning services.

 

Drug abuse, physical illness and stress can all interfere with regular menstrual cycles, so you CANNOT count on menstruation to tell you if you may or may not be pregnant.  If you become pregnant or suspect you may be pregnant, please inform your primary counselor so that an appointment can be made to meet with our physician.  We will provide urine pregnancy tests at a minimal charge at your request.  The clinic does not furnish contraceptives, but we can direct you to where contraceptives may be obtained at reasonable costs.  If you become pregnant, you should meet with our medical director as soon as possible.  We will request that you sign a release of information so that we can verify that you are receiving prenatal care.

 

No drug or medicine is absolutely safe during pregnancy, but through research methadone and buprenorphine have been shown to be generally safe for the woman and unborn fetus.  Methadone or buprenorphine treatment are the preferred treatment for women who are opioid dependent and become pregnant.  It can be extremely dangerous to withdraw from opioids during pregnancy including methadone or buprenorphine.  Withdrawal from street opioids, prescription pain medications, methadone or buprenorphine may cause harm to the fetus and miscarriage or premature delivery.

 

If you become pregnant while on opioid replacement therapy, inform our program medical director as soon as possible.  Our physician will follow you closely during your pregnancy, helping with referrals to obstetrical services, providing information to your obstetrical services, providing information to your obstetrician about pregnancy and methadone, and monitoring your dose to make sure it remains adequate for your needs.  Our physician will require that you give consent to share information with your obstetrician so that your pregnancy treatment can be well coordinated.  In addition, our physician will want to communicate with the pediatrician that you choose for your child before you deliver.  Pregnant women in the program may be required to have additional blood or urine testing to monitor their treatment if it is necessary for the mother or baby’s safety.

 

As with any pregnancy, patients on opioid replacement treatment should be prescribed prenatal vitamins by their obstetricians and should be encouraged to avoid any medications not prescribed by a physician.  Avoiding any illicit drugs, keeping regular attendance for stable dosing of methadone or buprenorphine, and having early prenatal care are the best ways to maintain a healthy pregnancy.

 

Because pregnancy can produce more emotional, social and financial stresses, a pregnant woman in treatment will be encouraged to meet more frequently with her counselor and develop strategies to cope with the life changes she is facing.  Goals leading towards a healthy pregnancy will be incorporated into the treatment plan.  When indicated, female patients anticipating detoxification from opioid replacement therapy should receive a pregnancy test before starting voluntary detoxification.

 

BLOOD TESTS

Upon acceptance into our program and each year thereafter, you are required to have a blood test and routine medical examination.  You will be asked to meet with a physician or other qualified staff if your laboratory results are abnormal.  A copy of any blood work can be sent to your primary care doctor with your written authorization.  You will be charged for all blood work required for general medical care.  We do not routinely test for exposure to the human immunodeficiency virus (HIV) or for exposure to hepatitis but this testing is available upon request, additional cost maybe incurred.

 

HIV/AIDS

 

Human Immunodeficiency Virus (HIV) is the virus which causes Acquired Immune Deficiency Syndrome (AIDS) is spread by sexual contact with an infected person, by sharing needles and/or syringes (primarily during drug injection) with someone who is infected or less commonly through transfusions of infected blood or blood clotting factors.  Babies born to HIV-infected women may become infected during delivery or through breast-feeding following delivery.

 

In the health care setting, workers have been infected with HIV after being stuck with a contaminated needle or less commonly when HIV-infected blood gets into another person’s open wounds or mucous membrane.  HIV has been detected in saliva and tears but in extremely low quantities.  Contact with saliva, tears or sweat has never been associated with the transmission of HIV.

 

Some people fear that HIV might be transmitted in other ways. However, no scientific evidence to support any of these fears has been found.  There is no risk of HIV transmission to co-workers, clients or consumers from contact in industries such as food-service establishments.  There is no known instance of HIV transmission through tattooing or body piercing. There have only been a few cases of HIV transmission related to acupuncture all of these have been associated with practitioners not sterilizing/disinfecting the needles between clients.  Casual contact through closed-mouth or “social” kissing is not a risk for transmission of HIV. The risk associated with open-mouth kissing is believed to be very low.

 

Tuberculosis

 

Tuberculosis (TB) is a disease caused by germs that are spread from person to person through the air.  TB usually affects the lungs, but it can also affect other parts of the body.  A person with TB can die if not treated.

 

The general symptoms of TB include feelings of sickness or weakness, weight loss, fever and night sweats.  The symptoms of TB in the lungs include coughing, chest pain, and coughing up blood.

 

There are two tests that can be used to help detect TB infection: a skin test or a special TB blood test.  The Mantoux tuberculin skin test is performed by injecting a small amount of fluid (called tuberculin) into the skin in the lower part of the arm.  A person given the tuberculin skin test must return within 48 to 72 hours to have a trained health care worker look for a reaction on the arm.  A positive test for TB infection only tells that a person has been infected with the TB germs.  It does not tell whether or not the person has progressed to TB disease.  Other tests, such as a chest x-ray and a sample of sputum, are needed to see whether the person has TB disease.

 

Bacille Calmette-Guérin (BCG) is a vaccine for TB disease.  BCG is used in many countries, but it is not generally recommended in the United States.  BCG does not completely prevent people from getting TB.  It may cause a false positive tuberculin skin test.

 

TB disease can be treated by taking several drugs for 6 to 12 months.  It is very important that people who have TB disease finish the medication, and take the drugs exactly as prescribed.

 

Syphilis

 

Syphilis is caused by the bacterium Treponema pallidum. It is passed from person to person through direct contact with syphilis sores.  The sores mainly occur on the external genitals, vagina, and anus or in the rectum.  They also occur on the lips and around the mouth.  Syphilis cannot be spread through contact with toilets seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing or eating utensils.

 

Until the sores appear there are few signs or symptoms of having the infection.  If untreated, syphilis may go on to more advanced stages, including a transient rash and eventually, can cause serious involvement of the brain, nerves, eyes, heart, blood vessels, liver, bones and joints.  Chancres caused by syphilis make it easier to transmit and acquire HIV infection sexually.

 

A simple blood test can be used to screen for syphilis and to diagnose it.   In the early stages, syphilis is easy to cure. A single intramuscular injection of penicillin remains the most effective drug to treat people with syphilis.  For persons having had syphilis for longer than one year, a longer course of treatment may be required.

 

Gonorrhea

 

Gonorrhea is a very common infectious disease caused by Neisseria gonorrhea.  Gonorrhea is spread through contact with the penis, vagina, mouth or anus.  Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from mother to baby during delivery. 

 

In the United States, the highest reported rates of infection are among sexually active teenagers, young adults and African Americans.

 

Some men with gonorrhea may have no symptoms at all. Those that do have symptoms usually have them within 2 to 5 days after infection but may take up to 30 days to appear.  Symptoms include burning sensation when urinating, or a white, yellow or green discharge from the penis.  Sometimes men may have painful or swollen testicles with gonorrhea infection.

 

In women, the presentation of symptoms is more common and is often mistake for bladder or vaginal infections.  Symptoms may include painful urination, increased vaginal discharge or vaginal bleeding in between menstrual cycles.

 

Symptoms of rectal infection in either men or women may include discharge, anal itching, soreness, bleeding or painful bowel movements.  Infections in the throat may cause a sore throat but usually causes no symptoms.

 

Laboratory tests are available to diagnose gonorrhea.  Several antibiotics can successfully cure gonorrhea.

 

Chlamydia

 

Chlamydia is the most frequently reported bacterial sexually transmitted disease in the United States. It is caused by the bacterium, Chlamydia trachomatis. Chlamydia can be transmitted during vaginal, anal or oral sex.  Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.

 

Persons who have a greater number of sex partners have a greater risk of being infected.  Anyone can be infected with Chlamydia and unknowingly transmit the infection. 

 

Three quarters of infected women and about half of infected men will have no symptoms.  If symptoms occur, they usually appear within 1 to 3 weeks after exposure.  For women, some symptoms include abnormal vaginal discharge, burning sensation upon urination, lower abdominal pain, low back pain, pain during intercourse or bleeding in between menstrual periods.  Pelvic Inflammatory Disease (PID) is a serious complication of Chlamydia and is a major cause of infertility among women of childbearing age.  For men, symptoms include discharge from the penis or a burning sensation when urinating, burning or itching around the opening of the penis or pain and swelling of the testicles.

 

There are laboratory tests to diagnose Chlamydia.  Chlamydia can be easily treated and cured with antibiotics.  All sex partners of a diagnosed person should be evaluated, tested and treated.  Persons with Chlamydia should refrain from sex until they and their partners have all completed treatment, otherwise re-infection is possible.

 

Viral Hepatitis

 

Hepatitis A is a liver disease caused by the hepatitis A virus (HAV).  HAV is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with HAV.  Fewer than 5% of HAV infections are transmitted during sexual contact.  Two products are used to prevent HAV infection: immune globulin shots and hepatitis A vaccine shots.

Hepatitis B is a serious disease caused by a virus that attacks the liver.  The virus, which is called hepatitis B virus (HBV) can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure and death.  HBV is spread when blood from an infected person enters the body of a person who is not infected.  Two products are used to prevent the spread of HBV: immune globulin shots and hepatitis B vaccine shots.

 

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV).  HCV is spread primarily by direct contact with human blood, including sharing of needles for injection drug use and sex with someone with HCV.  There is no vaccine to prevent hepatitis C.

 

Hepatitis D (delta) is a liver disease cause by the hepatitis D virus (HDV), a defective virus that needs the hepatitis B virus to exist.  HDV is found in the blood of persons infected with the virus.  Infection occurs when blood from an infected person enters the body of a person who is not immune. Since HBV is required for a person be infected with HDV, the hepatitis B vaccine should be given to prevent HDV infection.

 

Hepatitis E is a liver disease caused by the hepatitis E virus (HEV).  It is transmitted in much the same way as hepatitis A virus.  HEV is not common in the United States.

 

There are no specific treatments available for the acute symptoms of viral hepatitis.  Doctors recommend bed rest, a healthy diet and avoidance of alcoholic beverages.  Interferon alpha is used to treat people with chronic hepatitis C. Some studies also show the usefulness of interferon alpha in treating HBV as well.

 

STIs and Pregnancy

 

Pregnancy does not provide women or their babies any protection against sexually transmitted infections (STI).  The consequences of an STI can be significantly more serious, even life threatening, for a woman and her baby if the woman becomes infected with an STI while pregnant.  It is important that women be aware of the harmful effects of STIs and know how to protect themselves and their children against infection.

 

A pregnant woman with an STI may have early onset of labor, premature rupture of the membranes surrounding the baby in the uterus, and uterine infection after delivery.

 

The harmful effects of STIs in babies may include stillbirth (a baby that is born dead), low birth weight (less than five pounds), conjunctivitis (eye infection), pneumonia, neonatal sepsis (infection in the baby’s blood stream), neurologic damage, blindness, deafness, acute hepatitis, meningitis, chronic liver disease, and cirrhosis.

 

Chlamydia, gonorrhea, syphilis, trichomoniasis, and bacterial vaginosis can be treated and cured with antibiotics during pregnancy. There is no cure for viral STIs, such as genital herpes and HIV, but antiviral medications may be appropriate for pregnant women with herpes and definitely is for those with HIV.  For women who have active genital herpes lesions at the time of delivery, a cesarean delivery (C-section) may be performed to protect the newborn against infection.  C-section is also an appropriate option for some HIV-infected women.  Women, who test negative for hepatitis B, may receive the hepatitis B vaccine during pregnancy.

 

Risk Reduction

 

Condoms are classified as medical devices and are regulated by the Food and Drug Administration.  Condom manufacturers in the United States test condoms for defects, including holes, before it is packaged.  The proper and consistent use of latex or polyurethane condoms when engaging in sexual activity—vaginal, anal or oral—can greatly reduce a person’s risk of acquiring or transmitting sexually transmitted infections including HIV.

 

Long term mutually monogamous relationship with a partner who has been tested and is known to be uninfected will help to reduce your risks as well.

 

For more information…

 

Centers for Disease Control and Prevention               CDC National AIDS Hotline

1600 Clifton Rd.                                                         1-800-342-AIDS

Atlanta, GA 30333                                                      Spanish:           1-800-344-SIDA

1-800-232-4636                                                          Deaf:               1-800-243-7889

http://www.cdc.gov/nchstp/od/nchstp.html

http://www.cdcnpin.org/scripts/std/std.asp

 

 

GENERAL MEDICAL CARE

Your primary care provider should continue to provide general medical care.  However, if you have a need to see our clinic physician regarding your opioid replacement treatment, please make an appointment. If you receive a prescription for a controlled substance, in order to progress in our program, you will be required to provide copies of the pharmacy filled prescription.  We will also require that you sign a release of information for the prescriber so that we may notify him/her that you participate in our program and receive a prescription for methadone or buprenorphine from us.  You are not allowed to receive a prescription for methadone or buprenorphine from another prescriber while in our program.

 

HOSPITALIZATION

Your daily dose may be provided to you by the hospital, if you require hospitalization.  Notify the hospital physician caring for you that you are a client at Metro Treatment Center.  The hospital may require you to authorize the release of information of your medication from our program.  If authorization is not able to be obtained we will make every effort to verify the person contacting us is genuinely involved in your care at the hospital before releasing information about your medication.  Upon discharge from the hospital, you will need to provide documentation of your hospital stay and evidence of the last day that methadone or buprenorphine was provided to you from the hospital.  Documentation of controlled substances provided to you from the hospital will also be required to verify positive drug screen results.