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Late Stabilization & Maintenance Phase of Treatment.

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Presentation on theme: "Late Stabilization & Maintenance Phase of Treatment."— Presentation transcript:

1 Late Stabilization & Maintenance Phase of Treatment

2 Challenges in stabilization Management with higher doses “Carries”

3 Dose Adjustment Usual dose is 80-120mg Higher doses sometimes needed Consider a trough blood level if dose is going higher than 120mg or if there is uncertainty about the clinical picture of withdrawal symptoms Trough level - therapeutic range is 100- 400ng/ml

4 Rapid Metabolisers ‘I feel sleepy in the afternoon but I’m in withdrawal by nightime’ Peak blood level drawn 4 hours after witnessed drink Trough level drawn 24 hours after last dose Peak:trough >than 2:1 Dose may need to be split - twice daily dosing

5 Management of High Doses Risk of cardiac effects with doses higher than 140-150mg Prolonged QT interval - risk of arrythmia ECG should be done at this time & should be repeated with subsequent dose increases

6 “Carries” Take - home doses can be given when –At least 2 months in treatment –Clinical Stability is demonstrated –Client is able to store Methadone safely in a locked box Must consider patient safety & public safety when deciding to give carries

7 Clinical Stability This is more than just providing negative urine drug screens Methadone dose is stable Elimination of sustained problematic drug or alcohol use Emotionally stable Housing, employment or school &/or a stable support system Adherence to the treatment agreement

8 Schedule of increasing Carries After the first 2 months in treatment carries can be increased by 1 additional take-home dose/month Maximum of 6 carries/week - only 1 witnessed drink at the pharmacy per week

9 Counseling Once withdrawal symptoms have been controlled, clients can benefit from counseling Residential or out-patient rehab programs, 1:1 counseling & 12 step support groups Clients usually have multiple social & emotional issues to resolve

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