Wednesday, October 12, 2011

Methadone "Carries"

When people begin on the methadone maintenance program to stop opiate drug use, especially IV heroin addiction, they are required to get their methadone daily. It also must be witnessed daily by the pharmacist dispensing the methadone.  This is called DWI, or daily witnessed ingenstion.
"Carries" refer to the "Carry Policy" of the Methadone Maintenance Program. A carry is a dose of methadone that is mixed in Tang and dispensed at the drug store but the patient is allowed to take it home rather than ingest it there.
As with the whole methadone program, it is a privilege and carries are a 'priviledge' which reflects that a person is doing well with the program.
The criteria for initating carries require that the doctor decide that 'carries' are both safe for the patient and safe for society.  A person must be clinically stable, well established on a methadone dose which eliminated craving and also withdrawal symptons.  The patient must also demonstrate social, cognitive and emotional stability.  Egs which doctors use for this include, appointment schedule maintenance, reports of improved social relationships, better mental status examination, no illegal behaviour.  Most importantly a person must have urine drug screens which are free of all mood altering substances for a minimum of 12 weeks.
In addition they must have the ability to store methadone safelty.  The methadone must be stored in a safe and secure place where it will not be stolen and is not a danger to others especially children.  This requires that a person be in safe, supportive housing.
Reasons for giving carries are school, work, caring for young children, travel etc.
It is further recommended that carries not exceed 4 days or 400 mg whichever is less.
If a person has had methadone carries and relapsed the carry privilege must be reassessed.  They must then return to daily witness ingestion and demonstrate that they are 'stable' again. This includes at least 4 weeks of urines which are clean for mood altering drugs.
Further urine testing is being done not only to ensure no drug abuse but to confirm methadone in the urine indicating that it isn't being diverted.

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