Before clients begin methadone maintenance treatment (MMT), the physician must assess their physical health and psychosocial functioning to determine whether they fulfil the program's admission criteria. Candidates for MMT should meet the diagnostic criteria for opioid dependence and will often:
- have an extensive history of opioid use
- be physically dependent on opioids
- have been unsuccessful in other forms of treatment for opioid dependence.
Exceptions to these criteria may be made to accommodate people who are at risk. For example, people at high risk for relapse, pregnant women and people who are HIV-positive may be admitted to MMT without delay to stabilize them quickly and reduce harm. In addition, adolescents are occasionally admitted to MMT programs, but, concerning adolescents, specialized care is recommended.
During the assessment, clients should be told that entering an MMT program is a major commitment: They will need to meet the various MMT team members frequently for continued assessment, counselling, observation of dosing and urine drug screening.
Clients' initial contact with the MMT program is very important in that it has a major impact on the likelihood for successful treatment. The goal of the initial assessment is to gather information about the client's specific needs to determine the best treatment options. All treatment options should be discussed with the client. Clients must also be informed of any exceptions to doctor-patient confidentiality, and both the physician and the client should sign a treatment agreement.
The initial assessment should include:
- obtaining a complete substance use history, including the consequences of the client's substance use and previous treatment attempts
- determining if the client is experiencing withdrawal symptoms
- completing a brief psychiatric history
- asking about any family history of substance use problems
- gaining information about the client's social situation, including parenting arrangements if the client has children, and the children's safety if they live with the client
- assessing for high-risk behaviours, such as unsafe sex and sharing of drug paraphernalia
- performing a medical examination and requisitioning laboratory tests, including blood and urine tests
- obtaining information from the client's previous treatment providers.
Medical assessment should concentrate on:
- giving a complete medical exam
- confirming a diagnosis of opioid dependence, and the client's fulfilment of MMT admission criteria.
The medical exam should cover:
- history of opioid use
- history of other substance use
- signs of withdrawal
- treatment history
- social and physical consequences of the client's opioid use
- history of driving while under the influence of substances
- family history, including substance use, mental health and violence
- social history, including social support, relationships, children, legal issues, education and employment
- history of mental health problems, including suicidal thoughts, depression and anxiety
- use of birth control and whether the client is pregnant
- high-risk behaviours, including unsafe sex and needle sharing
- laboratory exams including CBC with MCV and platelet count, HIV, hepatitis B and C, GGT, ALT and AST.
A diagnosis of opioid dependence and/or opioid withdrawal is based on DSM-IV diagnostic criteria and the confirmation of opioid use through laboratory testing, such as urine drug screening. If the diagnosis is confirmed, ensure that the client fulfils the MMT program's other admission criteria.