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Determining the appropriateness of MMT

Adapted from: Chapter 7, "Assessment and Treatment Planning," in G. Martin et al. (eds.), Methadone Maintenance: A Counsellor's Guide to Treatment (© 2003 CAMH)


There are two principal issues in the determination of whether MMT is the appropriate treatment for the client. The first is whether the client meets the eligibility criteria and the second is whether there are other treatment alternatives that are equally well, or better, suited to the client's needs and preferences.

There are some major differences in the determination of eligibility for MMT when compared with other substance use treatments.

The assessment worker can and should review the client's presenting concerns and potential treatment options, but if MMT appears to be the treatment of choice, there are two additional steps to be taken before the treatment decision is finalized. First, opioid use must be verified by urine drug screening. Second, there must be a diagnosis of Opioid Dependence made by the physician who makes the final decision about whether to prescribe methadone.

Patients who have used opioids for less than a year, or who have never received other forms of treatment, are often advised to consider alternative treatments first. These include clonidine-assisted withdrawal management, outpatient therapy, intensive inpatient treatment and several available self-help or group counselling settings.

Other preliminary considerations

There are other important preliminary considerations to be addressed by the counsellor early in the assessment phase. For example, clients may have misconceptions about the nature of MMT and its suitability to their needs. Alternatively, the person may not understand that the service is limited to the treatment of opioid dependence.

The use of motivational interviewing strategies to explore the client's concerns and reasons for interest in MMT will generally serve to clarify whether MMT is a viable option and provide a basis for continuing the assessment process.

When MMT is clearly not an option, it is very important to help the client make a more suitable link to treatment. When the MMT service is part of a larger multifunctional service, there will normally be mechanisms available to effectively link the client with a more suitable alternative. The challenge is greater in stand-alone MMT services. Ideally, staff involved in screening clients for the MMT service should be familiar with other substance use treatment services in the community and be able to make an appropriate referral.

When MMT is a viable option, the client will need to be oriented to the nature of MMT as part of the process of giving informed consent to participate in the treatment. Often it will be part of the counsellor's role to provide this orientation. Clients should receive information about methadone and how it works, the relevant treatment requirements (e.g., frequency of urine screening and procedures for methadone pick-up) and aspects of the take-home carry system.

Clients may regard supervised urine collection procedures and methadone carry procedures as punitive and controlling. Consequently, counsellors should emphasize the therapeutic benefits as well as the rationale for any contingency management interventions used in the process. As well, the federal and provincial or state guidelines that apply to the administration of methadone can be discussed.

Finally, there should be a discussion of expectations. The counsellor should explain to clients what they can expect from the treatment team (e.g., to be treated respectfully). Similarly, the counsellor should outline the team's expectations of the client (e.g., drug dealing on the premises or engaging in threatening behaviour will not be tolerated).