Initial orientation to MMT
Orientation to MMT involves giving the client the information needed to understand and consent to treatment. Clients often feel physically uncomfortable during the first week of treatment, and it may be difficult for them to retain a lot of the information.
Orientation is also an opportune time to educate clients about health, safety and confidentiality. Many clients will continue to use other opioids until they become stable on methadone, and they need information about needle exchange programs, techniques for safe injecting, methods of needle cleaning and safe sex practices.
It is helpful to give the client a handbook about MMT treatment to help her or him understand the nature of MMT and to be used as a reference throughout the treatment process. (See, for example, Methadone Maintenance Treatment: Client Handbook, CAMH, 2001.) It may be best to give the client some time to read over the handbook after the preliminary discussion and then meet again to discuss any questions or concerns the client may have.
Counsellors should be sensitive to the fact that some of their clients may have difficulty reading or understanding written materials and will require assistance. Because of the stigma that is attached to illiteracy, this issue must be handled very carefully.
Once the client has agreed to participate in the MMT program, expectations of the client and treatment team should be documented in the form of a written treatment agreement, signed by both parties and a copy provided to the client.
Treatment agreements are a useful way to ensure that the rights and obligations of both parties are clearly understood. They are also useful in addressing any misunderstandings that may arise in the course of treatment.
The treatment agreement specifies the rights of the client (e.g., to be treated with respect, to receive methadone daily, to have access to counselling, medical and other services, and to have the opportunity to earn carries). The treatment agreement should outline the expectations of the client with regard to such things as urine screens, pharmacy hours, methadone pick-up and aggressive behaviour. The agreement should also describe the steps the client should take in the event that he or she believes that the agreement has been violated. (Here is a sample treatment agreement.)
Introduce all aspects of the MMT program
The orientation process should address all aspects of the program that the client is likely to use (e.g., physician, pharmacy and counselling services). Also, counsellors should introduce clients to the staff, orient them to the physical environment and make them feel welcome, to help alleviate their anxiety.
Limits of confidentiality
The limits of confidentiality should be discussed in a straightforward manner at the outset of discussions with the client. These limits include the legal duty to report (e.g., child welfare and driving), the legal duty to warn and/or protect (e.g., threats to harm self or others) and court subpoena.
Ideally, the nature of and limits to confidentiality should be included in written materials (e.g., client handbook or the treatment agreement) provided to the client; see, for example, CAMH's Methadone Maintenance Treatment: Client Handbook.
Although issues of confidentiality are a common concern of all clients, they are of even greater concern to clients who have been mandated to treatment or who have children and have experienced encounters with child welfare agencies.