Rules and Regulations:
Hakalau, Hawaii, United States adheres to strict regulations regarding methadone clinics, outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA). These regulations ensure safe and effective treatment.
Certification procedures:
Methadone clinics must be certified by SAMHSA and accredited by an independent accrediting body. Staff must complete required training and clinics must meet standards for quality patient care. Regular inspections ensure compliance.
Benefits of Medication-Assisted Treatment:
- Reduces opioid cravings and withdrawal symptoms
- Allows normalization of brain chemistry
- Suppresses euphoric effects of opioids
- Facilitates patient’s engagement in recovery programs
- Enables reduction or elimination of illicit opioid use
- Improves patient survival and psychosocial functioning
How clinics operate and their purpose:
Methadone clinics provide medication-assisted treatment to those with opioid use disorder. Patients visit daily to receive methadone doses under medical supervision. The clinics offer counseling and behavioral therapies to support patients in staying substance-free. The ultimate goal is successful recovery and rehabilitation.
Insurance Coverage
- Most private insurance plans and Medicaid cover methadone treatment. Those without insurance may qualify for state-funded treatment.
- Some clinics offer free or low-cost treatment based on patient need. These clinics often have government funding or grants. Patients without the ability to pay are encouraged to inquire about reduced-cost treatment options.
Drug Use in Hakalau
Opioid crisis declared public health emergency:
- In 2017, the U.S. Department of Health and Human Services declared the opioid crisis a public health emergency.
- From 1999-2017, almost 400,000 people in the U.S. died from an opioid overdose.
- In 2017, there were 70,237 drug overdose deaths in the U.S., with 47,600 involving an opioid.
Addiction Treatment Overview
Inpatient Treatment
Inpatient treatment involves living at a treatment facility for 30-90 days or longer. It includes medical detox, counseling, group therapy, medication management, and aftercare planning.
Outpatient Treatment
Outpatient treatment provides services 1-5 days per week for 1-6 hours a day. It includes counseling, group therapy, medication management, and recovery support.
Treatment Level Unreported
Many individuals receive addiction treatment through primary care physicians, self-help groups, and other sources that are not tracked. Estimates suggest these account for 40% of people receiving treatment.
Comparison of Treatment in Hakalau vs. Hilo, Hawaii
| City | Treatment Facilities | Inpatient Beds | Cost of Treatment |
| Hakalau | 0 | 0 | N/A |
| Hilo | 5 | 36 | $10,000-$20,000 |
Methadone Treatment
What is Methadone
- Methadone is a medication used in medication-assisted treatment (MAT) for opioid use disorder. It binds to opioid receptors, reducing cravings and withdrawal symptoms. It is taken orally once daily in supervised opioid treatment programs (OTPs).
- Methadone maintenance treatment is based on the principle that providing stable opioid medication overseen by healthcare professionals can allow patients to function normally without seeking illicit opioids. It can be an effective component of treatment for opioid addiction when combined with counseling and social support.
- Societal perspectives on methadone treatment vary. Some view it positively as an evidence-based medical treatment for a chronic disease. Others see it more negatively as “replacing one drug with another.” Explaining the mechanics and benefits of MAT can help reduce stigma.
Methadone Distribution
Methadone distribution is carefully monitored with several regulations:
Urine Testing
Methadone maintenance patients must undergo at least eight random urine tests in the first year of treatment to detect any ongoing illicit drug use.
Take-Home Requirements
During the first 14 days of treatment, the take-home supply of methadone is limited to a single 24-hour dose. More take-home doses are allowed over time for stable patients.
Monitoring
Methadone treatment programs should have an interprofessional team including physicians, nurses, and counselors to monitor patient progress.
Prescription Drug Monitoring
Clinicians should review their state’s prescription drug monitoring program (PDMP) data to carefully cross-reference other opioid medications a patient may be prescribed. Methadone has a narrow therapeutic window so doses must be coordinated carefully between providers.
The state of Hawaii has classified methadone as a Schedule II controlled medication with accepted medical use but a high potential for abuse and dependence.
Methadone Treatment Effectiveness Research
Methadone is an effective medication for treating opioid use disorder that has been used since 1947. Studies show methadone maintenance treatment reduces opioid use, disease transmission through injection, and crime when combined with counseling.
Evidence for Effectiveness
Research shows methadone maintenance treatment is effective when properly implemented:
- Patients had 33% fewer opioid-positive drug tests
- Patients were 4.44 times more likely to stay in treatment
- Retention in treatment reduces overdose risk, HIV risk from injection drug use, and increases employment
Major Drawbacks
However, methadone does carry risks including potential for misuse/diversion, severe withdrawal if stopped suddenly, possible QTc prolongation, and respiratory depression/overdose when combined with alcohol or benzodiazepines. Careful patient selection and monitoring is crucial.
Comparison to Other Medications
Methadone is equally effective as buprenorphine for reducing illicit opioid use.
Conclusion
Methadone maintenance has demonstrated benefits but also risks requiring careful management by an interprofessional team.
About Hakalau
- Hakalau is a census-designated place (CDP) located in Hawaii County on the Island of Hawaii, Hawaii, United States.
- Neighbouring CDPs include Honomū, Pepeʻekeo, Ninole, and Papaʻikou.
- The capital and largest city in the county is Hilo. The land area of Hakalau CDP is 3.4 square miles.
Population Statistics
As of the 2020 census, the population of Hakalau CDP is 620.
Gender:
- Male: 51.3%
- Female: 48.7%
Age brackets:
- Under 18 years: 19.4%
- 18 to 64 years: 59.2%
- 65 years and over: 21.4%
Occupations:
The most common occupations are education, training, library (17.3%), management (16.9%), office administration (12.7%), construction, maintenance (11.4%), and sales-related occupations (10.6%).
