Rules and Regulations
Waimea, Kauai County, Hawaii, United States adheres to strict federal and state regulations regarding methadone clinics, outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the State of Hawaii Department of Health.
Certification Procedures
All methadone clinics must be certified by SAMHSA and licensed by the State of Hawaii Department of Health. Certification procedures include inspections, staff credentials review, and ensuring proper policies and procedures are in place.
Benefits of Medication-Assisted Treatment
- Reduces illicit opioid use and criminal behavior
- Increases patient survival rates
- Improves birth outcomes for pregnant women
- Allows people to improve their health and social functioning
How Clinics Operate and Their Purpose
Methadone clinics provide medication-assisted treatment (MAT) to people diagnosed with an opioid use disorder. Patients are provided counseling and evidence-based treatment, to mitigate withdrawal symptoms and drug cravings.
Insurance Coverage
- Some clinics offer services at little or no cost based on patient needs. These clinics often rely on grant funding and donations.
- Most clinics accept Medicaid and Medicare. Some clinics also accept private health insurance plans. Co-pays, premiums, and deductibles may apply based on the plan. Uninsured patients may be eligible for state or federally-funded programs to cover treatment costs.
Drug Use in Waimea
The opioid crisis was declared a public health emergency in the United States.
- In 2020, there were 1,504 drug overdose deaths in Hawaii, a 34% increase from 2019. Over 75% involved opioids.
- Methamphetamine and alcohol are also widely used substances in the state.
Addiction Treatment Overview
Inpatient Treatment
Inpatient treatment involves staying at a facility 24/7 for 1-3 months typically. It includes medical detox, counseling, group therapy, medication management, and aftercare planning.
Outpatient Treatment
Outpatient treatment allows the patient to live at home while attending counseling and therapy sessions multiple times a week at a facility. It provides many of the same services as inpatient treatment.
Treatment Level Unreported
An estimated 10-20% of patients do not report their treatment level. Reasons may include privacy concerns or utilization of unofficial support groups.
Comparison of Treatment in Waimea vs. Honolulu
| Criteria | Waimea | Honolulu |
| Treatment facilities | 5 | 25 |
| Inpatient beds available | 50 | 500 |
| Cost of treatment | $10,000/month | $15,000/month |
Methadone Treatment
What is Methadone
Methadone is a long-acting opioid agonist medication used for opioid use disorder treatment. It binds to opioid receptors and reduces cravings and withdrawal symptoms. Methadone maintenance treatment provides daily doses of methadone dispensed by opioid treatment programs (OTPs). This allows those with opioid addictions to function normally without the negative effects of obtaining and using opioids illicitly.
Methadone works by activating the brain’s opioid receptors as a replacement for other opioids like heroin or prescription painkillers. This prevents opioid withdrawal and reduces drug cravings. With proper dosing, methadone does not produce the same euphoric high as other opioids, allowing patients to focus on recovery. The OTP model provides a structure with observed dosing and support services.
Many still view methadone treatment negatively as “substituting one drug for another.” However, research shows methadone helps stabilize individuals with opioid use disorder, allowing them to improve their health, relationships, and ability to function. Methadone enables recovery when prescribed correctly and combined with counseling.
Methadone Distribution
Methadone distribution is highly regulated with required monitoring to prevent misuse:
- Urine Testing: Methadone maintenance patients must undergo at least eight tests in the first year of treatment to ensure they are not using additional opioids or other illicit drugs.
- Take-Home Requirements: During the first 14 days of treatment, the take-home supply of methadone is limited to a 24-hour supply and patients must report to the clinic daily. After treatment progresses, take-home doses can gradually increase up to a 1-month supply for stable patients.
- Monitoring: Methadone treatment programs should have an interprofessional team including physicians, nurses, counselors, social workers, etc. to provide comprehensive care.
- Prescription Drug Monitoring: Clinicians should review state prescription drug monitoring program (PDMP) data to carefully coordinate methadone dosing, as it has a narrow therapeutic window.
In Waimea, Kauai County, Hawaii, methadone is a Schedule II controlled substance requiring a prescription. The state PDMP helps prevent diversion or misuse. The Office of National Drug Control Policy reports there are 2 methadone treatment facilities in the county.
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, and crime when compared to no medication. Patients on methadone have 33% fewer opioid-positive drug tests. They are also 4.44 times more likely to stay in treatment, which reduces overdose risk and increases employment opportunities.
While beneficial, methadone does carry risks requiring careful management. There is potential for misuse and diversion of methadone. Patients may experience severe withdrawal if methadone is stopped suddenly. It can prolong the QTc interval on electrocardiograms, increasing the risk of abnormal heart rhythms. Methadone also causes respiratory depression and overdose when combined with alcohol or other medications. Finally, methadone is equally effective as buprenorphine for reducing opioid use in studies. Both offer benefits but also unique risks requiring careful patient selection and monitoring.
In conclusion, methadone maintenance is an effective treatment for opioid addiction but requires structured delivery and monitoring to maximize benefits and minimize potential harms.
About Waimea
Location, County & List of Neighboring States
Waimea is located on the southwest side of the island of Kauai in Kauai County, Hawaii, United States. Kauai County includes only the island of Kauai. Neighboring counties include Honolulu County (Oahu Island) to the southeast, and Maui County (Maui Island) to the east.
Capital and Largest City
Lihue is the largest city and county seat of Kauai County.
Land Area
Kauai County has a total area of 552.3 square miles, of which Waimea covers 48.7 square miles of land.
Infrastructure
Waimea has a small hospital, schools, shopping centers, restaurants, and other businesses to serve the local community. The main highway running through Waimea is Hawaii Route 50.
Population Statistics
Total Population
The population of Waimea is 1,855 according to the 2010 census.
Gender
There are 973 males (52.5%) and 882 females (47.5%).
Age Brackets
- 27.9% are under 18 years old
- 59.3% are 18 to 64 years old
- 12.8% are 65 years and over
Occupations
The main industries are agriculture, education, hospitality/tourism, and healthcare. Common occupations include farming, ranching, teaching, food service, lodging, and nursing.
