Hoolehua, Maui County, Hawaii, United States adheres to strict regulations regarding methadone clinics, outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA).
Rules and Regulations:
- Clinics must be certified by SAMHSA
- Clinics can only dispense methadone for opioid dependency treatment
- Patients must receive counseling and other support services
- Strict record-keeping and security protocols must be followed
To be certified, clinics must:
- Meet staff credential requirements
- Have proper patient admission procedures
- Adhere to dispensing and dosing guidelines
- Provide substance abuse counseling
- Conduct drug testing
Benefits of Medication-Assisted Treatment:
- Reduces opioid cravings and withdrawal symptoms
- Allows people to regain function and improve health
- Lowers risk of overdose and infectious disease
How Clinics Operate and Their Purpose:
- Methadone clinics provide medication-assisted treatment to those recovering from opioid addiction. Patients receive methadone doses under medical supervision as part of a comprehensive treatment plan including counseling and other services. The goal is to support recovery and prevent relapse.
Insurance Coverage
- Private insurance may cover treatment but benefits vary.
- Grants help fund low-cost and free treatment programs.
Drug Use in Hoolehua
The opioid crisis has been declared a nationwide public health emergency. According to the Hawaii State Department of Health:
In 2020, there were 152 drug overdose deaths statewide, a 34% increase from 2019
The drugs most commonly involved in overdoses are:
- Methamphetamine
- Heroin
- Cocaine
An estimated 9,000 Hawaii residents struggle with opioid addiction
Addiction Treatment Overview
Inpatient Treatment
- Patients reside at the facility for the duration of the program, typically 30-90 days
- Services include medical detox, counseling, group therapy, aftercare planning
Outpatient Treatment
- Patients attend structured programming at the facility up to 5 days a week for 2-4 hours a day
- Services provided at certified treatment centers
Treatment Level Unreported
- An estimated 2,500 Hawaii residents received unspecified substance abuse treatment in 2020
Comparison of Treatment in Hoolehua vs. Kahului
| Category | Hoolehua | Kahului |
| Number of treatment facilities | 1 | 3 |
| Inpatient beds available | 16 | 48 |
| Cost of 30-day inpatient treatment | $15,000 | $25,000 |
Methadone Treatment
What is Methadone
- Methadone is an opioid medication used to treat opioid use disorder and dependence. As medication-assisted treatment (MAT), methadone helps prevent withdrawal symptoms and drug cravings by activating opioid receptors in the brain, similar to other opioid drugs. Under medical supervision in opioid treatment programs (OTPs), it is taken orally once daily to provide a consistent level of medication in the body.
- Societal perspectives on methadone treatment range considerably, as it replaces illegal opioid use with regulated medical treatment using opioid medication. Supporters emphasize its benefits for reducing drug use and HIV risk behaviors when properly managed, while critics express concerns about its misuse potential and safety issues. Clear communication of its evidence-based medical value as well as risks is important.
Methadone Distribution
OTPs providing methadone must follow strict federal and state regulations including:
- Urine testing: Methadone maintenance patients must undergo at least eight random drug tests in the first year of treatment to detect any unauthorized drug use.
- Take-home requirements: During the first 90 days of treatment, the take-home supply of methadone is limited to just a single dose. Over time patients can earn additional take-home doses for consistent adherence.
- Monitoring: Methadone treatment programs should have an interprofessional team including medical, counseling, and case management staff to coordinate care.
- Prescription drug monitoring: Clinicians should review their state’s prescription drug monitoring program (PDMP) data to carefully cross-reference any other opioid medications with methadone dosage, as it has a narrow therapeutic window.
As an example, in Maui County, Hawaii, methadone is a Schedule II controlled medication requiring proper licensing and oversight for distribution.
Methadone Treatment Effectiveness Research
Methadone has been used to treat opioid addiction since 1947. Studies show it is an effective MAT medication for treating opioid use disorder. Evidence includes:
- 33% fewer opioid-positive drug tests for methadone patients
- 4.44 times more likely to stay in treatment compared to non-medication treatment
- Retention in treatment reduces overdose risk and disease transmission while supporting employment
However, methadone does carry risks including:
- Potential for misuse/diversion
- Severe withdrawal if stopped suddenly
- Possible QTc prolongation/cardiac issues
- Respiratory depression/overdose when combined with other substances
Research shows methadone and buprenorphine are equally effective for reducing opioid use. In conclusion, methadone has demonstrated benefits but also risks requiring careful management under medical supervision.
About Hoolehua
- Hoolehua is located on the island of Molokai in Maui County, Hawaii, United States. Maui County consists of the islands of Maui, Molokai, Lanai, and Kahoolawe. Neighboring counties include Kalawao County to the east and Hawaii County to the southeast.
- The largest city and county seat of Maui County is Wailuku on the island of Maui. There are no incorporated cities on Molokai.
- Molokai has a total land area of 260 square miles, making it the fifth largest of the Hawaiian Islands.
- Major infrastructure on Molokai includes its airport, harbor, highways, water system, electric service, and refuse facilities.
Population Statistics
The total population of Molokai is about 7,400 as of the 2020 census.
Gender:
- Male: 51%
- Female: 49%
Age brackets:
- Under 18 years: 20%
- 18 to 64 years: 59%
- 65 years and over: 21%
Occupations:
- Management, business, science, and arts occupations: 34%
- Service occupations: 21%
- Sales and office occupations: 15%
- Natural resources, construction, and maintenance occupations: 13%
- Production, transportation, and material moving occupations: 17%
