Methadone substitution is a standard and world recognized method to treat opiate addiction (heroin, „braun“…). Substitute programs have been operating in the civilized world for almost 30 years. For person who repetedly tried abstinence and treatments the methadone substitution method is his/her opportunity. It is proved that within the bounds of substitution it is possible to live in a worthy and good quality way; which is also minimal burden for the budget of the society. The base of substitution is to change a street illegal opiate (for example heroin, „braun“…) for legal opiate. The street opiate is usually polluted and used with non-sterile needle, often shared with others. Risks following from this – transmission of AIDS, of hepatitis – are clear. Methadone has form of syrup or pills. It is also about making an addict give up using drug intravenously. Important fact is breaking down the connection dealer-client and connection with drug world in general. An essential component of the substitute therapy is resocialization of the client and his/her reorientation to the lifestyle convenient for the society and for the client himself/herself.

 

In the end must be said that methadone substitution is not omnisaving; it can not help everyone, it is just successful method for indicated group of addicts, nothing more.

 

Doctors and personnel of the centre can accept or reject anyone. It is very difficult to define a client suitable for the substitution program. He should be able to prove long-term opiate abusing (braun, heroin…), which is most ofen a written confirmation of registration from drop-in centres (for example „Drop In“ or „K centrum“) that he is addicted to opiate, the older the registration the better. Prefered are clients who have „rich“ drug career, HIV positive clients, clients with hepatitis A, B, C, non A, non B… and pregnant women.

 

Motivation of the client is important for acceptance. People with provable opiate addiction longer than 4 years and who made repeated attempts for abstinence are to the program accepted most often. For younger clients it is often important to produce evidence for attempted classic treatments in mental institutions.

 

Drop-in centres are the first filtres for applicants for substitution. Applicant has often advantage when having discharge papers from addicts rehabilitation centres – but they are not the condition. There are persons who have been using opiates daily for 5-10 years and have never absolved any treatment, in this case any official report is important for example expert opinion – note about opiate abusing, police and other reports.

 

Befor being accepted to the program, it is important to register in a drop-in centre. Even in the case the client was not accepted in the substitution program, the registration would be a big advantage for him. When the above mentioned is carried out, client comes with recommendation to the methadone substitution centre and there his/her anamnesis is reconsidered again. When the client is suitable to criterion, we talk in detail about the sense of substitution. Client´s notion about the program and about his participation in it is very important. Client´s notions are then incorporated into the therapeutic agreement, which is individual.

 

Signing the therapeutic agreement between the client and the personnel is the final step of acceptance into the program. Client´s signature confirms, that the client will follow the given rules of the program.

 

 

Indicated clients after bilateral understanding can go through outpatient detoxification. It is important to realize that with even very slow outpatient detoxification there is high-risk of recurrence.

 

The most often reason for application is excessive social and finantial situation of the user. Some clients try through outpatient detoxification to lower their tolerance to opiates and to aim the same states for less money. According to my oppinion even in these cases there is outpatient detoxification indicated, for one month spent in the regime of outpatient detoxification is huge motivation in the client´s life. It may be an inspiration to change. If nothing else, the client will physically take a break from an illegal and variously polluted street drug.

 

Detoxification can last different time. Doses´ lowering is very slow, it is often needed to stop on a special level for longer time. The lasting of detoxification can be therefore equal to substitution, it is only a question of terms.

 

In some countries there is practised such a way of detoxification: a client wants detoxification and he/she does not want to be informed about the levels of doses, the speed of doses´lowering and of course even about placebo. This is transmitting of responsibility to someone else. This way has according to the literature approximatelly same results as detoxification which is daily consulted with clients.

 

Determining of the dose in the regime of detoxification must be always given according to subjective state of the client. There can also rise a situation when from original detoxification evolve substitution, possibly with an open end.

 

Detoxification of pregnant women is a question. There is commonly held a view that sustitution is much safer for pregnant women. But when the client wants detoxification the most convenient is the third term of pregnancy. In some countries buprenorphin (Subutex) detoxification or substitution is preferred for the pregnant.It is posible to change methadone substitution for buprenorphin substitution and vice versa. According to producers ca 8 mg of buprenorphin is equal to ca 60 mg of methadon. This convert is of course only tentative, because subjective feelings of the client must be considered. Various expectations are often connected with the new substance. It is recommended to convert to methadone and vice versa on a dose of 30 mg of methadone, which is a very low dose.

 

We use automatic dispensers, which are operated from PC with a special software, that reduces possible mistakes in methadone doses and it firstly minimizes the manipulation with the opiate. The program contains all data about the patient including actual file, dig. photograph (reliable identification) and contains other outputs like statistics and other agenda of psychiatric outpatients´.

 

CMS Klimentská: 10:00-12:00 a.m., 3:00-5:00 p.m.

CMS Pankrác: 8:00-12:00 a.m., 3:00-4:00 p.m.