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Rules and regulations: Hawaii adheres to strict regulations regarding methadone clinics, outlined by both federal Substance Abuse and Mental Health Services Administration (SAMHSA) guidelines as well as state Department of Health policies.
Certification procedures: Methadone clinics must undergo inspections, obtain state certification for dispensing controlled substances, and ensure staff complete required training programs.
Benefits of medication-assisted treatment: Methadone and other medication options combined with counseling and behavioral therapies help opioid addiction patients stabilize while reducing potential overdose deaths.
How clinics operate and their purpose: Certified methadone clinics provide daily supervised methadone dosing as well as various therapy and community referral services. Their purpose is harm reduction for those struggling with opioid addiction.
Insurance Coverage
Free clinics: Hawaii has limited options for free or sliding-scale methadone and substance abuse treatment relying primarily on Grant funding.
Public and private insurance coverage details: Methadone treatment is covered under Hawaii’s Medicaid program. Certain private insurers like HMSA and Kaiser Permanente also cover methadone clinics with copays or restrictions. Uninsured patients pay around $80-150 weekly for treatment.
Drug Use in Hawaii
Opioid crisis declared public health emergency: Hawaii has seen increasing rates of opioid-related overdoses, with 139 deaths in 2021. Overdose deaths involving methamphetamine and cocaine are also on the rise.
Statistics on drug overdoses and deaths:
- 265 total overdose deaths in 2021, a 34% jump since 2020
- Primary substances involved in deaths: fentanyl, heroin, methamphetamine
- 1,312 non-fatal overdoses treated in Hawaii ERs in 2021
Data on prevalence of different substances: An estimated 43,000 people in Hawaii abuse or are dependent on illicit drugs. Methamphetamine is the most commonly used substance, followed by marijuana and prescription opioids.
Addiction Treatment Overview
Inpatient Treatment
Description: Residential rehab facility providing 24/7 structured care including medical detox and intensive clinical services.
Typical stays last 30-90 days. Treatment includes counseling, case management, discharge planning.
Outpatient Treatment
Description: Less intensive rehab based in clinics with <5 hours of services per week.
Outpatient varies from therapy sessions to partial hospitalization. Offered statewide.
Treatment Level Unreported
Nearly 50% did not specify treatment setting.
Comparison of Treatment in Hawaii vs. Neighboring Major City
| City | Facilities | Inpatient Beds | Cost of Treatment |
| Honolulu, HI | 28 | 400+ | $17,000+ |
| Los Angeles, CA | 326 | 5,000+ | $25,000+ |
Methadone Treatment
What is Methadone
Mechanism as medication assisted treatment: Methadone is an evidence-based medication option used in medication-assisted treatment (MAT) for opioid use disorder. It activates opioid receptors in the brain, blocking cravings and withdrawal symptoms.
Societal perspectives: Methadone treatment has faced stigma, with some seeing it as merely replacing one addiction with another. However, research shows MAT with counseling improves outcomes.
Explanation in layman terms: Methadone fools the brain into thinking it’s still getting the opioids of dependence, allowing people with substance use disorders to gradually rebalance their bodies and avoid severe withdrawal.
Methadone Distribution
Description of monitoring and regulations:
- Urine testing: Federal guidelines mandate at least 8 random urine tests in the first year of methadone treatment to ensure appropriate use.
- Take-home requirements: Patients must adhere to program rules for a period before taking limited doses home, with the possibility of earning a 30-day Supply after 2 years.
- Monitoring: Certified opioid treatment programs have interdisciplinary teams providing medical care, counseling, case management.
- Prescription drug monitoring: Providers cross-reference the state’s PDMP database to identify potentially dangerous drug interactions before dosing patients.
Hawaii drug classifications: Hawaii designates methadone as a Schedule II controlled substance, indicating medical use but also potential for abuse.
Methadone Treatment Effectiveness Research
Methadone is an effective medication for treating opioid use disorder used since 1947.
Evidence for Effectiveness:
- 33% fewer opioid-positive drug screens for patients on MAT
- 4.44 times more likely to stay in treatment with methadone
- Retention in treatment cuts overdose mortality risk by 50%
Major Drawbacks:
- Risk of misuse/diversion
- Severe withdrawal if stopped suddenly
- Cardiac issues in some patients
- Respiratory depression/overdose risk when mixing substances
Comparison to Other Medications: Research shows methadone and buprenorphine have similar efficacy in reducing illicit opioid use.
Conclusion: Methadone has demonstrated benefits but also serious risks requiring careful administration and monitoring.
About Hawaii
Location, county & list of neighbouring states: The Hawaiian Islands are an archipelago located in the Pacific Ocean, over 2,000 miles from the U.S. mainland. Hawaii consists of 8 major islands with no land borders to neighboring states.
Capital and largest city: Honolulu, on the island of Oahu, is both the state capital and the largest city in Hawaii.
Land area: Hawaii covers a total land area of around 6,500 square miles across all islands.
Infrastructure: Key infrastructure includes 25 public and 9 private airports, 10 commercial harbors including crucial military facilities like Pearl Harbor, over 13,000 miles of highway and public roadways. Tourism and the military drive the economy.
Population Statistics
Total population: Hawaii has an estimated total population of over 1.4 million as of 2021.
Demographics:
Gender:
- 50.5% female
- 49.5% male
Age brackets:
- 20% are under age 18
- 69% are ages 18-65
- 16% are over age 65
Occupations:
- 32% hold jobs in management, business, science and arts
- 26% in sales or office positions
- 19% in service sector occupations