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Rules and Regulations
Maryland adheres to strict regulations regarding methadone clinics, outlined by the Maryland Department Of Health Behavioral Health Administration. All clinics must be certified by SOTA and licensed by the DEA.
Certification procedures:
- Clinics must meet SOTA standards for treatment procedures, facility security, dispensing protocols, and counseling services
- Staff must undergo background checks and specialized training
Benefits of medication-assisted treatment:
- Improves patient survival rates and supports long-term recovery
- Reduces risk of relapse and overdose
- Allows people to regain functionality in work, family life
How clinics operate and their purpose:
- Provide methadone doses for opioid addiction under medical supervision
- Require counseling and urine drug screenings
- Support patients in ending substance misuse and leading healthy, productive lives
Insurance Coverage
Some nonprofit clinics offer free or low-cost treatment based on patient income eligibility and Grant funding.
Most private insurance plans and Medicaid cover methadone treatment to some extent, with specific authorization requirements, copays/deductibles, and restrictions. Clinics can provide details. Uninsured patients may establish sliding-scale fees based on income.
Drug Use in Maryland
Opioid crisis declared public health emergency: Governor declared a state of emergency in 2017 to unlock resources to combat opioid addiction and overdoses.
Statistics on drug overdoses and deaths:
- 2,379 overdose deaths in 2021, a 3.5% increase from 2020 (Maryland Dept of Health)
- Majority involved opioids like heroin, fentanyl, prescription opioids
Data on prevalence of different substances:
- Opioids involved in 93% of overdose deaths
- Cocaine involved in over half of deaths
- Significant rises also seen in meth and benzodiazepine deaths
Addiction Treatment Overview
Inpatient Treatment
Description: Intensive treatment while residing at a hospital/facility 24/7 for initial intervention and medical stabilization
Length of stay, procedures, services: Variable length from days to months; medication, counseling, group therapy, more
Outpatient Treatment
Description: Live at home and attend scheduled treatment sessions at a facility
Frequency of services, location: Sessions from 1-5 days per week; community clinics, private practices
Treatment Level Unreported
Description and estimates: Large number of patients receive addiction treatment through primary care, mental health centers and emergency departments that do not report treatment specifics. Estimates show this could represent over 500,000 additional Marylanders receiving some form of addiction treatment per year.
Comparison of Treatment in Maryland vs. Neighboring Major City
| Category | Baltimore | Washington D.C. |
| # of treatment facilities | 163 | 107 |
| Inpatient beds available | ~3,000 | ~2,500 |
| Cost of treatment | $15,000+/mo | $20,000+/mo |
Methadone Treatment
What is Methadone
Mechanism as medication assisted treatment, OTP principle: Methadone is an opioid agonist medication used to treat opioid addiction. It binds to opioid receptors and reduces cravings and withdrawal without producing a strong high. Used through medically-supervised opioid treatment programs (OTPs) alongside counseling and behavioral therapies.
Societal perspectives on methadone treatment: Despite clinical evidence supporting its efficacy, there are often negative societal attitudes towards methadone, viewing it as just replacing one addiction for another. However, research consistently shows that methadone helps opioid addicts stabilize their lives.
Explanation in layman terms: Methadone’s activating the opioid receptors tricks the brain into thinking it is still getting abused opioid drugs, preventing withdrawal symptoms. This lets people focus on counseling/therapy for addiction recovery without being distracted by cravings or feeling sick from withdrawal.
Methadone Distribution
Description of monitoring and regulations: Methadone clinics follow strict state and federal regulations for dispensing and monitoring patients:
- Urine testing: Methadone maintenance patients must undergo at least eight urine tests for illicit drugs in the first year of treatment.
- Take-home requirements: During the first 14 days of treatment, the take-home Supply of methadone is limited to a 24-hour dose with onsite consumption required. Over time clinics can authorize 1-4 weeks of take-home doses for stable patients meeting certain criteria.
- Monitoring: Methadone treatment programs should have an interprofessional team including physicians, nurses, counselors to continually monitor patient progress.
- Prescription drug monitoring: Clinicians should review PDMP data to cross-reference other opioid prescriptions and dosage titration must be done carefully, as methadone has a narrow therapeutic index.
Maryland state drug classifications: Classified as Schedule II controlled substance in the state due to potential for abuse/addiction.
Methadone Treatment Effectiveness Research
Methadone is an effective medication for treating opioid use disorder used since 1947. Studies support its efficacy:
Evidence for Effectiveness: Studies show methadone reduces opioid use, disease transmission, and crime:
- 33% fewer opioid-positive drug tests
- Patients were 4.44 times more likely to stay in treatment
Retention in treatment reduces overdose/disease transmission risk and increases employment.
Major Drawbacks: However, there are risks including potential for misuse/diversion, severe withdrawal if stopped suddenly, possible QTc prolongation/cardiac issues, and respiratory depression/overdose when combined with other substances.
Comparison to Other Medications: Research shows methadone is equally as effective as buprenorphine for reducing self-reported opioid use.
Methadone provides documented benefits but also has risks requiring careful patient monitoring and management.
About Maryland
- Location, county & list of neighbouring states: Maryland is located in the Mid-Atlantic region, bordering Virginia, West Virginia, Pennsylvania, Delaware, and Washington D.C. It has 23 counties and one independent city (Baltimore).
- Capital and largest city: The capital and largest city is Annapolis and Baltimore, respectively.
- Land area: Maryland covers 12,407 square miles including water area.
- Infrastructure: The state has an extensive transportation system including Baltimore/Washington International Airport, Metro subway lines, light rail, Amtrak, and an interconnected highway system. Other infrastructure includes shipping ports, healthcare facilities, and parks/recreation areas.
Population Statistics
Total population: Based on 2020 census data, the population of Maryland is approximately 6.18 million residents.
Demographics:
- Gender: 49% male, 51% female
- Age brackets: 18.7% under 18 years, 61.4% age 18-64 years, 19% over 65 years
- Occupations: Top industries by employment are government (13.8%), professional services (12.5%), healthcare (11.8%), retail trade (10.5%), and construction (6.3%), according to 2021 Bureau of Labor Statistics data. Other major occupation sectors include education, finance, hospitality services and manufacturing.