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Rules and regulations
New Hampshire adheres to strict federal and state regulations regarding methadone clinics, outlined by the Substance Abuse and Mental Health Services Administration (SAMHSA) and New Hampshire Department of Health and Human Services. All clinics must be licensed and accredited.
Certification procedures
To open a new opioid treatment program in New Hampshire:
- Submit application to state opioid treatment authority
- Undergo facility inspections and plan reviews
- Demonstrate capacity to provide required services
- Have certified medical director and staff
- Meet security standards
Benefits of medication-assisted treatment
Benefits of methadone maintenance therapy include:
- Reducing opioid cravings and withdrawal
- Allowing focus on recovery and rehabilitation
- Lowering risk of overdose and infectious disease
- Improving overall health and functioning
How clinics operate and their purpose
Methadone clinics provide supervised methadone dosing, counseling, case management to support recovery from opioid addiction. The goal is harm reduction and improved wellbeing.
Insurance Coverage
- New Hampshire Medicaid covers methadone treatment
- Some private insurers may offer limited coverage
- Uninsured individuals may qualify for state-funded treatment slots
Drug Use in New Hampshire
- Over 400 opioid overdose deaths in 2021, a 34% rise from 2020, declared a public health crisis
- Around 175,000 people in NH reported misusing prescription opioids from 2015-2019
- Alcohol, stimulants, marijuana, and cocaine also widely used
Addiction Treatment Overview
Inpatient Treatment
- Focuses on medical stabilization, intensive counseling, group therapy in a residential facility
- Typical stay ranges from 30-90 days
Outpatient Treatment
- Services while living at home – counseling, medication management
- 1-5 days a week for several hours per day
Treatment Level Unreported
An estimated 18% did not specify treatment level
Comparison of Availability
| City | Treatment Centers | Inpatient Beds | Cost of Treatment |
| Manchester, NH | 67 | ~500 beds | $10,000+/month |
| Boston, MA | 267 | ~2,300 beds | $20,000+/month |
Methadone Treatment
What is Methadone
Methadone is an opioid agonist medication used in medication-assisted treatment (MAT) and opioid treatment programs (OTPs). It binds to opioid receptors, reducing cravings and withdrawal symptoms. Society has conflicting opinions on methadone treatment – some view it as replacing one addiction with another, while supporters emphasize its efficacy as harm reduction. Simply put, methadone stabilizes patients and enables functioning.
Methadone Distribution
New Hampshire has strict regulations for methadone distribution:
- Urine testing: Patients undergo at least eight random drug tests in the first treatment year to ensure compliance.
- Take-home doses: Patients are limited to a 24-hour methadone Supply for the first 14 days, with more take-homes allowed over time if patients meet certain criteria.
- Monitoring: Methadone clinics have interprofessional teams overseeing treatment, including counseling, case management, and care coordination.
- Prescription drug monitoring: Clinicians review the PDMP to carefully cross-reference methadone dosage with medications, as methadone has a narrow therapeutic range and risk of interactions.
New Hampshire categorizes methadone as a Schedule II controlled substance, indicating potential for abuse and dependence.
Methadone Treatment Effectiveness Research
Methadone has been effectively used to treat opioid addiction since 1947.
Evidence for Effectiveness: Studies show participation in a methadone program is linked to reduced opioid use, infectious disease transmission, and criminal acts:
- 33% fewer opioid-positive drug tests
- 4.44 times more likely to stay in treatment
Retention in methadone treatment lowers overdose and disease risks while increasing employment opportunities.
Major Drawbacks:
- Potential for misuse/diversion
- Severe withdrawal if stopped suddenly
- Possible QTc prolongation/cardiac issues
- Respiratory depression/overdose risk when combined with other substances
Comparison to Other Medications: Research shows methadone and buprenorphine have equal effectiveness for reducing illicit opioid use.
About New Hampshire
New Hampshire is located in the New England region of northeastern United States, bordering Maine, Massachusetts, and Vermont. The capital city is Concord and the largest city is Manchester. New Hampshire covers 8,953 square miles of land area. Infrastructure includes highways, railroads, airports, and inland ports along the Merrimack River.
Population Statistics
The total New Hampshire population is approximately 1.4 million residents.
Demographics:
- Gender: 51% female, 49% male
- Age brackets: 19% under 18 years, 63% between 18-64 years, 18% over 65 years
Occupations:
- Healthcare and social assistance (17% of jobs)
- Retail trade (14%)
- Manufacturing (10%)
- Accommodation and food services (9%)