A client-developed methadone maintenance program

A realistic methadone maintenance program is a continuum of four related areas: intake, rehabilitation with on-going evaluation, detoxification, and postdetoxification followup, each jointly administered by client volunteers and professional staff. In the early stages of client treatment, pharmacists have more frequent contact with program participants than do other staff professionals. At the Minneapolis Pilot City Health Center, 31 of 69 participants in the methadone maintenance program were interviewed by their pharmacist to determine client understanding of program objectives, interpretation of program effectiveness, and suggestions for program improvement. Client understanding of the objectives or program elements ranged from 30 to 97 %. Client evaluation of the effectiveness of program elements ranged from 0 to 65%. The client-developed program included intake procedures to establish for each client the program objectives, rules, evaluation, guidelines, client goals, dismissal guidelines, and a review of supportive services. Rehabilitation would be continuous with consistent on-going evaluation to measure goal attainment, a decline in disruptive behavior, and freedom from illicit drug use. Detoxification should be undertaken after the client's behavior has stabilized and he has developed a marketable skill. Monitoring of the client to assure a drug-free state would be an important element of the postdetoxification follow-up.