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Winter's fury doesn't slow daily dosing in methadone program

February 18, 2010
by Gary A. Enos, Editor
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Careful planning of take-home doses protects patients who can’t get to N.J. clinic

Edward J. Higgins, the longtime executive director of JSAS Healthcare, Inc. and a board member of the American Association for the Treatment of Opioid Dependence (AATOD), owns several titles and much recognition in the opiate treatment community. Yet each winter in his home state of New Jersey, Higgins also takes on what would seem to be a more pedestrian role: He’s his agency’s chief weather watcher.

For an agency that processes about 400 visits a day to its Asbury Park clinic site for administered daily doses of methadone, anticipating what Mother Nature might deliver in any given week becomes a critical role. During a winter when East Coast snowstorms have been frequent but also unpredictable in their path, the challenge of being accurate has intensified.

“I’m on with the local stations, the New York weather, the Philadelphia weather,” says Higgins. “Our obligation to patients is our number one priority, and we also have to be sensitive to our staff.”

Programs such as Higgins’ have standing orders from regulators to distribute take-home doses of methadone when they anticipate that a patient won’t be able to visit the clinic. Yet they operate cautiously in this regard, weighing any risks of not administering the doses themselves against the possibility that a patient could miss one or more doses and experience severe withdrawal.

“Sometimes a patient will miss a dose and just say their stomach was a little off or they had trouble sleeping; it’s nothing they can’t handle,” Higgins says. “But someone with extreme withdrawal might go to the hospital, and the hospital might not give out methadone. But we have a 24-hour answering service that can provide any information that a facility might need for a patient.”

In a particularly stormy week earlier this month, Higgins twice had to make advance decisions about take-home dosing. On a Monday morning, with significant snow in the forecast for Tuesday into Wednesday, he ordered that take-home doses for Wednesday be distributed. As the week progressed and the forecast had become even more ominous, the take-home order was expanded to include Thursday.

Higgins says the decision-making about take-home doses tends to be based on the anticipated worst-case scenario with weather. He adds that based on staff members’ role and their level of comfort with driving in hazardous conditions, the staff is divided into three groups in terms of how essential it is for them to make it to work on a stormy day. “We take on the responsibility to be on top of things,” he says.

Despite its location in an area threatened by winter blizzards and summer hurricanes, JSAS Healthcare never has had to close operations for an entire day, Higgins says. It is a seven-day business in which patients visit at all times of the day for medication, counseling and other support.

He says that even within the addiction treatment community, individuals who do not offer methadone treatment underestimate the degree to which those services have become regulated and professionalized.

“People have no idea of the strict rules under which we have to operate,” Higgins says. His agency in January participated in its third CARF survey, a process that uncovered only one deficiency in performance on more than 1,000 standards examined, he says.

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