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law, assumes responsibility for administration of all medical services provided by the clinic. 42 C.F.R. § 8.12(b). Before a person begins treatment, they must have an initial medi- cal examination. is is incredibly important because of how deadly methadone can be. To put this in perspective, under federal regula- tions, an initial dose of methadone for a new patient in MMT can be as high as 30mg. 42 C.F.R. § 8.12(h)(3)(ii). For a person who is not addicted to methadone, this is a lethal dose right out of the gate.
With this level of toxicity, a high degree of medical attention is required and the medical oversight must continue over the course of the program. Liability can arise when a clinic opts for one-size- ts-all approaches and goes extended periods of time without medically evaluating its patients. Shortcuts in medical oversight can lead to signi cant problems, including overdose, relapse, and failure in the program.
LIABILITY FROM COUNSELING NEGLIGENCE
Another required piece of the MMT pro- gram is counseling, which can also be an- other source of risk. Counseling sessions are required by the federal regulations and when done right, are immensely helpful to patients. Counseling sessions cover the whole patient, and o en involve discussions about stressors outside of the limited world of drug addiction. Counselors are expected to inquire about family, job, and any other stressors in life to potentially identify issues before they arise. Methadone programs will run into trouble when counselors are not communicating with medical personnel about problems that come
up, because counselors are o en privy to the early warnings. Sometimes this information is recorded and never ends up going anywhere, which is a major risk. Clinics with no back- and-forth between the counseling and medi- cal personnel can cause major red ags to be overlooked.
LIABILITY FROM TAKE-HOME MEDICATION
For obvious reasons, the biggest risk of all comes in the form of take-home methadone. Patients begin MMT coming into the clinic six days a week to receive a dose under direct medical supervision. is can be burdensome for the patient, but the rules require it until the patient can build up trust, which is also de ned under the federal regulations. e regulations lay out eight criteria that all must be met for patients to receive any take-home medications at all. e criteria speak to ab- staining from alcohol and drugs, regular clin- ic attendance, length of time in the program, but they also look at stability of home life and relationships. ey are intended to make sure patients are safe, that they can be trusted to administer their own medication, and that the medication will not fall into the wrong hands. Clinics who take shortcuts in the take-home assessment process endanger not only the pa- tient, but innocent people at home and in the public as well. Clinics must take this respon- sibility seriously and be consistently vigilant, watching for any signs that the 8-point crite- riaarenolongerbeingmetintheirtake-home patients and be ready to dial them back and require regular clinic attendance when neces- sary.
the biggest risk of all comes in the form of take-home methadone.”
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