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2 Established in 1974 Non-Profit Federal Block Grant recipient Accept Medicaid, Private Insurance, and Self-Pay. Patients are not denied treatment if they do not have the ability to pay for services

3 Schedule II narcotic Half life in the range of hours Blocks the euphoric effects of opioids in the brain Can be administered one time daily Comes in liquid, pill, or wafer form Referred to as the gold standard for opioid addiction treatment

4 Prevents erratic maternal opioid levels and lessens fetal exposure to repeated withdrawal episodes Reduces fetal exposure to illicit substances Decreases the risks of mother to fetus infection from HIV, HCV, and STI s Reduces obstetrical complications and improves outcomes

5 Exposed to violence and trauma Generational drug use Lack of formal education Lack of employment Legal involvement Limited parenting skills and resources Hx of child abuse and neglect Psychiatric issues Unstable housing Food insecurity and lack of nutrition

6 Methadone treatment does not cause birth defects in the baby, but some infants experience withdrawal. There is no correlation between the mother s dose of methadone and whether or not the infant will experience withdrawal symptoms. Withdrawal usually begins a few days after birth but may begin 2-4 weeks after birth.

7 Withdrawal symptoms can last several weeks and include: fussiness, restlessness, not eating or sleeping well, fever, vomiting, or trembling Medication may be prescribed to minimize the symptoms Alaska Regional Hospital has the NEST Unit for babies experiencing withdrawal (Neonatal Abstinence Evaluation Support & Treatment)

8 Babies do as well as babies not born on methadone The baby s health is much better than a baby born on heroin The Center for Drug Problems staff has assisted pregnant heroin addicted mothers into treatment and coordinated care with local hospitals and OB/GYNs for hundreds of babies in the last 41 years.

9 Methadone is detected in the breast milk at very low levels Methadone concentrations in breast milk are unrelated to maternal methadone doses The amount of methadone ingested by the infant is low (average 0.2 mg/day) Studies show a relationship between breastfeeding and reduced NAS severity and duration HCV is not a contraindication for breast feeding HIV+ status and a unstable recovery environment are contraindications for breast feeding

10 Initial phone screening or walk in assessment. Orientation appointment Every Monday at 1:00 pm Waitlist Appointment Every Tuesday at 12:30 Initial Drug Screen Every Tuesday at 12:30 S.T.O.P. AIDS Class Every Tuesday at 12:30 Assessment scheduled (2 hour appointment) Enrollment Day Clinical Paperwork and MD H & P Documenting addiction/withdrawal

11 Patient is started on methadone after a period of observed withdrawal Patient is given a low dose of methadone and assessed for possible side effects If no dose side effects are observed the dose will be titrated every 3-5 days until it prevents cravings, withdrawal, and continued use of illicit opioids Optimal dose varies between patients Dosing does not have to be more complicated for pregnant patients

12 Based on the individuals assessment Treatment Plan addressing 6 ASAM Dimensions Acute Intoxication/Withdrawal Potential Biomedical Conditions and Complications Emotional, Behavioral, or Cognitive Conditions and Complications Readiness to Change Relapse, Continued Use, or Continued Problem Potential Recovery/Living Environment Weekly Individual Counseling Session Group Therapy Pregnant Women have to attend Pregnancy and Care of the Newborn

13 The primary goals are to help addicts cease heroin/opiate use and lead more stable, productive lives. But, as knowledge about heroin addiction and effective treatment practices has grown, so too have the objectives of most methadone treatment programs, which also aim to: Decrease criminality and reduce the numbers of substance abusers entering the criminal justice system. Assist patients in addressing multiple substance abuse (including crack/cocaine addiction and alcoholism). Assure treatment for general health matters, especially those related to drug use, such as HIV/AIDS, tuberculosis and hepatitis Promote patient employability and educational development. Identify and treat mental health problems and alleviate homelessness, family substance abuse and child and family dysfunction.

14 The prior appointments are adjusted because pregnant women are a priority and do not wait on a waitlist. When they call, they start the process and an enrollment day is given as soon as possible. Call if you have pregnant woman that may need services.

15 Narcotic Drug Treatment Center, Inc. Center for Drug Problems 520 East 4 th Avenue #102 Anchorage, AK (access to nurse 24/7) Leave me a message

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