Methadone Detoxification for Opiate Addiction
DESCRIPTION
Methadone detoxification is defined as the abrupt discontinuation, under medical supervision and monitoring, of a type of opioid agonist to which an individual manifests psychophysiologic dependence. Methadone is a long-acting opioid used exclusively as substitution therapy for individuals unable to remain abstinent from short-acting opioids. Detoxification is the abrupt and complete discontinuation of the substance of abuse, and is not to be confused with tapering. Tapering is a process during which the dosage of the substance of abuse is gradually decreased/titrated over time in a manner titrated to avoid the emergence of significant withdrawal effects. Methadone detoxification should occur in a hospital inpatient setting, whereas methadone tapering and methadone maintenance (no dosage changes over time) are appropriately addressed in federally licensed, publicly funded methadone clinics.
POLICY
Methadone detoxification for the treatment of opiate addiction is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
MEDICAL APPROPRIATENESS
Methadone detoxification in an inpatient hospital setting is considered medically appropriate if all of the following criteria are met:
An individual's methadone has been abruptly and completely discontinued; and
The individual manifests signs and symptoms of opioid withdrawal upon cessation of the methadone, including but not limited to:
Significantly abnormal vital signs
Excessive lacrimation
Nausea
Abdominal cramping
Excessive rhinorrhea
Piloerection
Vomiting
ADDITIONAL INFORMATION
For appropriate dosage information, contraindications, precautions, warnings, and monitoring information, please refer to one of the standard reference compendia (e.g., Drug Information for the Health Care Professional: USP-DI).
24-hour medical supervision is necessary during methadone detoxification to prevent serious medical complications associated with withdrawal.
Abrupt discontinuation of methadone may be facilitated by the use of an opioid antagonist, and the withdrawal signs and symptoms are treated palliatively, using alpha-antagonists (such as Clonidine), nonnarcotic analgesics, and antiemetics.
Methadone maintenance and methadone tapering are appropriately provided on an outpatient basis by licensed Methadone clinics.
Methadone detoxification should be conducted by individuals with experience and knowledge of methadone detoxification protocols.
SOURCES
Amato L, Davoli M, Minozzi S, Ali R, Ferri M. Methadone at tapered doses for the management of opioid withdrawal. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003409. DOI: 10.1002/14651858.CD003409.pub3.
American Society of Addiction Medicine. (1994). Detoxification: Principles and protocols. Retrieved June 3, 2002 from http://www.asam.org/publ/detoxification.htm.
BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2003). Methadone treatment for opiate addiction (3.02.01). Retrieved April 5, 2007 from BlueWeb.
Galanter, M., & Kleber, H.D. (1994). Opioids detoxification. American Psychiatric Press Textbook of Substance Abuse Treatment (1st ed., pp. 191-208. American Psychiatric Association.
McEvoy, G. K. (Ed.). (2007). AHFS Drug Information. (pp. 2139-2145). Bethesda, MD: American Society of Health-System Pharmacists, Inc.
MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2006). Methadone. Retrieved April 5, 2007 from MICROMEDEX Healthcare Series.
MICROMEDEX Healthcare Series. USP DI Drug Information for the Healthcare Professional. (2006). Opioid (narcotic) analgesics (systemic). Retrieved April 5, 2007 from MICROMEDEX Healthcare Series.
National Institutes of Health. (1997, November). Consensus Statements. 108. Effective medical treatment of opiate addiction. Retrieved April 6, 2007 from http://consensus.nih.gov/1997/1998TreatOpiateAddiction108html.htm.
Seifert, J., Metzner, C., Paetzold, W., Borsutzky, M., Passie, T., Rollnik, J., et al. (2002, September). Detoxification of opiate addicts with multiple drug abuse: a comparison of buprenorphine vs. methadone. Pharmacopsychiatry, 35 (5), 159-164.
Tennessee Code: Title 39 Criminal Offenses: Chapter 17 Offenses Against Public Health, Safety and Welfare: Part 4 Drugs: 39-17-408. Controlled substances in Schedule II. Retrieved April 5, 2007 from http://www.michie.com/tennessee/lpext.dll?f=templates&fn=main-h.htm&cp=tncode.
Tennessee Code: Title 68 Insurance: Chapter 11 Health Facilities and Resources: Part 16 Tennessee Health Services and Planning Act: 68-11-1607. Certificate of need - applications - exemptions - registration of equipment - critical access hospital designation. Retrieved April 5, 2007 from http://www.michie.com/tennessee/lpext.dll?f=templates&fn=main-h.htm&cp=tncode.
Umbricht, A., Hoover, D. R., Tucker, M. J., Leslie, J. M., Chaisson, R. E., & Preston, K. L. (2003, April). Opioid detoxification with buprenorphine, clonidine, or methadone in hospitalized heroin-dependent patients with HIV infection. Drug Alcohol Dependence, 1 (69), 263-272. Abstract retrieved April 19, 2007 from PubMed database.
U. S. Food and Drug Administration. (2006, November). Center for Drug Evaluation and Research. Information for Healthcare Professionals Methadone Hydrochloride. FDA Alert. Death, narcotic overdose and serious cardiac arrhythmias. Retrieved April 5, 2007 from http://www.fda.gov/cder/drug/InfoSheets/HCP/methadoneHCP.htm.
U. S. Food and Drug Administration. (2006, November). Center for Drug Evaluation and Research. Drugs @ FDA. Labeling Information. Dolophine hydrochloride® (methadone hydrochloride). Retrieved April 5, 2007 from http://www.fda.gov/cder/foi/label/2006/006134s028lbl.pdf.
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EFFECTIVE DATE |
6/27/2007 |
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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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