Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...

186or other side effects. This increase should occur gradually over a 3- to 6-weekperiod.Patients are not to be told their dose level since this leads to an unhealthy'"competition" among the patients for the highest doses. Dose level is a medicalissue and it should be managed by the medical staff.E. Side effects of methadoneSide effects of methadone include excessive sweating, constipation, edema,drowsiness, dermatitis, and relative impotence in men. None of these symptomsare serious, and, with the exception of excessive sweating, they usually disappearas treatment is continued and tolerance is attained. However, some patients continueto suffer from constipation. This can be treated symptomatically with alaxative, but even this is usually not needed once a tolerance develops.F. Take-home medicationMethadone is to be administered to the patient daily (6 or 7 days per weekdepending on the number of days the center is opened) on the premises of anNTA facility for the first 3 months of his treatment. Once the patient's druguse has ceased for at Idast 1 month and he has demonstrated stability in his lifepatterns, he may take home his weekend medication at the discretion of theappointed person in charge and after signing NTA Form 22 "Statement of Responsibilityfor Take-Home Medication" (see attachment 4).Individual doses to take off NTA premises must be properly labeled with thepatient's name, the date the dose is to be taken, and the specific program nameand telephone number. The label must also state that the bottle contains methadoneand that it is dangerous and may be fatal if taken by anyone other than thepatient.Patients are to return all empty bottles before new bottles are given. If thepatient fails to return his bottle, loses or breaks it, or reverts to drug use, he willbe required to report in daily again for at least 4 weeks.Because methadone may be fatal when taken by a nonaddicted person in dosesconventionally given to methadone maintenance patients, patients taking medicationhome must keep it in the locked container provided by the center. Thefact that methadone is packaged in a liquid form makes it particularly attractiveto children. The patient must be impressed with the danger involved in takingmedication home and be strongly encouraged not only to lock up his methadone,but to place it out of children's reach.In addition, the patient should be reminded that methadone should not berefrigerated.G. Urine testingEvery methadone maintenance patient must submit a monitored urine specimena minimum of once a week.These urine collections must be monitored by an NTA staff member or a staffmember of a cooperating program under the general direction of the programchief. Unmonitored specimens are worthless for our purposes and should bediscarded.All staff who are monitoring urine should sign the urine specimen label foundon the back of NTA form 6 (see attachment 5). These staff members should betrained so they recognize an adequate quantity of urine. No urines should bereported back from the laboratory as quantity not sufficient (QNS) : the staffshould discard urines of inadequate quantity.In unusual cases, or where there is special concern about the possibility ofpatients continuing to use illicit drugs, three or more samples a week may besent to the laboratory for analysis.H. Suspension from methadone maintenance programPatients failing to report for treatment for 30 consecutive days will automaticallybe suspended from treatment. The suspended patient will have towait 30 days before he is eligible for treatment or the waiting list again.If the center physician and/or the center administrator suspends a patientbefore 30 consecutive days without treatment have elapsed, the physician oradministrator must complete NTA form "Report of Pntirvt Chnnor of Status"(see attachment 6) 'and send it to Information Central. Tr^ this case, the patientwill not be accepted back into treatment or placed on the waiting list for 30 daysafter the suspension date.