Other Miscellaneous Issues

• Is it possible to use drugs other than methadone or LAAM for maintenance or detoxification purposes?
   
• An employee has been caught diverting controlled substances. What do we do?
   
• A patient who is disabled and suffering with severe chronic pain became physically dependent on prescribed opiate pain medication. The patient enrolled in an NTP at the suggestion of a doctor as the only way to stay on the "pain medicine" legally. Is this the only way the patient can obtain enough medication to alleviate chronic pain?
   
• Should an NTP replace tubing when it changes the source of the methadone product it uses?

Question: Is it possible to use drugs other than methadone or LAAM for maintenance or detoxification purposes?

Answer: You can only use those opioids that are approved by FDA to maintain or detoxify an opioid dependent individual. At this time, the Department of Health and Human Services and FDA have approved only methadone and LAAM for maintenance or detoxification treatment of narcotic addiction.

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Question: An employee has been caught diverting controlled substances. What do we do?

Answer: Contact local law enforcement as well as the local DEA diversion field office to report the diversion and to obtain the required forms. If the employee is a licensed practitioner (MD, RN, or LPN), the state licensing authority also should be informed of the situation. [21 CFR 1301.76, 21 CFR 1301.91, 21 CFR 1301.92].

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Question: A patient who is disabled and suffering with severe chronic pain became physically dependent on prescribed opiate pain medication. The patient enrolled in an NTP at the suggestion of a doctor as the only way to stay on the "pain medicine" legally. Is this the only way the patient can obtain enough medication to alleviate chronic pain?

Answer: No. If the doctor advised the patient that the only way to legally use "pain medicine" for a long period was to enroll in an NTP, he or she erred, even if the patient was physically dependent on the medication. The doctor can continue to prescribe narcotic medication for the treatment of pain. However, if treatment is for narcotic addiction, then the patient must be referred to an NTP. The key issue is whether the doctor referred the patient to the NTP because of pain or because of an addiction.

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Question: Should an NTP replace tubing when it changes the source of the methadone product it uses?

Answer: It is best to replace tubing that has been compromised in any way. NTP personnel are advised to follow the recommendations of the pump manufacturer when the NTP changes from one methadone product to another.

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