While a methadone clinic is a somewhat non-traditional setting for nursing, the functions and role of a nurse in this setting are quite similar to those of nurses in rehabilitation centers and psychiatric facilities. Methadone clinic patients are seen for limited amounts of time (5 to 10 minutes daily by nurses, perhaps once a week by counselors or monthly by physicians) as opposed to rehabilitation center patients, yet they usually have a serious heroin or opiate addiction that is the primary reason for methadone treatment and is often accompanied by other psychological, physical and social concerns. The nurse must take these factors into consideration to provide the best possible care.
Because methadone is a controlled substance and can have serious side effects for patients who wish to stop taking the medication or those with certain medical conditions, it is important that it be administered by a trained healthcare professional. Although experience in treating substance abuse is helpful, it is not absolutely necessary. However, nurses who work in methadone clinics should be trained to recognize familiar substance-abuse signs and symptoms to correctly identify when something may be amiss or when changes need to be made in the approach to the patient’s treatment. The nurse is also an important member of the interdisciplinary team that includes the patient's physician and mental health or addiction counselors, helping to ensure the patient is receiving treatment individually tailored to his needs and medical status.
During treatment, nurses in methadone clinics will see patients more frequently than counselors or physicians will, and they serve as the first line of defense of patient safety. Before any methadone is given, the nurse should affirm that the patient is alert and oriented, does not appear to be under the influence of any other substance (i.e., alcohol, illicit drugs, over-the-counter medications with mind-altering effects) and appears to be in good general physical health. If the nurse does not adequately assess the patient before medication administration, serious consequences to the patient's health can result, such as adverse medication reactions and methadone overdose that could result in death. Thus, nurses who work in methadone clinics should be careful to develop assessment as a habit with every single patient every time they see that patient.
Before the patient is given his first dose of methadone, the nurse must obtain as complete a physical and medical history as possible. Many of the side effects of methadone can exacerbate conditions such as hypotension, respiratory disorders and neurological/epileptic disorders, causing serious illness or death. Therefore, a complete physical and medical history is an important factor in determining the appropriate dosage for patients, as well as providing some guidelines for the nurse with regard to specific signs and symptoms to watch for during the course of treatment.
After the physician and nurse have determined an appropriate dosage for the patient, the nurse is responsible for ensuring the methadone is administered as directed. Nurses in methadone clinics are charged with maintaining the security of this somewhat dangerous controlled substance and must keep detailed records of what dosage was administered to whom and in what form, as well as documenting the overall status of the patient at the time the medication was administered, any lab results and other medical or psychological health concerns.
Methadone works similarly to other opioids, in that one can develop a tolerance to the drug and the withdrawal process can be physically debilitating. Many persons with opiate addictions believe they can tolerate a large dose of methadone initially, and it is important to note that a large number of deaths caused by methadone overdose occur when maintenance or detoxification treatment is first beginning due to miscalculation of tolerance. Thus, it is worth repeating that it is especially important that the nurse practice vigilant assessment of her patients to ensure their safety throughout the treatment program.