Methadone is a long-acting opioid that has been used for decades to treat people who are dependent on opioids like heroin, fentanyl, and certain narcotic pain medicines. When taken as prescribed, it is safe and effective. Methadone can be started at any time. There is no need to wait after the last use for withdrawal symptoms to begin. However, providers will not begin methadone treatment with anyone who seems to have just used and/or appears intoxicated.

Methadone works by changing how the brain and nervous system respond to pain. It lessens the painful symptoms of opioid withdrawal and blocks the euphoric effects of other opioids such as heroin, fentanyl, morphine, codeine, as well as semi-synthetics like oxycodone and hyrdocodone.

Methadone can be offered in pill, liquid, and wafer forms and is generally taken once a day.

Side effects of methadone include constipation, sexual problems, swelling, and sweating. It can also cause heart problems or make existing heart problems worse.

Warnings:

• High dosages may stop a person’s breathing.
• The highest risk of methadone overdose occurs at the start of treatment.
• There is a substantial risk of methadone overdose when combined with benzodiazepines (Valium, Klonopin, Xanax, Ativan, etc.) or with other substances including alcohol, due to a toxic buildup that occurs because methadone stays in the system so long.
• There is an increased risk of driving impairment at the start of treatment and during dosage adjustments.
• There is an increased risk of serious heart problems and sudden cardiac arrest.

Buprenorphine is an opioid partial agonist. This means that, like opioids, it produces effects such as euphoria or respiratory depression. With buprenorphine, however, these effects are weaker than those of other substances such as heroin.

Buprenorphine’s opioid effects increase with each dose until, at moderate doses, they level off, even with further dose increases. This ceiling effect lowers the risk of misuse, dependency, and side effects.

Buprenorphine is usually taken daily and must be dissolved under the tongue or inside the mouth.

Some common side effects are headache, nausea, and constipation.
Warnings: The same warnings for methadone apply to buprenorphine.

Naltrexone is a medication approved by the FDA to treat opioid and alcohol use disorders. It comes in a pull form or as an injection. The pill form can be taken at 50mg once per day. The injectable extended-release form of the drug (Vivitrol) is administered at 380mg intramuscular once a month. The injectable form has been much more effective for opioid use disorder. Once administered, the blocking effects are active for one month.

Naltrexone can be prescribed by any health care professional who is licensed to prescribe medications. To reduce the risk of precipitated withdrawal, patients are warned to abstain from opioids for a minimum of 7-10 days before starting naltrexone.

Naltrexone blocks the euphoric and sedative effects of drugs such as heroin, fentanyl, and morphine. It binds and blocks the opioid receptors and is reported to reduce opioid cravings. There is no abuse and diversion potential with naltrexone.

Naltrexone works for highly motivated people who can get through opioid withdrawal and remain opioid-free for at least 7-10 days prior to beginning treatment. It is a good option for those who want to eliminate all opioids right away. If a person relapses and uses the problem drug, naltrexone prevents the feeling of getting high. People using naltrexone should not use any other opioids, alcohol, sedatives, or tranquilizers.

Naltrexone does not help with withdrawal symptoms. Most people do not have many side effects from naltrexone, but soreness in the area of injection is very common. Other side effects can include stomach pain or nausea, diarrhea, and difficulty sleeping.

Warnings:

• There is a risk of causing severe withdrawal symptoms if administered to an opioid-dependent person without waiting the 7-10 days from last use
• Patients on naltrexone may have reduced tolerance to opioids and may be unaware of their potential sensitivity to the same or lower doses of opioids that they used to take. If patients who are treated with naltrexone  relapse after a period of abstinence, it is possible that the dosage of opioids that was previously used may have life-threatening consequences. Overdose risk is high for people who use large amounts of opioids while taking naltrexone and for those who return to opioid use after a period of taking naltrexone due to this decrease in tolerance.
• People with liver disease should check with their doctors before deciding to use naltrexone. Very large doses can cause liver damage, but studies show the recommended dose has been used safely, even with people being treated for Hepatitis C (HCV).
• There is a risk of cancelling effects of opioid pain medications given in a medical emergency.
• There is a risk of depression and suicidal thoughts.
• There is a risk of injection-site reactions.

To become a client, please call and speak with our intake staff at (617) 254-1271 x119.

We can complete a brief assessment, collecting basic demographics and substance use history and verifying health insurance eligibility and benefits. Afterwards, we can see about scheduling our earliest available appointment for an in-person intake, where you will provide photo ID and meet with our clinical, medical, and admin departments. After satisfactory completion of all necessary parts of the intake, our staff can set you up for admission that same day.

In-person intakes are available by appointment, typically scheduled between 6:30 AM and 8:30 AM, Monday through Friday.

Please note: admission criteria between our programs can vary slightly. Please call with any questions.

Once admitted to ATCNE, the long-term requirements for our methadone (MMT, 180 day) and buprenorphine programs are as follows:

• Daily dosing at our clinic between the hours of 6:15 AM until 1:00 PM weekdays and 7:15 AM until 12:00 PM weekends (holiday hours may vary)
• Submitting random urine tests when requested

ATCNE can accept a number of clients for our opioid treatment programs (OTPs) without insurance on a self-pay, sliding-scale basis, based on income.

Funding from the Mass. Dept of Public Health’s Bureau of Substance Addiction Services (BSAS) allows us to provide services on a sliding-scale basis. Proof of income is required and can include: a recent Form 1040, W-2 Statement of Wages, and/or a recent pay-stub. Other forms of proof of income may be acceptable, but must first be cleared by ATCNE staff.

Please note: Sliding-scale fees are available for all levels of care at ATCNE, including our behavioral health and naltrexone programs. For non-OTP applicants without insurance, ATCNE can also charge Medicaid rates for our services.

Our first priority is connecting our clients to the services they need. As a non-profit, we will not turn away a client based on their financial standing.