Take home doses are the salvation of a patient on methadone maintenance, and if you show a history of appropriate methadone use and avoid drug abuse you should be eligible in time for a full month of take home doses on a 30 day reporting schedule.

The regulations governing take home doses were changed in 2001 by SAMHSA, which is the federal agency governing opioid treatment programs. In 2001, SAMHSA eased regulations on take home doses, and although states and even individual clinics can enact more stringent regulations, each methadone clinic must apply for SAMHSA certification, and if SAMHSA thinks that any clinic's procedures vary too far from Federal Guidelines, it will not endorse certification renewal.

Basically, although there is a little leeway – clinics must stay close to federal suggestions if they want to keep their license to prescribe methadone (unless state regulations preclude them from following federal guidelines*).

*Most states have conformed their regulations to match Federal recommendations.

How to Get a Take Home Dose as Soon as Possible

So, if you want your take home doses as soon as possible, toe the line well on these 6 evaluatory conditions.

1. You must show (through random drug testing – a minimum of 8 instances per year) no evidence of drug abuse.
2. You must attend the clinic on your appointed schedule
3. You must show appropriate behavior
4. You must not engage in criminal activity
5. You must show a stable home and stable non drug-related relationships
6. You must promise to store take home methadone appropriately and safely

And…

1. The doctor must believe that the risks of diversion associated with giving you a take home dose of methadone are overshadowed by the benefits of easing reporting demands.
2. You must meet the minimum time in treatment regulations. (see as follows)

Essentially, you must prove to the medical staff at the clinic that you are serious about your recovery on methadone, and that you can be trusted to use methadone safely at home.

Time in Treatment Requirements

The following are mandatory minimum standards for the allowance of take home doses. You will not be allowed take home doses in excess of the following.

• Days 1-90 – A maximum of 1 scheduled take home dose per week, as well as a take home dose for one day if the clinic closes on Sunday.
• Days 90-180 – A maximum of 2 scheduled take home doses per week as wells as a take home dose for the one day a week the clinic will close.
• Days 180-270 – A maximum of 3 scheduled take home doses per week + 1 for days the clinic is closed.
• Days 270-365 – Up to 6 take home doses per week.
• Year 2 - Twice a month reporting.
• Year 3 – Once a month reporting.

Local Variations

Local regulations may call for slightly more stringent protocols, but local regulations should be basically in-line with federal regulations. No patient will be allowed take home doses unless the medical director of the clinic believes they are at low risk to divert the medication.

If You Aren’t Getting the Take Homes You Deserve?

1. If you feel that your clinic is unfairly restrictive, you can meet with your doctor to discuss your compliance with federal guidelines. These guidelines are in place to allow individual clinicians the flexibility to reward "good behavior" with take home doses.
2. If that doesn’t work, you can inquire at any other local clinics about take home regulations, and perhaps find a clinic that allows for greater flexibility.
3. You can also file a grievance at your local clinic. Your clinic is required by law to have a patient grievance mechanism in place and to respond to grievances within 5 days. (From SAMHSA's Opioid Drugs in Maintenance and Detoxification Treatment of Opiate Addiction; Final Rule (42 CFR Part 8.4.(e))

Dose Caps?

SAMHSA does not endorse dose caps. Research has found that clinics that operate with maximum capped doses are operating outside of best practices guidelines.

100mg Take Home Limit?

SAMHSA does not cap take home doses. There is no federal regulation against take home doses in excess of 100 mg per day.