Recommendation Report Revision

Jamiel Bowen
University of New Haven
ENG-2225-01W: Technical Writing & Presentation
Professor Miele
December 13, 2020
 Recommendation Report
I am on the board as a Clinical Addiction Counselor at a Substance Abuse Disorder
Clinic in my town. We treat clients with drug and alcohol addictions using group therapies, one-
on-one sessions, and offer community resources to them to help them get their lives back on
track. Adding medication for opioid abuse disorder, specifically, either Methadone or Suboxone,
or both have been brought to the table and I am in charge of creating a recommendation report
on the matter. My audience is the Board of Directors for the treatment clinic which consists of
clinical and nonclinical drug and alcohol counselors, other human services workers as well as
our human resources team.
 Table of Contents
Executive Summary
Introduction
Research Methods
Task 1. Determine community need for Opioid Treatment Services
Task 2. Research options for Opioid Treatment with prescription medicines
Task 3. Compare cost/benefit analysis of medicines available to treat opioid addiction
Task 4. Compare success rate of medicines available to treat opioid addiction
Task 5. Interview prescriber for feedback on changes needed to accommodate opioid
treatment at this facility
Task 6. List changes needed to accomodate adding opioid treatment to this facility
Task 7. Survey clients that have taken medications to determine which is preferred
Task 8. Survey local treatment facilities to guage availability of opioid treatment
Results
Task 1. Determine whether the community needs opioid treatment added to this facility
Task 2. Assess each medicine used to treat opioid addiction
Task 3. Assess most cost-effective option to treat opioid addiction
Task 4. Assess most successful medicine to treat opioid addiction
Task 5. Interview prescriber
Task 6. Assess client preferences to medications
Task 7. List changes needed to accomodate adding opioid treatment to this facility
Task 8. Assess availability of opioid treatment in the community
Conclusions
Criteria for choosing medicine to treat opioid addiction
Recommendation
Appendix
References
 Executive Summary
The Opioid Crisis is affecting towns and cities across the country at an alarming rate. More
people are overdosing from opioids than ever in the past. Our facility treats clients with
substance abuse disorders by offering group therapies, counseling services and community
resources to help them get their lives back on track. Adding opioid treatment to our clinic would
be beneficial to the community as well as our bottom line. The research conducted regarding this
endeavor includes:
 Surveying addicted population to assess whether there is a need for opioid treatment
 Online research of available options for opioid treatment
 Cost/benefit analysis of adding opioid treatment to this facility
 Success rates of medications used to treat opioid addiction
 Interview prescriber to determine changes necessary to accommodate adding opioid
treatment to this facility
 Survey clients with experience taking methadone and suboxone to see which they prefer
The criteria established for our analysis is based on research material that is valid and
credible in the medical field. It must be current (within the last five years) and suitable for our
needs. The goal of this recommendation report is to provide as much information as possible
about alternatives to treating opioid use disorder with medications that our facility can provide to
clients. Evidence suggests that the success rate of medically treated opioid addiction saves lives
and it is our goal as a substance abuse clinic to do that for every person that walks through our
doors.
 Introduction
Opioid Use Disorder is characterized by the withdrawal symptoms the user experiences
in the absence of the drug. Without the substance, the user goes through a series of
uncomfortable, often excruciating symptoms such as cold sweats, tremors, chills, diarrhea, body
aches and pains. Most addicts will tell you; this is what keeps them from stopping their drug use.
It is with these symptoms in mind that scientists have created drugs specifically designed to help
opioid addicts stop using opioids. Methadone and Suboxone are two medications prescribed to
opioid addicts to alleviate their withdrawal symptoms with the goal of getting them to abstain
from using opioids.
Both Methadone and Suboxone are medications that need to be monitored when first given to
clients. They come in different forms and take effect in different ways, however the ultimate goal
for both is to get the recipient to stop using opioids. Both medications can be effective if taken
properly, at the right dose. It is most effective for a client to receive additional substance abuse
treatment such as counseling and/or group therapy while they are taking these medications, so
they have the best chance at abstaining from drug use.
For a substance abuse clinic to add opioid medication treatment to their services, they will
need to make changes to their facility and staff. They will need to hire a doctor and nurses to
distribute the medication. They will also have to have a safe place to store the medication
securely. Changes in hours of operation will have to take place as well.
 Methods
Task 1. Determine community need for opioid treatment services
To determine whether the community has a need for our facility to add opioid treatment
services, a survey of 100 clients was conducted. The survey was anonymous to protect client
confidentiality and to promote honesty. There were three questions, with “yes” and “no” answers
for clients to respond to. Clients were asked the following:
 Do you use opioids?
 Would you take Methadone to stop using opioids?
 Would you take Suboxone to stop using opioids?
Task 2. Research options for Opioid Treatment with prescription medicines
The two medicines determined to be effective for treating opioid use disorder are
Methadone and Suboxone. Research for each medicine was done on their respective websites.
Research was also conducted on WebMd.com and other online resources that compared the
drugs to one another.
Task 3. Compare cost/benefit analysis of medicines available to treat opioid addiction
Research for the cost versus benefit of Methadone and Suboxone was done online on the
National Institute of Drug Abuse website. Further research on the salaries for necessary staff
additions to the facility were done on Glassdoor.com.
Task 4. Compare success rate of medicines available to treat opioid addiction
Research for this task was done through a website that conducted trials that studied 1500
participants. Online sites were also utilized to collect data to prove the effectiveness of both
drugs. Success rates are determined by the client’s abstinence from illicit and prescription
opioids.
Task 5. Interview prescriber for feedback on changes needed to accommodate opioid
treatment at this facility
Dr. Carol Greaves of Recovery Network of Programs was interviewed with regards to
adding either Methadone or Suboxone to an existing substance abuse clinic. She was asked the
following questions:
 What is your experience with prescribing Methadone and Suboxone to clients?
 What specifications related to staffing would a clinic with 100 clients need to
include these medications to our treatments?
 Do you find that these medications are helpful or harmful to clients?
 What advice would you give a clinic that is considering adding these
medications?
Task 6. List changes needed to accommodate adding opioid treatment to this facility
 Consider logistics and planning for space to include safety measures, staffing and
handling of medications.
Task 7. Survey clients that have taken medications to determine which is preferred.
One hundred fifty clients at an existing opioid treatment facility were given a survey with
the following questions to determine client satisfaction with Methadone and Suboxone:
 Do you prefer Methadone or Suboxone?
 Have you been successful at staying off opioids on Methadone?
 Have you been successful at staying off opioids on Suboxone?
Task 8. Survey local treatment facilities to gauge availability of opioid treatment.
Using Google Maps, a search within 25 miles of the facility was conducted. The criteria
included opioid medication therapy. The goal was to find how many opioid treatment facilities
exist within traveling distance of the facility.
Results
Task 1. Determine community need for opioid treatment services
Of the 100 clients that participated in the survey, the results follow:
 Do you use opioids?
 78 – yes 22 - no
 Would you take Methadone to stop using opioids?
 64 – yes 36 - no
 Would you take Suboxone to stop using opioids?
 48 – yes 52 – no
Table 1.0 summarizes the result.

Task 2. Research options for Opioid Treatment with prescription medicines

“Methadone is one component of a comprehensive treatment plan, which includes
counseling and other behavioral health therapies to provide patients with a whole-person
approach” (Methadone, 2020). It is considered an opioid agonist, meaning that it blocks the
effects of other opioids and reduces withdrawal effects related to opioid use disorder. Methadone
can be administered in a liquid, pill or powder form. It is “approved by the Food and Drug
Administration (FDA) to treat opioid use disorder (OUD) as a medication-assisted treatment
(MAT), as well as for pain management” (Methadone, 2020).
Methadone can only be prescribed by a doctor and is typically started off at 25mg.
Clients can receive it at any time after their last opioid use. As needed, dosages are increased in
increments of ten and can go as high as 200mg per day, depending on how clients are reacting to
it, meaning whether or not they are experiencing withdrawal symptoms and cravings for opioids.
Although methadone remains in the system for up to 48 hours, it is given daily. If a dose is
missed for more than two consecutive days, it is cut in half and the client must rebuild their
dosage in increments of ten until they get back to their normal prescription. All of this is
monitored by the administering nurse (Methadone, 2020).
Methadone, if over-prescribed, has side effects that mimic opioids. Clients will appear
lethargic and have spells drifting in and out of consciousness. It is because of this that the
prescribing doctor, administering nurse and counseling staff must all work together to monitor a
client’s demeanor when they are on methadone maintenance. It is not unheard of for a client to
abuse methadone and use it to get high which is one of the downfalls of this particular
medication. Overdoses, though uncommon, are possible with methadone (Methadone, 2020).
Suboxone is the brand name for a combination of the medications: buprenorphine and
naloxone. Buprenorphine blocks withdrawal symptoms while naloxone blocks the effects of
opioids. Unlike methadone, suboxone is not used for pain management. Its sole use is to treat
narcotic opioid addiction. Suboxone comes in the form of a sublingual film that dissolves under
the tongue (Suboxone, 2020).
Suboxone films are made in either 2mg, 4mg or 8mg. Clients are prescribed doses in
those increments at a target dose of 16mg per day. This is often broken up between the morning
and evening as the shelf-life differs from methadone, meaning that Suboxone does not last in the
system as long as methadone. Suboxone prescriptions are typically given to clients that submit
drug-free urine screens on a weekly basis so that they do not need nurses to distribute their doses.
They will, however, need to see the doctor weekly for another prescription and drug screen
(Suboxone, 2020).
Suboxone is chemically different than methadone in that it does not produce any euphoric
effect. Clients will not experience any kind of high if they are prescribed more than they need.
The rate of overdose on Suboxone is also lower than that of methadone. The problem with
prescribing Suboxone over methadone is that clients must be in withdrawal for at least twelve to
twenty-four hours before they take their first dose of Suboxone. If this is not the case, the
medication will throw them into acute withdrawal which will get them very sick. It is difficult to
get a client to wait that long (12-24 hours) to start Suboxone treatment as the nature of opioid use
disorder is to use opioids to avoid withdrawal (Suboxone, 2020).
Task 3. Assess most cost-effective option to treat opioid addiction
Methadone maintenance is only slightly more expensive than Suboxone when looking
solely at the cost of medication. The annual sum of methadone treatment comes to an average of
$6,550 per client whereas Suboxone lands around $6,000 per client. These prices are based on
median doses (Cost of methadone treatment, 2020). Costs that need to be factored in are the
salaries of nurses and doctors the facility will need to hire to administer these medications.
If the facility chooses to treat clients with methadone, it will need to employ four nurses
and one doctor, part-time. In Connecticut, with the doctor working two ten-hour days per week,
this will cost the facility approximately $60,300 (Q: What Is the Average Doctor Salary by State
in 2020?, 2020). To employ the nurses, the annual salaries combined will be in the area of
$323,000 (Indeed.com, 2020). In total, the payroll cost adds up to an additional $383,300.
Suboxone treatment also comes in at a higher number in regard to staffing. The facility
would only need to hire two nurses, cutting the salary costs for nurses to $161,500 (Indeed.com,
2020. There would, however, be a need for at least doctor to be at the facility at all times
therefore two doctors would need to be hired to cover twelve-hour days. The cost of the doctor’s
salaries would be approximately $241,200 (Q: What Is the Average Doctor Salary by State in
2020?, 2020). The difference in salary between adding methadone or Suboxone treatment would
be $19,400, in favor of methadone treatment.
Task 4. Assess most successful medicine to treat opioid addiction
Methadone maintenance has a success rate between 60 and 90 percent. This number is so
wide because short-term relapses are factored in as are long-term clients. Some clients use
methadone for a year while others choose to stay on it for several years. Without methadone, the
success rate of abstinence from opioid use disorder is less than ten percent (Nick, 2019).
 The success rate of Suboxone treatment has been measured around 50 percent, however,
it fell to 8.6% once the treatment discontinued (Getting off heroin with Suboxone: dangers and
benefits, 2020).
Task 5. Interview prescriber for feedback on changes needed to accommodate opioid
treatment at this facility
Dr. Carol Greaves of Recovery Network of Programs was interviewed with regards to
adding either Methadone or Suboxone to an existing substance abuse clinic. She was asked the
following questions:
 What is your experience with prescribing Methadone and Suboxone to clients?
Dr. Greaves has worked with both medications. It is her experience that clients are more likely
to choose methadone because they do not have to wait until they are suffering from withdrawal
symptoms to start the medication. It is also prescribed at higher doses for clients with a stronger
need.
 What specifications related to staffing would a clinic with 100 clients need to
include these medications to our treatments?
Dr. Greaves suggests having two doctors splitting twelve-hour days that we are open if we
choose Suboxone and only one, part-time doctor with methadone. She has no input on how many
nurses will be needed to administer the medications as that is not her area of expertise.
 Do you find that these medications are helpful or harmful to clients?
Dr. Greaves warns that clients will take advantage of methadone prescriptions and should be
closely monitored. If the dose is too high, it will intoxicate the client. Group and one-on-one
counseling sessions are essential to monitor how the client is reacting to their dose. Suboxone
does not have the same effect.
 What advice would you give a clinic that is considering adding these
medications?
Dr. Greaves suggests adding groups such as HIV awareness, Narcan (overdose prevention), and
family sessions to the facility’s roster if opioid treatment becomes available to clients.
Task 6. List changes needed to accommodate adding treatment to this facility
For a treatment facility to administer methadone or Suboxone to its clients, the facility
must first become a SAMHSA-certified opioid treatment program (OTP). Once this occurs, the
facility is then offering medication-assisted treatment (MAT). For this to occur, the facility must
have a “whole-person approach” (Certification of Opioid Treatment Programs (OTPs), 2020).
This means that the client is being treated with medication as well as counseling and behavioral
therapy. “OTPs must be both certified and accredited; licensed by the state in which they
operate; and registered with the Drug Enforcement Administration” (Certification of Opioid
Treatment Programs (OTPs), 2020). 
If our organization were to include methadone maintenance treatment for our clients, we
would have to devote two rooms for this service. One area would be secured with at least three
separate windows with counters and the other area would need to be larger and public as that
would be where clients would line up and wait to receive their medication daily. The secured
area would need to house a medical safe which would contain the methadone and enough room
for at least four people. There would also need to be a source for water as that is necessary for
clients to consume their medication. Each window would need a computer on the secured side
for the nurse to look up the client’s name and dosage information and log in their attendance.
In regard to staffing, if we add methadone maintenance treatment, we will need at least
four nurses working during operational hours. We will also need to employ a doctor although it
is not necessary for that person to be at the facility full-time. We can agree to a part-time, set
schedule for the doctor. Clients will need follow-up appointments with the doctor as well.
Because we serve one hundred clients, we will need to schedule them at different times
throughout the day to come in and receive their medication. Both options are given daily until
clients prove their commitment to abstinence from drugs. At that point, both methadone and
Suboxone can be supplied to clients in quantities that will last them up to seven days.
Task 7. Assess client preferences to medications
Of the 150 people that participated in the survey, the results follow:
 Do you prefer Methadone or Suboxone?
 97 – methadone 53 – Suboxone
 Have you been successful at staying off opioids on Methadone?
 68 – yes 39 – no 43 – n/a
 Have you been successful at staying off opioids on Suboxone?
 48 – yes 55 – no 47 – n/a
Task 8. Assess local treatment facilities to gauge availability of opioid treatment.
When Google Maps was searched with a search radius of 25 miles in all directions
around the facility, 17 treatment centers came up as opioid treatment facilities. The criteria
searched for included Methadone and Suboxone medication treatment. Of the 17 facilities, 8 of
them offered Suboxone and 9 offered Methadone.
 Conclusion
The use of opioids is prevalent in our community, among our client base. It would be
beneficial to our clients to offer an opioid treatment program. Our facility has the credentials in
place to get certified to do so. It also has the space necessary to make such a change. In terms of
cost/benefit, it is important to consider that humanity has no dollar value and our organization is
in the business of bettering human lives. Including either methadone or Suboxone will incur a
cost to our accounting department at first but will produce a profit in the long run. More
importantly, it will save lives. Methadone has a higher success rate than suboxone and is the
slightly less expensive of the two options. It is also the preferred medication, according to the
survey participants. Methadone scored higher in the decision matrix, as indicated above. The
criteria included was success rate, client satisfaction and cost, in that order. Methadone scored
higher in every category. See appendix 1.1 for decision matrix
 Recommendation
After reviewing both options thoroughly, I recommend adding methadone maintenance to
our facility. It is more cost-effective and has a higher success rate than Suboxone. Because it can
be prescribed and administered to clients at any time, it is more likely that they will request it.
The first thing the facility should do is contact SAMHSA to become certified for OTP. Once
certified, the lobby will need to be reimagined. The first two offices on the left side of the
building will need the wall between them knocked down to double the space and a half wall will
need to be erected between the lobby and that space with three windows and counters. The
facility will need to purchase a medical safe for the methadone that will be held in the back of
the office suite. Each window will need a computer as will the front desk with a program that
allows the receptionist to check clients in and the nurses to approve their doses once they reach
the window. Clients can check-in at the front desk then wait in line to get medicated. The doctor
can use one of the offices upstairs during their hours. Additional groups such as HIV awareness,
overdose prevention and family counseling will need to be added. Four full-time nurses and one
prescribing doctor will need to be hired as well. This can all be achieved within a three-month
period. In 2018, 67,367 people overdosed on opioids in Connecticut (Connecticut: opioid-
involved deaths and related harms, 2020). The sooner we get this project started, the more lives
we can save.
 Appendix
 The table below shows the decision matrix used in the at the end of the research.
Criteria & Weight Options
    Methadone Suboxone
  Weight Rating Score Rating Score
Cost 3 8 24 7 21
Success Rate 1 7 7 5 5
Client
Satisfaction 2 7 14 4 8
Overall     45   34
As illustrated in the decision matrix above, the most important criteria for
choosing between recommending methadone or Suboxone was their success rate,
client satisfaction, and cost, in that order. These items were weighted
accordingly. Methadone scored highest in all three areas, giving it the highest
overall rating. This is the premise for which I based my recommendation.
 References
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%20success,60%20and%2090%20percent%20overall
Q: What Is the Average Doctor Salary by State in 2020? (2020). Retrieved November 18, 2020,
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