Can methadone maintenance be continued in nursing homes/hospital?

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My mother (57) was on methadone maintenance for over 20 years at 120-140mg. She also has end stage liver disease from cirrhosis from hepatits c/congestive heart failure as a child. She is also going through heart failure and declines any sort of PT so she is permanently bed bound. I was her caregiver for about five years and I am an only child with no relatives or family members. (I am 24) My question is this: Can a person previously on voluntary methadone maintenance continue to receive the treatment in a skilled nursing facility? Additionally, the treatment plan for methadone was denied by Humana (I am in FL) because it is an optional outpatient program. I was told the SNF that she is placed in would provide her methadone maintenance, but they have not. My mother says methadone is the only thing she lives for. She was an opioid and cocaine addict for a very, very long time. The methadone she has been on for 25 years or more on and off. She was "kicked off" of her outpatient program because of her hospitalization due to hepatic encephalopathy (comatose for a few days until ammonia level decreased from lactulose) The hepatic encephalopathy was precipitated by the methadone and i got not one, not two, but three doctors' opinions on it. Every one of them said hospital detox, then skilled nursing. My mother got out of the hospital 10 days after the first coma. She refused to walk, move legs or arms, or close her own hands. Yet if I am not around she reaches just fine. I know she is bed bound but with PT she can learn how to be mobile again. I have to drive over 60 miles to see her. I want to see her for easter but she says she will not see or speak to me if I do not get her the methadone. How do I keep my mom, my only family member, out of pain? I am just so racked with guilt and a strange sense of relief. I don't know what agency to reach out to- I believe detoxing off methadone may kill her, and if she continues to take methadone she will certainly die. But should she live longer in this state in pain? How do I help her? Thank you.

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Tothill, thanks for the info.
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JoAnn29, Methdone is often a life time drug. I know nothing of the complications with Hep C, but I do know people who take it for years. It keeps the cravings at bay without providing a high.

beexagua, my heart goes out to you. You are very young to be dealing with this. It sounds like your mother is nearing the end of her life. Her liver and heart are both impaired by disease and the methadone is not helping either.

I know it sounds counter productive, but would any of the agencies or doctors prescribe opiates? They would at least help with the pain, will they extend her life, probably not, but unless she gets moving or at least trying, her quality of life is not good. Or Suboxon, which is used to treat chronic pain?

Good Luck with your appeal.
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This drug is not a maintenance drug, correct? It's used to help addicts become clean, right? Twenty years is a long time. She is now addicted to the drug to help her get off of other drugs. I think you need to sit down with the doctor caring for her at the Home. Cold turkey could effect her heart. Maybe he can deal with Humana explaining the need to we in her off.
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After much talking with NH and her GP it looks as if my only option is a Humana appeal or find a different facility.
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This is a tough scenario. Her doctor at the nursing home won’t write a prescription for it to be given @ LTC? As everyone stated she should not have to go through withdrawal cold turkey. I would continue to ask to discuss solutions for your mother with her NH physician as the NH is required to provide care of any sort to her.
Good luck!
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I also know that the hospital only administered her methadone one time eleven days after her second admission post coma. They could not obtain further authorization and the meds were pulled from her not complying with her "program" and the drug being dangerous to her survival. Really a tough spot. Also I cannot afford to pay that price for her medication.
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I should note that the dose for 120mg is daily not monthly. I cannot find a doctor to write it in my city due to methadone only being available through the outpatient facilities. Because my mother is on Humana I cannot find a doctor who will write that for her, especially against multiple advisories. They manage a lot in my area with pain management doctors and cracked down on doctors who can write it. She has never received it privately as a result.
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I just checked the price of methadone on GoodRX.com. It appears to be an affordable drug for private pay. Under $20 for 120 tablets (40mg). Get her doctor to write an order for administration (to give to the nursing home) and have him write an RX. People should not be required to go off their meds cold turkey.
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Reply to jjariz
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Will her doctor prescribe it? Will the nursing home administer it? If yes for both of these, perhaps you can private pay for it?
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There is an appeal process through Humana. You can attempt that process.
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