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Methadone, for One Thing or Another

As I’ve mentioned, I receive several e-mails each day asking questions about opioid dependence.  There are a number of confusing opinions, attitudes, and regulations that ultimately get in the way access to treatment.  And with opioid dependence, access to treatment can mean the difference between life and death.

One area of confusion relates to the use of methadone to treat opioid dependence.  Methadone is a potent, low-cost pain medication.  While a month’s prescription for Oxycontin may retail for $400, $500, or much more, a prescription for a similar amount and potency of methadone costs less than twenty dollars.

Besides treating pain, methadone is used to treat addiction to opioids through highly-regulated programs.  Laws allowing for these ‘methadone maintenance clinics’ were enacted in the early 1970’s, to counter the surge in heroin use that began in the late 1960’s .  The clinics were located mainly in inner cities, where most of the intravenous heroin addicts were located at that time.

Over the past ten years several corporations have purchased, consolidated, and refurbished methadone clinics, moving them to suburbs and rural areas to match the dramatic increase in addiction to heroin and other opioids in those areas.

51 Comments to
Methadone, for One Thing or Another

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  1. I live in Australia & have been on the methadone program for over 10 years. In Australia it doesn’t matter how long you have been on the program you are legally only allowed 6 takeaways,unless you are going away on holidays or something like that then you can have however many TA’S to cover you while away. My methadone is prescribed by a doctor.who writes my script for 3 months so I only see him 4 times a year & you get dosed at your local pharmacy. The cost is $35 a week. I am curious though in America do they give you methadone syrup which is what we get in Australia or methadone tablets.

    • They use the syrup at the clinics; I’m not certain what they do for take-home doses. Methadone is also commonly prescribed for pain, and in those cases the tablets are prescribed.

  2. I was a “client” at qam in wis and trust me no money no dose.I was up to a 100 mg s and i kept telling my counselor that i was tired it was way to high and she told me i was still in w/d and i finnally said i ll do it ur way went up to 155 and couldnt stay awake at work,they want u at a high dose and make it very easy so they hold all the cards.i eventually got my dose to 40 and went to suboxone cause i felt like only 20 percent of the staff actually cared if u came in with clean ua s and my counselor wasnt one of them.i had asked to switch counselors and was mildly toldthat i dont need to be causing trouble.suboxone was the next step mixed with a straight foward doc trying to help me with my problem i pay him for worked out.i relapsed resently but went to start again at the next best mmt center available . Or the only other one and plan to jump back to suboxone the minute i can and not make the relapse mistake ever again.

  3. I’m sorry but can someone tell me why you people are on Methadone for so long? Aside from pain management reason.I don’t want to start any arguments here, just interested in your answers. You see I am what you might call Pissed Off! A few years ago a man jumped into my car and demanded money.I was so scared at the ATM that I couldn’t remember my husbands pin number, so the ATM kept my card. The man then became very upset and kept poking me with the tip of his knife blade. I then decided to try and crash into a pole. He didn’t like that either. He took over driving and he drove and drove and drove. Clearly crazy, clearly needing a fix. He raped me and broke my arm at the same time. In the end he was attempting to drag me to a unknown house to sale me to his friends. Stating that I was going to make him some money! I knew if I went in that house I wasn’t coming out alive. Lucky for me a car drove by and I ran for my life, jumped in and never looked back! A year later I was still taking medication (as prescribed)and found out I was pregnant. My doctor for reasons I still don’t understand suggested a methadone clinic. I refused to go because I thought it wasn’t necessary. He said go or deal with CPS (Child protective services). I went 2 weeks before delivery. At no time was I ever at a high dose. At no time did I ever want to be there or deserve to be there. I wasn’t an addict but I was soon to see what it was like to be one. I can not even explain the way I felt having to leave the hospital, leave my child to go stand in line to dose. I can’t tell you how low I felt every day thereafter driving a hour and a half one way everyday with my new baby to go get methadone. To stand in line with her and feel all eyes on me. Let me tell you after methadone you can’t go back to Loratab. So every year I’d work on coming off the methadone. The first I was so close and became very depressed and had to go on antidepressants. It was so bad. I have never been that sick. They wouldn’t reduce my meds until I became stable on the antidepressants.I did it! It took another year. I started reduced meds right away and when I would be down to 20mgs or so I got a drug screen with no methadone in my system. They took my take homes, made me pay extra for a extra drug test and not to mention the drive with child in tow. More humiliation. The 3rd year however was the worst of all.Same old thing happened with my drug screen,only this time they humiliated me real good. They had already given me my meds for 2 weeks but they announced in front of everyone in the line and my child and who ever else watching that I would have to follow them and flush the meds because I failed my drug screen. I told them that I had already paid for the medicine. They told me to get a refund check. When I called to get my refund check they said that I could come and get medicine but they do not give refunds. Now I know some of you will say it is just a bad clinic. Could be.ohhh who am I kidding–yes it’s a cesspool. They all are. Methadone is very addicting. VERY powerful stuff. I know. I felt it after a week. I was hooked and hooked bad and I felt trapped and I was mad. Mad as hell and I still am. I am also mad that other people don’t wake up and get mad as well. This is my opinion but Methadone clinics are being used as a place to go get drugs legally. Any person in their right mind would feel like I did humiliated and want out of their immediately! Not stay for 20 years. I can see 3-5 years buts still to long. I wouldn’t have been there that long if they hadn’t had kept playing the “your not getting outta here” game with me. I have heard this from many many people. None of these Methadone clinics give a damn about your addictions and 1 out of every 5 Suboxone Dr’s are the same. It took me three trys and almost dieing after the Methadone incident to find a Suboxone clinic that didn’t want cash money to line their pocket and also charge my insurance. This should be a big fat sign…..CASH NO CHECKS! Same for the Methadone clinics. Now keep in mind these are my own experiences and feelings and I’m not judging anyone. I feel ya. I’ve been there. I am now on Suboxone since April. I didn’t plan on being on it this long but once again, my buddy Methadone held on for about 3 months fighting the Suboxone. It was hell. But in September I went from 1 a day to half and I plan on going to half a half in January. If you do any researchon either of these drugs you’ll find that the longer you stay on them the bigger the risk for addiction.

    • I suppose it depends on the research. If one reads the peer-reviewed literature, she will find that opioid dependence is a relapsing, chronic illness that claims more young lives than auto accidents. She’ll find that buprenorphine is about as safe a medication as ever existed, with few if any significant side effects beyond constipation– which can be treated by ‘spitting’ the non-absorbed buprenorphine. Many of the meds used routinely– say to lower cholesterol or blood pressure, or treat arthritis or asthma– have far greater long-term side effects and risks.

      As for why people stay on the drugs, I suppose the main reason is to avoid dying from overdose– since a couple recent studies showed relapse rates over 95% after a year of maintenance treatment. I think that reason is as valid as the reason people take blood pressure meds for a lifetime. We don’t have a cure for hypertension, or for addiction– and your risks of dying are much greater for heroin addiction than for hypertension. But it’s buprenorphine we should all be worrying about?!

  4. My only complaint or problem I would like to arguable try to point out to Doctors at this time would be that addicts/patients mostly have with having to go to the clinic every day to get your dose of proper meds for that day is when you are in the first few weeks of withdrawal (which is when your symptoms are at their worst part of your attempted recovery process) it makes it vary hard to try and find the strength (not mentally but physically) to make it to the clinic everyday when you have a fever over a 100 degrees throwing up sweating through your clothing having hot and cold flashes your body is acing your feel vary weak and you cant eat or sleep and lastly diarrhea. Those symptoms make it vary hard to do any kind of traveling anywhere your not close by a toilet. And you cant not start on any type of medication until you can test clean witch means being off of opioids for a solid three days to maybe even five. Witch for most is when your in the worst part of withdrawal because your body has gotten rid of all traces of this drug being in your system. I mean ask yourself if you think you could make it to the doctors every day when the sun comes up standing outside (because its first come first serve) to get any kind of help/relieve from this illness? I mean lest take away the fact that the type of people that are subjected to this are “drug addicts” and lets say for one second they are normal people with no addiction and they had a virus (cold/flu) and they needed medical to help them get better would you make them drag themselves out of bed and subject them to the same treatment that everyone expects people who are trying to become “recovering drugs addicts” too? No! Absolutely not! Why? Because its almost barbaric in a way. Don’t you think? Thats why its so hard for most people on methadone to continue to stick with it and stay committed to making a full recovery from this addiction. Then thats how you get people who have repeatedly try to get off then go back out them do it all over again. It becomes a vicious cycle and sadly most people get stuck in it and are never able to free themselves from or break. Now dont get me wrong i know there are those people who also take advantage and abuse the use of and help that clinics offer. Or are stupid enough to go right back out after successfully getting off of everything, but everyone shouldn’t have to pay for those few that take advantage. I suggest that maybe clinics only allow a person to participate in methadone maintenance once a year or maybe twice a year and for the first week give them enough to stay home and recover and change that they have to test clean when fist coming in but by the end of the fist week when they come back in to start coming in everyday for there meds to test clean from then on. I just think if we all really get together and think about this more we could come up with a better solution to help fixing this epidemic.

    • I am always promoting patient rights, arguing that patients with addictions be given as much respect as any other patient. But precautions are necessary when handling opioid agonists in people with history of addiction. As a recovering addict as well as an addiction doctor, I strongly suspect that if a week supply of methadone was provided to new patients, 80% or more of those patients would be out of methadone within 24 hours. I hear over and over (and I remember too) how people ‘plan’ to make opioids last a week or a weekend… but they are all gone in a few hours. Maybe you were different– but most opioid addicts cannot control an agonist the way you suggest.

      Those first weeks are difficult. But at the methadone program where I work, drop-outs in the first few weeks are rare– certainly below 5%.

      Change is hard, and staying sober is hard. Making it to the clinic that first week is hard– but it is not the hardest thing about getting off opioids. Frankly, getting off opioids takes at least as much work as it did for a person to get hooked on them– i.e. all of those scary, late-night meetings with strangers, all those dreadful early mornings when there is no dope to be found… most programs are not going to be interested in patient looking for an easy path to sobriety, because those are the patients who often miss counseling sessions and have trouble with the other requirements of the program.

      It is hard to choose where to place blame with this illness. Yes, many people get clean and then ‘go right back’– as that’s the nature of opioid dependence. Successful treatment requires a blend of professional help and patient responsibility. I suspect there is a wide range of opinion of the part that’s up to the patient.

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