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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.

49 Comments to
Methadone, for One Thing or Another

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  1. I just wanted to correct you about the Prescriptions over 30 days. Here in California you are not allowed,even in pain management,to receive any more then 30 days of methadone for pain. No 2 extra scripts for down the road. I believe in each State it is different. Much like treatment Nothing is one size fits all.

    • Thank you for the info. I am referring to Federal law– I would expect states to have various ‘add-on’ rules, such as triplicate prescriptions for schedule II meds (NY used to do that– although I heard that was eliminated?). The Federal law can be read on the DEA web site by searching for schedule II prescribing rules– it states that up to 90 days of schedule II meds can be provided at one time– providing that there is no more than 30 days of meds on each script, and each script is the same– and each script includes the ‘date written’ and ‘fill date’. It is stated more elegantly on the web site, of course!

  2. Why would a woman who have been on methadone for 20 years have to go in daily? Unless she’s still using illicit drugs that would be unheard of. I have been on methadone maintenance for 7 years and I only go to the clinic once every two weeks. If I were working full time I could go once a month. The same should be true for the woman quoted above. Daily dosing is usually just required for the first 90 days in treatment. After a year the law allows methadone patients to come in just once a week. After two years of negative drug tests federal law allows patients to come in just once a month. So it’s not as bad as the article above insinuates.

    While I’m at it I wanted to point out some minor inaccuracies in the article above.
    Although all clinics are different and have different rules the majority of them functions partly as harm reduction facilities in addition to treatment facilities. They do not normally kick patients out for missed counseling sessions or even several positive urine tests. Doing so would do more harm then good for the patient so to an extent these patients are allowed to stay at the clinic. Instead of being kicked out patients that have positive drug tests will lose their takehome doses, if they have any, and have to come in daily, get additional counseling and may have to have different rules and restrictions, etc. In some situations the dose is reduced or increased. Missing counseling sessions will also rarely lead to a discharge but instead usually leads to a loss of privileges. A good clinic will work with a patient before involuntary discharge becomes an option.
    Th;;’e average fee for MMT is $7-$14. Good clinics will work with their patients on financial issues and give them some leeway in hard times. However, if a patient is completely unable to pay for a longer period of time he is usually put on a taper schedule and discharged once the taper is done.

    Dr. Junig is correct that it is illegal for a doctor to treat addiction with narcotics unless he is with a methadone clinic that have received permission from the federal government to open. There is however an exception to this rule where a physician can in fact treat an addicted patient with methadone from his office. It’s called OBOT – Office Based Opioid Treatment. The doctor would have to get permission to do this and there are a lot of hoops he has to jump through but it is possible. An OBOT doctor using methadone can only dispense the drug, not prescribe like an OBOT doctor using Suboxone can. There aren’t very many OBOT methadone doctors but there are a few, mainly on the east coast.

    There is also the 3-day exception when any doctor can dispense a narcotic to an addict to treat withdrawal symptoms in an emergency situation while other plans for treatment are being made.

    • Thank you for the comments. Here in Wisconsin, $7 would be viewed as a ‘steal’ for methaone treatment– $12-$15 is the norm, but I know things vary by region. Likewise, I have never met a person who can get their methadone weekly– let alone monthly– and I meet many people on methadone by the nature of my practice. I suppose that again, different clinics have differing policies. I am not a proponent of smoking pot, but the clinics in this area respond to THC-positive urine by cutting methadone doses and forcing withdrawal and putting people back on the first rung– if not discharging them altogether. Other ‘infractions’- -like missing a payment– also put people back on the daily schedule. Again, I am aware that the federal laws say one thing– but local clinics can set their own rules– which are much more restrictive, and less ‘patient-friendly’.

    • Just to let you know my husband was put on a rapid detox and was kicked out of the clinic for failing 2 drug tests. Both of us were kicked out of the clinic we were put on a 2wk detox because we couldnt pay everyday so yes its true that a clinic will kick you out for failing a drug test and for not being able to pay. Also, the payment for methadone is much more expensive than what you are stating. My husband pays 150 dollars every 2wks and I pay 80 dollars a month for my take homes. Every clinic is different but the ones here in Illinois do not care at all about your financial situation.

  3. The Wisconsin patients should take a drive down here to Chi-town. The average here is $50-$60/week. One clinic only charges $45/week.

    I’m surprised that you’ve never met a methadone patient that gets weekly takehomes. At clinics I’ve attended both in Illinois and Indiana it’s very common and so are bi-weekly takehomes. Monthlies are not as common but I know several people who have them, all over the country. Perhaps the patients you meet are those that are fairly new to treatment and not very stable. Either that or Wisconsin have some very archaic regulations. I was under the impression that Wisconsin is very treatment friendly, though. At least so I’ve heard.
    Either way there should be no reason why someone would have to come in every single day after 20 years in treatment. That sounds very odd to me. Are you sure this woman is in the US?
    I do know of one man who have to go in daily after 12 years in the program but that’s because he keeps smoking crack. If this woman does not have extensive takehomes after 20 years the only reason I can see would be because of continued drug use which in some states, and some clinics, include pot use. It is by no means the norm though as your article would have you believe. Some states do not allow monthly takehomes but most, if not all, allow bi-weekly and so far I have never met a long term compliant patient that didn’t have at least that. That is the norm. The idea that methadone patients have to show up every day cash in hand is a myth left over from the ’80’s when that was the case. So far I have not heard of a clinic that does not allow takehomes after 90 days as long as the patient is clean and compliant. As I mentioned I just go every two weeks and I’m in and out in about 5-10 minutes. It’s really not any worse than going to the pharmacy.

    I’m curious, since you mention methadone clinics kicking people out for non-payment like it’s an example of why methadone clinics are bad, how do you deal with patients that don’t pay or don’t show up in your practice? Do you continue to treat them or do you discharge them which would lead to buying on the street or go through painful withdrawal from buprenorphine?

    I really don’t get this notion that Suboxone is this all-good miracle drug while methadone is the evil cousin that just causes trouble. Neither is true. They are both very useful medications but both have short comings as do the way they are being dispensed. Neither drug or method is right for every opiate addict. Suboxone was horrible for me. I felt like crap for the month and a half I stayed on it. Methadone however works great. Some people feel it’s the opposite for them. I’m glad that there are options. Why can’t we just recognize that, that both medications play an important role in helping people recover and one is not superior over the other? This belief in the superiority of Suboxone and the inherit evil of methadone seems to be quite common among Suboxone providers and in my opinion it’s a damn shame. I wonder how many failed Suboxone patients are out there that are left untreated because they have been told by their doctors that methadone is evil and they have to go to the clinic every day for 20 years.

    • Sounds like you are trying to pick an argument. I’ve never said methadone was ‘an evil cousin’ as you put it. I’m only stating how things are. Your suggestion that people from my area ‘drive down to Chi-town’ is appreciated, but it is not practical to drive the three hours every morning– even for the generous terms that you describe.

      Your norm is YOUR norm; the middle of Chicago has a number of differences from rural, northeast Wisconsin. We have a world champion football team up here, for example….

      As for clinics kicking people out for nonpayment, I do handle things differently. I work with people for weeks, and sometimes months, before discharging a person for nonpayment. I try to provide a taper strategy if they absolutely cannot pay, and I refer them to the county, with a script for enough meds until they get there. I can assure you that I don’t simply turn people away on the morning they arrived for their DAILY dose.

      You are welcome to join the discussion about methadone on my own site, where I have a section dedicated for people on methadone maintenance. I think we have covered the issue sufficiently here.

  4. I’m not trying to pick an argument. I’m simply questioning some of your facts and telling you why. The comment about driving to Chicago was a joke but clearly that did not come across. Sorry about that. Unfortunately though there are people who do drive several hours every day to get to a clinic when none is available closer. In those situations, if the clinic is good, the people can normally get a hardship exemption and get takehomes quicker.

    I’m not familiar with the methadone clinics in your area. From what you say here they sound pretty bad. There are definitely many bad clinics out there that simply don’t give a damn and think the patients are just a necessary evil they have to deal with. But there are good ones too and I would have liked it if you would have included in your piece that your experiences with methadone clinics are not the absolute truth of how they all are. There is so much stigma, misconceptions and myths surrounding methadone clinics. They are rarely described positively. But there are positive things and very good clinics and I think it’s a shame that people aren’t told that. Bad clinics, like the ones in your area seem to be, are not a reflection on the treatment method. They are just bad clinics just like there are bad suboxone providers.

    If your area clinics turn people away as soon as they show up without money then that’s a disgrace and someone should contact responsible authorities and accrediting agency about that. That’s definitely not part of best practices and it’s downright cruel. So far I’ve never seen or heard of that being done but of course that doesn’t mean that it doesn’t happen. Most clinics will work with you to an extent, some more than others. They will usually let you carry a balance for a week or two. If your balance becomes too high they will put you on an administrative detox, i.e., a taper schedule. I may be wrong but I think it’s required by law. Unfortunately some of the bad clinics will only do the bare minimum and will take you down from whatever dose you’re on to zero in as little as six days. The better clinics allow a 30 day taper. By the time I was put on an administrative detox at CAP Chicago, the first time I tried MMT, my balance was $360 and I was put on a 30 day taper. Now CAP is known as one of the better clinics but they are not the only one. At CAP I also was allowed to come in only 4 days a week after only 30 days in the program because it took me two hours each way to get there with public transportation.

    My point is that clinics in general are not as brutal as I thought your piece made them sound. The problems are not clinics or MMT, it’s bad ones. Had the woman who emailed you about having to go daily after 20 years gone to a decent clinic perhaps she wouldn’t been as unhappy with the system as she was.
    Although my experience with clinics come only from Chicago clinics and one in Indianapolis I also know many MMT patients from allover the country and this area is not the only place where there are good clinics that allow extensive takehomes, like 1 week or more.

    You’re right that driving 3 hours every single day is not reasonable but if there are WI patients who have been in treatment for a year or two and have documented clean urines for that time they could transfer to a good Chicago clinic and get bi-weekly or monthly takehomes right away, only having to make the trip once or twice a month. I think that would beat having to go every single day and paying half a fortune at the clinic up there. It’s a thought.

    I apologize if I upset you or sounded like I wanted to argue. That was not my intention.

  5. I’ve only been on mmt for 1 year and 9 months I only go in every 2 weeks to get my meds do a group and meet with my counselor! I can’t imagine why someone on mmt for 20 years having to go every day after 5 months I was going 3 days a week it could have been after 3 months if I would have stopped the pain meds before

  6. I’ve been on methadone for 27 years. I used to go to an OBOT (office based opioid treatment) in Maryland where I received monthly takehomes in the form of 40mg diskets (I’m on 30mg/day). Then I was transferred to Florida which also allows monthly takehomes for compliant patients (I have been clean for 20 years) and receive monthly takehomes also in the form of 40mg diskets. In Maryland, the doctor charged $80/month. Here in Florida, where they only have obot for buprenorphine, they charge $400/month for methadone. I have a good job, family and home. I look at taking my 30mg of methadone/day just as I take my 20mg of lisinopril for high blood pressure every day. No reason to switch to bup (which is $600/month here for those with no insurance). I’m just glad I live in a state that allows monthly takehomes for compliant patients although I have an issue with the high price.

    I should be able to get my monthly medication with a doctor’s prescription, leave a u/a to prove my compliance and not have to pay the absurd cost that kliniks charge. OBOT should be an option with the choice of either methadone OR buprenorphine. Thank you.

  7. I don’t know anyone in treatment in Wisconsin and I was really curious to find out if it is as bad as it sounds from your blog so I called the Green Bay clinic and asked them and was a bit stunned by what I found out. You are correct that they will not dose a patient if they show up without money one day and if you can’t pay at all there is no administrative detox. You’re just out on the street. Not even a six day taper. I guess I was wrong that that’s illegal. It should be. That’s downright cruel and irresponsible from a medical standpoint. I have never heard of any clinics that don’t offer at least a short admin. detox when a patient can’t pay. Since most clinics in WI are ran by QAM there aren’t any options for patients either.
    It’s important to note, though, that what these clinics in WI are doing is not how clinics are ran all over the country.

    They do offer takehomes though. They allow takehomes after 90 days if a patient has clean urines and are employed, a student, stay at home parent or disabled. After one year they allow weekly takehomes and after two years you get bi-weekly takehomes as long as you do what you’re supposed to. They don’t allow monthly takehomes. That may be state law as it is in some states.

    Their fees are outrageous. $97/week or $19/day. I’ve never heard of any clinic charging as much as $19/day. That’s what happens when there is no competition. Here in Chicago there are so many clinics that they have to keep their fees low to remain competitive. Oklahoma has a state law that dictates that no clinic can charge more than $65/week. WI patients and other interested parties ought to get together to push their legislators into passing similar legislation, one that bans clinics from kicking people out in the street for one day of non-payment. Do WI have any advocacy groups?

    • I don’t know of any local methadone advocacy groups– maybe you should come up and start one! I just saw a new patient today who had been going to the same clinic for over 3 years without a hitch; he was able to do ‘split dosing’, but was still not able any ‘take-homes’ except Sundays. He tested positive for marijuana for the first time, and they responded by eliminating his Sunday dose entirely, forcing him to be sick every weekend.

      I don’t have anything at all against methadone treatment; I recognize that for many people, it is a lifesaver. But the clinics really hold a huge amount of power over people, and have a duty, in my opinion, to take care to avoid abusing that power. Sounds like they are better at that in your area than in mine!

  8. Wisconsin is clearly more backwards than I thought when it comes to MMT. I have never, ever heard of any clinic pulling a patients Sunday dose or refusing to dose patients because they are short of money one day. These clinics are clearly worse than most. And the owners are getting filthy rich from it. Disgusting! You ought to tell this guy to contact Deborah Powers at the State Methadone Authority for help on this matter.

    Maybe you should start up a methadone clinic and run these shysters out of town. They need some competition up there.

  9. I live in Tennessee and the clinic i have been going to for the past 14 months has a Phase level guideline they go by,
    Phase 1; ,0-30 days = one take home dose for sunday only.
    Phase 2; ,30+ days = Weekend take home dose,Sat/sun,Two doses.
    Phase 3:90+ days= Clinic attendance four days per week, 3 take home doses.
    Phase 4:180+ days = Clinic attendance three days per week, four take home doses.
    Phase 5: 270+ days = Clinic attendance two days per week, 5 take home doses.
    Phase 6: 270+ days = Clinic attendance one day a week,6 take home doses.
    Phase 13: 360+ days =Clinic attendance once every two weeks, 13 take home doses.
    Phase 27: 720+ days = Clinic attendance every four weeks,27 take home doses.
    Patients must have Clean drug screens, Regular attendance, Compliance with program rules, Stability and appropriate Counseling units.
    Anyone to have been in treatment for 20 years and not getting take home doses must not be following the program and is testing positive for things other then methadone. Or the clinic they go to has some really bad treatment plans.
    If someone has no goals to reach then whats the point? they’ll just keep using as if they had no reason to stop. but thats not all people i grant you that , but 20 years? wtf

  10. I just wanted to make sure you were aware that there are clinics that let you have 2 week take homes if u pay regularly, see your couciler, and give clean U.A’s. I don’t understand why a women of 20 years was still having to go to the clinic everyday. It doesn’t make sense to me. She must have not been following the clinic rules. Either not paying regularly, not seein her counceler or dirty U.A’s. If she was doing everything the way she was supposed to there should be no need for her to go everyday. Some clinics let you take home for one week at a time. My clinic lets you take home for 2 weeks at a time After my 1 year of getting dosed everday at the clinic and following every rule they have listed.

    • As I mentioned, I am aware that different clinics have different policies. Hopefully some of the clinics in the area where I live will re-examine their policies.

  11. some of these statements are not correct i get weekly dosing only once week, rest takehomes and am in Australia. No way in the world after 20yrs would u pick up daily unless you relapsed, and if you were non compliant you wouldn’t last 20yrs. By that time i would looking at monthlys and deserve them.

    • I only know about the clinics in my part of the US– and cannot speak to practices elsewhere. I am glad that you are treated more humanely.

  12. I am the program director of an MMT program in the Midwest. We run a quality, patient-centered, therapy-oriented program.

    Articles like this are frustrating, because, though they don’t explicitly say it, they imply that all clinics are the same. They don’t address the effectiveness of MMT, only the problems with individual clinics.

    Yes, there are bad clinics. As the director of a quality clinic in a state with many bad ones, I find this very frustrating. However, just like any type of medical or therapeutic service, focusing on bad examples doesn’t tell the story. Anyone who pays attention can give you dozens of examples of pill-pushing physicians and psychiatrists, hospitals with horrible patient care, pain clinics that cut patients off of their pain meds without referral, etc. But, when you read an article about how to get your pain treated, they aren’t riddled with half-truths and cherry-picked examples of negative treatment.

  13. P.S. In all of my dealings with physicians who prescribe any form of buprenorphine, I’ve never met one who requires or tracks therapy, does regular drug screens, or provides any sort of case management. I’m glad you do, but you seem to be the exception rather than the rule. As anyone with even a basic understanding of addiction knows, these physicians are not providing recovery. Perhaps this should be highlighted along with the shortcomings of *some* MMT programs.

  14. In reference to the 30 day only thing, its correct, and they can provide another one or two prescriptions provided they are a 30 day supply and the same dose. For instance my doctor gives me methadone for pain management. 7 tablets 4 times daily, 280mg daily, 840 tablets a month. He then provides me with another 2nd prescription that says “Do not fill until xx/xx/xx” He doesn’t provide me a third script, only the two when I go see him, so I have to see him 6 times a year unless something else comes up. This is in California.

    • im moving back to cali…(if possible)
      even tho the dea is insane putting pot as a class 1
      at least its legal on the state laws.
      The fact u are getting pain managment while an addict (not sure if your on mtp or not)its a more humane situation than what most New Yorkers are dealing with who have legit pain issues and are on meth, “No combination of pain managment and drug treatment allowed” . It could and should be- Dolphine for the month, cheap, works, done…do we really have to educate these many cluelesss doctors? Oh and with these new anti-opiod laws passing (at least here in NYC) the ERs will only be allowed to prescribe maybe vicoden or percocet. God help yo9u if you a tolerence as most of do. One must be dying in front of them…and only maybe THAN. Has anyone every read Brave New World?? Grrrrrrrrrrrrrrrrrrrrrrrrr

  15. is it really federal law that daily dosing requirement is lifted after 90 days, 1 year and so on? If so, i am getting screwed.

    I am on my third year in mmt. I had a false positive about
    2 months ago which was excused by my physician as a mistake.
    I have never had a posive in 2 years. I was attending once a week but got that stripped to every day. My physician said it was ok to return to once a week, but now my counselor is demanding that i do an observed urine screen. In the first two years i had an issue “peeing” in front of someone so they opted to a search and pat down, and allowed me to progress in my treatment. now she cant do that anymore.(so she says) How can they just do that? Is there a law against it?

    Now that i am maxed out at 240 mgs a day they know i can’t just forget about it. I have to get there everyday.


    • Wow– and YUCK! I don’t know the laws– present or absent– about MMT. Hopefully someone will see this and provide you with information. Supporters of MMT, can you help this person out?

  16. I am from Wisconsin. QAM is notorious for disrespecting, and not caring for their patients. Their counseling is a joke. They say we treat everyone equal, but they don’t. They never mess up, but they do. If you dont have your money, too bad. They act like they don’t know you if you don’t have the money. Their famous saying”YOu came to us, we are not holding you here”.Ya RIGHT!!!! Most patients there are on at least 150-200mgs a day!! Legalized drug dealing?

    • I must admit to hearing some surprisingly negative things about QAM since their arrival in NE Wisconsin. I take comments with a grain of salt– until I’ve heard a ‘shaker-full’. It’s getting to that point.

  17. I’d like to point out that because a patient is on 150 – 200mg a day, does not make it ‘legalized drug dealing’. Many patients need far higher doses, it’s all individual. There are lots of patients, who over time, don’t need counseling to ‘live sober’ and ‘be in recovery’. It’s like taking a maintenance med for any other disease. Now I believe many if not all patients coming off the STREET, do need counseling and a strong structure to stay well. I myself use counseling as a help for my ‘life problems’ and not for my addiction problems. The medication eased the symptoms and allowed me to return to a normal life, not the counseling. But again it is a needed thing in MMT programs.

    What these clinics are doing in Wisconsin is very wrong, most patients after the 2 year mark (as long as they’ve been compliant) should have 2 week takehomes to month take homes. I’m in Oklahoma and we don’t offer month takehomes, but we do offer two week. We also don’t allow clinics to charge over 65.00/weekly. The clinic I attend in Oklahoma is amazing, even though there are some that aren’t up to par for sure.

    I would contact the Wisconsin State Methadone Authority

  18. I accidentally pressed submit on that last comment, but here is the info for the SMA

    Deborah Powers
    State Methadone Authority
    Wisconsin Bureau of Substance Abuse Services
    1 West Wilson Street
    Room 437
    P. O. Box 7851
    Madison, WI 53707-7851
    Phone: (608) 266-9218
    Fax: (608) 266-1533

    I’m sick of all MMT programs getting bunched up into the same pile, NOT ALL ARE THE SAME. More suboxone doctors cause more damage to patients than most methadone clinic (no offense to the dr. posting, you’re an exception) but I see so many of these bupe doctors just handing it out like candy and it all gets diverted to the street. I’ve been to 4 different bupe doctors and none made me do a UA, counseling, follow up, etc. They only wanted money and that was that. We need more training for these doctors and a platform in which to prescribe it, otherwise we are doing more harm than good.

    • Adam/All (excuse all the spelling issues)
      I am in NYC- probably the best city to be in for opoid addiction (except maybe L.A)due to all the many mpt centers. BUT Lets all just be frank and say what we all know to be..the clinic system is a draconian unfair solution for people who are trying to regain their life. I get weekly take homes -6 bottles -but I know if anything gets screwed up via a urine screen (meaning mistake on their part) or I miss an appointment because I had the flu, bang, they threaten to take a bottle. At 46 years old and after kicking heroin 14 years ago, I cant abide this anymore, I used to be a drug counselor as many of us become- but gave up after not being able to work for strictly abstinance modality treatment centers like Pheonix House etc. HARM REDUCTION is what I choose works. The mtp centers are simply NOT conduscive to having a life worth living. We can not go anywhere for days without the consent of the program,. States having one or no clinic to speak of or just one should be held accountable for not making treatment available or they need to get rid of the drug laws until the address the issue. And of course their are the many many sickening money making schemes of some of these places. (withdrawl beign the punishment) I used to go to a clinic where the “DR” gave out stars on ones paperwork if they went UP a few mgs or so. GOLD STARS>>wtf?
      I think its time we methadone addicts speak up. I have endometrosis which is a pain condition I am prescibed Oxycodone for. Hmmm why am I not “punished for that?” because I have a prescription, yet I cant get Dolphine instead of all this madness. Dolphine would solve the pain and the addiciton issues and easliy and cheaply, but noooooooooo too easy. you cant be a drug addict and seek pain relief at the same time. Its outragous. I am sick and tired of being sick and tired of these f’n program’s laws. Its time we speak up, -there are many of us with legit pain issues not being dealt with due all of thier nonsense all in the name of the all mighty dollar. I am williing to give it a try, to start some type of grass roots thing going and get our voices heard. Hell we may as well use facebook for something worth while! ALthough the MD on this site Im sure has good intentions u know there were hundreds of us screaming “DO SOMETHING ABOUT IT!” but they wont.
      SO if you are interested in speaking up for the quality of our lives we are loosing under these rules (they want to keep us under thier thumb while treating us like children IE:having 2 check our homework before we are allowed to travel,) etc. I for one have had enough. Please join me in this venture, what do we have to loose? (A bottle? Lol) . Lets get to the powers that be somehow- make these situations clear to the world- this world is suddenly filled with memoirs of everyone and thier addictions. This world is filled money making rehabs and treatment centers all contigent on how long the insurance lasts…these days 6 days is a good stay for most insurance. It feels criminal, it is certaintly not good for mental health or emotional issues. When getting clean Or just when getting out of bed each day, these things matter…the whole absurd pain/tx/ problems alone should be shouted to the world,. I have seen people going for chemo in my clinic. Are they saying they cant prescribe a person undergoing cancer treatment Dolphine or monthly bottles??? Someone shold answer for these clusterf***!
      my email is:

  19. J.Miller nice to know there’s an educated person here rather than the one size fits all mentality! The Pike County Transportation in Pa are criminals! They tried to move me to another clinic where I’d ahve to go everyday!!!!!for a month instead of the 2wice a month trips..for the last dose is low & I’m terrifed of withdrawalls..the taxi & the friver are inportant to me both mentaly& spiritually I also suffer from bi-polar disorder but I take SERENITY” an all natural urbanhealthsource,com I was sick on Lithium!dizzy,just sick the Transportation Act 121 states Methadone not “Methdaone Maintainace” & the mileage is the same but worse if I were to go w/a buch of starngers everyday,,and–suffer at age 61[March} almost a senior,my record is perfect having had not one dirty urine!!!!They had the ?? to call my counselor! The other clinic is on my side saying “you’re not on the list they’re insane This is personal on the part of the manger at Pike County Trasportation they received a 7pg letter after it went to Accessplus..why?because the taxi’s woman boss allowed a girl to ride without a seat belt–this girl she was so resentfull& jealous of my rapure w/ the driver thinking she rode alone.they picked her up w/ me then dropped her 20 min’s later- I’d get up front & then go to Beethlehem clinic– she went as far as to tell the taxi “I don’t wanna share” but …we live in the same community! she then threatened my ride– she was freinds w/ the dispatcher when our regular guy was off she took the opportunity to say “Hey you don’t know what I know ; you don’t know what I can do” so w/ that I was told “”we’re not picking you up anymore!!” I had 3 drivers for 7 yrs they all liked me the boss said “we drive kids w/ cancer your ride is not more important” the dispatcher said {intimidating me screaming at me!}””This is not the “Sacco taxi co!!” Boss broke her contract w/Accessplus when she suddenly stopped my ride ..cold?-No Complaint was ever made but “I” sent a 7 pg letter– so this is personal this taxi boss sabotaged the present cab I have now a yr I’ve been w/ this new company} her company actually got all the Disabilty rides from the Pike County manager telling people to take “AAA”{let’s say}where the “BBB” company was never mentioned and also after they refused to drive me I was told by the manager AT “PIKE COUNTY TRANSP-SAID “You’re not supposed to call another TAXI” I BELIEVE THE BOSS,THERE..WE WANT TO MOVE YOU TO ANOTHER CLINIC” I SAID “NO WAY–THE WOMAN WHO SAID THIS QUICKLY BACKED OFF “””OK OK OK I JUST ASKED’D” HAVE TO START THERE ALL OVER AGAIN..I’M NOT LEAVING MY CLINIC”SO GIVE ME THE ACCESSIBLE AVAIALBE TAXI NOW!!IT TOOK 2 WEEKS,,WITHOUT AN ANSWER..I HAD TO RETURN THE MONDAY OF THAT FRIDAY HE FINALLY CALLED AFTER IGNORING OR RETURNING MY MOTHER’S CALLS TOO,,{SHE’S AN AUTHOR HELPED ME W/ THE LETTER] NOW ANOTHER LETTER TO APPEAL TO THEM THIS GUY WHOSE TRYING TO FORCE ME EVEN THEY GOT THE NASTY WOMAN EMPLOYEE TALL MY CLINIC SAME AS CALLING THE DOCTOR BUT MY CLINIC GIVES NO INFO HOW DID THEY GET THAT NUMBER??} MY {NOW}DRIVER & THE EMOTIONAL PEACE I HAVE WOULD BE DEVESTATING TO EVER BE TAKEN AWAY W/ THEM AT PIKE COUNTY,,THIS INTIMIDATING UNEDUCATED GROUP OF CRIMINALS HAVE MADE MY MANIS DEPRESSION SURFACE,WORSE..I CANNOT EAT UNTIL I HEAR FROM THEM THE GUY WHO SAYS THE ‘STATE” SAID THIS SOOO” NO THIS IS AN EXCEPTION A MATTER OF 10 DOLLARS MORE?TRAVEL BUT MY TAXI HAS HEARD NOT ONE WORD RE:THIS MILEAGE ISSUE FROM 25CENTS TO 12 CENTS A MILE I CAN GET THERE IN AN ONE–HR & 10 MINUTES..TO THE OTHER CLINIC?? WOULD KILL ME..60 MILES?70? SHARING? A GROUP LASTING AN HOUR EACH DAY THEY ONLY GIVE 6 TAKE HOMES WHEN I AM ALLOWED 12..THEN I GET 3 CALL BACKS A YEAR TRANSPORTATION CANNOT DO THIS TO ME; I NEVER RECEIEVED A NOTICE DEC 22ND,,THESE PEOPLE ARE HANGING UP ON ME,&,NOT ANSWERING THE PHONE AT PIKE COUNTY TRANS HOW DO THEY GET AWAY W/ SUCH CRIMINAL BEHAVIOR SEE I STRONGLY BELIEVE PIKE COUNTY MANAGER IS BEING PAID FROM THE AAA” CO TAXI TO GIVE THEM ALL THE RIDES AS THEY DID 2 YRS AGO HAD THEY NOT LET ME GO FOR NO REASON THE DOOR WOULDN’T HAVE OPENED FOR THE OWNERS OF MY CAB..THEY EVEN WENT TO PIKE COUNTY MANAGER WITHOUT NOTICE..SAYING “WE DON’T WANT TO MAKE AN APP’T FOR FEAR HE’LL MAKE SOMETHING UP-SO WE’RE JUST SHOPWING UP”THE BOSS TOLD ME YOUR RIDE IS SECURE NOBODY CALLED US RE MILEAGE; MY MOTHER’S LETTER RE:THE APPEAL FOR ACT 121 WAS FAXED A DAY AFTER THIS GUY {AS I DO NOT KNOW HIS ROLE THERE “”BUT HE’S WITH THEM”””TOO ! HE KEPT SAYING THEY HAVE NOTHING TO DO W/ THIS” OH YES THEY DO!!! THEY’RE INSERTING THEMSELVES IN MY LIFE CALLING “MY CLINIC. BUT DIDN’T CALL THE OTHER CLINIC THEY HAVE A WAITING LIST..THIS WOULD KILL ME..HELP! PLEASE HOW DO I STOP THEM?ROSEMARY BROWN TOLD MY MOTHER “IF YOU EVER NEED ANYTHING..DON’T HESITATE TO CALL ME”SHE’S THE REP, WHO COULD STOP THIS CONSPIRACY MY TRIP IS 2 TIMES A MONTH,,NOT EVERY WEEK..NOT EVERY DAY!! MY MOM NEEDS ME AT HOME THE TIME I GET HOME..I CANNOT BE FORCED TO ANOTHER CLINIC..I’M ON A LOW DOSE NEAR DETOX..I WOULD,,BE DEAD! “ARE YOU TRYING TO KILL MY DAUGHTER BECAUSE SHE’LL END UP IN THE HOSPITAL OR DEAD” SHE WROTE..ETC HER LETTER WILL HAVE THE RESULTS WE NEED..THEY ALWAYS DO PLEASE GOD! I’LL CHANGE MY LIFE I PROMISE!

  20. Please,excuse me for divulging certain names,people places,DrJ wrotually listened to my cxomments & understands,this Ethics issue as I believe I’m dealing w/,,you could say..criminal mentality[ies] they laughed,saying Oh yes you’re coming w/ “us” that I’d be forced to ride w/ them..thus not returning to my regular taxo co & the driver to whom I’ve grown close he has helped me maintain a harmonious ride,we talk of deep things from UFO’s to Life after death & the needed intellectual stimululation is vital to my life & meantal state These people {Transportation}are intimidating devoid of intellectual depth,having no idea as to the severity re: a change of clinics I cannot go “everyday!” the clinic’s intake girl is sympathethic she said “nobody comes from your county or has been relocated.why are they sending you” here?”she also said you’re not {even} on the waiting list now the guy at the trasportation office is working w/ the ernemy I do not belive he is tyring to help me..this is their way of punishing me,afterall a 7pg letter was sent complaining that last yr he tried to move me refucing to give me another cab,after 7 yrs w/ the other company now I see a bigger conspiracy,,here that was the reason for the owners to say we’re not picking you up BUT she never have me a legit reason nor did she send any such “Complaint” to my provider,or anyone else,,all the men who drove for her company are all w/ the company I am not with they still haven’t heard of any reductiion in milegae or fare “hikes” also this was supposed to be told to me Dec 22,2011 BUT the call came jan 20th?2012?? then the letter appeared “after”{?} the call? which was a double emotional shock..thank you so so much for taking the tor giving me sound advice I will tell the woman who cime,& called yesterday when I was out w/ my mother from the “HEALTH DEPARTMENT” she sounded as if she were holding a China doll –she must have been told how emotional I am– but I will make her know she’s talking to someone intellegent– I will make her want to explore issues she knew nothing ABOUT.IF SHE READ THE FAXED LETTER FROM MY MOTHER ON MY BEHALF THERE’S NO WAY THEY’LL FORCE ME TO ANOTHER CLINIC THEY’LL BE SPENDING THE SAME AMOUNT OR MORE..THE STATE IS NOT BEING MADE AWARE OF MY BI-POLAR DISORDER OR BEING TOLD THE TRUTH,,RE:A POSSIBLE RELAPSE OR,WORSE! I’ve been,so upset I threatened them on a recording,manager of trasnportation office who INfEB- 2011-demanded I give him my clincis phone-number? they said if he called them they’d say sorry we cannot give you any info..reany patient here[This is the same as the dr’s office!} this manager called doctors before]belonging to another person I know! Oh yes the recording message,,I said “I’m going to make sure they find about what you’re doing to me”and,what you tried to do in 2011” for this “emotional deat out about you” this is the same as an {emotional} death sentence…a penalty against me? the other taxi company after 7yrs suddenly stopped my ride,,then manager said you’re not supposed to call another taxi company?” Disibilty Laws state no-one should be in “Fear” of their ride..{especially when you have a duel illness} those are my words {added} thank you again for the heartfelt message you sent..everyone should know Dr,J’s eyes are open,as he is reading all these comments..he took the time to read mine..I am so glad -that someone undertstands evil..I believe this is faith in humaness has been restored at least there are “some” people w/ education in the field of addiction,but also –go the extra mile so to speak tell me wht should I say to this woman besides the tears & terror I am facing? I left her a message saying I was out & then said they cannot do this to me I cannot withstand this DEMANDS that could kill me she knows nothing..yet,,thank you! any advice? from anyone pleaseeee help!

    • Lol. This woman is crazy. This rant is unintelligable and makes people on methadone or with mental illness look foolish. Please remove her two rambling rants. They are disturbing.

      • I hear you, Dan—- but they are completely typical, in style and content, of emails that I receive every day. There are many people in her situation, I.e. in pain, unable to find a doc who will listen long enough to sort through their symptoms to see what is ‘real’, what is psych, and what is addiction. Medicine has answers for people who fit into certain categories, but there are many people who don’t ‘fit’, (who doctors tend to avoid).

        Recent healthcare ‘reform’ created one more layer of administrators to drain from fixed resources; people already frustrated over being unable to find time with a doctor will not find the changes helpful.

  21. I attend a methadone clinic in Illinois. I get monthly take homes. I have been in the program for almost 4 years and NEVER had a positive drug screen or came up short on counts. Last week the clinic said my swab was positive for opiods. I get swabbed EVERY month, I know that its coming and WOULD never chance this. I have no desire to use anymore anyways. I offered to pay for a hair folicale test and the Dr refused. I am independently getting one next week anyways, but as a whole, should they not look at my history and willingness to prove it was a mistake. Also, I drive 2 houes ONE way to the clinic and did that EVERY DAY in the beginning. I have a lot to lose and my background should be taken into account. No one has offered me any avenues and the Dr will not return my calls. I am at a loss and am worried that this can happen again in the future putting me down to daily trips which I cannnot do all over again. I have now lost me code M and am on weekly, I cannot afford to do this. Any help would be appreciated (advice). Thanks

    • That’s a horrible situation. Whenever faced with a question about quality of care, I like to substitute another illness, and see how society would view treating people a similar way. Is it reasonable to take a long-term patient with any illness, accuse him of bad behavior based on one lab test, and discharge that person without a chance to prove his innnocence? Of course not. I think you are doing the right thing by getting your own test; you could send a letter to the director with the results, appealing their decision– but that doesn’t guarantee that they will do the right thing. I have another idea that I’ll email privately as well.

  22. The clinic in *** WI is terrible!!! It is very expensive for such a cheaply manufactured drug. Also the ***clinic will continue to give you higher and higher doses with no questions asked. Most people I talk to are between 300-325ml a day. To me it seems like they want to get you on an extremely high dose then drop you for the smallest thing with no taper or any support and put you out to deal on your own practically setting you up to fail to buy street drugs to cope with the withdrawal. I’ve seen it over and over their actions should be criminal but because they have the upper hand they do as they please. Unfortunately they have turned a potentially helpful program into a constant fear of what’s going to happen at the clinic next time you go. It’s really sad!!!!

    • I appreciate the comments, but I am not printing the specific clinic name– because I do not consider it fair for someone with anonymity to insult someone without anonymity. The important thing, anyway, is not the name of the clinic, but type of practice that the writer describes. I see no value in pushing tolerance higher, just to create greater withdrawal on the way down. I can only assume that there is more to the clinic’s plan than what the writer describes; perhaps somebody with experience in methadone maintenance will weigh in?

  23. I am in Indianapolis,In. I was readin ur commets on mmt,here u got to pay every day if u dont have the money u dont get dose. They dont play here. I was in the Clinic for a little over a year left came back try to leave and see if I can do it on my own. When I went to go back they would not let me. I didnt owe them money or anything,they said if it didnt work the two times,its not goin to work now,and did not take me in. There is only two mmt places here.I went to the other place,was there for six months and some one called said I was in the parkin lot saleing,I wasnt.I had them check me they found nothing.Two weeks later they had an mandatory meeting and kick me out that day.Now I have nowhere to go. Thanks for reading

  24. Indianapolis,In. At one place its $14.50 a day the other place it is $65 dollars a week and both if u dont have the money that day u dont get dose no matter how long u been there,how good ur doing or anything.But not all are the same. Im glad that there are some places that knows that its an illness not a want to. That treats people normal and not like drug users or dealers. I have been lookin for treatment for bout 8 months and still lookin,its hard out there its like they get on this then if u dont do what they want ur out. They wave it in front of ur face,u better obay or u dont get this

    • I am having a hell of a time finding a pain doctor I fell on my back in agu I have bulging disc I broke my tiba none of the 2nd or 3rd doctors told me I have. Been living in such horrable pain since I guess now I have to go to a Nuro surgen but I’ve been on every meds that the Nuro I was seeing gave me and I just want help with the pain and find out am I going to have drop root for the rest of my life needles to say they just keep giveimg up on me cause they don’t know what’s going on I’m from Indiana if u have a great pain doc please please let me know ……thanks

      • I also have
        2 children who r suffering and a husbend if u could just tell about a good doc I got on here because he was giving methadone and sroped please help

  25. I live in West Virginia and go to a clinic too. It is $14 a day. This is the second time I have been a patient at the clinic. The first time I was addicted to herion and wanted to get clean. I have not done herion since I left the program in 2006. I went back in 2012 because I could not find a doctor to treat me with pain medication for a chronic back problem because I am an addict. The clinic doctor took me back only because I was a prior patient but would prefer that I be treated by a pain management doctor. So what is a person to do? I need the methadone to subdue the pain in my back but I can not get treatment from a opain doctor because I am an addict. I feel like I am being told that I do not deserve treatment for pain because I am an addict. Any one have any sugestions on treatment options?

  26. 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.

  27. 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.

  28. 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?!


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