Counselor Magazine - Methadone and the Anti-medication Bias in Addiction Treatment

Wait a minute. This article says that therapeutic doses are between 80 and 120 mg/day. Those numbers are considered part of the past of most of the people I have talked to in mmt here. But I sure wish that would have been the case.

I don't know of anyone at my clinic now, or the other one I attended before that is on a dose over 110.
I was actually surprised when I started reading about how high some doses were, honestly....

No kidding? No one over 110? That's amazing to me.

My wife had NEVER tried heroin, and had only been on opiates for 8 months. Her doc was benzos. And she was ENCOURAGED to increase to 199.

Yes, when I first started in Canada..my highest dose was 80. The only time I got over that was when I got pregnant.
I know that most weren't over 110 because when they'd drink their drink for the day, they threw their bottles into the wastepaper trash and you could see the dosages on the bottles, I would happen to look down at them (and peruse) while I was waiting for my takehomes to be made up.
To be honest, most of the time, I would say the range that I saw was from 10 to 70.
Also, they would sometimes leave the list out of the dosages they were making up that day, and I could read down the list. Honestly, nobody over 110...and very few over 100.

They do the same thing at my wife's clinic. And I'm not speaking from what I've personally seen, but I do believe my wife. It's not that way at her clinic. Even the dr. here in my town that I talked on the phone with asked me "Who is putting these people on such high doses?" Or something like that.

Nobody over 110 is unreal. I only met one person at her clinic who made that mark. He made them stop him at 70. And he ended up jumping of because they wouldn't detox him like he wanted. He called my wife yesterday for the first time in about six months to tell her how hard it was gonna be.

MAT:

I know that not all clinics are the same. I have read about people who have the pleasure of being treated at clinics that are different than the one here. I know of only one other clinic that has ever been in this area, and it was closed for "incompetance." You know as well as I do, that my experience has definately effected the way that I view clinics, and you're not the first person on here to say that they did not like the b.s. at clinics, and some who have had similar experiences as ours in different places. No disrespect intended, but whether it is the norm or not is truly not what I'm concerned with, but moreso the fact that it is happening. I feel that if even one clinic is being ran as this one, then that is one too many. Like I have said before, I am happy that things have turned out the right way for you, and wish you continued success. I just hope no one ever has an experience similar to my wife's anywhere ever again. I truly feel that she was just a few mg/day away from death.

mike1975 wrote:

MAT:
I know that not all clinics are the same. I have read about people who have the pleasure of being treated at clinics that are different than the one here. I know of only one other clinic that has ever been in this area, and it was closed for "incompetance." You know as well as I do, that my experience has definately effected the way that I view clinics, and you're not the first person on here to say that they did not like the b.s. at clinics, and some who have had similar experiences as ours in different places. No disrespect intended, but whether it is the norm or not is truly not what I'm concerned with, but moreso the fact that it is happening. I feel that if even one clinic is being ran as this one, then that is one too many. Like I have said before, I am happy that things have turned out the right way for you, and wish you continued success. I just hope no one ever has an experience similar to my wife's anywhere ever again. I truly feel that she was just a few mg/day away from death.

Well I'm a bit confused just where you stand on this issue; you sound sensible and claim to support harm reduction, yet at the same time seem to support getting rid of methadone altogether, or at least support and find the closest comradery with those that do.

As I've said before, I respect you as a person, and as an individual and don't doubt that were I to meet you in person we'd get along fine because I get the sense that I like you, but you don't really know a whole lot about this subject, have less experience in the matter than most I discuss it with yet are quick to criticize posters you disagree with and make accusatory remarks (about "agendas" and "informational sources" for example) that are totally unfounded and unfair. You make an effort to get along in spite of all this, and I respect and appreciate that, but wish you'd look at the "bigger picture" and stop taking such an anti methadone stance. I've seen posts of yours where you've said things that were open minded and allowed for the idea that methadone may be good for some as if you supported the freedom of choice, then turn right around and post something that sounds almost hateful just because someone supported MMT.

I'm not sure where you stand on the issue half the time. It's obvious you've "chosen" a side and it's "anti-methadone" ... but you are the only one of anti-methadone posters that has the occasional post that really sounds as if you're trying to look at it with an open mind. I have to say you keep me guessing. You ever think of going into politics?(LOL)

MAT:

It's not so much anti-methadone, as it is anti-clinic and dr.s who have no business prescribing it. Here's how I see it:
Methadone is a drug. It will do what it does. In the right setting, and under the right supervision and circumstances, it has it's place. And outside of those circumstances, I am extremely of the belief that it should not be allowed as it is today. That's not only based upon my experience with the clinic here, but what I have read. You can't look at what SAMHSA reposted to the DEA in the last decade and tell me that methadone is not by far the most lethal opiate out there, when given by someone who is not educated in the dangers of methadone. All drugs are dangerous, but if you look at how many methadone scripts are wrote in a year as opposed to how many deaths are attributed to methadone each year, then you will see that there are far more scripts written of other opiates with far less deaths attributed to them. That does not mean that methadone has an evil intent, it's just a drug. It means to me that many dr.s are prescribing it without first knowing when to do so. I had no opinion on methadone whatsoever three years ago, but, as you have stated before, I have the ability to think for myself. And have. I have found that most of the pamphlets and information given out at the clinic here is complete propaganda. Now every time I hear or see the words, "MMT has been around for 40 years" I want to blow my lid. Because it has been around for 40 years does in no way mean that it is perfect, and is not a reason to accept that there is nothing to be changed anywhere. As I've stated before, if I put my left shoe on my right foot every day for the next 40 years, that does not mean that I am doing the best thing. There just might be something to better that situation. I have asked for actual information from a clinic dr. on what he was basing his reccomendations on, and been told "I'm basing it on the way things have been done for the last 40 years." That does nothing for me. Maybe it works for you, but not me. I want to see information where it has been tested and shown to be the best way and that attempting any other way would not be advisable. I replied to him "Where are the studies that back up what you are saying?" And he replied "I'm not sure there have been any, but it would be something worth looking into." Although he didn't look into it, I did. If I were a dr. I wouldn't base my practice on a pamphlet put out by anyone who was already a proponent of a drug, but would take other accounts into consideration also. It's no different than any dr. who signs a contract with a pharmaceutical company to prescribe only their brand, and in return gets a free cruise. I have no compassion for a clinic that does not take the best interest of patients and place them above a paycheck, nor any dr. who does the same. That's not just here, but anywhere. I do believe that methadone is being prescribed too often by dr.s who have no business prescribing it at all, and that until something changes, people will continue to die from overdose due to methadone being a factor.
Oh, and I got a kick out of the politics statement, and could ask you the same question.

Oh, one more thing. I don't believe an LPN or counsellor should be writing prescriptions either. I left that out.

mike1975 wrote:

MAT:
It's not so much anti-methadone, as it is anti-clinic and dr.s who have no business prescribing it. Here's how I see it:
Methadone is a drug. It will do what it does. In the right setting, and under the right supervision and circumstances, it has it's place. And outside of those circumstances, I am extremely of the belief that it should not be allowed as it is today. That's not only based upon my experience with the clinic here, but what I have read. You can't look at what SAMHSA reposted to the DEA in the last decade and tell me that methadone is not by far the most lethal opiate out there, when given by someone who is not educated in the dangers of methadone. All drugs are dangerous, but if you look at how many methadone scripts are wrote in a year as opposed to how many deaths are attributed to methadone each year, then you will see that there are far more scripts written of other opiates with far less deaths attributed to them. That does not mean that methadone has an evil intent, it's just a drug. It means to me that many dr.s are prescribing it without first knowing when to do so. I had no opinion on methadone whatsoever three years ago, but, as you have stated before, I have the ability to think for myself. And have. I have found that most of the pamphlets and information given out at the clinic here is complete propaganda. Now every time I hear or see the words, "MMT has been around for 40 years" I want to blow my lid. Because it has been around for 40 years does in no way mean that it is perfect, and is not a reason to accept that there is nothing to be changed anywhere. As I've stated before, if I put my left shoe on my right foot every day for the next 40 years, that does not mean that I am doing the best thing. There just might be something to better that situation. I have asked for actual information from a clinic dr. on what he was basing his reccomendations on, and been told "I'm basing it on the way things have been done for the last 40 years." That does nothing for me. Maybe it works for you, but not me. I want to see information where it has been tested and shown to be the best way and that attempting any other way would not be advisable. I replied to him "Where are the studies that back up what you are saying?" And he replied "I'm not sure there have been any, but it would be something worth looking into." Although he didn't look into it, I did. If I were a dr. I wouldn't base my practice on a pamphlet put out by anyone who was already a proponent of a drug, but would take other accounts into consideration also. It's no different than any dr. who signs a contract with a pharmaceutical company to prescribe only their brand, and in return gets a free cruise. I have no compassion for a clinic that does not take the best interest of patients and place them above a paycheck, nor any dr. who does the same. That's not just here, but anywhere. I do believe that methadone is being prescribed too often by dr.s who have no business prescribing it at all, and that until something changes, people will continue to die from overdose due to methadone being a factor.
Oh, and I got a kick out of the politics statement, and could ask you the same question.

Mike,
That was a wonderful post. I am learning more everyday about methadone, but don't feel I am educated enough about it to debate in the intellectual manner as you do. So much of what you posted is what I myself would like to say in response when confronted. It is heartwarming to call you friend!
(And, if you ever do go into politics remember me;})
Love,
Pam

sliverone wrote:

<quoted text>
Mike,
That was a wonderful post. I am learning more everyday about methadone, but don't feel I am educated enough about it to debate in the intellectual manner as you do. So much of what you posted is what I myself would like to say in response when confronted. It is heartwarming to call you friend!
(And, if you ever do go into politics remember me;})
Love,
Pam

Thank you very much. But I feel I am probably one of the least educated people in the regular group who post here where methadone is concerned, for I have never taken any methadone in my life. The state of affairs concerning prescription medicine today is terrible. It's all my opinion, but it's how I feel. That doesn't mean anyone has to take it to heart, but I do feel strongly about it and I want to make sure that both sides are brought out in the open, just as much as anyone else. That didn't happen for a long time, just look at the video MAT posted earlier and when it was made. I'm referring to what people on the street said when asked about methadone. Those answers would be different today. It's not a secret that is only known to addicts anymore.

Oh, As far as politics, I'm NOWHERE NEAR the thief it takes to be in politics in this state...lol

mike1975 wrote:

No kidding? No one over 110? That's amazing to me.

==========

Why should the dose amount make a hill of beans to anyone? It may take 2 mgs. for Suzie Q to feel normal and stable. But, it may take 275 mgs. for John Doe to feel normal and stable.

It's like any other medication. It must be monitored and titrated up or down to stabilize patients.

Sky~

sky wrote:

<quoted text>
==========
Why should the dose amount make a hill of beans to anyone? It may take 2 mgs. for Suzie Q to feel normal and stable. But, it may take 275 mgs. for John Doe to feel normal and stable.
It's like any other medication. It must be monitored and titrated up or down to stabilize patients.
Sky~

Because Sky, when the fact that one clinic has no one over a certain dose can be compared to a clinic that has everyone over that very same dose who has been there over 2 months, It SHOULD throw up a red flag to an "accredidation" group about the second clinic, who is jumping up the doses. And don't try to tell me anything about well, maybe everyone in one clinic could be more tolerant than everyone in the other. When things are this different, then the reason goes from differences in the patients to differences in the clinics. There's nothing more to say.

The dose amount is extremely important when prescribing something properly.

Oh I agree wholeheartedly with you on that one Sky.

mike1975 wrote:

MAT:
It's not so much anti-methadone, as it is anti-clinic and dr.s who have no business prescribing it. Here's how I see it:
Methadone is a drug. It will do what it does. In the right setting, and under the right supervision and circumstances, it has it's place. And outside of those circumstances, I am extremely of the belief that it should not be allowed as it is today. That's not only based upon my experience with the clinic here, but what I have read. You can't look at what SAMHSA reposted to the DEA in the last decade and tell me that methadone is not by far the most lethal opiate out there, when given by someone who is not educated in the dangers of methadone. All drugs are dangerous, but if you look at how many methadone scripts are wrote in a year as opposed to how many deaths are attributed to methadone each year, then you will see that there are far more scripts written of other opiates with far less deaths attributed to them. That does not mean that methadone has an evil intent, it's just a drug. It means to me that many dr.s are prescribing it without first knowing when to do so. I had no opinion on methadone whatsoever three years ago, but, as you have stated before, I have the ability to think for myself. And have. I have found that most of the pamphlets and information given out at the clinic here is complete propaganda. Now every time I hear or see the words, "MMT has been around for 40 years" I want to blow my lid. Because it has been around for 40 years does in no way mean that it is perfect, and is not a reason to accept that there is nothing to be changed anywhere. As I've stated before, if I put my left shoe on my right foot every day for the next 40 years, that does not mean that I am doing the best thing. There just might be something to better that situation. I have asked for actual information from a clinic dr. on what he was basing his reccomendations on, and been told "I'm basing it on the way things have been done for the last 40 years." That does nothing for me. Maybe it works for you, but not me. I want to see information where it has been tested and shown to be the best way and that attempting any other way would not be advisable. I replied to him "Where are the studies that back up what you are saying?" And he replied "I'm not sure there have been any, but it would be something worth looking into." Although he didn't look into it, I did. If I were a dr. I wouldn't base my practice on a pamphlet put out by anyone who was already a proponent of a drug, but would take other accounts into consideration also. It's no different than any dr. who signs a contract with a pharmaceutical company to prescribe only their brand, and in return gets a free cruise. I have no compassion for a clinic that does not take the best interest of patients and place them above a paycheck, nor any dr. who does the same. That's not just here, but anywhere. I do believe that methadone is being prescribed too often by dr.s who have no business prescribing it at all, and that until something changes, people will continue to die from overdose due to methadone being a factor.
Oh, and I got a kick out of the politics statement, and could ask you the same question.

Brilliant Post Lil Bush

Maximilian wrote:

<quoted text>Brilliant Post Lil Bush

Thank you, Mr. Editor. And once again, nice duds.

MATsavesLIVES wrote:

<quoted text>
Exactly Sky!!- This is what adequate dosing is all about. You have to keep in mind that Mike has never experienced opiate addiction, and knows nothing of the subject except for what he's learned from his wife and the one horrid clinic she attends. I frankly don't blame him for having the terrible opinion of it he does, I just don't see what qualifies him as expert or why anyone would think prohibition/regulation is going to solve any problems. It never has and it never will. How many deaths will it take before this country wakes up.

That's a cool dig at me there, MAT. Let me start by saying that I have not been alive as long as you have been in and out of mmt. And it's been over 10 years since I've had to have a "roommate" to help pay bills. I have not claimed to be any expert of anything, and don't understand why you keep trying to make people think that I have. I post my opinion just as you do, and much of my opinion is based upon facts just as yours. I'm sorry you don't agree with my posts to you or anyone else, but that happens. We have a difference of opinion about regulations or prohibition because since the advent of methadone into pain management, deaths have surpassed ALL other narcotics except for cocaine. And I am absolutely certain also that the clinic here is not the only one in the country that is ran this way. The company that owns that clinic also owns 18 more across the country. As for prohibition, do you think people should be allowed to get what they want, when they want? This has worked out so well with alcohol..... And alcohol is nowhere near the same class of substance as what we discuss. Think of alcohol times 50. Please reread the post in reply to Sky where I mentioned that there is no way one clinic can have their minimum maintenance dose higher than another's maximum maintenance dose and this be considered a safe accepted practice. There is no hiding that.