Wednesday, February 01, 2006

“For the first time, help comes from the doctor’s office, not the methadone clinic.”

An article on Buprenorphine appeared January 24, 2006, in USA Today, with the above byline.

The availability of opiate-agonist maintenance treatment through prescription by office-based practitioners is a welcome and long-overdue development, even though the rationale for limiting the prescription-writing authority exclusively to Buprenorphine is not clear. What is distressing, however, is the apparent equanimity with which even the most knowledgeable experts in the field view the shortcomings of the government-designed and government-controlled system that has constrained methadone maintenance for the past four decades. That system is summarized by the news article in the following quote: "People who would never come to a methadone clinic, because it is both degrading and stigmatized, will come to a private physician’s office.”

This highly pejorative assessment of methadone maintenance facilities undoubtedly has some basis in fact. For sure, it reflects the perception of most Americans – and it would appear to be shared by Charles Schuster, to whom the quote is attributed. Schuster, however, is a former Director of the National Institute on Drug Abuse, and – along with virtually all of his colleagues in Government before, during or after his tenure – bears responsibility for the way in which methadone treatment is provided. What has he – and what have other leaders in the field of drug abuse treatment – done to lessen the degradation and stigmatization of “clinics”? Even now, as Schuster applauds the availability of Buprenorphine in private doctors’ offices, he seems to have zero concern over the roughly 200,000 patients who receive methadone under the only circumstances allowed by law.

The Government’s control over the facilities that offer methadone maintenance is absolute, and operating authority can be revoked for failure to adhere to any of the myriad rules, regulations and “standards” which apply. Why are degrading practices tolerated (in fact, many are required!)? What has Schuster done to lessen the stigma surrounding methadone treatment? What have other government, academic or clinic leaders in the field done? The most generous answer has to be, “Not enough!”


At 3:45 AM, Anonymous Anonymous said...

Congrats to you Doctor!

I wish there were more doctors that are sympathetic to the opiate addicts in this world.

More and more of the "referrals" that come into the methadone clinics now are from pharmaceutical drugs instead of heroin, in fact the vast majority! The governemnt HAS to provide relief for these people. Myself, I was prescribed methadone because of my intolerance to morphine and codeine, for an accident ten years ago.

I run a medium size buisness that employs just over 100 people. I go to a doctors office to get my methadone refilled once a month. This doctor is retiring in a month and he has referred me to several different pain doctors in the area, and every one of them has declined to take me on as a patient---JUST BECAUSE they do not prescribe methadone---so now, for the first time in over 10 yeas, I am looking at have to drive over 150 miles roundtrip every single day to a methadone clinc for my medication.

Is something wrong with this picture? You bet it is!

Please e-mail me at:

if you have any suggestions as to what I could possibly do.

Mark B.

At 10:56 PM, Blogger Melissa said...


I am not a Doctor but a fellow Methadone patient. I also had to drive a very far distance when I first started the program, and found out that if you have a hardship, such as driving a certain amount of miles each day (especially with gas prices nowadays) or if you have a child under the age of 5 years old, (and perhaps a few other circumstances) you can apply for "exceptions" which means you can get "take home" methadone, instead of coming in every day. I had to drive every day for about 2 months before I learned of the hardship take homes, and since then, I only have to go to the clinic once a week. I know it is still not the best solution, but it could help tremendously. Perhaps you already know about this option, but I figured it was worth mentioning.

Good luck,

At 8:07 PM, Anonymous Anonymous said...

they are, I mean doctors beginning august 23 of 2006 authorized to prescribe methadone to opioid treatment patients just thought i would inform you.

At 12:28 AM, Blogger Debbie said...

I have perused thru your information and have not found any information concerning private doctors prescribing methadone weekly from their office if there are such physicians I would greatly appreciate any and all information concernin such. Thank you in advasnce

At 10:22 AM, Anonymous Anonymous said...

To Mark B. my name is mike and after several years trying different opiates for intractable pain because of a back accident,my attending pain mgmt Dr. gives me the great news that I'm opiate intolerant(2002)and there is nothing he can do but take me off my pain pump and supplement me with a few pills of a daily dose of methadone 10mg the pain was still unbearable but this same MD told me there was nothing else he can do treaing me like a long lost adopted redhead stepchild (no offense I found a dr not too far from me who gave me a dilaudid pain pump to make the pain more bearable put it this way I can function a little bit better (it beats a blank)See if you can explore this option with a local pain mgt md GOOD LUCK,Mike Post a reply if you can!

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At 4:03 PM, Anonymous Methadone Detox said...

It may be a good idea to make sure you're patients are also in some kind of recovery program. It's so easy for a opiate addict fresh of the streets to abuse any opiate they get in their hands. Community and support are essential in the process of harm reduction.

At 12:42 AM, Anonymous Anonymous said...

Mark, i dont know where your from but ive been told just to get a referel from doc, i could get wrote tommorrow, methadone clinic patient of 12 yrs.

At 1:36 PM, Blogger Kelly said...

I second what Melissa said. My brother is undergoing a methadone detox for heroin. He also was rejected as a patient at many doctors offices and ended up having to get someone to drive him to a clinic everyday. Once he found out about only having to go in once a week for "take home" medicine, it has made his life a little bit easier.


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