Tuesday, October 10, 2006

METHADONE MAINTENANCE: the non-pharmacological impediments to functioning

A highly respected long-term (30-plus years) researcher in the field of addiction and its treatment with methadone, Dr. Philip Appel, made the following observation recently in email correspondence with colleagues:

"Having been in the addiction treatment-health policy research area for quite some time, my view is that the principal impediments to the functioning of methadone maintenance patients have little if anything to do with subtle neuropsychological deficits, if they exist. Mostly, they have to do with poverty and destitution, punitive welfare reform mandates, employment discrimination, tight-fisted treatment financing, over-regulation of MMT clinics and ubiquitous anti-methadone prejudice, not only among the public, major institutions, and employers, but also, among addiction treatment and research professionals."

20 Comments:

At 2:11 PM, Anonymous Kristan Hilchey said...

WOW!

As a patient and an advocate the one question I have always wanted to ask of regulators in America has always been:

How can you EVER expect a treatment to succeed as it has been proposed it can--if you never fully utilize the treatment the way it SHOWN to be the most effective?"

Which was brought up in another way by Dr.Appel in his quote. Incrediably, despite dose caps, tight regulation, undignified treatment and refusal of the majority of MMT clinics to give BEST PRACTICES TREATMENT, MMT still works better than any other method of opioid dependancy treatment!

Imagine the miracles that could happen IF ONLY our government actually allowed/FORCED methadone treatment to be given in the way that has been proven is the most effective?

 
At 9:04 PM, Blogger RGNewman, MD said...

hello Kristan - you are 100% correct in your observation. I have always tried to point out the incredible motivation of those who seek and remain in methadone
"programs" that are punitive, biased against the very treatment they provide, refuse adequate dosages, etc. (happily there are some exceptions, but . . . ._ Those patients deserve the
"miracles" that could be associated with rational, compassionate care.

 
At 10:07 AM, Anonymous JAdler said...

I have been on Methadone for many years. I am currently having dental surg, and feel that if I tell the md, I am opening a can of worms. My question is that I have not used drugs in 3 years, do I have to tell the dentist that I am on Methodone? I am having major dental work done and feel that he will not use anything for pain while he is pulling my teeth. He will be using Valium and novocaine
What will happen if I don't say anything to the dentist.

Thank You Jim

 
At 11:49 PM, Anonymous Anonymous said...

Probably nothing will happen if you don't say anything about being on methadone but if you DO divulge this fact it is quite likely that you will leave with nothing for pain and should you be unfortunate enough to have any post op complications like dry socket you are likely to be brushed off and put off as well.How very unfortunate that patients on methadone are most often looked on with disgust and labeled as "of course s/he is a junkie looking for more drugs"when they suffer any complications and treated as though we deserve to suffer.As one MD said to me "Its time to pay the piper"

 
At 4:28 AM, Anonymous someone that was helped said...

I live on Vancouver Island in B.C Canada and we have a great clinic here that has provided excellent help for people needing help with getting off of herion, they have very helpful Doctors, Counselors and of course staff that will help wih pretty much anything that you need to get your life back on track. There needs to be more places for people to get help like this and more people that are caring and understanding as well,everyone needs help with something and people should'nt treat us like shit because we had a drug. Ive been on methadone for about 4yrs and the program and people at the Clinic have been wonderful the methadone program does work and help, i recamend it to others needing and looking for help. It worked and still is working for me. The clinic info is : The Outreach Clinic Ltd. 2004 Fernwood road Victoria, B.C V8T 2y9 Phone:(250) 480-1232 Fax:(250) 480-1231

 
At 7:52 PM, Anonymous Robert N. said...

I am a patient at the largest prescribing MMT Programs (20,000+ patients) in the USA. I am also a gainfully employed individual of one of the largest Financial Institutions in the world (400,000+employees). A proud husband of 15 years, and father of 2 primary-school age children didn't stop my take-home schedule from being reduced from reporting to the 'clinic' 1 time a week to 5 times a week when in the course of a supposedly confidential meeting with the Clinic Director and the Senior RN I divulged (Much to my later disdain) that someone had made an anonymous report to Children's Services that I 'attempted to kicked' my daughter. Yes, I provided my pediatrician's report on my child's well being and her signed statement as a physician and professor at Cornell New York Hospital that my child showed no evidence of abuse. Yes, I provided my Pastor's recommendation that he knew me for over 25 years and 8 years as a father and never observed any inappropriate behavior by me towards my children. And Yes, My wife and I have custody of our children. Yet, I am nothing but a liability to the legal department of this very large organization (BIMMTP)which has decided 'when in doubt, yank 'em out' (I am referring to my 'privilidges' as a patient) Oh, and did I say that my wife and I home-schooled our children as well?

I have been told that I need evidentiary documentation from Family court that describes the status of my case. I have offered to sign releases to my attorney who has all court documentation to communicate with BIMMTP personnel. No, that will not suffice. Because, my lawyer is not in possession of a document that will satisfy the needs of BIMMTP, who have interpreted Family court involvement with Criminality, and Hence I am in violation of on of the States' 8 mandatory steps for a reduced pick-up schedule.

I have been a patient, not a client as I am of my lawyer, since 1992 of this medical establishment. I have succeeded in life, liberty, and the pursuit of happiness against astronomical odds -- all because of a life saving medication that I view as no different than the many SSRI's who have made Manic Depressives able to lead normal functioning lives. But the medical jurisdictional powers in this country view Methadone as a great risk, a risk so great that this wonder drug, which is not even on the 10 most illegally diverted prescribed medications in this country, that it's use and spread must be curtailed at all costs to the individual truly in need of life-saving treatment.

Non-pharmacological impediments? Yes, if I had been asked 7 weeks ago I would have stated that the treatment climate had changed substantially for the better with the federal jurisdictional transfer of the operating and licensing of methadone clinics a few years ago...But my 1st-hand knowledge has changed that.

Sincerely,
Robert N.

 
At 6:00 PM, Blogger RGNewman, MD said...

Dear Robert n. - I was greatly distressed to read your blog posting of your treatment at BIMMTP (which I gather is Beth Israel,). Stories like this are sadly quite common everywhere, but as someone associated with the beth israel program almost since its inception I am particularly upset to think this sort of thing might happen here.

So . .. my question to you is how can I be helpful? We've experienced in the past problems where I or someone working with me has contacted the central administration of BI MMTP and they've generally responded quickly and the outcome has usually been positive. But it's your call. By the way, there is a patient advocate office at Beth Israel for the MMTP - have you contacted them? Or asked to meet personally with the supervisor of your clinic? Or contacted the administration in central office and asked what the procedure is to appeal a decision at the clinic level?

Again, if you feel you want me to try to assist, let me know. Feel free to use this email address rather than correspond through the blog. Good luck - and hope you can enjoy this thanksgiving day holiday. Robert Newman

 
At 8:39 PM, Anonymous Anonymous said...

i am taking a small dose of methodone. 10 mg. a day. I need dental work done and it will involve iv sedation. My question is if i discontinue methodone for 2 days will that which is stored in my tissue inertact with the iv sedation. I am not telling dr. i am on methodone because he will not give me pain meds
Thank you

 
At 9:23 AM, Blogger RGNewman, MD said...

In Response to the last anonomous comment regarding dental visit:
It's too bad that you feel you can't tell your doctor about the methadone, but you may well be right that it could be the cause of denial of pain meds. Sad, but possible. Since you've apparently been taking 10 mg methadone for a while, there should be no interaction even if you had methadone on same day as the sedation, but surely after 2 days there would be little if any chance of the slightest problem. As always, answers to questions such as these can only be answered most authoritatively by a patient's own physician (or dentist). Certainly the physician or program providing the methadone 10 mg per day should be a good source of information, and we urge you to approach him/them.

 
At 6:58 PM, Anonymous Anonymous said...

I also have problem w/ dental care & methadone. I was at the dentist today to have teeth pulled. Nurse asked me if I take meds I said no. However I do take 150 mg every day. Was afraid to tell also for fear that they would not give me pain meds following procedure. The dentist gave me two injections of novacain. Shortly after my heart started beating so fast I felt like I was going to have a heart attack. Consequently, the dentist was unable to pull tooth. Was there some kind of drug interaction or was I experiencing a panic attack? Would there be an interaction if I were sedated instead before having teeth pulled?

 
At 7:15 PM, Blogger RGNewman, MD said...

To The last Entry...

We are not aware of any pharmacological effect of methadone that would explain the very rapid heart beat. We strongly urge, though, that you discuss this experience with the doctor in the methadone clinic. Good luck...

 
At 12:26 PM, Blogger sonyamariesavoy said...

always tell a doctor what kind of medicine you are taking if u gonna have any!!!!! kind of surgery !!
you could die!!!!

methadone stay in your liver 5 to 6 day after you quit taking it.
your methadone doctor need to talk
with your dentist too so they can
come up with best treatment for you..... methadone is a powerful drug....sonyamariesavoy

 
At 6:10 PM, Anonymous Anonymous said...

You've got to tell a doc if he is going to sedate you. Too dangerous to take the chance. Ask your councelor if they can recommend a Dentist they know understands the needs of a MMT client. Don't risk your life like that. I understand why you are reluctant but it's not worth dying over.

 
At 11:20 PM, Blogger Lorraine said...

im on to high of meth dose its 150 mg i been clean from drugs. exspect my meth havent gottin high since 2003 just methadone i take ad all my teeth are bad and need to cum out but i was told through a dentist that being im on a high dose of methadone i can die being put out to sleep to get upper n lower instraction done they all have tocum out what can i do if i go to a nother dentist n start fresh i go to my pg once a week n get pick up for the week if i dont take my meth that day and go to the dentist what are my chances please help i want my mouth done and want to look good from my email address email me with information to lorraineorengo69@aol.com... latinamami69

 
At 6:25 PM, Anonymous Anonymous said...

is there any other methadone clinics in victoria; my boyfriend and i are moving from london ontario and we have been looking places to go. is the ferndale clinic good

 
At 12:55 AM, Anonymous Anonymous said...

I also attend BI MMTP and I hope that someone here can help me . I have been on methadone for almost 10 years . I got off for two years and had to come back in 2009. I recently had a problem with receiving take home. I have been sober for almost 3 years and I am going to clinic 3 times a week . I contacted the beth is real patient advocate and I must say I CANT BELIEVE HOW THEY TREAT PEOPLE . It saddens me to think I am a patient and yet I am treated like a parolee …please I am contacting all of the news media and hopefully one day someone will listen !!!!

 
At 3:31 PM, Blogger CVBNH said...

How can I email you doctor Newman ??

 
At 3:32 PM, Blogger CVBNH said...

How can I email you Dr. Newman ??

 
At 10:58 AM, Anonymous Anonymous said...

As far as Methadone and rapid heart beat after novacaine injections.....
I also take methadone 120mg/day and I had the same response to novacaine injections. When I inquired about this-I was told that most novacaines used contain epinephrin-which is what causes the palpitations, but is also what makes the effects of the novacaine last so you don't need so many shots of it. Most dental offices also have novacaine available that does not contain the epinephrin, so just ask for novicaine that does not contain epinephrine and you will not have heart palpitations at all! Take Care!

 
At 4:41 PM, Anonymous Anonymous said...

Is it safe to b sedated while taken methadone

 

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