METHADONE PATIENT RAISES IMPORTANT QUESTION:

QUESTION:
"I am a patient in a clinic in ______ state and have been for 6 plus years. This is the only clinic I have ever been to so I have nothing to compare it with, but things have gotten progressively worse. It seems as though now there is an UNWRITTEN rule that is being enforced clinic wide that is you are 10 years or more on the clinic, and doing well patients are being forced into a detox and being told that "You have reached a point where you cannot benefit from the clinic anymore". We are talking about people that have a good amount of clean time, have take homes and attend all appointments and groups.

There is definitely a trend of prodding, if not forcing clients that would like to stay on Methadone Long Term off of the clinic. I am wondering if this is a practice used by other clinics or perhaps new regulations causing this drastic change in policy? This isn't the first time this clinic has changed their philosophy regarding Methadone Maintenance Treatment. Over the past 3 years they have changed from the "Harm Reduction" model which allowed much more room for relapse, to the "total abstinence" model which is VERY strict regarding dirty urines. I know of dozens of clients kicked off over the past 2 years for frequent relapse... which for quite some time we were told that relapse was "part of the disease".... Is this change of philosophy common among other clinics of is the one I am going to just really bad? "

ANSWER from ICAAT: It's terrible! Bottom line: whatever the circumstances - duration of treatment, excellence of response, stability of work/home, age, etc etc etc - I believe there's no evidence anywhere that contradicts the assumption that relapse remains the rule rather than the exception when treatment is stopped. There is absolutely no justification for encouraging detox, and as for terminating people because they don't achieve complete "abstinence from drug use while in treatment" - the question that's critical is: what's the basis for concluding that the patient will be at less risk of illness, incarceration and death if I discontinue treatment rather than continue to try to afford help to her/him in the program.

The problem is: what can a patient do in fighting a policy/practice of the clinic which has the ultimate say in everything, including dosage, take-home "privileges," and even termination. Some suggestions: expressing concern to the accreditation body - either anonymously or with an assurance upfront that confidentiality will be assured. And/or express concern to state drug authority. Beyond that, I fear that a patient who fights a clinic will ultimately lose, one way or the other.

If the patient needs an advocate with accrediting or regulatory bodies, We are happy to assist in whatever way possible.