Thursday, April 03, 2008


"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.


At 9:11 PM, Blogger Remember JP said...

After ten years they should get help to get off not cold turkey but detox. We can not countine to hide the deaths methadone has caused.
Heather bell

At 10:02 PM, Anonymous Anonymous said...

Should high blood pressure patients be "detoxed" off their meds after ten years? Diabetics? Cardiac patients? Why would you force someone off a medication that is helping them to live a normal life by supplementing permanently disordered brain chemistry? This is a chronic condition--some people can do well after a few years on MMT by tapering off if their endorphin system gradually takes over again--but this does not happen with everyone--for many, the damage is permanent. Methadone replaces the missing endorphins without causing a high. If the patient feels nothing but misery and cravings while off methadone--no matter how long they try to wait it out--and are doing great ON methadone, why should they then be forced off medication?

At 10:12 PM, Anonymous Anonymous said...

Methadone and these clinics were intended to assist the addicted with a crutch to become drug free, they were not intended to purposely keep someone on a highly addictive narcotic for the rest of their life, that is not living "clean". Now would be a good time to slowly tapper your dose and during that time address the underlying issues that may be associated with your addiction. Success from addiction is not just staying off drugs or substituting your addiction with a replacemnet drug.

Mothers Against Medical Abuse. Org

At 10:24 PM, Anonymous Anonymous said...

Insulin, BP medications are not Schedule II narcotics that are highly addictive, to compare that association is ridiculous. The endorphin issue is controversial and in most all cases temporary. Addicts need to stop using it as an excuse to continue using. There is a place for the use of Methadone on a minimal scale but even the addicts are wanting to abuse this drug and take away what it was intended for. The more people encourage every one to climb on board and take this drug for the rest of their life the greater risk there is for society to say "No", this practice is no longer acceptable. All in all an addict must take responsibility for recovery and not depend on a drug forever, and YES it is very possible, not an easy road but very possible, many have done it. Even people with many, many years of very hard core heroin addiction have become completely drug free and they will tell it was not easy but can be done. Staying on Methadone is still an opiate addiction, bottom line.

Mothers Against Medical Abuse. Org

At 2:02 PM, Anonymous Anonymous said...

GETTING FACTS STRAIGHT: Death has never ever been attributed to the consequences of remaining on methadone for a long period of time. That is never, ever! On the other hand, we know that terminating addiction treatment, whether that is treatment with methadone or therapeutic communities or any other form of therapy, is followed in a very high proportion of former patients with relapse and all that goes with resumption of drug taking, including death.

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At 5:13 AM, Blogger Mord_Mckee said...

This happened to me. I was on methadone but couldnt stop taking heroin. After testing positive over and over I was forced out. I was taking 40mgs at the time. It pissed me off so bad that i went and got a bunch of downers and some opium pills (tramal 200) and did detox at home with help from family.

Ever since I havent taken any heroin or methadone or subutex. Its benn 3 and half months may not seem like alot but I havent been that long without heroin since i was 14 years old.

So what seemed terrible was in fact (i hope) a blessing. Time will tell. Never the less at the time I though it was terribly unfair and inhumane

At 4:56 AM, Anonymous Anonymous said...

Yet again we hear from the experts & then from the opinionated. Grief does not make one an authority on anything other than grief. Have you ever heard the expression "I can stand in a garage all day but that doesn't make me a car?" Furthermore, it is not healthy to prevent oneself from progressing through the grief process. When blame is stopped healing & acceptance can begin.
Please don't judge me until you have walked in my shoes. Those who have medical degrees like Dr. Newman & all of the researchers who have done study after study conclude that Methadone is safe & effective in the treatment of addiction. Yet, whenever statistics are requested from any anti-methadone group they dodge the subject. Give one study, one qualitative, reproducible, scientific study that proves long term therapy is physically or psychologically harmful. Until then I would suggest grief counseling.
Oh, BTW...there are many articles that support MMT....For example...
From JAMA (Journal of the American Medical Association)did a study of this exact topic called Methadone Maintenance vs 180-Day Psychosocially Enriched Detoxification for Treatment of Opioid Dependence
Context:Despite evidence that methadone maintenance treatment (MMT) is effective for opioid dependence, it remains a controversial therapy because of its indefinite provision of a dependence-producing medication.
Design Randomized controlled trial conducted from May 1995 to April 1999.

The results were as follows...
Conclusions:Our results confirm the usefulness of MMT in reducing heroin use and HIV risk behaviors.
I could site more but it would be a waste of time because I doubt if I will get a legitimate response to this.

At 11:20 AM, Blogger Unknown said...

I would go to another clinic. I have 4 years clean and don't plan on getting off. I did it before and it did not work.


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