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  1. #1
    beckettmd is offline Member
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    Default Lions and Tigers and Methadone...OH MY!!!

    I need to get a consensus on something. In the past 2 weeks, I have had at least 20 phone calls from potential clients who want to get off methadone......They all share certain things in common: addicted to heroin or pain pills, switched to methadone, and have all had their doses increased methodically over the past few years. To me, these guys are no better off than the oxycontin or heroin addicts, except for the fact that the methadone is legal. However, many of these patients have coaddictions anyways. The last five were either still using heroin or cocaine or crystal meth. Personally, I am so dissappointed in the whole "Methadone Thing"....One place here in particular seems to specialize in getting people hooked on methadone so they can continue to bill for daily visits.....From what I am told, the mere mentioning of wanting to get off methadone automatically qualifies you for a big BUMP UP in your dose, so you will stay hooked...

    Get Off That Bus!!!!!! It's going nowhere!!!!
    Get Off That Bus!!!!!! It\'s going nowhere!!!!

  2. #2
    arlenewla is offline Senior Member
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    quote:Originally posted by beckettmd
    One place here in particular seems to specialize in getting people hooked on methadone so they can continue to bill for daily visits.....From what I am told, the mere mentioning of wanting to get off methadone automatically qualifies you for a big BUMP UP in your dose, so you will stay hooked...
    Love the name of your thread! Oh my is right.

    There's a lot of the Wizard in the Land of Methadonia. No doubt.

    I think there are a several things operating at MMT clinics that speak to your insightful question.

    The first is the belief that opioid addicts in general will never get and stay clean. That we lack the stamina to recover for any length of time.

    The second belief is that, once on Methadone, never off. Or very rarely. This is the starting premise.

    With that in mind, there's a built-in trap (for staff and *client* alike) that says, "Halt...you're entering unknown territory. You can't do this. You're going to relapse without the Methadone. The only reason you want to get off is because you're dose isn't *stable."

    By *stable* they mean not high enough. Soooo....upppp goes the dose. Doses are obscenely and routinely high these days. Also, you've got the Graying of Methadone Maintenance going on. People on it for so long, that chances diminish that they'll ever get off. High doses...long-term. Very difficult to face getting clean.

    And the word clean. Here's another blocker. Methadone clinics will undermine addicts who want off by telling them they're already clean...as long as they're not using any other substance other than Methadone. So, where's the incentive with this kind of corrupted vocabulary? It feeds the lie.

    Clinics will also make it as difficult as possible for addicts looking to taper to see the Clinic physician for a decrease order. The reverse is not true. Ask for an increase...instant happening. Decreases require a fight.

    Yeah...the Wizard is alive and well and living at Methadone Clinics. He's a fraud.

    Regards,
    Ar

    Arlene F.
    Exodus From MMT;12-25-02
    <center>THIS TOO SHALL PASS</center>

  3. #3
    beckettmd is offline Member
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    Arlene,

    Well said... I know that our beliefs differ regarding UROD, but I have taken on this patient who seems quite sncere in getting off. I switched him to roxicodone for two weeks, since it is impossible to rapidly detox from methadone. I also put him on antidepressants to stabilize him during the switch to roxy. I just detoxed him on Thursday morning. He was under anesthesia 4 hours and I kept him in my facility over night. He wasa doing much better yesterday except for some leg cramps which I prescribed arthrotec for. Clonidine patches are still on, but he will remove them tomorrow and start a 3 week taper of clonidine. I will let you know how he does........I was working with an insurance company here to get my procedure covered by them so people who really want it are not turned away by the cost......

    Get Off That Bus!!!!!! It's going nowhere!!!!

  4. #4
    arlenewla is offline Senior Member
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    quote:Originally posted by beckettmd
    I switched him to roxicodone for two weeks, since it is impossible to rapidly detox from methadone.

    I just detoxed him on Thursday morning.

    He was under anesthesia 4 hours and I kept him in my facility over night. He wasa doing much better yesterday except for some leg cramps which I prescribed arthrotec for. Clonidine patches are still on, but he will remove them tomorrow and start a 3 week taper of clonidine.

    I will let you know how he does........
    Yes....please do let me know. I'm quite interested.

    A couple of questions for you, Dr. Beckett.

    What was his dose of Methadone (and for how long) prior to transfer to Roxi?

    Also, how do you ascertain the amount of time someone has to be under anesthesia? What is the clinical marker in the detox procedure that would differentiate one patient needing 1 hour as opposed to this patient requiring 4 hours?

    And I guess, one last thing. You indicated that he felt better yesterday. My concern would be the long-lasting effects of Methadone and that 2 weeks of Roxi would only serve to buffer the WD from Methadone itself. So, is the UROD treating the detox/WD from Roxi or Methadone...or both?

    Hope I'm making sense....I know what I'm trying to say. Perhaps not writing it clearly.

    Regards,
    Ar

    Arlene F.
    Exodus From MMT;12-25-02
    <center>THIS TOO SHALL PASS</center>

  5. #5
    dennish is offline Junior Member
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    Hello - could not resist posting on this topic. I run an out patient detox in Florida - I mean a real "detox". I clarify because many proclaim to detox but frequently maintain. I recently visted the local methadone clinic for an open house and one of the first questions I asked was do they "detox" if requested. This is a chain of clinics and I asked a managing regoinal man this question and he quickly corrected me and said that they do not detox. If some one request to "step off", then over the course of a year or so they would be reduced a few MG a week. Or, they could get an "administrative" detox for continual pos drug screens that would take a month or so.

    They stress "harm reduction" as a basis to justify their "replacement" therapy. I agree with the MD here that there is a mentality that states that you are an opiate addict for life and that MMT is the only answer. This is insane. We see scared MMT patients who want to jump, but are paranoid of wd's. Today we can transition patients to short acting opiates for a brief period and then to subutex and have them clean in 4-8 weeks with relatively little overt wd symptoms.

    However - and this is a big however - little can last without an unrelenting program of recovery. Our clinic provides and requires group therapy and 12 step work during the entire detox. I know that anyone can be free from this insanity, because I was freed 7 years ago.

    PS - I also had MORE than a little help from my Lord and Savior....

    Psalm 31: 9-10
    “Have mercy on me, O Lord, for I am in trouble; my eye wastes away with grief. Yes, my soul and my body! For my
    life is spent with grief, and my years with sighing; my strength fails because of my iniquity, and my bones waste
    away.”

    It is amazing how when I reached out for help, it was there.

    I read frequently on this forum and figured it was about time to add something.

    Blessings,

    Dennis

  6. #6
    arlenewla is offline Senior Member
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    quote:Originally posted by dennish
    he quickly corrected me and said that they do not detox.

    They stress "harm reduction" as a basis to justify their "replacement" therapy.
    Good to see Dennis!:)

    Absolutely right.

    They don't *detox*. The reason is that for those in the MMT community (MAT)....they word detox is equated to ridding oneself of a toxin. They do not consider Methadone a toxin; ergo....no detox. The switch up in the vernacular, for them, is taper.

    Nor do they see as MMT *clients* as addicted to Methadone. The word used is dependent.

    The initial concept of *harm reduction* was, I suspect, a decent one. Using MMT as a [u]short-term </u> bridge from active heroin addiction to the transition to sobriety. The harm reduction of sharing dirty needles....certainly when AIDS was first discovered.

    Now, however, it's a whole another thing. Its about a life-time of *harm reduction*. Problem is that the very harm reduction produces more harm than good the longer one is on.

    The whole vocabulary is corrupted and bastardized.

    Arlene F.
    Exodus From MMT;12-25-02
    <center>THIS TOO SHALL PASS</center>

  7. #7
    sam bailey is offline Senior Member
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    Hi Dr. Beckett,

    The subject of Methadone and, in particular, Methadone Maintenance, has been a terrible, intensely aggravating issue to me for years. While there is, I confess, more than a little irony in the fact that I once believed that Methadone had (ye gad, I shudder to type this!) actually saved my life, I finally "saw the light" (and endured the beginning of some of Mdone's very negative consequences. In total, I spent more than 4 1/2 years as an MMT patient.

    Today, even though I continue my front-line-addiction-battle (and am, thank God, closer(!) to victory than ever before), I am enormously grateful to have broken the Mdone chain that both shackled and enslaved me.

    Dr. Beckett, you write, about your addicted clients, "To me, these guys are no better off than the oxycontin or heroin addicts, except for the fact that the methadone is legal."

    For what it's worth Doctor, I (strongly) suggest that those clients (depending, of course, on their particular medical/health status) would be better off on Oxycontin than Methadone. Yes, of course, I recognize that you cannot, even if you wanted to, make this change. Yet, if one could, somehow, INSURE that, for example, one's patient would consume ONLY his proper Oxy dose and then be willing, subsequently, to titrate down...and then out, he would, IMO, suffer far less detrimental consequences. Heck, it'd also just be plain easier, too.

    Moreover, Arlene's point is also exceedingly maddening to me. It was a "fact back then", when I was a MMT client, just as it's a "fact" today, "Methadone clinics will undermine addicts who want off by telling them they're already clean...as long as they're not using any other substance other than Methadone."

    Finally (apologies, Doctor, for topic-bouncing)...while I consider ODR to be my Home Base (of Addiction Websites), I am a frequent visitor to several other addiction forums. There is one in particular that, sometimes, drives me (nearly) mad. Clearly, as justification for using, sometimes, vast quantities of methadone, MANY of this site's members NOT only boast about their great joy in being CLEAN, but (often) add plenty of digs to abstinence sites, making light via such inane claims that "no one over there is happy, there's NO joy...I mean, if they can't have fun and feel good, they don't want anyone else to feel good." Blah blah blah.

    What a crock! Yet, I realize that (IMO) they are a member of the walking dead, each one of them, their poor souls drained of their lifeblood, wandering the world in a narcotic haze. OK, OK, a little self righteous prattle, I guess. But still...

    My (rambling?) point is, frankly, quite simple: Methadone is the devil and it has, and uses, its power over addicted people to keep them addicted...and, as most civilized society knows, it's the addicted person (whether politically, ideologically, religiously or chemically) that is most easily manipulated.

    Or something.

    best,

    sam


    sam bailey

  8. #8
    arlenewla is offline Senior Member
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    quote:Originally posted by sam bailey


    My (rambling?) point is, frankly, quite simple: Methadone is the devil and it has, and uses, its power over addicted people to keep them addicted...and, as most civilized society knows, it's the addicted person (whether politically, ideologically, religiously or chemically) that is most easily manipulated.
    If you weren't married already, Ole' Sam....I'd propose.:D;)

    Arlene F.
    Exodus From MMT;12-25-02
    <center>THIS TOO SHALL PASS</center>

  9. #9
    beckettmd is offline Member
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    Arlenwala....Thank you for your post. The idea of switching my client to methadone was for two purposes..First, the absence of methadone itself, although we gave an equipotent dose of roxicodone, already started a mild withdrawal process. Secondly, methadone is around much too long for a four hour detox to serve any purpose, so we give two weeks without it to minimize the chances that any is remaining. I coordinated with his methadone clinic (although with much eluctance from the director), to stop his methadone the same day I gave him the prescription for roxicodone. The way I decide on how long to keep him under depends on how his body reacts to narcan challenges at different intervals during the procedure. If his heart rate, blood pressure, etc. continues o react to the challenges, then I know that I have not adequately detoxed, thus, I continue until I see no further aeefect.

    Get Off That Bus!!!!!! It's going nowhere!!!!

  10. #10
    beckettmd is offline Member
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    By the way arlenwala, his dose was 150 mg per day. I a seeing a young gal this week who is on 200 mg methadone per day.

    Get Off That Bus!!!!!! It's going nowhere!!!!

  11. #11
    arlenewla is offline Senior Member
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    quote:Originally posted by beckettmd

    By the way arlenwala, his dose was 150 mg per day. I a seeing a young gal this week who is on 200 mg methadone per day.
    Sad....and I'm not surprised by the dosages.

    The Clinics give us just what we want....more. With their encouragement, we dig very deep holes for ourselves.

    Do you have a follow-up process for the patients, MMT in particular, you've detoxed; say 6 months or a year down the road?

    Arlene F.
    Exodus From MMT;12-25-02
    <center>THIS TOO SHALL PASS</center>

  12. #12
    traktor is offline Junior Member
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    Clinics can provide a needed break from a self-destructive free fall of a heroin addict.

    I agree that the methadone industry is un-informed, mis-informed, and in many ways antiquated. It is but a bueracratic solution. A patch. Our government is not in the business of solving problems, in case anybody isn't aware of this, but covering them up.

    I would take what is needed from the methadone experience. However, an informed person would either side-step the entire process and simply go through the sickness and detox from heroin or whatever substance, or use methadone with caution. What I mean by caution is keep your methadone experience in YOUR hands...not in the hands of the counselors. (who mean well, but are mis-informed...and that alone can hurt more than help.)

    Be informed. I thank this forum for a big part of my detox.
    Today is the ending of my third week off Meth. 21st day.

    I have been active all day on the forum...writing. I feel a lot of energy. I also feel a lot of pain. It is comforting to read other peoples struggles with same thing. I know, and I keep drilling into myself that TIME is the only cure. So. I spend time. I will spend as much time as necessary until i have to "think" no more of this. and be free.

    life is too short and too painful as it is to make it shorter and more painful with drugs.

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