Patient Prefers Subutex

Buprenorphine Post
kcairns
Posts: 571

Postby kcairns » Tue Jun 02, 2015 1:04 pm

Dave what you tell me I sure believe..because i believe in you and makes me sad tho not surprised re having health care practitioners doing wrong by their pts.sure some are here for conning and I know if you were here e me you would see a different story than what you encounter there .great majority lead full normal unrestricted lives and are good people grateful and only wishing had started sooner. You are a good man..thnx for all you do for your pts...andvthe good way of life I a sense in you..b well...PS methadone maintenance not meth

rac1210
Posts: 87

Postby rac1210 » Tue Jun 02, 2015 1:04 pm

M Kaylor I applaud your commentary!!! I am owner and medical director of two Methadone clinics and I can tell you these clinics save patient's lives. Not everyone is a candidate for BUP. Many patients need a very tight program that Methadone clinics. CARF certification is a very very big deal for Methadone clinics and I can****ure you anyone who operates a Methadone clinic will know what I am saying. Many of my patients who failed Suboxone therapy moved to my Methadone clinic and are DOING EXTREMELY WELL. My Methadone clinic has 8 counselors who see patients twice a month and more if needed. We drug test monthly and more if needed. We require patient's come in daily for first ninety days. Once patients have shown they are in compliance w program requirements we start slowly giving them take homes. Methadone patients dont get high they just get normal similar to BUP patients.

Dave
Posts: 187

Postby Dave » Tue Jun 02, 2015 1:04 pm

Kcairns, Thanks for the information about your personal experiences. I have never heard any of my former methadone patients say anything positive about their experiences at the meth clinics. Perhaps you are right that the quality of meth clinics varies a lot. Around the tri-state area where I work, they must not be too good. We see many patients from PA, W.VA, and Ohio. There are nowhere near enough bupe docs. Some come from hundreds of miles away even as far as Maryland and Virginia. How do you know your meth patients are not "drugged"? Are they allowed to drive? The former meth patients I see sometimes ask me if bupe will rot their teeth like the meth did. Some get hyperexcited when a meth clinic is mentioned as an alternative to OBOT. To them, going to a meth clinic is like returning to Hell.

kcairns
Posts: 571

Postby kcairns » Tue Jun 02, 2015 1:04 pm

these folks are good human beings, I would encourage our good obot docs to consider putting in some hours in such work

kcairns
Posts: 571

Postby kcairns » Tue Jun 02, 2015 1:04 pm

Dave, I think quality in methadone maintenance clinics varies a whole lot. i have worked in one as one of my works for 5 years, we have 240 clients and 4 great caring full time counselors, the whole staff being high quality all around. full of clients who were down to last neck vein for their ms etc,, now working all kinds of good works where the clientele of lots of them would be shocked to know that sweet person is a past ivdu now on methadone maintenance.... we fight the same struggle as all us obot docs do in re such as their being insulted by their ob staff etc and those everywhere who know nothing and try to drive them from their treatment, most could not afford bup, they are not drugged and when earn privilieges showing they can have meds safely for home they get takehomes gradually of up to a month...i post so message from this board does not end up making it so even fewer people can get rx that works for them, also mtd better for many for whom bup not adequate...if your pts are having bad experience in local clinic they need know their rights of appeal, ours do...best ken ....just as w obot bup we keep many many from being back crowding costly prisons where after jonesing enough and getting "corrected" they emerge free in the light of a summer day and od

Dave
Posts: 187

Postby Dave » Tue Jun 02, 2015 1:04 pm

If M Kaylor's comments are true, I wonder why so many of my bupe patients tell me they would never under any circumstances go back to a methadone clinic. They tell me it is just like taking heroin and their mental obtundation is the same as with heroin. Not only people who came from methadone clinics, but people from pain clinics too have said they never want to go back to the pain clinic when bupe relieves their pain just as well and without the mental fogginess induced by pure mu agonists. It is hard to believe all these patients were lying about methadone and the euphoria and mental slowing it produces.

The study mentioned by Kaylor in 1994 was well before such studies occurred with OBT and bupe. The 1994 study cannot be compared with contemporary OBT. To say methadone works like buprenorphine works is absurd and against all evidence to the contrary. I can easily understand why those who have been afflicted with methadone clinics would be happy never to go back to the daily routine of checking in every day for a dose of what they need to keep from getting seriously ill.

rac1210
Posts: 87

Postby rac1210 » Tue Jun 02, 2015 1:04 pm

Methadone is a lifesaving drug if used properly. If not used properly it is like a rattlesnake that will cause great harm. MAT is lifesaving to many and yet it still caries a stigma!

drpasser
Posts: 1404

Postby drpasser » Tue Jun 02, 2015 1:04 pm

And not every Opiate Dependent pt does well with Bupe. Some just do better with Methadone. Also, Methadone is cheap, compared with bupe.

One can buy 120, 10 mg Methadone tablets for under $15.

When Methadone was most popular in the 70s, many Heroin addicts in Methadone programs were able to get jobs and work and be productive and pay taxes and turn their lives around. All the things we see improvement in the lives of our bupe pts; the same level of improvement occurred for Methadone pts.

Do we need a Methadone thread?

m_kaylor
Posts: 22

Postby m_kaylor » Tue Jun 02, 2015 1:04 pm

Wow! I am shocked that in a forum of addiction specialists there would be such a high level of ignorance in regards to methadone.

Dave and adavid: just as with proper dosing of buprenorphine, proper dosing of methadone does not allow patients to be "high in a controlled environment." The mu receptor is blocked preventing euphoria when taking other meds. Just like suboxone. Methadone clinics are more than a place for addicts to hang out, get high and stay off the street so as not to cause "US all sorts of problems." I recommend you check out TIPS 43 from SAMHSA regarding MAT. You will understand that methadone is simply another tool in your tool box.

Why aren't there 100 patient caps on methadone clinics? Because they have a higher level of regulation. First OTPS (opiate treatment programs as opposed to methadone clinics as many prescribe suboxone as well) have to be approved and licensed by CARF. There is much more oversight then a dea officer showing up and asking to see a list of how many patients you have. Patients are kept on a much tighter leash and are required to dose daily for weeks, months or years before allowed to get even one dose to take home. THey must demonstrate no illicit drug use, no illegal behavior, be present in clinic, demonstrate stable home life and have time in clinic before they are allowed one take home. THey can slowly build from there. OTPs don't just dose but provide groups, counseling and social work to help achieve all of the above. With methadone, just like suboxone, people achieve stability and lead productive, quality lives--just like you and me. Typically OTPs end up with patients who are higher complexity and risk. Usually the patients that you or I have fired from our clinic.

To end my rant I will quote the California Department of Alcohol
and Drug Programs study published in 1994 which loooked at the the
effectiveness, benefits,and costs of substance abuse treatment in
California.
1. Methadone treatment was among the most
cost-effective treatments, yielding savings of
$3 to $4 for every dollar spent. This was true
for each major methadone treatment modality,
but costs were lower in an outpatient OTP
than in a residential or social modality
(Gerstein et al. 1994).

2 Patients in methadone maintenance showed
the greatest reduction in intensity of heroin
use, down by two-thirds, of any type of opioid
addiction treatment studied.

3.Patients in methadone maintenance showed
the greatest reductions in criminal activity
and drug selling, down 84 percent and 86
percent, respectively, of any type of opioid
addiction treatment studied.

4. Health care use decreased for all treatment
modalities; participants in methadone maintenance
treatment showed the greatest reduction
in the number of days of hospitalization,
down 57.6 percent, of any modality

Methadone works, just like buprenorphine works. In my neck of the woods there isn't "us vs them" mentality and I don't see the imagined resistence to increased suboxone use from methadone clinics.

Just my 2 cents (maybe that was more than 2 cents)

M Kaylor

Dave
Posts: 187

Postby Dave » Tue Jun 02, 2015 1:04 pm

So methadone clinics are just a poor, but more expensive, substitute for simply making opiates legal and selling them like we do alcohol, a more dangerous drug for US.

It might be good for people in the big cities to see the result of the worldwide epidemic of drug dependency. As it is now, most people do not realize this disease is epidemic and leads to many deaths every day. I challenge the only choice to our miserable Congress is to repeal the DATA 2000 law. Whenever someone says there is only one choice, you know you are being misled. A better choice would be to make it easier for more doctors to prescribe bup and to establish clinics for the overflow. I do not think making the epidemic invisible to people is ever a good choice. We have a federal administration that is too invisible as it is(they call it "transparency"), and we see what that is doing.


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