[20after4]

I think that many methadone clinics are operating very unethically, to the point I would call it fraudulent. Certainly it's cruel to the patients. They essentially set up the patient to be a lifetime methadone addict. This may be an improvement over getting your fix on the street but it's still addiction dependence and it's expensive (profitable!). I'm unsure if it's just a few or a large fraction of them that operate this way. Maybe my data point is a unique outlier but here's what I saw:

I had a friend who was going through the program in Springfield Missouri, approximately 10 years ago, and the clinic literally increased his dose every week or two. They also had strict controls to make sure the patients actually take the full dose (because otherwise they might sell some of it on the street). So they were left with just 2 options, either drop out of the program and find their fix elsewhere, or accept a gradually increasing dose of methadone, forever. It's a sick program that is set up to make sure patients gradually descend deeper into addiction while they rake in huge profits. It's not really any different from what the drug dealers on the street are doing except that it's even more exploitative and dishonest. The doctors had zero plan for weaning people off of the methadone and some people had been on the program for years, with correspondingly huge doses doled out to them every time they came in. This was 10 years ago, at the time it cost something like $50 per visit, paid by the patient or possibly medicaid.

Edited slightly for clarity.

[deepsun]

Well, addiction or not, the main question is what medics call "quality of life" -- whether a patient can life their life to the full potential.

There are millions of people addicted to caffeine, the most popular psychoactive substance in the world, but as it usually doesn't prevent them to live their life and "be a productive member of society", no one cares of treating caffeine addiction, save for religious societies.

My point is -- is methadone addiction "better" than fentanyl in that regard? If yes, than that's ok.

[20after4]

My complaint was about the forced increasing of dosage. They literally would not allow the patient to wean off of it. So yes, it might be an improvement over the shit on the street but it's diabolical that they force patients to continually increase their dose rather than gradually decreasing it.

I have no idea if this is common or just this one shady clinic but my data point of 1 still stands. If there is one, then given that this would be very profitable, it's highly likely that there are other clinics with similarly unethical policies.

[antonvs]

To answer my own question: what you described sounds like part of the standard recommended protocol, and it seems likely your friend misunderstood or misrepresented that.

I'll explain with liberal quotes from the document linked below. Dosages start out low to avoid risk to the patient, because "the most common reason for death or non-fatal overdose from methadone treatment is overly aggressive prescribing/dose-titration during the first two weeks of treatment."

Because of this, "methadone induction and titration MUST be approached slowly and cautiously. It may take several weeks to address opioid withdrawal effectively. It is important to be upfront with patients about this requirement and to discuss ways to cope with ongoing withdrawal and cravings, to maintain engagement in treatment."

The dose increase is described in the following paragraph:

"...methadone can be initiated without the prerequisite presence of opioid withdrawal. This may be preferential for some patients. The patient’s dose should be titrated with a “start low and go slow” approach, based on regular clinical assessment, until initial dose stability is reached – see specific recommendations below. A stable dose is achieved when opioid withdrawal is eliminated or adequately suppressed for 24 hours to allow patients to further engage in ongoing medical and psychosocial treatment. The ultimate goal is to work toward clinical stability."

In other words, for patients who are continuing to take other opioids, the methadone dose is increased over time to make it easier for the patient to reduce that other intake. Dosage is based on interviews with the patient.

Addicts are very good at subconsciously coming up with rationales for remaining addicted. It's much more likely that your friend found himself in that trap, than that he was going to an unethical clinic trying to keep him addicted "forever". That would be a major violation of the law and breach of medical ethics, and would be likely to come to the attention of regulators if it was a recurring pattern.

https://cpsm.mb.ca/assets/PrescribingPracticesProgram/Recomm...

[patmorgan23]

> They literally would not allow the patient to wean off of it

If true that clinic needs to be reported. Patients have a right to taper down and exit treatment.

When a patient enters treatment at an OTP (Methadone clinic) they start with a small initial dose that is increased over the initial 30-60 days of treatment. Some clinics do this somewhat aggressively because they are trying to get the patient up to a "protective" dose. Methadone blocks the 'euphoric' effects of other opioids and protects patients who may still be taking other substance outside of their prescribed treatment program from overdose. Getting to a protective dose faster ends up saving patients lives.

So that maybe why the clinic was firm about trying to increase you friends dose.

OTPs are also required to offer counseling, the idea being methodone is used to address the physical aspects of addiction, and counseling is use to address the psychological/emotional side of addiction. Help patients build coping skills, figuring out what their triggers are, and find ways to stay out of those situations, etc. Some patients are instrested in that and eventually getting off of Methadone, some aren't. Some clinics provide really great counseling, some don't. The "dose and go" clinics are definitely a problem in the industry.

https://www.samhsa.gov/substance-use/treatment/options/metha...

[vladvasiliu]

> Methadone blocks the 'euphoric' effects of other opioids and protects patients who may still be taking other substance outside of their prescribed treatment program from overdose. Getting to a protective dose faster ends up saving patients lives.

How does this work? Naively, I'd expect addicts to up the dose of the "other substances" if they can't reach their high. Or does methadone outright "block" the other substances' effects?

[antonvs]

Was there some stated rationale for the dose increase?

[20after4]

It's possible my friend wasn't telling me the whole story or just misunderstood the program. I don't think he was actually trying to stay addicted though because after a few weeks on methadone (with increasing doses and doctors telling him that he would always be an addict for life) he decided to take the more extreme route of getting clean by quitting cold turkey. He moved to a different state and cut ties with every possible source he had to acquire the drugs.

[idiotsecant]

And yet, you're comfortable accusing the people trying to cure addicts of some diabolical plot to ensnare them into permeant addiction in order to make money off them forever. Maybe next time you'll think before you propagate nonsense.

[20after4]

I still think that this was a shady clinic. Why would they have people on the program for many years and give them ridiculous doses instead of weaning them off of the program?

[antonvs]

This is certainly possible, but it sounds more like what AA tells its clients. Doctors are less likely to say things like this, because it can have consequences for them.

Going cold turkey like you're saying he did is fine if (1) it doesn't kill you and (2) you're able to do it. For many people, it's just not very practical.

I don't think it's a good idea to demonize medical professionals for doing their jobs to the best of their abilities in the face of enormous challenges. That's the kind of thing that the conspiracy theorist and anti-science Robert F. Kennedy Jr. does, and it's not helping the US in any way at all.

[XorNot]

Did it work? Is he clean?

[20after4]

Yes it worked.

[20after4]

Not that I'm aware of, it seemed rather arbitrary. The people who had been going to that clinic for a while all had massive doses, almost to a ridiculous degree. My perception was that it was to keep them hopelessly addicted. I was only peripherally involved as it was my friend who was the patient. He was very fortunate to have family with influence in the Mormon church - his family had the church send some local missionaries to help him - and they genuinely did help him escape that terrible situation.

[lazarus01]

Agreed.

Methadone is effective because it comes with lower respiratory fatigue.

If you have a nasty addiction, methadone is the gold standard for treatment. It's really all that's available to ween people down.

There are other medications for maintenance like buprenorphine and naltrexone. But you can't take those if you're in the throws of heavy addiction, you can die.

[vixen99]

And no one bothers much about these either: 'A Neglected Link Between the Psychoactive Effects of Dietary Ingredients and Consciousness-Altering Drugs.' https://www.frontiersin.org/journals/psychiatry/articles/10....

[herbst]

In Switzerland there is state grown heroin because it should be even less quality of life inferencing than most other alternatives. They do this for a long while now and it works, most people have jobs and you couldn't tell they get daily heroin in the best quality you could imagine (for free)

[kakacik]

Dude, caffeine ain't no heroin. I drink 2-3 coffees a day and skipping this (ie traveling on vacation, easily for a week or two) does 0 to my body, mind or sleep. I just don't feel the effect at all, I drink it purely for the taste.

There is no human in this world who could say something similar about heroin.

[deepsun]

Sure, but your case is 1. There are many people addicted to caffeine, and it did affect their sleep and mind. (Writing this sipping my mandatory coffee :)

[scotty79]

> no one cares of treating caffeine addiction

If people were aware in how many ways caffeine messes up a lot of people there would be. Exhaustion, migranes, anxieties, twitching, insomnia, mental issues to name a few. Most never attributed to caffeine but mysteriously going away after a person manges to kick the habit.

[SkyPuncher]

Your argument seems to be missing the fact that methadone clinics are serving people with an existing addiction. They didn’t create that addiction, but they can fill the desire created by that addiction in a safe manner.

The ideal situation is the client leverages methadone into a recovery/remission from addiction - but that can be incredibly hard for them to do.

[Lord-Jobo]

If someone is addicted to ice cream, and the most effective treatment is to replace that addiction with spinach(scientifically supported), would anyone have this problem? I doubt it. People’s knee jerk reaction to any kind of “”””drug enabling”””” treatment is infuriating. I know multiple people personally who have had their life saved by methadone. Yes that makes me biased but it also justifies the bias (alongside the many medical professionals advocating for it)