I had a $200 heroin addiction before doing a voluntary rapid detox in a hospital and then going into a methadone maintanence treatment clinic. I have been steady four years at 110 mg methadone, and clean from any other drugs since. I just moved to a different state, Florida, and previously had all my records sent to a clinic, on the pretext they were going to honor my "phase" earned at the prior clinic, and give me a month of take home medication. Once I showed up they changed all that and are making me dose on a daily basis. I have to drive three hours every morning to dose, and they say it could take years at their clinic to get the earned phase to take home a months' supply. A nurse told me that my transfer should be just like a prescription and I should have received the same amount of medication I had been getting in Tennessee. I would like to quit the clinic altogether and see a private physician.Can a private doctor write me a prescription of 110mg of methadone on a monthly basis for my needs? If not, is there a recourse to take on the position of the clinic?
Formula's answer is only partially correct. The Harrison Act has was passed 80 or so years ago, making it illegal to prescribe narcotics for the prevention of withdrawal or treatment of opiate dependence. In the early 1970s an exception was passed, allowing clinics to prescribe methadone under very strict guidelines-- including rules on how the drug is dispensed. In 2000 another exception was granted for the use of buprenorphine (or other schedule III- V medications). But the Harrison act ONLY applies to the use of opiates to treat addiction-- NOT, as the prior post suggests, to treat ADDICTS. Opiate addicts are just as entitled to pain treatment as is anyone else; a doctor is much more likely to get into trouble for refusing to treat the pain of an addict than for treating pain in an opiate addict!
Methadone and buprenorphine can be prescribed to treat pain by any doctor who can prescribe scheduled substances. If a doc can prescribe percocet, he can prescribe buprenorphine (including Suboxone). There is confusion on this issue, but there shouldn't be; 'off-label' prescribing is extremely common for many conditions and medications. Likewise, methadone can (and is) prescribed for pain quite often. I have a number of patients in my chronic pain practice for whom I prescribe methadone. But I CANNOT prescribe them methadone in order to treat opiate addiction. If one of my chronic pain patients becomes addicted to opiates, that doesn't mean I have to stop treating him-- just that I have to make sure that I am treating his pain carefully, documenting things carefully and appropriately, etc.
It gets quite confusing; any doc who has a DEA license can use an exception to the Harrison act for up to three days, and dispense a scheduled narcotic to prevent withdrawal. But the doc cannot PRESCRIBE the medication; he can only DISPENSE it, one day's dose at a time, for a total of three days. What a mess!
Just to echo Dr. Junig (who btw, I think is a genius - started reading subtalkzone a number of months ago and was literally at my computer for 24 hrs straight reading his posts - he is to blame for my black circles!) - my fiance has severe inoperable degenerative disk disease, which unfortuantely attributed to an addictive predisposition leading to a full blown opiate addiction. Physical dependence on the opiates is one thing, as he does have chronic pain, but this was a mental addiction and definite abuse of medications. He was not able to take the meds as rx'ed - tried everything too- percocet, vicoden, norco, OC's, fentanyl patch, muscle relaxers, spinal block, injections, epidurals - you name it.
As I stated, his condition is inoperable as he has 4 disks in a row literally crumbling - and apparently a doctor (at least in the states) cannot replace this many disks in succession. Hopefully the future will bring new treatments, but he is currently SOL. He decided that enough was enough with the opiates as his back pain became the lesser of two evils. He tried alternative therapies - physical, cognitive, etc. Also acupuncture and specific exercise. Did not bring the same pain relief though his quality of life returned.
Anyway, on his road through the world of opiates, his first stop after full agonists was suboxone. This worked okay for awhile as far as w/d. Didn't numb the back pain, but dulled it somewhat. Eventually the side effects were too much for him - constipation, mood swings, depression (he is also bi-polar) and his doctor suggested MMT. This doctor I believe is a specialist, though I'm not sure of his field. I know he deals w/pain management, but I think also does ortho type work. Anyway (after my long rambling) - it came down to MMT for my guy, and this dr was able to prescribe it monthly.
He basically told us the same story about writing the prescription montlhy - though my fiance is partly on MMT as just that - maintenance off of an opiate habit, the medication is specifically prescribed to him for pain management. Now if he had no valid excuse for pain management, the doctor would not be able to help with this. His dual dx was really key here - but for all intents and purposes the meds are for his chronic pain, otherwise, it would be illegal.
This is not to say he doesn't have a problem filling/refilling the rx b/c he ALWAYS does. He now goes exclusively with one pharmacy who is ok (though they still look at him funny and call to confirm with the dr each and every refill) - but it took us forever to find one that would fill it. We had to physically go to the pharmacies and ask as they all told us over the phone they do not carry the medication (and later learned over 1/2 the places we talked to do.) The laws are super strict. It's really unfortunate too, b/c it must be really difficult for opiate maintenance patients in your position. My guess would have to be the abuse potential. Of course, any substance can be addictive, and any substance can be abused/overused. I've taken subutex for opiate w/d - and though I know the abuse potential is 'low' - I've certainly had binge periods -- which makes no sense as I actually feel better on lower doses. I've never taken methadone, but I suspect, as a full agonist, there is a higher abuse potential? I'll tell you this, I wouldn't trust myself with a months worth. What happens when you use a month's worth in a week - you're effed for the next 3 wks! This is why I wasn't so keen on the loophole with my fiance. Luckily, he's been responsible and taken the necessary steps to use the MMT appropriately (going as far as to lock it up when need be) - but there's def. potential for things to go bad.
On a side note, the MMT greatly helped his pain for several months until he went into a deep depression (along with other nasty side effects.) Turns out his testosterone levels went down to lower than a woman's should be, and his entire chemistry was out of whack. It was very scary to witness. He is now on replacement therapy for the testosterone (oy!) and coming down off the methadone. It's been a bumpy road. Sorry I've gone so off topic, but the simple answer here is this: if you do not have a legitamite need for pain management meds (whether or not in addition to opiate maintenance) the dr cannot prescribe a monthly amount. And even with the pain management aspect, it's shady - as I feel some drs may be 'persuaded' to diagnosis a pain problem for this purpose.
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