dopetalk
Core Topics => Opiates & Opioids => Drugs => Methadone and Buprenorphine Maintenance => Topic started by: Tainted on November 21, 2015, 11:43:35 PM
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So I never realized methadone clinics had a cap on patients. There's like 3 dozen suboxone doctors in my county but only two clinics (both owned by the same company)
Called to try to get in, they just told me show up on Tuesday or Friday at 545am it's first come first serve for intake. I've gotten there 515am (and there's always been half a dozen ppl already there) 3 times now, they only seem to let pregnant chicks in, they get priority so showing up is like pointless. Finally today they let me inside the building and told me their at capacity and took my name and said it'll be very minimum a few weeks till I get in, but when I was leaving someone else was coming in to do their intake, said they had to wait 3 months. The other clinic is 45 minutes away and full, doctor nurse dude only other suggestion was goto the one in the next county over, which is easily 60+miles away.
It's not like I live in a tiny town, I'm not in a huge city, but my towns got like 120k people. Is this normal for methadone clinics? I expected to show up, do the intake and get dosed at worst the day after. Didn't think id be waiting months (if the waiting list is that long, why the fuck is there 50 suboxone docs and only one methadone clinic???)
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Suboxone docs are basically the next pill mill deal down here. 2 methadone clinics in my county last time I checked, also 13 bux a day, cash only. Maybe 15 now.
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It's an omen: get on suboxone instead.
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It's an omen: get on suboxone instead.
Been off and on suboxone for years. Used to work really really well, but the past year or two it hasn't been at all. Methadone has always worked really well for pretty much everyone I know, I've just refused to take it because I don't wanna get stuck on it. But I've been on opiates for close to ten years so I'm ready to resign myself to always being on some form of opiate
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Sorry that you are having to wait to get in. I don't know if all clinics have a patient cap, but I guess they probably do. I'm sure there are regulations that dictate how many counselors vs how many patients etc.
I know at my clinic the only people who have to wait are medicaid patients. Due to the reimbursement rate being so poor, they only allow 50 medicaid patients at one time. If someone has medicaid and there are no available slots, you have the option of paying cash. ($70.00 per week, but you need to be paid up a week ahead of time...I guess that is so if you say fuck it and leave, they will still have some of your money! Bastards!!)
I will have to ask how many patients my clinic can have..now I am curious. I know right now, there are approx. 350...it's a pretty small place.
Are you having to wait due to medicaid or insurance issues or are they just at capacity? I know the other clinic is far, but could you get in to that one and then when an opening happens, switch to the clinic near you/
I know it sucks to have to travel and stuff, but for me it beats the hell out of being sick and having my entire life in the crapper. Good luck! I hope you get in soon!
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Nah I'm paying cash. This place doesn't take regular insurance, only medicaid which I don't have.
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My clinic is exactly the same! I just thought maybe that was the hold-up. Is the linic that is in the other town full/ I know you said it was 60 milws...is that one way or round trip/
It totally sucks how hard it is to get treatment. Even Suboxone places have patient caps. If they made clinic life a little easier to access, maybe more people could get the treatment they need.
Were you able to put your name on a waiting list or do you have to keep going there in the early morning hours until they have space?
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My clinic is exactly the same! I just thought maybe that was the hold-up. Is the linic that is in the other town full/ I know you said it was 60 milws...is that one way or round trip/
It totally sucks how hard it is to get treatment. Even Suboxone places have patient caps. If they made clinic life a little easier to access, maybe more people could get the treatment they need.
Were you able to put your name on a waiting list or do you have to keep going there in the early morning hours until they have space?
I was able to put it on a list after I went 3 times. Haven't bothered calling to see if the other place is taking new people, I'm on felony probation and don't have a license, thats too far and too risky to do on a daily basis
I get why suboxone docs have caps on patients since they only have to see their patients once every month to 3 months, would be easy for doctors to cram in too many patients and neglect them, but methadone clinics make you show up every day.
I guess what I'm asking is if there is actually a restriction on the number of methadone clinics patients or if it's just the place near me's policy? I've got a lot of friends on methadone out of state and none that I've talked to have ever been put on a waiting list
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I am pretty sure in Colorado where I am at that is the case. When I got arrested and tried to get back on methadone they told me it would be at least 3 months. They got me on a list and there was about 10 people ahead of me and the only reason I got on that was because I was on probation. If you aren't on probation or pregnant your out of luck. They weren't doing any intakes for 3 months then one a week after that so it would of taken probably 5 months if my counselor hadn't gone to talk to the doctor to squeeze me in for intake. The doctor knew me cus i had been there for 18 months before getting arrested.
I only had to wait a month to get in but there is still a huge waiting list to get on at my clinic. It was the same for the other 2 companies that do them in my area. I think there are about 5 clinics within 45 minutes of me and they were all full. They can't get federal funding and its a bitch to open them because of all the regulations and cost.
It is a known fact that we need more clinics but if you see what is happening in monument, colorado that is pretty much what all clinics have to go through. A company was told by the city council they could open and given all there licenses. Then after they spend around one million buying a retail property and getting their ducks in a row. The people in their area throw a huge fit and boycott and petition the city council until they deny them their licenses after they already gave them the okay. It is a fucked up situation I hope that company is allowed in and sues the city and wins for all their losses plus some.
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In Quebec I don't think there is a strict limit. Most doctors limit themselves to a percentage of their practice, and the programs seem to know how many people they are able to serve.
My doctor told me that he regularly takes new patients, and staggers intakes. At first he sees them weekly, and within a year most are moved to every three months. He told me that he tried to move his regular patients to other doctors to make more room, but he wasn't able to.
They don't dispense methadone in-clinic here. If they did it would probably be much more strict.
There are two programs in downtown Montreal. The CRAN is prettytypical, and was the first methadone clinic here. The interesting one is called relais methadone. They are geared towards the homeless, and have low waiting lists. No carries are given, and urine testing is minimal. It is a dirty program, so you won't be kicked off for dirty tests.
You don't see a doctor, but instead see a doc from a pool. You don't get an appointment specifically, but instead get Tuesday morning for example. I think the appointments are every week.
It is really geared towards at risk users. Probation officers often call and jump whatever que there is.
Waiting lists can be brutal here. The average is about three months. Usually you are told to phone at a certain time, but often services like cps or parole will jump the line, and the phone stays closed. From my experience, you might do well to get an advocate to call them. Maybe a drug counsellor?
Good luck. Hang in there. The wait van be brutal, but it is worth it. I would be proactive, and show up at a quiet time to regularly ask if they have any suggestions for what to do.
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@ Tainted. I'm in New Jersey. The guidelines here are that there has to be one counselor for every 50 clients. I asked my counselor about it and she said if our clinic was to exoand to accept more people, they would have to hire more counselors first. I don't know if this is a "Jersey" thing or if this is a federal regulation. I think I'm going to go research that. *Lolleedee opens new window to google federal methadone regs*
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Probation officers often call and jump whatever que there is.
wow, if only this resource was available to the at risk and usuallyy paper bound populations of the USA
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Probation officers often call and jump whatever que there is.
wow, if only this resource was available to the at risk and usuallyy paper bound populations of the USA
Was thinking the same thing. Whole reason I'm getting on methadone is I been on probation for 18 months, been pissing dirty the whole time but my po liked me and never tested me for opiates, but my po just changed so he's prolly gonna gimme a ten panel next time I go in or an opiate dip stick. Pregnant women are the only ppl who get to cut the line for methadone here
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I would call the clinic and let them know you are on probation to see if that moves you up the list at all. My clinic only allows people on probation and pregnant women on their list when they aren't accepting new patients. They haven't been accepting anyone new sense April but in September they started doing one a week from the probation and pregnant women list. It is crazy how high the demand for methadone is and still there is no funding for new clinics. It is a known fact that when a methadone clinic is introduced in an area the crime rate goes down. At least that is what my counselor told me when we were discussing the shenanigans going on with the mmt clinic trying to open in monument colorado.
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In the US there are stringent requirements for methadone clinics. Dated requirements. For suboxone, most doctors could easily do a data 2000 course and dispense it.
Here they are both governed by a 1 day, 6 hour course. They are both treated the same with earning carries and going to the pharmacy.
I wonder if some of you who are on subs would be on methadone if you had to get your subs every day and earn privileges. Here they stream pill users onto subs and heroin users onto methadone for the most part. That is the experience in the circles I run in at least.
I would call and say you are on probation, and your PO wants you on methadone. Just be aware they might want to talk to the PO, so don't spread lies. Can't hurt right?
Edit: my doctor is expanding his practice right now. If anyone from Montreal/Québec needs a referral drop me a line. I'm pretty sure I'm the only one though.
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Yes that's why they have wait lists backed up for months ,..
My clinic is 50 patients per counselor, nothing more..we have
Five counselors ,250 patients ..people are literally waiting weeks to get in
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In the US there are stringent requirements for methadone clinics. Dated requirements. For suboxone, most doctors could easily do a data 2000 course and dispense it.
Here they are both governed by a 1 day, 6 hour course. They are both treated the same with earning carries and going to the pharmacy.
I wonder if some of you who are on subs would be on methadone if you had to get your subs every day and earn privileges. Here they stream pill users onto subs and heroin users onto methadone for the most part. That is the experience in the circles I run in at least.
I would call and say you are on probation, and your PO wants you on methadone. Just be aware they might want to talk to the PO, so don't spread lies. Can't hurt right?
Edit: my doctor is expanding his practice right now. If anyone from Montreal/Québec needs a referral drop me a line. I'm pretty sure I'm the only one though.
To answer your question yes I would be on methadone over suboxone if the regulations and rules for dispensing it were the same. Cost would play a factor and anyone that accepts insurance would still be considered over another.
There is actually a clinic here where I am at that despenses suboxone just like methadone and is $22 a fucking day to go to. Fuck that noise, gimme the juice.
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I was wondering-
So your on the mmt to get and stay off other opiates/opioids, to get your life back on track and such, a lot of folks on probation. From what most are saying, you must pay in advance, unless you have Medicaid? Well, what happens, say you've become stable at a certain dose, and you get laid off from your job or something like that? Do they give some leeway to find other employment, or do they just cut you off ct, or at least taper you down?
Then what? How do they expect folks to get and stay clean when they can't pay their bills, because they are out of a job due to no fault of their own?
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I was wondering-
So your on the mmt to get and stay off other opiates/opioids, to get your life back on track and such, a lot of folks on probation. From what most are saying, you must pay in advance, unless you have Medicaid? Well, what happens, say you've become stable at a certain dose, and you get laid off from your job or something like that? Do they give some leeway to find other employment, or do they just cut you off ct, or at least taper you down?
Then what? How do they expect folks to get and stay clean when they can't pay their bills, because they are out of a job due to no fault of their own?
It depends on the clinic. It's referred to as a 'feetox' policy. Some clinics will give you up to a 21 day detox, some clinics, such as the one I go to, will not dose you if you're not paid up (no exceptions). My clinic won't even give you ANY of your takehomes unless you've paid for all of the takehomes you're supposed to get, so say for example if it's a holiday weekend and you forget to bring money for the dose for Monday, they won't give you your takehomes for Sat and Sun until you've paid for Monday as well, even though you've already paid for them. It's bullshit, I think it's incredibly unethical to not have some sort of detox policy in place for non-payment. You'd think they'd want to do it, because it only looks bad on them, if you don't get dosed, and have no money, I would imagine most people would do what they had to to come up with it, including breaking the law. It just seems counter-productive to the whole point of having methadone clinics.
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That's just down right CRUEL. and tells me they are not interested in anyone's well being, let alone recovery- just the all mighty dollar, would understand how easy it would be to just say "FUCKIT". 2 steps forward and $15 back or whatever it is a day these clinics charge.
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I was wondering-
So your on the mmt to get and stay off other opiates/opioids, to get your life back on track and such, a lot of folks on probation. From what most are saying, you must pay in advance, unless you have Medicaid? Well, what happens, say you've become stable at a certain dose, and you get laid off from your job or something like that? Do they give some leeway to find other employment, or do they just cut you off ct, or at least taper you down?
Then what? How do they expect folks to get and stay clean when they can't pay their bills, because they are out of a job due to no fault of their own?
It depends on the clinic. It's referred to as a 'feetox' policy. Some clinics will give you up to a 21 day detox, some clinics, such as the one I go to, will not dose you if you're not paid up (no exceptions). My clinic won't even give you ANY of your takehomes unless you've paid for all of the takehomes you're supposed to get, so say for example if it's a holiday weekend and you forget to bring money for the dose for Monday, they won't give you your takehomes for Sat and Sun until you've paid for Monday as well, even though you've already paid for them. It's bullshit, I think it's incredibly unethical to not have some sort of detox policy in place for non-payment. You'd think they'd want to do it, because it only looks bad on them, if you don't get dosed, and have no money, I would imagine most people would do what they had to to come up with it, including breaking the law. It just seems counter-productive to the whole point of having methadone clinics.
Repped. It IS counter-productive. And cruel. And has nothing to do with a client or patients well-being when applied in this context imo. You'd *think* it'd make these clinics look bad, but when so much we hear in the media is "abstinence is attainable if they do the work" etc, the blame for not succeeding gets placed right back on the very people who WANT help (aka recidivism).
And who in mass media gives "junkies" (hate that word in this context too) an equal voice over "Dr Drew" and his ilk?. Grr sorry for rant-it's just disgusting to me.
I hate that for so many - not all, but enough - it seems to just be about big business (= all about the $$$). I'm curious--does anyone have info i.e., studies/stats on whether or not there was a surge in these types of businesses by doctors immediately following crackdowns by DEA, state politics etc? I though someone had written and posted a link to media attention. but I'm not certain so apologies if Im just not seeing it.
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They do a feetox at my clinic too but it is a 10 day detox no matter what dose your at. So if your on 200 your going down 20 a day regardless. It is 230-300 a month on a sliding scale or $20 a day to guest dose there. They also dispense methadone on my clinic and its more expensive and you have to go about getting take homes the exact same way.
I wouldn't be surprised if the amount of docs switching to done shot up after the crackdown. Even though not very many new ones have been able to open due to regulations and funding. I bet a lot of doctors followed the money and were able to get jobs at the ones available. I also adds on becoming drug counselors all the time.
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My clinic has the exact same policy as Griffin's.. If you can't pay they drop 10% of your original dose each day until you get to zero and are dropped entirely. The fucked up thing too is, say you're on 120 mg and get fee-toxed for 8 days due to non-payment and then on day 9 you're finally able to pay your debt. Well now you're stuck at 12 mg and will have to do a slow and steady increase instead of just having your original 120 mg dose re-instated. This means an additional 1-2 weeks of sickness and w/d until you can get back where you were all because of a week-late bill that's somewhere in the $80-100 range.
It's redic and they don't give a shit about the patients' success or stability, only getting their money every week like clockwork while every one else suffers.
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That's disgusting. My pharmacy has given me my methadone before I go to the doctor before. Just because the pharmacist is nice, and doesn't want me to be sick.
I couldn't pay $20 a day. I would still be actively involved in bad ways to make money if I had to pay 500 a month for methadone. I pay $17 a month right now.
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That's disgusting. My pharmacy has given me my methadone before I go to the doctor before. Just because the pharmacist is nice, and doesn't want me to be sick.
I couldn't pay $20 a day. I would still be actively involved in bad ways to make money if I had to pay 500 a month for methadone. I pay $17 a month right now.
Seems like the moral of this thread is America sucks and we should all goto canada.
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That's disgusting. My pharmacy has given me my methadone before I go to the doctor before. Just because the pharmacist is nice, and doesn't want me to be sick.
I couldn't pay $20 a day. I would still be actively involved in bad ways to make money if I had to pay 500 a month for methadone. I pay $17 a month right now.
Seems like the moral of this thread is America sucks and we should all goto canada.
do you get methadone in jail in canada?
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You do get methadone in jail, but it has to be set up through a bureaucratic nightmare.
I wouldn't say America sucks, and we certainly have our problems. The public health system is overburdened, and waiting lists are long. I waited two months for my initial appointment. Then a month later they moved the appointment forward yet another month. In all it was 4 1/2 months between first call and getting my methadone.
Some people wait less long, and some wait longer. I heard from one guy that waited a year. To me, that is unacceptable. People have died waiting for treatment. That is part of the reason for relais methadone. That is also my motivation for offering referrals to my doctor. Someone in crisis needs help now, and not in 4 1/2 months.
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I hate al of the hoops you have to jump through to get treatment here it is horrible. I don't know how many people have to be addicted for them to start making getting treatment easier, cheaper, and more accessible. I couldn't imagine paying $20,000+ a month to go to in-patient treatment. I am glad that methadone is finally free with medicaid here in colorado but I know some states aren't as lucky.
They need to do studies that show how many people are dying because the treatment system in americas unavailability. There are plenty of studies that show that it is more cost-effective for people to get treatment. It is way more cost-effective for people to get meds in jail, and the crime rate goes down. The only down side to it is a politician saying he is wrong or saying another way might work which will probably be the hardest hurdle to jump.
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I wouldn't say America sucks, and we certainly have our problems. The public health system is overburdened, and waiting lists are long. I waited two months for my initial appointment. Then a month later they moved the appointment forward yet another month. In all it was 4 1/2 months between first call and getting my methadone.
These waits are very similar to what I'm dealing with being on medi-cal. It's typical (tho admittedly a little faster lately) for me to have to wait 1.5 - 2mos for an initial appt. with my "GP" - who is about as useful as a hemorrhoid, then he makes a referral, and another 2mos. goes by before I can get an appt. with a specialist.
Ideally anyway.
I just had a small cyst removed (actually there were three of the fuckers), it took well over a year for my Quack and his Krew to get their shit together for what was ultimately a 15 minute surgery that happened in a small office with nothing more than a little Novocaine and 4 stitches; it was a joke. But at least for us in the US, this is SOMETHING -- I went >10 years without a chance in hell for health insurance simply because I've had something they didn't know how to easily deal with (pre-existing condition, for me in the form of daily un-relenting 'heartburn' that you wouldn't wish on an enemy).
Anyway. Our system is far from perfect but we've made a TON of progress on that front (THANK YOU OBAMA!). Now if we could just get a single-payer system set up, we'd be even further down the road to acting like we actually have some humanity and live in the same century as the rest of the "first" world.
/rant ;)
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Our "feetox" policy is you don't pay, you don't dose..at all. If you miss three days, then you get kicked off with no detox. It is fucking barbaric!
I'm not under the delusion that treatment should be free. I am willing to pay a fair price for treatment. I hear people at the clinic all the time bitching about the clients who have medicaid and have their methadone paid for. While I would love to have mine paid for, I realize (but the people bitching don't) that I am lucky to have enough income to pay for my treatment and I have private insurance. People on medicaid do not have that wiggle room in their budget.
Believe it or not, the only time they wean you down is if you have an administative detox for noncompliance. Soooo if you are an ass to staff and are a fuckwad, they will detox you..if money is tight, it is fuck you!
This has to change. It never ceases to amaze me that the most effective treatment for opioid dependence is so hard to access.
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I realize all clinics will have diff policies, but what's the general UA policy? Fail two or three ua and your out or what? I'm figuring methadone will get my tolerance so high that opiates will be pointless, but I wouldn't mind rolling now and then or doing some coke. Am I gonna have to pee in a cup before I dose and keep it in the fridge for safe keeping in case they test me
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At my clinic, fail or come up 'non-therapeutic' as they put it, and you will have your step-level decreased. This means if you are on monthly take-homes, then you go back to bi-monthly. If you are on the weekly phase, as I am, then you will be reverted back to 3x week.
If you are daily, and fail a UA, nothing really happens except it'll take longer to progress. You have to have 3 'therapeutic' UA's, and some classes completed to increase or phase up your step-level.
If you aren't accruing any clean UA's, then you're gonna be daily for the foresee-able future. For some people this is no big deal.....I know some who have been daily for years....they piss dirty, and just keep showing up they keep getting dosed.
Benzos are the only thing that if you piss dirty for them, you'll get kicked the fuck out. And it still takes a while of them saying 'hey, don't do that' before you are up for termination.
I think for the most part clinics are pretty tolerable of people cross-using, as long as it's not benzos.
That's MY experience....Florida could be entirely different.
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A single payer system would make a huge difference for you guys. I forget the exact numbers, but medicare and the va costs a similar amount per capita as the Canadian system that covers our entire population.
A single payer system makes the difference. Instead of the hospitals setting their prices, the government assigns a value and pays that. There is no need for hmo's to get rich at the expense of the citizens. It's too bad that the aca was watered down to its present state, but it is a good start.
Sorry if it seems like I turned this into a USA vs Canada thing. Not trying to offend anyone. I was just trying to add my experience from the other side of the border.
In Alberta the experience was similar to what you guys describe. It cost me 400 per month, and I had three times a week urine and alcohol tests. We had to blow a 0.00, and they were strict about it. Fail three times and you're out.
One woman I knew there was still prostituting to afford the clinic. Tragic.
It isn't all rainbows and lollipops here.
In Vancouver it was the opposite. You could get a same day appointment, welfare covered prescription costs even if you were not eligible for welfare, and I dosed at a pharmacy that only did methadone. They mixed up 1 gallon water jugs full of 1mg/ml, and dispensed with graduated cylinders into Styrofoam cups. No bottles available. If you had tskehomes they sent you to a different pharmacy.
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My clinic is the same as smacky-doodles when it comes to UAs except they don't care if you fail for benzos or anything. I know a guy whose been there 18 years and hasn't had a clean UA most of them are for pot or benzos. I think you have to have 12 clean UAs in a row to get weeklies here along with all of the other stuff smacky said.
My clinic started a new policy last month that if you fail your breathalyzer on Saturday you can't get your Sunday take-home either. They only give breathalyzers to the people who have alcohol issues. Luckily they didn't start me on them when I got the DUI even though it wasn't for drinking. They are required to take them everyday and to get off I think you have to have 6-12 months of no hot breathalyzers and no alcohol in your UAs after you've been put on them.
The workers dose first policy is still in effect as well if you guys remember reading about that in the other MMT thread. Basically everyone who works early gets to dose first the first 30 minutes of each day including Saturdays where they are only open 6-930.
I am not sure if you even have to work early or if their is a cut off time. It may just be for anyone who has a job and brings in their schedule every 2 weeks gets put on the workers list. No one else can dose the first 30 minutes unless there is no one in there. If someone on the list shows up they are moved to the front of the line. It pissed off a lot of people at first but now I don't hear many complaints about it.
No worries about adding your input about Canada Z. I think most of us are very interested in how things are done there and everywhere else. I think it is interesting to read how other countries are doing things. It seems Canada has a leg up on the US when it comes to addiction treatment.
I have a lot of respect for the woman who started the Heroin maintenance stuff in Canada. My counselor is a huge fan of her and went to a class she did here in Denver about her findings and research of Heroin Maintenance. From what I understand she lobbied for almost 10 years to get the regulations put in place to be able to do research on it and start up a clinic to do so. I love reading about it, it gives me hope.