Are Methadone Clinics Glorified Drug Dealers?
Methadone Maintainence Therapy (MMT) began in the 1960’s, in the United States and remains controversial today. Long half life Methadone is used as a replacement for heroin and other opiate and opioid medications, in MMT, offered at methadone clinics. Many argue methadone clinics reduce crimes caused by heroin addicts and reduce the personal and societal cost of heroin and other opiate addictions. Others argue methadone clinics merely replace one addiction with another. Methadone is the most difficult opioid to detoxify from, due to the extremely long half life.
Methadone tapers seldom work
Very few methadone patients succeed in withdrawing from methadone and remaining opiate free. In a 41 month study of methadone dependent veterans, none of the 30 veterans studied, succeeded in becoming methadone free, without using the opioid medication, buprenorphine. Four patients, 13.3 percent, succeeded in becoming methadone free, using buprenorphine. www.oatc.ca/research/Slow.tapering.from.methadone.maintenance.in.a.program.pdf
Illicit methadone reported easy to obtain
Unfortunately, methadone is abused, as an illegal street drug, by many addicts and has a high black market value. To reduce illegal diversion of deadly methadone to the drug black market, methadone clinics generally require methadone patients to report daily, to the methadone clinic, for witnessed methadone dosing.
The few clues that should have warned me against Methadone Maintenance escaped me then, as I ignorantly believed that hydrocodone addiction was the worst addiction one could have. I should have looked at the fact that people will wait outside the clinic doors in freezing cold weather just to be able to be the first in line at the Methadone clinic’s counter. I should have realized that if they are worried one may actually take the Methadone outside the clinic in their mouths, there must be someone willing to then buy the Methadone that had once been inside that patient’s mouth. It did not occur to me, however, that my measly little pill addiction was not something that would cause that behavior. I would never have bought a pill someone smuggled to me inside their mouth. No way. It did not occur to me that perhaps Methadone was a drug that could cause someone to be that desperate in obtaining more.
That first day, however, nothing anyone could have told me would have ever swayed my support of this ingenious little answer known as Methadone Maintenance. I was on cloud nine, if there ever were such a place. Methadone was it, buddy, and if you didn’t think so, you just had not tried it before. I was higher than I had ever been on any other opiate, and for that matter, on any other drug I had tried up until Methadone. It was the god of highs. It was my answer. And the very next morning, bright and early, I was up and standing in that line, ready to receive that second dose of 30mgs, which I actually did not need because I was still as high as a freaking kite. Upon standing once again at that counter and peering into the window at the seemingly imprisoned nurse, I went through the signing and paying routine, again only $11, and was then asked, “Is 30mgs holding you?” I answered that it was, and she told me that if it does not, I can go up 5 more milligrams. In fact, a Methadone Maintenance patient at that time could go up 5mgs a day until they reached 50mgs. At that point, they could increase another 10mgs a day until they reached 100mgs. And the $11 per day remained the same, no matter what milligram a Methadone Maintenance patient dosed at. These days, the milligram allowed is much higher per day. EMPHASIS ADDED
Jeanne Sparks-Carreker ,Methadone: The Cure for Opiate Addiction? April 11, 2007 Used with permission from the author
Methadone is promoted as an inexpensive opiate medication, which does not cause a buzz or high. If methadone is dosed correctly, despite variations of almost 100 fold, in individual rate of methadone clearance from the body and interactions with dozens of prescribed and unprescribed medications, methadone does not cause a high or buzz. During the first two weeks of methadone medication, patients are 7 times more likely to die, while physicians perform the extremely difficult task of determining the correct dose of methadone. Clinics often overdose methadone patients and many opiate addicts intentionally mislead physicians and clinic staff to obtain the high or buzz from excessive methadone doses.
Some methadone clinics allow “take home” methadone doses, to methadone patients, who have consistently provided “clean” urine samples, without amphetamines, cocaine, morphine, benzodiazepines or barbiturate metabolites or residues. Many methadone clinic patients report selling part of their take home dose, which is provided as a pink liquid.
Illegal diversion of dangerous clinic methadone is not new.
Illegal diversion of methadone prescribed by methadone clinics has been occurring, for over a decade. Unfortunately, regulatory agencies and methadone clinics often fail to respond adequately, to prevent illegal diversion, of potentially deadly methadone.
At a hearing on August 2, 1989, the Select Committee heard from DEA officials regarding a month-long DEA undercover investigation of methadone diversion in the vicinity of methadone treatment programs in the five boroughs of New York City in August 1988, during which agents were able to purchase 98 containers totaling 5.45 grams of methadone, with an average price of about $35 per 80 mg (U.S. Congress, 1989, pp. 150–152; A.L. Carter, DEA, personal communication, April 15, 1994). Agents observed as many as 20 to 25 people selling their methadone at a given location. As a result of this investigation, DEA, in cooperation with FDA and the New York State Bureau of Controlled Substances, inspected five programs near which illegal methadone sales had been observed. The violations found at two of these programs led to the initiation of proceedings to have their DEA registration revoked (the cited problems were later corrected). The results of this action appeared on a nationwide news broadcast and were reported at a hearing of the Select Committee in March 1990 (U.S. Congress, 1990). Thus, methadone diversion remained before members of Congress and the public. EMPHASIS ADDED http://www.nap.edu/openbook.php?record_id=4899&page=98
In March 1992, acting on the basis of an undercover purchase of illicit methadone, DEA ordered a privately owned, for-profit methadone clinic in Houston to show cause why its license to dispense methadone should not be suspended. The clinic was closed and this closure was soon followed by similar orders to close two more clinics—all three owned by the same person. DEA orders to close these three clinics were described in a series of articles by the Houston Chronicle (e.g., “Methadone Clinic Shut in Raid Here,” March 19, 1992, and “2d Methadone Facility Shuts Down,” April 10, 1992), which were distributed over the national wire services and publicized widely. The 1992 DEA investigations were discussed in a 1995 Institute of Medicine report.
A San Francisco methadone clinic was unable to account for 22,069 milligrams of methadone, when inspectors with the state Department of Alcohol and Drug Programs dropped by BAART’s Market Street facility in May 1999. A year and a half later, inspectors returned to find the clinic didn’t know what had happened to 18,088 milligrams of methadone. (Fatal methadone overdoses, have resulted from single methadone doses as low as 20 milligrams.) EMPHASIS ADDED http://www.sfbg.com/37/51/cover_kingpin.html
Creative Living magazine exposed illegal methadone dealing and inadequate regulation of Atlanta area methadone clinics, in a 4/04/01 article, which is available at http://atlanta.creativeloafing.com/gyrobase/Content?oid=oid%3A4156 Creative Living reported all of the following, in the 2001 article, by MARA SHALHOUP.
Clinics regularly give methadone to patients who haven’t proved an addiction, increase dosages without a physician’s approval and provide take-home doses even to patients who were caught selling previous take-home doses on the street.
Some of metro Atlanta’s 10 methadone clinics have gone up to four years without state inspections, and some have faced no penalties or follow-up visits despite reports of multiple violations of state and federal regulations. One was skewered in a 1995 inspection report citing “serious violations,” but the state didn’t get around to visiting again until last year.
“It’s an open-air drug market in those clinics,” says Bill Reeves, a former heroin addict who spent three years in a methadone treatment program. “They’re worse than dope dealers. The way it’s dispensed is wrong.”
At GPA Treatment Center in Doraville, a patient caught selling methadone was allowed eight take-home doses the next month. Counselors, not physicians, had been writing medication orders for four years, according to a 1995 inspection report. For three days, the pharmacy door was left open. “The program’s accountability for methadone was very poor,” the DHR noted.
At the end of that inspection, the DHR listed more than a dozen violations and eight recommendations for improvement. Hester wrote: “It should be noted that all of the above recommendations concern serious violations of applicable rules and regulations.” The letter urged the clinic to “take all steps necessary to come into compliance with all applicable state and federal rules and regulations.”
That letter was sent shortly after the 1995 inspection. The DHR did not check on the clinic again until November 2000.
“You walk in with $10 and a picture ID, and you’re high for two days,” Reeves says of opportunistic patients he knows at one Atlanta-area clinic. “You take a drug test, but it doesn’t come back for a week. It takes 30 minutes to get dosed. I didn’t even see a doctor.”
Patients interviewed by CL claim they can easily work the system to get more methadone. State rules say clinics can start a patient on a maximum dose of 30 milligrams and can increase the dosage until signs of withdrawal disappear.
Although authorities have been aware of patients illegally reselling methadone obtained from clinics, many methadone clinics fail to adequately supervise patients today. An August, 2007 undercover video, filmed at the Parkville methadone clinic, in West Philadelphia, revealed suspicious activity, indicating drug dealing was apparently occuring immediately outside the methadone clinic building. When the methadone clinic learned NBC 10 was filming outside the clinic, security was increased and the suspicious activity ceased. A former addict reported, going to Parkville was a disaster for her. “They sell drugs right out front of the place. It’s kind of hard when you’re first trying to get clean to walk out of the place and they’re selling drugs right there in your face, mostly pills. They sell their methadone bottles, you know, their take-home bottles,” the former addict said. EMPHASIS ADDEDhttp://www.nbc10.com/news/13868849/detail.html
Illegal diversion of clinic methadone also occurs in Australia, where almost a third of injection drug users reported using illicit methadone syrup, in the preceeding six months. Illicit methadone was reported easy or very easy to obtain, by injection drug users.
Many methadone clinics are closed on Sunday and allow all patients a “take home” dose, Saturday, to prevent methadone withdrawal, on Sunday. Reporting to the methadone clinic daily for a methadone dose, is costly, inconvenient and prevents some methadone patients from obtaining employment. In May, 2007, a Pensylvania methadone clinic patient was arrested for selling clinic methadone to undercover officers, three times. Fortunately the Discovery House, where he was treated, opened all of their methadone clinics, on Sundays and ceased providing take home doses, on Saturday, to reduce illegal sales of liquid clinic methadone. http://www.phillyburbs.com/pb-dyn/news/113-08282007-1398732.html http://www.phpbbplanet.com/methadonedeath/viewtopic.php?t=289&highlight=parkside+clinic+west+philadelphia&mforum=methadonedeath
Most methadone clinics are open from approximately 0500 AM, till about 1200 AM. Strangely, few methadone clinics are open in the evening, when daily methadone dosing might interfere less with employment, education and childcare. While liquid clinic methadone is a source of dangerous illegal methadone, methadone tablets or diskettes, prescribed to outpatient pain patients, by nonclinic physicians may be contributing even more heavily to the methadone overdose epidemic.