Just thought I would say hello.

I'm new here......... I will tell you a bit about myself.
I'm a mom of 3 children, my current dose of methadone is 70ml. I have been slowly tapering for 2 yrs. My highest dose was 140mls. I have been clean for 3 yrs and my Dr. refuses to increase my take homes from only weekends to more. I just feel I have been doing so well, I should be getting more carries than only 2 per week!
My Dr. is so difficult! He will not grant me any more carries. I'm very frustrated. I have children that I have to get up and get ready for school everyday. I have had clean urine's for 3 years and I'm tapering down OFF of methadone yet I can't get daily carries?
I just don't get it!
Other than that,...... methadone helped me get my life back, without it I know I would not be here today.
I'm so thankful. It does help if you do it right and don't abuse it.
Anyhow that's just my thoughts I hope everyone is doing well, and never give up. It does work!!!

onmyway

If your Dr./Clinic was going by federal and state regs after 2 years you would only have to dose in your clinic one day a month. You would think after 3 years clean that the clinic would have a lil more trust in you. I know that has to be hard on you. Have you looked into finding a new clinic? I know a lot of ppl drive hr's to get into a clinic and most of the time it's the only clinic they can make it to, so the clinics know they can do anything they want because most ppl have no choice in moving to a new treatment center.

Good luck, hope it works out for you.



~~~If You Aren’t Getting the Take Homes You Deserve?~~~
If you feel that your clinic is unfairly restrictive, you can meet with your doctor to discuss your compliance with federal guidelines. These guidelines are in place to allow individual clinicians the flexibility to reward "good behavior" with take home doses.
If that doesn’t work, you can inquire at any other local clinics about take home regulations, and perhaps find a clinic that allows for greater flexibility.
You can also file a grievance at your local clinic. Your clinic is required by law to have a patient grievance mechanism in place and to respond to grievances within 5 days. (From SAMHSA's Opioid Drugs in Maintenance and Detoxification Treatment of Opiate Addiction; Final Rule (42 CFR Part 8.4.(e))

One thing you have to also consider, Fed Regs are a guideline and a "minimum" of what the clinics have to go by. Each state can have their own rules which may be more restrictive and then again each clinic can have rules in addition to the state and/or Fed regs.

For example, I originally started going to a clinic in Texas. After 2 yrs, I was eligible for once a month take outs. I moved to Louisiana but in Louisiana, the state rules say that you can never have more than TWO WEEKS worth of take outs regardless of how long you have been in treatment. You will NEVER be able to get once a month status no matter if you have been in MMT for 10 yrs. (which was my situation) SO, I ended up driving an extra 25 minutes to attend a clinic in Texas so that I could keep my once a month take out status.

There are other members on the forum who go to clinics that will only ever allow you ONCE A WEEK take outs and you would never be eligible for more than that.

You should have gotten a copy of your clinic rules and guidelines when you started treatment and in it there should be a section about take outs and your clinics policy about take homes. Iif you no longer have them, ask for another copy so you can see what they have in writing about their take home rules.


Do you know if your clinic does allow for more than 2 take outs a week? If so, what reason has your doctor given you for not allowing you to get the advanced take out status? What state do you live in and if you don't mind, what clinic do you go to? If you would rather not give the name of the clinic, that is fine, but I want to research your state regs so if you could at least give me the state that would be great.

I do understand your frustration though. I use to drive 3 hrs one way to get to my clinic and it was so hard waiting for those times when I could get more take outs. I had 2 small babies and a part time job and it was killing me!

Hi! As I envy you! Here I already almost 3 years on the program metaDon-therapy and me every day it is necessary to go behind tablets! And all as go, and it almost 6000 person! At us such laws! But Thank God, that though there is in general a program and for this thanks, and here in Russia in general is not present! Respectfully Denis. Ukraine.

Welcome to the site, this is a very helpful place to seek answers, there are very nice people here that try to help you the best they can. Glad you joined

I just realized something....... we can quote Federal Regulations from the US all we want in response to onmyway's post, but it will do absolutely NO GOOD! ONMYWAY lives in Canada and our rules don't apply at all to her situation........

DUH! Guess I better pay closer attention next time before I start spouting off the rules!

Sorry about that ONMYWAY, I think I do have a Regulations for Canada somewhere, let me see what I can find.

O yea, guess we over looked that part, sorry. Here is what I found ....

http://www.hc-sc.gc.ca/hc-ps/pubs/precurs/opi-treat-trait/index-eng.php

5.6 Carry priveleges

In view of the risks associated with methadone diversion, carry privileges must be limited. Appropriate dispensing facilities (such as pharmacies, hospitals, or treatment centres) should be used for dispensing and administering methadone under supervisionon a daily basis, except for weekends.

In all instances, carry privileges must be limited to a maximum period of four days or a maximum total dosage of 400 mg, whichever is least.
No carry privileges, except for weekends, will be granted to patients receiving more than 100 mg of methadone per day.
NOTE: Carry privileges should be used as a therapeutic tool which is granted as a reward for satisfactory adherence to the treatment contract and is revoked for non-compliance. These conditions should be clearly specified in the treatment contract drawn up at the initiation of treatment.

Maybe this will help, good luck.

yeah I found my copy of the canada regulations . This is the METHADONE MAINTENANCE TREATMENT PROGRAM STANDARDS AND CLINIC GUIDELINES and it is the current 4th edition put out Feb 2011. It is put out by THE COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO,, Section 8.0 and starting on page 49 is the section on takeouts. Here is the original link so be sure and read the entire booklet bu here are the highlights

http://www.cpso.on.ca/uploadedFiles/policies/guidelines/methadone/Meth%20Guidelines%20_Oct07.pdf



►Standards
S8.1 When prescribing take-home doses, the MMT physician shall ensure that patients understand how to store their methadone securely, that they understand the risks of diverted methadone, and that they agree never to give or sell even part of their dose to others.

S8.2 The MMT physician shall not prescribe take-home doses if:

1) the patient is at risk of taking more than prescribed, due to an untreated mental illness or cognitive
impairment

2) the patient is not able to safely store the methadone

3) there is reasonable evidence that the patient is diverting methadone

4) the patient does not understand the risks of methadone diversion.

S8.3 The MMT physician shall prescribe an accelerated take-home schedule only if:

1) prolonged daily pick-up is likely to cause the patient to drop out of treatment because of lack of
transportation or work or family commitments

2) the patient is able to safely store the medication

3) the patient does not have an active addiction or mental illness that increases the risk of methadone
misuse or diversion.

S8.4. The physician may prescribe a Sunday take-home dose after four weeks (rather than eight weeks) only if the patient:

1) is able to safely store the medication

2) does not have an active addiction or mental illness that increases the risk of methadone misuse or
diversion

3) lives in a community that does not have a pharmacy that is open on Sunday

4) has no hospital available for Sunday dispensing

5) does not have transportation to a pharmacy in a different community.

S8.5 The MMT physician shall prescribe take-home doses that are exceptions to the take-home dose schedule (“special carries”) only if:

1) the patient is able to safely store the medication and has good insight for carry safety issues

2) the patient is emotionally stable and displays good judgment to recognize the risks for methadone
misuse or diversion

S8.6 The MMT physician shall reduce the level of take-home doses if the patient has a sustained relapse to
problematic substance use.

S8.7 The MMT physician shall cancel all take-home doses abruptly in the circumstances listed below. The daily observed dose should be reduced if the MMT physician suspects the patient may not have been taking the full take-home dose.

1) There is reasonably strong evidence that the patient has diverted their methadone dose, or has
tampered with their UDS.

2) The patient has missed 3 or more days of methadone (except in unavoidable circumstances such as
hospitalization).

3) The patient has become homeless or in unstable housing, and can no longer safely store their
methadone.

4) The patient is actively suicidal, cognitively impaired, psychotic, or is otherwise at high risk for misuse
of their methadone dose.

5) The patient has recently been released from jail when incarcerated for prolonged periods of greater

than 3 months.

G8.21 Patients may be given 13 days of take-home doses, if the following criteria are met:

1) They have a documented history of full take-home doses and clinical stability, while on MMT, for
5 years or more.

2) There have been no past reported mishaps with lost or stolen carries.

3) They are working, in school or have daily family commitments that make weekly attendance at a
pharmacy difficult.

4) They have been abstinent and clinically stable for most of their time in the program, and they are
reliable historians.


5) The methadone dose is 120mg or less.

WOW, thank-you everyone who responded so fast! I did receive and read the Canadian regulations info. I had an appointment last Monday and asked my Dr. AGAIN if he would pls increase my take homes. He did, ....by 1 extra day. I basically said "Hey, I'm clean, tapering and doing well. Why are you so leery?
He didn't really give me a reason bur agreed to 1 extra day. But, he told me now I will have to give random urine samples with 24 hours notice by the clinic. I MUST come in and do the test or I will lose ALL my carries.
I am not a bad client. I don't disrupt things. Pay my fees EVERY month in FULL.
Oh well, I asked him to drop me another 5 mls ,so now my dose is 65mls . I 'll see how this month goes.
Thanks everybody for your support!!!
This seems like a really great place with good ppl.
Onmyway

Hi, well done on your tapering plan. It seems that your doing so well. I`m currently tapering on my program, about to go to 18lms this week from 20mls highest point this time was 75mls. I did 5mls every two weeks but only took it serious again at the start of the year and stopped using on top. Since then life been good came down from 50mls to present. passed 3 drug tests and due another real soon. I`ve been doing 12step meetings. I`ve been involved for around 3yrs. I have faith in it but not all of it. I belive today in abstance but struggle with higher power stuff.

I`m in England and would be nice to make a few friends on here to have a laugh with who are going through the same stuff. I hope you get your script sorted out. In this country they give it out like pop but to get a weekly take out you either need to be in employment or have a halo on your head. 3x`s weekly seems to be the carrot and stick routine in the area where i live..

Anyways keep it up and good luck with it all.

Thanks. I feel pretty good so far on 65mls. I have heard that it get's really horrible when you get down to under 10mls. I post on another methadone forum and the stories of people tapering off are just scary! I was feeling alright about myself, now I'm worried a bit. Having 3 children and being a single mom, I just can't afford to get sick. Who will take care of my children?
Going into a detox is just not an option because I'm a single mom with nobody to take care of my kids. I have to do this alone. PLS tell me the truth.........can one have a fairly good taper if they go slowly, or does everyone get really sick no matter how slow they go down?

There has to be a way to get off of methadone when a person is ready....and I'm so ready.
HELP!
onmyway

It really is going to depend on the person and how their body reacts. You are right, I think it is that last little bit that is so hard to go from a wee bit, to nothing.

It also has a lot to do with mental preparedness as well. You sound like an upbeat person who has a good outlook on things. DO NOT let what other ppl tell you scare you! You said you were feeling allright about yourself until you started reading the horror stories.......DO NOT let it hurt you! Keep that positive outlook and tell yourself how good you have done so far and that you are ALMOST to your goal! Keep that in mind as you are jumping off that last bit of methadone.


I have had some ppl say they were able to get off that last bit with very minimal problems at all, but then I have known others who struggled with it. There is no definate answer for each person.

Is the 10ml the lowest you can go? I am use to dealing in MG not ML so I don't know how the dosage of methadone works in 10ML. With MG, at 10 you can still go down to 5mg and quite possibly even lower if you can break it into smaller pieces. I would think the lowest possible dose you can go before jumping off into none would be the best way to go.

No matter what, just know that we are here to support you EITHER way. If you find it's too hard and you need to stay on the 10ML a bit longer, or if you are able to hang in there at zero......we are here so don't forget that.

If you want, if you let me know what day it is you are going to try zero, I will make sure I am available for you to talk to during that time and the days following. I imagine if you are going to have any trouble, it will be the days after you stop that will be the hard ones, not necessarily the first day or two.
So keep us posted and let me know if that is something you think would help or not.

Take care and keep that positive outlook on your recovery, YOU ARE ALMOST TO YOUR GOAL!

onmyway,
RuthAnn makes a good point. Please don't listen to what other people say, as long as you know your feel ok, then that's all that matters.
There will always be others ready to tell you their horrors.

I really belive your going to be okay. You know what you want and have the desire to obtain it. If you need anything we will all be here for you.
All you have to do is let us know.