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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 essentia

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 9mo ago
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.
- lazarus01 9mo ago
  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.
- 20after4 9mo ago
  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 9mo ago
    Was there some stated rationale for the dose increase?
    - 20after4 9mo ago
      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.
    - 20after4 9mo ago
      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.
      - XorNot 9mo ago
        Did it work? Is he clean?
- herbst 9mo ago
  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)
- vixen99 9mo ago
  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/10.3389/fpsyt.2019.00591/pdf https://www.frontiersin.org/journals/psychiatry/articles/10....
- scotty79 9mo ago
  > 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.
- kakacik 9mo ago
  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 9mo ago
    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 :)
SkyPuncher 9mo ago
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 9mo ago
  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)

deepsun 9mo ago

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.

lazarus01 9mo ago
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.
20after4 9mo ago
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 9mo ago
  Was there some stated rationale for the dose increase?
  - 20after4 9mo ago
    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.
  - 20after4 9mo ago
    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.
    - XorNot 9mo ago
      Did it work? Is he clean?
herbst 9mo ago
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)
vixen99 9mo ago
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/10.3389/fpsyt.2019.00591/pdf https://www.frontiersin.org/journals/psychiatry/articles/10....
scotty79 9mo ago
> 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.
kakacik 9mo ago
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 9mo ago
  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 :)

SkyPuncher 9mo ago

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 9mo ago
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)