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Sunday, September 17, 2023

The transition from street drugs to a therapeutic level of methadone in outpatient clinics is dangerously slow.

As I write this article, a woman is walking the streets of Kensington, fearfully hoping to be picked up by some random guy so as to ‘do a date.’  Her goal is to have money to buy the drugs she’s working on removing from her life by way of the outpatient methadone clinic she’s been faithfully attending daily for over two weeks.

If you’re thinking that something seems very wrong with that statement, you’re right.  This woman began attending a Methadone clinic 16 days ago (as of this writing).  By policy of the clinic, she started on a daily dose of 20 milligrams.  A therapeutic daily dose for her is about 150 milligrams.  20 milligrams has no therapeutic effect.  Every five days or so, after a required discussion with her counselor, that counselor will submit to the doctor at the clinic a request for an increase. Her dosage will probably (but not definitely) be raised by five milligrams.  At that rate, she will not reach her therapeutic level for 6 to 7 months.

That’s multiple months of simultaneous (intended) therapeutic and illicit drug use.  Methadone is one of several forms of M.A.T. (Medication Assisted Treatment) therapy.  By using it at a therapeutic level, patients can free themselves of ‘dope’ and move on to a healthier life.  If they are not permitted by clinic policy and/or state/federal regulations, to receive a therapeutic amount of Methadone promptly, that interval between starting at a very low level and reaching that therapeutic level will have within it the ongoing use of illicit drugs.  The patient doesn’t want to continue using the illicit drugs but they must so as to avoid the agony of dope sickness.

The fundraising process to buy those illicit drugs…

  • A very few of these patients may have the money available without doing anything to earn it. 

  • Some will rely on family or friends to provide the money. 

  • Others will continue to engage in prostitution, retail theft, or other illegal activities to raise the money.

Of these three modes of money-making, this third one concerns me most. Prostitution (or ‘doing a date’) is dangerous. Assaults and rapes are increasingly common. As an illegal activity, this as well as buying illicit drugs, retail theft, etc. carries with them the potential for a new or lengthened criminal record, time in jail, appearances in court, probation, fines, and more.  

What an incredible miscarriage of justice and shame on the healthcare process for anyone to wind up dealing with these legal issues simply because they were not given a therapeutic dose of an accepted M.A.T. in a timely manner after finding their ‘ready moment’ and starting this as their chosen health recovery process.

While I can appreciate the need to regulate the flow of methadone, the policies of the clinics and the state/federal regulations that are blocking the patients from quickly reaching therapeutic levels of Methadone need to be in better balance with the reality of the patient’s desire to be illicit drug free.  

As it is now, the drug trade is the big winner here while these M.A.T. patients continue to buy that which they are seeking to remove from their lives.  Family and friends who don’t want to see their loved one prostituting are put in a terrible moral dilemma to be or not to be the funders of the drugs that their loved one is seeking to remove from their lives. And let’s not forget, with the use of illicit drugs, overdose lurks in the shadows.

There is something very wrong with this current system of Methadone distribution in outpatient clinics. Let's identify why the system is the way it is and how it can be improved upon so as to allow these patients to achieve their therapeutic level sooner and get on to a healthy life.

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