Hello Annette:

From my experience with methadone maintenance and take-home regulations, I find it unlikely that the reason the Feds do not like to issue approval for take-homes to people with high doses is one of self-medicating our problems away. More likely it is the possibility of illicit diversion of methadone to the black market which concerns them. Now the percentage of patients who have done this is probably infinitesimally small compared to all the people who are methadone maintenance patients. But this is, in my opinion, the primary concern of the Feds.

When I first started my treatment (10/9/1970), we were given extremely high doses of methadone. The highest dose I ever received was 130mg/day. At that level, I experienced symptoms which I thought were related to withdrawal. In fact, it turned out that I was being overdosed. When my dose was lowered to about 80mg/day, I felt much better. This is simply my experience at the time and I'm not saying that it is a universal truth for everyone. I'm just throwing out a thought to consider. At any rate, right now I would not want a dosage level higher than about 50mg. Even at that level I tend to get drowsy for a few hours after dosing. I try to keep my dosage level as low as I can due to two reasons: 1. I need to be very alert at most times because I am taking classes in geological science and computer applications and this requires extensive note-taking, research and study. 2. I fear the clinic and its methods of operation; I never know what situation may arise which will cause them to play with my biochemistry. Anyway, back to your situation.

Undoubtedly, the endorphin/enkephalin production in your body has been severely curtailed because your body hasn't needed to produce them at anything like a normal level. You and I, and most other people who have used opiates extensively have introduced compounds into our bodies which supplant the natural production of endorphins/enkephalins and therefore our bodies don't produce them to any great degree. I suspect that our ability to produce them has been adversely affected, and when we attempt to quit using the chemicals which have replaced them at the receptor sites, our bodies have to re-establish the ability to produce the natural body opiate compounds. It may be possible that, for some of us, the ability to make these body opiates has been permanently affected and we cannot re-train our bodies to do this. Also, it is possible that many of us have defective endorphin/enkephalin production systems to begin with.

Anyway, I sympathize deeply with your situation. You will undoubtedly have to establish an extensive history of clean UA's to convince your clinic and the Feds that you are a good risk for special consideration for high-dose take-home medication. Out here in So. Calif. it takes a minimum of 2 years of continuous clinic attendance with completely clean UA's to be able to reduce attendance at the clinic to twice a week. Recently, the option of once a week attendance has been offered. I know of no one eligible for this level at our clinic, and God knows what hoops you'd have to jump through to get approval to do this.

I wish you the best of luck in obtaining your take-homes. I believe that the more often an addict is required to associate with other practicing drug users, the less likely it is that successful rehabilitation will occur. I know that at our clinic, much of the time it is hard to get by all the people hustling, doing deals, etc, and that just tends to open my nose up, so to speak. The clinic tries to curtail the activity, but you would need an armed guard outside most of the time to truly affect all the goings-on. For people in our situation, the best solution would be to have us pick up once a week at our local pharmacy, and check in with our home clinic once a month for counseling, paperwork, physical exams and the like. I hope this will happen someday. Good luck!

Sincerely, WSB

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Posted on: 10/17/97
Last modified on: 10/23/97