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rhianmoon

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Jun 30 14 10:20 AM

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I just spoke to someone at a clinic I was thinking of transferring to. I told him I have been on mmt for 13 years. He immediately told me I need to get an EKG to test for elongated QP. He said they are seeing this on people who do or have taken opiates in any form for a long period of time. He was not surprised I have never heard of it and neither has my doctor. I just sent a request for an EKG to my primary since it's been a long time since I have had one and he did say unless you tell them to look for this syndrome, it is missed. Has anyone ever heard about this or any other possible problems from long term mmt? I appreciate any comments! Thank you.
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cherbear

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Jun 30 14 12:15 PM

Rhianmoon-QT Prolongation is a hot topic in MAT. If you go to the articles and brochures section here at AT Watchdog there are several references. You know, the best I can say is that every patients heart and heart risks are different. I don't think that it is a reason to kick people out of treatment but for some will need to be watched. A baseline EKG is not a bad idea. IMHO. If your current clinc has not asked for an EKG it could be that they do not feel like you fall into a risk category-dose over 120? multiple QT prolonging meds?, smoker?, heart issues in family? That said it is a highly debated topic. How concerned the MD is about it will vary from MD t MD.

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rhianmoon

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Jul 1 14 6:24 AM

Thank you for your reply. I am a higher risk as my dose is well over 100mg a day and I do smoke, have kidney disease and always had a heart murmur that was never a real concern. I'm sure my primary will honor my request for an EKG when she gets back in her office Thursday. I would feel much better having it checked especially since it's been a while. 

The new clinic Evergreen that just opened close to me is unable at this time to grant monthly take homes because they only give tablets for that and don't have them yet. The person I spoke to told me that their other clinic which is further but would still be closer than my current one that the medical director would have to approve my transfer because of my dose and they generally do not have people on more than 100mg or so. I certainly cannot go down in dose, I've been on it for offer 10 years and I still have symptoms in the morning prior to dosing. I do not want to increase but I know I cannot decrease either. It's looking like I am stuck at my current clinic. 

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cherbear

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Jul 1 14 1:18 PM

R-States are not supposed to have DOSE CAPS. Dosages are supposed to be individually determined by individual patient need, not some arbitrary rule.
Get you EKG checked out so the MD has an idea of what kind of shape your heart is in-maybe there is room to adjust your dose and get served by the closer clinic once they get their dry meds.

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sapphire76

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Jul 2 14 5:52 AM

SAMHSA have said that unless patients have increased risk, just being on MMT is not enough to warrant EKG'ing everyone. Your doctor is also incorrect when he states that it would be missed on an EKG. There is a specific section on all EKG's where the QTc is measured.

Thing is, even things like anaemia or thyroid issues can interfere with the QT interval. As a woman, yours should be 470ms or below to safely continue with methadone.

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rhianmoon

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Jul 2 14 9:01 AM

I really appreciate everyone's response. It was a supervisor at the new clinic who told/advised me about the EKG. I should get one since it's been a while anyways. Thank you al! I know there are not supposed to be dose caps but a clinic I have been to would not go over 100mg. They have closed a while ago but it took me a long time to finally get to a dose that is good for me. I'm getting ready to call the clinic that is a little closer than my current one to see what there deal is. Wish me luck! 😊

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mythoughts2

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Jul 2 14 9:07 AM

No, a clinic cannot legally tell you that they won't take you because of your dose. Also. prolonged QTs can occur whether you are on MMT for a week or 10 years. It is asinine to say that you are at more risk b/c of the length of time on treatment.

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rhianmoon

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Jul 2 14 1:11 PM

I am not surprised by what you are telling me. I had told the guy who told me this that I have never heard of this problem and obviously the 3 physicians (including an addiction specialist) have never warned me or mentioned this at all. Having stage 4 kidney disease, I am as careful as I can be and I feel my doctors are good and have my best interests at heart. 

I have put put a call to the other clinic that is closer and waiting to hear back. Even though it is the same company as the one who told me about dosing and the needing an EKG, I am hoping the person from this one is able to help me. It is a good 20 some miles closer to me and $30 a month cheaper but I won't transfer if they have issues with my dose and 30 day take homes. I do kmow initially I would come in multiple times the first month or so and then hopefully have my monthlys reinstated.  

Im am going on my first vacation in a number of years in October so I don't want to lose any take home doses. I hope this new clinic will be decent to me.

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xjunkie4jesus

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Jul 7 14 8:17 PM

EKG

Docs here in Maine make you have an EKG to start certain Psychiatric Meds but the 2 clinics I went to never asked for 1!-just a physical exam when I started.

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wayovermyhead

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Jul 8 14 9:34 PM

I have posted many many topics and brochures regarding QTC Issues and Methadone.......Cherbear has it right check in brochures......

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wayovermyhead

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Jul 8 14 9:37 PM

SAMHSA no longer supports qtc interval EKG's for MMT....

No Evidence to Support QTc-Interval Screening in Methadone Maintenance Treatment: Cochrane Review

EKG“Methadone represents today the gold standard of efficacy for the pharmacological treatment of opioid dependence,” states the newly published (June 20) Cochrane Review on QTc interval screening for cardiac risk in methadone treatment. The review goes on to say that “methadone, like many other medications, has been implicated in the prolongation of the [QTc] interval of the electrocardiogram (ECG), which is considered a marker for arrhythmias such as torsade de pointes (TdP).” It further notes that the recommendations and consensus statements regarding QTc screening developed for patients receiving methadone maintenance treatment (MMT) have been questioned

At times, that questioning has been contentious (see issues of theAT Forum newsletter: Spring 2009, Summer 2009, and Winter 2012 ).

Cochrane investigators undertook a review study “to evaluate the efficacy and acceptability of QTc screening” to prevent cardiac-related morbidity and mortality in MMT. The authors performed an extensive search of MEDLINE, EMBASE, other databases, and electronic sources of ongoing trials, and identified 872 pertinent records.

Their finding: “No evidence has been found to support the use of the electrocardiogram (ECG) for preventing cardiac arrhythmias in methadone-treated opioid dependents.”

Gold Standards

Just as methadone is considered the gold standard in treating opioid dependence, Cochrane reviews are internationally recognized as the gold standard in evidence-based medical information. Using predefined criteria, Cochrane researchers conduct meticulous statistical data analyses to determine the efficacy of medical interventions. Cochrane Reviews are published by The Cochrane Collaborationan independent nonprofit organization with 28,000 volunteers in more than 100 countries.

Existing Screening Recommendations

Screening guidelines recommended several years ago by an Expert Panel (Krantz, 2009) were a pretreatment ECG for all patients being considered for methadone treatment, to measure the QTc interval; a follow-up ECG within 30 days and annually; and additional ECGs if the daily methadone dosage exceeds 100 mg, or if unexplained syncope (loss of consciousness) or seizures occur.

A different Expert Panel (Martin, 2011) recommended instead a baseline ECG at the time of admission and within 30 days only for patients with significant risk factors for QT prolongation, and additional ECGs annually, or whenever the daily dose exceeds 120 mg.

Untoward Consequences of ECG Screening

The Cochrane study points out that the procedures involved in ECG screening may be “too demanding and stressful,” and “may expose patients to health consequences of untreated opioid addiction, including increased mortality risk.”

Untoward health consequences can occur when unnecessary evaluations and false-positive findings result in delays for additional studies and other treatments. In the meantime, some patients’ opioid addiction goes untreated, with potentially fatal outcomes—a factor that “does not seem to have been appropriately ruled out” by those drafting the screening guidelines, according to the authors.

Key Points in the Review

  • QTc prolongation is “not a safety concern per se,” but a “sharply imperfect” surrogate marker for the risk of TdP. A QTc longer than 500 milliseconds—considered the threshold of increased danger—is found in about 2 percent to 16 percent of MMT patients. But the prolongation isn’t necessarily due to methadone; liver disease, low potassium levels, and therapy with a variety of drugs also prolong QTc in MMT patients.
  • Estimated mortality for TdP is about 10 percent to 17 percent. But the “supposed involvement of methadone in TdP-related mortality” is thought to be only 6 deaths per 10,000 patient-years. Studies typically do not rule out other known risk factors, such as heart disease and various medications, so the true figure is probably lower. In contrast, mortality of untreated heroin dependence is estimated to be far higher: 100 to 300 per 10,000 person-years. Methadone maintenance, with an annual mortality rate of 0.1 percent, reduces by 2 to 11 times the mortality risk of people with opioid dependence.
  • The benefits of methadone treatment include increased retention in treatment, and a reduction in opioid use, HIV transmission, and mortality.
  •  Other treatments for opioid dependence with substantially lower risk of cardiac complications, such as buprenorphine, are available, but “their pharmacological profile, efficacy and acceptability by patients do not allow them to be thought of as an easy alternative to methadone.”
  •  “Undue focus on QTc prolongation,” which may not be an appropriate way to screen for TdP, may decrease patient safety by diverting attention from other risk factors.
  •  Planning and performing ECG screenings isn’t easy; most physicians and many cardiologists cannot correctly calculate a QTc and identify a long QTc.

Unable to find any study that fulfilled methodological criteria for their review, The Cochrane authors said “it is not possible to draw any conclusions about the effectiveness of ECG-based screening strategies for preventing cardiac morbidity/mortality in methadone-treated opioid addicts.” Their recommendation: “Research efforts should focus on strengthening the evidence about the effectiveness of widespread implementation of such strategies and clarifying associated benefits and harms.”

In summing up, the authors note the lack of scientific evidence supporting ECG-based screening, and point out that “many examples of screening tests that were believed to be efficacious and recommended until rigorous evaluation showed their disadvantages are reported in the literature.” So, this appears to be another case of recommendations and guidelines being enacted “without the scientific rigour applied to other areas of medicine.”

The Cochrane study, with a complete description of study methods and results, is available for purchase through the Wiley Online Library at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008939.pub2/abstract

Resources

Krantz MJ, Martin J, Stimmel B, Mehta D, Haigney MC. QTc interval screening in methadone treatment. Ann Intern Med. 2009;150(6):387-395. doi:10.7326/0003-4819-150-6-200903170-00103.http://www.tandfonline.com/doi/abs/10.1080/10550887.2011.610710#.UdL01zssnj4

Martin JA, Campbell A, Killip T, et al. QT interval screening in methadone maintenance treatment: report of a SAMHSA expert panel. J Addict Dis. 2011; Oct;30(4):283-306. doi: 10.1080/10550887.2011.610710.http://www.tandfonline.com/doi/pdf/10.1080/10550887.2011.610710

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Jul 8 14 9:40 PM

Here is article about it....from AT Forum

SAMHSA Panel: No Mandatory ECG Testing for OTP Patients


 A panel convened by the Substance Abuse and Mental Health Services Administration (SAMHSA) has stopped short of recommending mandatory
electrocardiograms (ECGs) on patients treated with methadone in opioid treatment programs (OTPs). In “QT Interval Screening in Methadone Maintenance Treatment: Report of a SAMHSA Expert Panel,” published November 3 in the Journal of Addictive Diseases, the panel described the process that resulted in the inability to recommend ECG screening for all OTP patients.

The panel, convened initially in 2007, was charged with coming up with recommendations for addressing cardiac risk—specifically, an arrhythmia that can lead
to a dangerous condition known as torsade de pointes (TdP).  An erroneous report by this panel on cardiac effects was published—and later retracted—in the prestigious Annals of Internal Medicine (see related links). Finally, the case has been closed: no required baseline ECGs on OTP patients. There was no consensus
—five panel members voted to recommend baseline ECGs, and four voted against.

The story began six years ago when the Food and Drug Administration (FDA) issued an alert relating to methadone and cardiac arrhythmias, followed by a warning label. At higher doses, methadone may prolong the QT interval.

It’s important to note that the presence of QT prolongation does not necessarily lead to TdP, and that TdP can also occur in people who have normal QT intervals. It is also important to know that many medications are related to QT prolongation, alone and in combination with others.

Nobody knows how many OTP patients have suffered methadone-related arrhythmias. “It’s hard to put a finger on it; we really don’t have that much data,” said Anthony Campbell, DO, medical officer with the division of pharmacologic therapies at SAMHSA’s Center for Substance Abuse Treatment (CSAT). “The only way you can capture this is if you have a Holter monitor on the patient at the time of event.”

Panel Recommendations

The recommendations from the panel: Patients with significant risk factors for QT prolongation should have a baseline ECG at admission, and again within 30 days, the panel agreed. These risk factors include a history of cardiac arrhythmia or prolonged QT interval; symptoms suggestive of arrhythmia, such as episodes of syncope, dizzy spells, palpitations, or seizures; medication history; family history of premature death; or any other historical information suggestive of a possible cardiac arrhythmia.

Nothing in the recommendations has the force of law or regulation behind it. These are recommendations only. “Opioid treatment programs and other providers are encouraged to consider these conclusions to the extent that they are practically or financially capable of doing so,” the article concludes. “Nothing in this report is intended to create a legal standard of care for any opioid treatment program or to interfere with clinical judgment in the practice of medicine.”

Not a ‘Major Danger’

OTPs have been divided by this issue. “When we went to the initial meeting the deck was stacked,” said Brian A. McCarroll, DO, of BioMed Behavioral Healthcare in Sterling Heights, Michigan, one of the panel members who voted against requiring ECGs of all patients within 30 days of admission. “It didn’t matter what the clinical evidence was, they wanted something to come out that said this is a major danger with methadone. And it’s not.” Dr. McCarroll is a diplomate of the American Board of Addiction Medicine.

While screening ECGs should not be mandatory for all new OTP patients, complete cardiac histories should be, he said. “If someone has a history of dizzy spells that could be a sign of an arrhythmia, it would be prudent to do an ECG.”

Prevalence of Prolonged QT Interval

The panel concluded that 2 percent of OTP patients have a very prolonged QT interval. If so, of the 250,000 people currently enrolled in OTPs, 5,000 would need “interventions for cardiac risk reduction,” and an additional 40,000 to 60,000 would have a lesser risk but may need an intervention, the article states.

One of the factors the panel considered in coming up with its recommendations was “compelling evidence that the majority of physicians who direct treatment in opioid treatment programs are not fully aware of methadone’s association with adverse cardiac events,” the article stated. In one survey, only 41 percent of 692 physicians in OTPs were aware of methadone’s QT-prolonging properties, and only 24 percent were aware of the possible risk for TdP.

Costs of ECGs

“There were some people who said requiring screening is wrong because OTP patients can’t afford the cost of going to a cardiologist,” said Robert Lubran, MA, MPH, director of CSAT’s Division of Pharmacologic Therapies. “We took the opposing view, which is that it’s
important for patient care and patient safety that the medical staff be aware of this potential problem, and that it’s really incumbent on them to help the patients access needed services.” According to Mr. Lubran, ECGs cost about $100.

If OTPs themselves don’t offer ECGs—and Mr. Lubran acknowledges that many can’t—then it’s “incumbent on the OTP to help the patient find an affordable medical service.” Some OTPs are going to become medical health homes, which means that they will be able to offer affordable ECGs, he said. “And as we’re moving toward health care reform, everybody is supposed to have access to primary medical care. This is another step. We are suggesting that programs understand the consequences of not screening.”

Another argument against requiring ECGs, said Mr. Lubran, was that patients who couldn’t afford them would then be denied treatment. “One side said it was better to get people into treatment, and the other said it was better to get the ECG baseline done at admission.” He has also heard the argument that programs will discharge patients or reduce their dose if they appear to have cardiac risks. “We have never made any recommendation that suggests the answer is discharging patients,” he said. “We don’t want programs to take the easy way out and discharge patients instead of doing a reasonable assessment and treating them as the standard of care provides.”

CSAT was to meet in late January to discuss the issue further. Mr. Lubran admitted that there is still controversy about whether QT prolongation contributes to deaths. But there’s enough data to warrant a cardiac risk assessment on each patient. “Whether that includes an ECG or not is up to the OTP,” he said. “Nobody is being required to do this by the federal government.”

Resources:

Krantz MJ, Martin J, Stimmel B, Mehta D, Haigney, MC. QTc interval screening in methadone treatment. Ann Intern Med.2009;150(6):387-395.
http://www.annals.org/content/150/6/387.full?HITS=10&hits=10&RESULT=&maxtoshow=.
Accessed February 20, 2012.

QTc Interval Screening – AATOD Policy and Guidance Statement. March 30, 2009. American Society for the Treatment of Opioid Dependence, Inc. New York, New York. http://www.aatod.org/qtc.html.  Accessed February 20, 2012.

Mandatory QTc Screening for Methadone Patients – OTPs Respond to Published Guidelines. ATForum. 2009 #2 (Spring); vol 18. http://atforum.com/newsletters/2009spring.php#QTc.
Accessed February 20, 2012.

For a link to the abstract, go to http://www.ncbi.nlm.nih.gov/pubmed/22026519.
Accessed February 20, 2012.

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sapphire76

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Jul 12 14 6:04 AM

As SAMHSA are no longer saying that patients should be EKG'd upon admittance to treatment, I don't know why clinics are persisting with it. Capping doses 'in case' a patient might suffer from LQTS is crazy, as it's more likely to put their health at risk from them using on top of their script and possibly OD'ing, getting HepC/B or HIV etc.

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rhianmoon

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Jul 12 14 2:54 PM

I spoke to the intake person at another clinic that the person who told me about this issue is also a supervisor. He works at both clinics as they are owned by Evergreen. I am having my records faxed so the doctor can review and see if they will take me. I have reservations because I was told I will have to come in everyday for a month and then they will see what they want to do as far as take homes go. I was also told I would have to take them in tablet for  because they do not send home that much liquid dose. I asked her why and she said because it expires. I have never had anything but liquid and I know it doesn't expire within the 28 days I have at home. I am not familiar with the tablets and when I asked her if they are the diskettes that have to be dissolved in water she didn't know. They have the 20mg ones which would be a lot of pills for my 225mg a day dose. 

If my clinic was better and wasn't screwing around with my money and insurance (they owe me over $700) for months, I would be happy to stay put. Evergreen is a little cheaper and would be a good 25 minutes closer also. 

I'm pissed that I would have to go daily for a month (along with a couple of their mandatory classes) and still not sure how many take homes I would get. I don't want to give up my monthly status as it took a long time to get. I really hope methadone clinics become more reasonable in the future.if we have been on mmt for many years and have clean ironies etc. we should be able to just have to pick up our monthly meds without all the bullshit that comes with it. 

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wayovermyhead

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Jul 13 14 8:15 AM

acclimating to a new clinic is scary as you never know until it's too late what is the "usual protocol"

rhianmoon wrote:
I'm pissed that I would have to go daily for a month (along with a couple of their mandatory classes) and still not sure how many take homes I would get. I don't want to give up my monthly status as it took a long time to get. I really hope methadone clinics become more reasonable in the future.if we have been on mmt for many years and have clean ironies etc. we should be able to just have to pick up our monthly meds without all the bullshit that comes with it. 

Many people ask me why do I drive 1000 miles every 2 weeks to a clinic when there are clinics much much closer, and well, "usual protocol" is one of the several reasons why......I know what is expected of me and I know what I can expect of them.  I am so thankful  as listening and reading some of the situations and incidents that people are in with their clinics I come to realize MY CLINIC is one of the VERY BEST in operation.  

I don't like some of the rules such as we do EKG's and this can be issue upon admitting a patient or not but I was "a fall between the cracks" patient or I possibly would not be a patient there today or ever.  Upon admission they had tried to draw blood work and none of them could hit a vein so it was eventually forgotten about.  Also I did in fact need an EKG because they had failed to do one at admission and ended up doing one at 6 months and my qtc's were 527....I was suppose to get a repeat one in 3 months after that and then they would have to possibly alter my medication to a lower dose or put me on Suboxone so I had deliberately been dodging that bullet for quite a while and She knew I was one of the patients that could not pee in front of people as I was always doing swabs. Now all of a sudden 18 or 19 months into MMT treatment, I am hit with all this blood work that is almost impossible to get from me, an EKG that was going to probably cause me to get my dose lowered and/or switched to Suboxone and have me do an observed UA as she has claimed there was a rule that every 3rd UA was a mandatory observed and I had somehow always got away with swabs.     

I am convinced  this interest had arose from me challenging her in the lobby with a comment she had made i.e. "there are plenty more junkies out there on the streets to replace you all in the line if you don't like the way we do things around here".  She had not said this to me but had said it to another patient in her window she was refusing to dose because they had failed to bring their empty bottle back from the weekend.  This was a nightmare and caught me so off guard though as I would not think a Nurse would retaliate by "looking and fishing" thru my file etc...to find ways to screw me.......That morning I walked up to the counter to pay my fees and I was told that Terri (the Nurse) had flagged my chart and I needed to have an EKG, schedule a peak and trough test and do an observed UA before I could dose.  

The EKG was my biggest fear as the doctor who was brand new had made it emphatic to me that he was not satisfied with my methadone needs with readings that high.  She knew all this as she had been the nurse to do the EKG.  It was almost 2 years that methadone had given me life back and that day I found myself in utter fear of losing it.  I was hysterical, even drove around to my dealer's house in search for Opana's because I was giving up.  I might as well before they/she takes it all away.   This is how and why I am on the DAWG (our forum) right now.....I turned to the computer for help that very day and found it.....I was researching methadone and qtc's and posted a long long post on here (the DAWG) about all the above.  I was told to file a grievance on the nurse the very next day (which I did) and ended up switching clinics a few days/week later.  I was not going to take any chances of this Nurse compromising my MMT treatment my dose needed increasing not lowered.  I had learned from people on here that day she was seeking my levels in asking for the Peak and Trough probably to suggest I get a lowered dose. I was unable to do the observed UA that day (as I am sure she already knew I would not be able) so I was thinking I would lose my takehomes and/or worse yet discharged or switched because of qtc's which were 524 that day.

Long story shortened just a tiny bit...lol....I was called back by the Administrator/Director.  He had already told me the day I left that the nurse had lied there was no rule about the observed UA's every 3 months she had started that ruling herself and the clinic did not back it.  But he was calling to see if I had ever gotten my peak and trough results as the doctor had seen them on his desk that day and pointed out that I probably needed a split dose consideration from the interpretation of the numbers..He also told me Terri the nurse was gone and I was welcome back if I ever wanted to come back....OMG was I happy.  Of course I did but what about the EKG...he said for me not to worry he would handle the doc regarding the fears I had.  I had done suboxone twice and failed in the past etc...and throughout the last 3 years since then I speak to him if I have issues and he usually does the right reasonable thing.  And just for the record...I began to worry about the qtc issue myself so without them knowing I went and got an EKG from primary doc and was told my qtc's were 409 so actually I did not have problems there.  SO THAT DAMN EKG DID AND CAN CREATE PROBLEMS for patients that need methadone MORE than being concerned about something that might happened as RARELY AS torsades des pointes does.  

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rhianmoon

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Jul 13 14 8:39 PM

I get very freaked out at the thought of my dose being lowered or forced to taper etc. I feel your pain wayovermyhead. I am hoping the financial problem I have with CRC in them owing me a substantial amount for a long time will be fixed soon. I am really thinking hard about switching. I don't want to lose my monthly status especially when I have no assurance I will get even bi weekly take homes. I am so sick of nurses or any staff person bullying patients. The director at my clinic whom I've never met or even seen has the worst reputation of any clinic I've been or heard of. I cannot tell you how many counselors I have had here because they keep quitting along with other office staff. When this current director came over a year ago, her previous coworkers had a big celebration after she left to come here. 7 counselors quit within the first 3 months. She is out spoken about not liking or agreeing that anyone should be allowed monthly take homes. Peopl in this industry really get off with hurting and controlling us. They really feel we should be punished for our past drug use and many jump at the any chance they get. There is very little compassion from many of the people who work in this industry. 

I just oust went to see a psychiatrist just for an evaluation and to answer some of my concerns. If he recommended seeing either hi or a colleague I certainly would. He is the first medical doctor to totally support and validate my mmt and antidepressant medication. He told me to never stop taking them. His specialty is addiction and knows the only people who stay clean are the ones on mmt. He was very surprised how I didn't just nod off and was very alert etc. because he has seen many on methadone who apparently are very sedated from their dose. I certainly am tired most of the time and will nod off when sitting at the computer for many hours. It was so wonderful for me to have a doctor be so supportive and say he would go to bat for me if anyone thinks I should lower my dose etc. I have never had this kind of support. 

I hope your clinic lets you be the one who decides if you think you want to try a lower dose etc. It is so easy for anyone not in our shoes to tamper with our dose or want to get us off mmt because they really domt know or understand what our body and brain is going through. Take care and thank you so much for sharing with me. 

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freeatlast

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Aug 1 14 3:04 PM

My clinic does annual EKG's and they diagnosed me with long qt syndrome and immediately lowered my dose by ten milligrams. I have to repeat my EKG in two weeks, if my numbers are still off I will be dropped again. I have been told they will dose you completely down if they can not get my numbers right. Do I have any recourse to fight this? Help I am scared to death! 

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rhianmoon

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Aug 1 14 4:06 PM

This does not sit well with me. If you are comfortable with your dose being lowered and tolerate it well then Im comfortable with that. However if you are being forced to go down and find your having withdrawal symptoms then I would get another opinion from an outside doctor who has experience with mmt.

i saw a specialist recently and he was adamant I do not change my dose or any other medications I am on. He is an addiction specialist and is the first doctor who was extremely supportive of my mmt. He told me most people who stop mmt go back to using and mmt is what keeps us clean. He really understood and agreed when I told him before I started mmt, I was on painkillers for many years and went through that horrific rapid detox and was clean over 6 months but still felt like crap. Mmt is the only thing that makes me feel as normal as I can be. I hope you feel okay and have some control of your dose. 

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freeatlast

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Posts: 7 Member Since:08/26/13

#18 [url]

Aug 1 14 5:11 PM

It took me years to get to a comfortable dose. I am hoorfied and scared to death. I do not want to go down on my dose. But, this is the only clinic within 200 miles and I feel as if they have all the power. What kind of doctor would be able to override the clinic. I feel as if the only thing the clinic is concerned with is CYA. Any advice is appreciated.

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jaks1

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Posts: 67 Member Since:02/22/10

#19 [url]

Aug 2 14 5:24 PM

I am with Way over my Head on this one. I would travel a lot of distance in order to be comfortable with my clinic and the way its run. In Oregon they are a bit strict on a few things but since I have
been with the clinic here in Salem, OR for fifteen or so years and ten years prior to that in   CA I simply could not get into another clinic where i would have to "start over" . I am okay with the fact
I  only have to go once a month. Actually twice a month is required but my counselor has allowed me quite a lot of latitude since he is not around during the times I am off work and the type of job
I do is not one where I can get someone to subsitute for me. We tried that and since I care for special needs children most people end up wanting to kill the kids instead of trying to understand
them. One supposed substitute duc-taped my 11 year old boy who is severly autistic to the wall. SO I have been given some slack in that I do not have to attend group which I would not like at all
since I was fronted by a counselor years ago in the same clinic I am in now. She said things in my group that I had told her in confidence. So I have not had to attend group since then. But I do
try to comply with everything I am supposed to comply with like every year I have to get a TB test and an EKG, blood work for Hep C etc etc etc and i never have to be asked to get this done
each year. My doctor calls or his nurse does and makes my appt each year for those tests that the clinic insists on.  I only have a sixty mile round trip once a month for the clinic I go to so I
do consider myself lucky because there are only two clinics that take care of Salem and all the surrounding areas and when it snows out here the people who have to come in all the way from the
coast are the ones who suffer the most as a lot of the curvy streets they must drive are sometimes closed because of mud slides etc.  And they have little choice but to come in asap. It takes
18 months to get 27 take outs with no dirty tests or missing appts etc. Many patients find that hard to do but I found it easy because my motivation was to  avoid going to the clinic.  It has
never been my favorite place to go. lol. Good luck with your new clinic if you choose to change yours. I would not change mine simply because they do not try and take me down on my 150 mg
dose daily nor do they deny me a raise if I need it however I havent for years and years.  My doctor from my clinic took me up ten mgs because I was in quite a bit of pain with my leg awhile
back. So no hassles in that dept. I hope everyone has a clinic they can trust and feel comfortable with. Jax

Don't take life too seriously, you never get out alive.

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rhianmoon

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Posts: 29 Member Since:02/23/10

#20 [url]

Aug 3 14 8:34 AM

I don't think I will be switching clinics. I am still waiting for my almost $800 that I overpaid 3 months ago to be given to me. I have complained to my counselor and wrote a note to the director as per requested by my counselor. 

My clinic does not require EKG's and it took quite a while to get to a therapeutic dose. Not to mention monthly take homes. I don't want to switch to a clinic that I will have to go to every day the first month and counseling sessions twice a week. I've been through the counseling years ago. My record has proven the years on mmt and following the clinics rules. I don't know what I would do if forced to cut back my dose. It took so long to get it and doesn't usually last the 24 hour a as I wake up with symptoms prior to dosing. 

Luckily I met a doctor who works and specializes in addiction who told me he would go to bat for me if I ever need it. I really hate it when some clinics can just have so much control over our doses. For most of us it really comes down to life and death which is why we got on mmt. 

I hope you are able to stay on the dose you are comfortable with.

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