They just are afraid we might get some kind of pleasurable high out if the extra milligrams etc...or we are getting away with something etc....
I think that you're exactly right, and that's what it boils down to at the end of the day.
They are worried that if a patient's dose is what they deem as "high", that the patient must be getting some kind of pleasure out of it, and they just will not allow anyone getting high on their watch!
Some kind of national qualification is what is needed for anyone that wants to work in a MMT clinic. SO that everyone is equally trained, and they know that just because some people need higher doses than others, it doesn't mean they are getting "high" from their dose.
A lot of the problem, I think, is that treatment staff see patient 1 on 50mg/day doing fine, and then patient 2 on 120mg who says he is not doing well.
They cannot comprehend that if patient 1 is fine on 50mg, why is patient 2 not fine on more than twice the dose.
They add 2 and 2 and come up with 67 and conclude that patient 2 must be trying to get "high" off his dose.
So much more education is needed for people working in MMT clinics. It is very sad that most of us have forgotten more about MMT than many clinic professionals will ever know.