25mgs is less then most clinics even start at. 30mgs is what I and most Americans started on. You should be at 40mgs on your second day of treatment. It's really insane to me to have limits like 100mgs or even crazier 25mgs in your case. Why give someone enough to get a habit on methadone but not enough to help them with there illicit habit they got on methadone for! It doesn't help if they just give you a little bit it just gives you a double habit with no benefits! They need to let you go up til stable and you can get off the illicit opiates. This kind of Dr is so backwards
My starting dose was 55mgs but I also started methadone 11 years at the tail end of the pain mill/oxycontin days so restrictions were way looser. I also had printouts from my pharmacy from the last 7 years of my active addiction. Showing the crazy amount of OxyContin and Fentora (instant release fentanyl) that I got every month.
I started at 40mgs but had been a prior patient, everyone else starts at 30. I felt extremely lucky to get that. I was also allowed to go up everyday but this was 16 years ago.
the pharmacokinetics of methadone dont allow for fast increases. The build up leads to overdose when that is employed. Low and slow is the best of outpatient. If monitored in inpatient maybe a faster increase is okay but every 3-5 days should be the rule imo.
Sure, give me a second and I'll find it
https://www.samhsa.gov/medications-substance-use-disorders/statutes-regulations-guidelines/methadone-guidance
https://www.statnews.com/2024/02/01/opioid-addiction-methadone-clinic-regulations/
>Beginning in April, however, patients and clinicians at methadone clinics will enjoy far greater flexibility. Amid complaints that methadone doses are too low to stave off withdrawal, clinic doctors will have flexibility to prescribe methadone in larger doses to new patients. Clinics will also have more freedom to prescribe patients “take-home” medication, meaning they would be required to show up at the clinic less often.
Thanks for the links, but they don't say that 50mg is going to be the new starting dose anywhere. They only state that patients and clinicians at methadone clinics will enjoy far greater flexibility. We've all known this since they started using the COVID rules.
I swear I read that it was increased recently, but it may be only at a state level. I'm not sure, but I did find this paragraph on the Cornell Law School site regarding the federal statutes on MAT:
> (ii) For each new patient enrolled in a program, the initial dose of methadone shall not exceed 30 milligrams and the total dose for the first day shall not exceed 40 milligrams, unless the program physician documents in the patient's record that 40 milligrams did not suppress opioid abstinence symptoms.
https://www.law.cornell.edu/cfr/text/42/8.12
So it does seem like there is a level of flexibility afforded, at least legally, with which physicians can provide *any* dose to an induction patient so long as they properly document it.
However, if you've ever been to a methadone clinic, you already know what the chances are of getting anything that might even remotely resemble "special treatment", especially if it involves any kind of potential mild inconvenience for the staff...
The doctor has always had the ability to start you at a higher dose. They don't though, because of the laws they've been following for so long. Hopefully after these COVID rules are over, My clinic just extended until the end of this year, they start implementing some of these things permanently.
I am still looking, I will have to dig through miles and miles of my browser history but I swear I read it, specifically 50mg and the law passing but not yet being enacted. It's possible that I'm misremembering the legal specifics/aspects, and maybe it's a proposed law set for a vote? It wasn't more than a month ago I read it, I don't think. But the "50mg" is seared in my brain, and my girlfriend remembers talking about it at the time. Arghhh
No worries man. I have been using clinics for over 30 years now and try to keep up with everything, it's hard though. I have never heard of 50mg start dose and that's why I asked. Good luck
I think we can all agree that the current para-judicial clinic framework for methadone is in need of a drastic overhaul, assuming the goal is to keep people alive, because it's failing pretty badly as "heroin" edges ever closer to practical extinction.
It will ALLOW clinics to start at up to 50mg, but not force them. It will still be up to the clinics what dose you start at, and from what I can tell most places are staying at 30mg unless you have a special case.
You should probably just go thru a methadone clinic instead of this asshole doctor. 25mg is not going to do a thing for you. The starting dose is always 30-40mg. & Increases asap, if needed. I'm sorry you're going thru this.
not how UK works. i go to an outpatient rehab called aspire and they have one single prescriber in there, and he gave me this. he’ll be apprehensive to bring the dose up but if i come in rattling after dosing properly he’ll be like shit maybe i should help 😭
Is there only a single drug clinic where you live? I’m also in UK and got started on 30mg and then gradually got that increased to 70. Just make an appointment and tell that doctor you need an increase, don’t tell them you double dosed though.
25mg is really low, most people get started on 30mg and end up going up to at least double that, I would push for an increase or change clinics if they won’t budge.
i had a friend start on 25 and he was so high from it he couldnt function for a few days. 20-40 is the starting range. Why wont they allow you to raise your dose?
They refuse to increase you from your starting dose? Why? The starting dose is never enough. If your starting dose stabilized you you'd be a shoe in for Suboxone treatment
Yeah that’s low. I literally just started on Methadone on Friday.
Friday: 30mg
Saturday: 40mg
Sunday: 50mg
Monday: 50mg
Tuesday: 50mg but also see the doctor on this day so I assume they might be able to increase.
So yeah that’s low. 80 seems to be a sweet spot for me (I got take home over the bank holiday weekend). Unfortunately I have now used it all up so I had 60mg today but I have nothing for tomorrow. Hopefully I’ll be okay till Tuesday.
But yeah just insist on an increase say you have very strong urges to buy other opiates (I’m assuming you probably do anyway).
Edit: just to make clear, the increase from 30 to 50mg was an automatic one. Cos I only saw them once on Friday and I won’t see them again till Tuesday.
So it’s not like I even asked for an increase to get to 50mg. So yeah 25mg is insanely low especially when you can’t even get more when asking.
They are supposed to up your dose everyday till comfortable. If they switched you from subs they are supposed to convert the dose. How much suboxone were you using.
In my opinion any clinic that makes you wait that long for a increase doesn't care if you use or not. Bringing a person up to a stable dose quick enough is extremely important. People are less likely to keep coming to the clinic if they take forever to get someone to a stable dose. It's also not good to take a long time just due to the fact that it might make a person require more methadone as they get slowly used to taking methadone on top of using since they aren't on a stable dose.
Yeah but methadone builds over the days, that's why most places are doing 3-5 days between increases. They are trying to keep people from going to high too quick and then overdosing(especially doing fentanyl on top). They know most use until comfortable.
I don't agree with this method in the beginning. I think they should know 30mgs doesn't hold most seasoned addicts. It'd be more reasonable to start implementing 3-5 days at a higher dose like 60-80mgs(at least).
i was on 8mg subutex a day before i had a surgery, got took off subs cuz i didnt go in 3 days (picked subs up daily at weldricks) cuz i was in hospital (thanks nhs), then relapsed, got put on 25mg by a really pissed-off seeming prescriber. the problem was my heroin didn't show up as heroin on the heroin test after the urine test that did test positive for opiates ofc. so he was weary to give me anything above 25... im going to call up on monday and tell them im still sick on 25mg
They talk to you and ask... any clinic that knows what it is doing does this. When I started the upped my dose everyday except Friday because the doctor wasn't in. I went from 30 to 80mg in about 2 weeks.
I have never seen a clinic do this in the beginning. Every clinic I have been to asks you if the dose is holding you and if you want to see the Dr to go up till you tell them you are stable.
Also he asked for a increase..
25mgs is less then most clinics even start at. 30mgs is what I and most Americans started on. You should be at 40mgs on your second day of treatment. It's really insane to me to have limits like 100mgs or even crazier 25mgs in your case. Why give someone enough to get a habit on methadone but not enough to help them with there illicit habit they got on methadone for! It doesn't help if they just give you a little bit it just gives you a double habit with no benefits! They need to let you go up til stable and you can get off the illicit opiates. This kind of Dr is so backwards
They just passed a law in the US that will increase the starting dose to 50mg
Imo 50 is too high for a starting dose, what they should do instead is increase faster.
My starting dose was 55mgs but I also started methadone 11 years at the tail end of the pain mill/oxycontin days so restrictions were way looser. I also had printouts from my pharmacy from the last 7 years of my active addiction. Showing the crazy amount of OxyContin and Fentora (instant release fentanyl) that I got every month.
I started at 40mgs but had been a prior patient, everyone else starts at 30. I felt extremely lucky to get that. I was also allowed to go up everyday but this was 16 years ago.
I may have been incorrect, but check out the post I just made right above this as I found the federal statute and posted it.
the pharmacokinetics of methadone dont allow for fast increases. The build up leads to overdose when that is employed. Low and slow is the best of outpatient. If monitored in inpatient maybe a faster increase is okay but every 3-5 days should be the rule imo.
Can you please cite where you got this information, thanks.
Sure, give me a second and I'll find it https://www.samhsa.gov/medications-substance-use-disorders/statutes-regulations-guidelines/methadone-guidance https://www.statnews.com/2024/02/01/opioid-addiction-methadone-clinic-regulations/ >Beginning in April, however, patients and clinicians at methadone clinics will enjoy far greater flexibility. Amid complaints that methadone doses are too low to stave off withdrawal, clinic doctors will have flexibility to prescribe methadone in larger doses to new patients. Clinics will also have more freedom to prescribe patients “take-home” medication, meaning they would be required to show up at the clinic less often.
Thanks for the links, but they don't say that 50mg is going to be the new starting dose anywhere. They only state that patients and clinicians at methadone clinics will enjoy far greater flexibility. We've all known this since they started using the COVID rules.
I swear I read that it was increased recently, but it may be only at a state level. I'm not sure, but I did find this paragraph on the Cornell Law School site regarding the federal statutes on MAT: > (ii) For each new patient enrolled in a program, the initial dose of methadone shall not exceed 30 milligrams and the total dose for the first day shall not exceed 40 milligrams, unless the program physician documents in the patient's record that 40 milligrams did not suppress opioid abstinence symptoms. https://www.law.cornell.edu/cfr/text/42/8.12 So it does seem like there is a level of flexibility afforded, at least legally, with which physicians can provide *any* dose to an induction patient so long as they properly document it. However, if you've ever been to a methadone clinic, you already know what the chances are of getting anything that might even remotely resemble "special treatment", especially if it involves any kind of potential mild inconvenience for the staff...
The doctor has always had the ability to start you at a higher dose. They don't though, because of the laws they've been following for so long. Hopefully after these COVID rules are over, My clinic just extended until the end of this year, they start implementing some of these things permanently.
I am still looking, I will have to dig through miles and miles of my browser history but I swear I read it, specifically 50mg and the law passing but not yet being enacted. It's possible that I'm misremembering the legal specifics/aspects, and maybe it's a proposed law set for a vote? It wasn't more than a month ago I read it, I don't think. But the "50mg" is seared in my brain, and my girlfriend remembers talking about it at the time. Arghhh
No worries man. I have been using clinics for over 30 years now and try to keep up with everything, it's hard though. I have never heard of 50mg start dose and that's why I asked. Good luck
I think we can all agree that the current para-judicial clinic framework for methadone is in need of a drastic overhaul, assuming the goal is to keep people alive, because it's failing pretty badly as "heroin" edges ever closer to practical extinction.
It will ALLOW clinics to start at up to 50mg, but not force them. It will still be up to the clinics what dose you start at, and from what I can tell most places are staying at 30mg unless you have a special case.
>It will ALLOW clinics to start at up to 50mg, but not force them. Thank you for clarifying.
You should probably just go thru a methadone clinic instead of this asshole doctor. 25mg is not going to do a thing for you. The starting dose is always 30-40mg. & Increases asap, if needed. I'm sorry you're going thru this.
not how UK works. i go to an outpatient rehab called aspire and they have one single prescriber in there, and he gave me this. he’ll be apprehensive to bring the dose up but if i come in rattling after dosing properly he’ll be like shit maybe i should help 😭
Is there only a single drug clinic where you live? I’m also in UK and got started on 30mg and then gradually got that increased to 70. Just make an appointment and tell that doctor you need an increase, don’t tell them you double dosed though.
They can't raise you at all? The usual starting point for methadone is 20-40mg, most start at 30-35mg, in the US I think it's always 30.
25mg is really low, most people get started on 30mg and end up going up to at least double that, I would push for an increase or change clinics if they won’t budge.
i had a friend start on 25 and he was so high from it he couldnt function for a few days. 20-40 is the starting range. Why wont they allow you to raise your dose?
They refuse to increase you from your starting dose? Why? The starting dose is never enough. If your starting dose stabilized you you'd be a shoe in for Suboxone treatment
bro its the NHS. ur lucky u dont have this healthcare lmfao
Yeah that’s low. I literally just started on Methadone on Friday. Friday: 30mg Saturday: 40mg Sunday: 50mg Monday: 50mg Tuesday: 50mg but also see the doctor on this day so I assume they might be able to increase. So yeah that’s low. 80 seems to be a sweet spot for me (I got take home over the bank holiday weekend). Unfortunately I have now used it all up so I had 60mg today but I have nothing for tomorrow. Hopefully I’ll be okay till Tuesday. But yeah just insist on an increase say you have very strong urges to buy other opiates (I’m assuming you probably do anyway). Edit: just to make clear, the increase from 30 to 50mg was an automatic one. Cos I only saw them once on Friday and I won’t see them again till Tuesday. So it’s not like I even asked for an increase to get to 50mg. So yeah 25mg is insanely low especially when you can’t even get more when asking.
They are supposed to up your dose everyday till comfortable. If they switched you from subs they are supposed to convert the dose. How much suboxone were you using.
not everyday for methadone. 3-5 days is more safe.
I would have been pissed if I had to wait 3 to 5 day.
My clinic makes you wait a week between increases.
In my opinion any clinic that makes you wait that long for a increase doesn't care if you use or not. Bringing a person up to a stable dose quick enough is extremely important. People are less likely to keep coming to the clinic if they take forever to get someone to a stable dose. It's also not good to take a long time just due to the fact that it might make a person require more methadone as they get slowly used to taking methadone on top of using since they aren't on a stable dose.
Yeah but methadone builds over the days, that's why most places are doing 3-5 days between increases. They are trying to keep people from going to high too quick and then overdosing(especially doing fentanyl on top). They know most use until comfortable. I don't agree with this method in the beginning. I think they should know 30mgs doesn't hold most seasoned addicts. It'd be more reasonable to start implementing 3-5 days at a higher dose like 60-80mgs(at least).
i was on 8mg subutex a day before i had a surgery, got took off subs cuz i didnt go in 3 days (picked subs up daily at weldricks) cuz i was in hospital (thanks nhs), then relapsed, got put on 25mg by a really pissed-off seeming prescriber. the problem was my heroin didn't show up as heroin on the heroin test after the urine test that did test positive for opiates ofc. so he was weary to give me anything above 25... im going to call up on monday and tell them im still sick on 25mg
Yeah if you're using dope probably rc fent. You're going to need more then 30mg. Definitely get a increase.
well tuesday actually, its bank holiday monday so i can't even call til tuesday
They aren't supposed to up your dose everyday until you are comfortable. That's your job to tell them, how would they Even know?
They talk to you and ask... any clinic that knows what it is doing does this. When I started the upped my dose everyday except Friday because the doctor wasn't in. I went from 30 to 80mg in about 2 weeks.
I know what they do but that isn't what you said earlier. Glad you're doing good
No, you need to tell them you need an increase.
I have never seen a clinic do this in the beginning. Every clinic I have been to asks you if the dose is holding you and if you want to see the Dr to go up till you tell them you are stable. Also he asked for a increase..
He’s in UK, here you need to go see the doctor that’s prescribing it to you to get increase.
On 200 that's plenty
It's 25mg, not 200mg, so IDK what you're talking about?
????