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PostPosted: Sun Mar 07, 2010 11:23 pm 
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Can a psychatrists perscribe methadone? will he? or she?

I have been on subs for a wile. (about a year) I tapered ok. down to 8mg from 18mgs. I'm stedy on subs now but very depressed, lifeless, craving OC. I have no desire to do much. I know maybe a adjustment in my sub dose may be needed but I really don't want it. I have been interested in trying the methadone way but the clinics are far away. too far to drive everyday.

I would want to see a psychatrists to help me aloung with depression and other psycological issues. but I also would want him to treat my addiction with methadone. Because I have been on suboxone in my home setting do you think he will perscribe methadone for me, or does it have to come from a clinic?

Are there any experiences out there? any Psychatrists who might have a idea? anything helps. thanks everyone!


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PostPosted: Sun Mar 07, 2010 11:28 pm 
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oh i forgot to tell you all that I'm dealing with pain issues as well. we have tried to treat it with suboxone but it hasn't been working. perhaps this is where the depression is coming from. I know that it is possible to treat pain with methadone but i don't know if they will considering I've been on suboxone.


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PostPosted: Mon Mar 08, 2010 3:41 pm 
I'm sorry I can't really answer your questions. I don't know that anyone other than an psychiatrist specializing in addiction (Addictionologist) or a Pain Management specialist can answer those questions.
At first blush, I'd say that starting methadone would be a step backwards for someone who is stable on bupe. I would think your doctor could find better ways of managing your depression than with an opiate....in fact I'm sure of that.
However, your chronic pain issues throw a wrench into the whole thing. Only you know how much pain you're in. You and your doctor will have to decide when or if you need to go back to full-agonist opiates for pain management. If I were you, I would exhaust absolutely every alternative to opiates for managing your pain before I'd go back down that road again. One of the biggest problems with opiates (as all us addicts know all too well) is the fact that you simply cannot escape tolerance.
Again, I'm pretty sure you won't find your answers here. I would suggest you start checking in your area for or get a referral to an Addictionologist and/or a Pain Management Specialist.
Good luck to you and let us know what you find out.


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PostPosted: Mon Mar 08, 2010 5:28 pm 
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Thanks. I know the answer probably is not out there but: maybe someone out there does get methadone from a psy. anyway i agree that it would be a step backwards but perhaps that is what i need. I will let you know how everything goes. I probably won't see a psyc. for a month or so but I'll keep you posted. I have a appointment on friday with a PM doctor and hopefully he has some ideas for me.


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PostPosted: Thu May 27, 2010 2:24 am 
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Mine can't prescribe Methadone, I asked, but took the course to be able to prescribe Sub.


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PostPosted: Sat May 29, 2010 12:26 pm 
I know of people getting take home prescriptions of methadone from an MD for pain, but not addiction. I've never been on it myself, but others have reported needing ever increasing doses to get the same effect (sound familiar). I too, have been depressed, lifeless and craving OC on Sub. I'm treating it now with lexapro, which is helping. Also, I was off sub for about two weeks total after a car accident, which snapped me out of it a bit, too. Now I'm going back on Sub but starting at a lower dose.
Good luck,
Lilly


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PostPosted: Sat May 29, 2010 11:33 pm 
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Phychyatrist in the US can Rx medadone for pain but NOT for addiction. Same goes for any US doctor.


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PostPosted: Sun May 30, 2010 12:03 am 
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It is against the law (in the US) for any doctor to prescribe opiates (other than Suboxone/Subutex) for the treatment of addiction. Suboxone and Subutex can only be prescribed by doctors who have a special waiver to do so. Methadone as a replacement therapy for opiate addiction can only be dispensed by specially licensed clinics. This is all due to a federal law called the Drug Abuse Treatment Act (DATA).

Any doctor can prescribe methadone for pain though. Psychiatrists are MD's, so I guess they could prescribe painkillers, though it seems to be outside the realm of their usual practice. Different states have different laws about the amount of opiates doctors can prescribe, so I'm sure that plays into it.

If you have chronic pain that needs to be treated with full-agonist opiates, seeing a pain management doctor is probably the way to go...especially since you have issues with addiction. Methadone is a full agonist and has high abuse potential.

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PostPosted: Sun May 30, 2010 12:35 am 
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Briboston and Diary are correct. The 'Harrison Act' was passed in the 1920's, preventing the prescribing of opiates to treat addiction or to preventt withdrawal. In the early 1970's an exception was passed that allowed for methadone clinics, where methadone could be used to treat addiction under very tight regulatory control. The second exception to the Harrison act was DATA 2000, which allows for the use of buprenorphine.

But methadone is just another cheap, potent narcotic, and any doctor with the proper DEA license can prescribe methadone or any other narcotic to treat pain (or to treat anything else, except for addiction or to prevent withdrawal). As Diary says, pain treatment is out of the domain of many psychiatrists, although it really shouldn't be; psychiatrists SHOULD be the people prescribing a medication that has such potential to cause psychiatric problems.

There SHOULD be an entire specialy dedicated to treatment with opiates. More and more doctors are trying to avoid prescribing opiates, for fear of getting into trouble with the DEA for prescribing too much medication or for prescribing to the wrong person. Meanwhile the doctors who ARE prescribing pain medications have an ever growing body of knowlege to keep up on-- knowledge of the science of pain and addiction, and knowledge of the regulations related to prescibing!


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 Post subject: methadone rx
PostPosted: Thu Nov 25, 2010 8:07 pm 
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I am not sure why you want to be on Methadone since you are on suboxone. If you want to get high then my understanding is that your sub dose needs adjusting. You shouldn't be feeling those ruminating using thoughts if your dose is correct and I think that adjustment is worth doing to help you in my opinion.
Methadone is heavily regulated and when used for addiction needs to come from clinics. Each state has varying rules...for instance in my state you need 2 years on it to get a month take out as long as you are compliant but Florida you need 5 years on it to get a months take outs.
It really sounds like some counseling would be helpful and if you have an undiagnosed depression, maybe getting on something for that. I know someone who prescribes suboxone and also puts a lot of his patients on Celexa as well, but obviously each pt has a different need.
Hope that helps and again, it is just my opinion, but I hope you are open to adjusting your sub dose...you will feel better.


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PostPosted: Mon Jan 30, 2012 1:45 am 
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This is odd! When I went in for my Sub induction my doctor tells me he can do one of 2 things for me. He can either start me on a drug called Suboxone/Subutex or he can start me on Methadone. Now this was in the care of a DOCTORS office. I said I wanted to take the Suboxone. So as for laws against prescribing an opiate for addiction I am not so sure. Keep in mind that I was NOT going in for pain management but for addiction.


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PostPosted: Mon Jan 30, 2012 9:08 am 
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The law is written as Dr. Junig described it. That's not to say there aren't Drs out there that will prescribe methadone. For your Dr to prescribe Methadone he would have to say he was prescribing it for pain. The other way he could have prescribed it is that he is involved at a methadone clinic and had you chose methadone, treated you from there.

I would think the 2nd way makes more sense, I know if I was a Dr I wouldn't risk my license to prescribe a patient methadone.


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PostPosted: Mon Jan 30, 2012 10:01 pm 
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suboxdoc wrote:
psychiatrists SHOULD be the people prescribing a medication that has such potential to cause psychiatric problems.


Methadone causes more psychiatric symptoms than buprenorphine?


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PostPosted: Tue Jan 31, 2012 2:22 pm 
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tearj3rker wrote:
suboxdoc wrote:
psychiatrists SHOULD be the people prescribing a medication that has such potential to cause psychiatric problems.


Methadone causes more psychiatric symptoms than buprenorphine?




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 Post subject: take home methadone
PostPosted: Sat Feb 11, 2012 8:37 pm 
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I live in Canada, and had a roommate who got his methadone prescribed as carries, for addiction, I think a wk at a time, but quit and went back using and died, a story for another day


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 Post subject: Re: take home methadone
PostPosted: Sun Feb 12, 2012 5:06 pm 
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baggie wrote:
I live in Canada, and had a roommate who got his methadone prescribed as carries, for addiction, I think a wk at a time, but quit and went back using and died, a story for another day


Well i think we all know canada is much different than the usa. I mean shit herion can be legally prescribed. But sorry to hear your roommate.

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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
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