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PostPosted: Fri Dec 16, 2011 11:42 pm 
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Joined: Fri Dec 16, 2011 12:49 pm
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I am new on this site as I accidently ran up on it looking for methadone information. I was reading the topic “Cravings” and realized I can relate to a lot of the people posting on that topic so I wanted to throw a topic up for discussion. Should clients be allowed to practice/execute “INFORMED CONSENT” when I have been on MMT for 2 years now. I am still not stabilized and I feel the reason is because I have a health issue that Methadone may have caused or me being on methadone Maintenance may be a liability for the clinic. I have weekly take homes but have been after my clinic for an increase for a year and a half. I was capped out at 160 but told after I reached this cap if still experiencing cravings and withdrawals I could increase after I had a Peak and Trough and if indeed the results show a result to validate such. They tried and failed to get blood three times over this year and a half as I am a “Hard Stick” so they say and everyone that has ever tried to draw blood from me all my life has always said the same thing too. They have stuck me eleven times first try, 9 times second try and the nurse only tried three the last time so nonetheless I have been refused increases. Anytime I ask to speak to the Doctor regarding this they all including my counselor would just say that nothing will be done without the P&T so they in such were refusing me the right to seek any alternate plan. I have terrible cravings and dreams, but because of the consequences of any relapse and my loss in levels and/or MMT I have managed to fight my way thru them so far. I recently took care of my best friend’s Father at Hospice not thinking anything about it as I had a childhood to adulthood love for him as we have been best friends for over 30 years and she just could not do it but yet she did not want him left alone either. I made the commitment to do it and found myself tortured with temptations as the medicine used in such a facility and in his stage is my drug of choice. He passed away 10 days into it and Thank God I made it thru with no relapse. But back to the story after repeated request for P&T unsuccessful I got flagged for a mandatory/random Peak and Trough Test by chart audits as I guess my dose at 160 mgs put me in a grouping susceptible to needing validation on my dose being checked randomly. This could be BS as I do have QTC Prolongation (527) and I think the clinic may have been wanting to decrease my dose and may have been looking for some validation to do so because I complain of withdrawals still and cravings and they have put me thru the ringer trying to get an increase and I think my chart got flagged because of my dose with the qtc prolongation being a liability so….CYA time for them.

I could be totally wrong on this, but guess what this time since I HAD to have the P&T and I was not requesting this one they got blood after three sticks on each draw (2 draws). I hear and have read that P&T’s are not worth the paper they are written on in the US as our methadone has inactive/active isomers that require special testing further than just serum. But at least the results would land me an interview with the doctor so I can tell him my cravings and withdrawals have NEVER subsided like he said they would or like other clients have. My results came back 881 Peak and 226 Trough, which was explained to me that the Peak number was pretty normal but when up beside the trough number, I indeed am what they call a “Fast Metabolizer”. I must admit the whole time we were waiting for the results, I was in fear since the P&T’s are not reliable supposedly in the US my thoughts were consumed with thoughts they were going to get the numbers and decrease or detox me etc because of the liability issue. So when they came back that way (Fast Metabolizer), I couldn’t help but be like Hooray, finally I am going to be heard because even if it’s the truth about the P&T's not being reliable, the doc must believe in them as I had been denied increases because I had not been able to give the blood needed and worse yet I had been denied a doctor interview or any other alternative so as to get to the bottom of my issues of Cravings and Withdrawals. I must admit after all the resistance they gave me over increases because I had not been able to get a P&T draw done I was totally surprised when I meet with the doctor who does not give believe in or gives any weight to Peak and Trough’s results can you believe it? WTF? He tells me he gives increases from his finding on a physical exam (which they never let me schedule for) and questioning the patient/client.

So, I start telling him my symptoms one after the other and each one I bring up he says oh I get the yawns, sneezing and runny nose at night myself or yeah well Restless Legs could be you do not exercise enough or Goosebumps Hot/Cold Flushes could be hormonal or joint pain could be my age or nausea and abdominal spasms with diarrhea could be irritable bowel syndrome etc….Thank God I had choose to hold off on my dose that morning until I had seen him because what finally made him start talking about possibly me not being stabilized was from a physical assessment of my pupils being a 8 or 9, clammy hands and forehead, rapid heart rate and something else I forget but nonetheless, he sat down beside me and said I am going to be honest with you, I fear increasing your dose because of your EKG readings........ BOOM......... just what I suspected. He further stated that I do indeed show signs of non stabilization but he is at a catch in my case. Well just that little bit of validation brought out a major meltdown in me. I began to cry and tell him that I have been and will continue to hold out on relapsing but my history (30 years of unsuccessful attempts 9 inpatient 7 detox units) says I will relapse if I don’t stabilize out and/or I lose my choice to be on methadone because he is in fear of my qtc's I am in fear of being back on dope. Then, of course, he mentions suboxone and I tell him that I was on suboxone before it was even heard about here in NC (I was in Florida about 15 years ago) and while yes it worked while I was inpatient, but left to my own resources, I relapsed each time I tried. He finally mentioned me exercising what is called “Informed Consent” allowing me to make the decision that even with him telling me that my qtc's are high (I have researched this subject for over a year and a half so he wasn't telling me anything new I know it is a problem) and warning me that it can be fatal, as I see it like this, if I relapse and/or continue the road of drug abuse, to me there is just as much of a probability of fatality then if I stay on Methadone may appear to him. The risk of relapse outweighs the risk of stabilized MMT to me so if I need to exercise my right of INFORMED CONSENT show me the line to sign on Please. I see a new life right around the corner with methadone maintenance. Now if I just could get there.

He gave me 10 mgs increase for four weeks with split dosing and an appointment back with him to follow up on January 12 along with an Order for a new EKG and believe it or not another P&T (what’s up with this he says he does not believe in their results or does he?) This is to take place after the four increases but before our appointment. I really hope that the 40 mg helps if I have to take all 40 maybe I won’t need but 20 etc…. the 10 mg so far I have not felt any better in fact I am worse, but I believe the reason for that is because I went from a large dose of 160 at 5 or 6 am every morning to half that amount at 5 or 6 am in the morning and by the time I take the evening amount I feel quite sick all over and maybe as soon as my body realizes I am getting the same amount (with a bit of an increase ) in the realm of the whole day, my body will adapt to this and the split dosing will level out. I have summed this up to how sometimes things have to possibly worsen before they can get better. I know the post became real lengthy, but thanks for the opportunity to tell my story and I would be real interested in any responses to this dilemma or dilemmas I seem to have several of them in this post so please comment on Informed Consent, cravings and withdrawals, Peak and Troughs, QTC Prolongation and methadone, inadequate access to the doctor etc....just pick one as there are many topics in this post.

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

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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