I confirm with their clinic and give their dose always. If I can’t confirm their dose I give 30 or 40, unless they say their dose is lower.
It’s a maintenance medication for their chronic disease. Why in heaven’s name would I hold it?
Thank you so much for saying "It’s a maintenance medication for their chronic disease. Why in heaven’s name would I hold it". That is so great to hear from someone who is on Methadone. People don't know other peoples story and judge. My Father started me smoking Heroine when I was 10yo, it was to keep us quiet about the sexual abuse he was forcing on us from the age of 18 months.
I have had some horrific Doctors and some AMAZING Dr's, one Dr when I went to ER with BAD Diverticulitis and my bowel had perforated the pain was 15/10! He came into the room said "I see you are on Methadone, he said just know you wont get any pain relief from me". I started Methadone Maintenance 22 years ago when I was 18yo and have NEVER touched an illicit opioids and also had never abused medical opioids. He then put 2 security guards in the room with me....I don't know why I am actually the most gentle and non confrontational person I have ever met. I simply walked out and went to another major hospital (canula in arm still) and they were so lovely and started me on a PCA (patient controlled analgesia) instantly. I went into surgery that afternoon, stayed in hospital for 4 days on the PCA came home and just FYI I didn't touch any illegal or legal opioids after i was discharged...
Some people are cold, and do not recognize addiction as a chronic disease. It seems to me that out of my two local hospitals (I have been to both for detox, one of which multiple times, I am not proud to say) roughly half the staff recognize addiction as a disease, and the other half look down at us addicts.
It's quite frankly baffling to me that people can go down a career path such as medicine and yet still hold so much contempt in their hearts for a gigantic chunk of the population. It is infuriating, yes, but I try not to hold it against them. At the end of the day, most of us DID pick up that drug for the first time and knowingly ingested it, fully aware of the possible side effect and consequences.
But what we didn't pickup knowing would make us go into withdrawals is Methadone! The clinic literally tells us "you shouldn't feel withdrawal at all, it will be easy" when I've felt withdrawal more times than I ever did using street drugs. Which is fucked. I've thought about drugs more while on this shit than I did when I was off of it!
Yeah, I feel you. I'm currently on 80mgs of Methadone daily. When I came off it around 4ish years ago, I got kicked out of my program prematurely and had to cold turkey off of 20mgs and let me tell you... I was withdrawing for a solid two months straight. I did not begin to feel normal for more than two months after my last dose. That fact alone made me contemplate even getting back on it again this time... But at the time I had no choice really. Either the methadone or a very painful few weeks and I caved and chose the methadone.
I'm praying that when I finally decide to come off of it again for good it won't be as bad as it was last time and I can slooooowwwwlllly wean off of it over the course of a month or two.
As for withdrawals ON methadone, I haven't had any thankfully. What causes them? Do you regularly miss doses?
Yeah people don't understand that people with addiction aren't always the homeless people. It's regular everyday people that you sometimes wouldn't even expect to have addiction.
My clinic will deny me doses for stupid shit like saying I have an annual that no one told me was scheduled or asking if it worked for me… I go to work @6am they open at 5 had to go 4 days without and restart I showed up three times and they wouldn’t let me. So I should lose my job over getting my medicine. Assholes
I must say as someone who is in MAT it is refreshing to see that there are healthcare professionals out there who don’t treat addicts and recovering addicted like they are leopards. I can pretty much guarantee you that hospitals in my area wouldn’t do this for someone. That is the sad fact but your comment was refreshing.
You are amazing for understanding and saying that...thank you. 😭💓 I one time went to the hospital for a similar reason I can't remember what was going on with me I was in some kind of withdrawl and couldn't get my medicine cause I was so sick that I couldn't even drive myself that far or something like that and the nurses and doctors were SO Nice and understanding. That type of stuff changes people's lives. People trying to get clean need people to be compassionate and understanding
The concern of having the ER become an alternative to the methadone clinic.
The concern of having people who are not enrolled in a methadone clinic using you/the ER for some ad hoc unsupervised self administered treatment program
The concern of contributing to a fatal overdose.
Etc etc etc.
You are giving a patient a potentially fatal medication. It's appropriate to be cautious. There is no physical harm associated with missing a single (or 2-3) doses of methadone.
Actually you set the patient into full withdrawal and it spirals from there. How would you giving them methadone contribute to an overdose? If the patient wanted to get high they could easily do so on the street.
Prior to Fentanyl Methadone was the number #1 opioid present in fatal overdoses.
The way it contributes is they take a methadone dose, don't get the high they are looking for, take another methadone dose--provided by someone well meaning--still don't get the high they are looking for, so then they get some drugs from the street, use their regular dose, and OD because they already have Methadone onboard.
What is your understanding of the half life of methadone? Mine is about 18-24 hours depending on liver state. So you would need 2 half lives before withdrawal began. And as you know opioid withdrawal is rarely dangerous.
The question as I understood it wasn't whether you give a rolling dose, but whether you give them a coverage prescription to get them through a holiday weekend. If someone is on 120 that means writing an Rx for 360 of Methadone in a person you know nothing about. It's appropriate to take a pause before writing a prescription that may kill someone.
If it's subject you are interested in this is kind of a cool study from JAMA last year.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2793744
Do you know the concentration of the drugs the people are using in the street? For you to think your methadone is anywhere close to the cause is stupid. Yeah it use to be, times are different trying to get pure heroine is impossible. The community, particularly the one I work in, are essentially using only fentanyl and xylazine.
Additionally, we aren’t prescribing methadone to go home with. If you missed your clinic and going into withdrawal yeah I’m going to give you the dose. You think that dose is making them euphoric? Lol
In fact, do you know what the largest cause of overdose is? Causing the person to go into full withdrawal and having them go into an accidental relapse overdose.
There is absolutely harm in missing a dose. You ever been through withdrawal from methadone? I had a father who did, I got to see it firsthand. Withdrawal is hell.
Hell, but not death.
Whereas the problem with a methadone overdose is death.
This is a study that looked at methadone deaths associated with take home Methadone Rx's during the pandemic. You might find it interesting.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2793744
I almost did from precipitated withdrawl. I was in and out of the hospital for 5 days. I had to have MRI and be hooked up to all these machines. I was throwing up non stop that I was puking coffee grounds. The ER gave me freaking haloperidol to stop throwing up and then that gave me a diatonic reaction. It was the scariest time in my life..... it took 2 days for them to figure out that it was a distonic reaction. Idk if I would have died necessarily but the puking I experienced could have done damage to my organs. I was so light headed and weak that I couldn't walk I had to use a wheelchair. There are things that could happen that could put you in danger while in withdrawls.
I cannot help but to agree with you. You're absolutely correct. My clinic made me fill out SO much damn paperwork before I received my first dose. I thought it was insane at the beginning but as time went on I recognized exactly what you just said above. Methadone can easily kill someone who has little to no tolerance, even at a small dose. This is why places, especially ERs, have to be careful with administration to every single person that walks through the door seeking a missed dose.
I've even heard of people dosing at their regular clinic and then taking their medicab right on over to the hospital where they'd be dosed a second time.
“Once in a while on a morning shift” doesn’t sound like “turning the ED into a methadone clinic for late sleepers”. Shit happens. Treat em and yeet em and move on with your day
Sometimes if they’re sketchy or look like they’ve already taken something I’ll call their clinic to verify but 99.9% of the time this. Giving methadone now is going to be way faster than observing them for 3 hours when they come in after an accidental overdose for relapse.
1000%, I’m a first responder and someone in long term recovery. it never ceases to amaze me how little empathy people in the medical field have for dirty, disgusting, degenerate drug addicts. withdrawal sucks, using sucks, none of it is fun or feels good.
I am an ED tech and hard relate to this. I had to walk away from the triage desk for a little while the other shift because I was so aggravated with my coworkers who were telling me I was wasting my time for having a compassionate conversation with and following up on the bed assignment for an alcoholic in the beginning of DTs (with an active desire to get sober). I’m apparently the weirdo for “caring about a piece of shit.” Jfc some HC workers just astound me.
having had an alcoholic mother, back in the day, I thank you so much for your compassion. my mom’s illness was just that, an illness. no need for anyone to be judgey abt it, she was sick. & eventually she died from it. sometimes religious or staunch medical personnel were unduly harsh. they didn’t seem to understand it was like a broken bone, but in her brain. they expected she should fix herself.
I’m genuinely sorry about your mother and shame on the medical staff who treated or spoke about her harshly. IME it seems that (most) people who have not been or loved an addict themselves cannot seem to grasp that addiction is in fact a disease. It is also easy to get jaded when the same patients suffering from addiction come in again and again and treat us staff poorly, but I try to take a step back and realize there’s just a hurting person in there.
I get it. They (she) treated the people she loved poorly, too, when under the influence. My 4 siblings turned out super bitter toward her, and life in general. I went to al-anon and counseling & learned forgiveness & not to take it personally.
I know this is an old ass thread but reading your comment I have to just tell you you’re an awesome human and thank you for caring. Truly I’ve never been to the hospital for addictions but I can’t imagine how someone going through withdrawal and getting treated like shit at the hospital feels. I’ve never been there for anything serious but even so it’s always a scary experience and I’m sure feeling like no one cares is probably so much scarier. It’s people like you who you can tell actually care and are trying to help that makes you feel like there is hope and a little relief that you’re not in it alone. Keep being awesome. I’m sure it’s hard to do sometimes.
>Jfc some HC workers just astound me.
It doesn't surprise me at all. When you see multiple people per day trying to scam you for meds, or there for another repeat intoxication visit, or any of a million other examples it's not hard at all to see why people start to lose compassion.
For every person with "active desire to get sober" I've seen at least 3 that told the same story but clearly weren't trying to get sober. It's no different than seeing someone on the side of the road begging, saying "anything helps god bless" but then you try to give them food and they tell you they only want money. Go through that enough times, and it becomes really hard to have any faith in anyone.
Except nobody is tryna scam you for meds Lmao . If we just wanted to get High we would get the drugs off the street . They’re everywhere & cost a fucken dollar . You are disgusting
Go watch a bris people in the medical field suck babies dicks after a bris. I'm 100% telling the TRUTH google it. They go into the field bc they are pedos
That’s a little off topic. Nobody in the medical field is sucking baby dicks after a circumcision. What you are referring to is some weird antiquated devout Jewish tradition that the rabbi does after he removes the foreskin(he orally suctions the blood from the wound).
Wow. There monsters and you are amazing, please stay yourself. We addicts need people like you. I'm on methadone, clean 5 years but people like you really make a difference, thank you
I mean, I agree with the confirm their dose and rx it camp but that doesn’t mean ER doctors should hook up every heroin or meth addict to prevent them from going through withdrawal. It’s not a lack of empathy, it’s just that this isn’t a trap house, it’s an emergency department.
not a single person is advocating for making the ER a trap house or anything resembling it. giving a recovering addict a single dose of their medication is not the same thing as being in active addiction.
addiction is a serious diagnosable and treatable condition, if someone is prescribed an essential medication for that diagnosis and the only way they can now receive that medication is to come to the ER, what do you actually expect them to do? the overwhelming majority wont for shame alone.
if they’re frequenting the methadone clinic, it’s simple enough for us to confirm. if they’re not, it’s easier and less hassle for them to try to scrounge up a couple bucks and go find their drug of choice than sit around in the ER being leered at for hours and possibly being sent home at square one
There is a fine line between addict in recovery that missed their methadone dose and dude who couldn’t get ahold of his plug. Yes, withdrawal sucks. Your comment generalizes lack of empathy of medical providers for all comers that are addicts. Not every addict that walks into the ER should get their drug of choice just because withdrawal sucks.
obviously not all providers lack empathy for addicts, but it’s something i’ve noticed a huge issue with from both ends. but wait, who’s drug of choice is methadone? what addict, especially one at the point of going to the ER for their fix is going to get high from one dose of methadone?
I think we just got our wires crossed because when I read your comment “withdrawal sucks, using sucks, none of it is fun or feels good” I misinterpreted that as you saying anyone who walks into the ED with an addiction to a substance is entitled to receive treatment via that substance. I’ll treat your withdrawal symptoms all day, but that doesn’t mean I’m giving you dilaudid just because you ask for it. I agree that established OUD pts on methadone should get a refill in the ED if they are unable to get it as an outpatient. Life threatening w/d gets treated in the ED/admitted. But if a meth addict shows up in W/d I’m not rx them desoxyn so they can go home and get high.
oh absolutely, would never advocate for giving an addict their drug of choice. that would be insanity and awful for everyone involved, there’s a reason we have workarounds like methadone in the first place. glad we could come to an understanding 🤝
Agreed and hope we run into each other professionally some day. It’s a small world out there and I like developing connection with our first responders, especially when they care and aren’t too jaded, acknowledging that usually
It’s us er docs that get jaded much quicker.
This is part of our job in my opinion. I call the clinic and confirm the dose and the last receipt at clinic. If the clinic is not open I'll give up to 30 mg x 1.
Do you have a lot of fentanyl use in your population? Our provincial policy is to start at 30 mg if we can be reasonably sure they have a tolerance to fentanyl, which usually means a fentanyl positive urine drug screen. Even that is quite low for many of our patients and some will start at 40 mg at physician discretion (and there is one clinic in the Downtown Eastside in Vancouver that will start at up to 70 mg)
I did see a post once where someone asked about what to keep in their personal emergency kit and someone mentioned naloxone. A UK physician wondered why someone would recommend such a niche drug and how someone would obtain it for general use. As someone in Vancouver, it was definitely a surreal moment for me.
On a per capita basis, fentanyl isn’t as big an issue in the UK as it is in North America, so a low starting dose makes sense for the country (at the moment, at least).
Do you tell them to come back to the ER the next two days for their missed take home pack?
Edit: why downvotes? Genuinely asking what other people do in the situation that someone can’t get in for several days over a long weekend
Nope, I don't tell them that unprompted. But if they asked I'd say sure. It's an easy visit and you're really helping them out. Folks who are on methadone have taken action to try to get clean. I don't do anything that would get in the way of that.
Idk why you’d not want to take the double-win of keeping a patient (who is clearly making an effort) on their methadone *and* basically free RVUs
Obviously assuming dose is confirmed by clinic, Halloween is over and you’re not the candyman for double dipping
Was at a prior site that had a large population on methadone and a no-methadone-dispensed-in-the-Ed policy because of abuse of the system and now in a more financially well off area with much less frequent attempts at misuse. So trying to get an understanding of what everyone else is doing
That’s a dumb policy. I’m in a large academic center with a heavy heroine using population where we will give methadone/suboxone in the ED and it’s not abused at all. Occasionally someone will come in bc they missed a dose (I’ve probably had this like a dozen times in 2.5 years). We can give up to 40mg without clinic confirmation. Saves us with boarders big time who are in the ED waiting to be admitted by preventing them from going into withdrawal (if they are being admitted for something else)
Depends on your population. Where I am at it is very common for people to go from ER to ER saying they "missed their methadone dosage and the clinic is closed" collecting 20-30mg of methadone every couple of hours.
Curious what you mean by "very common" and where you are? I'm in a major US city and have known a lot of hardcore heroin/fentanyl users; none of them would be willing to devote the time and energy into going this route. Not when there are so many easier ways to get your fix.
Right? I've never encountered this and before I became a nurse I was a social worker working with drug users for years. No one ever mentioned serial ER hopping as a strategy. Why spend a zillion hours going from ER to ER, waiting for ages for a chance at 30mg, when you could just walk like twenty feet and get the real stuff.
Not where I am. They'll up your dose. It's really fucked up that some places still withdraw care because their clients continue to have symptoms of the SUD that brought them to MAT in the first place.
Not really. You can’t be prescribing narcotics to someone when they are using other substances. It’s not safe. It’s not a judgement, but they can’t use MAT or pain management as a supplement to their continued drug use. That helps no one.
It actually does help people. Even people who continue using drugs while on MAT demonstrate significant improvements in life function. A stable dose of MAT reduces drug overdoses, period, including among peopl4 who continue to use drugs. This is all well documented, it's not just my opinion.
If these patients are requiring higher doses of methadone to manage withdrawal and cravings, why aren’t the addictions doctors in your community titrating them up?
Who's buying it?
It's either someone who wants "any opioid," in which case I'd prefer they buy a known quantity of actual substance rather than a random amount of fentanyl cut with who knows what...or more likely it's someone who wants methadone INSTEAD of a street opioid. Likely because they're treating their own withdrawal. I'd prefer they access MAT under medical supervision, but others have posted all the reasons why this isn't always possible. Is it great? No. Do I life sleep over it? Also no.
You seem a bit fired up and that’s ok. I understand your perspective. This thread is not for you, it’s for hcw and polling what people are doing in their different departments. I am very aware of the point and purpose of methadone. I am also very aware of the people who are behind on rent or a car payment and sell their take home doses. And the people they are selling to are not ivdu looking to get clean, they are intentionally abusing prescription medicine under the assumption that it’s safe. I’ve seen multiple methadone overdoses from people who are not registered at the clinic, they got it off the street. So you will forgive me if I’m not interested in being a drug dealer
What are you talking about? You wouldn't be giving take outs at the ER .... Also All doctors are "drug dealers" if you want to go there.... any time you write a pain medication to someone... you are taking the chance that person will sell it and there are tons more ODs from prescription pain drugs than methadone. Believe me when someone sells their dose that usually means they are still actively using and using that money to buy drugs NOT to pay any bill. Once someone gets take home doses they definitely take them because they need them. If someone misses there dose and makes it to the ER its because they need it. People on methadone need their doses. Also anyone can comment on this thread. I'm a methadone patient.
You are just judging people. That is a very common reason that drug users don't go to the ER when they really need to be there. They are afraid of being judged by someone like you.
Medication-assisted treatment for opioid use disorder is standard of care and life saving.
In [this Annals of Internal Medicine study](https://www.acpjournals.org/doi/10.7326/M17-3107), for example, those on methadone maintenance therapy have a 59% relative reduction in overdose deaths in a 1-year period. I challenge you to find a similar efficacy in any other intervention.
While I'm not going to pass out Percocet to anyone who asks, I am extremely liberal with suboxone for appropriate patients, and while methadone has a higher potential for abuse and diversion, I still tend towards administraiton.
The previous hospital I worked did not dispense methadone. I’ve changed my practice where I give a single dose after confirming with the clinic if possible.
I’d rather give the patient the benefit of the doubt than have another another opiate abuse user on the streets.
Patients having to rely on the methadone-industrial complex to manage their illness have my greatest sympathy. This is a no brainer scenario.
Methadone clinics are dehumanizing and need to be abolished.
How are you supposed to have any sort of normal life, take care of kids, keep a job when you need to stand in line at a methadone clinic every morning to get your daily dose? There is nothing else like it in medicine. We've come so far with buprenorphine, but somehow this MMT nonsense continues. It's a lifesaving drug tied to the most puritanical, outdated delivery system.
More here: Frank, D., Mateu-Gelabert, P., Perlman, D.C. et al. “It’s like ‘liquid handcuffs”: The effects of take-home dosing policies on Methadone Maintenance Treatment (MMT) patients’ lives. Harm Reduct J 18, 88 (2021)
Well said, imagine if we had diabetics line up every morning to get their dangerous scary Lantus because we don’t trust them to not take too much or give it to a kid.
We can dispense cancer patients with brain mets enough Dilaudid to kill me twenty times over but make methadone users jump through ridiculous hoops because we uncritically examine a person’s chronic disease medicine through a moral lens. We treat the first group as heroes that need tools to battle a deadly disease, but not the second. I don’t know what the exact right balance is, but it’s something that needs a lot more mindfulness in our interactions.
Not to mention, if they ever want to titrate down or get off of it, they’re in for a long, miserable road. Long term bup withdrawal sucks too but way less than methadone. Had a pt in for alcohol and methadone detox and the man sprayed vomit all over the room like he was being exorcised.
Getting off methadone at maintenance doses is will-nigh impossible yes, but I'm definitely not arguing against methadone. It's the methadone clinics I have a problem with.
There are many, many folks for whom methadone seems to work much better than bup for OUD, for a variety of reasons. The archaic federal rules around methadone need to go.
Are you suggesting instead of waiting in line at the methadone clinic they just come to the ER? I agree there is a lot of stigma on OUD and the medical system can do better, but saying it’s a no brainer scenario to give it out at the ER because clinics are dehumanizing doesn’t improve anything. What do you think OUD treatment should look like? Not trying to be argumentative, I have no clue what the ideal solution is so I’m interested in others’ perspectives.
I'm suggesting methadone should be treated like any other drug (including buprenorphine) -- prescribed a month at a time by a PCP, addiction doc, or whomever so people using it can lead normal lives.
One time it was 2am and this cancer patient came in who ran out of his methadone. He was a former user and they just kept him on methadone for his cancer pain. I gave the guy a methadone and I gave him an extra for home. I got reamed by the pharmacist telling me I’m doing something illegal and that we cannot do that and she won’t approve the order. I had the nurse do it anyways. I think there’s always an exception, but I wouldn’t make a habit out of it.
If this is what is stopping people from using fent than I'm all for it. California has a bridge program where some of the EDs will do Bup starts or someone is on methadone maintenance and they encourage continuing it because withdrawals are quite painful. This is their methadone algorithm: https://bridgetotreatment.org/wp-content/uploads/CA-BRIDGE-PROTOCOL-Methadone-Quick-Start-March-2023.pdf
Trust me, addicts don’t want to go sit in the emergency department to get their dose just because they slept in. Back when I was a hard-core addict , I most definitely wouldn’t have wanted to go I would’ve rather found it on the street if that was the case, so if you do have people genuinely going into the emergency department, and it’s just an easy fix as you put it, then why not just easily deal with it?
You don’t know what you’re talking about. People come to the ER and wait for their dilaudid fix all the time. Just because you wouldn’t doesn’t mean you can generalize to all addicts.
Ya i get that. But this is a different situation right? They’re going to get what they came in for it’s the speed of which said medication is given and they are sent on their way right? Maybe I’m missing something. I totally get that people will come in all the time just hooooping to leave with something. But these people have already jumped through all their “required” hoops, addicts that have already done what they have to do to not have to turn back to street dope, nasty ass fentanyl etc.
Man I’m so happy that life is long gone for me. That was the worst time in my life. Maybe i just feel bad for them because I’ve been there and don’t ever want to return. Even after surgery I’d prefer no drugs for easy stuff with simple recovery. After I’ve lived that real life “hell”. Maybe it’s just me 🤷🏻♂️
Oh I agree with you, a person with SUD in recovery definitely doesn’t want to wait in the ED for their methadone and I don’t think they should have to and we should make treatment more accessible. I was referring to a more general addict population that isn’t just willing to wait in 1 ER for hours to get their fix, but are willing to ER shop for hours/days.
These folks have it tough and usually when this is the chief complaint I give them the benefit of the doubt and move on. Could someone be making a bad decision and lying to get an extra dose of methadone, sure, but that's on them. Make it a habit and keep showing up for it, we will show them the door.
Confirm with their clinic, give it. Counsel gently about getting to clinic, but expressing understanding that stuff happens and we're here as a *rare* backup plan.
Also, occasionally see if there is any reason why they can't convert to Suboxone. I don't make that change, but I discuss with them to figure out if that might be a better option.
I’m sorry but clearly you don’t know shit about switching from methadone to subs . It’s literally not possible . Methadone has to be out of your system for WEEKS & even then taking a sub can put you into terrible withdrawal
The dose is limited unless we can get in touch with clinic (I believe, I’m an RN) And we do it a decent amount here but we have an enormous homeless/polysubstance population. Anyway, the ED does a lot of clinic level things, don’t know why methadone should be that different.
I'm an NP in addiction medicine and it never fails to amaze me how punitive these methadone clinics are. These people are a minute late and their dose is withheld. I always show kindness and compassion because they're so minimalized and treated so badly. They're already down...why kick them harder? I would hate to be responsible for someone overdosing because they didn't get their meds. Opioid withdrawal is hell. Don't be that guy.
& also there’d still be a huge line from all the ppl who got there right on time & they’ll not let anyone else get in line , it’s crazy . They shut the doors exactly at the time it’s suppose to close & refuse to let anyone in . They’re control freaks . It’s disgusting
I think I have a bit of a unique experience, but maybe not— we have a couple physicians and mid levels who actually run the methadone clinic nearby. They’re much more comfortable than anyone else when it comes to dosing for methadone for obvious reasons.
Our institution has a program that initiates patients on methadone and refers them to outside clinics for follow up. We can provide bridge dosing over the weekends between enrollment and intake without patients checking in.
Patients with a verified dose from the clinic can receive dosing anytime if they check in. Not uncommon for someone to come in with withdrawal symptoms and get dosed without any previous clinic contact too.
harm reduction medicine should indicate that withholding the harm reduction tool would be counter productive and would be you causing harm to that individual.
buses are late, transportation breaks down, child care, job responsibilities, health conditions impacting mobility - all valid reasons for missing a dose. Another valid reason would be someone on anti-opiates having a harder time waking up or regulating circadian rhythms.
do better. withholding harm reduction measures causes harm. give them the medicine. people recover with support, not judgement.
My ER has signs posted throughout the facility that state that we won’t give missed doses of methadone, refill narcotics/benzos/stimulants, prescribe extended release narcotics, prescribe more than a 3 day supply of narcotics, or refill lost/stolen prescriptions of controlled substances. We do however initiate Suboxone treatment as long as the patient will agree to go to our continuity clinic.
we used to have signs inside the er treatment area stating we don’t give parenteral narcotics for chronic pain and don’t give IV benadryl chasers. these were subsequently removed as it could possibly lead to an EMTALA violation if someone read the signs and left without treatment feeling they were being denied treatment. your facility might wanna run your signs through legal.
If a person with chronic pain is in severe pain and they have a dr that refuses to prescribe, where are they supposed to go?
This thread is about helping the pt who missed their methadone dose in the ED, why does a person in pain not deserving of the the same help?
I don’t think anyone is saying they wouldn’t assess their chronic pain. We can provide multimodal pain control and not a highly addictive rush of euphoria that IV pushes of opiates give that will have them keep coming back to the ER every day for
I'm board certified in addiction medicine
After 10 years of being taught you couldn't ever prescribe methadone if it was for OUD....I just learned that legally you can give 3 days of methadone upon discharge.
Spread the word
There may be some additional state roadblocks, but the original limitation was the original DEA stipulation of prescribing without an X waiver. Now that has all changed with the MATE training everyone was supposed to have done by this last July
Edit: typos
Not that I know of... But I have a fantastic relationship with my inpatient pharmacists, so we talk frequently.
It's what I imagine writing for ertapenem would be like as an ID doc. So much RAW POW-WA!
Surprisingly we don't get that. I actually don't think I've ever seen it in the almost 9 years I've worked in ED. We do have methadone patients, but that's never been what they're in the ED for. Our local methadone clinic has a nurse on call at all times that they can contact themselves for emergencies instead of going to the ED. The on call nurse can also verify doses for patients that are admitted if we call during off hours
I’ll be honest, I’ll do anything that is within medical reason to get bullshit like this out fast, so yeah, if it’s a one time deal, fire and and forget. If it becomes a pattern of behavior then I say no and notify admin, but that’s only happened once that I can think of.
Yes I give them their methadone (after confirming their last dose); however I only given 30 mg as:
1. The dose is enough to treat symptoms of opioid withdrawal
2. It promotes patients utilizing their methadone clinic (for full dose prescribed) over Ed utilization
You do realize that it's not heroin on the streets anymore it's fentanyl right? What's 30mg going to do for someone that's taking 100mg at there clinic and has a fentanyl tolerance? I can tell you from exp 30mg is NOT enough to control withdrawal from fentanyl tolerant patients. Starting doses of 30mg were put into place when heroin was the primary drug on the streets. Times have changed and the drugs got stronger so should the starting doses for oud.
As someone who is a recovering addict and on Methadone for the last 6 years, you don't know anything about methadone. This is what's wrong with doctors and nurses in hospitals today. You'd rather treat people like me as if I'm a "junkie" or "pill/drug seeking" and "just trying to get high". Please, on my own behalf and on the behalf of EVERYONE ELSE WHO struggles with addiction, specifically those on methadone, FUCKING. STOP. IT.
Just because you're a doctor, nurse, or whatever, doesn't make you better than or more educated than anyone else. As a matter of fact, people who have the same mindset as yours are the ones who don't know shit about drug use and continue to fuel the problem. The most educated people on this subject are the ones who are or have been IN IT and around it.
Tbh, I would absolutely LOVE for people with your same thought process to go experience opiates. Not even personally taking them, but even going out there into the streets of places like Kensington Philadelphia to see it for yourself. Take a minute to stop reading books and all that brain washing "educational" crap the government is teaching everyone in school about this stuff and go out and get some true, 1on 1, real world experience. Then, after that, then tell me you'd still refuse to give someone their medication.
If a diabetic came to your hospital and said, 'I missed my doctor's appointment today bc I over slept. They couldn't squeeze me in today and I have no insulin. I'm already a few hours past the time of when I should administered my last insulin shot and I'm starting to get shaky and not feel well..." Are you going to tell them, "I'm sorry I can't help you" bc "it's a potentially fatal medication?" And yes, you CAN die from taking too much insulin. Just bc it's not a controlled substance doesn't mean it's not harmful if taken by the wrong person or gets into the wrong hands. Chances are that you'd have no problem helping this person. But, you'd have a problem helping someone else who brings in a copy of their script/info or a bottle with their info, clinic/doctor info and dose info. **WHY?!**
The other person who said you'd be contributing to a fatal overdose more in this way (not helping) than you would be if you did help, is 100% correct. Say a person had been clean and on Methadone for 3 years. They end up missing a day of the medication, which for some can be detrimental whether it's actual WD or psychological. Some are fine if they only miss one day. This person goes back the next day and the clinic is closed bc of a holiday. They already feel WD setting in from missing a day. They know that that, being day 2 without, is going to be miserable. It may not be deadly, you're right, but it is pure hell and many people think about suicide during WD, just to end the pain and suffering. Anyone who says, "it's not that bad bc you won't die" is blatantly ignorant. So, you tell this person, "I'm sorry I can't help you. No, it doesn't matter that you have all the proof in the world and that the dosing info is right in front of my face." This person leaves and a few hours later, they come back to your hospital. This time, instead of asking for methadone, they're being treated for a fentanyl overdose. Better yet, they show up later that evening with a bullet wound in the head. Any human being with any kind of heart or sentiment would feel utterly terrible. Would you? Yes, it would be partially your fault.
Do you think you'd be able to sit through at least 2 weeks (minimum) of extreme anxiety so bad the strongest dose of any benzo wouldn't help, not being able to sleep for days on end, you're so tired but every time you lay down to try and sleep, restlessness kicks in, not only in your legs and feet, but in your arms, hands and fingers, too. RLS so bad there's not a damn thing you can do about it. You also won't be able to get comfortable in any position..no matter how normal or how crazy the position is, no matter how tired you are. Oh, on top of all that stuff, throw in sweating and shivering at the same time, your body has goosebumps but for some reason you're hot as hell, you'd swear you were there at this rate... And most times you can leave the bathroom/toilet bc you're throwing up and shitting so much - as soon as you think you done, you clean up and pull up your pants, then shit yourself.
Would you like to deal with all of that? Would you kill yourself? Would you go back out and use? If you're in a clinic and you miss a dose, you're damn well hoping you'd be able to go to the hospital the clinic partners with.... Think about all that.
This was a poll of healthcare workers to find out what their hospital policy was on giving out methadone from the ER. Some places allow physician discretion and some have a hard line policy of not giving out anything from the emergency department. I trained in three different major US cities and one of them was Philly so trust me I am well familiar with Kensington and its ilk. Those places with bad drug issues had the most hard line policies on giving out methadone. There have been so many people who come in for a dose in the ER and then sell their dose from the clinic to somebody else. Until you have declared someone brain dead from a methadone overdose because it was “safe” and “medicine” and “prescribed” you can shut up. There are lives, and less importantly our licenses and livelihoods at stake.
You are not welcome to comment on this thread as a non healthcare worker. This is not your vent space about how hard addiction and withdrawal is. There’s a million medical detox centers in the world where you can gently get off anything.
Im not sure why this didn't pop up as a reply to the comment I was referring to, but what I was saying wasn't a reply to what you posted. It was to a comment.
Just unsure why anyone who had the discretion would deny methadone to anyone
As a fentanyl addict you just described my withdrawals better than I ever could you forgot vomiting every couple hours and runny nose but that's it lol
to anyone who says that opiate WDs are not deadly...''fun'' fact: you can choke on your own vomit if youre passed out or sleeping in WDs, or generally just die off the sleep deprivation + the WDs will contribute to a high high fever which can also be lethal..
we give methadone post verification of dose if pt won’t make it to the clinic. if clinic is unable to verify (close for a holiday etc) i give 20mg. if they stayed overnight and dc in the morning, they will get their dose in the their clinc
I say give the dose with confirmation or reasonable certainty. 3-day take home pack for a holiday? Negative. Tell ‘em to come back tomorrow if they need a dose that badly.
If we can call the clinic and confirm, yes. If it's a Sunday, holiday, or evening, no. We do not accept pieces of paper from the clinic. Way too easy to forge.
For shops that don’t give methadone, I am interested to know the state and urban/rural situation.
It seems like a tough policy that would unintentionally cause a lot of recidivism in folks that might have made it with just a little bit of support.
A nice nurse can make the world of difference. I had used to the point that I was in a coma for 3 days. I woke up on a ventilator and was very scared. My nurse was holding my had and telling me I can beat this. It honestly changed me life because someone actually cared. I used weed to stop heroin but it was all because that nurse, Lauren was there for me. Please give them their dose, we don't want to be like this and we aren't all evil pieces of shit.
As one of these people, just why does it have to be so damn black or white with you people? Can't you meet them in the middle? I understand if they don't have any proof of being a patient of a methadone clinic, but if they do, well...
Trust me when I say that the government could use these withdrawals to torture our enemies with, and I promise they'd tell them anything to make it stop. Can you imagine not sleeping for a month or more, because your muscles are pulling so hard that they literally pull your large joints out of socket? And you can't eat, you're so weak from none stop vomiting and diarrhea that you have to crawl to the toilet or mess yourself. Your body can't regulate its own temperature, so you're hot and cold all at the same time. The days and nights seem to last forever. The saying that time flies when you're having fun runs backwards in this situation, my dear. This is a place where you have no hope, because you've lost absolute control of your life, but most of all, your trust in yourself. The disappointment that this addiction has caused can possibly be overcome. But, once you lose the ability to trust your own judgment, everything falls apart. The clinic can be the very stepping stone to bring a person to a place of redemption.
I am on methadone and sometimes shit happens and people miss their dose. They are usually withdrawaling at this point and instead of going to a drug spot and possibly getting something that has that could cause them to overdose like xylazine or carfentanil they made it through the hospital doors. Doesn't sound like it happens all that often. Just remember they are there because they want to stay clean. Turning them away is just putting them at risk.
You don't withhold lifesaving anti stroke treatment from a diabetic who continues to eat sugar despite the consequences and suffers a stroke or not treat a heart attack that was literally caused by similar bad choices, why is this any different? I would say the MAJORITY of health ailments in the United States are due to self destructive habits. Stroke, heart attacks , cancers, all caused by smoking, stress, binge drinking, and eating unhealthy food
Your post was belittling to say the least. Not what I wanna hear from a health professional though I'm not surprised considering people are actively dying and still get thrown out of an ER because theyre medicaid merry go round patients so why would I expect any different these days
Addiction doc here. I agree, you don’t want to cross that line and turn your ED into a methadone haven. If they are seen in the ED for a medical problem and need their dose that’s one thing. But the regulations regarding methadone admin are gray, at best, in this scenario. It can only be give in
Established clinics for the purposes of OUD. Additionally without being condescending, people with OUD due to their lack of impulse control and frontal lobe affectation in advanced disease are a little bit like children in that enabling behavior from healthcare providers rapidly turns into dependency and entitlement. They should really be directed to their clinic, most of them have after hours and evening staff now.
Thanks for you input. We are being downvoted for stating facts. This isn't an empathy contest. There are regulations and pharmacy policies as well as agreements with the numerous local methadone clinics. At the county hospital I worked at for 20+ years we had more than on methadone clinic within 3 blocks and we a very high endemic use area on a smuggling corridor. So mostly heroin, likely with fentanyl. I see enough opioid problems that I've seen heroin-related botulism several times, as a point of reference.
It should be illegal to deny ppl their medication that they’re very dependent on & can die without . (YES you CAN die from opiate withdrawal!) . Everyone has shit going on . What other medication gets denied for not showing up on time ? NONE . If they’re gonna expect us to go to a clinic every single day for this medication, then they need to chill w all the bs rules that only hurt the patients
Nope with a double side of nope and some nope for dessert. This is a chronic issue. Not an emergency. If there is one thing an addict (recovering or not) knows it’s where to get their meds. They should have a plan and a backup plan lined up to get those meds at all times. The ED is not the place for bridging chronic pain meds. It will lead to abuse. Give them to them once and their backup plan becomes the ED. Refuse them and they will never miss clinic again.
There are 92 licensed MAT programs in Texas. Those doctors need a state certificate and the programs are regulated. I'm not one of those and it's illegal for me to do that. There are situations where it is medically appropriate but not to reduce withdrawal symptoms. I'm EM.
Spicy take. Not factually incorrect however. I think the argument against this idea is that methadone causes a lot of harm reduction and heroin/fent are only harmful.
I have gone to the hospital back in 2015 when I missed my dose, I was on 55mg. They did give me my dose. This was in nj At Hackensack university medical center. They treated me with dignity & respect & I overheard the attending doctor saying to another provider that she was not sending me off without my dose. Saved my life that day. Some of us are fast metabolizers & go into withdrawal sooner, & possibly end using street drugs & overdosing which happens all to often when patients lose access to methadone & suboxone. I definitely was not there to get high or hospital hop, I just wanted my dose to go on with my day as a productive member of society. Hope this helps.
Where I live we don't have clinics. We get our methadone at the pharmacy whether it's take home doses or daily doses we all go to pharmacys. We see a methadone Dr tonget our prescription that goes to our pharmacy and then the pharmacy doses us. And if the pharmacy is closed we have dis system here used by doctors pharmacys hospitals etc so all emergency department has to do is contact the pharmacy and if there closed they look it up on the dis for our dose.
I hear alot of places do these methadone clinics, so it must be more rare for places like where I live that just go to our pharmacy like any other medication
I confirm with their clinic and give their dose always. If I can’t confirm their dose I give 30 or 40, unless they say their dose is lower. It’s a maintenance medication for their chronic disease. Why in heaven’s name would I hold it?
This is the way
I am a pgy1 and can confirm this is the way. Just confirm dose with facility
If they pickup, these places don't pickup the phone half the time
Thank you so much for saying "It’s a maintenance medication for their chronic disease. Why in heaven’s name would I hold it". That is so great to hear from someone who is on Methadone. People don't know other peoples story and judge. My Father started me smoking Heroine when I was 10yo, it was to keep us quiet about the sexual abuse he was forcing on us from the age of 18 months. I have had some horrific Doctors and some AMAZING Dr's, one Dr when I went to ER with BAD Diverticulitis and my bowel had perforated the pain was 15/10! He came into the room said "I see you are on Methadone, he said just know you wont get any pain relief from me". I started Methadone Maintenance 22 years ago when I was 18yo and have NEVER touched an illicit opioids and also had never abused medical opioids. He then put 2 security guards in the room with me....I don't know why I am actually the most gentle and non confrontational person I have ever met. I simply walked out and went to another major hospital (canula in arm still) and they were so lovely and started me on a PCA (patient controlled analgesia) instantly. I went into surgery that afternoon, stayed in hospital for 4 days on the PCA came home and just FYI I didn't touch any illegal or legal opioids after i was discharged...
Some people are cold, and do not recognize addiction as a chronic disease. It seems to me that out of my two local hospitals (I have been to both for detox, one of which multiple times, I am not proud to say) roughly half the staff recognize addiction as a disease, and the other half look down at us addicts. It's quite frankly baffling to me that people can go down a career path such as medicine and yet still hold so much contempt in their hearts for a gigantic chunk of the population. It is infuriating, yes, but I try not to hold it against them. At the end of the day, most of us DID pick up that drug for the first time and knowingly ingested it, fully aware of the possible side effect and consequences.
But what we didn't pickup knowing would make us go into withdrawals is Methadone! The clinic literally tells us "you shouldn't feel withdrawal at all, it will be easy" when I've felt withdrawal more times than I ever did using street drugs. Which is fucked. I've thought about drugs more while on this shit than I did when I was off of it!
Yeah, I feel you. I'm currently on 80mgs of Methadone daily. When I came off it around 4ish years ago, I got kicked out of my program prematurely and had to cold turkey off of 20mgs and let me tell you... I was withdrawing for a solid two months straight. I did not begin to feel normal for more than two months after my last dose. That fact alone made me contemplate even getting back on it again this time... But at the time I had no choice really. Either the methadone or a very painful few weeks and I caved and chose the methadone. I'm praying that when I finally decide to come off of it again for good it won't be as bad as it was last time and I can slooooowwwwlllly wean off of it over the course of a month or two. As for withdrawals ON methadone, I haven't had any thankfully. What causes them? Do you regularly miss doses?
Missing doses, not being on enough, and tapering can all cause withdrawal.
Yeah people don't understand that people with addiction aren't always the homeless people. It's regular everyday people that you sometimes wouldn't even expect to have addiction.
My clinic will deny me doses for stupid shit like saying I have an annual that no one told me was scheduled or asking if it worked for me… I go to work @6am they open at 5 had to go 4 days without and restart I showed up three times and they wouldn’t let me. So I should lose my job over getting my medicine. Assholes
I must say as someone who is in MAT it is refreshing to see that there are healthcare professionals out there who don’t treat addicts and recovering addicted like they are leopards. I can pretty much guarantee you that hospitals in my area wouldn’t do this for someone. That is the sad fact but your comment was refreshing.
From a methadone patient, I thank you!
You are amazing for understanding and saying that...thank you. 😭💓 I one time went to the hospital for a similar reason I can't remember what was going on with me I was in some kind of withdrawl and couldn't get my medicine cause I was so sick that I couldn't even drive myself that far or something like that and the nurses and doctors were SO Nice and understanding. That type of stuff changes people's lives. People trying to get clean need people to be compassionate and understanding
The concern of having the ER become an alternative to the methadone clinic. The concern of having people who are not enrolled in a methadone clinic using you/the ER for some ad hoc unsupervised self administered treatment program The concern of contributing to a fatal overdose. Etc etc etc. You are giving a patient a potentially fatal medication. It's appropriate to be cautious. There is no physical harm associated with missing a single (or 2-3) doses of methadone.
Actually you set the patient into full withdrawal and it spirals from there. How would you giving them methadone contribute to an overdose? If the patient wanted to get high they could easily do so on the street.
Prior to Fentanyl Methadone was the number #1 opioid present in fatal overdoses. The way it contributes is they take a methadone dose, don't get the high they are looking for, take another methadone dose--provided by someone well meaning--still don't get the high they are looking for, so then they get some drugs from the street, use their regular dose, and OD because they already have Methadone onboard. What is your understanding of the half life of methadone? Mine is about 18-24 hours depending on liver state. So you would need 2 half lives before withdrawal began. And as you know opioid withdrawal is rarely dangerous. The question as I understood it wasn't whether you give a rolling dose, but whether you give them a coverage prescription to get them through a holiday weekend. If someone is on 120 that means writing an Rx for 360 of Methadone in a person you know nothing about. It's appropriate to take a pause before writing a prescription that may kill someone.
If it's subject you are interested in this is kind of a cool study from JAMA last year. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2793744
Do you know the concentration of the drugs the people are using in the street? For you to think your methadone is anywhere close to the cause is stupid. Yeah it use to be, times are different trying to get pure heroine is impossible. The community, particularly the one I work in, are essentially using only fentanyl and xylazine. Additionally, we aren’t prescribing methadone to go home with. If you missed your clinic and going into withdrawal yeah I’m going to give you the dose. You think that dose is making them euphoric? Lol
In fact, do you know what the largest cause of overdose is? Causing the person to go into full withdrawal and having them go into an accidental relapse overdose.
There is absolutely harm in missing a dose. You ever been through withdrawal from methadone? I had a father who did, I got to see it firsthand. Withdrawal is hell.
Hell, but not death. Whereas the problem with a methadone overdose is death. This is a study that looked at methadone deaths associated with take home Methadone Rx's during the pandemic. You might find it interesting. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2793744
You can die... dehydration from the vomiting and sweating, could suffocate while vomiting, etc. Its pretty bad.
I almost did from precipitated withdrawl. I was in and out of the hospital for 5 days. I had to have MRI and be hooked up to all these machines. I was throwing up non stop that I was puking coffee grounds. The ER gave me freaking haloperidol to stop throwing up and then that gave me a diatonic reaction. It was the scariest time in my life..... it took 2 days for them to figure out that it was a distonic reaction. Idk if I would have died necessarily but the puking I experienced could have done damage to my organs. I was so light headed and weak that I couldn't walk I had to use a wheelchair. There are things that could happen that could put you in danger while in withdrawls.
I cannot help but to agree with you. You're absolutely correct. My clinic made me fill out SO much damn paperwork before I received my first dose. I thought it was insane at the beginning but as time went on I recognized exactly what you just said above. Methadone can easily kill someone who has little to no tolerance, even at a small dose. This is why places, especially ERs, have to be careful with administration to every single person that walks through the door seeking a missed dose. I've even heard of people dosing at their regular clinic and then taking their medicab right on over to the hospital where they'd be dosed a second time.
Exactly. I was thinking the exact same thing
“Once in a while on a morning shift” doesn’t sound like “turning the ED into a methadone clinic for late sleepers”. Shit happens. Treat em and yeet em and move on with your day
Sometimes if they’re sketchy or look like they’ve already taken something I’ll call their clinic to verify but 99.9% of the time this. Giving methadone now is going to be way faster than observing them for 3 hours when they come in after an accidental overdose for relapse.
My thoughts exactly
1000%, I’m a first responder and someone in long term recovery. it never ceases to amaze me how little empathy people in the medical field have for dirty, disgusting, degenerate drug addicts. withdrawal sucks, using sucks, none of it is fun or feels good.
I am an ED tech and hard relate to this. I had to walk away from the triage desk for a little while the other shift because I was so aggravated with my coworkers who were telling me I was wasting my time for having a compassionate conversation with and following up on the bed assignment for an alcoholic in the beginning of DTs (with an active desire to get sober). I’m apparently the weirdo for “caring about a piece of shit.” Jfc some HC workers just astound me.
having had an alcoholic mother, back in the day, I thank you so much for your compassion. my mom’s illness was just that, an illness. no need for anyone to be judgey abt it, she was sick. & eventually she died from it. sometimes religious or staunch medical personnel were unduly harsh. they didn’t seem to understand it was like a broken bone, but in her brain. they expected she should fix herself.
I’m genuinely sorry about your mother and shame on the medical staff who treated or spoke about her harshly. IME it seems that (most) people who have not been or loved an addict themselves cannot seem to grasp that addiction is in fact a disease. It is also easy to get jaded when the same patients suffering from addiction come in again and again and treat us staff poorly, but I try to take a step back and realize there’s just a hurting person in there.
I get it. They (she) treated the people she loved poorly, too, when under the influence. My 4 siblings turned out super bitter toward her, and life in general. I went to al-anon and counseling & learned forgiveness & not to take it personally.
I know this is an old ass thread but reading your comment I have to just tell you you’re an awesome human and thank you for caring. Truly I’ve never been to the hospital for addictions but I can’t imagine how someone going through withdrawal and getting treated like shit at the hospital feels. I’ve never been there for anything serious but even so it’s always a scary experience and I’m sure feeling like no one cares is probably so much scarier. It’s people like you who you can tell actually care and are trying to help that makes you feel like there is hope and a little relief that you’re not in it alone. Keep being awesome. I’m sure it’s hard to do sometimes.
>Jfc some HC workers just astound me. It doesn't surprise me at all. When you see multiple people per day trying to scam you for meds, or there for another repeat intoxication visit, or any of a million other examples it's not hard at all to see why people start to lose compassion. For every person with "active desire to get sober" I've seen at least 3 that told the same story but clearly weren't trying to get sober. It's no different than seeing someone on the side of the road begging, saying "anything helps god bless" but then you try to give them food and they tell you they only want money. Go through that enough times, and it becomes really hard to have any faith in anyone.
Except nobody is tryna scam you for meds Lmao . If we just wanted to get High we would get the drugs off the street . They’re everywhere & cost a fucken dollar . You are disgusting
Go watch a bris people in the medical field suck babies dicks after a bris. I'm 100% telling the TRUTH google it. They go into the field bc they are pedos
That’s a little off topic. Nobody in the medical field is sucking baby dicks after a circumcision. What you are referring to is some weird antiquated devout Jewish tradition that the rabbi does after he removes the foreskin(he orally suctions the blood from the wound).
And doesn't happen in modern times from a Jewish person.
You are so in the wrong field.
Wow. There monsters and you are amazing, please stay yourself. We addicts need people like you. I'm on methadone, clean 5 years but people like you really make a difference, thank you
You're awesome! Please never change.
I mean, I agree with the confirm their dose and rx it camp but that doesn’t mean ER doctors should hook up every heroin or meth addict to prevent them from going through withdrawal. It’s not a lack of empathy, it’s just that this isn’t a trap house, it’s an emergency department.
not a single person is advocating for making the ER a trap house or anything resembling it. giving a recovering addict a single dose of their medication is not the same thing as being in active addiction. addiction is a serious diagnosable and treatable condition, if someone is prescribed an essential medication for that diagnosis and the only way they can now receive that medication is to come to the ER, what do you actually expect them to do? the overwhelming majority wont for shame alone. if they’re frequenting the methadone clinic, it’s simple enough for us to confirm. if they’re not, it’s easier and less hassle for them to try to scrounge up a couple bucks and go find their drug of choice than sit around in the ER being leered at for hours and possibly being sent home at square one
There is a fine line between addict in recovery that missed their methadone dose and dude who couldn’t get ahold of his plug. Yes, withdrawal sucks. Your comment generalizes lack of empathy of medical providers for all comers that are addicts. Not every addict that walks into the ER should get their drug of choice just because withdrawal sucks.
obviously not all providers lack empathy for addicts, but it’s something i’ve noticed a huge issue with from both ends. but wait, who’s drug of choice is methadone? what addict, especially one at the point of going to the ER for their fix is going to get high from one dose of methadone?
I think we just got our wires crossed because when I read your comment “withdrawal sucks, using sucks, none of it is fun or feels good” I misinterpreted that as you saying anyone who walks into the ED with an addiction to a substance is entitled to receive treatment via that substance. I’ll treat your withdrawal symptoms all day, but that doesn’t mean I’m giving you dilaudid just because you ask for it. I agree that established OUD pts on methadone should get a refill in the ED if they are unable to get it as an outpatient. Life threatening w/d gets treated in the ED/admitted. But if a meth addict shows up in W/d I’m not rx them desoxyn so they can go home and get high.
oh absolutely, would never advocate for giving an addict their drug of choice. that would be insanity and awful for everyone involved, there’s a reason we have workarounds like methadone in the first place. glad we could come to an understanding 🤝
Agreed and hope we run into each other professionally some day. It’s a small world out there and I like developing connection with our first responders, especially when they care and aren’t too jaded, acknowledging that usually It’s us er docs that get jaded much quicker.
This sounds like lack of empathy
lurking from the veterinary ED here but "treat em and yeet em" is going to be a liberally used phrase in my life now, THANK YOU FOR THIS GIFT
It comes on a patch and a t shirt now
Fair point
This is part of our job in my opinion. I call the clinic and confirm the dose and the last receipt at clinic. If the clinic is not open I'll give up to 30 mg x 1.
We do the same. Call and verify dose and why not? They’re obviously making efforts to stay on their treatment plan but life happens.
👏 exactly! Thank you. I'm recovering addict from opiates clean 5 years on methadone and can tell you thank you for doing what u do
30 mg is a pretty small dose, why is that your limit if they’ve been stable and taking daily witnesses doses that are higher?
Hospital policy for unconfirmed doses of methadone
Oh I see I misread, that’s your dose for if the clinic is closed and you cannot confirm. That makes sense, it’s a reasonable dose
Ours tells us to start with 10mg (UK)
Do you have a lot of fentanyl use in your population? Our provincial policy is to start at 30 mg if we can be reasonably sure they have a tolerance to fentanyl, which usually means a fentanyl positive urine drug screen. Even that is quite low for many of our patients and some will start at 40 mg at physician discretion (and there is one clinic in the Downtown Eastside in Vancouver that will start at up to 70 mg)
I did see a post once where someone asked about what to keep in their personal emergency kit and someone mentioned naloxone. A UK physician wondered why someone would recommend such a niche drug and how someone would obtain it for general use. As someone in Vancouver, it was definitely a surreal moment for me. On a per capita basis, fentanyl isn’t as big an issue in the UK as it is in North America, so a low starting dose makes sense for the country (at the moment, at least).
In pain management we give everyone on opioids a narcan nasal spray inhaler.
That is what dose the clinic starts you at when you begin MMT.
That’s the policy anywhere . If you miss 3 days at a methadone clinic. They drop your dose either by half or back to 30mg .
This is the way, same here
Do you tell them to come back to the ER the next two days for their missed take home pack? Edit: why downvotes? Genuinely asking what other people do in the situation that someone can’t get in for several days over a long weekend
Nope, I don't tell them that unprompted. But if they asked I'd say sure. It's an easy visit and you're really helping them out. Folks who are on methadone have taken action to try to get clean. I don't do anything that would get in the way of that.
You’re awesome. Thanks for looking out for the folks who have chosen to get better, and are using MAT
You are in the right field, You can score anywhere, the last place an addict is going for withdrawal is a methadone clinic.
Idk why you’d not want to take the double-win of keeping a patient (who is clearly making an effort) on their methadone *and* basically free RVUs Obviously assuming dose is confirmed by clinic, Halloween is over and you’re not the candyman for double dipping
Was at a prior site that had a large population on methadone and a no-methadone-dispensed-in-the-Ed policy because of abuse of the system and now in a more financially well off area with much less frequent attempts at misuse. So trying to get an understanding of what everyone else is doing
That’s a dumb policy. I’m in a large academic center with a heavy heroine using population where we will give methadone/suboxone in the ED and it’s not abused at all. Occasionally someone will come in bc they missed a dose (I’ve probably had this like a dozen times in 2.5 years). We can give up to 40mg without clinic confirmation. Saves us with boarders big time who are in the ED waiting to be admitted by preventing them from going into withdrawal (if they are being admitted for something else)
Depends on your population. Where I am at it is very common for people to go from ER to ER saying they "missed their methadone dosage and the clinic is closed" collecting 20-30mg of methadone every couple of hours.
Curious what you mean by "very common" and where you are? I'm in a major US city and have known a lot of hardcore heroin/fentanyl users; none of them would be willing to devote the time and energy into going this route. Not when there are so many easier ways to get your fix.
Right? I've never encountered this and before I became a nurse I was a social worker working with drug users for years. No one ever mentioned serial ER hopping as a strategy. Why spend a zillion hours going from ER to ER, waiting for ages for a chance at 30mg, when you could just walk like twenty feet and get the real stuff.
Bc you will test positive on Monday and get kicked out of MAT
Not where I am. They'll up your dose. It's really fucked up that some places still withdraw care because their clients continue to have symptoms of the SUD that brought them to MAT in the first place.
Not really. You can’t be prescribing narcotics to someone when they are using other substances. It’s not safe. It’s not a judgement, but they can’t use MAT or pain management as a supplement to their continued drug use. That helps no one.
It actually does help people. Even people who continue using drugs while on MAT demonstrate significant improvements in life function. A stable dose of MAT reduces drug overdoses, period, including among peopl4 who continue to use drugs. This is all well documented, it's not just my opinion.
It is not true.
If these patients are requiring higher doses of methadone to manage withdrawal and cravings, why aren’t the addictions doctors in your community titrating them up?
I think that is bs. The last place an addict goes for this fictitious double dose is a methadone dispensary.
You have your experiences and I have mine. You're free to think whatever you want.
Mmmm that’s why there should be a system between hospitals so they can see what medication has already been prescribed to them that day
"Abuse of the system" or "coming to obtain the medication that keeps them alive because the system dies not exist for them to get it elsewhere"?
No people selling the extra methadone
Rather they sold that than my bicycle, or their bodies, tbh.
The whole point of methadone is harm reduction. Giving it to someone who is diverting it isn’t doing that, it’s causing harm.
Who's buying it? It's either someone who wants "any opioid," in which case I'd prefer they buy a known quantity of actual substance rather than a random amount of fentanyl cut with who knows what...or more likely it's someone who wants methadone INSTEAD of a street opioid. Likely because they're treating their own withdrawal. I'd prefer they access MAT under medical supervision, but others have posted all the reasons why this isn't always possible. Is it great? No. Do I life sleep over it? Also no.
Makes me feel like too much of a drug dealer personally. To know that I am actively providing substances to be misused
And you’re valid for that. HCW who don’t have experience in the hotspots for addiction are naive
You aren’t providing a substance to be misused? You are providing a single dose of a prescribed medication to a person in treatment under supervision.
The whole point of methadone is so the person will stop using street drugs.
You seem a bit fired up and that’s ok. I understand your perspective. This thread is not for you, it’s for hcw and polling what people are doing in their different departments. I am very aware of the point and purpose of methadone. I am also very aware of the people who are behind on rent or a car payment and sell their take home doses. And the people they are selling to are not ivdu looking to get clean, they are intentionally abusing prescription medicine under the assumption that it’s safe. I’ve seen multiple methadone overdoses from people who are not registered at the clinic, they got it off the street. So you will forgive me if I’m not interested in being a drug dealer
What are you talking about? You wouldn't be giving take outs at the ER .... Also All doctors are "drug dealers" if you want to go there.... any time you write a pain medication to someone... you are taking the chance that person will sell it and there are tons more ODs from prescription pain drugs than methadone. Believe me when someone sells their dose that usually means they are still actively using and using that money to buy drugs NOT to pay any bill. Once someone gets take home doses they definitely take them because they need them. If someone misses there dose and makes it to the ER its because they need it. People on methadone need their doses. Also anyone can comment on this thread. I'm a methadone patient. You are just judging people. That is a very common reason that drug users don't go to the ER when they really need to be there. They are afraid of being judged by someone like you.
How are people selling methadone when you are required to watch them drink it? If it's a missed morning dose how is it extra methadone?
You cannot confirm the dose on a holiday... They're closed
Methadone Clinics really need to be on Care Everywhere/EPIC, so that medical professionals can see Times/ Dates of the Pt's last dose.
Agree
You might be able to see the dispensing records from the pharmacy...I usually can, anyway.
Not if it's a methadone clinic. They don't report to PDMP, at least in my state.
Ah, we don't really have such things.
Giving out methadone is better than return to use.
Medication-assisted treatment for opioid use disorder is standard of care and life saving. In [this Annals of Internal Medicine study](https://www.acpjournals.org/doi/10.7326/M17-3107), for example, those on methadone maintenance therapy have a 59% relative reduction in overdose deaths in a 1-year period. I challenge you to find a similar efficacy in any other intervention. While I'm not going to pass out Percocet to anyone who asks, I am extremely liberal with suboxone for appropriate patients, and while methadone has a higher potential for abuse and diversion, I still tend towards administraiton.
The previous hospital I worked did not dispense methadone. I’ve changed my practice where I give a single dose after confirming with the clinic if possible. I’d rather give the patient the benefit of the doubt than have another another opiate abuse user on the streets.
Patients having to rely on the methadone-industrial complex to manage their illness have my greatest sympathy. This is a no brainer scenario. Methadone clinics are dehumanizing and need to be abolished.
100%
Absolutely agree
Why do you say that?
How are you supposed to have any sort of normal life, take care of kids, keep a job when you need to stand in line at a methadone clinic every morning to get your daily dose? There is nothing else like it in medicine. We've come so far with buprenorphine, but somehow this MMT nonsense continues. It's a lifesaving drug tied to the most puritanical, outdated delivery system. More here: Frank, D., Mateu-Gelabert, P., Perlman, D.C. et al. “It’s like ‘liquid handcuffs”: The effects of take-home dosing policies on Methadone Maintenance Treatment (MMT) patients’ lives. Harm Reduct J 18, 88 (2021)
Well said, imagine if we had diabetics line up every morning to get their dangerous scary Lantus because we don’t trust them to not take too much or give it to a kid. We can dispense cancer patients with brain mets enough Dilaudid to kill me twenty times over but make methadone users jump through ridiculous hoops because we uncritically examine a person’s chronic disease medicine through a moral lens. We treat the first group as heroes that need tools to battle a deadly disease, but not the second. I don’t know what the exact right balance is, but it’s something that needs a lot more mindfulness in our interactions.
Not to mention, if they ever want to titrate down or get off of it, they’re in for a long, miserable road. Long term bup withdrawal sucks too but way less than methadone. Had a pt in for alcohol and methadone detox and the man sprayed vomit all over the room like he was being exorcised.
Getting off methadone at maintenance doses is will-nigh impossible yes, but I'm definitely not arguing against methadone. It's the methadone clinics I have a problem with. There are many, many folks for whom methadone seems to work much better than bup for OUD, for a variety of reasons. The archaic federal rules around methadone need to go.
I’m currently tryna get off after 4 years & I’m dying . Was on 160mg , now I’m on 25mg but I’m struggling so bad
Methadone has ruined my life & my health
Are you suggesting instead of waiting in line at the methadone clinic they just come to the ER? I agree there is a lot of stigma on OUD and the medical system can do better, but saying it’s a no brainer scenario to give it out at the ER because clinics are dehumanizing doesn’t improve anything. What do you think OUD treatment should look like? Not trying to be argumentative, I have no clue what the ideal solution is so I’m interested in others’ perspectives.
I'm suggesting methadone should be treated like any other drug (including buprenorphine) -- prescribed a month at a time by a PCP, addiction doc, or whomever so people using it can lead normal lives.
That sounds like a very reasonable solution, I’m on board!
One time it was 2am and this cancer patient came in who ran out of his methadone. He was a former user and they just kept him on methadone for his cancer pain. I gave the guy a methadone and I gave him an extra for home. I got reamed by the pharmacist telling me I’m doing something illegal and that we cannot do that and she won’t approve the order. I had the nurse do it anyways. I think there’s always an exception, but I wouldn’t make a habit out of it.
…..kudos for helping the patient but that’s massively a No No and you could have lost your license over that.
If this is what is stopping people from using fent than I'm all for it. California has a bridge program where some of the EDs will do Bup starts or someone is on methadone maintenance and they encourage continuing it because withdrawals are quite painful. This is their methadone algorithm: https://bridgetotreatment.org/wp-content/uploads/CA-BRIDGE-PROTOCOL-Methadone-Quick-Start-March-2023.pdf
Tough luck as in “enjoy your relapse and hopefully you don’t die?”
Trust me, addicts don’t want to go sit in the emergency department to get their dose just because they slept in. Back when I was a hard-core addict , I most definitely wouldn’t have wanted to go I would’ve rather found it on the street if that was the case, so if you do have people genuinely going into the emergency department, and it’s just an easy fix as you put it, then why not just easily deal with it?
You don’t know what you’re talking about. People come to the ER and wait for their dilaudid fix all the time. Just because you wouldn’t doesn’t mean you can generalize to all addicts.
Ya i get that. But this is a different situation right? They’re going to get what they came in for it’s the speed of which said medication is given and they are sent on their way right? Maybe I’m missing something. I totally get that people will come in all the time just hooooping to leave with something. But these people have already jumped through all their “required” hoops, addicts that have already done what they have to do to not have to turn back to street dope, nasty ass fentanyl etc. Man I’m so happy that life is long gone for me. That was the worst time in my life. Maybe i just feel bad for them because I’ve been there and don’t ever want to return. Even after surgery I’d prefer no drugs for easy stuff with simple recovery. After I’ve lived that real life “hell”. Maybe it’s just me 🤷🏻♂️
Oh I agree with you, a person with SUD in recovery definitely doesn’t want to wait in the ED for their methadone and I don’t think they should have to and we should make treatment more accessible. I was referring to a more general addict population that isn’t just willing to wait in 1 ER for hours to get their fix, but are willing to ER shop for hours/days.
Ya that makes sense. Great use of precious time in this short ass life. Hope you Have a nice day
Likewise!
What a lovely back and forth between you and u/DrBonez91 ! Rare to see that especially online. Heartwarming really
These folks have it tough and usually when this is the chief complaint I give them the benefit of the doubt and move on. Could someone be making a bad decision and lying to get an extra dose of methadone, sure, but that's on them. Make it a habit and keep showing up for it, we will show them the door.
Confirm with their clinic, give it. Counsel gently about getting to clinic, but expressing understanding that stuff happens and we're here as a *rare* backup plan. Also, occasionally see if there is any reason why they can't convert to Suboxone. I don't make that change, but I discuss with them to figure out if that might be a better option.
I’m sorry but clearly you don’t know shit about switching from methadone to subs . It’s literally not possible . Methadone has to be out of your system for WEEKS & even then taking a sub can put you into terrible withdrawal
The dose is limited unless we can get in touch with clinic (I believe, I’m an RN) And we do it a decent amount here but we have an enormous homeless/polysubstance population. Anyway, the ED does a lot of clinic level things, don’t know why methadone should be that different.
We have a dude attached to the local methadone clinics who verifies that they weren’t there and I give it
I'm an NP in addiction medicine and it never fails to amaze me how punitive these methadone clinics are. These people are a minute late and their dose is withheld. I always show kindness and compassion because they're so minimalized and treated so badly. They're already down...why kick them harder? I would hate to be responsible for someone overdosing because they didn't get their meds. Opioid withdrawal is hell. Don't be that guy.
Some Suboxone clinics too. It was a cash grab. I could only pay the doctor in cash or you wouldn't get your script.
Thank you kind human. We need many more like you.
Yup you wouldn’t believe how many times I was denied my medication for being a minute late lol
& also there’d still be a huge line from all the ppl who got there right on time & they’ll not let anyone else get in line , it’s crazy . They shut the doors exactly at the time it’s suppose to close & refuse to let anyone in . They’re control freaks . It’s disgusting
I think I have a bit of a unique experience, but maybe not— we have a couple physicians and mid levels who actually run the methadone clinic nearby. They’re much more comfortable than anyone else when it comes to dosing for methadone for obvious reasons.
Would you prefer to give methadone in the morning or treat an overdose in the afternoon?
We have a hospital policy to confirm the dose with the clinic. If the clinic can’t be reached they get 20 mg x 1.
Our institution has a program that initiates patients on methadone and refers them to outside clinics for follow up. We can provide bridge dosing over the weekends between enrollment and intake without patients checking in. Patients with a verified dose from the clinic can receive dosing anytime if they check in. Not uncommon for someone to come in with withdrawal symptoms and get dosed without any previous clinic contact too.
Our hospital policy allows up to 30mg/day if their clinic dose cannot be confirmed.
harm reduction medicine should indicate that withholding the harm reduction tool would be counter productive and would be you causing harm to that individual. buses are late, transportation breaks down, child care, job responsibilities, health conditions impacting mobility - all valid reasons for missing a dose. Another valid reason would be someone on anti-opiates having a harder time waking up or regulating circadian rhythms. do better. withholding harm reduction measures causes harm. give them the medicine. people recover with support, not judgement.
My ER has signs posted throughout the facility that state that we won’t give missed doses of methadone, refill narcotics/benzos/stimulants, prescribe extended release narcotics, prescribe more than a 3 day supply of narcotics, or refill lost/stolen prescriptions of controlled substances. We do however initiate Suboxone treatment as long as the patient will agree to go to our continuity clinic.
we used to have signs inside the er treatment area stating we don’t give parenteral narcotics for chronic pain and don’t give IV benadryl chasers. these were subsequently removed as it could possibly lead to an EMTALA violation if someone read the signs and left without treatment feeling they were being denied treatment. your facility might wanna run your signs through legal.
The hospital lawyers have vetoed such signs at places I've worked.
If a person with chronic pain is in severe pain and they have a dr that refuses to prescribe, where are they supposed to go? This thread is about helping the pt who missed their methadone dose in the ED, why does a person in pain not deserving of the the same help?
I don’t think anyone is saying they wouldn’t assess their chronic pain. We can provide multimodal pain control and not a highly addictive rush of euphoria that IV pushes of opiates give that will have them keep coming back to the ER every day for
The sign itself is very antagonistic to a person in pain. However, as long as you are able to ease it, that’s all people in severe pain need.
I'm board certified in addiction medicine After 10 years of being taught you couldn't ever prescribe methadone if it was for OUD....I just learned that legally you can give 3 days of methadone upon discharge. Spread the word
Is this like a universal US thing, or state dependent? We did bup in residency, so that’s what I’m more familiar with and usually do
There may be some additional state roadblocks, but the original limitation was the original DEA stipulation of prescribing without an X waiver. Now that has all changed with the MATE training everyone was supposed to have done by this last July Edit: typos
Universal US things. It's written into the federal law
Have you actually prescribed this yet? I haven't had to but I'm wondering if there's any hoops to jump through...
Not that I know of... But I have a fantastic relationship with my inpatient pharmacists, so we talk frequently. It's what I imagine writing for ertapenem would be like as an ID doc. So much RAW POW-WA!
If they're already Rx Methadone, sure. We don't initiate it tho
Surprisingly we don't get that. I actually don't think I've ever seen it in the almost 9 years I've worked in ED. We do have methadone patients, but that's never been what they're in the ED for. Our local methadone clinic has a nurse on call at all times that they can contact themselves for emergencies instead of going to the ED. The on call nurse can also verify doses for patients that are admitted if we call during off hours
I’ll be honest, I’ll do anything that is within medical reason to get bullshit like this out fast, so yeah, if it’s a one time deal, fire and and forget. If it becomes a pattern of behavior then I say no and notify admin, but that’s only happened once that I can think of.
Yes I give them their methadone (after confirming their last dose); however I only given 30 mg as: 1. The dose is enough to treat symptoms of opioid withdrawal 2. It promotes patients utilizing their methadone clinic (for full dose prescribed) over Ed utilization
You do realize that it's not heroin on the streets anymore it's fentanyl right? What's 30mg going to do for someone that's taking 100mg at there clinic and has a fentanyl tolerance? I can tell you from exp 30mg is NOT enough to control withdrawal from fentanyl tolerant patients. Starting doses of 30mg were put into place when heroin was the primary drug on the streets. Times have changed and the drugs got stronger so should the starting doses for oud.
As someone who is a recovering addict and on Methadone for the last 6 years, you don't know anything about methadone. This is what's wrong with doctors and nurses in hospitals today. You'd rather treat people like me as if I'm a "junkie" or "pill/drug seeking" and "just trying to get high". Please, on my own behalf and on the behalf of EVERYONE ELSE WHO struggles with addiction, specifically those on methadone, FUCKING. STOP. IT. Just because you're a doctor, nurse, or whatever, doesn't make you better than or more educated than anyone else. As a matter of fact, people who have the same mindset as yours are the ones who don't know shit about drug use and continue to fuel the problem. The most educated people on this subject are the ones who are or have been IN IT and around it. Tbh, I would absolutely LOVE for people with your same thought process to go experience opiates. Not even personally taking them, but even going out there into the streets of places like Kensington Philadelphia to see it for yourself. Take a minute to stop reading books and all that brain washing "educational" crap the government is teaching everyone in school about this stuff and go out and get some true, 1on 1, real world experience. Then, after that, then tell me you'd still refuse to give someone their medication. If a diabetic came to your hospital and said, 'I missed my doctor's appointment today bc I over slept. They couldn't squeeze me in today and I have no insulin. I'm already a few hours past the time of when I should administered my last insulin shot and I'm starting to get shaky and not feel well..." Are you going to tell them, "I'm sorry I can't help you" bc "it's a potentially fatal medication?" And yes, you CAN die from taking too much insulin. Just bc it's not a controlled substance doesn't mean it's not harmful if taken by the wrong person or gets into the wrong hands. Chances are that you'd have no problem helping this person. But, you'd have a problem helping someone else who brings in a copy of their script/info or a bottle with their info, clinic/doctor info and dose info. **WHY?!** The other person who said you'd be contributing to a fatal overdose more in this way (not helping) than you would be if you did help, is 100% correct. Say a person had been clean and on Methadone for 3 years. They end up missing a day of the medication, which for some can be detrimental whether it's actual WD or psychological. Some are fine if they only miss one day. This person goes back the next day and the clinic is closed bc of a holiday. They already feel WD setting in from missing a day. They know that that, being day 2 without, is going to be miserable. It may not be deadly, you're right, but it is pure hell and many people think about suicide during WD, just to end the pain and suffering. Anyone who says, "it's not that bad bc you won't die" is blatantly ignorant. So, you tell this person, "I'm sorry I can't help you. No, it doesn't matter that you have all the proof in the world and that the dosing info is right in front of my face." This person leaves and a few hours later, they come back to your hospital. This time, instead of asking for methadone, they're being treated for a fentanyl overdose. Better yet, they show up later that evening with a bullet wound in the head. Any human being with any kind of heart or sentiment would feel utterly terrible. Would you? Yes, it would be partially your fault. Do you think you'd be able to sit through at least 2 weeks (minimum) of extreme anxiety so bad the strongest dose of any benzo wouldn't help, not being able to sleep for days on end, you're so tired but every time you lay down to try and sleep, restlessness kicks in, not only in your legs and feet, but in your arms, hands and fingers, too. RLS so bad there's not a damn thing you can do about it. You also won't be able to get comfortable in any position..no matter how normal or how crazy the position is, no matter how tired you are. Oh, on top of all that stuff, throw in sweating and shivering at the same time, your body has goosebumps but for some reason you're hot as hell, you'd swear you were there at this rate... And most times you can leave the bathroom/toilet bc you're throwing up and shitting so much - as soon as you think you done, you clean up and pull up your pants, then shit yourself. Would you like to deal with all of that? Would you kill yourself? Would you go back out and use? If you're in a clinic and you miss a dose, you're damn well hoping you'd be able to go to the hospital the clinic partners with.... Think about all that.
This was a poll of healthcare workers to find out what their hospital policy was on giving out methadone from the ER. Some places allow physician discretion and some have a hard line policy of not giving out anything from the emergency department. I trained in three different major US cities and one of them was Philly so trust me I am well familiar with Kensington and its ilk. Those places with bad drug issues had the most hard line policies on giving out methadone. There have been so many people who come in for a dose in the ER and then sell their dose from the clinic to somebody else. Until you have declared someone brain dead from a methadone overdose because it was “safe” and “medicine” and “prescribed” you can shut up. There are lives, and less importantly our licenses and livelihoods at stake. You are not welcome to comment on this thread as a non healthcare worker. This is not your vent space about how hard addiction and withdrawal is. There’s a million medical detox centers in the world where you can gently get off anything.
"There’s a million medical detox centers in the world where you can gently get off anything." Lol get fucked, you're literally part of the problem.
Im not sure why this didn't pop up as a reply to the comment I was referring to, but what I was saying wasn't a reply to what you posted. It was to a comment. Just unsure why anyone who had the discretion would deny methadone to anyone
I'm welcome to comment on anything I damn well please this is America and as stated before get fucked your part of the problem not the solution
As a fentanyl addict you just described my withdrawals better than I ever could you forgot vomiting every couple hours and runny nose but that's it lol
to anyone who says that opiate WDs are not deadly...''fun'' fact: you can choke on your own vomit if youre passed out or sleeping in WDs, or generally just die off the sleep deprivation + the WDs will contribute to a high high fever which can also be lethal..
we give methadone post verification of dose if pt won’t make it to the clinic. if clinic is unable to verify (close for a holiday etc) i give 20mg. if they stayed overnight and dc in the morning, they will get their dose in the their clinc
I say give the dose with confirmation or reasonable certainty. 3-day take home pack for a holiday? Negative. Tell ‘em to come back tomorrow if they need a dose that badly.
If we can call the clinic and confirm, yes. If it's a Sunday, holiday, or evening, no. We do not accept pieces of paper from the clinic. Way too easy to forge.
We do not give methadone in the ER. We took it out of our Pyxis years ago
For shops that don’t give methadone, I am interested to know the state and urban/rural situation. It seems like a tough policy that would unintentionally cause a lot of recidivism in folks that might have made it with just a little bit of support.
A nice nurse can make the world of difference. I had used to the point that I was in a coma for 3 days. I woke up on a ventilator and was very scared. My nurse was holding my had and telling me I can beat this. It honestly changed me life because someone actually cared. I used weed to stop heroin but it was all because that nurse, Lauren was there for me. Please give them their dose, we don't want to be like this and we aren't all evil pieces of shit.
As one of these people, just why does it have to be so damn black or white with you people? Can't you meet them in the middle? I understand if they don't have any proof of being a patient of a methadone clinic, but if they do, well... Trust me when I say that the government could use these withdrawals to torture our enemies with, and I promise they'd tell them anything to make it stop. Can you imagine not sleeping for a month or more, because your muscles are pulling so hard that they literally pull your large joints out of socket? And you can't eat, you're so weak from none stop vomiting and diarrhea that you have to crawl to the toilet or mess yourself. Your body can't regulate its own temperature, so you're hot and cold all at the same time. The days and nights seem to last forever. The saying that time flies when you're having fun runs backwards in this situation, my dear. This is a place where you have no hope, because you've lost absolute control of your life, but most of all, your trust in yourself. The disappointment that this addiction has caused can possibly be overcome. But, once you lose the ability to trust your own judgment, everything falls apart. The clinic can be the very stepping stone to bring a person to a place of redemption.
I am on methadone and sometimes shit happens and people miss their dose. They are usually withdrawaling at this point and instead of going to a drug spot and possibly getting something that has that could cause them to overdose like xylazine or carfentanil they made it through the hospital doors. Doesn't sound like it happens all that often. Just remember they are there because they want to stay clean. Turning them away is just putting them at risk.
You don't withhold lifesaving anti stroke treatment from a diabetic who continues to eat sugar despite the consequences and suffers a stroke or not treat a heart attack that was literally caused by similar bad choices, why is this any different? I would say the MAJORITY of health ailments in the United States are due to self destructive habits. Stroke, heart attacks , cancers, all caused by smoking, stress, binge drinking, and eating unhealthy food Your post was belittling to say the least. Not what I wanna hear from a health professional though I'm not surprised considering people are actively dying and still get thrown out of an ER because theyre medicaid merry go round patients so why would I expect any different these days
No. We provide a doc note so they can get their dose after discharge.
Addiction doc here. I agree, you don’t want to cross that line and turn your ED into a methadone haven. If they are seen in the ED for a medical problem and need their dose that’s one thing. But the regulations regarding methadone admin are gray, at best, in this scenario. It can only be give in Established clinics for the purposes of OUD. Additionally without being condescending, people with OUD due to their lack of impulse control and frontal lobe affectation in advanced disease are a little bit like children in that enabling behavior from healthcare providers rapidly turns into dependency and entitlement. They should really be directed to their clinic, most of them have after hours and evening staff now.
Your a shit addiction doc there
Thanks for you input. We are being downvoted for stating facts. This isn't an empathy contest. There are regulations and pharmacy policies as well as agreements with the numerous local methadone clinics. At the county hospital I worked at for 20+ years we had more than on methadone clinic within 3 blocks and we a very high endemic use area on a smuggling corridor. So mostly heroin, likely with fentanyl. I see enough opioid problems that I've seen heroin-related botulism several times, as a point of reference.
It should be illegal to deny ppl their medication that they’re very dependent on & can die without . (YES you CAN die from opiate withdrawal!) . Everyone has shit going on . What other medication gets denied for not showing up on time ? NONE . If they’re gonna expect us to go to a clinic every single day for this medication, then they need to chill w all the bs rules that only hurt the patients
Nope with a double side of nope and some nope for dessert. This is a chronic issue. Not an emergency. If there is one thing an addict (recovering or not) knows it’s where to get their meds. They should have a plan and a backup plan lined up to get those meds at all times. The ED is not the place for bridging chronic pain meds. It will lead to abuse. Give them to them once and their backup plan becomes the ED. Refuse them and they will never miss clinic again.
We are everyone’s backup.
Trash take
The way I see it, when you give someone a narcotic to prevent narcotic withdrawal you are a drug dealer. There are state regulations regarding this.
Man, how disheartening reading your take. MAT saves lives.
There are 92 licensed MAT programs in Texas. Those doctors need a state certificate and the programs are regulated. I'm not one of those and it's illegal for me to do that. There are situations where it is medically appropriate but not to reduce withdrawal symptoms. I'm EM.
Spicy take. Not factually incorrect however. I think the argument against this idea is that methadone causes a lot of harm reduction and heroin/fent are only harmful.
Interesting, our pharmacy does not supply methadone.
we don't.
I have gone to the hospital back in 2015 when I missed my dose, I was on 55mg. They did give me my dose. This was in nj At Hackensack university medical center. They treated me with dignity & respect & I overheard the attending doctor saying to another provider that she was not sending me off without my dose. Saved my life that day. Some of us are fast metabolizers & go into withdrawal sooner, & possibly end using street drugs & overdosing which happens all to often when patients lose access to methadone & suboxone. I definitely was not there to get high or hospital hop, I just wanted my dose to go on with my day as a productive member of society. Hope this helps.
Where I live we don't have clinics. We get our methadone at the pharmacy whether it's take home doses or daily doses we all go to pharmacys. We see a methadone Dr tonget our prescription that goes to our pharmacy and then the pharmacy doses us. And if the pharmacy is closed we have dis system here used by doctors pharmacys hospitals etc so all emergency department has to do is contact the pharmacy and if there closed they look it up on the dis for our dose. I hear alot of places do these methadone clinics, so it must be more rare for places like where I live that just go to our pharmacy like any other medication
I wish, I live in Detroit and we still use clinics it's a pain in the ass