perhaps I have to disagree. Methadone provides a legal and efficient replacement for illicit opiates, but I've yet to come across a convincing argument for its value in the treatment of addiction.
Personally, I've had to discontinue methadone treatment on close to a dozen occasions because it's just so damn pleasant--even after months of daily use. The passage in which Odysseus' crew members are slowly lured to their deaths by the wicked Sirens comes to mind...
I was maintained on methadone for a 3 or so years at 380mg/day. My clinic was extremely high-end, in the penthouse of a Beverly Hills hospital (the hospital itself is actually pretty shitty). It was ultra-private, no patients ever saw another, it was geared for high-profile patients who wanted great anonymity. It was quite expensive, paid in cash (don't want that shit on my insurance record), and very liberal with the dose (which is how I got to 380mg, yes, 38 10mg tablets per day which was actually getting me high as fuck). They did drug tests, but if you failed, they didn't care (I was using benzos, sometimes some ultra-high doses of fentanyl or heroin, and some cocaine here and there). Towards the end I was only going once every THREE months, which means bottles upon bottles of 10mg methadone tablets.
My point is, they gave me as much methadone as I wanted (again, for a hefty price, but I was fortunate to have the means....~$2,000 a month is a lot cheaper than heroin), so much so that I became "bored" with it, and felt the inevitable lengthy nod that 380mg of methadone causes was "no longer necessary". I slowly began tapering (without telling the clinic, i'd come every 3 months for my massive amount of pills....hey I was paying $2,000 for what is technically a cheap drug, why not get the 38 pills/day), and after around a 14 months, I wrote them a letter saying that I no longer needed their services. Again, I went at a pace comfortable to me, and finally went "cold turkey" at 1/4 of a 10mg tablet (2.5mg). This was the most unpleasant part, but lasted all of 12 days. It was honestly trivial compared to cold turkey heroin withdrawal (ultra-intense, open-eyed visual hallucinations etc), and didn't even come close to benzo withdrawal. Even though I still had thousands of extra methadone tablets I felt no "lure" or "craving" for the drug. I actually used alot of the tablets for my two dying dogs (canines are poor metabolizers of methadone, and need large doses).
Bottom line..........its unfortunate how "rigid" our methadone maintenance laws, and one shouldn't have to pay $6,000 for a 3 month supply. The drug can be without question abused (I would still rank it among my top 5 opioids for recreation), and yes, can also result in acute toxicity fatalities in the non-tolerant individual. But, it is technically, cheaper than buprenorphine, is a pure-agonist and NMDA-antagonist, and requires no unpleasant induction-precipitated withdrawal, and is extremely predictable. Those who have had "bad" experiences with methadone are those who have been abruptly "cut off" or "disciplined" by low end clinics which strictly adhere to the law, and require humiliating lines, drug tests, etc (I experienced this in Australia, I went to a state run methadone clinic, and it was very humiliating). Personally, I feel as though "disciplining" a patient by withholding or reducing a dose to illicit withdrawal to be a very real form of torture/gross malpractice.
The DEA has made buprenorphine extremely easy to prescribe for addiction (a elementary "DATA 2000" waiver; 8-hour "test"), yet in order to open a methadone clinic, one must go through overly extensive regulatory red-tape.
When used properly, methadone is a great drug for getting off of opioids, or staying on them until you feel it is necessary. Access and "celebrity" treatment should not cost $2,000 (actually more with deliveries, $400 a pop) given the ultra-low cost of methadone's production. My clinic never did psychotherapy or anything unrelated to dispensing methadone. At a normal methadone clinic I probably would not have excelled as I did. To be sure, drug laws are very prohibitive in respect to methadone. Personally, I admit that I prescribe it less than I probably should (for pain only, I am not licensed to prescribe methadone for addiction......yet I am able to write bupe scripts for addiction). The fear associated with "over-prescribing" methadone is a real one; the DEA would thinking I am running some unlicensed methadone clinic if I prescribed it as much as I felt it was needed (again, I do not work in addiction medication, I am an a rather 'green' anesthetist and do not have a secondary "chronic pain").
The simple truth..........methadone is valuable too, but is too hard to access........
In regards to d-amphetamine tolerance reduction...........what dose and ROA are you using?
My point is, they gave me as much as I wanted, and eventually I realized......
