I'm guessing people have a lot of questions regarding how this stuff works, so I thought I might type up a quick little blurb regarding how I understand these maintenance programs to work.
I cannot truly speak to the functionality of the Australian system. I have limited knowledge regarding the systems in place in the UK and a slightly better understanding of what goes on on the continent, as I have more friends there that I speak with. At any rate, it's safe to assume that uniformity is not the rule in place in practically any of these locales. Ironically, it
seems that there is more uniformity in law and treatment standards from country to country on the continent than between states here in the US or even provinces in Australia. Addiction treatment as a right has arrived pretty late to the party. It's only just recently that moral opinion has begun to shift in our favor and even that is happening quite slowly.
The United States has clinics operated by the state/county/city etc. and those operated by corporations/private owners. For instance, Mitt Romney's (Republican Senator from Massachusetts, former R-Presidential Candidate) Bain Capital owned a series of corporate shell companies that in turn operated a series of well-populated Methadone clinics in Greater Boston. The speed at which addiction rates have climbed in the past 20 years had led to a severe glut in the few private clinics in the state. For-pay was the only route for many folks. In the past 5 or so years, at least here in New England, we've seen a normalizing of the process.
Clinics in the United States have some leeway in how they prescribe, but in theory and practice, all of their behavior must exist within the guidelines of the Federal Government. The feds watch pretty closely, but that didn't stop me from crying my way into 6 take-home doses per week after only 2.5 months of treatment. It can be done, but you need to have a good, convincing story, as that story will in all likelihood end up at the desk of some DEA scumbag, who will decide whether it's credible or not. In general, clinics operate upon these guidelines in the United States.
3 months of completely clean urinalyses, 1-2, but probably 1 take home dose of Methadone
6 months of completely clean urinalyses, 2-3 take home doses of Methadone
9 months of completely clean urinalyses, 3-5 take home doses of Methadone
12 month of completely clean urinalyses, 6 take home doses of Methadone
12 months/1 year of completely clean urinlayses in essence, means you come to the clinic once per week to pick up 6 daily doses of Methadone
In the United States, Buprenorphine can be prescribed outright for the purpose of addiction maintenance, but it's not typical for a severely addicted, poly-drug user to walk out of a prescriber's office with a month's worth of Buprenorphine. That just wouldn't make sense. That would be like throwing money after money, but I'm not saying it never happens. In general, they like to make sure people have at least even a small, infinitesimal shred of sobriety before giving them a month's worth of Opioids. So, many folks begin their Buprenorphine at one of our regions lovingly-appointed Methadone/Bupe clinics. The timeframe of which is notedly much less severe than with Methadone, a bottle of which, to be fair, is like handing a loaded shotgun to an infant. If anyone wants to hear a funny story about teenager's breaking into a Methadone clinic in my hometown in the early 00's and subsequently dying in their homes that same night, send me a private message
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Treatment in the United States with anything other than Buprenorphine w/ Naloxone is rare and is typically only prescribed to pregnant women or those who can demonstrate a great need for it.
As previously stated, there are much less restrictions upon Buprenorphine prescribing, so you can expect a much greater variation in these guidelines than with Methadone.
1 month of daily attendance with at least 2 clean urinalyses: 1 week's worth of Buprenorphine w/ Naloxone (Suboxone): Weekly prescriptions for Suboxone.
3 months of daily attendance with clean urinalyses throughout: Golden Ticket to a doctor's office, monthly UA's and monthly prescriptions picked up at a normal pharmacy
I just thought that this might be helpful, as it seems many are curious as to how the process works. I think making the outlook a little bit less vague could help push some folks with anxiety over the process into maintenance a little bit faster.
