If I go into a methadone clinic (canadian) and say I've been using various opiates., how do they decide what dose of methadone to give me? Do they make me take enough to see some bevahioral sign? Do they use a chart based on say how mych heroin I've used daily? What if I'm not sure wha amount I've been using
They will take a urine sample to make sure you have actually been using opiates, they will ask you how much heroin or whatever opiate(s) you take you normally use per day, and they will start you on a relatively low dose and gradually increase it if you need more. If you're not sure how much you've been using just tell them you're not sure and are just estimating. Most people starting on methadone don't need a very high dose of methadone to alleviate withdrawals, so I wouldn't worry too much that you're going to be "severely sick" while waiting for your first dose increase. Hopefully the clinic you go to will have it so you see the doctor again the next day. You can (and should) also talk to the clinic about all your concerns and questions.
I don't know what province you live in, but in most provinces you will have to go to the pharmacy to pick up your methadone. It might vary depending on the province, but in most you go to the doctor at the clinic, get a prescription, take it to the pharmacy and drink your liquid methadone in front of the pharmacist. Although some methadone clinics do have a pharmacy in or near the clinic, so in that situation you should be able to get your first dose and presumably see the doctor again soon after to see how it has affected you. It really depends on the clinic and how they do things, there isn't really a standard country-wide protocol for starting someone on methadone aside from the things neversickanymore and I mentioned like assessing the person and starting them on a dose that is low enough to be unlikely to kill them.
Once you have started on methadone, your dose may be gradually increased every few days if you find it is not fully alleviating withdrawal symptoms, or some clinics might encourage you to increase it until you are at a typical "blocking" dose that would make it hard to feel much from a normal dose of heroin. Or some will just keep increasing it until you no longer use other opiates or complain of having cravings. But again, it really depends on the clinic and doctor. Some like to keep people on as low a dose as possible, and some like to encourage higher doses and staying on methadone for life. I think it's important that your methadone doctor considers what you want to do and what your goals are.
I think it's really important that you work on your mental addiction. Methadone is not a cure, once stabilized it merely alleviates your withdrawals, giving you a break from having to use heroin/whatever simply to not be sick, so you can work on changing your life - you still have to put in the time and effort. I strongly encourage you to take this chance work on the reasons why you use opiates in the first place, try to stay on a low dose of methadone and don't stay on it too long - it becomes harder and harder to get off it the longer you're on methadone. Of course you don't want to be forced to taper off it when you're not ready and just go straight back to using heroin, but you really don't want to end up like me and spend a decade on methadone telling yourself you'll get off it "later" and then find out how incredibly difficult methadone withdrawal is after 10 years of use. I absolutely wish I'd gotten off it a long time ago, it's had some major adverse impacts to my health from being on it for so long. I've been off it for around 5 months now and getting off it was the hardest thing I've ever done. Not trying to scare you, I just think it's important to tell people that they may want to have a plan to actively work on their addiction and the goal of getting off methadone sooner rather than later. It's so easy for people to end up on it for the rest of their lives and it's so limiting to your freedom.
Best of luck to you and sorry this was so long
