Oh yeah I agree the doses prescribed for maintenance are absurdly high. Hardly anyone needs over 8mg yet they start everyone at 16mg. I have certainly seen Suboxone turn a small habit into a much larger one
Yeah, I tend to think methadone has a similar issue. Not so much with starting doses, for me one of the big problems, the reason methadone didn't work for me for so long is their utter refusal at my original clinic to increase my dose faster or start me on a higher dose.
But the doses people get stable on are a whole other story. Once I went to a clinic that increased my dose properly, I found it quite eye opening how much I actually needed compared to how much many other people I've seen were on. Many of them seemed to wind up on doses much higher than mine dispute having originally had smaller heroin habits.
Many methadone providers are super sensitive about how fast you increase your dose to start with, but so long as you don't miss doses, the sky's the limit.
Now, I'm not saying that they should stop letting people get on high doses, all in all I tend to think the risks of them fucking up trying to predict a suitable ceiling dose is an even bigger problem than increasing people's tolerance, but it was still quite surprising to me how little methadone I needed to how much I might have expected going off other people.
I certainly wouldn't say, at least where I lived, that there was a problem with excessive starting dose. The problem was they wouldn't increase my dose fast enough, so I'd use heroin. And doing shit to make money for heroin would make me miss dosing which would mean I'd remain stuck on a starting dose. So many times I wanted to slap them for telling me how easily I could die if they put me up faster. Which was a total joke. Cause not only did a better clinic do just that, it's just total bullshit with the habit I had. But that was the other issue, they never seemed to believe how much I was using. It's a little hard to blame them, the amount of money I was able to spend at the time was just stupid.
Also most of the staff were just disrespectful assholes. It was quite amusing to me to see how much less security my next clinic had, which I soon realized was because they didn't need as much. People were just much better behaved. And the reason they behaved better was because they respected the staff, and the reason they respected the staff was because the staff showed respect to them.
All that money saved by just not acting like pricks.