Guest response by Robert Newman

Further Reading

Why won’t they let me off methadone?

Dear Mr. Peele,

I was addicted to H for about 3 years. Then I knew it was time to get off the train, so I got on methadone which worked well for me. I have been clean for about 2 years, nothing but methadone, I'm still on the methadone and I have been slowly decreasing my dose because I want to get the hell off methadone now. Soon I will be completely drug free and I will do it. The problem is that I am running into major resistance from the clinic. I have a private doctor also who supports my wanting to get off methadone. It seems now the only people who want me to remain on methadone are those at the methadone clinic. They are refusing to take my dose down for no reason, they say going down 2 mg a week is against medical advice because it is too much of a decrease. (If you miss a payment they will immediately take you off going down a harsh 5-10 mg a day until your on 0.) I could just use this method by just not paying and they will automatically take me down immediately, but 5 mg a day is too much too fast of a decrease for me.

Is there any action I can take? I have been pleading with them for months to no avail. There are no medical doctors in this facility only medical assistants. What do you think I should do? When I'm off methadone I'll never use again. I hate drugs so much, they ruined my life, but methadone served its purpose but now it's time to get off the methadone. How could any clinic in their right mind want to stand in my way on the road to total sobriety? I think its money, and that angers me quite frankly. Do you know if there is anyone I can call to put pressure on them to take me down.

Thank you,

This answer is provided by Dr. Robert Newman, of Beth Israel Hospital. Stanton notes: Observe that strict adherence to informed consent is outlined by Dr. Newman – why does this not prevail in general in the addiction treatment field, where so much treatment is coerced?

Dear Frank:

The story, as presented here, is an outrage. Patients retain their autonomy in this as in all treatment of disease and can decide whether and when to discontinue treatment, regardless of the physicians' views. If the physician explains that the patient's decision is in conflict with medical advice, fine - then have the patient sign an AMA form and get on with the detox. The consent to proceed AMA can be in terms as stark as the physician feels appropriate: e.g., "I have been advised that proceeding with detoxification at the rate I am requesting has a high likelihood of relapse, and that it can lead to severe illness and to death. Nevertheless, I have instructed my physician, notwithstanding these dire warnings of potentially fatal outcome, to proceed . . . . "

So what to do? Plenty of options. I suggest first and foremost that you ask for a complete copy of his medical record - and express a willingness to pay copying charges if needed. I'd submit such a request immediately. Second, review the chart and ensure it conforms to reality - if not, write a contrary summary and insist it be placed in the chart. Third, and best after the chart is in hand, tell the clinic you are going to report its refusal to detoxify to both the single state agency that licenses methadone clinics, and also the accreditation agency (Joint Commission on Accreditation of Healthcare Organizations or whichever other – a clinic is supposed to post such accreditation, but if not, ask, and if there's no answer, ask the single state agency or the federal agency that's responsible).

Finally, I would suggest the patient demand to see the physician in charge, and if threatened with discontinuation of treatment, then I'd get a lawyer immediately and let the lawyer deal with it. Again, few programs are so stupid as to fight a determined patient when their entire operation hangs in the balance.

Bob Newman

Thank you Mr. Newman, your email was Extremely Helpful, some really good info. It's a breath of fresh air for me, because I've been having to deal with this damn Methadone clinic. I am going to do just what you were saying in the email, I really want to get a copy of my whole chart, I will pay them upfront for copying charges. That will scare them, I know they will resist this so bad, they will say no, I know it, they'll say we can't make copies of these and they can't leave the building, or something to that affect, but if I know that they have to do that for a patient then they will do it. At some point they are going to realize it's not worth fighting me, I will contact some of the organizations that you mentioned, they would have to be complete morons to want to escalate the issue to that level and still fight my decision just as you eluded to in the email.

Many thanks,

Good luck - and if you want a lawyer to help intimidate them, or a physician to review the char t when you get it, let me know. If we can't help, we'll tell you at once; if we can, there'd be no charge - then it's a privilege to do so.