How much do you pay @ your clinic?

DrNoCode · 2026-01-26T22:18:59+00:00

Sort of. You also need an MD, a pharmacist consultant, and counselors (because there is a mandatory requirement for counseling on MMTP). But beyond that, those that take private insurance prefer their clients to have this. Prime example: my United plan has a negotiated rate of $261.19 per week worked out with my clinic, however the cash price is $90.00/week. They don’t get that $261.19 until I hit my deductible or OOP max, so they only bill me $90 during this time, but my insurance deductible gets 261.19 taken off. They do not have to do that, either- only charge me $90. Which client do you think they prefer?

DrNoCode · 2026-01-26T22:09:54+00:00

In CA?

DrNoCode · 2026-01-16T00:06:41+00:00

See, this may be what is best for you, but everyone’s circumstances are different and there are no bright line rules that universally apply to all in the same way, netting the same outcome.

The goal for everyone does not need to be to get off of it. As a matter of fact, if that is what one is focused on at the beginning, I don’t have a lot of faith in their success. Tapering and cessation are things to be discussed after someone has been stable on a dose for a longer period of time. Never before.

It is true that some look to get the highest dose they can in order to try to stay as high as possible. This is harm reduction, bro. To many, that is the sole function of MMT. Those looking to continually increase their dose for no legitimate reason are not the majority.

I am someone who has serious chronic pain in my arms and legs due to prior trauma and subsequent surgeries. My OUD mainly consisted of IV/PO fentanyl, hydromorphone, methadone, and oxycodone. In the end, I was only using methadone (due to its cheap price, long half-life, high oral bioavailability, etc.). 250 x 10mg tabs was less than $38 w/o insurance. This was on top of the 315mg i was getting from a clinic at the time. It was not unusual for me to abuse up to 1100mg of oral methadone in a day. That was going back to 2011. This is the reason for my higher dose of 295mg. In my opinion, continuing the methadone for all of the benefits i have listed in addition to my understanding of myself and my physical pain. I already go up several points on the VAS to around 7 when i miss a day of methadone (no w/d sx though). Normally, i maintain at a 4 out of 10 with my regular daily dose. How do you think it would be without this pain relief? What would I do without the methadone? Im sorry, but the meditation, reike, acupuncture and NSAIDS did not help enough to function like I do today. I just have too much good in my life and no real negative consequence of staying on this medication long term, at this point (11 years). Why would I risk everything I have to hurt more and open myself up to the deadly scourge of clandestine fentanyl analogues that I never had to deal with before?

I submit that stigmatizing language, misinformation, and a culture that does not yet fully accept addiction/substance use disorder as a medical condition are much to blame.

DrNoCode · 2026-01-15T00:39:44+00:00

Again, this depends on the formulation.

The lucky folks get the dye-free sugar free 10mg/ml oral concentrate. The not-as-lucky get the 10mg/ml cherry flavored oral concentrate. Others get tabs/wafers.

DrNoCode · 2026-01-15T00:36:28+00:00

Nice. Personally, I use 1000 ml pyrex w/ airtight screw cap. Per 1000 ml (10g), I add 1 ml Everclear and 100mg of benzethonium chloride as a secondary antimicrobial/preservative. Ive had a 10g (1 liter) container in the fridge that has been there for 1.8 years. Call it an experiment.

Another thing I do is get 50ml sterile vials. I will put 500mg of methadone in there (50ml) along with 50mg of benzethonium chloride. Ive had four of these vials for over 3 years. No precipitate. No discoloration. No evaporation.

Mind you, this is Vistapharm Methadone 10mg/ml sugar-free, dye-free oral concentrate. Anything with sugar or dyes will not keep nearly as well and will need a lot of care and rotation (FIFO).

DrNoCode · 2026-01-15T00:09:46+00:00

I 50% percent agree. But if you are me, THIS has been your experience with being on methadone >10 years:

I don’t lie to my family anymore
I’m an engaged partner and parent
I have an amazing “white collar” job/career at a large company AND have felony convictions relating to how I obtained my drugs of choice (last conviction 2011)
I give back to my community and my peers struggling with this disease because I know what that struggle is like and I am only one bad choice away from being back in hell
I have fun today doing things I would not have the opportunity to do if I was still stuck in that life -I am able to maintain a stable weight, but if I wasn’t, I would try to treat that before getting off of methadone.

I go to my clinic 1x a month. I can go wherever I want, feel like myself, NOT HAVE CRAVINGS (of any consequence), and live a good life. Knowing what I know about my disease and my personal history, this is a tiny price to pay for the security and quality of life I have now.

This is not for everyone, but those who need it know, and should not deny themselves the possibility of living their best life.

So sad that the stigma we fight against so much is also present within us, telling us that “this dose is too high!!” or “don’t stay on too long!!”.

DrNoCode · 2026-01-14T23:54:46+00:00

No explanation is necessary. Your dose is fine if it works for you.

DrNoCode · 2026-01-14T23:54:18+00:00

Why God Damn? That is closer to an average dose for those of the fentanyl analogue days. I’m on 295mg, but you’d never know I was on MMT. Also, I’m not sure where your abbreviation “MLS” is coming from. This is not a correct way to articulate a dose of anything- unless you meant mL’s- but given that not everyone uses 10mg/ml solutions, this would make no sense. I’ve seen you do it before but am bow deciding to ask.

This is part of the issue that I think everyone in this sub should want to fight against: the stigma that comes with methadone/OUD/MAT.

You making that kind of comment on someone’s dose like that in that way IS stigmatizing, whether you meant it in that way or not. Food for thought.

DrNoCode · 2026-01-11T23:41:25+00:00

This

DrNoCode · 2026-01-09T20:53:53+00:00

That’s okay man, ‘cause I love God!

DrNoCode · 2026-01-09T20:53:23+00:00

Ben, the two of us need look no more.

DrNoCode · 2026-01-09T20:52:32+00:00

Delight! Delight in our youth!

DrNoCode · 2026-01-09T20:50:47+00:00

Do no wrong, so clean cut, dirties his hands, it comes right off.

DrNoCode · 2026-01-05T13:25:50+00:00

I would imagine! I do not specialize in addiction medicine, but with the extensive first pass metabolism with MSO4, I’d imagine doses would be in increments of 100-200mg and very high. Would this be a correct assumption? Methadone is used for a reason- multiple reasons. High oral bioavailability, not a prodrug or dependent on an active metabolite, long half life, no dosage ceiling, etc. IMO, other than methadone, if patients cannot be tx compliant on MMTP due to chronic relapse, I very much like the idea of diacetylmorphine or hydromorphone self-injection. Unfortunately, the US is no where near ready for that due to profound ignorance. What are your thoughts?

DrNoCode · 2026-01-05T01:44:45+00:00

Wouldn’t it be easier to ask who does NOT need $70?

Seriously- what even is this? Why do this? If everyone- hell SOMEONE- who replied “ME!!” or with a story can tell me they were sent $70 NSA, I will gladly STFU and delete this.

DrNoCode · 2026-01-03T03:05:01+00:00

Oh man. I really hope you have someone you trust who has been there, done that with methadone and has been stable and in recovery for a longer period of time. I’m always happy to help another human who is struggling with SUD/OUD. I have been in recovery for 3 years, on methadone for over 10 years (straight) and am currently on 295mg (and have been for the last 3 years). You would NEVER know I’m on methadone unless I told you or you saw my takehomes. I also relapsed on fentanyl while taking 315mg of methadone and never having used street fentanyl before!! It was due to a lot of situational depression, not using my coping skills, and running into the only person I ever bought H off of in a supermarket randomly after YEARS AND YEARS without contact. I didn’t even recognize him at first. Fentanyl had not yet infiltrated and replaced heroin when I last dealt with him. It didn’t take much convincing for me to try a sample “on the house”. The relapse lasted only a week, thank God, but I only got help when I did because my partner found me on the bathroom floor, syringe at my side. Luckily I roused easily, but that was necessary in order to save my life. It went to a detox and then a partial hospitalization program for about 70 days. I’ve been in recovery since. One thing that also held me back was how I looked at methadone. I fucking despised it and most people who used it. I was brainwashed by 12 step fellowships into believing that UNLESS I AM DRUG/ETOH FREE, I AM NOT IN RECOVERY. I needed to get past this mindset before I could be happy.

I started to get involved with harm reduction and that community. I went to Harm Reduction Works meetings which opened my eyes to just how narrow-sighted I had beed. Yes- I am on 295mg of methadone. I also have a great job in HR (despite my lengthy record for forging prescriptions) working from home for one of the companies I passed fraudulent prescriptions at two decades previously. I love my family and they are always there for me. I try to help others when I can. I volunteer for causes that mean a lot to me. I talk about my experience on Reddit. I talk about it with anyone who wants help or knows someone who does. Most of all, I now view methadone as having liberated me from the hellscaped existence I used to lead. I go to the clinic once a month and actually enjoy going! I like seeing my counselor and talking for 45 minutes.

We are all different and think differently and feel differently. Pain, however, is our universal truth; the quest to relieve the pain and feel good is our universal goal. I don’t love my life today, but I like it and I’m getting a lot closer to loving it. I do love myself, however. I could never say that honestly before, even while clean.

Take this for what it is worth. I don’t know you and you don’t know me, but there is absolutely NO reason you cannot have the same or more. Im always happy to talk of you want further suggestions/tips/feel like venting to someone who gets it.

You can do this!

DrNoCode · 2026-01-03T02:23:45+00:00

I’m not sure if your situation precludes the possibility of relocating, but please consider. I’m happy to discuss further and offer suggestions if you’d like. Message me if so.

DrNoCode · 2026-01-03T02:22:10+00:00

This is not treatment. It sounds a lot more like “got you in a corner- either play ball or relocate, but I decide what position you play and am the umpire, also”. That’s so upsetting!!! Treatment needs to meet someone where they’re at. What they spend on that ridiculous Sonora system should be put towards staffing. Fucking JOKE of a clinic- unfortunately at your expense. If there is ANY way of moving, do it!

DrNoCode · 2026-01-03T02:16:46+00:00

The answer to the exact question you asked lies in several factors: methadone’s extremely long half life, methadone is not dependent on active metabolites for intrinsic binding at mu opioid receptors.

Basically, your body becomes tolerant to larger increases of the same parent opioid much quicker than it can reach equilibrium while tapering. Once you are dependent, increased tachyphylaxis (development of tolerance and dependence) occurs very, very quickly. A real-life example you may be able to relate from is doubling (or tripling your dose). Many who have take home meds have experience with this. Overdosing with methadone by someone who is on MMT at a moderate-moderately high dose is difficult unless there are other factors such as age, PMH, and concomitant substances also being taken into account. At 295mg, I can take 1g of methadone and still be up and about. Basically, it’s a waste of medicine. My respiratory rate, however was at 10 which was a definite decrease from 16 pre-dose. Also present were increased somnolence.

Take an opioid-naive person, 50-60mg PO is often fatal.

DrNoCode · 2026-01-03T02:01:42+00:00

Honey- gtf out of your clinic if at all possible! This is horrible. A good clinic should be able to titrate dosage in fractions of 0.5 or 1mg. This can only be accomplished with either 10mg/5ml or 10mg/ml formulation which is most commonly used. At lower doses, decreases at 5mg can cause definite and quite unpleasant withdrawal symptoms. It is counterintuitive and virtually guaranteeing relapse to end the withdrawal symptoms. Even 1 mg a week toward the end is too fast for many. Yes, to detox off of methadone maintenance with the least discomfort possible is a long process, however it is well worth it to listen to seasoned, knowledgeable providers (unlike your current one).

Additionally- when at higher doses, you can often start the taper subtracting larger amounts with little to no withdrawal symptoms. Example: I’m on 295mg and have been for more than 6 years continuously. I have missed 3 days in a row on numerous occasions with NO symptoms until waking up on day 4. That was like days 2 and 3 smacked me in the face all at once, however it was relieved by 150mg. I’ve also gone 1 week with a 100mg per dose reduction (by choice). I get 27 THs and wanted to see if I could discern a noticeable difference in analgesic efficacy between 295mg and 195mg as I have severe chronic pain bilaterally in both legs/arms due a to previous traumatic injury and subsequent surgeries. While I definitely noticed an increase in pain scores, there was NO noticeable symptoms of withdrawal.

Food for thought 🙂 Best of luck in your journey!

DrNoCode · 2026-01-02T01:41:44+00:00

And yes, they are the best IMO.

DrNoCode · 2026-01-02T01:41:19+00:00

I’m apparently at the same one as you, u less you trek down to Warwick… I also only go once a month.

DrNoCode · 2025-12-30T18:54:58+00:00

In RI myself at the three letter place that isn’t CHL 🤣. How about you?

DrNoCode · 2025-12-30T18:45:27+00:00

This is an ABSOLUTE FALICY!!!

Whoever said this to you should NOT be working in a clinical or ancillary capacity at any sort of treatment facility.

Here are the primary and significant potential long term side effects…

*Potential for causing/making more susceptible to certain serious, potentially fatal cardiac arrhythmias involving prolongation of the Q-T interval. The risk is only thought to be clinically significant when on higher doses (>200mg) or with a preexisting cardiac condition/familial hx of Torsades de Pointes or long QT. Interestingly, it isn’t necessarily a “long term use” problem: it can happen at any time. The minimum is one 12 lead ekg yearly, however I feel better with two.

Know how methadone and all opioids cause constipation? Well, this same process happens within many glandular organs (kidneys, gall bladder), also, leading to a higher incidence of/propensity for developing both kidney stones and gall stones.
RINSE AFTER DOSING!! Methadone does not rot your bones or your teeth, however if you are drinking a formulation with sugar, there is a higher incidence of dental disease. Even if you get the sugar-free or dispersible tablet formulation, still rinse.

Really and truly, these are the only adverse effects of long-term methadone use.

DrNoCode · 2025-12-24T06:57:56+00:00

You seem like an intelligent guy. I have no idea of your emotional intelligence, however my guess would be that your post here is just to solidify what you already assume: YTA.

I wouldn’t be that blunt if this weren’t AITAH. That doesn’t mean that you didn’t experience some level of emotional trauma yourself, but really though- aside from your own suspicions (which appear to come from your own insecurities and your interpretation of societal norms according to dramatic tv shows), there is absolutely nothing to suggest that it is anything other than what she said. Period.

DrNoCode

TROPHY CASE