Not many physicians in our communities are familiar with what methadone clinics do or how they work. Some physicians criticize their patients on methadone, even if the patients are doing well and are in stable recovery. Some physicians are unyielding in their opposition to methadone treatment, even though they know little about it.
When given an opportunity, I try gently to educate these doctors, and offer them information. Sometimes I’m pleasantly surprised at the desire of other doctors to learn more about the treatment of opioid addiction with methadone. Sometimes, I’m not surprised at their resistance.
I’ve felt frustrated by these doctors, but I need to remember that before I knew much about methadone, I opposed it too. Back then, it just seemed wrong to give an addict methadone. I didn’t have any reason for my belief, not being familiar with actual data. I try to remember my past actions and beliefs, and have compassion for other doctors. They probably know as little about methadone as I did, before I worked at an opioid treatment center.
A doctor does not work at methadone clinics because of the professional prestige. If subspecialty prestige were a totem pole, and cardiovascular surgeons and neurosurgeons were at the top, then addiction medicine doctors would be the part of the totem pole that is underground.
Our colleagues know little about what we do, and tend to think of us as on the fringes of “legitimate” medicine, even though, as I’ve said before in this blog, we have more evidence-based data to support what we do than perhaps any other specialty.
Occasionally, I encounter a physician who refuses to take care of a patient who is prescribed methadone by a treatment center. One doctor, a bariatric (weight loss) surgeon, told a patient who was doing well on methadone that she would have to taper off of methadone before he would schedule her weight loss surgery. The patient asked me why she needed to be off methadone. Since I knew of no good reason, I called the surgeon. I tried to advocate for my patient, and explain that methadone patients can, and do, undergo all sorts of surgeries. I explained the usual method of maintaining the same methadone dose while in the hospital, and giving short-acting opioids for management of pain after surgery, but this surgeon didn’t relent. He didn’t give me a reason for his decision, and since this was elective surgery, he had the right to refuse to do the operation.
The patient, eager to have this surgery, tapered off methadone. It took months, and I don’t know what happened to her after surgery. I do know she was at high risk for a relapse back into active addiction, particularly since she would need prescription opioids during the post-operative period. I hope she did well.
Recently, a prescription pain pill addict, also being treated for an anxiety disorder, entered treatment at the methadone treatment center where I presently work. She was seeing a psychiatrist who, in addition to counseling this patient, was prescribing alprazolam (Xanax) for anxiety. The patient hadn’t told the psychiatrist about the pain pill addiction, due to shame and embarrassment. When she started methadone, I asked her permission to contact her psychiatrist, so that we could coordinate our treatments. When I spoke to this psychiatrist, she said this patient would be kicked out of her practice. The psychiatrist said, “Going on methadone goes against what I’ve been trying to do for her.” I pressed about what she meant by this remarkable statement, but she wouldn’t, or maybe couldn’t, elaborate. Because this patient entered treatment for opioid addiction, she had to find a new psychiatrist.
These are extreme examples. Most doctors are hesitant to prescribe anything for a patient on methadone, but are grateful if I call them with information, and offer to work with them. After becoming more informed, many doctors are willing to work with, and not against, the opioid treatment center helping their patient.