What? No Methadone 'Take-Homes'?

methadone

If you follow me on Twitter, I'm sure you've noticed by now that just about every morning around 8 a.m. (8:45 a.m. on Sundays!) I send a tweet about heading out to get my dose of Methadone from my favorite local pharmacy.

Seeing these daily tweets, many of my followers quickly take note of the fact that I don't dose at home, ever. Instead, I make daily trips to the pharmacy for my dose of Methadone around 8:15 a.m. every single morning. That's right, every single morning. That little tidbit of information is what seems to be throwing people for a bit of a loop. The questions ensue ...

"What? No take-home doses?"

"You STILL have to go EVERY day? Like, even ... Sundays?"

"But carries are the reward for maintaining sobriety! Are you still using?"

"What are you, high? Why go daily if you technically don't have to?"

No, I do not have "take-home," or "carry-home" doses. Yes, I go to the pharmacy every single morning to get my dose of Methadone. No, I am not still using. The insanity!

Many people seem to find this quite confusing. Making daily trips to the pharmacy when I technically don't have to probably seems ridiculous, not to mention totally inconvenient, and a huge waste of time. Why in hell would I go out of my way every single morning just to go to the pharmacy for a dose of Methadone I could have had in the comfort of my own home?

This piece was first published on Studio L Online. You can read the original here.

But before we go any further, let's define exactly what "take-home" Methadone doses or "carries" are and how they work, in case anyone is unfamiliar with the term and its meaning.

When a patient initially enrolls in a Methadone Maintenance Treatment (MMT) program, they are required to attend their local Methadone clinic or Methadone dispensing pharmacy for supervised daily dosing. The pharmacist provides the patient their dose, and must witness its ingestion. After swallowing the dose, the patient is generally required to say a couple words before leaving to ensure that the dose has indeed been fully swallowed. According to the Centre for Addiction and Mental Health (CAMH), supervised daily dosing generally continues until the patient has reached a stable dose, has been in treatment for at least two months, and consistently returns urine tests negative for drugs.

Once you've reached the two month point in treatment, are stable and consistently returning negative urine tests, you qualify for the privilege of "take-home" or "carry" doses.

"Carry doses are a privilege given to you when you have progressed well in treatment, and are prepared to take responsibility for using and storing the doses safely. Some providers grant carry privileges only to those who produce drug-free urines." - CAMH Methadone Maintenance Treatment: Client Handbook, Chapter 4 - Living with Methadone

Many physicians and pharmacies have their patients sign special agreements prior to dispensing take-home doses. This is a basic agreement to ensure that the patient fully understands the policies surrounding take-home doses, how to properly and safely store the medication at home, as well as any other requirements there may be (such as returning empty bottles, producing a negative urine test upon request, not to sell the medication, etc.).

Back to the initial question. Why in hell would I go out of my way every single morning just to go to the pharmacy for a dose of Methadone I could have had at home?

Put simply ... because it works for ME.

Some might think that's just a cop out, a lack of self control and the obvious avoidance of the responsibilities involved in take-home Methadone doses. Call it what you will. Your opinion on my recovery is totally irrelevant to me. In my eyes, it is simply being honest with myself about what I need and what is most beneficial for me and my recovery process right now, regardless of what the "norm" may be.

At this point, I truly prefer making daily trips to the pharmacy, and for many different reasons. It keeps me in a great routine. It gets me up and out of the house first thing each and every morning. Biking there each day gets me great exercise and some fresh air. I get regular and vivid reminders of what my life used to be like when I was using. I get to see and speak with fellow Methadone patients on a regular basis. It keeps me on track, and prevents slips with dosing.

I have been offered carry-home doses by my physician on many occasions (and I mean many). I have opted for the odd carry-home dose on various different occasions over the years (Christmas, going out of town for the day, etc.), and the convenience of it was undeniably nice. Instead of rolling out of bed and and biking 10 minutes to the pharmacy every single morning, all I had to do was walk to the fridge, pull out the bottle, and drink. Done. Easy. No weather to contend with, no traffic, no line ups. For me, though, even with all those lovely little perks, it simply isn't the kind of convenience I want hanging around in my fridge 24 hours a day, 7 days a week.

I am still an addict, after all.

While it has been years since I have used, and even though I have had no problems with the take-home doses I've had in the past, I am well aware of the fact that I am very much still an addict. Several days worth of Methadone as easily accessible as a jug of milk is something I'd rather not get used to. I don't doubt that I would continue to do just fine, but it simply isn't necessary at this point for me to have my drink at home.

I realize that I'm quite lucky to even have the option. Not everyone has the convenience and privilege of choosing whether or not to go the pharmacy daily or to opt for take-home doses. Many of the patients attend the pharmacy for supervised dosing despise the daily excursion, but they have no choice in the matter (failed drug test, etc.) if they wish to continue treatment. Other patients have jobs or obligations that make it difficult to dose at the pharmacy on a daily basis and therefore need take-home doses, regardless of what they might prefer. For others still, mobility issues can be the deciding factor in dosing option.

Whether a patient doses daily or has take-home doses, the reasoning can vary widely. Simply because a patient is attending a pharmacy daily for supervised dosing does not necessarily indicate that they are still using drugs. Some of us simply prefer it. I'm certainly not opposed to the possibility of having carry-home doses in the future. In fact, I would love to dose at home at some point. As it stands right now, though, I am getting more benefit from my daily bike rides to the pharmacy for supervised dosing, and I have no problem admitting it.

We need to stop judging a person's path to recovery simply because it doesn't necessarily follow the traditional methods and steps. There is no one correct path or journey to recovery. Every single person is unique, and their treatment needs to be also.

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Studio L is a freelance writer living in Southwestern Ontario. She is a recovering IV drug user, methadone patient, and harm reduction advocate, and covers these issues in her blog.