Point of order for **zoo ** and qad the merc. It’s actually desmostylus, as in extinct marine mammal.
Hmmm … you know, I’ve often wondered about people in this kind of situation – is methadone maintenance available for prisoners?
Nope. At least not in my state. You need a special license from the DEA to prescribe methadone to maintain an addiction or manage opiate withdrawal. I can and do prescribe it to treat pain, but if the inmate comes in on it to maintain an opiate addiction, then he or she gets shifted over to another opiate for a gradual taper.
A friend of mine, about 20 years old, black, with cornrows in his hair, walked into the ER and was refused pain medication because they thought he was just trying to get drugs.
Of course, the truth is that he has sickle cell anemia, and even morphine is not enough sometimes. Boy, did his doctor give the ER an earful…
One thing I’ve learned over the years is that I need to try very hard to drop all my expectations and assumptions before talking with the patient. I’m supposed to act like a professional, and they really do pay me pretty well to be one. So I might as well try to be one.
If, after taking an appropriate history and physical exam, my earlier assumptions turn out to be correct, that’s fine. But so often what I expected is not what was going on. And I hate getting it wrong like that. Getting it wrong while making the right effort is one thing, but screwing the pooch because I wasn’t listening is another.
I think this was pretty much a case of learning that there are assholes in every profession.
And at one time or another, I’ve been one of them. But I do try not to be one so much. And I think I’ve met with some success.
Okay, so what’s wrong with Soma? 
Well, it’s marketed as a muscle relaxer, but it doesn’t actually relax muscle. The drug, aka carisoprodol, is metabolized into a barbiturate (meprobamate). So basically it’s nothing but a downer. It causes sedation, tolerance, and dependence. It doesn’t treat muscle spasms, it just covers up the symptoms. And some patients get quite fond of them as a method for dealing with life’s little unpleasantnesses.
It’s a crap drug with little or no true utility in the medical field. If a barbiturate is needed (and one doesn’t treat back pain with barbiturates), there are better ones out there. If a muscle relaxer is needed, there are actual drugs that relax muscles out there. So the main reason for prescribing Soma is to get the patient to shut up and go away. (IMNSHO)
Wow, so if somebody has been on methadone maintenance for years and is imprisoned for any reason, they have to go through forcible detox?
/hijack
HEY! I’ve been pre-scribed/taken carisoprodol…I didn’t know that! In your medical opinion - what would be a better alternative? I have bad discs (L4/L5 and L5/S1) for which my GP has variously prexcribed the aforementioned carisoprodol, darvocet & percocet. I have hardly taken any of the meds since the pain normally goes away if I stop stressing my back, by I’m curious since it would seem to reinforce negatively with the narcotics.
Thanks.
/hijack
Also, it’s called Soma. Jeezy creezy, what were the marketing department thinking?
For those not in the know, Soma is the drug in Brave New World that is distributed to everyone in daily rations to keep them passive and unquestioning of the totalitarian regime they live in.
I’m weirdly, deathly allergic to Soma. If I take it very bad things happen involving full body itching and swelling up hideously and not breathing. Accordingly, I’ve never much seen the attraction.
Yup. The State does not make it a priority to maintain an addiction. Least of all when the detox is not life-threatening. Uncomfortable as hell, but not life-threatening. Hell, they take alcoholics off alcohol too, in prison, forcing a detox on them. And that procedure is far more life-threatening.
The opiate addiction is maintained on the theory that being on methadone makes the heroin addict less likely to commit crimes in order to get and use heroin, and more likely to engage in constructive behavior.
In prison, the addict us unlikely to knock over a liquor store to get money for his fix, and you can imagine the howls of outrage from the public when they’re informed a criminal is getting methadone at taxpayer expense, not for pain, but to keep him from craving heroin? That won’t fly.
Hell, our state speaker of the house killed a bill which had support across party lines to make treatment rather than prison an option for non-violent drug users. He said it would make him look “soft on crime” in the eyes of his constituency.
:rolleyes:
Anyway, I’m not a big fan of methadone maintenance anyway. And I am not unknowledgeable in the field of Addiction Medicine. So I don’t have a problem with it. I take my time, and have even spent 3 or 4 months detoxing some of these guys who came in on 160 mg of methadone a day, slowly reducing their dose of alternate opiates by about 5% a week.
Ask your doc. But if one has muscle spasms, a muscle relaxer would be better. If one has pain, a pain reliever is probably better. If both, then both could be considered.
Tho if you are not exhibiting the tendency towards chemical dependency at this stage of your life, carisoprodol is less likely to cause you problems.
One of the (many) problems with methadone maintenance is that in practice it is frequently not done well. It’s a tool - not a magic elixir. For some people it works well. For others it works not at all.
Methadone programs are chronically underfunded, disrespected, and the environment in which they operate provides numerous opportunities for illicit shennanigans. There’s also the problem that people tend to want to rush the addicts through the program - when I worked at such a clinic we used to plan at least two years of therapy and work with an addict prior to starting a taper to (ideally) sobriety. At least two years. Meanwhile, judges, social workers, and relatives all wanted the problem “fixed” in a month. Well, geez, none of these people got to this state in a month - you’re looking at a 10, 15, 20 year long habit/problem/addiction, you’re not going to fix that for good in just a month.
Two years then off methadone? I’m getting guys who have been on 140 mg of methadone or more for 15 years showing up in prison. Usually on drug charges.
Methadone’s a tool that too many people want to use when it’s the wrong tool. Frankly I think harm reduction has its role, but I’ve seen too many gainfully employed people with an oxycontin Jones and no adequate trials of abstinence combined with mutual help group support get told “you need methadone maintenance! It’s your only hope!”
Frankly I wish we could convert a few of our prisons to the old-style “therapeutic community” type treatment centers. I’d love to get some of my patients into a COPAC style setting.
Wow. Toradol, Flexeril and Naproxen – my three favorite drugs mentioned in the same thread!
Along with my least favorite, Morphine (whose effects on me are indistinguishable from those of syrup of ipecac).
– Dragonblink, sufferer of migraines, tension headaches, back problems, and a chronically bad knee.
I don’t doubt it - we used to get a few long-timers, too showing up at our door from other treatment centers, prisons, the street… plus we had a few folks who just could not seem to detox.
Yes, we DID get people throught the program in 2-3 years from initial intake through final methadone dose through (when possible - we recommended it) six months of post-detox support.
Of course, being an outpatient clinic that people could walk away from at any time (and people did, except for the BoP parolees, who weren’t allowed to) only the most motivated addicts were going to stay with the program that long. We had plenty of people who joined then dropped out again in a very short time frame after making zero progress.
You’re preaching to the choir, doc - I agree, too many people will only hold onto the methadone hammer and see all addictions as nails. Some people do well on it, some even get worse.
That’s yet another reason why I got out of the business after four years in the trenches. I still believe treatment for addiction is the right course of action, but it has to be done properly, not as a one-size-fits-all sort of thing.
Oh, don’t get me started…
I’d vote for it - I’d prefer to see that over another supermax prison being built any day. But they don’t let me be in charge of anything these days…!
Be grateful. They put me in charge just enough to think I might be able to create positive change, which is always just beyond my mandate. :smack: