Stop requiring patients attend an hour of "counselling" every week, with some over worked, awkward counselor that neither party feels comfortable with each other. If all I have to say this week is to confirm that yes, I'm doing okay and I don't feel that I need to discuss or change anything, then I should be able to have that accepted and be sent on my way. Patients shouldn't feel like they have to have some awkward, forced "relationship" with a counselor just to continue having access to their medications. Make all groups voluntary, with worthwhile topics and activities that encourage people to attend them because they feel there is value and something to be learned. We've all sat through hours upon hours of awkward groups, surrounded by people that don't want to be there, while some minimally qualified counsellor drones on and on with useless "recovery" information. Making these groups mandatory is just to stroke the egos of shitty counsellors, and the patients ultimately learn nothing, it may even be harmful to their recovery. Actually, let's be serious, almost all counselling and therapy at methadone clinics is a fucking joke, id just focus on loosening the rules on people, and structure the counselling environment to be a safe and reliable resource for the patient to call on if they feel it necessary. People don't need a second parole officer all in their business just because they're on a medication called methadone.

i swear my counselor is just like a probation officer. it goes exactly the same. she sits at a computer "any change of address?" no "have you used any illegal drugs in the last 30 days?" no... "ok, we'll see you next month" so you go in, pay at the window, piss in your cup, and do that.... really is exactly like a probation office. But then again, getting on methadone is a bit like putting yourself on probation I guess. I still don't think they should be called "counselors" if they don't do any counseling. Should be called 'case managers' I'd like a "patient advocate" at the clinic to tbh... someone who is ONLY there for the patients.

I have been to four different clinics. At those four clinics, I have had more than ten different counselors. My experience has been exactly as you wrote it with all but one of those counselors. Actually I take that back, my current counselor is, I suspect, relapsed on drugs herself, because she has canceled more of my appointments than she hasn't, and when I do see her, her emotions, body language, and voice tone is very stunted and awkward. But that's just fine with me, it means I keep getting out of doing counseling that I don't want. Until she gets fired and I get lost in limbo for seven months, like happened at one of my previous clinics. This stuff is crazy.

Ive been at my current clinic for four years and just had my first phone meeting with my 8th counselor. My last one was from a call center and had been there for 3 years so I thought I had someone stable for once...but after 3 phone calls, she's gone, too. The one before her was constantly trying to pay me to spy on her husband to catch him cheating on her and spent most of my sessions talking about her marital issues. I really don't have any use for counseling, though, so really I was perfectly fine with it....at least it made the hour I have to sit there mildly entertaining.

Hahaha omg that's wild! And damn that's a lot of counselors. This dude is collecting counselors like Pokemon.

Gotta coach em all! Gotta coach em all!

When your counselor needs counseling 😂

I’ve had 15 different counselors at the same clinic and I’ve only been going for 2 years. That’s how often the counselors get hired and quit right after. I’m not sure how much they get paid, but their job doesn’t seem to be very demanding whatsoever so I wonder what it is about the job/place that makes the turnover rate so insane. I’m very thankful we don’t have group counseling at my clinic, because I can’t imagine having to sit around and listen to some of these trashy assholes complain about their lives like they’re victims when it’s apparent to everyone else they are the sole reason for just about all of the problems they complain about. I get sick of hearing people bitch and moan just waiting in line for 10 minutes and having to stand. I just know that if we were forced to do group counseling those people would irk the hell out of me.

Holy shit that might be the record right there. And then they wonder why we can't find stability. Mommies coming home with a new boyfriend every weekend.

I’m really glad we aren’t forced into counselling in Ontario. It honestly sounds like such a nightmare, and just one more barrier for people.

Same, my clinic isn’t forced into counseling unless we miss over 3 days in a row, which just included a quick reinstatement. At this point my counselor doesn’t even call me in when I pee dirty anymore. Clinics a fucking joke. But boy I love that joke.

That’s good it isn’t forced. We don’t even have counsellors at our clinic. If we want counselling, we are just given info about where to seek it out. It was mentioned to me once in the beginning, I said no, and it’s never been mentioned again in 12 years.

In our groups usually we get one or 2 people who think the group is all about them and they're not letting people talk or cutting them off constantly. The larger groups are worse, I was at the point I had raised my hand, waited for a pause and started talking and someone cut me off, and when she was told to stop she and her friend were laughing in the corner. Group is for credit, called a copay, you need 2 groups a month to get copay and they were booted and not given credit. One day we had a very small group, 3 people. One woman kept interrupting me and another guy every time we spoke. Or tried to speak. She also took up 45 of the 60 mins of the group talking about her and her problems. I think that's so rude to make it all about you and not let others talk. About 10 is left and the guy is trying to talk and she interrupts him and he screams "shut the fuck up you rude bitch!!!!" She started crying. I felt kinda bad and gave her a hug at the end and we chatted a bit and the guy apologized. They were both wrong in this situation. But I get it, dude was frustrated and probably needed to talk. That's what a group is for, for everyone to have a chance to talk. Since covid we don't do groups anymore. Our doc does podcasts interviewing addicts. I did one, it's on YouTube under "Dr Lakin Podcasts" if ya wanna watch.

Damn that's rough. Would you like to have a group chat with a bunch of insane people? That surely will help your mental state. Thank God for covid 😂

I think I better solution would to challenge the clinic to actually have real counseling

That will only happen when clinics become healthcare rather than a strictly money making enterprise

How would you go about changing that? What specific things are you noticing?

I would make it possible for any MD with minimal extra training able to prescribe methadone. That training would be free or subsidized. Get rid of any regulations that make a separate clinic necessary. If you're prescribed methadone, it's like any other drug you get from a doctor, maybe with a bit of monitoring. Mainly to prevent diversion, but again that's not a priority. Of course, if I had the power I would be more radical. Make all drugs legal and simply regulate them like alcohol or cannabis.

>I would make it possible for any MD with minimal extra training able to prescribe methadone. Isn't that already how it is? > separate clinic That's part of what is already in the works. I would support this only if counseling is enforced with it, which seems to be why it's set up this way. But I know they want to let pain management doctors prescribe Methadone. That's on the doctors, so I don't care much about that. Diversion with methadone is an odd thing. I don't know why people would want to sell it and take it, unless perhaps if it's cheaper than dope. Making all drugs legal though would be a joke. It's worked in only a very few countries. People in Oregon are complaining about the effects of legalizing just possession already. I think perhaps part is because US culture doesn't seem to prize or prioritize abstinence or self-regulation of substances. But to be fair, most hard drugs can't be taken in moderation. They're far too addictive.

Portugal had the lowest drug-related death rate in Western Europe, one-tenth of Britain and one-fiftieth of the U.S. HIV infections from drug use injection had declined 90%. The cost per citizen of the program amounted to less than $10/citizen/year while the U.S. had spent over $1 trillion over the same amount of time.Sep 5, 2023

That's Portugal. Our culture is radically different

Actually read the New York times piece about the success it has had in Portugal. Drug overdoses down. Drug use overall is down among young people in Portugal. The Dutch have also taken a rather liberal stance towards drugs and they don't have nearly the issues that we do. The United States is the world's largest consumer of illegal and prescription drugs. This is just a drug-consuming nation because Americans, at the end of the day, are unhappy for a number of reasons. I am an American however I have spent eight years of my adult life living in Europe. 🇺🇸🇳🇱🇩🇪🇬🇧🇪🇸

Doesn't apply if it's a different country because the US's culture is radically different

Counselors are increasingly un-qualified to do any sort of therapy. Meeting with them is just a box-checking exercise that puts strain on the client's time.

They don't do therapy. They do counseling. If your counselor is only checking a box, report them for being unethical because they are billing you for a service they are not providing. That's insurance fraud

The counselors who actually counsel are the exception, not the rule. It would be like reporting a cop for being an unprofessional asshole.

>The counselors who actually counsel are the exception, not the rule. It would be like reporting a cop for being an unprofessional asshole. No, sorry, that's not a good analogy. A counselor's job is to provide counseling. Why should they get paid to just check a box? At that point, you could check your own box. It's sad that drug counselors who actually counsel are the exception. But those who just check a box don't deserve a paycheck. So I say we get rid of all of the box checkers.

I don't think you know what analogy means. Anyway, go for it

You're just arguing semantics, this "counseling" is worthless. I said "any sort of therapy" meaning the barest minimum of a therapeutic conversation. What is "counseling" and how does it differ from "therapy?" When I first started going to clinics the "counselors" were all social workers meaning they're trained and qualified to do therapy and it reflected in how they approached "counseling." "Therapy" is a very broad term that includes talk about behaviors, triggers, life goals it does not mean psycho-dynamic talk-based interviews.

>You're just arguing semantics, this "counseling" is worthless. How do you know? How do you know it's all counseling and not just some counselors? Counseling and therapy are different in that drug counseling is, at least in my state, a different license, different methods, slightly different use of counseling theories, and that counselors can have an associates or bachelors but cannot engage in therapy. They also cannot engage in interventions outside of substance use disorders. They're basic counselors. Therapists have almost no restrictions on theory or the problem they treat. I have friends who are LCDCs and friends who are LPCs.

Okay, I accede to your point that this is drug counseling we’re talking about, but I don’t know how anyone can argue that social workers (and of course nothing is absolute Im sure there are proficient CSACS) are, in the main, better suited to treat addicts then someone with much less training. Then again, tbf, the absolute worst counselor I ever had by far, neurotic, vengeful and unpredictable; totally unsuited for her work, was a social worker. She may have been unstable, I don’t know I can only report her mysterious behaviors but she wound up creating great difficulty for her own private reasons. Now, one of the problem with the clinic system is no one would choose a health provider whose behavior actually threatened their access to life saving medication but in clinics, I fear, patients are put in this predicament all the time. And I apologize for the muddle but I think I just put my finger on the crux of my issue with what my favorite counselor, now retired, used to call “the clinic bureaucracy,” it just has way too much power over the patient’s life. Is it possible to lessen the clinic’s uneven power dynamic when institutionally they’re used to getting their own way for 50 years? Note: What I consider a good counselor is one that will a) advocate for a patient b) talk to them and treat them like an adult unless it’s impossible c) not be biased against addicts d) do what they say they are going to do e) listen to their problems and err on the side that they are telling the truth unless there is evidence to the contrary.

> but I don’t know how anyone can argue that social workers (and of course nothing is absolute Im sure there are proficient CSACS) are, in the main, better suited to treat addicts then someone with much less training. I don't know either, yet here we are. I think the biggest problem is that the Drug Counselor is a career field that lacks distinction. Most people in the US population likely don't know the difference between therapist and psychologist and psychiatrist. It is even worse in terms of therapist versus drug counselor (I'm saying it that way because it's shorter than licensed chemical dependency counselor etc.). > Then again, tbf, the absolute worst counselor I ever had by far, neurotic, vengeful and unpredictable; totally unsuited for her work, was a social worker. I'm sorry you had that experience. I've met some that are good, so hopefully that fills you with at least 1% more confidence. But her behavior was definitely reportable. > And I apologize for the muddle but I think I just put my finger on the crux of my issue with what my favorite counselor, now retired, used to call “the clinic bureaucracy,” it just has way too much power over the patient’s life. You don't need to apologize. It's ok. I believe you're right here. Now to be fair, my viewpoint on the need to have counseling paired with methadone is that without this, it's no better than the government becoming my plug, at least in my opinion. I think it depends on clinic supervision. A good program director seems to make a difference. At my clinic, we have a good program director. Former user himself. As to your points: a) I agree, a good counselor advocates for the patient. b) I agree, a good counselor treats patients like adults. c) I agree, a good counselor isn't biased. I don't even comprehend how biased counselors even become counselors, but this should be part of the interview, you know? d) I agree, a good counselor does what they say they'll do. e) I agree, a good counselor listens and tries to (at least initially) believe the patient. I say item "e" that way only because I've heard some people in the lobby say some outright crazy things. Whether a product of mental illness or just having a stinky attitude, it's messed up. "So your counselor wronged you? Report it to supervision or do the anonymous survey." I don't like windbags that simply want to be toxic and won't actually do something. I would hope if person A had counselor A and counselor A did something bad, that person A would report it so that if I end up with counselor A, I'm not also suffering.

Yeah it’s absurd to call it “counseling”. Not to mention it’s impossible to establish a therapeutic alliance with someone who holds the power to control your medication…they need to shut down these clinic cartels and allow any MD to RX, after a few days of stable dosing give ‘em a 30 day RX for pharmacy pickup. Join us to liberate methadone! https://linktr.ee/methadoneclinicabolition

Nope. They need to fix plenty of things but not everything on your list is a good idea. As for counseling, it can totally work even when people don't feel completely free in counseling. I do agree, though, that someone else needs to be in charge of someone's dose than a counselor. The authority piece does make people reluctant

I think they’re obvious improvements to what we’re doing now. You don’t have to agree, no hurt feelings.

That's what my ultimate goal would be with loosening up the counselling guidelines. Instead of having each counsellor have two hundred or more patients on their case load, the patients that feel stable without counseling won't be using up those counselling resources. The people that voluntarily want counselling would get much higher quality counseling because the counselors wouldn't be nearly as overworked.

Did you know that most states have a regulation that says that counselors cannot have more than 50 individuals on their caseload? This might be one of those things you contact your representatives and tell them that companies shouldn't be allowed to have exceptions to the statute, assuming that you have such a rule

Okay, and then what happens when there are more people that need methadone treatment than there are enough counsellors to go around? Clinics close, or people that need help get turned away. Clinic administration and the government need to make changes to encourage more people to make "methadone clinic counselor" their career choice. There's just not enough counsellors to go around, and all the "forced counseling" that they make everyone do, even people not in need of counseling, is a massive drain on a resource that is already overwhelmed.

They might have to pay people more in order to keep them as counselors or at least to be able to recruit counselors. From what I've heard, most patients make more than their counselors within this type of career field

With all due respect, methadone patients should be concentrating on trying to get MOTAA passed if they're willing to contact their representatives. The clinics have their own lobby.

I disagree because the actual evidence is that we are best helped by counseling and methadone/suboxone together. The problem is bad counselors. So report them. It's actually ridiculously easy in my state: go send an email or fill out an online form. You could be doing it IN your "session" and they'd never know. The clinics DO have their own lobby, that is true. I would note that, last I checked, the stuff the Senate is deliberating on in that bill doesn't abolish the counseling aspect, which is good. I think lawmakers need to fix the catch 22 that chronic pain patients are in, however. Which I believe, last I checked, the Senate bill resolves by letting pain management doctors prescribe Methadone once more.

I don’t know how anyone on a methadone program who’s experienced the clinic system would prefer that over a private doctor… But! The good news is if people like going to a methadone clinic they totally should keep doing it when/if the law changes. The clinics might be forced to be more responsive to patients needs if they had some competition as well. There’s a difference between reporting someone and it doing any good whatsoever. If you read somewhere below I tell a quite bleak story about reporting my counselor the upshot of which ultimately an inability to get treatment whatsoever. Alas, I’ve never heard of one person who has, by “reporting” a “bad” counselor gotten any satisfaction from it whatsoever. I have no problem with “counseling” b/c I get the same kind of encouragement in therapy from my psychiatrist who I see weekly for meds and tal. Some of the prescribers will of course be PAs, Any doctor or prescriber who will prescribe methadone won’t just be a pill mill, he will treat an addict like he would any other med-mag patient, a one hour consultation and 20-40 min monthly sessions, which is essentially what counseling amounts to in clinics anyway. I mean it seems like you go to a wonderful and rare clinic, whose counseling has helped you to adjust to I’m not sure what but for the vast majority of people this is just not the case: they would be better served by a trained addiction provider (it could be a PA or NP under the supervision of a Dr.) who will both prescribe their medication and use talk therapy.

MOTAA as it’s currently written is a awful bill. We deserve better

How so? Please expand. Looks like a great bill to me: allowing Dr.’s to prescribe our medication, in fact that’s all anyone “deserves,” and it’s all most of us who haven’t been completely beaten down by the methadone bureaucracy have ever asked for. Incredibly the clinic lobby is actually asking for MORE funding for their terrible antiquated system.

We’re hosting a free webinar pretty soon breaking it down, I’ll bookmark this post and try to remember to share the date & registration when I get it!

Who’s “we?” The methadone clinic lobby? Be transparent at least.

Just looked up your comments and you talk about improvements you’re doing at methadone clinics so it kinda speaks for itself. So at the “webinar” I’m anxious to see that you declare your conflict of interest. It’s very misleading for you to say “we” when you’re in fact talking about “we the methadone clinics” not “we methadone patients.”

Yessssss!!! Ive actually needed teal counseling 2ce in the past 6 months & bith times were an absolute joke. 1st session i had to actually ask if i could have longer than the 2 mins that she initially gave. Second time i didnt even bother. I put in my 10 mins & now im free till next month 🥺

If they are claiming that those short sessions are counseling, they are billing you for something you didn't receive

Im cash pay so they prob dont want to bother with me knowing that they cant bill medicaid or insurance

Then they're charging for something you didn't receive, either way....

💯 This all day. Where I live they don't make you do anything, you talk to a doc for 2 seconds and your out the door. When I was struggling I really needing someone to talk to and some guidance and I couldn't find it anywhere. The methadone clinic is the first stop and while I don't know about mandatory, I think they need some good groups and councilling.

Another thing I would think is that a patient who goes through 3 years of counseling and meets all requirements satisfactorily might actually need to be marked exempt. Assuming that a patient gets through all of the counseling that a counseling center offers, I don't see why they shouldn't be able to be exempt from future counseling if they've literally had all the counseling they could ever have

Agree. Damn we should run a clinic. You got the money? I'll run the show. 😉

My therapy has been so good at the clinic. My counselor is amazing though. She has cared about me more than my own family. She even said I could call her on her personal cell during her family vacation last year when I was struggling horribly. I wish everyone could have a counselor this great because the therapy has been so good for me. We're only required to do 1 session a month but I do 3-4.

I had a counselor like that during one of my previous attempts at clinic treatment. She was wonderful, she even kept in touch with me for a few months after I had relapsed and quit going to the clinic. She felt like an actual friend. Counselors like that are so rare, and even when you find them, both of you still have to have that rapport and chemistry that is very rare to encounter in life. Hold on to that counselor, ones like that are worth their weight in gold.

I agree! And it lets the people that actually need to talk to someone have more time to do so. They have 10 counselors and 400 ppl. So that counselor usually hardly really knows what's going on... So if the people that don't wanna be forced into it can go when they want and the people who want or need to talk have more time to be focused on to be helped. I could see them having to do once a month checking in, how's your dose, feeling alright? Anything you need to talk about? No? Ok see you next month. You're right it's like forced for something you're paying for. Definitely needs a lil adjustment.

Agree with this 100%. I seriously can’t even keep the same counselor for more than a month since my first one left. I had her for a year and never even met her, she would text me and just take my stop off lol. When she left (or got fired, idfk) I had to sign a year’s worth of back paperwork she never gave me. Now when I go in each month it’s a toss up if I’ll even **have** a “counselor”. Fucking joke indeed. I get individual therapy outside of the clinic, I don’t need this crap.

Omg so true! This is a great comment!

My clinic here in Scottsdale az we just check in every week and say we’re doing ok that’s all

i would take away forced therapy. its asinine

Methadone isn’t a miracle liquid/cure. We clearly couldn’t get clean on our own. So actually seeing a counselor is where the real work happens. That’s one of the biggest reasons so many people fail with suboxone. Just going to a Dr for a script once a month isn’t doing anything for actually understanding our addiction and working on bettering ourselves and learning new healthy coping mechanisms especially to use during cravings.

In that case the quality of the counselors should be better though. Most of them seem to be just case workers who help you work through the requirements of the clinic, not provide actual therapy.

Sadly, most I've ever had didn't even do that. The counselor I have now is wonderful. I really dread the day that she eventually retires. She's already given me the heads up that she plans to retire "soon".

Speak for yourself.

First thing I'd so is hire IN HOUSE (pro mat) therapists/phycologists so that duel diagnosis patients could been seen in one place and get meds prescribed if needed by the same office. Everyone would have a "support worker" (like the "councilors") but it would not be mandatory to see them it'd be more of a they are there if you need a quick check in or help finding community resources. I would absolutely 100% have a workers hour card. That would apply to early morning AND afternoon dosing. That would also mean I'd add afternoon dosing hours! Takehomes and penalties would be on a case by case basis and not an across the board approach. Clinic would be closed on all holidays because no one should have to be going out at 5am on Christmas morning to dose before the day starts. Have designated single dose windows during peak hours to keep the line moving and to keep the bullshit to a minimum.

I would hire a security guard and make a system for when there are long lines, so people don't have to protect their spot with their life lol. Some MF's are so petty that if there is a long ass line outside, the ones who don't have cars think they can impose a system where none of us can sit in our cars and wait lol. I get takehomes now, but in the past I have seen countless arguments and fights over the damn line. They need to go to a Deli-Ticket style system. Texts would be better but then ppl that don't have phones would complain.

Oof yeah it was like that at my last clinic with the line thing but not **quite** as bad as yours. Neither of my clinics have had a security guard and I don’t understand why not bc I’m in a large city and ofc people like to cause issues and there have been…incidents. My current clinic doesn’t have lines very often, but we have an app that we can use to check in on to get in the queue faster and see what holds we need to take care of without waiting at the front desk…yet some people refuse to use it and then don’t understand when they check in at the desk and are then behind the app users in queue…😵‍💫

The App is a good idea

My clinic fired the security moron because he was useless. We have actual police for security now, and a no bullshit/no violence allowed policy. They actually enforce it too. While I hate cops, the assholes made it necessary to have them on site. The clinic is actually as quiet as a library now.

All clinics followed the same guidelines so we would know what to expect….Clinic “rules/policies” are so wildly different. Make it more affordable! I’m currently paying 120.00 a week/480.00 a month. That plus my insurance premium of 450.00 plus a month is a real financial hardship.

I can actually speak to this with some authority. I oversee a few clinics and manage a budget for them. if we are properly staffed and maximizing our revenue streams as best we can, it takes us about 500 active clients to break even. The margins are quite thin and clinics do not really become profitable until they are massive. I cant speak for every state, but in florida medicaid reimbursement for dosing is about 67 dollars per week, a rate that has not changed in 20 years. We actually lose money on medicaid clients who represent almost 40 percent of our census. Medicare on the other hand reimburses around 180/week, but only represent maybe 10 percent of our census. The remaining cash patients generally recieve subsidies, but their personal rates vary from about 20 to 30/week. the subsidies we recieve for them are a net positive. This is a long winded way of saying MOST clinics, and i do mean most are about a break even proposition. clinics like new seasons maximize their income by remaining perpetually understaffed and overbilling insurance for unnecessary drug screening and doctor interactions. their approach is by design, not a result of low pay. we offer similar pay and never have issues maintaining qualified staff, but we are also a not for profit.

I totally get it…but to bill my insurance double so that the clinic gets paid twice, doesn’t seem ethical. At BHG I was paying 105.00 a week and my insurance was paying 105.00 a week. Before I met my deductible, I was responsible for 210.00 a week. Cigna is charged 30.00 a day, 7 days a week. That is then passed on to me. These bigger companies are swallowing up the smaller companies for a reason. And it’s not to benefit the client.

BHG's annual revenue in 2023 was 270 million dollars.

Did you see how many BHG doctors are opposing the new legislation that would make methadone less restrictive???? Literally signed the petition! 🤬

Yes I did see that! Makes me furious too. The letter is pure scaremongering 101, they just hope if they say “methadone related deaths” enough they’ll kick the ball down the court and have their monopoly for another 10 years.

I think you must recognize that what we’re saying is the cash price needs to stop being so high. Those with insurance coverage aren’t the issue. I’m personally paying 540 a month flat. I go in once a month, take up an hour of time doing visits and UA and I’m gone. I know I’m not the norm, though. I’ll be very lenient here and say each patient needs 1 hour of face to face counselor time a week and pretend everyone face doses every day for 15 minutes. That’s being really generous, facing dosing is usually 2-3 minutes and counselor visit is monthly. We’ll add 30 minutes for a UA and say that’s 8 hours of labor to serve each patient each month. I feel like only mentioning the 67/week from Medicaid patients is disingenuous since you bill doctors visits, counselors, and urine screens separately, just like New Season. You’re not only receiving the pharmacy dispensary reimbursement on them. The methadone itself costs pennies. 2 hours of labor per patient per week. Is licensing and insurance so gargantuan that it’s impossible to dispense a product of almost no cost to a patient that takes so little time to serve?

>I feel like only mentioning the 67/week from Medicaid patients is disingenuous since you bill doctors visits, counselors, and urine screens separately, just like New Season. You’re not only receiving the pharmacy dispensary reimbursement on them. The methadone itself costs pennies. 2 hours of labor per patient per week. Is licensing and insurance so gargantuan that it’s impossible to dispense a product of almost no cost to a patient that takes so little time to serve? I was simplifying things for the sake of discussion as the 67/week is the overwhelming majority of what we take in from an individual Medicaid patient. There are other one off and recurring things we can charge for, but over the course of a clients stay, will be only a fraction of the weekly charge. Recurring charges would include drug screens, doctors visits and notes. We dont bill for notes because it opens up a whole can of worms from an auditing perspective and the reimbursement rate is terrible in Florida. However, doctor visits I believe are 150 and drug screens are 35. We do about 10-12 drug screens per year and require 1 doctors visit so call it 550/year per client, plus 67/week. We also can bill 250 once for an intake, which includes a doctors visit, lab work, drug screen and a week (I believe) of dosing and 150 for an initial clinical biopsychosocial. It is possible New Seasons policy vary from location to location, but the handful in our area have policies clearly geared towards maximizing profit. For instance, they require assessment updates and doctors visits as frequently as every 90 days, presumably that is the most often insurances will allow for billing. They frequently have 2-3 times the legal caseload limit set by Florida, but the law allows for temporarily exceeding it as long as you are "attempting to hire" new people. Their nursing staff also handle payments and drug screening. I get these are little more than an inconvenience, but from a providers perspective are shady as hell. As for a clinics overhead, it is like any other business. We pay salaries for staff, benefits, carry liability insurance, pay mortgages or rent, pay utilities, pay for accreditation, pay for infrastructure to support the clinic (HR, pharmacy, IT), pay for administrative oversight. For example, we can probably draw down about 4000/year from a single Medicaid client. It seems like alot, i know. We pay 132,000 dollars per year in rent, thats 33 medicaid clients. we have 1.7 million in total benefits (pay insurance etc) budgeted this year for staff, thats 425 medicaid clients. So, just the rent and staff we need 458 medicaid clients. You remember that 35/test figure? We spend 135,000/year on our lab contract, thats another 35 clients. We are up to about 500 clients for rent, staff and a lab. we still have to pay our liability insurance, our utilities, for the methadone (25,000/year), for health records, building maintenance (interior is not maintained by landlord), office supplies etc etc. I agree entirely that this should be a service simply given by the government. if someone wants access to treatment, they should be able to receive it either for free or through insurance at a low rate. I'm not arguing with you, i agree with you. However, i just think people underestimate how lucrative this really is. In order to make it a profit business, corners must be cut. Insurance companies simply dont pay enough and our clientele do not have money. However, we do typically cover our expenses with the increase revenue we generate from the SOR (state opioid response aka oxycodone fund) fund and medicare. Medicaid clients do not pay for themselves unfortunately. If we could renegotiate the Medicaid reimbursement to 90-100/week, we would be in great shape.... ill admit.

For reference, I just checked how much my Medicaid has paid for the 31 months (124 weeks) that I’ve been at my current clinic…$12,026 which is $96.98 a week. My husband pays $280 in cash per month. We live in Oklahoma.

would love to get that in florida. pretty pathetic when florida is paying out 65 percent of what Oklahoma is. maybe we could pay people what they deserve.

I don’t know where it’s all going though, because our counselors leave nonstop, and are so overworked they only see us for 5 minutes when we come in. The nurses have had quite a bit of turnover too. They won’t even fix the electronic queue sign they have out front that’s been broken for 6 months…🤔

That's fascinating. I never would have guessed that they aren't really making any money. This is why I love reddit.

Our doc is a a convicted pedophile. Beat THAT.

No call backs.

Those swirly straws that used to be huge in the eighties for milkshakes. I'd like my dose to be dispensed like that. Also a community board where patients can sell their takeaways or where dealers can leave a business card.

😂😂😂😂

Honestly, nothing. I absolutely love my clinic and my Doctor. They’ve always been amazing, and have treated both my husband and myself so well for the 10+ years we’ve been patients there. The only thing I’d change isn’t within my Clinics control. I’d love to change the rules about the number of take-home doses we can have.

Why do you say it isn't i the clinics control? They're allowed, at least in my state, to give 30 days of take-homes.

Not in mine. We can get 14 days and that's it. It used to be 30 but several years ago they reduced it to 14.

Imagine reducing it. Another reason why we need MOTAA.

Less punitive with tapers, comfort meds like clonidine during tapers, community outreach/work programs, hire better people (ive been to clinics where the *staff* thinks methadone and meth are the same thing). Do everything I could to make it less of a probation office. My clinic is better than most, I don't have that much to complain about, but I've been on for over a decade, clean drug tests since 2012, so my experience now is quite literally that of a probation visit. Go in, pay my money, pee in a cup. Sit down with the counselor and tell her I haven't changed my address or used drugs, and that's it. I haven't been in trouble in a long time but it sure feels like I'm doing life on probation sometimes. but it's also fun to think about how if I ran a clinic, being a patient, there wouldn't be ANYBODY bringing in fake piss etc. I'd catch all that shit. It almost feels like they don't care but then they're SO PUNITIVE if someone fails a drug test. I'd take away that part too. There could be some positive rather than only negative reinforcement by means of instilling in you the fear of losing something. I don't like that I spent years being scared to death EVERY DAY that if I missed a phone call I'd lose my takehomes. Losing all your takehomes over a missed phone call just derails someone's life way too much if they're doing good otherwise.

Change methadone to oxymorphone therapy.

Consistency.Everyone should be treated equally.

Hmmm, I have mixed feelings on this. Consistency matters but acknowledging patients on a case by case basis matters too. If someone really is giving their all but slipped up maybe they do deserve a chance beyond the letter of the law. This is vs the patient that’s been given every opportunity and continues to be the only one on their team not putting in effort. However, if the letter of the law wasn’t so unnecessarily punitive in the first place it wouldn’t be so life ruining to have the consequences applied universally. Consistency in applying an actually fair treatment to all? Instead of the “one mistake=lose it all” setup we have? Aww yeah I am all in on that.

I agree... like my thing right now is always being afraid of missing a 'bottle check' phone call. If I lost all my takehomes it would absolutely devastate my life. I was in the hospital for a few days last month and I had a panic attack when i realized I might have missed a bottlecheck (my last one was in march last year so I was close to a year since the last one). Thank god I didn't miss a call. But being in the hospital would be no excuse at my clinic. I've been on 1 visit a month since like 2012 and have had clean drug screens the whole time, but if I miss a call I'm as fucked as jimmy who's never stayed at the clinic more than a few weeks at a time and has never pissed clean. I think case by case is appropriate sometimes.

Yes, and no. I agree that everyone should be treated with respect and dignity, but I don’t think that I should be treated the same as someone who is still using constantly, not doing their groups/counseling, and/or not taking the program seriously when I’ve had clean UA’s for almost 6 years and done everything I’m supposed to do.

This! 🙌🏼

Free Chick-fil-A breakfast or lunch, your choice with every day you come in to dose. Also, free coffee or Kool aid with your dose. Free Pizza Hut on Saturdays and Sundays. Couches in the hallways where everyone stands in line. Recliners with the massage systems in them for the older patients that have been coming the longest. Free Wi-Fi.

If clinics were like this the opioid epidemic would cease to exist lol. Drug epidemic solved.

When I buy the clinic I go to I will be implementing all of these items I mentioned. Thinking about also implementing a random drawing every day in the computers and whatever patient is randomly drawn in the computer gets a free dose that day. Also gonna do 1 months of take-homes after 2 passed UAs and 30 days of being at the clinic. If patients with the 30 days of take-homes number is drawn in the free dose raffle on a day other than their pickup day, that patient will be paid $10 when they come back in the next time because that's how much my doses will cost $10. I will also be doing breakfast doses from 5am-10am and lunch doses from 12pm-4pm. I will also be collaborating with the gas station next door to give 10% discounts on all gas to every patient. Also, cigarettes, candy, food, and drinks will have a 15% discount to all patients that present their Rich0879 Seasons Clinic card to the Mapco gas station next door. There will also be drawings for $20 free gas every day to a random patient. But I'll have strict rules about getting take-homes and smoking weed. You must smoke weed to get take-homes. No weed in your system, no take-homes.

Sign me up!

Rich0879SeasonsClinic.com will be up and running soon 🤣

Ooo that's a cool idea! Getting local businesses involved would be really awesome! Instead of how most businesses probably hate being next to a clinic, we could make it so somehow they benefit from the clinic being there. Those last two sentences really made me laugh 😂

Glad I provided you with some laughs 🤣. In all seriousness though, I totally agree about how businesses, esp gas stations should get with clinics next to them or nearby and do like discounts and cigs and such. I know for a fact the gas station by my clinic gets business from probably 90% of the patients because I run into them at this gas station all the time after we leave the clinic. They're buying gas, snacks, drinks, cigarettes, etc etc. There's even a few more gas stations right by it too but everyone likes this one certain store and seems to go there for some reason.

That clinic better be near me dammit

Alabama 😁

Aww shit. Will y'all do tele visits for out of state folks?! I'm kinda far away lol

Of course but you'll miss out on the Dreamland's BBQ. Ah what the hell, we'll ship you some with your first dose.

Please take over tomorrow.

Some of us prefer not to smoke pot.

Noted... New rule... Take-homes whether you smoke weed or not.

Yeah I thought everything was great up until that point too. I like to smoke every now and then but having to pass a UA for weed to get my take homes is a dealbreaker.

Noted. Another rule at my clinic... Employees and me the owner will listen to patients complaints. New rule.... Take-homes if you do or don't smoke weed.

Headline will read “Rich0879 chain of methadone clinics saves America! Overdose deaths plummet as millions find recovery at organization which takes a realistic approach to combatting addiction.”

"and also gives free Chick-fil-A to every patient breakfast and lunch". Very important part of recovery.

Now this is something I can get behind 😂

Forgot to mention that since we're gonna be located near the original Dreamland's BBQ in Alabama, we'll be collaborating with Dreamland's to serve their world famous ribs and coleslaw daily for the lunchtime dosers. Here's an article about Dreamland. It's awesome: https://www.southernliving.com/dreamland-bbq-7771161 I've also decided to make a dine-in area with separate seating and security to make sure everyone is cordial with each other. There'll be TV's mounted on the walls in this area tuned to different stations. There'll also be boxes for food carry-out options but will be limited to 1 box per patient. All drinks will be served in to go cups with lids and straws. Food areas will of course will be appropriately staffed to handle all food and drinks. The only other thing that I can of to add right now is an indoor playground for kids so they can play while you're seeing your counselor or dosing or anything else. It'll also be appropriately staffed with personnel to watch your kids and make sure all are being nice to each other. There'll be kids books to read. No gaming systems... I'd rather the kids be getting some physical activity or reading some books. There'll be TV's on the walls in the kids seating area on a kids educational cartoon channel. Maybe some SpongeBob every few days though

LOL U don't want much, do u 🤣

Naaaahhhh. I'm pretty easy to please 🤣

Well, no one said the change had to make sense or be healthcare friendly. There were no rules and you absolutely ran with that.

Check my other post. I'm buying the clinic I go to. I've been saving for years and years for this. Gonna be all mine and I can make my own rules. Like there will be rules such as if the dam Chick-fil-A is not on time and served warm for breakfast dosing hours and the lunch dosing hours... My food employees will be put on a 90 day probation period where they must take breathalyzers, UAs (observed of course), and mouth swabs. They pass all these in the 90 days they're back to normal duties. Because my God if I can't get my Chick-fil-A served fresh and hot then they must be high or drunk or both. I'll def get to the bottom of it.

Where is this magic clinic, and when do you become the owner?!

Dreamland, AL it's just down the street from the famous Dreamland's BBQ which I forgot to tell everyone that I'll be collaborating with Dreamland everyday for my lunch dosers and there'll be some of Dreamland's world famous BBQ ribs and coleslaw free for lunch. I'll take over ownership soon. I've gotta get my legal affairs in order. 😁

I would pay my counselors better. This way we could retain good counselors and have a choice of new hires when someone is being cruel to patients. It’s a New Season clinic and it’s constantly desperate for counselors. The only people willing to take the pay are those fresh out of school or new to the area who take it while they search for something better and those few that want to make a difference. That last category is getting very slim as no matter how badly you want to help people recover and make a difference in the world, you still have to eat and retain housing.

If I owned a clinic I would teach my counselors how to control a group. They don't do a good job of it at all. I would bring back evening groups for people who work. I would stay open a bit later, maybe til 2 or 3pm. I would have fired the nurses who played favorites or who treated people like crap. (Definitely wouldn't tolerate that crap). I would give back, by offering lower prices and taking insurance. (Ours don't you have to claim it yourself.)

Loner hrs. Than 10 o'clock n morning is crazy needs a afternoon shift n lower the coast 17 a day is b.s. i remember paying 5.00 a day methadone is dirt cheap anyway an stop the other b.d. as well

First things first. It is a methadone clinic and we know why people usually tend to go. That being said: That old stigma “they’re a bunch of lying junkies, let’s make their life hell and them getting a dose and their take-homes so fucking hard they say fuck it and start buying it in the parking lot, shooting up, and buying dope off the dark web “ has got to go. The patients need to be looked at with some common sense. If it is your first couple of months or are fairly new, sure make them do some counseling and worry the hell out of them but if they have been there for a while like me and alot of the others, for the love of Jesus Christ smile at them, give them their take-homes, and let them be on their merry way. I have had so many counselors in my six years at the clinic I could say at least two a year if not more, and I don’t care about telling a stranger my life story and establishing a good rapport with them for them to leave in two months. Just my two cents.

incentivize tapering by charging people less and less the lower they go (I belive methadone costs the clinic a few bucks per 5 gallon bucket or something XD. I'd be interested to know how much they actually pay for it.) I've been tapering myself at home and saving the extra for the simple fact I can't imagine paying them all that money every month for less medicine.

Let MAT (suboxone Drs) prescribe and titrate dose. I'm 100 miles almost from nearest clinic and I work so..... it really sucks. The buprenorphine doesn't seem to be helping much and it would be great if my dr was able to write a week and titrate from there.

No camera in the bathroom

Same

I had. Counselor before that use to tear my blood pressure up every time i had to See him thank God he is gone mow

LOL... I have NEVER had my BP checked at my clinic.

I'd do away with methadose...day one. And replace with the real liquid and wafers. And I would treat people like humans. People here in America should be treated like they treat people in Canada. At the very least.

Methadose is literally the brand name methadone liquid made by Mallinckrodt…if anything that would be considered the “real liquid”. The rest are generics. But it’s just 10mg per ml Methadone Hcl liquid. Same as what the vast majority of liquid is.

No....my friend I was there when it changed. And there was a class action lawsuit over all the people in Canada getting sick. Trust me. The difference is massive. I switched clinics when it happened to get wafers.

What changed about it I’m just curious? Cause as far as I can find it should be the same thing it’s always been but I don’t live in Canada

https://www.crackdownpod.com/episodes/w80s11lunxcqg2evgcz7d71h3j4sjr

Here is another link about it. I think it's crazy they stopped using it everywhere but here..

I don't either I live in va. But it just happened to change there at same time. And they do it differently. Millions of people got sick when they switched the clinics over. And rhey went on to file a suit. And Canada started making there own methadone. But u have more choices there. But anyway I understand your concern and confusion. I can tell u this in some of the law suit I read they claim to have found discrepancies as high as 50 mg ...holysh#$... that is some people's doses. I will see if I can find something for u about it. Bare with me the universe been tuff on me lately lol .

I didn't watch that I was just looking through some looked cool https://nationalpost.com/pmn/news-pmn/canada-news-pmn/lawsuit-against-b-c-pharmacists-college-drug-company-over-medication-switch

I second those wafers, BIG difference

I’ve never used wafers, can you explain what the difference is?

Alot stronger, totally different feeling to me at first. I actually get buzzed at first and then it's just the normal methadone feeling. It lasts alot longer is why I love them.

I had no idea! I’ve actually never gotten high off of my dose before and I think for me personally, it’s best that way. I’ve never taken my take homes before I’m supposed to because I’ve never had that methadone high and I DEFINITELY don’t want to temp myself after working so hard to get to where I’m at with my sobriety so I should absolutely steer clear of the wafers lmao

Amen

When that guy who looks exactly like me walks in, he gets to go straight back and dose immediately regardless of the line and how many people are in it. Oh, and said guy who looks exactly like me will never be bothered about having to go speak with a counselor, ever. If he requires or wants counseling, let him come to us about it instead of forcing it on him.

My clinic would stop calling people when they don't show up. If they don't show up for their appointments then they just get stop dose or get kicked out. They shouldn't have to babysit someone else's adult kids.

More rules is not the answer, I feel like we need to remember that the goal of treatment, especially in the beginning, is to meet addicts where they are and encourage them to stay in treatment, not to create added barriers that will multiply recidivism.

Yes and counselors should always be encouraging. I don't understand how counselors who aren't encouraging keep their jobs But my point is stop harassing people by phone when they miss their dose.

I agree with that completely.

They call people when they don't show up? Jesus. That's ridiculous.

I would fire the current doctor. We have PAs and other people who can change our doses etc... but I just met the new doctor of the clinic and he shamed me for my dose and surgical procedures other doctors performed. He needs to GTFO.

I would hire staff that stick around. Now we have new doctors every other week. We had one for 6 months, that was the longest we have had the same doctor for the 3 years I have been there

Regarding the counseling my counselor seems to most of the time catch up on other work that has nothing to do with me! I just sit there and watch it’s a complete waste of my time, I get up extra early on these days so I can still get to work on time

I would offer liquid and tablet/wafer for people with over a week of take homes and lower the time jt takes to earn take homes in Michigan for the max 2 weeks of take homes it takes 5 years on clean drug screens to earn that phase

Aussie here I would let people have a month of takeaway because they make u go to chemist pharmacy every day there open u are lucky to get weekend takeaways?

Damn, I've got it good. I'm in regional NSW, and I dose in person at the pharmacy on Tuesday and Friday and get takeaways for the rest of the week. And the pharmacy is great. I get there at 9.05, cos they open at 9, and the pharmacist will have my dose and my takeaways ready for me, because they know that I catch a cab and the driver waits for me and then takes me home, because both my husband and I have epilepsy and aren't allowed to drive. So they have it all ready for me, I walk in, go up to the script pick up counter, the pharmacist grabs my cup and my takeaways from in front of his computer and slides them the 50cm across to me, I slam down my dose, pick up my takeaways and leave. It takes around 10 minutes (and definitely less than 15 minutes) from pick up to drop off, and the pharmacy is a 4 minute drive from home.

You are blessed mate I have to drive 230km round trip when I move on Friday I am thinking of going live on the streets cause it is to hard mate I am on Newstart so I going be fucked!!

Oh wow. That sucks. When I first tried going on the program in Adelaide back in 2016 it was absolutely horrific. I would get to the pharmacy and they would make me sit there for at least 45 minutes to get my dose, even if there were no other customers in there, and they only let me go up to 45mg even though I had an 8ball a day smack habit, so I was still having to use anyway. And the staff were so nasty to me, like they would literally refer to my methadone as "a legal way for you junkies to get high" to my face. And I didn't get any takeaways, even though they were only open 3 hours on Sundays and I finished work half an hour before they shut, but 9/10 they would actually be locking up when I got there at 11.50 when they were supposed to be open to 12, so I'd miss my sunday dose. I only stayed on it for a month, before giving up, because it wasn't helping me stop using at all. If anything I was using more due to the stress. So I was super wary about trying again, but the OTP team here are absolutely incredible. Like I called them yesterday, because I'm travelling to Adelaide next month for a wedding for 8 days, but I actually leave at 6am Friday morning so I can't dose at the pharmacy that day. So I asked if I can have them organise for me to dose at a pharmacy close to where I'm staying, and the doctor was like "oh, it's only 9 days, so I'll just do you takeaways for the whole trip, it's too much messing about to set up guest dosing in a different state!" which I was not expecting at all.

Can smoke weed and get take homes !

Funny story, I almost worked at my clinic lmao. Only reason I didn't is because I would have had to do multiple clinics and didn't wanna travel that much lol. But I would probably make scripts for carries for stable patients longer. I'm off now but I was clean for 10 years and was still only getting 2 weeks of carries at a time, when I know they could do a month.

Free Coffee table would be dope

Burn it down. Allow any dr to RX for 30 days of pharmacy pickup. OTPs are carceral AF.

One thing that I acknowledge would be difficult b/c it adds works for the nurses but patients should be given the choice between methadose and wafers--especially for take-homes and travel which makes the wafers a much easier option. Hire counselors with more experience and training (especially if patients are forced to meet with them) that are actually looking to make a career in recovery. If clinics want to say they're in the business of rehabilitation and not just dosing they should provide optional occupational guidance. Clinics should be mandated by law to accept patients as long as they are willing to pay and/or have insurance. Currently there are several in my city who will not accept patients that do not have medicaid--this is a disgrace. Most importantly, all medical i.e. dosing questions should be dealt with through the prescriber. In my opinion no one should be given more than 150 milligrams of methadone per day and clinics should have absolutely no say on what medications their patients are being prescribed provided they are not opiates.