The Curbsiders Internal Medicine Podcast Addiction Medicine - #25 Methadone in the Clinic with Dr Ruth Potee and Dr David Frank
Jul 18, 2024
Dr. Ruth Potee and Dr. David Frank discuss methadone treatment for opioid use disorder, emphasizing its benefits and challenges. They explore access issues, intake procedures, dosing, and the role of primary care doctors in supporting patients. The episode covers personal experiences, advocacy efforts, and opportunities for improving methadone programs.
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Methadone Pharmacology Requires Individualized Dosing
- Methadone is a full mu opioid agonist with excellent oral bioavailability and a long half-life that requires slow titration to a personalized effective dose.
- Ruth Potee compares dosing variability to thyroid replacement, noting patients stabilize anywhere from ~60 mg to >200 mg and levels build over days to weeks.
Methadone Access Is Hamstrung By A Carceral Delivery System
- US methadone delivery is separated from mainstream medicine by 42 CFR rules created in 1973, producing a carceral, surveillance-based system around an effective medication.
- Ruth Potee emphasizes that the problem is the delivery system, not the molecule, and 80% of US counties lack OTPs.
First Clinic Visit Felt Scary Then Life Changing
- David Frank describes his intake as frightening but transformative: after initial paperwork and a small first dose he realized he wouldn't be dope sick that day.
- He recalls leaving the clinic amazed that daily chaos of stealing and scoring could stop, calling methadone life-changing.