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NP, Nurse Practitioner
Category: Health
Satisfied Customers: 15
Experience:  Family Practice, Pain Management- work both in clinics and in hospitals.
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What is the legal limit of methadone the dea will allow a ...

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Customer: replied 8 years ago.
What is the legal limit of methadone the dea will allow a doctor to prescibe a patient for pain? Also is there doctors that can prescribe methadone besides the methadone clinics to addiction patients? If so how do you find them?
Expert:  NP replied 8 years ago.

DEA does not limit the dosage of Methadone prescribed for pain management. The limit of dosage of Methadone prescribed for pain occurs due to side effects. The higher the dosage the more side effects you will have. Methadone toxicity is a major consern with higher dosages. Usually if you go above 120 mg/day Methadone toxicity is a consern.

All doctors who are certified as addictionologists can prescribe Methadone for addiction, and not all those doctors work in Methadone clinics. Some psychiatrists who treat pain are licensed as addictionologist, some pain management specialists are also licensed addictionologists. Some doctors choose to be licensed addictionologists some do not. It is just a matter of calling around and asking doctor's offices if they treat addictions. However, those addictionologists, who do not work in Methadone clinics, may choose to prescribe some other non-narcotic medications instead of Methadone for addiction , most do. They prefer to get you off narcotics all together.

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Customer: replied 8 years ago.
Reply to NP's Post: I just want to make sure we are on the same page.
After the first of the year the DEA or FDA, or someone like that, changed it to where doctors could no longer prescribe the 40mg methadone pills. The methadone clinics can still treat with the 40's, but every other doctor must write their prescriptions with the 10 mg methadone. So are you positive it is still the same? The doctor has no legal limit by the DEA? I'm not saying you don't know what your talking about I just need to be sure. The reason I am asking in the first place is because I have been going to my doctor for the past year and have been on 2 and a half methadone pills a day, thats 100mg a day. On my December appt. he informed me of the switch. On my January appt. he only wrote me 1 and a half pills a day, 60mg. That is a whole pill less than what I am used to, almost half of my dose he cut me. I did not really get a chance to ask him why and since their clinic is only open on Saturday and Wednesday I have not got a chance to call him. I am trying to figure out everything in the mean time. I called another clinic today and a man told me something about "60mg is all the DEA is allowing doctors to prescribe", which sounded really strange to me. I am just trying to figure out if my doctor "forgot" to tell me something. I do know that when he cut my RX in almost half he should have explained things to me, like why he was doing it. He should have went over things like how this drastic cut in medicine will affect my body. Thank you in advance for you information and knowledge.
Expert:  NP replied 8 years ago.

I could not find any information regarding the "new" regulations by DEA for Methadone. DEA is in no position to tell doctors how much and what to prescribe, that would be practicing medicine without license. DEA however, can regulate other aspects such as that prescription cannot be given for more than one month supply, and that patient has to be seen and assessed prior each prescription given, that medciation cannot be called into pharmacy.

Prescribing Methadone for pain, and Methadone for addiction is two totally different issues.

Methadone for pain is given multiple times a day and even though patient may have abuse issues if they also have pain, their pain is treated in the same manner as it would be treated for any other patient the only exception they have to be monitored more closely. Most doctors in that case would refer those patients to addictionologist.

Regarding your doctor cutting your prescription into half because of DEA regulation sounds a bit strange to me. If he is giving you methadone for pain, and even if DEA regulation came out restricting the dosage given, still you would have to be weaned off it slowly to desired dose due to withdrawal symptoms, this means your well-being is a consern. DEA regulations usually apply to new patients and with old ones you would have to wean them down to comply with regulations if those regulations existed. Again, doctors do have extensive freedom in treating their patients regarding how much and what they are going to prescribe and how they are going to wean you off.

I went to DEA site and below is copy and paste information from their site that would be of interest to you. I also included website address for you if you would like more information you could go to their site. Please let me know if you require anymore information.

Question: Can a practitioner prescribe methadone for the treatment of pain?

Answer: Federal law and regulations do not restrict the prescribing, dispensing, or administering of any schedule II, III, IV, or V narcotic medication, including methadone, for the treatment of pain, if such treatment is deemed medically necessary by a practitioner acting in the usual course of professional practice.

Confusion often arises due to regulatory restrictions concerning the use of methadone for the maintenance or detoxification of opioid addicted individuals, in which case the practitioner is required to be registered with the DEA as a Narcotic Treatment Program (NTP).

Can methadone be used for pain control?

Methadone, a schedule II controlled substance, has been approved by the FDA as an analgesic. While a physician must have a separate DEA registration to dispense methadone for maintenance or detoxification, no separate registration is required to prescribe methadone for pain. However, in a document entitled "Methadone-Associated Mortality: Report of a National Assessment,'' SAMHSA recently recommended that "physicians need to understand methadone's pharmacology and appropriate use, as well as specific indications and cautions to consider when deciding whether to use this medication in the treatment of pain.'' \35\ This recommendation was made in light of mortality rates associated with methadone.

What additional precaution should be taken when a patient has a history of drug abuse?

As a DEA registrant, a physician has a responsibility to exercise a much greater degree of oversight to prevent diversion and abuse in the case of a known or suspected addict than in the case of a patient for whom there are no indicators of drug abuse. Under no circumstances may a physician dispense controlled substances with the knowledge they will be used for a nonmedical purpose or that they will be resold by the patient. Some physicians who treat patients having a history of drug abuse require each patient to sign a contract agreeing to certain terms designed to prevent diversion and abuse, such as periodic urinalysis. While such measures are not mandated by the CSA or DEA regulations, they can be very useful.

Expert:  NP replied 8 years ago.

I just called ,and you are right, I found out that DEA regulations prohibit prescribing 40 mg Methadone starting January, 2008. However, DEA did not put limit on how much you can prescribe, you still can be prescribed the same amount of medication but only lesser strenth pill (comes in 5 mg, and 10 mg strenth besides 40 mg). So if you are on 100 mg Methadone a day, you would have to take 10 methadone pills of 10 mg a day. The reason doctors are cutting back their patients on amount of medications they are getting is that they do not feel comfortable prescribing too many 10 mg pills, it is the amount that scares them, not DEA regulation.


Customer: replied 8 years ago.
Yes I accept and I really appreciate you taking the time to respond to my response you've been very helpful. I'm sure that I will have another question soon and its good to know that I will get the best possible answer.     Thanks Chad