> They literally would not allow the patient to wean off of it

If true that clinic needs to be reported. Patients have a right to taper down and exit treatment.

When a patient enters treatment at an OTP (Methadone clinic) they start with a small initial dose that is increased over the initial 30-60 days of treatment. Some clinics do this somewhat aggressively because they are trying to get the patient up to a "protective" dose. Methadone blocks the 'euphoric' effects of other opioids and protects patients who may still be taking other substance outside of their prescribed treatment program from overdose. Getting to a protective dose faster ends up saving patients lives.

So that maybe why the clinic was firm about trying to increase you friends dose.

OTPs are also required to offer counseling, the idea being methodone is used to address the physical aspects of addiction, and counseling is use to address the psychological/emotional side of addiction. Help patients build coping skills, figuring out what their triggers are, and find ways to stay out of those situations, etc. Some patients are instrested in that and eventually getting off of Methadone, some aren't. Some clinics provide really great counseling, some don't. The "dose and go" clinics are definitely a problem in the industry.

https://www.samhsa.gov/substance-use/treatment/options/metha...

To answer my own question: what you described sounds like part of the standard recommended protocol, and it seems likely your friend misunderstood or misrepresented that.

I'll explain with liberal quotes from the document linked below. Dosages start out low to avoid risk to the patient, because "the most common reason for death or non-fatal overdose from methadone treatment is overly aggressive prescribing/dose-titration during the first two weeks of treatment."

Because of this, "methadone induction and titration MUST be approached slowly and cautiously. It may take several weeks to address opioid withdrawal effectively. It is important to be upfront with patients about this requirement and to discuss ways to cope with ongoing withdrawal and cravings, to maintain engagement in treatment."

The dose increase is described in the following paragraph:

"...methadone can be initiated without the prerequisite presence of opioid withdrawal. This may be preferential for some patients. The patient’s dose should be titrated with a “start low and go slow” approach, based on regular clinical assessment, until initial dose stability is reached – see specific recommendations below. A stable dose is achieved when opioid withdrawal is eliminated or adequately suppressed for 24 hours to allow patients to further engage in ongoing medical and psychosocial treatment. The ultimate goal is to work toward clinical stability."

In other words, for patients who are continuing to take other opioids, the methadone dose is increased over time to make it easier for the patient to reduce that other intake. Dosage is based on interviews with the patient.

Addicts are very good at subconsciously coming up with rationales for remaining addicted. It's much more likely that your friend found himself in that trap, than that he was going to an unethical clinic trying to keep him addicted "forever". That would be a major violation of the law and breach of medical ethics, and would be likely to come to the attention of regulators if it was a recurring pattern.

https://cpsm.mb.ca/assets/PrescribingPracticesProgram/Recomm...

Was there some stated rationale for the dose increase?