What do Methadone Peak and Trough levels Mean?

 

In patients prescribed methadone to treat opioid addiction, the blood level of methadone peaks at around three hours after dosing. The methadone level is at its lowest at twenty-four hours after the last dose, just before the patient is due for their next dose of daily methadone. We can draw blood at the time of lowest methadone level, called a trough level, just before the next dose is due. Then we can draw blood at the time of the highest concentration of methadone in the blood, called a peak level, at about three hours after the last dose. These numbers provide some information about the adequacy of the patient’s dose, though they’re far from definitive.

Usually, patients need to have a trough blood level higher than 200 – 400 ngm/ml to stay out of withdrawal at the end of a dosing cycle. Some patients need higher levels. And a peak level that is more than two times the trough level indicates that the patient is metabolizing methadone quickly, and may need to increase the dose or consider split dosing.

But the blood levels are only one piece of the pie that determines dosing. Dosing decisions are based on the patient’s symptoms, observable physical signs, urine drug screens, the patient’s other medical problems, and other prescription medications. Doctors are usually able to make dosing decisions based on these factors, without having to get blood peak and trough levels. But when the clinical picture doesn’t match with what the patient is saying, blood levels can help.

For example, if a patient dosing each day at one hundred and twenty milligrams says he feels fatigue and sweats starting ten hours after his dose, but he looks great in the mornings before he doses, a trough level can be drawn. If his trough level is adequate, he may be misinterpreting his physical symptoms. For example, he could have fatigue and sweating from a newly acquired hepatitis C infection.

Patients on replacement medications like methadone or buprenorphine – and their doctors – often forget that non-addiction related factors also affect the way patients feel. Pregnancy often causes physical symptoms that feel a bit like opioid withdrawal. Doctors working with patients on replacement medications need to remember to look at the patient as a whole, not just at the disease of addiction.

About these ads

82 responses to this post.

  1. Posted by Zenith on July 12, 2010 at 5:46 am

    Peak and Trough levels should never be used to determine need for an increase in dosage. In the USA and in most other countries except Germany, methadone is a mixture of racemic and non racemic isomers. This mixture is used because it is slightly cheaper–it is a mix of active and inactive isomers of methadone.

    When the peak and trough test is performed, however, the test cannot tell the difference between active and inactive isomers. The test, for example, may show that a patient has plenty of the drug on board, but the patient may actually not have enough of the ACTIVE drug–it may be the INACTIVE isomers causing the test to indicate that they should have plenty on board. In this case, the patient could still be exhibiting signs and symptoms of withdrawal, while the doctor reviews the test and tells the patient that their dose is adequate, or perhaps even “too high” and they will have to have their dose reduced. Many a patient has shied away from requesting a much needed dose increase because they fear this very thing, though they may not understand WHY the test is misleading the doctor.

    Unfortunately, though this information is in the medical literature and plainly available to anyone in the field , many methadone clinic doctors are unaware of these findings regarding the peak and trough and simply continue to use this test as a primary tool to determine need for dose increase, when it should not be used AT ALL for this purpose.

    In Germany, the single isomer form of the drug is used. Most patients require about half the dosage they do in other countries, for this reason. In Germany alone, the test would be an effective indicator of adequate dose. Additionally, some Swiss studies have indicated that the mixed isomer methadone used elsewhere is tied to the recent discovery of a link between methadone and Torsades des Pointes, a cardiac condition. The studies showed that the single isomer methadone was far less likely to be linked to the condition.

    Reply

    • Ah!

      Thank you for your learned comments.

      I agree with you in the whole. The last opioid treatment center where I worked never used blood levels of methadone, feeling the physicians could determine dosage on clinical basis only. But I do think occasionally they can be useful. The studies done on methadone blood levels through the years have, I think, been done on racemic methadone. That is, containing both the D- and S- enantiomers.

      Over the past year and a half at my present clinic, I’ve asked for trough levels twice, and both times I’ll admit I got the levels more for my reassurance than anything else. Both situations were patients on relatively (>130mg) doses who still reported withdrawal at the end of the dosing cycle. Both had troughs less than 200ng/ml, which made me feel I was doing the right thing by continuing to increase.

      Reply

  2. Treatments for Opioid Withdrawal…

    I found your article interesting thus I’ve added a Trackback to it on my weblog :)…

    Reply

  3. Posted by Anthony on January 17, 2011 at 6:31 pm

    I currently work at a clinic where doses are DECREASED if a peak is more than 2x the trough and increases are routinely denied in the same instance. Could you direct me to any litterature that backs up “And a peak level that is more than two times the trough level indicates that the patient is metabolizing methadone quickly, and may need to increase the dose or consider split dosing.”
    Thanks.

    Reply

    • I’ve found that I rarely need methadone levels, because the patient’s dose can usually be safely established on clinical grounds, meaning how the patient feels, how she looks pre and post dose, vital signs, pupillary reaction, and drug screens. All these factors are pieces of the pie, and levels are another piece of the pie. Using only methadone blood levels to establish the dose makes me nervous. For example…what if you had a patient who felt fine, doing well, has a blood level of 200ng/ml. Should her dose be increased? No. Treat the patient, not the number.

      TIP (Treatment Improvement Protocol)43, titled “Medication-Assisted Treatment for Opioid Addiction in Opioid Treamtent Programs,” published by the U.S. Department of Health and Human Services, contains information all doctors at treatment programs should know.

      Pages 72-76 contain information about dosing and drug levels. On page 75, first paragraph: “…peak level should be no more than twice the trough level and that, if it is more, the patient should be considered a “fast metabolizer” and be administered split dosing.”

      Hope this helps. By the way, this information can be obtained from DHHS at this website, free of charge: http://store.samhsa.gov/home
      Just search on this site for TIP 43. You can also get a digital version. (The book takes about 6 weeks to come in the mail)

      Hope this helps.

      Reply

  4. Posted by Shawnee on March 17, 2011 at 12:28 pm

    I currently go to a clinic in Michigan my dose is at 185 mg of methadone. my peak is at .79 trough is at .43 What dose the numbers mean? I know i need more Medication HELP…

    Reply

    • Your peak and trough numbers look pretty good, but that’s only one piece of the entire picture. I get nervous when doctors use only the peak and trough numbers to decide a patient’s dose. When I’m trying to decide if a dose needs to be increased, I (of course) meet with the patient, maybe check pupil size, blood pressure, heart rate, and ask about symptoms. Ideally I see them during their trough, right before they dose, and if possible, three hours after dosing. I ask if they’ve started any new medications, and I always ask about alcohol. Many patients who start to drink will have lowered methadone blood levels due to the effect of alcohol. It induces metabolism of methadone, speeding clearance. I ask the patient about physical and emotional health also. Occasionally, a patient will have unrealistic expectations about how the methadone is supposed to make her feel.

      Hopefully you can meet with your doctor to discuss all of these issues, and the symptoms that you believe will imporve with a higher dose.

      Reply

      • Posted by priscella vanhorn on March 29, 2013 at 5:05 pm

        I found out 12 years ago that i have Hep C and nothing has been done about it..I hve been put on so many pain meds like Vicidon,loratab,,ect..An i also have takein Methadone an that seems to be the only one that has helped with out taking so many to help the pain.. Now i am going to see a new Doctor Monday an i a not sure to ask him about the Methadone..With having servere pain all over an not being able to sleep cause of the pain it is so hard to be able to do anything but cry cause i am in so much pain i a not sure on what do since nothing has been done about my Hep C..Any Advice cause i am at the end of my rope!!

      • If you have Hep C, your doctor will likely ask you to stay away from meds with acetaminophen in them. Methadone, though stored in the liver, doesn’t damage the liver. The hepatologists (liver specialists) I deal with prefer opioid addicts to be in treatment on methadone before starting treatment protocols for Hep C, since the methadone may alleviate some of the flu-like symptoms associated with interferon-based protocols. However, now there are protocols that don’t make people as sick in their treatment for Hep C, that don’t even use interferon.
        My advice is to tell your doctor everything, so that you can get the best care possible. If you have opioid addiction, she may recommend you get treatment at a methadone clinic, if available in your area. Methadone dosed daily may not help too much with chronic pain but it will – at least – keep you out of withdrawal, and may give some pain relief for 6-8hrs after your dose.

  5. Posted by Shawnee on March 18, 2011 at 12:37 pm

    I know by 3pm it’s not holding me anymore? I don’t take ANY meds but my Methadone… Nor do i drink.. My days are busy somewhat school… At night i can’t sleep, i find myself wakeing up three times a night?

    Reply

  6. I’m on 140mg of meth, i still am very uncomfortable the clinic doctor took trough not peak levels and says they are to high to increase me, i know i am going to relapse no one hears me or seems to care!!!!

    Reply

    • Mike, obviously that’s a bad situation. Maybe you could ask your doctor to talk with you again, and examine you just before you dose, then three hours later, so she can check your pupils, blood pressure, level of alertness, etc. Or if she’s already done this, have you gone to a primary care doctor, in case there’s something else going on that’s making you feel bad??
      For example, I’ve had a patient with fatigue and muscle aches, despite a decent dose of methadone. Quite naturally, we blamed it on withdrawal at first. When there was really no improvement with dose increases, she went to her primary care doctor. We later came to believe it was an acute hepatitis C infection.
      It may be a long shot, but it’s worth getting checked for other medical conditions

      Reply

  7. Posted by frank d on May 5, 2011 at 11:00 pm

    Dear sir or ma’am, I go to a clinic in Knoxville, TN, and my dose is 120mg. daily, they want me to take a peak and trough test,and see if I am in their eyes getting too much medication. I am feeling normal, despite what the test would say. The clinic feels noone should be on more than 60mg. daily, and I feel they are just looking for proof to confirm forcing me to go down. I say forcing, because they would either take away all my take homes (2 weeks) or kick me out. I am at wits end, I am one of the few people who really NEED this medication, at this clinic, I have NEVER DIVERTED a single milligram, and have been clean since OCT.2003, I started the program on May 20 2003. It has given me a new life, and it is great, it works. I am a low pain threshhold person, and know I need this dose (at least) they will not let me go up no matter what, so I am not asking! My counselor thinks I am at too LOW a dose! What can I do, I am terrified the test will “open the door” to them lowering me until THEY are satisfied. I am not intoxicated, not sleepy, I have arthritis and fibromyalgia, and injuries to my spine, and legs and hands, so I can barely move with the methadone as it is. They won’t allow me ANYTHING else than Ibuprofen. I am OK with this, I just do not want them to do the peak and trough test, or at least for it to show a too low level. I think I need help!

    Reply

    • First, I wonder why your clinic wants to draw methadone levels. Have you requested an increase, and for some reason the doctor isn’t sure if you your symptoms are from opioid withdrawal or perhaps another problem?
      Most clinics don’t routinely draw methadone levels, unless there’s conflictiing data. Has someone called the clinic, saying you appear sleepy? Are they worried you are diverting doses?
      As I’ve said before, methadone blood levels can be helpful, but clinical appearance of the patient is probably the most important. If I had a patient who is doing well on 120mg and feeling great, I wouldn’t even consider drawing levels because it wouldn’t change what I’m doing.
      In other words…is there more to the story?

      Reply

    • Oh, and if you are requesting an increase because of chronic pain issues, not opioid withdrawal (granted it can be hard to tell the difference sometimes), increasing your dose probably won’t help much, if any.
      This is because the anti-pain effect of methadone wears off after about 6 hours, no matter how high the dose. That’s why when pain medicine doctors prescribe methadone for pain, they prescribe smaller amount three or four times per day. But the methadone clinics usually aren’t set up to dose more than once per day, making it a less-than-ideal treatment for chronic pain.

      Reply

  8. Posted by juanita (jay) on June 30, 2011 at 1:48 am

    My name is Jay, and was established on the methadone about 2 wks ago, im currently on 95mgs but feel i need to be increased, however the doc wont increase me until i do a peak & trough next week! I know my body therefore i no i need more but am worried what i test will cum back saying? what if it says im on to much even though im not????????? They wont decrease me will they? cos if they did i would NOT COPE and would have to start using again which i DONT want to do!!!! can anyone out there PLEASE PLEASE give me sum feed back/advice as im stressed to the max here!!!!thank you

    Reply

    • Hello Jay,
      You can look at the prior posts about peak and trough levels…they help, but aren’t the only thing you doctor will likely look at.

      I rarely need to order peak and trough levels, because I find that most patients can be stabilized without it. I ask them about withdrawal symptoms, and examine them before dosing to look for withdrawal signs (check pupils, blood pressure, heart rate, look for tremor, gooseflesh, etc.). Many times the withdrawal signs are minimal even when the patient is feeling a good bit of withdrawal, though, so at times levels can be helpful. If I”m worried the patient is on too much, I request they return to the clinic at three hours after dosing so I can look for signs of intoxication, when the blood level is peaking.

      I recommend you trust the process. Presumably, your doctor works at your OTP because she knows it helps opioid addicts, and she wants you to do well. This means getting you to an adequate dose, because the methadone literature definitely shows that patients do the best when they are at an adequate dose. So let her check your methadone levels.

      Some methadone patients have told me it’s hard to know the difference between wanting and needing a dose increase, because the addiction is always screaming, “More! More!” The goal is to get rid of withdrawal symptoms. That little bit of a high that many patients describe for several days after a dose increase always goes away. If that’s the feeling you are expecting, it’s not going to happen, no matter how high the dose. This is because tolerance to the euphoria of methadone develops quickly.

      I suspect you will be proven to be correct, and the levels will confirm what you are feeling. Please write back to let us know.

      Reply

    • My recovery, and as I see it anyone with a working system, has to be based on more than just methadone. I’m in a similiar situation, I feel I may need an increase they got trough and peak done my trough is .45 my peak like .88, i get fatigued too early in the day, never used to be this way it has come upon me recently. However if I am going to stay clean it can not solely depend on me getting an increase. You have doomed yourself before even sitting down with the doc, as said above it could be other facts, vitamin deficiency or something. Don’t doubt yourself like this. Think of those days you could only get like on bag, one oxy, one perk w.e you made it thru that day. Some of those days you prob did a lot. You made it thru that day you wrote that. That day could have been a lot better too, if you didn’t run your mind on a marathon. I hope your making it, I hope you got an increase but if not keep on keepin on bro. You can do this. You’ve been doin it all along, just haven’t seen it. You’ve conditioned yourself to doubt yourself. Don’t.

      Reply

  9. Posted by Jennifer on September 25, 2011 at 8:18 pm

    Hello, my name is Jenn. I currently am in a MMT program and have taken 3 peak and trough test. The first one was taken when I was at 80mg, trough level .065 and peak .232 so i was allowed to increase. I was still having severe withdrawal symptoms when I would return in the mornings for my next dose and had another p & t test done at 160mg. The values were .161 and peak of .411 so with the symptoms that I was still having the doctor allowed me to increase rather rapidly. I am now at 260mg, I do feel much better, but I know that I am nowhere close to being overmedicated and still experience feelings of anxiety and insomnia with pain in my hips and lower back every morning. I get nausea every morning and am visibly shaky and gooseflesh all over. I am terrified of increasing anymore as I never expected to need such a high dose of methadone. Then again, I don’t want to cheat myself of ever feeling stable. I just took another p & t test last week and are anxiously awaiting the results, but now I am getting questioned and “blamed” of manipulating the test results so I can increase my dose. I know that I haven’t done anything to manipulate the test and I haven’t had an illicit UDS either in the 6 months that I have been a patient. I’m just getting frustrated and discouraged at this point because I feel like the doctor is not looking at me as a person, only as some numbers on a piece of paper. I have done everything they have asked me to do. I just feel like I may never be stable. Has anyone experienced anything similar to this?

    Reply

    • Like I’ve said before, the peak and trough are only part of what helps a doctor decide about the right dose, but I suspect you’re a fast metabolizer. Please write back and let us know if you go to a split dose.

      Reply

      • Posted by Jennifer on September 26, 2011 at 12:13 pm

        so i got the p & t results back and the values were t- 654ng/ml and p- 967ng/ml so now I’m being decreased 10 mg and considered toxic regardless of the symptoms that I am still having. I know from the research I’ve done on the p & t test that if the peak isn’t twice the trough that there is something else going on. I guess none of this matters now because I have been completely shut down and there will be no more looking into increasing or decreasing unless I want to detox off the program. I will not be considered for split dosing either. The doctor says there is no significance to split dosing. I am supposed to have a one-on-one with the doctor tomorrow with my counselor to hopefully get some of my questions answered. It doesn’t matter to me if I’m increased or decreased
        I just want to feel better and if there is something else going on like I’m metabolizing fast or whatever I would like to know that too. I know that a majority of MMT patients are not interested in knowing the how and why of it, but this is my life. I feel like I’m automatically looked at as a manipulator and a liar and no matter what I say they will still only look at the numbers, and not listen to me. It’s very frustrating. I will keep you updated…..

      • Well, those numbers don’t suggest a fast metabolism.
        Now I would suspect something else is going on. Maybe a visit to your family doctor is in order, to look for non-methadone related causes for your symptoms.

  10. Posted by Nicole on September 26, 2011 at 4:23 pm

    I’ve been a patient at a methadone clinic in WI since March, so 6 months almost 7 now. My dose is 160mg and I’m still having some withdrawal symptoms, cravings, irritable, sleeping poorly at night. I actually have a part of the day where I get sleepy because of the methadone, that’s probably about 3hrs after I dose, I just feel like I NEED a nap, and sometimes I do nod off. Then I also feel like my dose is wore off at the end of the day, or after I wake up from a nap. Usually it feels like its really wearing down at around 6ish. I’m soooo sick of this and STILL not feeling good after almost 7 months at this place, I just wanna get this dose crap figured out so I feel better. I’ve been telling the nurses and my counselor all my symptoms and what not so they had me do a P&T test, so I did and when I got my results my counselor seemed almost shocked when she seen the numbers, and I was like WHAT?? WHATS WRONG?? lol ya know… I guess my P&T numbers turned out to be exactly the same, and she tried explaining it to me and I just dont understand. She asked me all these questions like, if I had thrown up the dose, took more methadone off the street the day before and some others I forget. But I’m like NOO!!! Cuz I pay out of pocket to go to this play plus I drive 40miles both ways to get there, WHY would I waste all my money just to throw up the dose.. PLUS I’m trying to get better here, not do what I was doing before, it’s crazy and I still dont really get how my P&T came out like that, and I KNOW that I didnt do anything different or anything I wasnt supposed to do. Sooo they decided to give me another P&T test but this time I had to stay at the clinic for the 3hrs. So I’m now waiting to see the results, I should get them wed. or thurs., hopefully I can get this worked out and get on the right dose.
    Does anybody know what that would mean if my P&T came back the same levels???

    Reply

    • I would suspect lab error on the first one, or else you level really doesn’t fluctuate much at all. Let us know what happens please.

      Reply

      • Posted by Nicole on September 28, 2011 at 3:05 pm

        Well I found out the lab results to my 2nd P&T test, Trough-.4 and Peak-.7 …. So I’m not sure myself exactly what that means, if it’s normal or not, and the nurse at my clinic didnt really say much of anything except for “oh yeah, its ok, its in the “normal” range, and everybody is different”, that doesnt really tell me much of anything at all???? So what happened is I got my dose increased AGAIN to 170mg. Good thing I have an appt. to see my counselor 2morrow, maybe she can clarify some things for me, I still believe that I need a split dose, just taking in consideration how my dose makes me feel a few hrs after taking it and then later in the evening until the next morning till I dose again.
        Is there anything anybody on here can think of with the P&T numbers and symptoms of getting drowsy(like I just NEED to nap, and sometimes I do nod off) about 3 – 4 hrs after dosing, not sleeping well, and I also had a using dream the other night (been a LOOONG time since I’ve had one of those), cravings, VERY heavy heavy sweating while I’m at work (and later at night sometimes) which is 6pm-9pm (I dose at 9am), but the sweating might also be a side effect of the methadone, irritable, my nurse said my pupils were huge today lol, and then I just feel like the dose wore off at the end of the day and feel like thats why I’m feeling all these symptoms yet….
        I forgot to mention I also have hypothyroidism, I dunno if that has an effect on anything or not???

      • Untreated disorders causing your thyroid to be underactive or overactive can cause you to feel bad.
        Have you seen a primary care doctor to rule out any other medical issue that may be going on? Some patients tend to assume that if they feel badly, it’s related to their dose, and overlook other medical problems.
        I’m a little worried about your dose increase if you’re already sleepy during the methadone peak. Have you specifically told your doctor about this? Of course, don’t drive or operate machinery while drowsy.

        You can have craving and drug dreams even on an adequate methadone dose. Are you also getting treatment for the emotional, psychological aspects of addiction?

  11. Posted by Nicole on September 30, 2011 at 3:23 pm

    I’ve had the thyroid disorder since I was young, I wanna say around 13 I believe. (I’m 24 now) And yes I know that me having the disorder can cause NUMEROUS of things in my body to be messed up, it’s just hard to catch or determine because even though my thyroid blood levels look “normal” something from it can still be off in some way or another, and you can still have tons of symptoms too, kind of like the methadone eh? lol No I have not talked to my primary doctor about whats going on with my dose, but I am gonna be seeing the doctor at the clinic in about a week to discuss my symptoms/problems, sooo hopefully he can help me, maybe give me a split dose, but then I’m not even really sure exactly how that works either…
    And to answer your question about getting treatment for the emotional/psychological aspects of addiction.. Umm.. Well, kind of but not really I guess, I see the counselor at the clinic like once a week or so but it doesnt really help anything, always seems like we start talking about my using and then we slowly start talking about someting else always, and I dont get to meetings, I live in a small town that only has a few AA and there all late at night and thats when I work so it doesnt really work out.

    Reply

  12. I requested a P&T for about a year at my clinic. They tried two times in this year to give me a P&T but both times were unable to get blood. I was never a IV user, but my veins are deep and small. They stuck me 11 times firts time and 9 times the second attempt. Then about 6 months after just giving up I get flagged my counselor said for a mandatory/randomly picked P&T. They also had me to do a EKG and a physical all at the same time and were treating me oddly so I felt like someone or something had been said or happened to make them all of a sudden act like this. I am a 48 year old woman who has finally found something that works for me to stay off drugs so I get very afraid and threatened when all of a sudden I feel targeted because it does not matter who you are at the clinic I go to the nurses make comments and are always trying to catch somebody in diverting their medication. I had a client recently tell me the reason they are hesitant to give increases is due to diversion etc.. I am at a dose of 160mg. So for three days I went to the clinic and had to dose at 6:30 am in front of the nurse and on the third day is when they did the trough at 6:30 am then they dosed me and I did the Peak 4 hours after dosing and Well anyway after 6 sticks for the Trough and 4 for the peak and some rude comments from the nurses they were able to do the “mandatory/randomly picked P&T” Well in between waiting for the results my fear and insulted esteem overtook me as now I was scared they were trying to find a way to decrease me I called another clinic in town and switched over. My trough was 236 and my peak was 881. I had told the new doctor the results when he admitted me so he gave me a 5mg increase and told me he woukd give me 5mg every three or four days for me to tell my counselor. That day I drove back over to the old clinic to get my P&T results just in case they failed to send it over. Well after the next week when I ask for another increase it got denied as he wanted a Peak and Trough, like he forgot I had one already and my counselor said he had failed to attach it to the request. My natural or unnatural assumption was the old clinic has somehow stopped me from getting an increase by something they said and I still kind of believe this as when he resubmitted it with the P&T the next week I get there and it is not denied but it is not signed either. When that doc admitted me with the results I quoted which were the same as the documented results he said that was showing me as a fast metabolizer thats why I got the 5mg right then and he told me to tell my counselor every three or four days. I only go to clinic once a week so no way to do tell my counselor but once a week, but nonetheless my point is he thought then I needed an increase and now he has the papers showing my results which are the same I reported. Is it fair for me to think they are upset with me or think I am up to no good etc…I mean the results do show me a fast metabolizer right? They monitor you to make sure you take your doses for three days made me stay in a chair for half hour after each days dose etc.. What’s up? And why does have to be so fearful to be a MMT patient. I finally found a freedom from illicit drugs and I feel more opressed then I did visiting the dopeman daily. I have just left it alone now for a few weeks because I am afraid because I am new at this clinic he will take my take homes etc… make me come everyday monitoring for my increases which it is winter and I live 40 miles away on a mountain and it could and would be a transportation issue. PLUS even though I have not been stabilized I have honored all the rules to maintain my takehomes etc. Been very compliant, go to groups, go to meetings etc… help!!!

    Reply

    • Hello Tonya,
      I’m sorry you feel your clinic is mistreating you.
      Many times when I fuss over a patient – ask for levels, want observe for up to three hours, repeat EKG – it’s not because I think the patient is doing anything wrong. It’s because I want to make sure I’m not doing anything wrong. At higher doses, it is a good idea to observe a patient at their peak, to watch for sedation. I do repeat EKGs more frequently at doses over 120mg, only because I want to make sure the methadone isn’t putting the patient at risk for a heart rhythm problem. I might suggest not taking the safety measures personally.

      However, rude comments are not acceptable. Your clinic has a grievance process, and you should take advantage of it. It’s sad that some personnel feel like they can treat patients on methadone any differently than patients getting other types of healthcare. Personnel should always be professional and polite. When they are not, clinic supervisors need to know this.

      As for the doctor…I suspect he forgot you had levels. It happens. I’ve done similar myself, then feel foolish when I remember I’ve already talked to someone about the given issue.

      Your P & T do suggest fast metabolism. In such a case, I usually like to consider split dosing. That way, you don’t have to increase the dose to get a more stable blood level. Your new clinic may want to get to know you better before they decide if that’s safe. I’d suggest trying to form a relationship with your new counselor so she/he can see how well youa re doing. You’ve been stable for years, but your new clinic just hasn’t had time to get to know you.

      Reply

  13. I did file a grievance and the director has rescheduled three meetings he set up with me the latest one he has failed to call me back and reschedule. I am just going to leave it all alone because it is such a negative focys. I do tho think of all the clients left behind to the victimization of these two nurses, but I tried and I have only stayed in a victim mode myself by keeping it going. I have had to worry since the day I was admitted that my QTC’s were a possible problem for me too etc… I do not want to lose MMT for in almost 30 years of a little sobriety here and there nothing works very long. MMT has been a life saver for me. As far as all the test being preformed I get fearful that the doctor will want to protect themselves against me when in fact if I lose MMT I know what is in store for me, the dopeman. I personally think Mrthadone for me even if not totally stable etc…is the better alternative here. I am 48 years old and Dope is going to be the death of me. I just know it, but thats not enough for me when I am left to my own devices. I beg to let me remain on Methadone for it’s the only hope I have ever had. In saying that I must ask that could a doctor not take into consideration this client has done pretty well on MMT and if this client has/had high QTC’s that a contract be written up relieving a doctor of any liability/liabilities if the doctor could and would keep this patient on MMT.
    Upon admission 2 years ago I had a QTC reading of 540 for almost two years I stayed in fear as the kept talking about needing to do a repeat one but I kept falling thru the cracks, under the radar whatever until the repeat one was done a month ago at the old clinic was the reading was 454 and is 454 a reason to worry? I had heard that under 500 was acceptable but of course I am in fear that somewhere down the libne this will become an issue as when I was admitted the nurse had said that I might not be able to remain on Methadone with high QTC’s.

    Reply

    • A QTc of 540?
      Yikes. I would not have wanted to continue the methadone for fear of a fatal heart rhythm.
      For whatever reason, your QT has improved, and that’s good.

      The doctor/nurses are not picking on you by being worried about the QT interval. They are doing their job. I’m putting myself in your doc’s shoes. If I allowed a patient to stay on methadone with a terribly high QT and they died, I would feel awful. Of course in this country there’s the liability issue, but it is emotionally devastating to feel like you should have done something different with a patient, but didn’t. It’s upsetting for the nurses and counselors too, not to mention your loved ones.

      Having said that, any time we prescribe a medication, it’s a matter of balancing risks and benefits. In such a case, I’d ask myself what are the options? Is there a chance that buprenorphine would work? Have you tried prolonged inpatient residential treatment? How about a therapeutic community? All of these methods work for some patients. Methadone’s a good treatment, but it’s not the only way to recovery.
      If there are no good options (you’ve tried these other methods in the past & they didn’t work) and the patient fully understands the risks of maintaining on methadone, it’s still possible that methadone is the best answer.
      Your doctor may feel more at ease if you get the opinion of a cardiologist, to get a second opinion on exactly how risky methadone is for you.

      Reply

      • I have been in several inpatient treatment facilities the longest being 180 days to half way housing to AA/NA step work etc….I did Suboxone before anyone knew about it. Well mainstream persons. I went into detox early 2000 might have been 2001 or 2003 not sure, but my mother paid $1390.00 to get a script at a pharmacy drove it to the detox in Daytona Beach Florida where I had been admitted and they gave it to me. They were going to discharge me because they said I was too sick for their care. I got the same BS from a detox this last time I went. I then entered into a court ordered residential facility. I relapsed because I left went to jail for five days because I left the Court Order went back stayed on suboxone a couple more months then went off that by a taper stayed in treatment got out made it 7 months got a kidney stone which I often get, back on the pills for another 3 years to moving to NC and going to detox in NC where I once again was drove to the hospital daily for IV etc… Cannot take clonodine blood pressure bottoms out for 11 days stayed there where every day they tried to talk me into Methadone Treatment I know everybody has their story and I try not to make mine any worse than the next person, but I get sick, terribly sick. I don’t get better in 5 to 10 days like most people I know. I get taken from detox to hospitals because I am so sick. You would think that alone would be enough for me and I think it is every time then….it happens. I fail. Well two years ago after being in a detox like I said 11 days and being so sick for another month or so after I got out I just said the heck with it and try to once again take just enough to let me function. Well we know where that got me so in the back of my mind I never forgot this nurse at detox telling me that I should consider MMT so I did and here I am. But everyday scared something is going to take it all away. Death is a better choice than returning to drugs. I have gained so much in these two years if I fail again after proving to my family how well I have done for these two years I will no doubt be out of the family again and that is too hard to handle at 48 not like when I was 20 or even 30 and I could substitute with friends etc…Another relapse looks like the end to me. When I first realized drugs to be a problem was before recovery was acceptable etc…. The first time I was put inpatient was on an eating disorder floor at a hospital because there was no drug treatment facilities in the area I lived in the NC Mountains. They kept me there and on the eating disorder treatment plan too but a therapist came in and saw me individually too. I did not have any eating disorder so this was really odd to have to participate in especially being sooooo sick and unable to even sit up for the groups I just stayed in non compliance with their counselors and/or groups after three or so weeks they sent me out of there into Broughton which is our State Mental Hospital, boy was that a trip. I was a drug addict not crazy, but must not have had insurance etc…Because I am sure if I did they could have done something a little better suited for me. I have been diagnosed with mental disorders but this was all after suicide attempts because I was tired of being the DRUG ADDICT etc… My family mostly my matriarch mother totally kicks me to the curb if I am using no questions asked. Like I said my road ahead looks real bleak if I relapse anymore. And…Methadone keeps me from wanting to use. Thank God.

  14. Oh and split dosing really makes me feel terrible more hours of the day. I gave it a three month trial and atleast now I have until midnight or so no withdrawals etc… Split dosing I felt yucky throughout the entire day.

    Reply

  15. Posted by todywife on November 21, 2011 at 6:00 pm

    I went to a mmt clinic for a year and i was at 140mg. Had a peak n trough at 100mg n said i could go up. i felt great!!! i came back to the same clinic n they made me do a peak n trough at 95mg b/c my counselor said she observed me nodding in group. (it had nothing to do with me taking care of 3 children, 2 disabled in-laws, a part-time job, aa/na, group, etc.) my results showed i was 553 n somewhere around 800. basically that i was to high!! i explain that i feel sick around 3-4 pm after dosing around 8 am daily. i get aches, pains, gi problems, shakes, etc. CAN YOU PLEASE TELL ME WHAT IS GOING ON???? i swear i am dope sick yet i can’t get any help. please write me back.

    Reply

    • Have you talked to the doctor at your clinic? That’s where I recommend you start. I’m confused about why you had a peak and trough at 95mg and was told you were too high, and now are on 140mg.

      Reply

    • Posted by ashleigh fuller on March 5, 2014 at 12:35 pm

      Maybe your peak is high…but then after that you metabolize the methadone at a ridiculous rate.
      Discuss split dosing with your doctor. That way you MAY not need to go up, but you’d have get half in the morning and half 12 hrs later…that should keep you from going into withdrawals for the full 24 hr period.
      Keep in mind not all doctors are advocates of split dosing and it is most ccommonly used in pregnant women in methadone maintenance treatment. However, they do use it in other situations when the doctor feels it is necessary.
      Keep us updated

      Reply

  16. Posted by todywife on November 29, 2011 at 7:42 pm

    There are 2 separate occasions. The 1st time I went to the clinic I started in Mar 2010 and left Feb 2011. Thats the time I was at 140mg. I came back to the same clinic Sept 2011 and am currently there. I spoke w the p.a. and told him I still felt withdrawal so he bumped me up to 100mg. I told the p.a. that I was comfortable at 140mg and I guess I just assumed I could go back to that dose. Should I just continue to tell the p.a. that I am uncomfortable or should I do another peak n trough? I just want to feel better.

    Reply

    • I’d recommend you keep talking to the physician assistant and/or doctor at your clinic about how you feel. If they just increased you to 100mg, give that at least 5 days and if you still feel withdrawal, let them know. I tell patients try not to get too wrapped up in what the number is – just tell me how you feel on this dose. You may need 140mg, maybe not. Probably it’s too early to tell. If you aren’t sure if your symptoms are withdrawal, let the P.A. know that too, and he/she may then see the need for a trough level, and maybe a peak.
      Just keep talking to the providers at your clinic.

      Reply

      • Posted by todywife on December 17, 2011 at 8:20 pm

        I got up to 110mg and there was a note saying I couldn’t go up til I saw the p.a. I explained to him how I felt like straight crap. We went over mental health, if being dope sick is in my head, if I’ve seen my dr. for my physical health, if I’m burning the candle at both ends, etc. All of it is no…I just feel sick. So I can go up to 125mg (5mg a week) and if i still don’t feel good the I have to do another peak n trough. The p.a. checked me for withdrawal and I had a score of 14 out of maybe 30? So I’m in withdrawal, but treated like a problem more than a patient wanting help. What can I do to show the clinic that I am sick!!!

      • It sounds to me like your clinic is being careful, yet also listening to you. I think they’re doing a good job. After all, they gave you a window of 15mg more. My advice is keep talking to the doctor/physicians assistant. And don’t exaggerate – some people exaggerate out of fear they won’t get enough methadone, and they get unfairly labelled. I also advise patients not to get fixated on some number of milligrams. Just wait, and with each increase, see how you feel.

  17. Posted by todywife on December 17, 2011 at 8:23 pm

    P.s. my peak n trough was 553 and 812. The p.a. said my numbers show I am “more than fine” which to me was not at all correct!!

    Reply

  18. Posted by megan on January 18, 2012 at 3:35 pm

    hi. My name is megan and I’m 21 years old. I have a 17 month old daughter and I’ve been clean since october 17 2009. I’ve been on methadone since march 2010. I was on suboxone prior to being on methadone, it was working great but I switched to methadone because my doctors told me it was safer for my pregnancy. Within three months of being on the methadone I was up to 120mg. I kept going up in dose because I felt strong withdrawals I’m the morning. Body aches, nauseua, chills, hot and cold sweats, etc. I take my dose everyday at 830am. By am the sickness starts. I can barely function I can barely even make it to the clinic. Now while I was pregnant, I thought it was possible that what I was feeling was just morning sickness. But now over a year later, I’m still sick every morning. I’ve gone up and up in dose and I’m still sick, no matter what. Its really bad, it just seems unfair. I’m sober, I don’t drink or do any drugs anymore I’m a good person and good mother..and I’m stuck being sick every morning. Its unfair. I’ve tried to come off the methadone several months a go. I slowly detoxed, and then came off. I was off for two and a half months and in brutal withdrawals the whole time. I ended up going back on the methadone in order to function. Prior to being on methadone I never had a single cavity. Now in the past two tears I’ve gotten 32 cavities. I’ve needed four root canals, two extractions and the rest filled in. I never have craving, I don’t want to get high and I don’t want to be on methadone. Its the worst thing that’s happened to me.. I get constant bladder infections from the side effect of urine retention. Im doing a trough test next week so they can see if im actually sick every morning. I’m hoping that goes well. Please someone give me advice or encouragement. Thank you.

    Reply

    • There are so many variables that of course I can’t give you medical advice.
      However, I have some thoughts you may want to discuss with your own doctor.
      You say you did well on Suboxone. Is that an option now? You did taper off methadone at one point; have you talked with your doc about tapering again, only this time, switch back to the medication that you know has worked well? Maybe your body just doesn’t do as well with methadone. Also, when you say sick, do you mean nausea/vomitting kind of sick? If so, is there something else medically going on? Have you seen a medical doctor to make sure?
      The trough level won’t tell you if you’re sick; it just gives an indication as to whether the sickness is due to opioid withdrawal.
      If you have a decent trough level, I’d look for something else going on medically.
      Hope you get to the bottom of it soon!

      Reply

    • Posted by Sherri Brawn on September 15, 2012 at 3:57 pm

      Hi there. I have been on Methadone tx for over 6 years now, and my urine screen’s were always fine. I switched to a new treatment program closer to home in November 2011, and all of a sudden in March 2012 my weekly urine drug screens started coming back NEGATIVE for Methadone. It really upset me because at the time I was drinking my daily dose (50mg)every morning at the Pharmacy,and doing my urine’s supervised by a nurse. I had 5 out of 6 urine’s come back this way, and then my doctor put me up 5 mg, and it didnt’ happen again until July 2012, and I have been testing negative 90% of the time since. This almost got me kicked off of the program because I think they were accusing me of giving fasle urine sample’s. I even went so far as to volunteer urine sample’s fo an entire week to show them that I was not doing anything wrong, and they came back negative too. Finally last week they called me into a meeting to tell me that they are giving me a 3 month probationary period to increase my dosage up to at least 70mg/day, and then will do a peak/trough test to see if I am a “fast metabolizer” or not. They told me that this particular blood test is expensive, and has to be sent away to a lab in Toronto. My problem is that why are we made to feel like criminals, and almost lose our treatment when there is a test to prove what is going on with some patients who are in the same situation. I just pray to God that when this test is done it show’s that I do metabolize methadone more quickly than some other’s do, and I will not feel as if I am going insane!

      Reply

      • Posted by Sherri Brawn on September 15, 2012 at 4:06 pm

        Oh I forgot to mention that the urine drug screen’s I was doing always had to be done prior to getting my medication at the drug store. I wasn’t allowed to get my dose until I gave the urine, and came back with a note signed by the nurse who was with me.

      • I’ve seen this in a few patients. Your clinic needs to ask their lab to run your sample without a lower limit of detection. You are on a relatively low dose, and I suspect you are a fast metabolizer. I’m betting you do have methadone in your urine, but it’s below their cut off for a positive. I saw this in one patient who always drank a bunch of water, so her urine was somewhat dilute all the time. I’ve also seen it in one patient who was swallowing large amounts of baking soda to treat an upset stomach. The latter made his urine pH go way high, and I think that interfered somehow with excretion of methadone and methadone metabolites.
        I’m not sure why they want to raise your dose, unless you are feeling withdrawal or unless you are still using illicit opioids. They can do a test to see if you are a fast metabolizer, but what will that change? Peak and troughs are occasionally needed, but usually the methadone dose can be stabilized without them, on clinical grounds. They aren’t expensive, usually run around $15 for each blood level, or $30 for both peak and trough.
        Interesting situation. Please keep us posted on what happens.

    • Posted by ashleigh fuller on March 5, 2014 at 12:28 pm

      I’m surprised they don’t put you on a split dose. If they did that, the need to go up in dose may go away. And your teeth…I have had similar issues. Methadone can be acidic, but the main 2 reasons for tooth decay on methadone…
      1. You crave sweets. Oh my lord do you EVER.
      2. Methadone is notorious for drying your mouth out and lowering saliva production significantly.

      After taking your methadone, drink water and swish it around your mouth. Brush teeth an hr after you take methadone. Try to increase your water intake..and there are mouthwashes out there that help with dry mouth. Give em a shot.
      I’ve had weight issues and sweating issues on methadone personally. Was a size 3 pants at 105-110 lbs max..then pregnancy and methadone happened. Eek.

      I wish you luck dearie.

      Reply

  19. Posted by Ralph DeLorso Jr on June 19, 2012 at 11:17 am

    I/M On 100MG a Day Been on since 1995 always clean urines,I HAVE A SEVER SPINE INJURY AND REITERS SYNDROME BLOCK FUSION and now Im having diffulculty cleared with pysical yet Im in full withdraw in morning Ive told my councelor who wants to due a peak and trough but shes told me if they don,t show anything shell have me decreased auto mactically and lose my bottles THIS IS AN OUT RAGE THEY ARE NAZIS WITH MY MEDICINE THEY TREAT THIS STUFF LIKE PLUTONIUM , ITS A MEDICINE PERIOD IM FED UP WITH THERE TREATING ME AS A DONKEY REACHING FOR A CARROT TO MOVE ALONG,AND ALWAYS USING THREATS OF TAKING AWAY

    Reply

    • Wow. Can you talk to the doctor?

      Reply

    • Posted by Sherri Brawn on September 15, 2012 at 4:02 pm

      Don’t they understand that with any medication that is taken over a long period of time you build up a “tolerance” to it, and require an increase? If you were on Morphine, or Hydromorphone for example you would need an increase at some point because your body naturally builds a tolerance to something you have been taking so long. Good luck to you Ralph… :)

      Reply

      • One of the reasons why methadone works so well is that you do not develop a tolerance to the withdrawal-blocking effects of methadone. Some people stay on the same dose for years. However, tolerance does build to the anti-pain effect, as well as the euphoric effect, just like other opioids.

  20. I have been going to a MMT center. & my methadone level was .8 they said that i am buying it off the street but i have ask them at the clinic to cut my dose down because it was making me sick so could someone tell me if they have had a problem with the same thing i dont understand how my level is going up because i dont take anything besides what they give me at the clinic but the 60 mg i need this program and i would really appreciate anyone who could tell me if they know what could be causing this

    Reply

    • Posted by ashleigh fuller on March 5, 2014 at 12:20 pm

      Little man,
      I would get your liver checked..just in case. Sometimes methadone can affect your liver or past drug use could have done so…This can affect how the methadone is processed and such.
      Good luck!

      Reply

  21. Posted by April on February 7, 2013 at 11:20 am

    I am knew here I just figured someone here could answer a question for me. I need to know how toxic a .43mg/ml of methadone is? Here is the story. My 14 year old son past away the other day and they found .43mg/ml of methadone in his blood. He was found with the pill bottle. The pill bottle had 10mg pills in it. So I was wondering how many pills he took to get a .43 in his system. We already know it was an accidental overdose. He was having issues with his bipolar meds and we assumed he took the methadone to calm himself not knowing what the turn out would be. When they did the blood test they of course just looked for the methadone and didnt do any research on if his bipolar meds could of been the issue which leaves me with questions. So again if anyone could tell me if .43 mg/ml is high enough to kill my son and how many 10 mg pills that would be it would be highly appreciated for this mothers broken heart. Thanks

    Reply

    • My heart ached when I read your comment. I can’t imagine the pain of losing your 14 year old, and I pray for your healing.
      I’m assuming the methadone wasn’t prescribed for him, and that he had not been taking it for any length of time. If he had no tolerance to opioids, yes, this could well be a fatal blood level. But the science isn’t precise enough to use a blood level to determine how many pills he took.

      A blood level of .43 would not be a fatal blood level for someone on methadone maintenance. In fact, when assessing patients for adequate dosing, I prefer their trough blood level, the lowest level the patient has all day, to be in the .200 to .400 range. So of course their peak would be higher than that.
      With methadone in specific and opioids in general, tolerance determines what’s a fatal blood level and what’s not. For a person who hasn’t taken any opioid, ever, even a dose of 30mg of methadone could be fatal, while I have patients on as much as 150mg who may report feeling withdrawal.
      That’s why pathologists can’t (or shouldn’t) make a determination that methadone was the cause of death without knowing more about the circumstances of the patient. They would need to know how long the patient had been on methadone and other clinical details. But if this wasn’t your son’s medication, and he had not taken methadone before, it could well be the cause of death.

      My sympathies. Your loss underlines the importance of responsible opioid prescribing by physicians.

      Reply

      • Posted by April on February 8, 2013 at 9:36 am

        Thank you for your response. The medicine wasn’t prescribed to him. The reason I was wondering the count is to know if it was possible that if it was the bipolar meds that he was on could of been the cause of death. He had only been on bipolar meds for about 2 month, we had just refilled his prescription of Depokate, Seroquel and Zoloft a week prior to his death and the night before he started to get bad hand tremors. My son had experimented with different drugs in the past but had been clean since the diagnosis of bipolar so in my head he only took the methodone to try and calm his nerves. But of course with the methadone not being prescribed to him they didn’t look at the blood work for the levels of his bipolar meds. I know I have so many questions and there will probably never be an answer so I want to thank you again for your response and your time.
        To everyone else out there, throw away any old unused medicine and keep your current medicines locked up, cause you never know who might take it. I would hate for anyone else to go through this pain because of a pill.

  22. April

    My sympathies for you . I can’t even imagine what you must be dealing with at this time and how the actions of one person can cause such harm for so many. It is sad to say but so many addicts are born out of trying to self medicate and maybe your son dealing with bi-polar had or was doing such, but nonetheless there is nothing that can make any sense out of this terrible tragedy. I did take a moment to pray for the healing of you and your family. I hope that you can find all the answers you need to make any sense of the methadone versus the bi-polar medications as you might be on to something there also.. Best of luck

    Reply

    • Posted by ashleigh fuller on March 5, 2014 at 12:18 pm

      April,
      When not monitored, a mixture of antidepressants and methadone CAN be fatal. So while the methadone in it and of itself may or may not be the reason…The combination of drugs is the most likely culprit. As mentioned before by another poster…if your son didn’t have a tolerance, it very well could have ended his life prematurely.
      I have a 6.5 yr old and a 2 yr old…my oldest is the only one I can discuss this with right now, but I am honest with him about my past and what it has done to me. He sees the face I make when I drink my methadone and I’ve told him before that a mere drop could kill him. He has never been tempted to even go near the lock box my dose is in. He knows I get violently I’ll without it, but I also say the medicine is made special for me, so it would kill anybody else who takes it. To an extent it is true..As far as the dose amount goes.
      On the flip side, I have a 15 yr old brother whose main thing is pot BUT takes anything he can get his hands on. I warned our mom that he may be saying what she wants to hear to get out of treatment faster…and he proved I was right shortly thereafter. I know all of the tricks, so it is impossible for him to run game on me. I love him and want to save him, but we all know addicts only change when THEY want to. Plus he still won’t accept that he is an addict. :/
      I fear he’ll get stabbed or murdered…or take something and it’ll kill him…Or sell something to another kid and that kid will die.
      I fear these things every day.
      He feels because he didn’t do heroin like I did that he isn’t doing anything too wrong.
      I want to save him before he makes a fatal mistake, but…he was a thick wall up.

      I’m so very sorry your beloved son passed away, april. These stories hurt my heart and make me afraid for my kids and family in general.
      We all need to focus on saving our youth…so many preventable and unnecessary deaths.
      And when I say preventable, I’m not in any way insinuating that you could have known or prevented it, sweetie. If our kids want to do something or hide something, they will…regardless of how hard we try. I pray you aren’t in any way blaming yourself because being a terrible addict myself…I can tell you it wasn’t you at all nor could you have changed his mind.
      I know some of these posts I’m replying tto are old, but I hope you all see them…especially you, april.
      I send you my love and compassion. <3

      Reply

      • Posted by April on March 6, 2014 at 5:50 am

        Thank you so much for compassion. It been just a little over a year since I lost my son and there isn’t a moment that goes by that there isn’t regrets.
        I don’t know anything about methadone. I do know that the pills my son got a hold of were 10mg pills and they were prescribe to my grandmother for pain. She had only taken them a couple of times. The pills got left at my house on one of her visits about 5 years prior. We had put them away in a drawer to get them back to her and she didn’t want them back. After that the pills had just been forgotten about until that horrible morning when my son just didn’t wake up.
        I read what you said about your brother and I hope he can find himself and realize the road he is going down is dangerous and very destructive for everyone around him.
        I pray for you and your family.
        Sorry that this was a little drawn out been one of those days
        Thank you Ashleigh

  23. Posted by Jennifer R on April 22, 2013 at 12:21 am

    My name is Jenny. I have been in MMT for seven months now. I was an active addict for eight years, approximately, and for the most part am doing very well. First and foremost, I’d like to thank you for replying faithfully to these posts, as most addicts, including myself, have a hard time working past the fear of being grouped as liars, etc, and if they are serious about doing this correctly, are scared of bringing anything up that could possibly leave room for suspicion, e.g., asking for an increase in doses. I am currently on 95mg/day, taken around 6:30am. I was fine on this for the last 5/6 months. My question is, how normal is it to need to increase dose after an established dose has been given for seven months. My sleeping patters have changed, and in the morning I am in the early anxious stages of withdrawal. Feeling like a can’t sit down, sensitive skin. Some days a runny nose. I have not relapsed during MMT, something I am very proud of, and the staff is always exceptional with me, commending my progress, etc. I am concerned about bringing this up. What I have been trying to find out is just how common increasing a dose is in patients that were, at one point, stable? I have thought of ways to hypothetically bring up the subject, but for the most part, am still on the search for a simple answer. Thank you for your time. What you’re doing is extremely helpful.

    Reply

    • You need to talk to your program’s doctor. From what you are describing, it sounds like withdrawal. You shouldn’t be ashamed of asking for a higher dose; we know patients do better if they get up to a dose that gets rid of all the withdrawal symptoms. I still think the best way is to be straightforward, and say hey I think I need a bit higher dose and here’s why, then tell him/her your symptoms.

      Reply

  24. Posted by Jenny R on April 23, 2013 at 1:30 am

    I will make a point to talk with my provider. But, out of curiosity, is it normal for doses to lose effectiveness over time in some patients? Is this a situation you have seen with your clients, or could it be manifesting due to differences in my lifestyle? Like I mentioned, I will make a point to talk to my counselor and nurse about this. But I would like to know if it’s uncommon or not. Thank your for responding. I really appreciate it.

    Reply

    • Patients don’t usually develop a tolerance to the blocking dose of methadone. But things change, like activity levels, body weight, medications, stress, etc.

      Reply

      • Posted by ashleigh fuller on March 5, 2014 at 12:02 pm

        Agreed.
        Now I know every person’s body is different, but let me ask you if this is….reasonable…

        A very tall and lanky lady in her early 30s (which indicates a high metabolism, yes) who isn’t pregnant nor has she been for at least 3 or 4 years…on a dose of 400 some mg.
        Does that seem.. Excessive or is that not that unheard of?

    • Posted by ashleigh fuller on March 5, 2014 at 12:05 pm

      Jenny,
      Have you started a new job in the last month or two that has you moving more or doing more physical labor? Of so, this may have revved up your metabolism and could be the culprit.
      Best of luck!

      -A fellow MMT’r

      Reply

  25. Posted by jordan on February 14, 2014 at 12:46 am

    been n treatment for 9 years currently on 160mg been clean since treatment no dirty urine screens we recently got a new doc he is making everyone over 120mg take peak n trough test seen this post b4 I took test but did not think much bout it well now im being told that he is going to start decreasing me to 120mg note I have never even spoke to him and he is going to change my dose I would like to show them some info on active and inactive isomers that they will take serious but don’t know where to find it all the medical terminology is hard to follow I haven’t seen the results yet for the p&t so I don’t know the numbers I hope u can help thanks

    Reply

    • What you are describing isn’t accepted medical practice. Peak and trough blood levels can help decide if a patient would do better with split dosing, but wouldn’t have value at this point for you if your doctor’s not considering split dosing. if you feel fine on 160mg there’s no reason for blood levels. If he’s concerned you are drowsy because you’re on too much methadone, I’d recommend he ask you to see him three hours after dosing. He can assess your level of alertness, and if you are sleepy or sluggish, reduce your methadone dose. If you are awake, perky, and living life, no reason to change the dose.
      Sounds like your doctor thinks blood levels can tell him more than the clinical picture. This is rarely the case.

      Reply

    • Posted by ashleigh fuller on March 5, 2014 at 11:59 am

      Is there another clinic you can try within reasonable driving distance?
      The doctors at my clinic are very understanding..all within reason.
      I do know there are some doctors out there who look purely at numbers and assume the patient is lying to “get high” or feel somewhat euphoric. I am sorry if that is the case at your clinic. Is there more than 1 doctor there you can speak to?

      Reply

  26. Jordan
    there is a forum that can supply you info on the active inactive isomer details for your clinic at
    atwatchdog.lefora.com

    Reply

  27. Posted by ashleigh fuller on March 5, 2014 at 11:56 am

    I have been successfully attending the same clinic for seven years. This is my third pregnancy..and this one was an absolute oops. Think antibiotics and birth control.

    Had blood work done at 9.5 weeks gestation, and I got my results today; trough was .2 and peak was .41.
    Not only was my trough low, but my peak to trough ratio is 2 to 1… yikes. I was doing my best to
    A. Avoid going up in dose
    B. Just do a split because it works well when I am pregnant.
    Except I’ve had to go up since then and will continue to a little more. The blood work was carried out because I was requesting a split dose…evidence in my favor. I’ve know for a bit that my body has been burning through the methadone quickly…withdrawal symptoms. :(
    Thing is, I don’t remember my other kiddos sucking down this much this quick. Then again, I was on a much lower dose at the start of this one than I was in previous pregnancies.

    So in specific situations, I can see blood work helping…especially when it is showing LOW levels. However, when revealing high levels I see how it could be misleading.. measuring both active and inactive isomers.
    I’m happy to say they take so much more into consideration at my clinic that JUST the blood work.

    Reply

  28. Posted by Robert on July 15, 2014 at 3:19 am

    I started mmt today at my local clinic here in dothan al. I was reluctant to go because several people told me that they refuse to dose high enough to be successful, but I decided to start any way because I figured it beat what I have been doing just to stay “well”. The first thing the dr tells me is that they don’t dose higher than 80mg and that I would have to have a p&t when I get to 80mg. I was floored when I heard that. I have been taking 150mg a day just to maintain with out getting sick and now I reached out for help just to find out I’ll have to keep scoring methadone on the streets. All I want is to have some quality of life and be a productive member of society but when I finally try to get the help I need I feel like I’ve pretty much been shot down. I wish that Dr could read this blog. The sad thing is I think they are risking patients’ successful treatment just so they can make more $. They charge a flat rate of $13 a day whether someone doses at 25mg or 200mg and it seems to me that they decided it made more “cents” to keep doses low therefore keeping their methadone costs low yet still treating the same amount of patients at a flat rate. I don’t think they really care if the patient’s treatment is successful because they will keep coming regardless due to the fact it’s the only clinic within an hour and a half drive and should the patient stop coming the demand for opiods will have another person enrolling right behind them. Sorry for venting on your blog I am just very worried about my future at the moment. It does it look as bright now as it did this morning. I kind of got the wind taken out of my sails when the doctor told me that he caps at 80 milligrams

    Reply

    • Well that’s just weird.
      You can a documant contaning the best practices for doctors at opioid treatment programs. You can order this information to be mailed to you, OR download it for free, at http://store.samhsa.gov/home
      Please order two copies – one for yourself and one for your doctor, who appears to desperately need information about optimal dosing. Ask him to go to pages 70 and 71 so he can better educate himself about proper dosing. The poor thing needs information.

      Reply

  29. Posted by Robert on July 17, 2014 at 11:55 am

    Yes I thought it was strange for him to say that also. Plus I am no Dr but I know you can’t treat every patient the same and that’s what is happening when he stops increases at 80mg. The counselors at the clinic also inform the patients that they won’t be dosed higher than 80mg. I have done mmt in south Carolina and Florida but this is the first time I had ever heard anything like that from a Dr or counselor. I was a little aggravated when I made my last post so I apologize for the rant. I was searching for info on p&t tests because I had never had one before and the understanding I got from the Dr was that he used the test to solely determine a patients treatment. I’m glad I stumbled acrossed your blog. Thank you for all of the info and I will get a copy of that document to my Dr and see if it makes a difference.

    Reply

  30. Posted by Rachel on July 31, 2014 at 5:41 pm

    Hi- I have been on a MMT program for about four months now. I normally get dosed around 5:30-6 a.m. and I am currently at 170mg. The issue is that around 6 p.m. I start going through extremely bad withdrawals. I am still so sick that I need to use other (illicit) drugs in order to make it through the night. I just want the methadone to block me from getting high for a full 24 hours like it’s supposed to! Since I can use again after 12 hours, wouldn’t you think that meant I was a fast metabolizer? The doctor stopped letting me increase my dose and had a peak and trough done, and the physician assistant read the results first and originally told me that I was definitely a fast metabolizer and that I probably need to be increased and should also consider a split dose. I think a split dose would be a life savor for me. But then the main doctor saw the results and he disagreed- he says I am not a fast metabolizer. My trough was .37 and my peak was .70. Doesn’t the fact that I can still use and that I am in complete withdrawal after 12 hours (huge pupils, stomach and back aches, eye watering, constant yawning, anxiousness) mean that I am metabolizing it too fast? I am having another peak and trough test done tomorrow because the physician assistant doesn’t think that my “peak” is actually at the normal 3 hour mark. So we are going to try taking my peak around 2 hours instead.

    I’m terrified that the results will come back the same as the first one and that I am never going to get better! I’m scared he won’t even let me increase my dose anymore because of the results of these tests.. I can’t believe that the doctor can even make these decisions without seeing me- the physician assistant could tell I was in withdrawl when I came back for my peak test the first time after 3 hours. So she believes me…

    Can you please let me know your thoughts? Do you think it sounds like I am a fast metabolizer? Do you think doing the second peak and trough- with the peak being done after 2 hours is a good idea? (about 1 to 2 hours later is when I feel the methadone the most, at 3 hours it already feels like it’s decreasing to me and I am starting to get sick.. I don’t know if that’s in my head though or what..)

    Reply

  31. Posted by Robert on September 3, 2014 at 1:34 pm

    I have now reached a dose of 75mg after weeks of 5mg increases. I’ve been white knuckleing it the entire time and have resorted to supplementing my dose. I just increased to 75 today and the Dr wrote an order for a p&t to be done if I request another increase. The nurse that dosed me this am recommended that I not risk a p&t because she has never seen anyone get increased. Only forced to decrease their dose. I have tried talking to the Dr but it’s pretty difficult considering they are rotated weekly and u can’t really build a Dr patient relationship with them. this has been extremely disappointing to me because I started going to the clinic in order to get my life together with the hopes that they can help me. Now it’s like I’m being told yes we could help you but we are not because they determine increases after 80 milligrams solely on a p&t. There is another clinic about 45 minutes away from where I live that could possibly be an option but I’m barely getting by financially driving 10 miles a day much less 40. All I want is to get stabilized and eventually detox completely but it seems the clinic I’m a patient at here in Houston county Alabama is giving people just enough to keep them coming back but not willing to give an amount that some patients actually need. They are also making $40 a pop on the p&t test for the ones not to scared to ask. I don’t know what to do I mean they can tell when I go in in the mornings when I have the sweats and nausea and my pupils are large plus a heart rate of almost 100 beats a minute that I am not doing well. All I want is a good night sleep and to be able to lead a productive life without fighting sickness everyday or doing illegal deals to get by. To my knowledge the clinic I am at is the only one in the area ran this way. I have talked to people from Birmingham, Montgomery, Bainbridge Ga, and Panama city fl and they’ve all looked at me like I was crazy when I told them how the clinic here does. Is there anyone i can contact about this?

    Reply

    • Sounds odd to me, and not in line with how methadone dose requests are usually managed. I’d recommend talking with your state methadone authority and ask if they can do some education programs for physicians at OTPs in your state. Or you can find out what company owns your program, and file a grievance. We’ve known for more than twenty years that it’s better to take patients to a dose that works, which is usually around 80-120mg
      but PLEASE don’t take illicit methadone because it will make you look like you are not in withdrawal, and only complicate the issue.

      Reply

  32. Posted by Alex Cruz on September 17, 2014 at 7:18 pm

    I’m on 147 mg and got a trough done and my counselor said that I have 670 mg of methadone in my blood how is that possible please help me

    Reply

  33. Posted by Robert on October 14, 2014 at 1:22 pm

    I confided in my counselor about the information I have read on p&t. I also told her what the nurse said to discourage me from getting one. I don’t believe the nurse had bad intentions I think she was just trying to save me from wasting my $. It has been weeks since i spoke about my concerns to my counselor and I had decided just to deal with the fact that the clinic I am a patient at did things a certain way and there wasn’t anything I could do about it so I never brought it up again. It is time for me to phase up and my counselor informed me that I had to see the Dr since I wasn’t on a stable dose ( keep in mind I only broached the subject once several weeks ago and only to my counselor ). Well the Dr came in this morning and basically treated me like some trouble making junky. I was talked down to and told that everything I read was wrong and that they used the p&t to determine dosing. I was also told if I didn’t agree with it I could go somewhere else. He refused to phase me up and basically talked to me like I was a piece of crap. I have never caused one problem, have not failed a drug test, and have not missed a day. I am 100% compliant with my treatment program but apparently since I voiced my concerns to my counselor once I am a trouble maker. I feel humiliated and I feel like this Dr totally abused his authority and the fact that there are no other local options mmt. I am not a disrespectful person but I really wanted to be this morning. However I didn’t talk back and I even asked him why I was being treated that way when I had done nothing but voice my concerns about some information I had read. His reply was if I didn’t like it I could seek treatment elsewhere. I am not an ignorant person nor am I some piece of trash. I am a well spoken educated young man that happens to have issues with addiction. I don’t deserve to be spoken to that way. In fact no one does. It makes me question how that man treats other people if he treats me like that just for asking a question. I’ve thought about writing a complaint but I found out that he is the one that would receive it and I don’t want to risk getting discharged. It’s a sad day when someone in the position that physician is in abuses their authority. I guess I’m just stuck where I’m at and it’s pointless to even say anything but this has really upset me. is there anyone i can contact that could actually or would actually do anything? Or will they be just like this doctor and since I’m a drug addict look at me and treat me like I am scum and will not take my concerns into consideration?I have never been treated that way before my life.

    Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 470 other followers

%d bloggers like this: