What can be done about my  dose not holding me all day?

An adequate daily methadone dose will prevent withdrawal symptoms and drug craving for at least 24 hours. The simple fact is, however, that patients respond differently to methadone and there is no single best dose that works for everyone.

Some patients need higher doses of methadone to hold them throughout a day. This can be due to the amount and purity of street heroin the person was used to, a current physical ailment, or methadone interactions with prescription medicines or other drugs. Also, some patients are “fast metabolizers” – they digest the methadone more quickly – due to how their digestive tracts and livers function.

A blood test can be used to measure the amount of methadone in a patient’s system at various times. This is called a serum methadone level or SML test. When blood is tested just before taking the dose and 3-4 hours later, it helps indicate how fast the methadone is being metabolized. This test alone, however, rarely tells the whole story. An important measure is how the patient feels throughout the day: withdrawal sickness and drug craving coming at the same time each day are good indicators that a dose adjustment is needed.

Some patients in methadone maintenance treatment (MMT) are not prescribed sufficient daily methadone doses. When MMT for opioid addiction was developed during the mid-1960s, doses in the 80 mg/day to 120 mg/day range were recommended, with some persons requiring much more. Today, many clinics consider 100 mg/day as the very highest allowable dose, possibly because special permission was once required from state or federal authorities for higher dosing. Research has shown that there really is no upper limit as to what certain patients may require and find beneficial, with some needing as much as 200 to 300 mg/day, or even much more.

Another approach helpful for some patients is splitting the dose; for example, taking half early in the day and half in the evening. This allows them to have a steady serum level of methadone in their systems throughout the day, without an extremely low period that produces withdrawal or craving. Patients must be honest with clinic staff in describing problem symptoms and to work patiently with staff in arriving at a methadone dose and dosing schedule that is best.