METHADONE MAINTENANCE DOSE AND RATE OF "INDUCTION
A study by Brady and co-workers (J Addict Diseases, 24(3):2005) found that two weeks after admission "more than two-thirds of methadone clients nationally were receiving below 60 mg/day [of methadone] ." Reference is made to the long-standing knowledge - reaffirmed by a consensus statement of an NIH expert panel in 1997 - that maintenance doses below 60mg are suboptimal for the majority of patients.
A question not addressed by this study, which may invalidate the criticism of maintenance dose practices, is the appropriate and safe starting dose and rate of increase. It would not be unreasonable to have a starting dose of 30 mg, and to prescribe increases of no more than 5-10 mg twice weekly. With such policies the dose after two weeks might still be rising and permit no conclusions regarding what providers ultimately aim for and achieve with respect to "maintenance" levels. Furthermore, the only outcome measure reported here - retention - did not show any consistent dose effect: retention was lower in patients receiving 41-60 mg after two weeks than those receiving only 21-40, and patients who were getting over 80mg had the lowest retention rate of all. NOTE: The Province of Ontario's methadone guidelines should be kept in mind: START LOW, GO SLOW (to which one should add, "AIM HIGH").
posted by RGNewman, MD @ 10:19 AM
3 comments
3 Comments:
Our physician increases new admission doses only 5 - 10 mgs every 5-7 days. Our retention rate is fairly good for patients new to treatment. On the other hand, re-admitting patients who have been on methadone before, this is not quite fast enough. Usually they are using fairly heavily when they return and "know" what their maintenance dose should be. They do present in withdrawal and know how quickly they will feel better and stop using illicitly, but getting to that dose "quickly" is more of a challenge for our physician. He is new to this modality and is concerned about the safety of increasing more often thatn 5 days, which is about how long it takes for each increase to be fully effective.
i am a pharmacist involved with maintenance programs...most addicts usually need somewhere between 70-80-even 120mg per day to keep from relapsing due to withdrawal symptoms. once they are stable it is then possible to take them down by 5-10mg per week until the reach around 50mg per day for 3-4 days with no discomfort, then continue with smaller reductions
When on methadone program, and your take home dose is a certain mg. what are some side effects if you play around with your doses? like more for a few days and then less the next few days?
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