Re: [METHADONIA ] a new rule?
your counselor is referring to a test called peak and
trough and it sometimes can be used as a tool but it should never be used in
denying or approving a patients request for a dose increase as it is not
100% reliable. The problem is that in this country they use methadone in
what is called a racemic mix and that means it consist of an active and
inactive portion to make up the complete dose so half of the dose is active
and half is inactive and only the active portion is effecting how a patient
feels but when they do these peak and trough test the results they get
cannot distinguish the difference between the 2 so when they read a graph it
can consist of the inactive component and give it the appearance that one's
level are good but in reality the blood serum levels could be very low and
other factors in the body can effect the levels.
Also what you stated about being on half of your present dose and always
being in a nod not being able to stay awake is quite common and it is called
a paradoxical effect as when a patient is underdosed he/she goes through
slight w/d and at night they never are able to achieve a deep or rem sleep
in which your body requires in order to get a restful nights sleep and
during the day one becomes tired due to lack of quality sleep and it makes
one appear to be over-medicated when the case is the opposite. So once a
person is brought up to a therapeutic dose the nodding goes away because the
patient is not going through early withdrawal and is getting a better
quality of sleep.
The federal regs states that after 9mos to a year you should be eligible for
6 t/hs a week now state regs can be stricter I'm not sure on the calif regs
but you can go to www.methadone.org and you can look up the info on who to
contact in calif that represents nama and they would have a better handle on
the state stuff. Now after the state regs the clinic can have rules that are
stricter than the state regs. So it is important whenever you speak to
someone at your clinic to ask them if the rules they speak about are from
the federal regs and if they say they are the clinic's rules ask for the
written set of rules and even if they say federal or state always ask for a
copy that they are going by. Keep me posted.
Date: 10/22/04 16:44:47
Subject: [METHADONIA ] a new rule?
I was recently told by my clinic counselor that if I want to raise my
dose beyond 150mg I would need to get a blood test done. Has anybody
else heard of such a rule or is this just something the doctor
connected with my clinic decided to enforce? I'm currently at 130mg
and I'm okay with it but I just happened to mention to my counselor
that I may eventually want to go up another 10 or 20mg.
When I was on maintenance back in 1990 I was drinking 65mg and had
a hard time staying awake all day. My present dose is exactly twice
that amount and it seems to have less of a sedative/opiate effect
than when I was on 65. Could it be that I was 40 then and I'm 53 now?
Could it be a difference in the type of methadone used by the
different clinics? I've heard so much talk about methadone this and
methadose that. Does anybody have the actual facts?
One more thing -- at my clinic (in Santa Cruz California) after
making it up to what they call Step 4 (getting 4 take-homes/week) we
have to wait a year before getting to the next step (whereas previous
steps are separated by 30 days). Are these rules & regs uniform or do
they vary from clinic to clinic or state to state?
Any answers/info would be appreciated. Thanks! -- sw
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