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Re: [METHADONIA ] a new rule?

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  • claude
    Sw, 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
    Message 1 of 1 , Oct 22, 2004
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      Sw,
      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.

      Claude
      NJ/Nama/cma
      claude@...

      -------Original Message-------

      From: DOLOPHINEA_CAFE@yahoogroups.com
      Date: 10/22/04 16:44:47
      To: DOLOPHINEA_CAFE@yahoogroups.com
      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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