From: Chapter 8: Phases of Treatment: Stabilization, in Methadone Maintenance: A Counsellor's Guide to Treatment (© 2003).
Counsellors can play an important role in monitoring client progress in the dose stabilization process. However, to do so they must be familiar with clinical signs of over- and under-medication, as well as the side-effects of methadone (see Chapter 3).
Optimal Daily Dose
The optimal daily dose of methadone is one that is sufficient to keep the client free of withdrawal symptoms over the full 24-hour period between doses and minimize the signs of overmedication or side-effects (see Chapter 3 for the symptoms of acute opioid withdrawal). However, the client’s experience of withdrawal may be more subtle and subjective.
Counsellors should explore how the client is feeling throughout the day and whether she or he has observed any changes. The counsellor should be especially alert to potential withdrawal symptoms late in the 24-hour period when the serum methadone level is lowest.
Subjective symptoms of withdrawal can include drug craving, anxious feelings, depression, dysphoria, irritability, fatigue, insomnia, hot or cold flashes, aching muscles and/or joints, anorexia, nausea and restlessness (Brands & Brands, 1998; Leavitt et al., 2000). The presence of any of these symptoms may be an indication that optimal stabilization has not been achieved.
Potential Drug Interactions
The counsellor also needs to be alert to potential drug interactions. When used in combination with methadone, some other drugs (illicit or prescribed) can produce adverse reactions or alter the degree to which the methadone dose prevents the onset of opioid withdrawal. (See the summary of drug interactions in Chapter 3.)
Reports of opioid use by clients have often been viewed as indicating the client’s ambivalence to change and have resulted in reductions in methadone dose. In reality, such reports may be a strong indication that the methadone dose is inadequate. There are many clinical examples where increasing the dose under these circumstances has resulted in the discontinuation of illicit opioid use.
As a general rule, continued opioid use should be interpreted as an indication that the methadone dose may be inadequate unless there is good evidence that an optimal dose has been achieved. The physician may wish to test serum methadone levels (SMLs) as clients taking the same methadone dose can have very different SMLs because of individual differences in drug metabolism (Leavitt et al., 2000).
Phases of Treatment: Stabilization
Other online chapters from Methadone Maintenance: A Counsellor's Guide to Treatment: