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How do Doctors Determine the Best Methadone Dosage?

By B. Chisholm
Updated May 17, 2024
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Methadone is a drug used to help addicts withdraw from heroin. The methadone dosage is determined according to the amount of heroin the addict was using previously. The drug is normally taken orally, either as liquid methadone or methadone tablets. Determination of the methadone dosage needs to be done carefully by the medical professional involved in the withdrawal process. The methadone dosage will change as the patient withdraws, becoming less over time.

Heroin is a highly addictive substance and an opioid related to morphine. Heroin is rapidly absorbed, providing an almost instant "rush," followed by a period of sedation. Tolerance develops after prolonged use, requiring ever-increasing amounts of heroin to achieve response. This tolerance explains why there is not a single methadone dosage used in everyone. Instead, it needs to be tailored according to the patient's heroin usage at the time of cessation.

Withdrawal from heroin is a difficult and often unsuccessful process and needs to be performed under medical supervision. Symptoms of withdrawal include sweating, anxiety, severe cramping, insomnia, nausea and vomiting, and diarrhea. Methadone is used to minimize these effects as it has the same effect as heroin but is slowly absorbed and longer acting. This allows for the rapid cycling of heroin—initial rush, come down, then need for more—to be controlled.

Depending on the amount of heroin used at the time of withdrawal, the doctor will determine the methadone dosage. Too much methadone is potentially dangerous. The dose will slowly be reduced over a time period. The thinking behind the use of methadone is that without the unbearable symptoms of heroin withdrawal it will be easier for an addict to stop using. It is vital, however, that the recommended methadone dosage is adhered to, as overdose of methadone is a dangerous possibility.

Heroin withdrawal, determination of methadone dosage and follow-up treatment should be done under the supervision of a trained professional. Ideally, the chemical dependence and withdrawal process should be accompanied by non-drug measures such as counseling and support groups. Drug addiction, including that to heroin, is a worldwide pandemic and there are many organizations throughout the world involved in helping addicts beat their addictions.

Many programs are pharmacist-assisted, especially in areas where heroin addiction is rife. Local drug stores work in collaboration with the doctor supervising the withdrawal. The withdrawing addict receives the correct methadone dosage on a daily or weekly basis, thus minimizing the chances of overdose or abuse of methadone.

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