I don’t believe there is a maximum dose of methadone. You may have to get permission from the state opioid treatment authority for certain amounts. The largest dose I’ve seen is 1400mg a day. The patient was functioning well and it helped his pain. Most of overdose deaths with methadone occur in the pain sector. Methadone can be very tricky and careful monitoring is necessary.
It can take a while for urine tests to become negative. People have been suffering for many years so you can’t expect this problem to go away after a few treatments. Maybe it’s an indication that the patient should be placed on maintenance rather than tapering.
Yes but not as much as when people are on chronic opiates for pain. The methadone experience has been remarkable – people who are doing well on methadone seem to be able to stay on the same dose of methadone for years. People have ascribed that to the fact that methadone is an opioid agonist but that it also has NMDA(a glutamate receptor) antagonist effects, and this may moderate the development of tolerance.
We have less experience with buprenorphine but my own experience is that people generally don’t require an increase in dose and will often go down in dose to see what happens. If they still feel good they’ll usually stay at that new dose. Generally tolerance does not create a problem for opioid agonist therapy.
