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Questions About Accuracy Of Peak & Trough

Posted: October 8, 2018, 9:30 AM

I've been on methadone maintenance for almost 1.5 years now. I'm currently on 90mgs and this past Monday I submitted a request to increase my dose by 5mg (most that my clinic allows at a time). I went to dose this morning and was told before I could get my increase, the doctor wanted a peak and trough done. I'm mostly worried that my doctor will lower my dose based on the results when I would think these results wouldn't account for tolerance. In an opiate naive person, 50mg could prove to be fatal but if that same person were opiate tolerant, their peak and trough numbers would be the same but that dose wouldn't hold them for 24 hours. Or am I misunderstanding something? I worry that my dose may be lowered because I have a slow metabolism in general so I'm assuming that would also apply to how fast/slow I metabolize methadone. I've been on 90mg for atleast 3 months and I am definitely not overmedicared. No nodding, sweating, constipation, etc. I would feel more comfortable of this test also included a visit with the doctor as well but I've only seen the doctor during my intake visit so I'm pretty sure the decision will be based solely on the results of the peak and trough test. If anyone has any input, personal experience, anything that might help me understand, please feel free to chime in.

I feel that 95mg will be the dose I need since the wds I experience now late night/early morning after a dose is what I would describe as nagging. It's not unbearable but as time goes on, I feel that nagging starting to wear me down and I've been thinking about using more and more so the last thing I want or need is my dose decreased. I've managed to only have 1 or 2 drug screen come back positive for opiates since i started and I feel this may also work against me.

Sorry for such a long and rambling post but I want to hear from people with experience instead of from the doctor who only has clinical experience about this. Hope everyone has a great day!
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