Most people can stay at the same dose for years. In fact dose changes the other direction are most common in stable patients – we decrease the dose so someone can taper off methadone or Suboxone. However there are some situations when the methadone or Suboxone dose needs to be increased:
Increased physical activity. Endorphins (your body’s “opiates”) are basically a stress neurotransmitter. They are released during periods of physical stress (e.g. the “runners high”). The responsiveness of this system is lost when people have overloaded the body with opiate medication and drugs. Therefore if you get a new job more physical job or start strenuous workouts you may find you dose is not lasting as long.
Increased emotional or situational stress. Endorphins (your body’s “opiates”) are basically a stress neurotransmitter. They are released during periods of emotional stress (e.g. battlefield bravery). The responsiveness of this system is lost when people have overloaded the body with opiate medication and drugs. Therefore if you find yourself in a stressful period in your life like a marital break-up or trouble with the law you may find your dose is not lasting as long.
Significant weight gain. Basically, if you get bigger you may need more methadone or Suboxone.
Medications. Many medications affect the metabolism of both methadone and Suboxone. Some may speed the metabolism resulting in the need for an increase. Some slow the metabolism. Slowed methadone metabolism can become dangerous – a previously stable dose now becomes too high resulting in sedation or nausea. Always tell you methadone physician about new medications whether prescribed, over-the-counter or herbal.
- Pregnancy often results in an increased methadone requirement for a few reasons. The pregnant woman gains weight, has more circulating blood volume and especially in the third trimester (week 27 to 40) increases the rate of metabolism of some compounds including methadone. Our experience at BMC is about 60% of pregnant women need an increased dose. The same percentage decreases their dose – usually a few months after delivery.