Missing one or two doses in a row is not a problem except that it will take 5 doses in a row to get your blood level back to where it was. Missing doses also frequently leads to using.

Missing 3 or more doses in a row should be avoided. This requires a restart. Restarting involves lowering the dose of methadone or Suboxone and then being reassessed several days later. The concern is because tolerance to opiates drops rapidly and going back to the previous dose could lead to an overdose.

For methadone patients restarting can result in a huge change in dose and can take a couple of weeks before you are back at the stable dose. While you are restarting all carries (take home doses) are suspended because of the concern of patients “dipping” into the next day’s dose.
Patients must attend clinic and see a Dr to be restarted because they have to be assessed in person first. BMC staff will cooperate to get you in for a restart as soon as possible. Do not delay calling.

Remember that with Suboxone and methadone the maximum effects of withdrawal happen at 5 days. Some patients doing well in recovery have missed 2 days and do not feel too bad so they think it might be a good opportunity to get of the program. If because of weekends or holidays they can’t get into clinic until 5-6 days after their last dose most have either relapsed or feel very uncomfortable by the time they are restarted.

If you miss or are going to miss an appointment call BMC and ask for an extension of your prescription. If the clinic is closed you might try BMC pharmacy. BMC pharmacy has access to the medical record which can help the physician on-call. They may be able to get an extension for you. Also, if you have missed a sample you can provide one there before your dose is given.