therapeutic drug monitoring for methadone maintenance programs

Methadone is one of the medications approved by the US Food and Drug Administration (FDA) for use in the treatment of Opioid Use Disorder (OUD). It is a long-acting opioid agonist that falls under Schedule II control. This generally means that when prescribed and used under the supervision of a physician, methadone is considered safe and effective and can be used as medication-assisted treatment (MAT) or for pain management. It helps patients achieve and sustain recovery from opioid addiction to lead active and purposeful lives.

How Methadone Works

The medication works by reducing opioid craving while also managing withdrawal symptoms. Patients are typically advised to take methadone daily in liquid, diskette, or powder form to block the effects of opioids.

How Patients Receive Methadone

SAMHSA (Substance Abuse and Mental Health Services Administration) says patients undergoing methadone treatment must be supervised, as methadone can pose a risk for misuse. Any treatment program dispensing the medication must be SAMHSA-certified.

After patients’ stability is established, they may be allowed to take the medication at home between program visits. This approach to addiction treatment is known as “a whole-person approach.” Its success largely depends on the progress patients demonstrate, and their proven consistent compliance with the required dosage. Some patients on MAT transition to buprenorphine or other MAT medications as directed by their physician.

How long a patient continues with methadone treatment depends on various factors. The National Institute on Drug Abuse indicates the period must be a minimum of 12 months. Patients will work with their MAT practitioner to gradually reduce dosage over time and in a way that prevents withdrawal. 

Methadone Safety Control

Methadone is a safe and effective medication, but only when taken as prescribed. Each dose is tailored to the individual patient. Users should never share it with others, something that care providers must monitor and patients who take the medication at home without direct supervision should remember.

Unfortunately, there is a risk of misuse or abuse of methadone by patients. That is why routine drug testing is essential through a therapeutic drug monitoring (TDM) program for methadone.

In some of these programs, patients must physically attend regular clinic appointments for blood collection. This is to measure the amount of methadone present in the blood — blood testing can help detect overuse of the drug, addiction or withdrawal. The concentration levels of methadone in the blood samples will inform the physician how to adjust the dosage safely and effectively, or whether their patient is misusing methadone.

In other programs, more stable patients are allowed to self-collect the blood samples remotely. This is possible with the use of Mitra^® devices from Neoteryx. The devices can be sent to patients as a component of at-home specimen collection kits that come with instructions and supplies needed for easy blood collection. Patients can then mail the samples to the clinic or lab for drug testing. More labs now process remote blood "microsamples" from Mitra devices for drug testing and therapeutic drug monitoring. One advantage of blood collection and testing with these devices is that patients cannot easily adulterate, dilute, or substitute their blood samples to try and pass a drug screening.  

Importance of Methadone Monitoring

Therapeutic drug monitoring for methadone in addiction recovery patients is crucial for safety and success in recovery. It also helps care providers determine how other medications interact with methadone. Long after the effects of methadone wear off, the active ingredients may remain in the body. Toxic interactions could occur. Monitoring drug concentration levels through blood sampling ensures patients adhere to the prescribed methadone usage to avoid addiction or withdrawal complications and other related hazards. 

Looking for a lab that processes remote blood samples for drug testing and therapeutic drug monitoring? Click the icon below to find a microsampling lab near you.