Abstract
This case report describes the 26-month induction and stabilization phases of methadone-maintenance treatment (MMT) in a young Caucasian woman addicted to oral prescription pain medication. The patient is an ultra-rapid metabolizer and requires a daily methadone dose of 1200 mg, split 400/400/400. Her dosing history and peak and trough serum methadone levels (SMLs) are discussed. Updates on addiction, substance abuse, MMT, and SMLs provide a background for appreciating the complexity of concerns surrounding both methadone dose determination and high-dose MMT. Determining appropriate, effective methadone doses for individual patients utilizing evidence is supported and actively encouraged: (a) Develop a relationship with, listen to, and observe your patient, (b) have frequent face-to-face interactions, particularly during induction, granting credence to descriptions of Opioid Abstinence Syndrome (OAS) symptoms, (c) base dose on good clinical judgment and subjective and objective data, giving most weight to subjective complaints, and (d) prescribe a dose that eliminates the OAS for 24 hours and allows your patient to live a productive life.