Dear Doctor:

 

My clinic thinks they have to take blood twice when checking serum levels. From what I have read, this is not necessary. Also, I have heard there is a test that doesn't do much good and/or is used against the patient. Can you clarify these issues for us? - Wondering

 

Dear Wondering:

 

The only lab that can be trusted is the Quest LAB which is in San Diego; it used to be called Nichols, then Met Path Corning, and now "Quest." They are expensive at $30 to $40, per test.

 

Peak levels are useless to me. I prefer observing the effect of a dose on a patient three or four hours after dosing and getting a serum methadone trough level (24 hours after last dose). If the patient shows sedation or intoxication at 4 hours but has a low serum level and complains of withdrawal, I infer that they are fast metabolizers needing a split dose. If there is no intoxication with complaints of withdrawal or continued illicit drug use and a low serum methadone trough level, a substantial increase is required.

 

I am aware of an inexpensive test from another San Diego Lab which does not measure serum levels in the customary way and presents results as: "25 ng/ml is low - 400 ng/ml is high." There is no useful conversion factor between this and the traditional method, where 400 ng/ml at 24 hours after dosing is the LOWEST level considered adequate to reduce craving. Citing the results of this test and using the traditional numbers, patients can be denied adequate treatment even by well-intentioned clinicians. What this test calls "high" is actually low by numbers cited in the CSAT literature.

 

Beware of any test that does not come from the Quest Lab. I have had bizarre results with every other lab that I have tried. Please let the advocates know that the labs used can have a big difference on outcome.

 

 

 

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