3. I’m a family physician. A user has asked me to increase his dose of methadone: he complains that it doesn’t last 24 hours. However, during the consultation, he didn’t seem to be in withdrawal. When I went to see him in the waiting room, he was asleep i

Check what time he took the medication at and determine whether it is one of the following situations:

• If the discomfort occurs within hours of taking the methadone, you must explore the user’s perception of the discomfort with him and point out to him that he even seems drowsy. You must also find out if he is using psychotropics, which could explain the drowsiness.
• If the user’s discomfort occurs in the hours before he takes the methadone and he doesn’t feel drowsy in the hours after taking it, the dose can be increased. Drowsiness can also be caused by insomnia or some other reason unrelated to the methadone. That’s why it’s important to check what time it was taken at.
• Users who metabolize the medication quickly may experience drowsiness post-dose and symptoms of withdrawal before the end of the 24-hour period. If this happens, it may be appropriate to split the dose in two.