"I've been on 100 mg/day of methadone for almost two years, but I wake up in withdrawal every morning. My clinic recently gave me something called a 'trough test.' They never told me what that meant, but it justified their raising my dose. I thought 100 mg/day was the highest one could go. Now I'm up to 130 mg/day and I feel a little better but am still doing poorly every morning. What could be the matter with me?"
-via e-mail to AT Forum.

What is the "trough test"? Why and when should it be used? How can it help? Patients in methadone maintenance treatment programs sometimes complain of problems with a given dose of methadone: "My dose isn't holding me"; "I get sleepy at work"; or, "I wake up sick in the morning" (in our reader's case). Certainly, there is some variation in how patients react to methadone, and blood level measurements can be very useful when the clinical picture does not agree with the typical or expected response to a given dose of methadone. [1]