Methadone and how it is mixed

[Enlightenment]

Hi,

I am hoping to get some input from the pharmacists on this forum.
I'm currently on quite a low dose of Methadone which I have been reducing over the last year. I have been clean from heroin for over a year now (thanks to Methadone, my family, a great drugs clinic, and lots of will power) However, I have a query regarding the way my Methadone is mixed. On the bottle it says Physeptone 1mg/1ml SF (sugar free) Mixture. Now normally the same pharmacist dispenses my Methadone and they are the one who mixes it up. However, certain times I pick-up and another pharmacist dispenses to me (I take it my original pharmacist is away on these days), and what I've noticed is when I pick-up from this pharmacist there's sometime more Methadone in the bottle. I take it it's just the way it has been mixed-up with the SF mixture i.e. this pharmacist mixes the Methadone with more of the SF mixture.
So, my question to the pharmacists on here is, does mixing the Methadone with more (or less) of this SF mixture have any kind of affect on the strength of the Methadone? Do you have any kind of rules regarding the mixing of Methadone with it's SF or normal, non-SF mixture? I mean, does it matter if one day you mix it with slightly more of the SF mixture and then another day mix it with less? Or does it have to be mixed with this solution precisely? What are the rules and standard procedure for this? I'm just wondering why one pharmacist seems to mix it the same every time and the other sometimes seems to add more of the SF solution

Thank you kindly! It's great to find a forum where you can find answers such as these which are hard to find elsewhere

[johnep]

No mixing at all in the average pharmacy, bought in ready prepared. Some pharmacists will purchase a bottle of base sugar free syrup and add preweighed methadone to it. Minimal mixing required. However Methadone syrups supplied by variety of manufacturers and these may vary from supplier. Not always possible to guarantee one supplier only.
johnep

[DavidS]

If you are on a daily pickup, its possible that one pharmacist rinses the bottle before filling it: the additional water would look like you are getting a bigger dose.

[Enlightenment]

Thanks for the replies.

@DavidS - I'm not on daily pick-up.

The reason I thought it was mixed at the chemist is because sometimes I have to wait for it and the pharmacist will say 'is it OK to wait as I've got to make it up' or something along those lines. What they probably mean there then is they've got to pour the ready made/prepared Methadone into its bottles for me to take home.

Maybe my chemist is one of the ones who buys in the bottles of base sugar free syrup and does it that way then. Hmm, interesting! Like I said, its only happened with this one pharmacist, my normal pharmacist is very good (not to say this other pharmacist isn't).

[johnep]

Not so much the actual measuring but the paperwork and checking that take the time.
johnep

[Sir_Dispensalot]

sometimes in addition to this not all the bottles used are perfectly cast in the same batch, and can vary from batch to batch - hence they have extra room in the top over their marked quantity to compensate. This can result in different levels in bottles which externally look the same.

or, quite simply the person doing the measurement might be doing it slightly differently and misreading the scale on the measure by not checking the parallax mark on the back. Easily done and can result in an overmeasurement (although it can be as little as 1ml).
Fortunatley (and i don't mean to be flippant) the dosing of methadone + or - a ml here or there for a patient isn't a big issue, even when on a reducing dose as 1mg up or down isn't normally enough to induce premature withdrawal symptoms or cause someone to overdose. After all most service users on a take home dose will struggle to get all of their daily dose out of the bottle and not leave 1 or 2 ml in the bottom.

[nicholass]

most pharmacist get the bottle(s) ready before people come for collection, don't they? it shouldn't take that long. if it isn't the regular pharmacist, it'd probably take longer for checking and verifying.

[DavidS]

most pharmacist get the bottle(s) ready before people come for collection, don't they?

Actually the preprepared SOPs at the shops I work at (which I ignore) suggest you label the bottles ready but don't pour it out until they arrive.

Green labels, anyone?

[bobbin]

The reason I thought it was mixed at the chemist is because sometimes I have to wait for it and the pharmacist will say 'is it OK to wait as I've got to make it up' or something along those lines. What they probably mean there then is they've got to pour the ready made/prepared Methadone into its bottles for me to take home.

When they say 'make it up' what they actually mean is pour it, label it, check it etc. The Physeptone brand that you mentioned is a ready mixed product. It is not something that has to be mixed in the pharmacy. The concentration of methadone is always 1mg/ml.

[SolomonQ]

The total pickup is probably close to a bottle size e.g. 100ml or 200ml. So a 1ml or 2ml difference in say a total quantity of 190ml would look bigger due to the neck of the bottle.