A patient receiving supervised methadone oral solution for opioid dependence fails to attend the pharmacy for 4 consecutive days. On the 5th day, the patient returns requesting their usual dose of 40 mg. According to national guidelines, what is the most appropriate action the pharmacist should take?

• A. Do not dispense and contact prescriber before supplying any dose
• B. Dispense as usual
• C. Increase dose
• D. Refer to emergency department

Answer: (A)

When a patient on supervised methadone maintenance misses several consecutive dosing days, the safe approach is to verify the plan with the prescriber before dispensing any dose. Methadone tolerance can rapidly change during a lapse in treatment, so giving the usual 40 mg without new instructions risks overdose or withdrawal complications. The pharmacist needs to confirm with the prescriber whether the dosing plan should be restarted at the same amount, reduced, or resumed under supervision, and to ensure the take-home authorization is still appropriate.

Dispensing as usual would ignore the interruption and safety concerns. Increasing the dose without prescriber input could be dangerous due to reduced tolerance. Referring to the emergency department is unnecessary unless there are acute signs of overdose or other emergent issues. The correct action protects the patient and aligns with proper monitoring and communication with the prescriber.