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Substitution therapy for opiate abusers reduces dependencies on illicit drugs by utilizing opioid agonists that bind to opioid receptors in the brain. Apart from the physical benefits of reducing cravings and withdrawal symptoms, it also plays a role in reducing other problems associated with opioid abuse. Their longer duration of action means they do not require frequent administration and hence enables patients to carry out activities of daily living without disruption. The spread of infectious blood borne diseases is also curbed by the fact that they are usually administered orally [1]. Methadone and buprenorphine are the two most commonly prescribed and effective opioid agonists for substitution maintenance therapy in Malaysia as their oral preparation can avoid injecting behaviour among opiate users. Hence, the harm reduction promotion will be further strengthen as injecting related behaviour among opiate users are the main contributor to HIV transmission in Malaysia. Methadone Maintenance Therapy (MMT) was started in 2005 through harm reduction programme and is getting a strong foothold since then. Therefore we are seeing a lot of opioid abuser on methadone in Emergency Department with potential overdose or withdrawal symptoms. A lot of these opiate abuser drafted into the program also frequently have whole hosts of other health problems such HIV, Hepatitis B and C or Tuberculosis which may complicate diagnosis and treatment. MMT adds importantly to our ability to deal with the ever increasing menace of illicit drug use. Methadone is a long-acting drug. It occupies the opioid receptors at a slow pace and this creates a steady level of opioid in the blood. This characteristic avoids the "high and low” levels that generally occur with short-acting opioid administrations.

Plasma Methadone Level Monitoring in Methadone Maintenance Therapy: A Personalised Methadone Therapy