Missing methadone doses is a more significant issue than missing a buprenorphine dose, because of how methadone tolerance and dosing interact.
Why this matters more with methadone: Missing several days can lower your tolerance meaningfully — resuming your prior dose after a gap can carry real overdose risk, since the dose that was safe before may no longer be. overdose risk after a break tool
What OTPs typically do after missed doses: Most programs have specific protocols requiring dose reassessment after a certain number of missed days (varies by program) — expect your dose to potentially be reduced and re-titrated rather than automatically resumed at the same level.
What to actually do: Contact your OTP as soon as possible after missing doses, rather than waiting until your next scheduled visit — being upfront gets you a safer, faster path back to a stable dose.
This isn’t punitive: Programs reassess doses after gaps because of genuine safety concerns, not to penalize you — approaching this honestly tends to go better than trying to minimize how many doses were missed.
Medically reviewed by [pending]. Sources: SAMHSA TIP 63, 42 CFR Part 8.