J Psychoactive Drugs 1999 Apr-Jun;31(2):95-102
- Chicago, Illinois
- 60610
Using signs, symptoms and serum methadone levels to guide evaluation, the
authors treated 164 patients in a methadone maintenance program with doses of
methadone exceeding 100 mg/d. The mean dose of these higher dose (HD) patients
was 211 mg/d (range 110-780 mg/d). A comparison group (C) of 101 patients was
randomly selected from the general clinic population (mean dose 65 mg/d). At
intake the HD group reported $153/day of heroin use versus $87/day in the C
group. The HD group had more patients whose opiate of choice was an oral
pharmaceutical (30% versus 2% of the C group). Sixty-three percent of the HD
group had comorbid Axis I psychiatric diagnoses compared to 32% of the C group.
Response to psychopharmacologic treatment was enhanced by increased methadone
dose in HD patients with “refractory” psychiatric disorders. Urine
toxicologies described as “before” were collected prior to increase
over 100 mg/d in the HD group or at the first routine urine toxicology
collection of the calendar year for the C group. These results were compared to
the most recent urine toxicologies for both groups (“after”). The
percentage of toxicologies positive for illicit drugs in the HD group dropped
from 87% “before” to 3% “after”. The C group were 54%
positive “before” and 37% positive “after”. We conclude that
doses of methadone in excess of 100 mg/d (range 110-780 mg/d in our sample of
164 patients) are not only safe but necessary to prevent illicit opiate use,
stabilize psychiatric symptoms, and diminish abuse of alcohol and
benzodiazepines in many patients.Publication Types:
Maxwell S, Shinderman M
- Clinical trial
- Randomized controlled trial
