The International Journal of Psychosocial Rehabilitation

High Dose Methadone May Be More Effective

JAMA - April '99

CHICAGO, IL - The Journal of the American Medical Association; March 17,
1999;281:1000-1005 - Not only are higher doses of methadone safe for heroin addicts on
maintenance therapy, higher doses than those usually used may help more patients recover, a
study suggests.

Dr. Eric C. Strain and colleagues at the Johns Hopkins University School of Medicine in
Baltimore, Maryland, compared moderate and high doses of methadone in a 40-week trial
involving 192 patients. The researchers note that methadone clinics commonly use daily
maintenance doses ranging from 30 to 60 milligrams. In the study, the team defined a moderate
dose as 40 to 50 milligrams per day and a high dose as 80 to 100 mg/day. Patients in the study
also received substance abuse counseling.

While illicit drug use dropped in both groups of patients, patients on the higher-dose regimen
"had significantly greater decreases," according to the report.

The results "provide evidence that significantly improved outcomes can be achieved with daily
methadone doses greater than 40 to 50 mg," the authors conclude. "The most important aspect
from therapeutic and public health perspectives is that methadone treatment over a broad range
of doses is associated with large and significant clinical improvements."

In a statement issued by the National Institute on Drug Abuse, Director Dr. Alan I. Leshner also
noted that the study showed that heroin addicts who receive methadone have better treatment
outcomes than those not on methadone, and that "a comprehensive treatment program, including
behavioral as well as pharmacological therapies, is the most effective treatment regimen for
opiate addiction."

[Numerous past studies have supported the "high-dose" advantages reported in this
investigation and, in fact, doses higher than 100mg/day have been demonstrated as being
even more appropriate for many patients. - Editor]