To the Editor.—
As indicated by Dr. Chappel, "Treatment of Morphine-Type Dependence by Withdrawal Methods" is a definitive statement by the AMA. It should be stressed, however, that these guidelines should be interpreted flexibly and should not substitute for thorough clinical evaluation of each individual patient with appropriate application of the guidelines. The following relate to Dr. Chappel's specific comments:
The Committee agrees that deep aches are a common symptom of withdrawal from methadone. All symptoms of opioid withdrawal may be seen in withdrawal from methadone, but they tend to be less intense and more prolonged than those seen in withdrawal from the shorteracting opioids. Insomnia and tension are among those symptoms commonly seen, but when they are protracted over a period of several months and are fluctuating in nature, underlying psychic factors must be considered.
Many schedules of withdrawal are possible and medically proper, including that suggested