Methadone Maintenance and Amitriptyline

To the Editor.—  I read the article "Abuse of Amitriptyline" by Cohen et al (240:1372, 1978) and must concur with their conclusions that misuse and abuse of amitriptyline (Elavil) among drug-dependent patients are not uncommon. Through patient interviews and abuse patterns, it has been obvious for many years that an active "street market" has and does exist for this drug. Early recognition of amitriptyline's abuse potential has led to a clear warning to patients and staff of our methadone program. We rarely use amitriptyline in treating this patient population. A review of urine profiles from March to September 1978 shows a 2.5% positive mention for amitriptyline (13 mentions involving nine patients; treatment capacity, 350). Only one of these patients was receiving amitriptyline under proper medical guidance and with our knowledge. Thus, despite strong program pressure for avoidance, the drug was still abused.More important from a treatment aspect of patients