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ARTICLE |

Ineffective Use of Psychoactive Drugs Methadone Treatment Is No Exception FREE

James R. Cooper, MD
[+] Author Affiliations

Reprint requests to Division of Clinical Research, Medical Affairs Branch, Drug Abuse and Mental Health Administration, Rockville, MD 20857 (Dr Cooper).


JAMA. 1992;267(2):281-282. doi:10.1001/jama.1992.03480020091039
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The provision of ineffective methadone doses and the premature termination of methadone maintenance treatment have been well-recognized problems for many years in the treatment of opioid addiction. In 1980, 41% of the approximately 64 000 patients receiving methadone maintenance treatment had their dosages stabilized at less than 40 mg/d. Concern over the clinical implications of these treatment data was

See also p 253. a major reason my colleagues and I at the National Institute on Drug Abuse (NIDA) in 1983 asked a group of drug abuse researchers and clinicians to review the wealth of drug abuse treatment research data compiled over the previous 15 years.1 The issue of appropriate methadone dose was reviewed in detail. The review resulted in a consensus that the dose of methadone should be individualized for each patient and that, for the majority, the most effective dose is between 50 and 100 mg. Furthermore, the

REFERENCES

Cooper JR, Altman F, Brown BS, Czechowicz D, eds. Research on Treatment of Narcotic Addiction: State of the Art . Rockville, Md: National Institute on Drug Abuse; 1983;. US Dept of Health and Human Services publication ADM 83-1281.
Strain EC, Stitzer ML, Bigelow GE, Liebson I. Methadone dosing level: effects on treatment outcome. Presented at the 53rd Annual Meeting of the Committee on Problems of Drug Dependence; June 17-20, 1991; Palm Beach, Fla.
Dole VP.  Methadone treatment and the acquired immunodeficiency syndrome epidemic. JAMA . 1989;;262:1681-1682.
Cooper JR.  Methadone treatment and acquired immunodeficiency syndrome. JAMA . 1989;;262:1664-1668.
D'Aunno T, Vaughn TE.  Variation in methadone treatment practices: results from a national study. JAMA . 1992;;267:253-258.
Batten HL, Horgan CM, Prottas JM, et al. Drug Services Research Survey: Phase I Final Report: Non-correctional Facilities . Rockville, Md: National Institute on Drug Abuse; 1991;. Contract 271-90-8319/1.
Schuster CR.  Methadone maintenance: an adequate dose is vital in checking the spread of AIDS. NIDA Notes . (Spring/Summer) 1989;;4:3, 33.
Quitkin FM.  The importance of dosage in prescribing antidepressants. Br J Psychiatry . 1985;;147:593-597.
Uhlenhuth EH, Balter MB, Mellinger GD, Cisin IH.  Anxiety disorders: prevalence and treatment. Curr Med Res Opin . 1984;;85:37-46.
Max MB.  Improving outcomes of analgesic treatment: is education enough? Ann Intern Med . 1990;;113:885-889.
Joranson DE.  Federal and state regulation of opioids. J Pain Symptom Manage . 1990;;55:12-23.
Portenoy RK.  Chronic opioid therapy in non-malignant pain. J Pain Symptom Manage . 1990;;55:46-62.
Woody GE, Mc Clellan AT, Luborsky L, O'Brien CP.  Severity of psychiatric symptoms as a predictor of benefits from psychotherapy: the Veterans Administration-Penn Study. Am J Psychiatry . 1984;;141:1172-1177.
Rounsaville BM, Kosten T, Weissman MM, Kleber HD.  Prognostic significance of psychopathology in treated opiate addicts. Arch Gen Psychiatry . 1986;;43:739-745.
Ball JC, Ross A. The Effectiveness of Methadone Maintenance Treatment . New York, NY: Springer-Verlag NY Inc; 1991;.

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Cooper JR, Altman F, Brown BS, Czechowicz D, eds. Research on Treatment of Narcotic Addiction: State of the Art . Rockville, Md: National Institute on Drug Abuse; 1983;. US Dept of Health and Human Services publication ADM 83-1281.
Strain EC, Stitzer ML, Bigelow GE, Liebson I. Methadone dosing level: effects on treatment outcome. Presented at the 53rd Annual Meeting of the Committee on Problems of Drug Dependence; June 17-20, 1991; Palm Beach, Fla.
Dole VP.  Methadone treatment and the acquired immunodeficiency syndrome epidemic. JAMA . 1989;;262:1681-1682.
Cooper JR.  Methadone treatment and acquired immunodeficiency syndrome. JAMA . 1989;;262:1664-1668.
D'Aunno T, Vaughn TE.  Variation in methadone treatment practices: results from a national study. JAMA . 1992;;267:253-258.
Batten HL, Horgan CM, Prottas JM, et al. Drug Services Research Survey: Phase I Final Report: Non-correctional Facilities . Rockville, Md: National Institute on Drug Abuse; 1991;. Contract 271-90-8319/1.
Schuster CR.  Methadone maintenance: an adequate dose is vital in checking the spread of AIDS. NIDA Notes . (Spring/Summer) 1989;;4:3, 33.
Quitkin FM.  The importance of dosage in prescribing antidepressants. Br J Psychiatry . 1985;;147:593-597.
Uhlenhuth EH, Balter MB, Mellinger GD, Cisin IH.  Anxiety disorders: prevalence and treatment. Curr Med Res Opin . 1984;;85:37-46.
Max MB.  Improving outcomes of analgesic treatment: is education enough? Ann Intern Med . 1990;;113:885-889.
Joranson DE.  Federal and state regulation of opioids. J Pain Symptom Manage . 1990;;55:12-23.
Portenoy RK.  Chronic opioid therapy in non-malignant pain. J Pain Symptom Manage . 1990;;55:46-62.
Woody GE, Mc Clellan AT, Luborsky L, O'Brien CP.  Severity of psychiatric symptoms as a predictor of benefits from psychotherapy: the Veterans Administration-Penn Study. Am J Psychiatry . 1984;;141:1172-1177.
Rounsaville BM, Kosten T, Weissman MM, Kleber HD.  Prognostic significance of psychopathology in treated opiate addicts. Arch Gen Psychiatry . 1986;;43:739-745.
Ball JC, Ross A. The Effectiveness of Methadone Maintenance Treatment . New York, NY: Springer-Verlag NY Inc; 1991;.
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