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Published on: November 11, 2013
Levo-alpha-acetylmethadol (LAAM) versus methadone: treatment retention and opiate use
Douglas Longshore1, Jeffrey Annon, M Douglas Anglin
1UCLA Integrated Substance Abuse Programs, Neuropsychiatric Institute and Hospital, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90025, USA. dLongsho@ucla.edu
Aims:
To compare the effects of levo-alpha-acetylmethadol (LAAM) and methadone maintenance (MM) on treatment retention and abstinence from opiate use.
Design:
A two-group experimental design with patients randomly assigned (2 : 1 LAAM : MM) to receive LAAM (three doses per week) or methadone (daily dosing).
Setting:
A community clinic in Los Angeles, California.
Participants:
A total of 315 patients seeking LAAM or methadone maintenance.
Intervention:
LAAM or methadone maintenance, plus ancillary services available to all patients. LAAM and methadone dose levels varied according to clinical judgement. Electrocardiograms were administered to LAAM patients monthly.
Measurements:
Treatment status at 26-week follow-up and number of days retained in treatment, weekly clinical urine tests and 26-week research urine test.
Findings:
LAAM and methadone patients did not differ on treatment retention. LAAM patients were less likely to test positive for opiate use during treatment (40% versus 60%) and at 26-week follow up (39.8% versus 60.2%). Benefits of LAAM were confined to patients (n = 204) still in treatment at 26 weeks (33% positive in patients receiving LAAM and 61% in patients receiving methadone). No adverse events, cardiological or otherwise, were observed with LAAM administration.
Conclusions:
LAAM is an effective medication for the treatment of opiate dependence with clinical advantages due not only to the reduction of opiate use but also to the alternate-day dosing schedule. LAAM may be more effective than methadone in promoting abstinence from opiate use among patients for whom LAAM is an acceptable alternative to methadone.
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