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Methadone dose and treatment outcome

E C Strain1, M L Stitzer, I A Liebson

  • 1Department of Psychiatry, Johns Hopkins University School of Medicine, Francis Scott Key Medical Center, Baltimore, MD 21224.

Drug and Alcohol Dependence
|September 1, 1993
PubMed
Summary

Higher doses of methadone (50 mg) significantly reduced opioid-positive urines and heroin use compared to lower doses (20 mg) or no methadone. Non-pharmacologic factors also played a role in patient improvement.

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Area of Science:

  • Addiction Medicine
  • Clinical Pharmacology
  • Psychiatry

Background:

  • Optimal methadone dosing for opioid dependence lacks consensus, with some programs using low-dose regimens.
  • Understanding dose-response relationships is crucial for effective opioid dependence treatment.

Purpose of the Study:

  • To compare the efficacy of fixed doses of methadone (50 mg vs. 20 mg) versus methadone-free treatment in opioid-dependent patients.
  • To investigate dose-related effects on illicit opioid use and psychosocial functioning.

Main Methods:

  • A double-blind, fixed-dose clinical trial involving 95 opioid abusers.
  • Comparison of outcomes between patients receiving 50 mg methadone (n=44), 20 mg methadone (n=34), and methadone-free treatment (n=17).
  • Assessment of psychosocial functioning, psychological symptoms, and opioid-positive urines.

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Main Results:

  • All patient groups showed psychosocial and psychological improvements over time.
  • Patients receiving 50 mg methadone demonstrated significantly lower rates of opioid-positive urines (36%) compared to 20 mg (60-73%).
  • Higher methadone dose (50 mg) correlated with reduced self-reported heroin use frequency (3 days/month vs. 11-12 days/month).

Conclusions:

  • Methadone efficacy in treating opioid dependence is dose-related.
  • Higher methadone doses (50 mg) are more effective in reducing illicit opioid use and improving drug-related behaviors.
  • Non-pharmacologic factors are important but do not negate the dose-dependent benefits of methadone.