Dose-response effects of methadone in the treatment of opioid dependence.
OBJECTIVE
To compare the dose effectiveness of low to moderate doses of methadone in a sample of a contemporary population of opioid abusers, because the optimal dosing of methadone in the treatment of opioid dependence remains an issue.


METHODS
A randomized, double-blind, placebo-controlled study.


METHODS
A methadone treatment research clinic.


METHODS
Participants (n = 247) were opioid-dependent patients with a high rate of cocaine use.


METHODS
All participants were initially treated with active methadone for a minimum of 5 weeks and then received 15 weeks of stable dosing at 50, 20, or 0 mg per day. Individual counseling and group therapy were included.


METHODS
Treatment retention and illicit drug use as determined by intensive urine monitoring.


RESULTS
Retention was better for patients who remained on active medication. By treatment week 20, retention was 52.4% for the 50-mg, 41.5% for the 20-mg, and 21.0% for the 0-mg group (50 versus 0 and 20 versus 0, P < 0.05; 50 versus 20, P > 0.05). Only the 50-mg treatment group had a reduced rate of opioid-positive urine samples (56.4% versus 67.6% and 73.6% for the 20-mg and 0-mg groups, respectively; P < 0.05) and cocaine-positive urine samples (52.6% versus 62.4% and 67.1% for the 20- and 0-mg groups, respectively; P < 0.05).


CONCLUSIONS
There is a dose-response effect for methadone treatment. Doses as low as 20 mg may improve retention but are inadequate for suppressing illicit drug use.
Department of Psychiatry, Johns Hopkins University School of Medicine, Francis Scott Key Medical Center, Baltimore, MD 21224.
E C
EC
Strain
M L
ML
Stitzer
I A
IA
Liebson
G E
GE
Bigelow
D000328:Adult; D003042:Cocaine / Q000652:urine; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D009294:Narcotics / Q000652:urine; D009293:Opioid-Related Disorders / Q000150:complications / Q000534:rehabilitation* / Q000652:urine; D010349:Patient Compliance; D010352:Patient Dropouts; D019966:Substance-Related Disorders / Q000150:complications; D016019:Survival Analysis
D009294:Narcotics; D003042:Cocaine; D008691:Methadone