Dose-related efficacy of levomethadyl acetate for treatment of opioid dependence. A randomized clinical trial.
OBJECTIVE
To compare the clinical efficacy of different doses of levomethadyl acetate hydrochloride (known as LAAM) in the treatment of opioid dependence.


METHODS
A randomized controlled, double-blind, parallel group, 17-week study.


METHODS
Outpatient facilities at Johns Hopkins University Bayview Medical Center, Baltimore, Md.


METHODS
Opioid-dependent volunteers (N=180) applying to a treatment-research clinic.


METHODS
Thrice-weekly (Monday/Wednesday/Friday) oral LAAM dose conditions of 25/25/35 mg, 50/50/70 mg, and 100/100/140 mg and nonmandatory counseling.


METHODS
Retention in treatment, self-reported heroin use, and opioid-positive urine specimens.


RESULTS
Retention was independent of subjects' sex and dose. Self-reported heroin use decreased in a dose-related manner. At final assessment, patients in the high-dose condition reported using heroin 2.5 of 30 days as compared with 4.1 or 6.3 days for patients in the medium-dose and low-dose conditions, respectively (high dose vs low dose, P<.05); urinalysis results were similarly dose related. Overall, 20 (34%) of 59 patients in the high-dose condition remained opioid-abstinent for 4 consecutive weeks, as compared with 8 (14%) of 59 in the medium-dose and 7 (11%) of 62 in the low-dose conditions (P<.01). Self-report and urinalysis data are consistent with a greater than 90% reduction in illicit opioid use by the high-dose group relative to pretreatment levels.


CONCLUSIONS
Opioid substitution treatment with LAAM substantially reduces illicit opioid use. The clinical efficacy of LAAM is positively related to dose.
Eissenberg
T
T
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224-6823, USA.
Bigelow
G E
GE
Strain
E C
EC
Walsh
S L
SL
Brooner
R K
RK
Stitzer
M L
ML
Johnson
R E
RE
D000328:Adult; D000704:Analysis of Variance; D003042:Cocaine / Q000652:urine; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D003932:Heroin / Q000652:urine; D006556:Heroin Dependence / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008692:Methadyl Acetate / Q000008:administration & dosage*; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage*; D019966:Substance-Related Disorders / Q000150:complications; D016896:Treatment Outcome
D009294:Narcotics; D003932:Heroin; D003042:Cocaine; D008692:Methadyl Acetate