Methadone dosing, heroin affordability, and the severity of addiction.
OBJECTIVE
This study sought to track changes in US heroin prices from 1988 to 1995 and to determine whether changes in the affordability of heroin were associated with changes in the use of heroin by users seeking methadone treatment, as indexed by methadone dose levels.


METHODS
Data on the price of heroin were from the Drug Enforcement Administration; data on methadone doses were from surveys conducted in 1988, 1990, and 1995 of 100 methadone maintenance centers. Multivariable models that controlled for time and city effects were used to ascertain whether clinics in cities where heroin was less expensive had patients receiving higher doses of methadone, which would suggest that these patients had relatively higher physiological levels of opiate addiction owing to increased heroin use.


RESULTS
The amount of pure heroin contained in a $100 (US) purchase has increased on average 3-fold between 1988 and 1995. The average dose of methadone in clinics was positively associated with the affordability of local heroin (P < .01).


CONCLUSIONS
When heroin prices fall, heroin addicts require more methadone (a heroin substitute) to stabilize their addiction--evidence that they are consuming more heroin.
Bach
P B
PB
Robert Wood Johnson Clinical Scholars Program, Department of Medicine, University of Chicago, Ill., USA. bachp@biosta.mskcc.org
Lantos
J
J
D006306:Health Surveys; D003932:Heroin / Q000191:economics*; D006556:Heroin Dependence / Q000145:classification / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D013287:Illicit Drugs / Q000191:economics*; D008691:Methadone / Q000008:administration & dosage*; D017059:Models, Econometric; D015999:Multivariate Analysis; D009294:Narcotics / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011159:Population Surveillance; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014504:Urban Health
D013287:Illicit Drugs; D009294:Narcotics; D003932:Heroin; D008691:Methadone