title: Implementation of a clinic policy of client-regulated methadone dosing.
abstract: A six-month interval (baseline) during which methadone doses above 99 mg required individual approval by the clinic's physician was compared with the subsequent 16-month period in which a policy of patient-regulated methadone dosing with no preset upper limit was implemented. During the later phase, all patients were required to remain at each selected dose for a minimum of four days, and standard compliance-based take-home dosing procedures were followed. For patients in the study sample (n=57), the daily maximum methadone dose increased from 165 mg during baseline to 300 mg during the self-regulation period, while their average daily methadone dose increased from 76.84 mg to 80.04 mg (W=473, n=57, p=0.01). Monthly percent of opiate-positive urine specimens decreased significantly from 5.26% during baseline to 1.64% during the self-regulated dose period (W=169, n=57, p<0.01), and use of other drugs remained unchanged. No patient failed to show possession of recalled take-home doses, and no instances of liquid methadone diversion were reported by law enforcement agencies in the area.
authors.affiliation: Department of Pharmacology and Toxicology, Substance Abuse Treatment Clinic, University of Arkansas for Medical Sciences, 4301 West Markham St., Slot 611-1, Little Rock, AR 72205-7199, USA. RoblesSoteloElias@exchange.uams.edu
authors.forename: E
authors.initials: E
authors.lastname: Robles
authors.forename: F B
authors.initials: FB
authors.lastname: Miller
authors.forename: K K
authors.initials: KK
authors.lastname: Gilmore-Thomas
authors.forename: D E
authors.initials: DE
authors.lastname: McMillan
mesh_terms: D000284:Administration, Oral; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage* / Q000627:therapeutic use / Q000652:urine; D012646:Self Administration; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D008691:Methadone