title: Determining effective methadone doses for individual opioid-dependent patients.
abstract: BACKGROUND
  Randomized clinical trials of methadone maintenance have found that on average high daily doses are more effective for reducing heroin use, and clinical practice guidelines recommend 60 mg/d as a minimum dosage. Nevertheless, many clinicians report that some patients can be stably maintained on lower methadone dosages to optimal effect, and clinic dosing practices vary substantially. Studies of individual responses to methadone treatment may be more easily translated into clinical practice.
  
  
  RESULTS
  A volunteer sample of 222 opioid-dependent US veterans initiating methadone treatment was prospectively observed over the year after treatment entry. In the 168 who achieved at least 1 mo of heroin abstinence, methadone dosages on which patients maintained heroin-free urine samples ranged from 1.5 mg to 191.2 mg (median = 69 mg). Among patients who achieved heroin abstinence, higher methadone dosages were predicted by having a diagnosis of posttraumatic stress disorder or depression, having a greater number of previous opioid detoxifications, living in a region with lower average heroin purity, attending a clinic where counselors discourage dosage reductions, and staying in treatment longer. These factors predicted 42% of the variance in dosage associated with heroin abstinence.
  
  
  CONCLUSIONS
  Effective and ineffective methadone dosages overlap substantially. Dosing guidelines should focus more heavily on appropriate processes of dosage determination rather than solely specifying recommended dosages. To optimize therapy, methadone dosages must be titrated until heroin abstinence is achieved.
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System and Stanford University School of Medicine, Menlo Park, California, United States of America. Jodie.Trafton@va.gov
authors.forename: Jodie A
authors.initials: JA
authors.lastname: Trafton
authors.forename: Jared
authors.initials: J
authors.lastname: Minkel
authors.forename: Keith
authors.initials: K
authors.lastname: Humphreys
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004361:Drug Tolerance; D005260:Female; D003932:Heroin / Q000494:pharmacology; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage* / Q000494:pharmacology* / Q000627:therapeutic use; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D003932:Heroin; D008691:Methadone