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December 8, 1999

Moderate- vs High-Dose Methadone for Opioid Dependence—Reply

Author Affiliations

Phil B.FontanarosaMD, Interim CoeditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephenLurieMD PhD, Fishbein FellowIndividualAuthor

JAMA. 1999;282(22):2121-2123. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-22-jbk1208

In Reply: Dr Grabowski and colleagues point out that their work has shown how the required frequency of clinic visits for methadone treatment can affect retention, while methadone dose influences rates of illicit opioid use.1 Methadone regulations require patients to attend clinics on a daily basis initially, and months or even years can elapse as patients gradually earn the right to attend on a less frequent basis. Their work suggests these attendance requirements may increase attrition from methadone treatment programs. This is an important point that needs to be considered as federal agencies work to revise current methadone regulations. It is also worth noting that some forms of insurance reimburse daily treatment delivered on-site but do not provide reimbursement for take-home doses of methadone. This can be another factor influencing the current practices of methadone clinics.

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