Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
To the Editor: In their study of methadone
maintenance, Dr Sees and colleagues1 used
suboptimal methadone doses. According to the National Institute of Drug Abuse
(NIDA), Substance Abuse and Mental Health Services Administration (SAMSHA),
and the Center for Substance Abuse Treatment (CSAT),2
the initial therapeutic dosage for methadone maintenance treatment is 80 to
120 mg/d, while the study by Sees et al restricted the dosage to 100 mg/d.
In fact, many patients were receiving far lower dosages. It does nothing to
remove the stigma from methadone maintenance treatment to subject patients
to suboptimal doses and then publish the "failure" of methadone maintenance
treatment by stating "that 50% of participants used an illicit opioid at least
once a month is not encouraging" and then postulating that "failure may rest
in the realm of psychosocial treatment," when neither program provided extensive
legal, employment, family, or psychiatric services. I believe that the "failure"
rests in the suboptimal dosing of the patients.
Kelly C. Methadone Maintenance for Opioid Dependence. JAMA. 2000;284(6):694-695. doi:10.1001/jama.284.6.691