In Reply: Dr Newman makes an important point about the role of the FDA in properly informing physicians about safe dosing regimens. Its slow onset and long duration of action make methadone a valuable pain medication. Yet, as Newman suggests, the FDA 2006 published dosing guidelines1 (2.5-10 mg every 3-8 hours) are too broad to be useful; the highest dose and frequency parameters can be lethal in nontolerant individuals. We agree with his call for broader communication of the revised guidelines (40-mg maximum per day or less for smaller persons).
McLellan AT, Turner BJ. Prescription Opioids and Overdose Deaths—Reply. JAMA. 2009;301(17):1766-1769. doi:10.1001/jama.2009.582