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April 21, 1993

Methadone MaintenanceNew Research on a Controversial Treatment

JAMA. 1993;269(15):1995-1996. doi:10.1001/jama.1993.03500150107038

In a 1965 JAMA article, Dole and Nyswander1 presented an initial evaluation of what was then a new treatment for heroin addiction: methadone maintenance. These pioneering physicians recognized that drug-free treatments for opiate addiction were rarely successful, and that except for overdoses, the severe medical complications of heroin addiction were due to the hazards of unsterile injections rather than direct drug toxic effects. They reported that prescription of daily doses of methadone hydrochloride, a long-acting and orally effective synthetic opioid, could relieve craving for heroin and block its euphoric effects while creating a condition of pharmacologic stability that permitted psychosocial treatment and rehabilitation of patients whose lives had previously been dominated by their addiction.

See also p 1953.

The development of this medical treatment abetted the conceptualization of addiction as a disease, and increased the involvement of physicians in its treatment. However, methadone maintenance treatment was immediately controversial2