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August 9, 2000

Methadone Maintenance for Opioid Dependence

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(6):694-695. doi:10.1001/jama.284.6.691

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.