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April 15, 1974

A Sign of Heroin Use in Methadone Programs

Author Affiliations

Methadone Treatment Program Redwood City, Calif

JAMA. 1974;228(3):286. doi:10.1001/jama.1974.03230280014003

To the Editor.—  Our counselors have accurately suspected secret use of heroin by noting a puffy face in clients maintained on methadone in our clinic. This observation stimulated me to pay heed to the phenomenon myself and then to report it. The syndrome has not as far as we know been described before.The symptoms and signs are edema (face, extremities, and abdomen), arthritis, arthalgia (swelling, stiffness, pain, limitation of motion of fingers, wrists, and sometimes elbow or knee), and general sluggishness. Uniformly, such a client has been using heroin in addition to prescribed methadone. After heroin use stops (though methadone use continues), the disorder recedes.The syndrome has been observed in a substantial fraction of clients who consistently abuse heroin while receiving methadone. Ages range from about 20 to 50 years. We suspect that the combination of the synthetic relative of opium (methadone) when mixed in the appropriately sensitive