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Article
November 25, 1988

Implications of Methadone Maintenance for Theories of Narcotic Addiction

Author Affiliations

From The Rockefeller University Hospital, New York.

From The Rockefeller University Hospital, New York.

JAMA. 1988;260(20):3025-3029. doi:10.1001/jama.1988.03410200081030
Abstract

Clinical success in rehabilitation of heroin addicts with maintenance treatment requires stability of the blood level in a pharmacologically effective range (optimally, 150 to 600 ng/mL)—a phenomenon that emphasizes the central importance of narcotic receptor occupation. It is postulated that the high rate of relapse of addicts after detoxification from heroin use is due to persistent derangement of the endogenous ligand-narcotic receptor system and that methadone in an adequate daily dose compensates for this defect. Some patients with long histories of heroin use and subsequent rehabilitation on a maintenance program do well when the treatment is terminated. The majority, unfortunately, experience a return of symptoms after maintenance is stopped. The treatment, therefore, is corrective but not curative for severely addicted persons. A major challenge for future research is to identify the specific defect in receptor function and to repair it. Meanwhile, methadone maintenance provides a safe and effective way to normalize the function of otherwise intractable narcotic addicts.

(JAMA 1988;260:3025-3029)

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