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April 7, 1989

Methadone and Theories of Addiction

Author Affiliations

Dalhousie University Victoria General Hospital Halifax, Canada

Dalhousie University Victoria General Hospital Halifax, Canada

JAMA. 1989;261(13):1879. doi:10.1001/jama.1989.03420130041011

To the Editor. —  In the article by Dr Dole1 in the November 25 issue of JAMA, it was stated that clinical success in the rehabilitation of heroin addicts requires stabilization of the blood level of methadone in a pharmacologically effective range (150 to 600 ng/mL).Other investigators have studied plasma concentrations of methadone and have attempted to establish whether a threshold serum concentration or therapeutic window exists for methadone in the treatment of opiate dependency.2-7 All these studies measured the total serum concentration of methadone (protein-bound fraction and free fraction). Olsen8 studied the binding of tritiated l-methadone with solutions of purified human γ-globulin and human plasma. γ-Globulin bound 13% to 17.5% of the methadone and human plasma bound 83.7% to 87.3%. Since the maximum albumin binding was 43.8%, the author thought that other proteins probably bound methadone as well.Romach et al9 reported the