HARCP Archives

Browse by article

Browse by volume

Heroin Addiction and Related Clinical Problems: 2003, 05, 1 (pages: 17 - 32)

When “enough” is still not “enough”. Effectiveness of high-dose methadone in the treatment of heroin addiction

Maremmani I., Pacini M., Lubrano S., Lovrecic M.

Summary: In the longstanding diatribe about methadone maintenance, Dole & Nyswander were the first to support the practice of standard methadone treatment with dosages above 100 mg/day. However, several clinicians persisted in their view that lower dosages could provide most patients with significant improvement. Data from the literature strongly support the evidence that 100 mg-maintenance is more effective than that with 50 mg- in treating opiate abuse during the first 5-10 months of treatment. High dosages can be useful, bringing special benefits to patients whose opiate use has proved to be particularly resistant to treatment. Higher dosages may be used where there is a concurrent psychopathology, persistent opiate use or symptoms of incomplete coverage by methadone. Dosages above 100 mg/die, seem to give the best results. Therefore there is no scientific justification for boycotting the use of dosages between 80 and 120 mg/day .