Methadone dosing, heroin affordability, and the severity of addiction.

Abstract

OBJECTIVES: This study sought to track changes in US heroin prices from 1988 to 1995 and to determine whether changes in the affordability of heroin were associated with changes in the use of heroin by users seeking methadone treatment, as indexed by methadone dose levels. METHODS: Data on the price of heroin were from the Drug Enforcement Administration; data on methadone doses were from surveys conducted in 1988, 1990, and 1995 of 100 methadone maintenance centers. Multivariable models that controlled for time and city effects were used to ascertain whether clinics in cities where heroin was less expensive had patients receiving higher doses of methadone, which would suggest that these patients had relatively higher physiological levels of opiate addiction owing to increased heroin use. RESULTS: The amount of pure heroin contained in a $100 (US) purchase has increased on average 3-fold between 1988 and 1995. The average dose of methadone in clinics was positively associated with the affordability of local heroin (P < .01). CONCLUSIONS: When heroin prices fall, heroin addicts require more methadone (a heroin substitute) to stabilize their addiction--evidence that they are consuming more heroin.

Provision of Methadone Treatment in Primary Care Medical Practices

“…29,30 By 1998, the Scottish programs were administering methadone at ef-fective dose levels. As mentioned above, the average dose of methadone used in the early years of the CDPS program in Edinburgh was 40 mg, less than the dose usually considered therapeutic.…”

Individual and Environmental Factors Related to Quitting Heroin Injection

“…Additionally, social and physical environments have been examined as determinants of phases of drug use, from intiation to cessation (Boardman et al, 2001;Davis and Tunks, 1990;Gifford and Hine, 1990;Latkin and Knowlton, 1999;Schroeder et al, 2001;Waldorf, 1983). However, the preponderance of drug cessation research focuses on the effects of drug user treatment on individuals, ignoring broader environmental factors and, by definition, excluding out-of-treatment drug users (Bach and Lantos, 1999;Johnson et al, 2000;O'Connor, 2000;Pani et al, 2000;Schottenfeld et al, 1997). The purpose of this study is to examine the effects of the physical environment and individual characteristics on drug use cessation, independent of drug user treatment, over the period of 1 year among a sample of long-term inner-city injection drug users (IDUs) in Baltimore, Maryland.…”

Jail Management of Arrestees/Inmates Enrolled in Community Methadone Maintenance Programs

“…Consequently, jails either relied on the dose reported by the arrestee or made no attempt to tailor detoxification based on dose. Higher methadone dose is indicative of greater severity of addiction 9 and potentially more severe withdrawal.…”