Methadone Maintenance Dosing Guideline for Opioid Dependence, a Literature Review

Abstract

To date, methadone dosing is still an issue of debate and controversy among clinicians who are involved in methadone maintenance programs. The authors conducted a literature review to update clinicians about this issue and provide recommendations for proper methadone dosing. Studies eligible for inclusion in the review were retrieved from the PubMed database by searching for reports published between 1990 and September 2008 using the major medical subject headings Methadone (all fields) and dose. Only articles written in English were included. Additional reports were identified from the reference lists of retrieved articles and by manual review of the tables of contents of journals on drug of abuse included in the psychiatry and substance abuse subject category listing 2008 of the Journal Citation Reports. Abstracts of medical meetings were excluded. Twenty-four articles were included in the review. Twelve are randomized, controlled, or double-blind clinical trials, 10 are non-randomized and observational studies, and 2 are meta-analyses. Currently, the consensus is to have a goal for methadone dosing in the range of 60 to 100 mg daily. For patients who continue to use illicit opiates while prescribed this dose range, clinicians may consider doses greater than 100 mg daily. However, this is not the current consensus but rather is based on the limited promising data the authors have; it could be considered if the benefits outweigh the risks for some patients.

Methadone Induction in Primary Care for Opioid Dependence: A Pragmatic Randomized Trial (ANRS Methaville)

“…However it is difficult to say to what extent these results remain valid in countries where access to opioid maintenance treatment is not free for drug users. Nevertheless, the study was performed according to standard international guidelines [34], [35] in order to make our results as relevant as possible for other contexts.…”

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Substance Use and Related Disorders. Part 2: Opioid dependence

“…The evidence was summarized and categorized to refl ect its susceptibility to bias (Shekelle et al 1999). In addition, a number of national and international guidelines were reviewed (Lingford-Huhges et al 2004;Haasen 2006, Connock et al 2007;Kleber et al 2007;NHS NICE Clinical Guidelines Nos 51, 52, NICE 2007a,b;Meili et al 2008;Chou et al 2009;Fareed et al 2010;Nicholis et al 2010;Perron et al 2010).…”

“…Generally, 40 -60 mg of methadone will prevent the occurrence of the opioid withdrawal syndrome (Farre et al 2002). Experimental studies suggest that methadone doses of 60 -100 mg/day or higher are more effective than lower doses for reducing or stopping heroin self-administration in opioid-dependent patients (Strain et al 1999;Faggiano et al 2003;Donny et al 2005;Fareed et al 2010). Clinically, higher doses are associated with better treatment retention rates and outcomes (Ling et al 1976;Strain et al 1993aStrain et al ,b, 1999Prendergast et al 2000Prendergast et al , 2001 and may be necessary in patients with comorbid psychiatric disorders (Maremmani et al 2000a,b).…”

Positron Emission Tomography Molecular Imaging of Dopaminergic System in Drug Addiction

“…Methadone is an orally available synthetic opioid and a full agonist of l opioid receptor. There is substantial evidence to support the effectiveness of methadone in reducing illicit opioid use, intravenous drug use, crime, unemployment, and improving overall health status, social rehabilitation, and quality of life (Fareed et al, 2010;Fareed et al, 2011) and have been used in the treatment of heroin addiction for about 30 years (Kreek et al, 2002;Melichar et al, 2005;Fareed et al, 2010). Methadone substitution medication can occupy opioid receptors in the brain and thus minimizes withdrawal symptoms and prevents ''on-top'' heroin use from accessing the receptors.…”