Restabilization on Methadone After Methadyl Acetate (LAAM) Maintenance

Abstract

Sixty-eight heroin addicts maintained for 40 weeks on LAAM or methadone in a doub le-blind study were transferred to a uniform dose of 60 mg. methadone daily at the end of their tenure in the study and followed double-blind for the ensuing six weeks during which their daily methadone doses were adjusted according to their clinical needs. Patients were observed for symptoms and signs of discomfort and for the amount of illicit drug use during this period of transition. The results indicate that patients maintained on LAAM can be readily restabilized on methadone and that sudden decrease of methadone dose tends to result in patients’ supplementing with illicit heroin and, conversely, increasing methadone doses resulted in a corresponding reduction in illicit drug use. It is suggested that a chronic covert abstinence syndrome may exist in some patients on long-term methadone maintenance and that while it may contribute to their continued illicit drug use, it may have a different pathophysiological basis and require different therapeutic considerations.