Overview

The medications used in the treatment of opioid addiction (methadone, LAAM [levo-alpha-acetyl-methadol], and buprenorphine are those that are FDA approved), are used to stabilize clients, block euphoria, and eliminate withdrawal and craving. The initial dose of methadone should not exceed 30 mg of methadone and is individually determined by a physician following the history and physical examination. Dosing protocols are individualized.

Accreditation Requirement(s)

To conform to these standards, the organization must show evidence of the following:

• Medications should be used in sufficient doses to produce the desired response, block euphoria, and eliminate withdrawal and craving for the desired amount of time.
  
• The Food and Drug Administration (FDA) must approve all medications used for opioid addiction treatment.
  
• The initial dose prescribed by the physician is determined following the history and physical examination.
  
• Induction (the initial dose) of methadone should not exceed 30 mg, or, when appropriate, no more than 40 mg the first day.

Implementation Tips

Some Implementation Tips provided, in part, by Robert Johnson at: www.accreditationnow.com.

• There are multiple factors to consider when establishing the appropriate dose for each individual:
  
  
  • The history of dependence
  • The results of the history and physical examination
  • Withdrawal symptoms
  • The use of other prescribed medications
  • The evaluation of other illegal drug use and current practice standards
    
    
• The use of opioid pharmacotherapy should produce the following results:
  
  
  • Block the effects of other opiates without producing euphoria
  • Reduce or eliminate drug craving
  • Prevent the onset of abstinence symptoms for at least 24 hours
    
    
• There has been much controversy in the field of methadone maintenance over the past 30 years about the proper dosing level for clients. Current thinking is that "doses of methadone should be optimized on an individual basis without artificial ceilings, while maintaining caution to avoid adverse effects" (Tenore, P. L. [2003]. Clinical concepts: Guidelines on optimal methadone dosing. Addiction Treatment Forum, 12[2], 1). Also see Leavitt, S. B. (2003, September). Methadone dosing and safety in the treatment of opioid addiction. Addiction Treatment Forum, 1-8; www.atforum.com.
  
  
• Studies have shown that adequate medication dose levels are probably the single most important factor in patient retention. Individualized and appropriate dosing contributes to patient comfort and satisfaction by reducing withdrawal symptoms and cravings and allowing more attention to be paid to other treatment issues.
  
  
• Staff members should be familiar with drug interactions (see Leavitt, S. B. [2004, January]. Methadone drug interactions: Medications, illicit drugs, and other substances. Addiction Treatment Forum, 1-6; www.atforum.com).
  
  
• Recent data suggests that the average dose of methadone has increased nearly 90 percent from 45 mg in 1988 to 85.2 mg in 2003 (results from a survey of methadone treatment programs conducted by Leavitt, S. B. [2003]. Dose survey 2003: Upward trend continues. Addiction Treatment Forum, 12[2], 2).
  
  
• It is believed that stigma, inadequate training, regulation, and treatment philosophies that were not evidence-based led to low dosing rates during the 1970s and 1980s. Many clinics and states established an artificial "ceiling" of 100 mg as the ultimate dose. As a more individualized treatment approach emerges, average doses are increasing and the highest dose level is increasing. Some individuals may require individualized doses exceeding 200 mg (although this is still controversial in the field) in order to retain them in treatment.