SUBOPTIMAL DOSAGES (still)
A colleague from Australia, Andrew Byrne, calls attention to an article in the current Brit J Gen Practice (June 05) by Strang et al. The authors surveyed private physicians in UK who prescribe methadone maintenance, and found a mean daily dose of 36.9. It's been shown consistently (no exceptions, I believe!) for many years that for the great majority of patients doses under 60 are sub-optimal, and that many patients require daily doses of at least 100mg (any many a great deal higher). It's difficult to comprehend such apparent bias against reliance on dosages that will, predictably, be associated with persistent illicit opiate use and the substantial risk of illness and death. Sure - the refusal of methadone providers to practice evidence-based medicine is almost universal, but one might have expected better from the UK, where over 50% of GPs reported treating "at least one opiate dependent person" - presumably with methadone.
So . . . anyone offer an explanation? Anyone have suggestions regarding how to address a problem that has been associated with methadone treatment for many decades despite uncontested evidence that it is wrong? rnewman