ADMINISTERING SUBOPTIMAL DOSES OF METHADONE

In a study carried out in 1996-97 but just published now (J Subst Ab Treatm, vol 31, 187-194, 2006), HIV risk behaviors were compared among subjects assigned to various agonist medications for opiate dependence - LAAM, buprenorphine and methadone. One out of four subjects was given “…a fixed daily dose of 20 mg of METH [i.e., methadone] and served as a control group.”

The authors of the paper are Lott, Strain, Brooner, Bigelow and Johnson. Seven years before the trial commenced the then-Director of the National Institute on Drug Abuse had stated, "...in this age of AIDS, a low dose policy is not simply inappropriate, but can be fatal to the IV drug abuser in treatment as well as his or her sexual partners and children." (Schuster CR: NIDA Notes. Spring/Summer: 1989)

It is difficult to comprehend the rationale for unnecessarily subjecting people to potentially fatal outcome, even during the course of a study of limited duration and even with provision (when it’s not too late!) for “therapeutic rescue.”

Comments welcome.