Try Substituting Methadone for Aspirin ...

A recent study published in Substance Withdrawal Syndrome (Eds. Rees and Woodhouse, 2009, pp. 93-112) concluded as follows: "This systematic overview suggests that aspirin withdrawal has ominous prognostic implication in subjects with or at moderate-to-high risk for coronary artery disease. Such information should be borne in mind when advising patients under such treatment, and aspirin discontinuation should be advocated only when the risk of ... adverse effects clearly overwhelms that of cardiovascular atherothrombotic events."

Change a few words and this admonition applies - in spades! - to opiate maintenance treatment of dependence. "Advising patients" of the "ominous prognostic implication" of discontinuing maintenance treatment should be considered absolutely essential before any "tapering" begins. Indeed, ethical medical practice (and logic) would seem to demand that a written informed consent be obtained before beginning withdrawal. Clearly, the risk associated with discontinuing maintenance treatment is vastly greater than that associated with its commencement.