Alcohol and Methadone

US state opioid treatment authorities were surveyed as to their policies and guidelines (Harris et al. J Subst Ab Treatm 2010, 39:58-64). Eight states “stipulate patient discharge for continued alcohol abuse and … four states mandate or recommend patient discharge for continued failure of alcohol tests.”

Two critical questions are left unanswered. First, what is the evidence that methadone given in constant daily doses (at whatever level) – i.e., medication to whose agonistic effects the patient is presumably tolerant – potentiate the sedative effects of alcohol and thus pose a risk that warrants termination of treatment? And secondly, whatever one may consider to be the danger of continued methadone maintenance in these patients, and on whatever theoretical or empirical basis, is there reason to believe that therapeutic abandonment will be associated with less risk? It would seem imperative for state authorities and methadone treatment providers to ascertain compelling answers to both questions before suggesting or demanding patients be refused methadone treatment for their opiate dependence.