Letter to MMT Researcher

March 13, 2000

Journal of the American Medical Association
RE: http://jama.ama-assn.org/issues/v283n10/full/joc91501.html

research study was written about recently in the Journal of the American Medical Association. Surprise! The study proved that long-term methadone maintenance was much more effective than short-term (180 days) treatment. This is something that most of us know, and has been confirmed by other studies. This article is important because it is in the very well-respected JAMA. One very disturbing problem with the study is that the patients were only allowed a dose of 100 mgs. This study stated that up to 50% of all subjects tested positive for drug use during the research period. This is very disturbing news to have published in such a prominent journal. It can only add to the stigma of MMT patients using illicit drugs even while on a program. The therapeutic dose range for methadone maintenance is 80-120 mgs. Many of the subjects were very possibly severely underdosed. The Director of Washington, DC ARM/NAMA wrote to one of the researchers. Here is her letter, followed by the reply from researcher Sharon Hall. Please write a letter to the Editor of JAMA to express your feelings about the 100 mgs. cap used in the study.

Hello, I am the Washington D.C. Director of ARM, Advocates for Recovery through Medicine, and I would like a reprint of your article published in JAMA about MMT vs. 180 Day Psychosocial…,,,. I read the article and I wonder why you chose to use barely thereaputic doses of methadone in this study.

Even CSAT SAMSHA TIP 1 indicates that 80-120/mgs daily is the minimum therapeutic range for methadone dosages and the article states none of the patients were above 100mgs. Why is that? Why give your patients suboptimal doses and then expect them do discontinue using heroin and cocaine? In my experience if a patient is on an adequate dose, no matter what that dose is, they will almost always stop using illicit drugs and alchohol. What about the poor patient in your study whose adequate dose is 150mgs? What were they supposed to do? Suffer? It certainly doesn’t look very good for MMT to publish in a very widely respected journal like JAMA that 50% of your trial patients continued to use illicit drugs, including heroin and cocaine. If these patients were adequately dosed your use rates would go down to 1%.

Anyway, please send me a hard copy of the article at your earliest convenience, and if you have time, please explain the rationale behind your experiments dosing policy.

Thank you
Chris Kelly
Director, DCARM
Advocates for Recovery Through Medicine
National Alliance of Methadone Advocates
Washington, D.C. 20001

TO: Washington, DC ARM/NAMA
March 13, 2000

In answer to your dosing question, after consultation with several substance abuse experts (including those working in MMT and M detox), we decided on 100 mg as our maximum dose because detoxing from 100 mg in the 180 day program was thought to be the highest reasonable amount, and even that dose led to a fast detox. We also decided to keep the detoxification and the maintenance maximum dose the same, so that differences between the two conditions could not be attributed to the maintenance patients getting more methadone. Finally, we had resistance from patients who thought even 100 mg was too high, for both detox and for maintenance.

I’d suggest that you write a letter to the Editor of JAMA–that might stimulate a public discussion, which woukd include your perspective.

Thanks for your comments.

Sharon Hall