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Prescription medicine primer: maintenance treatment of opiate addiction.

Article Excerpt
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Of all the modern treatments for addiction, perhaps the most controversial is the use of maintenance opioid substitution in the treatment of intravenous drug addiction. "Maintenance" is defined as the continuation of prescribing some compound similar enough to stave off withdrawal to a person who is already addicted. With current concerns about the human immunodeficiency virus infection and other serious health complications, harm reduction is the primary argument for maintenance treatment of addiction to intravenous abuse of drugs such as heroin and opioid pain medications. In this country, we have used such medications as methadone, long-acting methadone, and, more recently, buprenorphine for maintenance, although in other countries the addicted person's drug of choice, such as heroin, might be used along with some sort of "clean" needle giveaway program.

Methadone (Dolophine[R]) is a synthetic opioid usually started orally at 30 mg or less per day and increased to the lowest dose that effectively blocks or stops use of other opioids (known as "chipping") for a given patient, usually 50 mg per day or more. Although it can be given in a tapering dose as a withdrawal agent, it is frequently used as a maintenance strategy, administered daily dissolved in juice or water. It has...

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