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Methadone Maintenance Treatment Is Theme of Periodical Issue

The April-June 1991 issue of the Journal of Psychoactive Drugs is devoted to exploring developments in opioid dependence and methadone maintenance treatment. It is dedicated to the memory of Dr. Marie Nyswander, the codeveloper of methadone maintenance treatment and a physician who gained the respect and admiration of the field through her contributions to research and clinical practice.

This special thematic issue looks at methadone maintenance treatment from the perspective of a new era. The rise and spread of human immunodeficiency virus (HIV) infection through the sharing of needles by injection drug users has reawakened interest and concern about opioid dependence. Similarly, the confirmed effectiveness of methadone maintenance treatment in reducing the spread of HIV infection has stimulated interest by policymakers and the treatment community.

Leading off is a history of methadone maintenance treatment from the perspective of J. Thomas Payte, M.D. A second article by Dr. Payte parodies illogical thinking about this treatment modality. Dr. Robert Newman and Nina Peyser look at the fact that scientific data have had a negligible impact on public policy and on the regulation of methadone treatment.

HIV and other health issues in patient populations

Several articles focus on concerns about HIV and opioid-dependent populations. Drs. Stephen Ferrando and Steven Batki share case examples of HIV-infected opioid addicts with psychiatric problems. They discuss the benefits of a multidisciplinary team approach and other strategies that are useful for the care of these patients in methadone maintenance treatment.

Dr. Alan Trachtenberg and his colleagues report on the prevalence of T-cell lymphotrophic viruses in injection drug users. These researchers suggest that the presence of such viruses can help pinpoint populations at high risk for HIV infection. They recommend prenatal screening for the viruses and testing for all patients admitted to methadone maintenance programs.

Other researchers discuss additional health issues important in opioid-dependent populations. Noting the high rate of cigarette smoking among substance abusers, Jim Story and Dr. Michael Stark designed a smoking cessation program for methadone maintenance clients. While clients were highly motivated to stop smoking, the researchers found that the increased doses of methadone they administered failed to overcome nicotine addiction.

Dr. Loretta Finnegan writes about the importance of methadone maintenance treatment for the improved functioning and health of pregnant, substance-abusing women. She also stresses that a comprehensive array of services, utilizing multiple disciplines, is needed to overcome addiction and to meet the myriad needs of pregnant women and their families.

Practical guidelines for clinicians

Several authors offer practical information and guidelines on issues that occur in clinical practice. In one article, Drs. Judith Martin, Thomas Payte, and Joan Zweben, essentially presenting a primer for physicians, review basic techniques of methadone maintenance treatment. These clinicians review intake and annual examinations, dose adjustment, withdrawal, management of pregnant patients, dual diagnosis, and ill or medically disabled patients.

Dr. Zweben contributes a second article covering counseling issues in methadone maintenance treatment. She addresses coexisting disorders such as depression, collaboration on medical issues, dosing policies, continued substance abuse, common psychological issues, women's concerns, family approaches, HIV infection, and strategies for training and supervision.

Drs. Richard Rawson and Walter Ling summarize the broad range of drug treatment modalities. They discuss therapeutic communities that provide reorganized, structured environments; outpatient models that offer a variety of support services and referrals; methadone maintenance; inpatient programs that incorporate the 12-Step concept; and such pharmacotherapies as l-I-acetylmethadol (LAAM) and clonidine.

An update on the growing body of knowledge about the neurobiology and pharmacology of opiate addiction is provided by Avram Goldstein. He suggests there is evidence that methadone maintenance may replace a neurohormonal deficiency in some patients. Goldstein concludes that dosage must be adequate (not less than 50-80 mg), some patients may require methadone maintenance for life, and other longer-acting methadone substitutes should also be used.

In another article, Dr. Forest Tennant and his colleagues report that methadone helps normalize adrenal metabolism, thereby improving treatment results and reducing vulnerability to AIDS and other infectious diseases.

Comments from NIDA and OTI

Directors of the National Institute on Drug Abuse (NIDA) and the Office for Treatment Improvement (OTI) discuss Federal Government roles and priorities in methadone treatment.

Dr. Charles Schuster affirms that NIDA-sponsored research intends to dispel the myths and prejudice that surround methadone maintenance treatment; he describes the agency's current activities and its relationship to other Federal organizations involved with methadone treatment.

Dr. Beny Primm provides current perspectives on methadone maintenance treatment and identifies the importance of training for the field. He suggests that OTI has funds for training of both physicians and counselors.

Concluding the issue are two classic works on methadone. These early works, which continue to be relevant to the field, include "Narcotic Blockade" by Drs. Vincent Dole, Marie Nyswander, and Mary Jeanne Kreek; and "Medical Safety and Side Effects of Methadone in Tolerant Individuals" by Dr. Kreek.

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