Control of methadone dosage by patients

A. Goldstein, R. W. Hansteen and W. H. Horns

Patients in a methadone clinic were given knowledge and control of their own dosages. Dosages could be changed by 5 mg/week, but if more than 50 mg was used, no take-home privileges were allowed. The maximum dosage permitted was 120 mg. Plasma methadone levels were determined for some patients. The result of the study was that there was little dosage change, with the median dosage increasing from 40 to 50 mg at the end of six months. A small group of patients did raise their dosages systematically, and these patients tended to decrease illicit opiate use. There was no indication that these patients had abnormally low plasma methadone levels. At the end of six months, patients and staff overwhelmingly preferred an open-dose self-adjustment system over the usual procedure of dosage management by professional staff and dosage changes achieved by negotiation.