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Vincent P. Dole, MD

JAMA. 1988;260(20):3025-3029.

Abstract
Clinical success in rehabilitation of heroin addicts with maintenance treatment requires stability of the blood level in a pharmacologically effective range (optimally, 150 to 600 ng/mL)—a phenomenon that emphasizes the central importance of narcotic receptor occupation. It is postulated that the high rate of relapse of addicts after detoxification from heroin use is due to persistent derangement of the endogenous ligand-narcotic receptor system and that methadone in an adequate daily dose compensates for this defect. Some patients with long histories of heroin use and subsequent rehabilitation on a maintenance program do well when the treatment is terminated. The majority, unfortunately, experience a return of symptoms after maintenance is stopped. The treatment, therefore, is corrective but not curative for severely addicted persons. A major challenge for future research is to identify the specific defect in receptor function and to repair it. Meanwhile, methadone maintenance provides a safe and effective way to normalize the function of otherwise intractable narcotic addicts.

(JAMA 1988;260:3025-3029)

Author Affiliations
From The Rockefeller University Hospital, New York.

Footnotes
Based on a lecture given at the presentation of the Albert Lasker Clinical Medicine Research Award, New York, Nov 18, 1988.

Reprint requests to The Rockefeller University, 1230 York Ave, New York, NY 10021 (Dr Dole).

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