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To the Editor: In Dr Knight’s discussion of a physician caught in opiate addiction,¹ the treatment options included only residential care, 12-step support, and individual counseling, all of which are important and may be successful. However, for many people (including physicians) the price of these options is exorbitant, and there are many who cannot leave home for such extended periods. For these reasons, I believe methadone maintenance therapy should have been included in this discussion. It produces rapid relief from the pains of withdrawal and a rapid return to normal function. In well-motivated patients it can be used together with a 12-step program and any psychotherapeutic approach, without extended absence or high cost. Additionally, the implication that only those in abstinence-based programs are in "recovery" needs to be corrected.

Michael Melcher, MD
melchem@cox-internet.com
Choices of Louisiana, Inc
Alexandria, La

1. Knight JR. A 35-year-old physician with opioid dependence. JAMA. 2004;292:1351-1357. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293:294.

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