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In Reply: Dr Newman makes an important point about the role of the FDA in properly informing physicians about safe dosing regimens. Its slow onset and long duration of action make methadone a valuable pain medication. Yet, as Newman suggests, the FDA 2006 published dosing guidelines¹ (2.5-10 mg every 3-8 hours) are too broad to be useful; the highest dose and frequency parameters can be lethal in nontolerant individuals. We agree with his call for broader communication of the revised guidelines (40-mg maximum per day or less for smaller persons).

The letter from Dr Layne and colleagues addresses a common problem: lack of consensus even among physicians working within the same practice on whether to prescribe opioids for pain; the types of pain for which opioids are appropriate; and when prescribed, which opioids and at which dose or duration. Lack of consensus on this topic and the resulting disparity . . . [Full Text of this Article]

A. Thomas McLellan, PhD
tmclellan@tresearch.org
Treatment Research Institute
Philadelphia, Pennsylvania

Barbara J. Turner, MsEd, MD
Department of Medicine
University of Pennsylvania School of Medicine
Philadelphia

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