Methadone Treatment for Opioid Dependence

Throughout the world, hundreds of thousands of people are addicted to opiates. The human, economic, and societal costs of this addiction are staggering: more than one-quarter of prison inmates are incarcerated for drug offenses and there has been a dramatic increase in the prevalence of HIV and hepatitis among intravenous drug users.

Methadone Treatment for Opioid Dependence examines various aspects of the most widely used medication for the treatment of opioid dependence. Used clinically for more than thirty years, methadone is the most common pharmacological treatment for opioid dependence. Some 115,000 people are actively enrolled in methadone programs in the United States, and estimates range as high as 250,000 worldwide. Methadone eases withdrawal symptoms and blocks the sensation of "high" if the person should take an opioid. But as the authors note, methadone treatment is more than simply the delivery of medication -- it is a combination of pharmacologic and nonpharmacologic treatments. The latter can include individual and group therapies, urine testing, education and vocation training, medical and psychiatric treatment of co-morbid conditions, and other services appropriate to the needs of the patient. When delivered properly, methadone treatment can be highly effective in decreasing illicit drug use and increasing prosocial behaviors in patients.

The authors -- all faculty members of the Johns Hopkins Medical Institutions -- provide a historical overview of methadone treatment as well as a review of the regulations associated with the treatment. While important principles and theory are thoroughly examined, the emphasis throughout is on such practical issues as dosing, urine testing, detoxification schedules, and contingency management. Other topics include individual and group counseling, behavioral treatments, and special issues for women. Finally, the book provides comparative information about the utility of other pharmacotherapies for opioid dependence, such as LAAM, buprenorphine, naltrexone, clonidine, and lofexidine. Methadone Treatment for Opioid Dependence is a focused and comprehensive reference for drug treatment policy makers, as well an invaluable resource for professionals who treat opioid substance abusers -- psychiatrists, psychologists, social workers, mental health nurses, and addictions counselors.

Eric C. Strain, M.D., is an associate professor and director of the Substance Abuse Service Line of the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine. Maxine L. Stitzer, Ph.D., is a professor of behavioral biology in the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine.