Comparison of 3 L-α-acetyl-methadol (LAAM) maintenance strategies for heroin dependence

Nidal Moukaddam, David V. Herin, Angela Stotts, Anne Hamilton Dougherty, Charles Green, Marc E Mooney, Ann Garcia, Richard A. Meisch, Katherine Cowan, Frederick Gerard Moeller, Joy M. Schmitz, John Grabowski

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

AIMS: Heroin dependence continues to be a major public health concern, with high relapse rates. The gold standard treatment for this disorder is long-term opioid maintenance. Dosing strategies for maintenance treatments have evolved over several decades, with lingering questions concerning optimal dosing regimens. DESIGN AND SETTING: The current study compared the effectiveness of 3 dosing regimens of the opioid agonist L-α-acetyl-methadol (LAAM) in a randomized controlled double-blind trial. INTERVENTION: One hundred and fourteen active heroin-dependent subjects meeting study criteria were randomly assigned to 1 of 3 LAAM dosing strategies (fixed dose, dose on the basis of subject weight, or variable dosing on the basis of efficacy and side effects). Subject selection included a stated goal of subsequent participation in a dose-reduction study. Subjects underwent a 28-day induction period followed by 5 months of LAAM maintenance therapy. FINDINGS: Treatment with LAAM resulted in a significant decrease in non-LAAM opioid-positive urine screens in all dosing groups, with few (∼10%) positive urine screens by the end of the 5-month maintenance period. No differences were detected between the 3 dosing strategies. Rates of attrition during medication induction were 20% and reached 50% by the end of the study period. LAAM was well tolerated, with few side effects. Subjects with methadone treatment experience reported a clear preference for LAAM. CONCLUSIONS: This study demonstrates the efficacy of LAAM, with equivalent results across the 3 dosing conditions. Although no significant difference among the conditions emerged, dosing to weight may be the most useful standardizing strategy for early maintenance beyond research settings.

Original languageEnglish (US)
Pages (from-to)191-200
Number of pages10
JournalAddictive Disorders and their Treatment
Volume8
Issue number4
DOIs
StatePublished - Dec 1 2009

Fingerprint

Methadyl Acetate
Heroin Dependence
Maintenance
Opioid Analgesics
Urine
Weights and Measures
Methadone
Heroin
Patient Selection
Public Health
Recurrence

Keywords

  • Agonist therapy
  • Heroin
  • LAAM
  • Opiates
  • Opioid maintenance

Cite this

Comparison of 3 L-α-acetyl-methadol (LAAM) maintenance strategies for heroin dependence. / Moukaddam, Nidal; Herin, David V.; Stotts, Angela; Dougherty, Anne Hamilton; Green, Charles; Mooney, Marc E; Garcia, Ann; Meisch, Richard A.; Cowan, Katherine; Moeller, Frederick Gerard; Schmitz, Joy M.; Grabowski, John.

In: Addictive Disorders and their Treatment, Vol. 8, No. 4, 01.12.2009, p. 191-200.

Research output: Contribution to journalArticle

Moukaddam, N, Herin, DV, Stotts, A, Dougherty, AH, Green, C, Mooney, ME, Garcia, A, Meisch, RA, Cowan, K, Moeller, FG, Schmitz, JM & Grabowski, J 2009, 'Comparison of 3 L-α-acetyl-methadol (LAAM) maintenance strategies for heroin dependence', Addictive Disorders and their Treatment, vol. 8, no. 4, pp. 191-200. https://doi.org/10.1097/ADT.0b013e3181848b04
Moukaddam, Nidal ; Herin, David V. ; Stotts, Angela ; Dougherty, Anne Hamilton ; Green, Charles ; Mooney, Marc E ; Garcia, Ann ; Meisch, Richard A. ; Cowan, Katherine ; Moeller, Frederick Gerard ; Schmitz, Joy M. ; Grabowski, John. / Comparison of 3 L-α-acetyl-methadol (LAAM) maintenance strategies for heroin dependence. In: Addictive Disorders and their Treatment. 2009 ; Vol. 8, No. 4. pp. 191-200.
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AU - Green, Charles

AU - Mooney, Marc E

AU - Garcia, Ann

AU - Meisch, Richard A.

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AU - Schmitz, Joy M.

AU - Grabowski, John

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AB - AIMS: Heroin dependence continues to be a major public health concern, with high relapse rates. The gold standard treatment for this disorder is long-term opioid maintenance. Dosing strategies for maintenance treatments have evolved over several decades, with lingering questions concerning optimal dosing regimens. DESIGN AND SETTING: The current study compared the effectiveness of 3 dosing regimens of the opioid agonist L-α-acetyl-methadol (LAAM) in a randomized controlled double-blind trial. INTERVENTION: One hundred and fourteen active heroin-dependent subjects meeting study criteria were randomly assigned to 1 of 3 LAAM dosing strategies (fixed dose, dose on the basis of subject weight, or variable dosing on the basis of efficacy and side effects). Subject selection included a stated goal of subsequent participation in a dose-reduction study. Subjects underwent a 28-day induction period followed by 5 months of LAAM maintenance therapy. FINDINGS: Treatment with LAAM resulted in a significant decrease in non-LAAM opioid-positive urine screens in all dosing groups, with few (∼10%) positive urine screens by the end of the 5-month maintenance period. No differences were detected between the 3 dosing strategies. Rates of attrition during medication induction were 20% and reached 50% by the end of the study period. LAAM was well tolerated, with few side effects. Subjects with methadone treatment experience reported a clear preference for LAAM. CONCLUSIONS: This study demonstrates the efficacy of LAAM, with equivalent results across the 3 dosing conditions. Although no significant difference among the conditions emerged, dosing to weight may be the most useful standardizing strategy for early maintenance beyond research settings.

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