11 September 1998

Dose-Related Efficacy of Levomethadyl Acetate

Eissenberg T, Biglow GE, Strain EC, Walsh SL, Brooner RK, Stizer ML, Johnson RE. Dose-Related Efficacy of Levomethadyl Acetate for Treatement of Opioid Dependence. JAMA 1997 277;24:1945-51

This study confirms the place of LAAM (levomethadyl acetate) in the treatment of opioid dependence. For over 20 years in the US it has proven safe and effective in a variety of situations. As well as being a useful alternative to methadone, this drug has a sufficiently long half life to allow three times weekly dosing, thus doing away with daily attendance.

Volunteer heroin addicts were randomised to low, medium and higher dose regimens. Predictably, there was significantly less illicit heroin used at higher doses (2.5 days per month reported heroin use vs. 6.3 in the low dose group). Retention in treatment at 17 weeks was not particularly high at 55% - 65% but there was no significant difference between the three groups.

This is the first time that a positive dose response has been demonstrated with LAAM, and in a representative group including women (39%). Patients had used heroin for an average of 8 years and most reported a previous treatment episode.

This study adds crucial pieces to the drug treatment jigsaw. Recent research also allows us to discern the position of other developments like buprenorphine, naltrexone, heroin prescription and ultra-rapid detoxification.

With numerous patients who are unsuccessful with methadone, LAAM should be made available in Australia without further delay.

Written by Andrew Byrne