Wednesday, July 21, 2010
A just-published paper from Canada (J Subst Ab Treatment 39:22-31, 2010) reports (non)compliance among British Columbia methadone programs with starting doses, buildup regimen, suggested standards for take-homes and tapering, etc. Among the findings: compliance with maintenance dosage recommendations (minimum of 60 mg/day or more for most patients) “… decreased between 2001 and 2006 . . . [and] this was mirrored by a decline in the provincial 12-month retention rate.” Difficult to comprehend the thinking of the providers! Equally difficult to comprehend is the “troubling finding [of] the low rate of compliance to guidelines on starting doses...“ - over one-third of patients received a starting dose above 40 mg/day. And finally, 46% of all patients were started ion “tapering” of methadone (median initiation of tapering was in 27th week of treatment); the result: of those for whom tapering was attempted only 11% completed it no data given regarding how many of the 11.7% relapsed subsequently).